The intersection between logical empiricism and qualitative nursing research: a post-structuralist analysis

PURPOSE

To shed light on and analyse the intersection between logical empiricism and qualitative nursing research, and to emphasize a post-structuralist critique to traditional methodological constraints.

METHODS

In this study, a critical examination is conducted through a post-structuralist lens, evaluating entrenched methodologies within nursing research. This approach facilitates a nuanced exploration of the intersection between logical empiricism and qualitative nursing research, challenging traditional methodological paradigms.

RESULTS

The article focusing on the "what abouts" of sample size, analytic framework, data source, data analysis, and rigour and methodological considerations, challenging the predominance of semi-structured interviews and the reliance on spoken voice as primary data sources, and re-evaluating the conventional notion of "rigour".

CONCLUSIONS

I advocate for a shift from qualitative positivism towards more interpretive and post-qualitative inquiries, this work proposes new trajectories through interpretive, critical, post-qualitative, and artistic turns in nursing research, aiming to transcend positivist limitations and foster a plurality of perspectives and research as praxis. Implications emphasize the need for nursing researchers to expand methodological horizons, incorporating visual and artistic methods to enrich understanding and representation of health experiences, moving beyond positivist norms towards a more inclusive and ethically sound research paradigm.

What counts as relevant criticism? Longino's critical contextual empiricism and the feminist criticism of mainstream economics

I identify and resolve an internal tension in Critical Contextual Empiricism (CCE) - the normative account of science developed by Helen Longino. CCE includes two seemingly conflicting principles: on one hand, the cognitive goals of epistemic communities should be open to critical discussion (the openness of goals to criticism principle, OGC); on the other hand, criticism must be aligned with the cognitive goals of that community to count as "relevant" and thus require a response (the goal-relativity of response-requiring criticism principle, GRC). The co-existence of OGC and GRC enables one to draw both approving and condemning judgments about a situation in which an epistemic community ignores criticism against its goals. This tension results from conflating two contexts of argumentation that require different regulative standards. In the first-level scientific discussion, GRC is a reasonable principle but OGC is not; in the meta-level discussion about science, the reverse holds. In meta-level discussion, the relevance of criticism can be established by appealing to goals of science that are more general than the goals of a specific epistemic community. To illustrate my revision of CCE, I discuss why feminist economists' criticism of the narrowness of the goals pursued in mainstream economics is relevant criticism.

The notorious man-in-the-street: Hermann Weyl and the problem of knowledge

Hermann Weyl's philosophical reflections remain a topic of considerable interest in the history and philosophy of science. In particular, Weyl's commitment to a form of idealism, as it pertains to his reading of Husserl and Fichte, has garnered much discussion. However, much less attention has been given to Weyl's later, and at that only partial, turn towards a form of empiricism (i.e. from the late 1920s onward). This lack of focus on Weyl's later philosophy has tended to obscure some of the most significant lessons that Weyl sought to draw from his decades of research in the foundations of mathematics and physics. In this paper, I develop some aspects of what I will term as Weyl's 'modest' empiricism. I will argue that Weyl's turn toward empiricism can be read in the context of a development of Helmholtz's epistemological program and his unique form of 'Kantianism'. The hope is that this reading will not only provide a better understanding of Weyl's later thought, especially his (1954) criticism of Cassirer, but that it may also provide the basis for a novel 'Weylian' account of the mathematization of nature underwriting the group-theoretic methodology of parts of modern physics.

Prophecy or empiricism? Clinical value of predicting versus determining genetic variant functions

The recent explosion of epilepsy genetic testing has created challenges for interpretation of gene variants. Assessments of the functional consequences of genetic variants either by predictive or experimental strategies can contribute to estimating pathogenicity, but there is no consensus on which approach is best. The Special Interest Group on Epilepsy Genetics hosted a session during the Annual American Epilepsy Society Meeting in December 2022 to discuss this topic. The session featured a debate of the relative advantages and limitations of predicting (prophecy) versus experimentally determining (empiricism) variant function using ion channel gene variants as examples. This commentary summarizes these discussions.

Making sense of domain specificity

The notion of domain specificity plays a central role in some of the most important debates in cognitive science. Yet, despite the widespread reliance on domain specificity in recent theorizing in cognitive science, this notion remains elusive. Critics have claimed that the notion of domain specificity can't bear the theoretical weight that has been put on it and that it should be abandoned. Even its most steadfast proponents have highlighted puzzles and tensions that arise once one tries to go beyond an initial intuitive sketch of what domain specificity involves. In this paper, we address these concerns head on by developing an account of what it means for a cognitive mechanism to be domain specific that overcomes the obstacles that have made domain specificity seem so problematic. We then apply this understanding of domain specificity to one of the key debates that it has figured prominently in-the rationalism-empiricism debate concerning the origins of cognitive traits-and introduce several related theoretical notions that work alongside domain specificity in helping to clarify what makes a view more (or less) rationalist. This example illustrates how the notion of domain specificity can, and should, continue to play a central role in ongoing debates in cognitive science.

Neither neural networks nor the language-of-thought alone make a complete game

Cognitive science has evolved since early disputes between radical empiricism and radical nativism. The authors are reacting to the revival of radical empiricism spurred by recent successes in deep neural network (NN) models. We agree that language-like mental representations (language-of-thoughts [LoTs]) are part of the best game in town, but they cannot be understood independent of the other players.

Zone 1 Endovascular Balloon Occlusion of the Aorta vs Resuscitative Thoracotomy for Patient Resuscitation After Severe Hemorrhagic Shock

Importance

Aortic occlusion (AO) is a lifesaving therapy for the treatment of severe traumatic hemorrhagic shock; however, there remains controversy whether AO should be accomplished via resuscitative thoracotomy (RT) or via endovascular balloon occlusion of the aorta (REBOA) in zone 1.

Objective

To compare outcomes of AO via RT vs REBOA zone 1.

Design, Setting, and Participants

This was a comparative effectiveness research study using a multicenter registry of postinjury AO from October 2013 to September 2021. AO via REBOA zone 1 (above celiac artery) was compared with RT performed in the emergency department of facilities experienced in both procedures and documented in the prospective multicenter Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry. Propensity score matching (PSM) with exact institution matching was used, in addition to subgroup multivariate analysis to control for confounders. The study setting included the ED, where AO via RT or REBOA was performed, and participants were adult trauma patients 16 years or older.

Exposures

AO via REBOA zone 1 vs RT.

Main Outcomes and Measures

The primary outcome was survival. Secondary outcomes were ventilation-free days (VFDs), intensive care unit (ICU)-free days, discharge Glasgow Coma Scale score, and Glasgow Outcome Score (GOS).

Results

A total of 991 patients (median [IQR] age, 32 [25-48] years; 808 male individuals [81.9%]) with a median (IQR) Injury Severity Score of 29 (18-50) were included. Of the total participants, 306 (30.9%) had AO via REBOA zone 1, and 685 (69.1%) had AO via RT. PSM selected 112 comparable patients (56 pairs). REBOA zone 1 was associated with a statistically significant lower mortality compared with RT (78.6% [44] vs 92.9% [52]; P = .03). There were no significant differences in VFD greater than 0 (REBOA, 18.5% [10] vs RT, 7.1% [4]; P = .07), ICU-free days greater than 0 (REBOA, 18.2% [10] vs RT, 7.1% [4]; P = .08), or discharge GOS of 5 or more (REBOA, 7.5% [4] vs RT, 3.6% [2]; P = .38). Multivariate analysis confirmed the survival benefit of REBOA zone 1 after adjustment for significant confounders (relative risk [RR], 1.25; 95% CI, 1.15-1.36). In all subgroup analyses (cardiopulmonary resuscitation on arrival, traumatic brain injury, chest injury, pelvic injury, blunt/penetrating mechanism, systolic blood pressure ≤60 mm Hg on AO initiation), REBOA zone 1 offered an either similar or superior survival.

Conclusions and Relevance

Results of this comparative effectiveness research suggest that REBOA zone 1 provided better or similar survival than RT for patients requiring AO postinjury. These findings provide the ethically necessary equipoise between these therapeutic approaches to allow the planning of a randomized controlled trial to establish the safety and effectiveness of REBOA zone 1 for AO in trauma resuscitation.

Alerting Clinicians to 1-Year Mortality Risk in Patients Hospitalized With Heart Failure: The REVEAL-HF Randomized Clinical Trial

Importance

Heart failure is a major cause of morbidity and mortality worldwide. The use of risk scores has the potential to improve targeted use of interventions by clinicians that improve patient outcomes, but this hypothesis has not been tested in a randomized trial.

Objective

To evaluate whether prognostic information in heart failure translates into improved decisions about initiation and intensity of treatment, more appropriate end-of-life care, and a subsequent reduction in rates of hospitalization or death.

Design, Setting, and Participants

This was a pragmatic, multicenter, electronic health record-based, randomized clinical trial across the Yale New Haven Health System, comprising small community hospitals and large tertiary care centers. Patients hospitalized for heart failure who had N-terminal pro-brain natriuretic peptide (NT-proBNP) levels of greater than 500 pg/mL and received intravenous diuretics within 24 hours of admission were automatically randomly assigned to the alert (intervention) or usual-care groups.

Interventions

The alert group had their risk of 1-year mortality calculated using an algorithm that was derived and validated using similar historic patients in the electronic health record. This estimate, including a categorical risk assessment, was presented to clinicians while they were interacting with a patient's electronic health record.

Main Outcomes and Measures

The primary outcome was a composite of 30-day hospital readmissions and all-cause mortality at 1 year.

Results

Between November 27, 2019, through March 7, 2021, 3124 patients were randomly assigned to the alert (1590 [50.9%]) or usual-care (1534 [49.1%]) group. The alert group had a median (IQR) age of 76.5 (65-86) years, and 796 were female patients (50.1%). Patients from the following race and ethnicity groups were included: 13 Asian (0.8%), 324 Black (20.4%), 136 Hispanic (8.6%), 1448 non-Hispanic (91.1%), 1126 White (70.8%), 6 other ethnicity (0.4%), and 127 other race (8.0%). The usual-care group had a median (IQR) age of 77 (65-86) years, and 788 were female patients (51.4%). Patients from the following race and ethnicity groups were included: 11 Asian (1.4%), 298 Black (19.4%), 162 Hispanic (10.6%), 1359 non-Hispanic (88.6%), 1077 White (70.2%), 13 other ethnicity (0.9%), and 137 other race (8.9%). Median (IQR) NT-proBNP levels were 3826 (1692-8241) pg/mL in the alert group and 3867 (1663-8917) pg/mL in the usual-care group. A total of 284 patients (17.9%) and 270 patients (17.6%) were admitted to the intensive care unit in the alert and usual-care groups, respectively. A total of 367 patients (23.1%) and 359 patients (23.4%) had a left ventricular ejection fraction of 40% or less in the alert and usual-care groups, respectively. The model achieved an area under the curve of 0.74 in the trial population. The primary outcome occurred in 619 patients (38.9%) in the alert group and 603 patients (39.3%) in the usual-care group (P = .89). There were no significant differences between study groups in the prescription of heart failure medications at discharge, the placement of an implantable cardioverter-defibrillator, or referral to palliative care.

Conclusions and Relevance

Provision of 1-year mortality estimates during heart failure hospitalization did not affect hospitalization or mortality, nor did it affect clinical decision-making.

Trial Registration

ClinicalTrials.gov Identifier NCT03845660.

Criteria Restricting Inappropriate Meropenem Empiricism (CRIME): a quasi-experimental carbapenem restriction pilot at a large academic medical centre

The broad-spectrum activity of carbapenems makes them appealing for empirical use; however, they are associated with development of Clostridioides difficile infection (CDI) and multidrug resistance. Selective carbapenem use is vital in maintaining their effectiveness. We examined the impact of meropenem restriction criteria on utilisation and patient outcomes. This quasi-experimental study was conducted at a single academic medical centre after medication use evaluation found frequent inappropriate meropenem utilisation. Antimicrobial stewardship-led restriction criteria were developed and implemented in February 2022. Investigators aimed to determine how restriction criteria affected meropenem utilisation across 8 weeks in the pre- (February-April 2020) versus post-implementation period (February-April 2022). The primary outcome was inappropriateness of meropenem utilisation. Secondary outcomes included days of therapy per 1000 patient-days (DOT/1000 PD), hospital length of stay (LOS), CDI Standardized Infection Ratio (SIR), and acquisition cost. Across the 8-week timeframes, reductions in inappropriate meropenem use (64.5% vs. 12.8%; P < 0.001), duration of therapy [5.8 (3.2-7.3) vs. 2.4 (1.0-5.5) days; P < 0.001] and utilisation (30.5 vs. 8.3 DOT/1000 PD; P < 0.001) pre- versus post-implementation were observed. Total meropenem orders decreased by 65% (P < 0.001). Median hospital LOS also decreased between periods [11.9 (7.8-20.4) vs. 9.2 (5.4-15.2) days], although not statistically significant (P = 0.051). There was no difference in CDI SIR (0.1 vs. 0.1; P = 0.99). Projected annual cost savings were ∼US$57 300. Implementation of antimicrobial stewardship-initiated restriction criteria can reduce inappropriate meropenem utilisation, overall number of orders, and total duration of therapy.

Kant's pragmatic use of reason from a sociological point of view: Third way or methodological impasse?

The paper focuses on the relevance of Kant's anthropologically oriented idea of the pragmatic use of reason for specific theoretical approaches in sociology. As I show in the first part, Kant's explicit presence in 20th-century sociology does not refer much to his anthropology and specifically to its cornerstone - the pragmatic use of reason which establishes a subtle connection between the theoretical and practical functions of reason. As an instrument for gaining systematic knowledge about the social world and ourselves as beings both passively and actively involved in this process, Kant's pragmatic use of reason serves a specific form of the theoretical use of reason. At the same time, it embodies a kind of practical reasoning concerning the "general welfare" in the social sphere. Building on the key arguments in the first part, I then address the question of whether we can view Kant's pragmatic approach as a possible third way for sociology today, beyond the simplifying opposition of 'theoretical' normativity and 'realistic' empiricism, and whether this third way can help us in clearing specific sociological issues. Here, I focus on two examples, namely the use of Kant's notion of "unsocial sociability" in Ralf Dahrendorf's conflict theory and on the criticism of Kant's cosmopolitanism in Ulrich Beck's reformed sociology of cosmopolitanism.

Holography, application, and string theory's changing nature

Based on string theory's framework, the gauge/gravity duality, also known as holography, has the ability to solve practical problems in low energy physical systems like metals and fluids. Holographic applications open a path for conversation and collaboration between the theory-driven, high energy culture of string theory and fields like nuclear and condensed matter physics, which in contrast place great emphasis on the empirical evidence that experiment provides. This paper takes a look at holography's history, from its roots in string theory to its present-day applications that are challenging the cultural identity of the field. I will focus on two of these applications: holographic QCD and holographic superconductivity, highlighting some of the (often incompatible) historical influences, motives, and epistemic values at play, as well as the subcultural shifts that help the collaborations work. The extent to which holographic research - arguably string theory's most successful and prolific area - must change its subcultural identity in order to function in fields outside of string theory reflects its changing nature and the uncertain future of the field. Does string theory lose its identity in the low-energy applications that holography provides? Does holography still belong under string theory's umbrella, or is it destined to form new subcultures with each of its fields of application? I find that the answers to these questions are dynamic, interconnected, and highly dependent on string theory's relationship with its field of application. In some cases, holography can maintain the goals and values it inherited from string theory. In others, it instead adopts the goals and values of the field in which it is applied. These examples highlight a growing need for the STS community to expand its treatment of string theory regarding its relationship with empiricism and role as a theory of quantum gravity.¹.

TTP: From empiricism for an enigmatic disease to targeted molecular therapies

The 100th anniversary of the first description of Thrombotic Thrombocytopenic Purpura (TTP) as a disease by Dr. Eli Moschcowitz approaches. For many decades, TTP remained mostly a mysterious fatal condition, where diagnosis was often post-mortem. Initially a pentad of symptoms was identified, a pattern that later revealed to be fallible. Sporadic observations led to empiric interventions that allowed for the first impactful breakthrough in TTP treatment, almost 70 years after its first description: the introduction of plasma exchange and infusions as treatments. The main body of knowledge within the field was gathered in the latest three decades: patient registries were set and proved crucial for advancements; the general mechanisms of disease have been described; the diagnosis was refined; new treatments and biomarkers with improvements on prognosis and management were introduced. Further changes and improvements are expected in the upcoming decades. In this review, we provide a brief historic overview of TTP, as an illustrative example of the success of translational medicine enabling to rapidly shift from a management largely based on empiricism to targeted therapies and personalized medicine, for the benefit of patients. Current management options and present and future perspectives in this still evolving field are summarized.

Scientific realism and empirical confirmation: A puzzle

Scientific realism driven by inference to the best explanation (IBE) takes empirically confirmed objects to exist, independent, pace empiricism, of whether those objects are observable or not. This kind of realism, it has been claimed, does not need probabilistic reasoning to justify the claim that these objects exist. But I show that there are scientific contexts in which a non-probabilistic IBE-driven realism leads to a puzzle. Since IBE can be applied in scientific contexts in which empirical confirmation has not yet been reached, realists will in these contexts be committed to the existence of empirically unconfirmed objects. As a consequence of such commitments, because they lack probabilistic features, the possible empirical confirmation of those objects is epistemically redundant with respect to realism.

Technoscientific control of nature: The ultimate paradox

The current interlinked environmental and socioeconomic global crises constitute the gravest threat to humanity's well-being, indeed survival, today. Studies of the historical roots and contemporary manifestations of the various elements of these crises-including accelerating environmental degradation, unfettered capitalist technoscientific/industrial expansion, overpopulation, and overconsumption-are plentiful. Also well-known is the influence of Francis Bacon's writings, particularly The Advancement of Learning (1605), Novum Organon (1620), and the utopian New Atlantis (1627), on the development of empiricism and the modern scientific method as well as the reform and organization of scientific research. Bacon's significance for the founding of the Royal Society of London (1660) and for the plan and structure of the Encyclopedie (1751-1772), coupled with his oft-cited aphoristic injunctions to study nature to control/dominate it, are staples in the lore and justification of technoscience. I argue that the enduring appeal of so-called Baconianism derives, in part, from a fundamental misappropriation of certain of Bacon's original ideas. Specifically, the complex ethical and religious framework within which Bacon situated his vision of scientific and technological development was discarded (or ignored) so that, by the early decades of the 18th century, Baconianism had come to be understood almost exclusively for its utilitarian role in society. This deracinated version became the familiar trope of technoscience's unlimited potential to transform nature (including human nature and behavior) in the service of an ideology of industrial/consumerist expansion since then. Linkage between the history of science/technology and addictive consumerism, apparent by the close of the 19th century, has been insufficiently examined. Such addictive consumerist behavior and continued virtually unregulated industrialization and production, were effectively removed from ethical scrutiny and a high degree of material acquisition and personal/societal rapaciousness became the norm rather than the exception in most countries. I suggest that further historical deconstruction of this denuded Baconianism will yield important insights in the search for viable solutions to the present global socioenvironmental crises.

Empiricism, sciences, and engineering: cognitive science as a zone of integration

An article by Alexandra Kirsch accepted for publication in Cognitive Processing occasioned debate among reviewers about broad methodological issues in cognitive science. One of these issues is the proper place of Popperian falsificationism in the interdisciplinary cluster. Another is the tension between abstract models and theories that apply to wide classes of cognitive systems, and models of more restricted scope intended to predict specifically human patterns of thought and behavior. The lead editorial in a Commentary debate invited by the journal's editors considers these issues from the perspective of a pragmatist philosophy of science inspired by Herbert Simon's classic (The sciences of the artificial (2nd edition 1981; 3rd edition 1996), MIT Press, Cambridge, 1969) reflections on the blurring of the distinction between science and engineering in cognitive science.

The need for a rationalist turn in evidence-based medicine

When evidence-based medicine (EBM) became established, its dominant rhetoric was empiricist, in spite of rationalist elements in its practice. Exploring some of the key statements about EBM down the years, the paper examines the tensions between empiricism and rationalism and argues for a rationalist turn in EBM to help to develop the next generation of scholarship in the field.

The German specimen case, Amalia X: Empirical studies

The authors provide a perspective on how psychoanalytic process research can be implemented. This is based on a process research model described elsewhere and summarizes the kinds of studies that can be situated on the four levels of the model. The authors summarize multiple empirical studies that were performed in a completely tape-recorded psychoanalytic therapy and have been published. These studies demonstrate the many modalities empirical process research has available to objectively study psychoanalytic process phenomena and their implication for outcome.

Logical empiricists on race

The logical empiricists expressed a consistent attitude to racial categorisation in both the ethical and scientific spheres. Their attitude may be captured in the following slogan: human racial taxonomy is an empirically meaningful mode of classifying persons that we should refrain from deploying. I offer an interpretation of their position that would render coherent their remarks on race with positions they adopted on the scientific status of taxonomy in general, together with their potential moral or political motivations for adopting that position.

Psychiatry outside the framework of empiricism

Science is interested in whatever that is empirical and objective. Any claim that cannot be objectively demonstrated has no place in science, because the subject does not deviate from the role, which it has set out to play in the life of mankind. Psychiatry, as a scientific discipline, plays along these basic principles. In the etiology, symptomatology, and management of psychiatric disorders, the biopsychosocial model recognizes the role of biological, psychological, and social factors. This essay views psychiatry from the biopsychosocial perspective and asserts that certain elements, which may not be readily and empirically verifiable, are important in the practice of psychiatry.

Empirical Research and Logotherapy

The purpose of this paper was to outline suggestions for future logotherapy applications and research. Empirical studies are available on logotherapy constructs, but additional research is sorely needed. The psychometrics of logotherapy measures need to be expanded. Carefully conducted experimental studies may aid in refining long-standing logotherapy concepts and supporting or refuting new ones.

Neither logical empiricism nor vitalism, but organicism: what the philosophy of biology was

Philosophy of biology is often said to have emerged in the last third of the twentieth century. Prior to this time, it has been alleged that the only authors who engaged philosophically with the life sciences were either logical empiricists who sought to impose the explanatory ideals of the physical sciences onto biology, or vitalists who invoked mystical agencies in an attempt to ward off the threat of physicochemical reduction. These schools paid little attention to actual biological science, and as a result philosophy of biology languished in a state of futility for much of the twentieth century. The situation, we are told, only began to change in the late 1960s and early 1970s, when a new generation of researchers began to focus on problems internal to biology, leading to the consolidation of the discipline. In this paper we challenge this widely accepted narrative of the history of philosophy of biology. We do so by arguing that the most important tradition within early twentieth-century philosophy of biology was neither logical empiricism nor vitalism, but the organicist movement that flourished between the First and Second World Wars. We show that the organicist corpus is thematically and methodologically continuous with the contemporary literature in order to discredit the view that early work in the philosophy of biology was unproductive, and we emphasize the desirability of integrating the historical and contemporary conversations into a single, unified discourse.

Counting, accounting, and accountability: Helen Verran's relational empiricism

Helen Verran uses the term 'relational empiricism' to describe situated empirical inquiry that is attentive to the relations that constitute its objects of study, including the investigator's own practices. Relational empiricism draws on and reconfigures Science and Technology Studies' traditional concerns with reflexivity and relationality, casting empirical inquiry as an important and non-innocent world-making practice. Through a reading of Verran's postcolonial projects in Nigeria and Australia, this article develops a concept of empirical and political 'accountability' to complement her relational empiricism. In Science and an African Logic, Verran provides accounts of the relations that materialize her empirical objects. These accounts work to decompose her original objects, generating new objects that are more promising for the specific postcolonial contexts of her work. The process of decomposition is part of remaining accountable for her research methods and accountable to the worlds she is working in and writing about. This is a practice of narrating relations and learning to tell better technoscientific stories. What counts as better, however, is not given, but is always contextual and at stake. In this way, Verran acts not as participant-observer, but as participant-storyteller, telling stories to facilitate epistemic flourishing within and as part of a historically located community of practice. The understanding of accountability that emerges from this discussion is designed as a contribution, both practical and evocative, to the theoretical toolkit of Science and Technology Studies scholars who are interested in thinking concretely about how we can be more accountable to the worlds we study.

Thinking Styles and Regret in Physicians

BACKGROUND

Decision-making relies on both analytical and emotional thinking. Cognitive reasoning styles (e.g. maximizing and satisficing tendencies) heavily influence analytical processes, while affective processes are often dependent on regret. The relationship between regret and cognitive reasoning styles has not been well studied in physicians, and is the focus of this paper.

METHODS

A regret questionnaire and 6 scales measuring individual differences in cognitive styles (maximizing-satisficing tendencies; analytical vs. intuitive reasoning; need for cognition; intolerance toward ambiguity; objectivism; and cognitive reflection) were administered through a web-based survey to physicians of the University of South Florida. Bonferroni's adjustment was applied to the overall correlation analysis. The correlation analysis was also performed without Bonferroni's correction, given the strong theoretical rationale indicating the need for a separate hypothesis. We also conducted a multivariate regression analysis to identify the unique influence of predictors on regret.

RESULTS

165 trainees and 56 attending physicians (age range 25 to 69) participated in the survey. After bivariate analysis we found that maximizing tendency positively correlated with regret with respect to both decision difficulty (r=0.673; p<0.001) and alternate search strategy (r=0.239; p=0.002). When Bonferroni's correction was not applied, we also found a negative relationship between satisficing tendency and regret (r=-0.156; p=0.021). In trainees, but not faculty, regret negatively correlated with rational-analytical thinking (r=-0.422; p<0.001), need for cognition (r=-0.340; p<0.001), and objectivism (r=-0.309; p=0.003) and positively correlated with ambiguity intolerance (r=0.285; p=0.012). However, after conducting a multivariate regression analysis, we found that regret was positively associated with maximizing only with respect to decision difficulty (r=0.791; p<0.001), while it was negatively associated with satisficing (r=-0.257; p=0.020) and objectivism (r=-0.267; p=0.034). We found no statistically significant relationship between regret and overall accuracy on conditional inferential tasks.

CONCLUSION

Regret in physicians is strongly associated with their tendency to maximize; i.e. the tendency to consider more choices among abundant options leads to more regret. However, physicians who exhibit satisficing tendency - the inclination to accept a "good enough" solution - feel less regret. Our observation that objectivism is a negative predictor of regret indicates that the tendency to seek and use empirical data in decision-making leads to less regret. Therefore, promotion of evidence-based reasoning may lead to lower regret.

Therapist perception of treatment outcome: Evaluating treatment outcomes among youth with antisocial behavior problems

Effective evaluation of treatment requires the use of measurement tools producing reliable scores that can be used to make valid decisions about the outcomes of interest. Therapist-rated treatment outcome scores that are obtained within the context of empirically supported treatments (ESTs) could provide clinicians and researchers with data that are easily accessible and complimentary to existing instrumentation. We examined the psychometric properties of scores from the Therapist Perception of Treatment Outcome: Youth Antisocial Behavior (TPTO:YAB), an instrument developed to assess therapist judgments of treatment success among families participating in an EST, Multisystemic Therapy (MST), for youth with antisocial behavior problems. Data were drawn from a longitudinal study of MST. The initial 20-item TPTO:YAB was completed by therapists of 111 families at midtreatment and 163 families at treatment termination. Rasch model dimensionality analyses provided evidence for 2 dimensions reflecting youth- and caregiver-related aspects of treatment outcome, although a bifactor analyses suggested that these dimensions reflected a single more general construct. Rasch analyses were also used to assess item and rating scale characteristics and refine the number of items. These analyses suggested items performed similarly across time and that scores reflect treatment outcome in similar ways at mid and posttreatment. Multilevel and zero-order analyses provided evidence for the validity of TPTO:YAB scores. TPTO:YAB scores were moderately correlated with scores of youth and caregiver behaviors targeted in treatment, adding support to its use as a treatment outcome measurement instrument.

[Herbal medicines against urinary tract infections--traditional empiricism or pharmacological evidence?]

Empirically, a variety of plants are used for uncomplicated urinary tract infections. The variety of phytopharmaceuticals with valid results is much smaller. There is a variety of observational studies about Cranberry, bearsgrape leaves, birch leaves and European goldenrod. This also justifies a recommendation in the pharmacy in a complementary medical treatment. Desireably, larger placebo-controlled studies, which proove the empirical healing, would provide more evidence. Children, pregnant women, men and patients with fever, severe cramps and blood in the urine should not medicate themselve. The patient should be referred to a doctor.

[Ideology and free will. A reflection for bioethics]

This article is about the ethics of the will that is caused by modern ideology of our century. The will, becomes desire, turns on itself to increase its own power. The ethics of the will is based on the decision of an individual, which prioritizes its will over reason and find many obstacles to act freely. Kant to avoid the moral limits of an arbitrary will, distinguishes the empirical subject, determined by their appetites, from the moral or rational subject, with a free will of conditioning. The ethics of the will is a reflection of Kant's empirical subject and current ideologies. Against ideologies the classical tradition is proposed, an ethic that reflects on human life and the realization of man in the world.

Latent and manifest empiricism in Q'eqchi' Maya healing: a case study of HIV/AIDS

This paper presents a case study of the traditional treatment of a Q'eqchi' Maya man in southern Belize in 2011 who is suffering from AIDS-related sickness. The purpose is to detail the empirical nature of Q'eqchi' Maya medicine, distinguishing between manifest and latent empiricism, as evidenced in the healers evolving attempts to treat the patient in the absence of knowledge of his biomedical diagnosis. The paper argues for a more complete understanding of the empirical nature of much Indigenous healing, which parallels aspects of scientific medicine, and for better collaboration among traditional healers and biomedical practitioners in strongly Indigenous areas.

[Herbal medicines against respiratory diseases--traditional empiricism or pharmacological evidence?]

Sinusitis and bronchitis belong to the most frequent respiratory infections. The relevant guidelines mention the therapy with herbal substances and assign a good activity to cineole and Myrtol as well as to combination preparations with cowslip. There is no final statement of the guidelines' authors concerning the extract of Pelargonium sidoides. Further studies will be necessary to give reliable therapeutic recommendations.

Linking the subcultures of physics: virtual empiricism and the bonding role of trust

This article draws on empirical material concerning the communication and use of knowledge in experimental physics and its relations to the culture of theoretical physics. The role that trust plays in these interactions is used to create a model of social distance between interacting theoretical and experimental cultures. This article thus seeks to reintroduce trust as a fundamental element in answering the problem of disunity in the sociology of knowledge.

Arguing about innateness

This paper lays out the components of a language acquisition model, the interconnections among the components, and the differing stances of nativism and empiricism about syntax. After demonstrating that parsimony cannot decide between the two stances, the paper analyzes nine examples of evidence that have been used to argue for or against nativism, concluding that most pieces of evidence are either irrelevant or suggest that language is special but need not invoke innate ideas. Two pieces of evidence - the development of home sign languages and the acquisition of Determiners - do show not just that language is special but that the child has innate syntactic content. The existential claim that nativism makes - there is at least one innate syntactic idea - is an easier claim to verify than the universal claim that empiricism makes - there are no innate syntactic ideas.

Data fabrication and falsification and empiricist philosophy of science

Scientists have rules pertaining to data fabrication and falsification that are enforced with significant punishments, such as loss of funding, termination of employment, or imprisonment. These rules pertain to data that describe observable and unobservable entities. In this commentary I argue that scientists would not adopt rules that impose harsh penalties on researchers for data fabrication or falsification unless they believed that an aim of scientific research is to develop true theories and hypotheses about entities that exist, including unobservable ones. This argument presents a challenge for constructive empiricists, such as van Fraassen. Constructive empiricists need to be able to explain why rules pertaining to data fabrication and falsification do not threaten their philosophy of science.

The philosophies of psychiatry: empirical perspectives

The past two decades have seen a surge in cross-disciplinary work in philosophy and psychiatry. Much of this work is necessarily abstract whilst those working in the area are aware of the necessity of relating the theoretical and conceptual work to the vagaries of day-to-day practice. But given the diverse methods and aims of philosophy and psychiatry, crossing the 'communication gap' between the two disciplines is easier said than done. In this article different methods of bridging this gap are presented and commented upon. A number of research studies are reviewed with an eye to the potential they display to develop interdisciplinary theory. An empirical approach to philosophy of practice with special attention to ordinary language use is proposed as a fruitful may forward.

The woman in the mirror: humanities in medicine

While the role of the sciences in medicine and medical training is unquestioned and should remain so, the traditional resistance of medical culture to the humanities and humanistic argument does not serve the medical profession well, nor does it do justice either to the challenges or rewards of clinical practice.

[Prescribing monitoring in clinical practice: from enlightened empiricism to rational strategies]

Monitoring of a medical condition is the periodic measurement of one or several physiological or biological variables to detect a signal regarding its clinical progression or its response to treatment. We distinguish different medical situations between diagnostic, clinical and therapeutic process to apply monitoring. Many clinical, variables can be used for monitoring, once their intrinsic properties (normal range, critical difference, kinetics, reactivity) and external validity (pathophysiological importance, predictive power for clinical outcomes) are established. A formal conceptualization of monitoring is being developed and should support the rational development of monitoring strategies and their validation through appropriate clinical trials.

[Language and metalanguage in bioethics]

The language of Bioethics is situated in a context of singular terminological complexity. On the one hand, if we look at the epistemological status of this discipline, we can realize that the knowledge of their material object (which refers to the Bios and transformations that technology involves) requires the assistance of several sciences, whose contribution is indispensable for understanding the empirical data. At the same time, the question which constitutes its formal object is clearly philosophical, and therefore requires moving at the level of ethics. This paper attempts to deal with some problematic knots of the issue, gathered around two axes: the role of techno-scientific language in bioethics and its explanatory ability and the characteristics of philosophical language. As for the second point, it also discusses the tentative to find a neutral language (structuring the same Bioethics as a lingua franca); the recourse to indirect speech that shifts the focus from the truth of the arguments to the framework of models; the rhetorical use of the language.

Divining and knowing: Karl Sudhoff's historical method

This article investigates the historical method of Karl Sudhoff (1853- 1938), Germany's first professor of medical history. It argues that in order to understand his ideas more fully, we need to step outside the historiography of medical history and assess his methodology in relation to the norms and ideals of German academic history writing in general. The article demonstrates that the philology-based "critical method" of Leopold von Ranke (1795-1886) was central to Sudhoff's methodological thinking. It investigates the underlying philosophical and epistemological assumptions of Ranke's method, which tend to be less appreciated than his overt empiricism and explores how Sudhoff applied these to the new professionalizing subdiscipline of the history of medicine. The article argues that Sudhoff's concerns with the methodology of history, which involved a particular conception of the relationship between the human sciences and the medical sciences, offers compelling addresses to our times.

Commentary: diversity and inclusion in the 21st century: bridging the moral and excellence imperatives

There is prolific evidence of a commitment to diversifying student and faculty populations in academic medicine, but far less evidence of its effectiveness. The social justice underpinning of this commitment is important and must continue to undergird diversity and inclusion efforts. In today's environment of pinched resources, however, moral arguments alone will not suffice. What the diversity and inclusion movement needs for the 21st century is to apply rigorous empirical methods to understanding the most effective and efficient interventions to contribute to institutional excellence.The collection of diversity and inclusion articles in this month's issue of Academic Medicine is quite comprehensive and speaks to a range of audiences, from those who consider themselves experts on diversity and inclusion to the casual and interested reader. This robust collection will afford diversity practitioners, institutional leaders, and policy influencers with greater insight into what defines an effective diversity strategy.The academic medicine community cannot derive top value from diversity efforts, however, until practitioners, deans, CEOs, and policy makers begin operating with a shared framework for success. The excellence imperative facing our medical schools and teaching hospitals calls for improved precision in decision making and resource deployment to drive sustainable outcomes, which in turn requires a strong degree of alignment among all involved parties.

Healthy marriage initiatives: on the need for empiricism in policy implementation

The association between marriage and well-being has led to policies that promote marital interventions and discourage divorce. These include federal initiatives specifically targeting poor couples and couples of color. While there are many prospective studies on marriage that have informed some couple interventions, the studies that are included in this literature sampled predominantly White and middle-class couples. By comparison, far less is known about the longitudinal predictors of relationship satisfaction and status for poor couples and couples of color. Therefore, it is unsurprising that preliminary data on applying current interventions to the couples targeted by these federal initiatives have been disappointing. In this article, I detail three concerns with these initiatives, propose a course of psychological research to address deficits in what is known about poor couples and couples of color, and make specific recommendations to enhance the effectiveness of these initiatives.

The compleat lawyer--medical law as practical reasoning: doctrine, empiricism, and engagement

Margot Brazier has modelled the relationship between legal scholarship and health care practice--an evidence-based approach to doing good in the real world through the application of the discipline of law. No ivory tower academic, but a good citizen. This paper explores the expression of her comprehensive contribution in an academic paper and a policy review. She has shown how law needs to take into account the realities of the clinic when considering the plausibility of various claims for the doctrine of informed consent. She has also demonstrated how discipline could be brought to bear on policy-making, where in the Surrogacy Review she prioritised empirical evidence over preconceptions: evidence-based policy not policy-based evidence as modern consultation documents too often elicit. Margot Brazier has also provided a role model for academic lawyers' contribution to the public good; not only through ensuring the proper administration of the law (as chair of the Animal Procedures Committee for the Home Office), but also in shaping a cathartic response to public concerns as Chair of the Retained Organ Commission. She did not set out to establish a grand theory of medical law, but rather has built an approach that has enriched its practice and has had a lasting impact on those working in the field. In her hands, law is a tool for improving the practice of health care. Efficient practice precedes the theory of it; methodologies presuppose the application of the methods, of the critical investigation of which they are the products. It was because Aristotle found himself and others reasoning now intelligently and now stupidly and it was because Izaak Walton found himself and others angling sometimes effectively and sometimes ineffectively that both were able to give their pupils the maxims and prescriptions of their arts.

Alcohol use and policy formation: an evolving social problem

This article explores the evolutionary course that the social problem of alcohol use has taken in the United States since the Colonial Era. This article utilizes a range of theoretical models to analyze the evolving nature of alcohol use from an unrecognized to a perceived social problem. The models used include critical constructionism (Heiner, 2002), top-down policy model (Dye, 2001) and Mauss'(1975) understanding of social problems and movements. These theoretical constructs exhibit the relative nature of alcohol use as a social problem in regards to a specific time, place, and social context as well as the powerful and influential role that social elites have in defining alcohol asa social problem. Studies regarding the development of alcohol policy formation are discussed to illuminate the different powers, constituents, and factors that play a role in alcohol policy formation.Finally, implications for future study are discussed [corrected].

[Anankastic phenomena in psychiatry (predestination and dace in mental life)]

The purpose of this communication is to compare behavioral mineralization occurring in mental illness to the freshness and plasticity behavior in health. The epistemological fundamentals of this paper include the theories of chaos and complexity of Edgar Morin, the concept of autopoiesis developed from the theory of systems, the latest discoveries on the neurobiology of consciousness and their associations with Darwinian psychiatry and also, following Lain Entralgo, recreating the Greek concept of ananke to describe the behavior fixation in an anachronistic place of the physis in mental illness. It provides some empirical evidence to support the proposal, and all this is rigorously examined with hermeneutic phenomenology and its theoretical possibilities. This leads to an epistemological rethinking of clinical and therapeutic proposal aimed at the subject and the recovery of his or her freedom.

Empirical foundations for the diagnosis of somatization: implications for DSM-5

BACKGROUND

The aim of this study was to develop empirically validated criteria for the diagnoses of clinically relevant somatization.

METHOD

This study was performed in a population-representative cohort consisting of 461 males (47.8%) and 503 females (52.2%), with an average age of 55.8 years (s.d.=11.1). Somatization, anxiety and depression were derived from the Composite International Diagnostic Interview. Mplus was used to perform confirmative factor analyses on the current DSM-IV symptom groups; on alternative symptom clusters previously suggested; and to perform latent class analysis in order to define an empirically derived cut-off for somatization.

RESULTS

The existence of symptom groups as described in DSM-IV was not supported by our data, whereas a differentiation between cardiopulmonary, musculoskeletal, gastrointestinal and general somatic symptoms did fit our data. Latent class analysis revealed two classes characterized by few (n=859) and many (n=105) symptoms. The class of subjects could be approached by a simple cut-off of four functional symptoms (sensitivity 79%, specificity 98%, positive predictive value 82%, negative predictive value 97%) regardless of the number of organ systems involved.

CONCLUSIONS

This study in a large population-representative cohort suggests that a simple symptom count can be used as a dimensional diagnosis of somatization. In those instances in which a categorical diagnosis is preferred, a simple cut-off of four out of 43 functional symptoms best fitted our data. We did not find any added value for incorporating the number of symptom clusters into the diagnostic criteria.