Against Pyrrhonian Equipollence

The production of equipollence is the most important part of the Pyrrhonian skeptic’s method for bringing about the suspension of judgment. The skeptic produces equipollence methodically, by opposing arguments, propositions, or appearances, in anyway whatsoever, until he produces an equality of “weightiness” on both sides of the conflicting views. Having no appropriate criterion to break the deadlock of equipollence, the skeptic (or his interlocutor) is left with no reason to accept either view. I have two main aims in this paper. My first aim is to distinguish between two different types of equipollence; that produced in the Pyrrhonist, called Psychological Equipollence, and that demonstrated to the dogmatist by the Pyrrhonist, called Normative Equipollence. My second aim in this paper is to argue that equipollence cannot be produced when the skeptic uses only epistemic possibility of error to oppose some compelling p

Transportation quality indices for economic analysis of non-metropolitan cities

It is generally agreed that transportation plays a role in economic development, but it often is assumed away in empirical work due to data voids or under implicit assumptions that it is largely an inert factor. This paper seeks to add to the quantitative material by offering estimates of the relative quality of surface freight transportation service resources available to non-metropolitan cities across the US. Indicators suggest that cities located in the Midwest have relatively higher freight transport service quality, and that a cluster of north-eastern states are at a disadvantage, considering the quality of freight service for non-metropolitan areas. Transportation quality indicators developed in this research offer a new opportunity to consider transportation in analysis of economic development policies and strategies

Juror decision making in acquaintance and marital rape: The influence of clothing, alcohol and pre-existing stereotypical attitudes

Stereotypical biases about women’s roles in intimate relationships including their marital status and lifestyle choices such as clothing and alcohol use influence juror attributions of rape case defendant guilt, potentially reducing access to justice for victims. Across two mock-juror decision making experiments, participants read identical fictitious sexual assault vignettes varying in intoxicated defendant-complainant relationship (married vs. acquaintance), accompanied by photographs of complainant clothing at the crime (body revealing vs. plain) and in court (smart vs. casual). Experiment 2 additionally described the defendant’s alcohol consumption as either under or over the drink drive limit. Most participants delivered guilty verdicts (Experiment 1: 86.7%; Experiment 2: 75.5%), recommending mean prison sentences of 5.04 years in Experiment 1 (n = 218 students) and 4.33 years in Experiment 2 (n = 1,086 members of public). In Experiment 1, guilty verdict rates and sentences were significantly higher when the married - but not the acquaintance - complainant dressed smartly rather than casually in court. In Experiment 2, significantly more guilty verdicts were delivered by females (80.3%) than males (66.9%), while sentence lengths were longer in acquaintance (M = 4.52 years) than married conditions (M = 4.10). Significant interactions between defendant alcohol use and clothing choice of the married - but not the acquaintance complainant - at the crime also influenced sentencing decisions. Higher scores on additionally administered scales measuring rape myth acceptance and sexist attitudes, but not alcohol expectancies, predicted lenient sentencing decisions in both experiments. These findings highlight how ‘rape myths’ concerning marriages drive juror decisions. Prosecuting lawyers should use these results to better challenge these attitudes in court. Internationally, rape is often unreported to the police, and married victims may be more willing to come forward if they believe unbiased access to justice is likely

Gastro-Oesophageal Reflux in Noncystic Fibrosis Bronchiectasis

The clinical presentation of noncystic fibrosis bronchiectasis may be complicated by concomitant conditions, including gastro-oesophageal reflux (GOR). Increased acidic GOR is principally caused by gastro-oesophageal junction incompetence and may arise from lower oesophageal sphincter hypotension, including transient relaxations, hiatus hernia, and oesophageal dysmotility. Specific pathophysiological features which are characteristic of respiratory diseases including coughing may further increase the risk of GOR in bronchiectasis. Reflux may impact on lung disease severity by two mechanisms, reflex bronchoconstriction and pulmonary microaspiration. Symptomatic and clinically silent reflux has been detected in bronchiectasis, with the prevalence of 26 to 75%. The cause and effect relationship has not been established, but preliminary reports suggest that GOR may influence the severity of bronchiectasis. Further studies examining the implications of GOR in this condition, including its effect across the disease spectrum using a combination of diagnostic tools, will clarify the clinical significance of this comorbidity

The Management and Use of Social Network Sites in a Government Department

In this paper we report findings from a study of social network site use in a UK Government department. We have investigated this from a managerial, organisational perspective. We found at the study site that there are already several social network technologies in use, and that these: misalign with and problematize organisational boundaries; blur boundaries between working and social lives; present differing opportunities for control; have different visibilities; have overlapping functionality with each other and with other information technologies; that they evolve and change over time; and that their uptake is conditioned by existing infrastructure and availability. We find the organisational complexity that social technologies are often hoped to cut across is, in reality, something that shapes their uptake and use. We argue the idea of a single, central social network site for supporting cooperative work within an organisation will hit the same problems as any effort of centralisation in organisations. We argue that while there is still plenty of scope for design and innovation in this area, an important challenge now is in supporting organisations in managing what can best be referred to as a social network site 'ecosystem'.Comment: Accepted for publication in JCSCW (The Journal of Computer Supported Cooperative Work

Le Plan d’action pour la médecine rurale : examen de l’éducation médicale pré-doctorale au Canada

Background: There is currently a maldistribution of physicians across Canada, with rural areas facing a greater physician shortage. The taskforce between the College of Family Physicians and the Society of Rural Physicians created a report, “The Rural Road Map for Action” (RRMA) to improve rural Canadians' health by training and retaining an increased number of rural family physicians. Using the RRMA as a framework, this paper aims to examine the extent to which medical schools in Canada are following the RRMA. Methods: Researchers used cross-sectional survey and collected data from 12 of 17 medical school undergraduate Deans from across Canada using both closed and open ended survey questions. Results were analyzed using quantitative (frequencies) and qualitative methods (content analysis). Results: Medical schools use different policies and procedures to recruit rural and Indigenous students. Although longitudinal integrated clerkships offer many benefits, few students have access to them. Leadership representation on decision-making education committees differed across medical schools pointing to a variation in the value of rural physicians’ perspectives. Conclusion: This study illustrated that medical schools are making efforts that align with the RRMA. It is critical they continue to make strategic decisions embedded in educational policy and leadership to reinforce the importance of and influence of rural medical education to support workforce planning.Contexte : À l’heure actuelle, la répartition des médecins sur le territoire canadien est inégale, les régions rurales étant confrontées à une plus forte pénurie de médecins. Le groupe de travail constitué par le Collège des médecins de famille du Canada (CMFC) et la Société de la médecine rurale du Canada (SMRC) a produit un rapport intitulé « Plan d’action pour la médecine rurale » (PAMR) qui vise à améliorer la santé des Canadiens vivant en milieu rural par la formation et la rétention d’un nombre accru de médecins de famille en milieu rural. Partant du cadre du PAMR, cet article évalue dans quelle mesure les facultés de médecine du Canada suivent le Plan d’action. Méthodes : Les chercheurs ont eu recours à une enquête transversale, comportant des questions fermées et ouvertes, pour recueillir des données auprès de 12 des 17 doyens aux études de premier cycle des facultés de médecine canadiennes. Les résultats ont été analysés à l’aide de méthodes quantitatives (calcul des fréquences) et qualitatives (analyse de contenu). Résultats : Les facultés de médecine appliquent des politiques et des procédures différentes pour recruter des étudiants ruraux et autochtones. Les stages intégrés longitudinaux offrent de nombreux avantages, mais peu d’étudiants y ont accès. La représentation des dirigeants au sein des comités décisionnels sur l’éducation diffère selon les facultés de médecine, ce qui indique une variation de la valeur des perspectives des médecins ruraux. Conclusion : Cette étude montre que les facultés de médecine déploient des initiatives qui sont conformes au PAMR. Il est essentiel que leurs décisions stratégiques demeurent ancrées dans un leadership et une politique éducative visant à renforcer et à mettre en valeur l’exposition des étudiants à la médecine rurale pour appuyer la planification des effectifs

Swingbed Amine Carbon Dioxide Removal Flight Experiment - Feasibility Study and Concept Development for Cost-Effective Exploration Technology Maturation on The International Space Station

The completion of International Space Station Assembly and transition to a full six person crew has created the opportunity to create and implement flight experiments that will drive down the ultimate risks and cost for human space exploration by maturing exploration technologies in realistic space environments that are impossible or incredibly costly to duplicate in terrestrial laboratories. An early opportunity for such a technology maturation experiment was recognized in the amine swingbed technology baselined for carbon dioxide and humidity control on the Orion spacecraft and Constellation Spacesuit System. An experiment concept using an existing high fidelity laboratory swing bed prototype has been evaluated in a feasibility and concept definition study leading to the conclusion that the envisioned flight experiment can be both feasible and of significant value for NASA s space exploration technology development efforts. Based on the results of that study NASA has proceeded with detailed design and implementation for the flight experiment. The study effort included the evaluation of technology risks, the extent to which ISS provided unique opportunities to understand them, and the implications of the resulting targeted risks for the experiment design and operational parameters. Based on those objectives and characteristics, ISS safety and integration requirements were examined, experiment concepts developed to address them and their feasibility assessed. This paper will describe the analysis effort and conclusions and present the resulting flight experiment concept. The flight experiment, implemented by NASA and launched in two packages in January and August 2011, integrates the swing bed with supporting elements including electrical power and controls, sensors, cooling, heating, fans, air- and water-conserving functionality, and mechanical packaging structure. It is now on board the ISS awaiting installation and activation

Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial

Background: Only one-third of patients with depression respond fully to treatment with antidepressant medication. However, there is little robust evidence to guide the management of those whose symptoms are 'treatment resistant'.<p></p> Objective: The CoBalT trial examined the clinical effectiveness and cost-effectiveness of cognitive behavioural therapy (CBT) as an adjunct to usual care (including pharmacotherapy) for primary care patients with treatment-resistant depression (TRD) compared with usual care alone.<p></p> Design: Pragmatic, multicentre individually randomised controlled trial with follow-up at 3, 6, 9 and 12 months. A subset took part in a qualitative study investigating views and experiences of CBT, reasons for completing/not completing therapy, and usual care for TRD.<p></p> Setting: General practices in Bristol, Exeter and Glasgow, and surrounding areas.<p></p> Participants: Patients aged 18-75 years who had TRD [on antidepressants for 6 weeks, had adhered to medication, Beck Depression Inventory, 2nd version (BDI-II) score of 14 and fulfilled the International Classification of Diseases and Related Health Problems, Tenth edition criteria for depression]. Individuals were excluded who (1) had bipolar disorder/psychosis or major alcohol/substance abuse problems; (2) were unable to complete the questionnaires; or (3) were pregnant, as were those currently receiving CBT/other psychotherapy/secondary care for depression, or who had received CBT in the past 3 years.<p></p> Interventions: Participants were randomised, using a computer-generated code, to usual care or CBT (12-18 sessions) in addition to usual care.<p></p> Main outcome measures: The primary outcome was 'response', defined as 50% reduction in depressive symptoms (BDI-II score) at 6 months compared with baseline. Secondary outcomes included BDI-II score as a continuous variable, remission of symptoms (BDI-II score of < 10), quality of life, anxiety and antidepressant use at 6 and 12 months. Data on health and social care use, personal costs, and time off work were collected at 6 and 12 months. Costs from these three perspectives were reported using a cost-consequence analysis. A cost-utility analysis compared health and social care costs with quality adjusted life-years.<p></p> Results: A total of 469 patients were randomised (intervention: n = 234; usual care: n = 235), with 422 participants (90%) and 396 (84%) followed up at 6 and 12 months. Ninety-five participants (46.1%) in the intervention group met criteria for 'response' at 6 months compared with 46 (21.6%) in the usual-care group {odds ratio [OR] 3.26 [95% confidence interval (CI) 2.10 to 5.06], p < 0.001}. In repeated measures analyses using data from 6 and 12 months, the OR for 'response' was 2.89 (95% CI 2.03 to 4.10, p < 0.001) and for a secondary 'remission' outcome (BDI-II score of < 10) 2.74 (95% CI 1.82 to 4.13, p < 0.001). The mean cost of CBT per participant was £910, the incremental health and social care cost £850, the incremental QALY gain 0.057 and incremental cost-effectiveness ratio £14,911. Forty participants were interviewed. Patients described CBT as challenging but helping them to manage their depression; listed social, emotional and practical reasons for not completing treatment; and described usual care as mainly taking medication.<p></p> Conclusions: Among patients who have not responded to antidepressants, augmenting usual care with CBT is effective in reducing depressive symptoms, and these effects, including outcomes reflecting remission, are maintained over 12 months. The intervention was cost-effective based on the National Institute for Health and Care Excellence threshold. Patients may experience CBT as difficult but effective. Further research should evaluate long-term effectiveness, as this would have major implications for the recommended treatment of depression.<p></p&gt