Preferences, predictions and patient enablement: a preliminary study

BACKGROUND: The widely used patient enablement instrument (PEI) is sometimes contrasted against measures of patient satisfaction as being a more objective measure of consultation quality, in that it is less likely to be positively influenced by fulfilling pre-existing expectations for specific consultation outcomes (such as prescriptions or referrals). However the relationship between expectation and enablement is underexplored, as is the relationship between ‘expectation’ understood as a patient preference for outcome, and patient prediction of outcome. The aims of the study are to 1) assess the feasibility of measuring the relationship between expectation fulfilment and patient enablement, and 2) measure the difference (if any) between expectation understood as preference, and expectation understood as prediction. METHODS: A questionnaire study was carried out on 67 patients attending three General Practices in the Australian Capital Territory. Patient preferences and predictions for a range of possible outcomes were recorded prior to the consultation. PEI and the actual outcomes of the consultation were recorded at the conclusion of the consultation. Data analysis compared expectation fulfilment as concordance between the preferred, predicted, and actual outcomes, with the PEI as a dependant variable. RESULTS: No statistically significant relationship was found between either preference-outcome concordance and PEI, or prediction-outcome concordance. Statistically insignificant trends in both cases ran counter to expectations; i.e. with PEI (weakly) positively correlated with greater discordance. The degree of concordance between preferred outcomes and predicted outcomes was less than the concordance between either preferred outcomes and actual outcomes, or predicted outcomes and actual outcomes. CONCLUSIONS: The relationship between expectation fulfilment and enablement remains uncertain, whether expectation is measured as stated preferences for specific outcomes, or the predictions made regarding receiving such outcomes. However the lack of agreement between these two senses of ‘patient expectation’ suggests that explicitly demarcating these concepts during study design is strongly advisable.NHMRC (National Health and Medical Research Council of Australia

Modelling religious signalling

The origins of human social cooperation confound simple evolutionary explanation. But from Darwin and Durkheim onwards, theorists (anthropologists and sociologists especially) have posited a potential link with another curious and distinctively human social trait that cries out for explanation: religion. This dissertation explores one contemporary theory of the co-evolution of religion and human social cooperation: the signalling theory of religion, or religious signalling theory (RST). According to the signalling theory, participation in social religion (and its associated rituals and sanctions) acts as an honest signal of one's commitment to a religiously demarcated community and its way of doing things. This signal would allow prosocial individuals to positively assort with one another for mutual advantage, to the exclusion of more exploitative individuals. In effect, the theory offers a way that religion and cooperation might explain one another, but which that stays within an individualist adaptive paradigm. My approach is not to assess the empirical adequacy of the religious signalling explanation or contrast it with other explanations, but rather to deal with the theory in its own terms - isolating and fleshing out its core commitments, explanatory potential, and limitations. The key to this is acknowledging the internal complexities of signalling theory, with respect to the available models of honest signalling and the extent of their fit (or otherwise) with religion as a target system. The method is to take seriously the findings of formal modelling in animal signalling and other disciplines, and to apply these (and methods from the philosophy of biology more generally) to progressively build up a comprehensive picture of the theory, its inherent strengths and weaknesses. The first two chapters outline the dual explanatory problems that cooperation and religion present for evolutionary human science, and surveys contemporary approaches toward explaining them. Chapter three articulates an evolutionary conception of the signalling theory, and chapters four to six make the case for a series of requirements, limitations, and principles of application. Chapters seven and eight argue for the value of formal modelling to further flesh out the theory's commitments and potential and describe some simple simulation results which make progress in this regard. Though the inquiry often problematizes the signalling theory, it also shows that it should not be dismissed outright, and that it makes predictions which are apt for empirical testing

Responsiveness and robustness in the David Lewis signaling game

We consider modifications to the standard David Lewis signalling game and relax a number of unrealistic implicit assumptions that are often built into the framework. In particular, we explore realistic asymmetries that exist between the sender and receiver roles. We find that endowing receivers with a more realistic set of responses significantly decreases the likelihood of signalling, while allowing for unequal selection pressure often has the opposite effect. We argue that the results of this paper can also help make sense of a well-known evolutionary puzzle regarding the absence of an evolutionary arms race between sender and receiver in conflict of interest signalling games

Responsiveness and robustness in the david lewis signaling game

We consider modifications to the standard David Lewis signaling game and relax a number of unrealistic implicit assumptions that are often built into the framework. In particular, we motivate and explore various asymmetries that exist between the sender and receiver roles.We find that endowing receivers with a more realistic set of responses significantly decreases the likelihood of signaling, while allowing for unequal selection pressure often has the opposite effect. We argue that the results of this article can also help make sense of a well-known evolutionary puzzle regarding the absence of an evolutionary arms race between sender and receiver in conflict-of-interest signaling games

Responsiveness and robustness in the David Lewis signalling game

We consider modifications to the standard David Lewis signalling game and relax a number of unrealistic implicit assumptions that are often built into the framework. In particular, we explore realistic asymmetries that exist between the sender and receiver roles. We find that endowing receivers with a more realistic set of responses significantly decreases the likelihood of signalling, while allowing for unequal selection pressure often has the opposite effect. We argue that the results of this paper can also help make sense of a well-known evolutionary puzzle regarding the absence of an evolutionary arms race between sender and receiver in conflict of interest signalling games

Social media and mobile apps for health promotion in Australian indigenous populations: Scoping review

Background: Health promotion organizations are increasingly embracing social media technologies to engage end users in a more interactive way and to widely disseminate their messages with the aim of improving health outcomes. However, such technologies are still in their early stages of development and, thus, evidence of their efficacy is limited.Objective: The study aimed to provide a current overview of the evidence surrounding consumer-use social media and mobile software apps for health promotion interventions, with a particular focus on the Australian context and on health promotion targeted toward an Indigenous audience. Specifically, our research questions were: (1) What is the peer-reviewed evidence of benefit for social media and mobile technologies used in health promotion, intervention, self-management, and health service delivery, with regard to smoking cessation, sexual health, and otitis media? and (2) What social media and mobile software have been used in Indigenous-focused health promotion interventions in Australia with respect to smoking cessation, sexual health, or otitis media, and what is the evidence of their effectiveness and benefit?Methods: We conducted a scoping study of peer-reviewed evidence for the effectiveness of social media and mobile technologies in health promotion (globally) with respect to smoking cessation, sexual health, and otitis media. A scoping review was also conducted for Australian uses of social media to reach Indigenous Australians and mobile apps produced by Australian health bodies, again with respect to these three areas.Results: The review identified 17 intervention studies and seven systematic reviews that met inclusion criteria, which showed limited evidence of benefit from these interventions. We also found five Australian projects with significant social media health components targeting the Indigenous Australian population for health promotion purposes, and four mobile software apps that met inclusion criteria. No evidence of benefit was found for these projects.Conclusions: Although social media technologies have the unique capacity to reach Indigenous Australians as well as other underserved populations because of their wide and instant disseminability, evidence of their capacity to do so is limited. Current interventions are neither evidence-based nor widely adopted. Health promotion organizations need to gain a more thorough understanding of their technologies, who engages with them, why they engage with them, and how, in order to be able to create successful social media projects

Responsiveness and robustness in the David Lewis signalling game

We consider modifications to the standard David Lewis signalling game and relax a number of unrealistic implicit assumptions that are often built into the framework. In particular, we explore realistic asymmetries that exist between the sender and receiver roles. We find that endowing receivers with a more realistic set of responses significantly decreases the likelihood of signalling, while allowing for unequal selection pressure often has the opposite effect. We argue that the results of this paper can also help make sense of a well-known evolutionary puzzle regarding the absence of an evolutionary arms race between sender and receiver in conflict of interest signalling games

Responsiveness and robustness in the David Lewis signaling game

We consider modifications to the standard David Lewis signalling game and relax a number of unrealistic implicit assumptions that are often built into the framework. In particular, we explore realistic asymmetries that exist between the sender and receiver roles. We find that endowing receivers with a more realistic set of responses significantly decreases the likelihood of signalling, while allowing for unequal selection pressure often has the opposite effect. We argue that the results of this paper can also help make sense of a well-known evolutionary puzzle regarding the absence of an evolutionary arms race between sender and receiver in conflict of interest signalling games

Are biological traits explained by their 'selected effect' functions?

The selected effects or ‘etiological’ theory of Proper function is a naturalistic and realist account of biological teleology. It is used to analyse normativity in philosophy of language, philosophy of mind, philosophy of medicine and elsewhere. The theory has been developed with a simple and intuitive view of natural selection. Traits are selected because of their positive effects on the fitness of the organisms that have them. These ‘selected effects’ are the Proper functions of the traits. Proponents argue that this analysis of biological teleology has the unique advantage that the selected effect function of a trait is also a causal explanation of the trait: the trait exists because it performs this function. We show, however, that selected effect functions as currently defined explain the existence of traits only under highly restrictive assumptions about evolutionary dynamics. In many common scenarios in which traits evolve by natural selection, selected effect functions do not explain those traits. This is because definitions of selected effect function extract from any evolutionary scenario only the information that would be explanatorily relevant in the simple evolutionary scenario implicit in those definitions. When applied to more complex scenarios selected effect functions omit the key information that is explanatorily relevant in those scenarios. The assumptions required for selected effect functions to be explanatory are particularly unlikely to hold in the domain that its proponents care most about - the evolution of representation. A more adequate selected effects theory of Proper functions may be possible, but will require much greater attention to the structure of actual evolutionary explanations

Making do without selection—Review essay of “Cultural Evolution: Conceptual Challenges” by Tim Lewens

Cultural evolution is a growing, interdisciplinary, and disparate field of research. In ‘Cultural evolution: conceptual challenges”, Tim Lewens offers an ambitious analytical survey of this field that aims to clarify and defend its epistemic contributions, and highlight the limitations and risks associated with them. One overarching contention is that a form of population thinking dubbed the ‘kinetic approach’ should be seen as a unifying and justifying principle for cultural evolution, especially when considering the role of formal modelling. This book makes a number of extremely valuable contributions to the literature. However, I argue that not all is as it may seem regarding the kinetic approach and that, while it does little to diminish the book’s value, the use which Lewens makes for it is problemati