Six Theses on Mechanisms and Mechanistic Science

In this paper we identify six theses that constitute core results of philosophical investigation into the nature of mechanisms, and of the role that the search for and identification of mechanisms play in the sciences. These theses represent the fruits of the body of research that is now often called New Mechanism. We concisely present the main arguments for these theses. In the literature, these arguments are scattered and often implicit. Our analysis can guide future research in many ways: it provides critics of New Mechanism with clear targets, it can reduce misunderstandings, it can clarify differences of opinion among New Mechanists and it helps to define a research agenda for New Mechanists

Reducing the psychological burden of isolated oncological patients by means of decision trees

This century has seen several outbreaks of epidemics caused by a common sub-family of coronaviruses such as the responsible for COVID-19 outbreak. The most ominous variants have developed a peculiar viral mechanisms that allows the virus to directly attack the pulmonary tissues often causing a set of dangerous symptoms. It made quite evident that we need a global response to prepare health systems for future epidemics. Unfortunately, during such kind of diseases’ outbreaks a large amount of time is required to the caregivers for sanitization and cleaning operations, therefore tampering with number and duration of visits to patients, especially in oncology wards. Such patients are then left alone for a long time, it follows that their perceived quality of service is greatly diminished, often determining ill-fated consequences also on the psychological side, with significant fallbacks on the recovery possibilities and speed. In this paper we explore an algorithmic approach to automatic communication interfaces that could enhance and enforce the perceived quality of care by the patients in in order to reduce predisposing factors that could potentially tamper with the patient’s ability to recover, also preventing the occurrence of precipitating factors that could lead a therapy to complete failure. The proposed interface could be used to connect the patients with a psychological support when it is most needed, and, moreover, to connect them with their physicians and families, and also to the outside world. In particular we aim to provide the psychological support that is actually excluded in pandemics such as the COVID-19 emergency, mainly in order to enforce the healthcare and sanification protocols, due to its potential unsafety related to the introduction of more personnel into the hospital

A cloud-oriented architecture for the remote assessment and follow-up of hospitalized patients

During the last months the dramatic COVID-19 outbreak has exposed the fragility of our healthcare system, as well as the need for a smart remote follow-up system for the patients, in order to less the burden on the healthcare service and reduce the average hospitalization time. In this paper we proposed a solution designed to grant maximum flexibility by means of the allocation of resources on a cloud service for the remote follow-up of patients. Such resources can be used as a remote support for the caregiver both when planning or enforcing a therapeutic path. A major explanation behind follow-up regards the location and treatment of potentially adverse reactions after treatments. Physical side effects of the different modalities of treatment might be various and crippling after chemotherapy and radiotherapy. Moreover remote follow up can be a life-changing solution also on the economical side, due to the implication of therapeutic attendances for patients as far as missed work and travel costs that must likewise be comprehended in the overall economical burden. In an investigation of patients with testicular disease, Campbell et al. Finally such a solution could effectively improve the patient's adherence to the therapeutic plan. The ability to remotely follow follow-up is therefore a monetarily alluring choice as far as investment funds, also given the improved efficiencies, reduced cost and number of missed working days for the patient. Patients with a patient-held record may also take advantage of a more conscious and motivated interest over their own wellbeing, illness and treatment, with a direct impact on patient's adherence to the therapeutic plan

What can polysemy tell us about theories of explanation?

Philosophical accounts of scientific explanation are broadly divided into ontic and epistemic views. This paper explores the idea that the lexical ambiguity of the verb to explain and its nominalisation supports an ontic conception of explanation. I analyse one argument which challenges this strategy by criticising the claim that explanatory talk is lexically ambiguous, 375–394, 2012). I propose that the linguistic mechanism of transfer of meaning, 109–132, 1995) provides a better account of the lexical alternations that figure in the systematic polysemy of explanatory talk, and evaluate the implications of this proposal for the debate between ontic and epistemic conceptions of scientific explanation

A Novel Radiotherapeutic Approach to Treat Bulky Metastases Even From Cutaneous Squamous Cell Carcinoma: Its Rationale and a Look at the Reliability of the Linear-Quadratic Model to Explain Its Radiobiological Effects

Introduction: Metastatic cutaneous squamous cell carcinoma (cSCC) is a very rare condition. The lack of definition of an oligometastatic subgroup means that there is no consensus for its treatment, unlike the mucosal head and neck counterpart. Like the latter, the cutaneous form is able to develop bulky tumor masses. When this happens, the classic care approach is just for palliative intent due to a likely unfavorable benefit–risk balance typical of aggressive treatments. Here we proposed a novel radiotherapy (RT) technique to treat bulky metastases from cSCC in the context of an overall limited tumor burden and tried to explain its clinical outcome by the currently available mathematical radiobiological and ad hoc developed models. Methods: We treated a case of facial cSCC with three metastases: two of them by classic stereotactic RT and the other by lattice RT supported by metabolic imaging (18F-FDG PET) due to its excessively large dimensions. For the latter lesion, we compared four treatment plans with different RT techniques in order to define the best approach in terms of normal tissue complication probability (NTCP) and tumor control probability (TCP). Moreover, we developed an ad hoc mathematical radiobiological model that could fit better with the characteristics of heterogeneity of this bulky metastasis for which, indeed, a segmentation of normoxic, hypoxic, and necrotic subvolumes might have been assumed. Results: We observed a clinical complete response in all three disease sites; the bulky metastasis actually regressed more rapidly than the other two treated by stereotactic RT. For the large lesion, NTCP predictions were good for all four different plans but even significantly better for the lattice RT plan. Neither the classic TCP nor the ad hoc developed radiobiological models could be totally adequate to explain the reported outcome. This finding might support a key role of the host immune system. Conclusions: PET-guided lattice RT might be safe and effective for the treatment of bulky lesions from cSCC. There might be some need for complex mathematical radiobiological models that are able to take into account any immune system’s role in order to explain the possible mechanisms of the tumor response to radiation and the relevant key points to enhance it

Mechanisms, Then and Now: From Metaphysics to Practice

For many old and new mechanists, Mechanism is both a metaphysical position and a thesis about scientific methodology. In this paper we discuss the relation between the metaphysics of mechanisms and the role of mechanical explanation in the practice of science, by presenting and comparing the key tenets of Old and New Mechanism. First, by focusing on the case of gravity, we show how the metaphysics of Old Mechanism constrained scientific explanation, and discuss Newton’s critique of Old Mechanism. Second, we examine the current mechanistic metaphysics, arguing that it is not warranted by the use of the concept of mechanism in scientific practice, and motivate a thin conception of mechanism (the truly minimal view), according to which mechanisms are causal pathways for a certain effect or phenomenon. Finally, we draw analogies between Newton’s critique of Old Mechanism and our thesis that the metaphysical commitments of New Mechanism are not necessary in order to illuminate scientific practice

In defence of activities

In this paper, we examine what is to be said in defence of Machamer, Darden and Craver’s (MDC) controversial dualism about activities and entities (Machamer, Darden and Craver’s in Philos Sci 67:1–25, 2000). We explain why we believe the notion of an activity to be a novel, valuable one, and set about clearing away some initial objections that can lead to its being brushed aside unexamined. We argue that substantive debate about ontology can only be effective when desiderata for an ontology are explicitly articulated. We distinguish three such desiderata. The first is a more permissive descriptive ontology of science, the second a more reductive ontology prioritising understanding, and the third a more reductive ontology prioritising minimalism. We compare MDC’s entities-activities ontology to its closest rival, the entities-capacities ontology, and argue that the entities-activities ontology does better on all three desiderata

Mechanisms and Difference-Making

I argue that difference-making should be a crucial element for evaluating the quality of evidence for mechanisms, especially with respect to the robustness of mechanisms, and that it should take central stage when it comes to the general role played by mechanisms in establishing causal claims in medicine. The difference- making of mechanisms should provide additional compelling reasons to accept the gist of Russo-Williamson thesis and include mechanisms in the protocols for Evidence- Based Medicine (EBM), as the EBM+ research group has been advocatin

Time to care: why the humanities and the social sciences belong in the science of health

Health is more than the absence of disease. It is also more than a biological phenomenon. It is inherently social, psychological, cultural, and historical. Social and personal resources are both key components and key determinants of health, as it has been recognised by major health actors for decades [1–3]. However, open questions remain as to how to build systems that reflect the complexity of health, healthy lives, disease, and sickness, and in a context that is increasingly technologized. Although we find in the literature an increasing understanding of the complexity of health [4–7], the implementation of this knowledge lags behind. Biological approaches to health and disease, as a matter of fact, dominate the development of curative and preventive interventions. We argue that an urgent change of approach is necessary. Methods and concepts from the humanities and social science must be embedded in the concepts and methods of the health sciences and of public health, if we are to promote sustainable interventions capable of engaging with the recognized complexity of health, healthy lives, disease, and sickness. This resonates with the vision expressed by UK Health Secretary and by many policy documents [8,9] from the last decades. Yet, given the difficulties associated with interdisciplinary research, integrated strategies to understand and to intervene on the complexity of health and that engage with biological, social, psychological and behavioural factors are still needed. Our vision is one of radical interdisciplinarity, integrating aspects of biological, psychological, social, and humanities approaches across areas of urgent health need. These areas include, but is not confined to, chronic conditions such as the obesity epidemic, cancer, mental health. Radical interdisciplinarity entails the practical, methodological, and conceptual integration of approaches to health, as they are developed in the health and social sciences, and in the humanities. It is the combination of cognitive resources from individuals belonging to different disciplines, who accept and respect the division of labour and the resulting epistemic dependence to tackle phenomena that would not be adequately conceptualised within any of the involved discipline alone [10]. In what follows, we describe our current understanding of these three aspects, and describe how radical interdisciplinarity would change them.Not funde