Nietzsche’s Epistemic Perspectivism

Nietzsche offers a positive epistemology, and those who interpret him as a skeptic or a mere pragmatist are mistaken. Instead he supports what he calls per- spectivism. This is a familiar take on Nietzsche, as perspectivism has been analyzed by many previous interpreters. The present paper presents a sketch of the textually best supported and logically most consistent treatment of perspectivism as a first- order epistemic theory. What’s original in the present paper is an argument that Nietzsche also offers a second-order methodological perspectivism aimed at enhancing understanding, an epistemic state distinct from knowledge. Just as Descartes considers and rejects radical skepticism while at the same time adopting methodological skepticism, one could consistently reject perspectivism as a theory of knowledge while accepting it as contributing to our understanding. It is argued that Nietzsche’s perspectivism is in fact two-tiered: knowledge is perspectival because truth itself is, and in addition there is a methodological perspectivism in which distinct ways of knowing are utilized to produce understanding. A review of the manner in which understanding is conceptualized in contemporary epistemology and philosophy of science serves to illuminate how Nietzsche was tackling these ideas

Evidence-based care of older people with suspected cognitive impairment in general practice: protocol for the IRIS cluster randomised trial

Background: Dementia is a common and complex condition. Evidence-based guidelines for the management of people with dementia in general practice exist; however, detection, diagnosis and disclosure of dementia have been identified as potential evidence-practice gaps. Interventions to implement guidelines into practice have had varying success. The use of theory in designing implementation interventions has been limited, but is advocated because of its potential to yield more effective interventions and aid understanding of factors modifying the magnitude of intervention effects across trials. This protocol describes methods of a randomised trial that tests a theory-informed implementation intervention that, if effective, may provide benefits for patients with dementia and their carers. Aims: This trial aims to estimate the effectiveness of a theory-informed intervention to increase GPs’ (in Victoria, Australia) adherence to a clinical guideline for the detection, diagnosis, and management of dementia in general practice, compared with providing GPs with a printed copy of the guideline. Primary objectives include testing if the intervention is effective in increasing the percentage of patients with suspected cognitive impairment who receive care consistent with two key guideline recommendations: receipt of a i) formal cognitive assessment, and ii) depression assessment using a validated scale (primary outcomes for the trial). Methods: The design is a parallel cluster randomised trial, with clusters being general practices. We aim to recruit 60 practices per group. Practices will be randomised to the intervention and control groups using restricted randomisation. Patients meeting the inclusion criteria, and GPs’ detection and diagnosis behaviours directed toward these patients, will be identified and measured via an electronic search of the medical records nine months after the start of the intervention. Practitioners in the control group will receive a printed copy of the guideline. In addition to receipt of the printed guideline, practitioners in the intervention group will be invited to participate in an interactive, opinion leader-led, educational face-to-face workshop. The theory-informed intervention aims to address identified barriers to and enablers of implementation of recommendations. Researchers responsible for identifying the cohort of patients with suspected cognitive impairment, and their detection and diagnosis outcomes, will be blind to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12611001032943 (date registered 28 September, 2011)

Differential effect of marrow adiposity and visceral and subcutaneous fat on cardiovascular risk in young, healthy adults.

BackgroundAdipose tissue is an endocrine organ that influences many metabolic processes and accumulates in different depots, including the bone marrow. While the negative associations between visceral fat (VF) or subcutaneous fat (SF) and cardiovascular disease (CVD) risks are well known, the relation between marrow fat (MF) and metabolic risk is unexplored.ObjectivesWe examined the relations between these three fat depots and whether CVD risks are associated with marrow adiposity.DesignObservational cross-sectional study.Subjects and methodsComputed tomography was used to measure VF, SF and MF depots in 131 healthy young adults (60 females, 71 males; 16-25 years of age). Weight, body mass index (BMI), waist and hip circumferences, blood pressure (BP), carotid intima-media thickness (CIMT) and serum levels of lipids, glucose and insulin were also measured.ResultsRegardless of gender, MF was not associated with values of VF or SF, anthropometric measures, or lipid or carbohydrate serum levels (P>0.05 for all). In contrast, VF was associated with SF (r values=0.74 for females, 0.78 for males; both P-values <0.0001) and these depots were related to anthropometric parameters (r values between 0.69 and 0.87; all P-values <0.0001) and to most measures of lipids, glucose or insulin (r values between 0.25 and 0.62).ConclusionsMarrow adiposity in young men and women is independent of VF and SF, and is not associated with CVD risk. These findings do not support the concept that marrow adiposity is involved in the comorbidities related to fat accumulation in other compartments

An addiction model-based mobile health weight loss intervention in adolescents with obesity.

Background: Clinical approaches to treating childhood obesity can be expensive and poorly reimbursed, and often produce suboptimal results. It has been theorized that overeating may have addictive qualities, and a sizable number of adolescents with obesity endorse addictive habits. Interestingly, few weight management interventions have tested techniques founded in addiction medicine principles. We therefore performed a pilot study of an addiction model based mHealth weight loss intervention in adolescents.Methods: Adolescents with obesity were recruited from an multidisciplinary weight management clinic (EMPOWER). Adolescents without significant obesity comorbidities, who exhibited signs of addictive eating, based on the Yale Food Addiction Scale, were enrolled in a pilot study of an interactive, addiction-based, weight loss smartphone app with coaching (http://clinicaltrials.gov: NCT02689154). The app was designed to help subjects omit problem foods, avoid snacking and reduce meal size. A contemporary cohort of adolescents who completed the EMPOWER program were evaluated. Feasibility of recruitment, adherence, retention rates, BMI change and cost of intervention were examined.Results: Eighteen participants were recruited to app intervention. App participants had higher retention (100% vs. 37%) and lower total cost per patient ($855.15 vs.$1428.00) than the EMPOWER clinic participants. App participants exhibited a significant decrease in zBMI and %BMIp95 over the 6 months (p < 0.001 and p = 0.001), which was comparable to the age-matched EMPOWER program completers (p = 0.31 and p = 0.06).Conclusions: An addiction medicine-based mHealth intervention targeted for adolescents was feasible to implement, resulted in high retention and adherence rates, and reduced zBMI and %BMIp95 in a more cost-effective manner than an in-clinic intervention

An addiction model-based mobile health weight loss intervention in adolescents with obesity.

BackgroundClinical approaches to treating childhood obesity can be expensive and poorly reimbursed, and often produce suboptimal results. It has been theorized that overeating may have addictive qualities, and a sizable number of adolescents with obesity endorse addictive habits. Interestingly, few weight management interventions have tested techniques founded in addiction medicine principles. We therefore performed a pilot study of an addiction model based mHealth weight loss intervention in adolescents.MethodsAdolescents with obesity were recruited from an multidisciplinary weight management clinic (EMPOWER). Adolescents without significant obesity comorbidities, who exhibited signs of addictive eating, based on the Yale Food Addiction Scale, were enrolled in a pilot study of an interactive, addiction-based, weight loss smartphone app with coaching (http://clinicaltrials.gov: NCT02689154). The app was designed to help subjects omit problem foods, avoid snacking and reduce meal size. A contemporary cohort of adolescents who completed the EMPOWER program were evaluated. Feasibility of recruitment, adherence, retention rates, BMI change and cost of intervention were examined.ResultsEighteen participants were recruited to app intervention. App participants had higher retention (100% vs. 37%) and lower total cost per patient ($855.15 vs.$1428.00) than the EMPOWER clinic participants. App participants exhibited a significant decrease in zBMI and %BMIp95 over the 6 months (p < 0.001 and p = 0.001), which was comparable to the age-matched EMPOWER program completers (p = 0.31 and p = 0.06).ConclusionsAn addiction medicine-based mHealth intervention targeted for adolescents was feasible to implement, resulted in high retention and adherence rates, and reduced zBMI and %BMIp95 in a more cost-effective manner than an in-clinic intervention

Energy Management for Personalized Weight Reduction (EMPOWER) Program: Three-Year Outcome Data.

BackgroundThe current consensus guidelines for management of pediatric obesity recommend clinic-based, family-centered, multi-disciplinary interventions. It is well reported that these programs often only lead to modest improvements in BMI status. The individual factors that differentiate which patient's BMI status will improve vs. worsen remains understudied. A retrospective cohort study was conducted to evaluate the outcomes of EMPOWER clinic and identify the participant specific characteristics that predicted BMI status improvement in this population.MethodsYouth who completed at least 6 visits in EMPOWER were included. Paired t-test was utilized to evaluate the mean change in zBMI, modified BMIz and %BMIp95 from baseline to 6th visit, and multivariate mixed effect models were utilized to analyze effect of baseline characteristics on change in BMI status.Results92 participants were included in the analysis, 87% with severe obesity and 66% Hispanic. At the 6th visit, there was a significant reduction in zBMI (-0.09 SD, p <0.001) and modified BMIz (-0.0003 SD, p = 0.04) with a small reduction in %BMIp95 (-1.15 %, p = 0.20). Lower BMI status (p < 0.001) and absence of a comorbidity (p < 0.05) at baseline were predictors of BMI status improvement whereas age, gender, ethnicity, family history of obesity and insurance status were not significant predictors.ConclusionsGiven that implementation of the current guidelines for management of obesity in pediatrics only results in modest BMI status reduction, further investigation is required to understand how the determinants of obesity-related health outcomes can guide development of more innovative, effective interventions for this high risk population