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Objectives: There have been multiple calls for explicit integration of ethical, legal, and social issues (ELSI) in health technology assessment (HTA) and addressing ELSI has been highlighted as key in optimizing benefits in the Omics/Personalized Medicine field. This study examines HTAs of an early clinical example of Personalized Medicine (gene expression profile tests [GEP] for breast cancer prognosis) aiming to: (i) identify ELSI; (ii) assess whether ELSIs are implicitly or explicitly addressed; and (iii) report methodology used for ELSI integration.
Methods: A systematic search for HTAs (January 2004 to September 2012), followed by descriptive and qualitative content analysis.
Results: Seventeen HTAs for GEP were retrieved. Only three (18%) explicitly presented ELSI, and only one reported methodology. However, all of the HTAs included implicit ELSI. Eight themes of implicit and explicit ELSI were identified. “Classical” ELSI including privacy, informed consent, and concerns about limited patient/clinician genetic literacy were always presented explicitly. Some ELSI, including the need to understand how individual patients’ risk tolerances affect clinical decision-making after reception of GEP results, were presented both explicitly and implicitly in HTAs. Others, such as concern about evidentiary deficiencies for clinical utility of GEP tests, occurred only implicitly.
Conclusions: Despite a wide variety of important ELSI raised, these were rarely explicitly addressed in HTAs. Explicit treatment would increase their accessibility to decision-makers, and may augment HTA efficiency maximizing their utility. This is particularly important where complex Personalized Medicine applications are rapidly expanding choices for patients, clinicians and healthcare systems.
Between 1897 and 1902, there took place a brief correspondence between Frege and Hilbert, consisting of four letters from Frege, and two letters and three postcards from Hilbert. It centres on Frege's reactions to Hilbert's classic Grundlagen der Geometrie, first published in 1899, and Hilbert's restatements in his letters to Frege of the foundational positions which that work, sometimes only implicitly, embodies. Despite the obvious richness of common purpose between Frege and Hilbert, the correspondence is especially instructive because of the strong disagreements expressed. For example, the two disagreed on the form and function of definitions, the nature, purpose and formulation of axioms, the nature of (axiomatized) mathematical theories, the method of independence proofs in geometry, the role and form of consistency proofs and the nature of mathematical existence. Many of the articles of disagreement, especially those on axioms and independence proofs, also reveal or underline significant differences in their respective conceptions of logic. Frege followed the correspondence with two polemical, and wider-ranging, articles on similar or related themes, Hilbert himself having apparently declined Frege's suggestion that their exchange of views be published. These two papers help to fill out the picture on Frege’s side, first by restating Frege’s opposition, and then by presenting his insights into the formal structure of Hilbert’s position. Especially important are Frege’s attempts in his second article to render central results of Hilbert’s project as read through his own system.
It is uncontroversial to say that the period in question saw more important changes in the philosophy of mathematics than any previous period of similar length in the history of philosophy. Above all, it is in this period that the study of the foundations of mathematics became partly a mathematical investigation itself. So rich a period is it, that this survey article is only the merest sketch; inevitably, some subjects and figures will be inadequately treated (the most notable omission being discussion of Peano and the Italian schools of geometry and logic). Of prime importance in understanding the period are the changes in mathematics itself that the nineteenth century brought, for much foundational work is a reaction to these, resulting either in an expansion of the philosophical horizon to incorporate and systematise these changes, or in articulated opposition. What, in broad outline, were the changes?
First, traditional subjects were treated in entirely new ways. This applies to arithmetic, the theory of real and complex numbers and functions, algebra, and geometry. (a) Some central concepts were characterised differently, or properly characterised for the first time, for example, from analysis, those of continuity (Weierstrass, Cantor, Dedekind) and integrability (Jordan, Lebesgue, Young), from geometry, that of congruence (Pasch, Hilbert), and geometry itself was recast as a purely synthetic theory (von Staudt, Pasch, Hilbert). (b) Theories were treated in entirely new ways, for example, as axiomatic systems (Pasch, Peano and the Italian School, Hilbert), as structures (Dedekind, Hilbert), or with entirely different primitives (Riemann, Cantor, Frege, Russell).
Robert G. Anthony, US Geological Survey, Oregon Cooperative Fish and Wildlife Research Unit, Oregon State University, 104 Nash Hall, Corvallis, Oregon 97331-3803, USA,
Margaret A. O'Connell, Eastern Washington University, Biology Department and Turnbull Laboratory for Ecological Studies, 258 Science, Cheney, Washington 99004-2440, USA,
Michael M. Pollock, National Oceanic and Atmospheric Administration, Northwest Fisheries Research Center, 2725 Montlake Blvd, Seattle, Washington 98112, USA,
James G. Hallett, School of Biological Sciences, Washington State University, PO Box 644236, Pullman, Washington 99164-4236, USA
The aquatic and terrestrial components of riparian systems provide ecological opportunities for many species of mammals. The importance of riparian habitat to wildlife populations has been documented in a wide range of habitats in North America: the midwestern United States (Stauffer and Best 1980), desert southwest (England et al. 1984), Rocky Mountains (Knopf 1985), Oregon (Anthony et al. 1987, Doyle 1990, McComb et al. 1993, Gomez and Anthony 1998, Kauffman et al. 2001), Washington (O'Connell et al. 1993, Kelsey and West 1998, Kauffman et al. 2001), and the Okanogan Highlands of British Columbia (Gyug 2000). These studies indicate that wildlife species richness is high in these ecosystems, and use of riparian zones by some species is disproportionately higher than in other areas. Although this is especially true in the more arid regions of North America (Johnson and Jones 1977, Brinson et al. 1981), this pattern can also be found in mesic forests of the Pacific Northwest. For example, Thomas et al. (1979) report that 285 of the 378 terrestrial wildlife species in the Blue Mountains of Oregon and Washington are found exclusively or more commonly in riparian areas, and Oakley et al. (1985) report similar patterns of 359 of the 414 wildlife species using riparian zones of western Washington and Oregon forests. Kauffman et al. (2001) estimate that 53% of the 593 wildlife species that occur in Washington and Oregon use riparian zones, whereas riparian zones and wetlands constitute only 1% to 2% of the landscape.
This paper treats some of the issues raised by Putnam's discussion of, and claims for, quantum logic, specifically: that its proposal is a response to experimental difficulties; that it is a reasonable replacement for classical logic because its connectives retain their classical meanings, and because it can be derived as a logic of tests. We argue that the first claim is wrong (1), and that while conjunction and disjunction can be considered to retain their classical meanings, negation crucially does not. The argument is conducted via a thorough analysis of how the meet, join and complementation operations are defined in the relevant logical structures, respectively Boolean- and ortholattices (3). Since Putnam wishes to reinstate a realist interpretation of quantum mechanics, we ask how quantum logic can be a logic of realism. We show that it certainly cannot be a logic of bivalence realism (i.e., of truth and falsity), although it is consistent with some form of ontological realism (4). Finally, we show that while a reasonable explication of the idealized notion of test yields interesting mathematical structure, it by no means yields the rich ortholattice structure which Putnam (following Finkelstein) seeks.
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