The notorious man-in-the-street: Hermann Weyl and the problem of knowledge.

Hermann Weyl's philosophical reflections remain a topic of considerable interest in the history and philosophy of science. In particular, Weyl's commitment to a form of idealism, as it pertains to his reading of Husserl and Fichte, has garnered much discussion. However, much less attention has been given to Weyl's later, and at that only partial, turn towards a form of empiricism (i.e. from the late 1920s onward). This lack of focus on Weyl's later philosophy has tended to obscure some of the most significant lessons that Weyl sought to draw from his decades of research in the foundations of mathematics and physics. In this paper, I develop some aspects of what I will term as Weyl's 'modest' empiricism. I will argue that Weyl's turn toward empiricism can be read in the context of a development of Helmholtz's epistemological program and his unique form of 'Kantianism'. The hope is that this reading will not only provide a better understanding of Weyl's later thought, especially his (1954) criticism of Cassirer, but that it may also provide the basis for a novel 'Weylian' account of the mathematization of nature underwriting the group-theoretic methodology of parts of modern physics.

What counts as relevant criticism? Longino's critical contextual empiricism and the feminist criticism of mainstream economics.

I identify and resolve an internal tension in Critical Contextual Empiricism (CCE) - the normative account of science developed by Helen Longino. CCE includes two seemingly conflicting principles: on one hand, the cognitive goals of epistemic communities should be open to critical discussion (the openness of goals to criticism principle, OGC); on the other hand, criticism must be aligned with the cognitive goals of that community to count as "relevant" and thus require a response (the goal-relativity of response-requiring criticism principle, GRC). The co-existence of OGC and GRC enables one to draw both approving and condemning judgments about a situation in which an epistemic community ignores criticism against its goals. This tension results from conflating two contexts of argumentation that require different regulative standards. In the first-level scientific discussion, GRC is a reasonable principle but OGC is not; in the meta-level discussion about science, the reverse holds. In meta-level discussion, the relevance of criticism can be established by appealing to goals of science that are more general than the goals of a specific epistemic community. To illustrate my revision of CCE, I discuss why feminist economists' criticism of the narrowness of the goals pursued in mainstream economics is relevant criticism.

The intersection between logical empiricism and qualitative nursing research: a post-structuralist analysis.

PURPOSE: To shed light on and analyse the intersection between logical empiricism and qualitative nursing research, and to emphasize a post-structuralist critique to traditional methodological constraints. METHODS: In this study, a critical examination is conducted through a post-structuralist lens, evaluating entrenched methodologies within nursing research. This approach facilitates a nuanced exploration of the intersection between logical empiricism and qualitative nursing research, challenging traditional methodological paradigms. RESULTS: The article focusing on the "what abouts" of sample size, analytic framework, data source, data analysis, and rigour and methodological considerations, challenging the predominance of semi-structured interviews and the reliance on spoken voice as primary data sources, and re-evaluating the conventional notion of "rigour". CONCLUSIONS: I advocate for a shift from qualitative positivism towards more interpretive and post-qualitative inquiries, this work proposes new trajectories through interpretive, critical, post-qualitative, and artistic turns in nursing research, aiming to transcend positivist limitations and foster a plurality of perspectives and research as praxis. Implications emphasize the need for nursing researchers to expand methodological horizons, incorporating visual and artistic methods to enrich understanding and representation of health experiences, moving beyond positivist norms towards a more inclusive and ethically sound research paradigm.

Neither neural networks nor the language-of-thought alone make a complete game.

Cognitive science has evolved since early disputes between radical empiricism and radical nativism. The authors are reacting to the revival of radical empiricism spurred by recent successes in deep neural network (NN) models. We agree that language-like mental representations (language-of-thoughts [LoTs]) are part of the best game in town, but they cannot be understood independent of the other players.

Making sense of domain specificity.

The notion of domain specificity plays a central role in some of the most important debates in cognitive science. Yet, despite the widespread reliance on domain specificity in recent theorizing in cognitive science, this notion remains elusive. Critics have claimed that the notion of domain specificity can't bear the theoretical weight that has been put on it and that it should be abandoned. Even its most steadfast proponents have highlighted puzzles and tensions that arise once one tries to go beyond an initial intuitive sketch of what domain specificity involves. In this paper, we address these concerns head on by developing an account of what it means for a cognitive mechanism to be domain specific that overcomes the obstacles that have made domain specificity seem so problematic. We then apply this understanding of domain specificity to one of the key debates that it has figured prominently in-the rationalism-empiricism debate concerning the origins of cognitive traits-and introduce several related theoretical notions that work alongside domain specificity in helping to clarify what makes a view more (or less) rationalist. This example illustrates how the notion of domain specificity can, and should, continue to play a central role in ongoing debates in cognitive science.

Prophecy or empiricism? Clinical value of predicting versus determining genetic variant functions.

The recent explosion of epilepsy genetic testing has created challenges for interpretation of gene variants. Assessments of the functional consequences of genetic variants either by predictive or experimental strategies can contribute to estimating pathogenicity, but there is no consensus on which approach is best. The Special Interest Group on Epilepsy Genetics hosted a session during the Annual American Epilepsy Society Meeting in December 2022 to discuss this topic. The session featured a debate of the relative advantages and limitations of predicting (prophecy) versus experimentally determining (empiricism) variant function using ion channel gene variants as examples. This commentary summarizes these discussions.

Zone 1 Endovascular Balloon Occlusion of the Aorta vs Resuscitative Thoracotomy for Patient Resuscitation After Severe Hemorrhagic Shock.

Importance: Aortic occlusion (AO) is a lifesaving therapy for the treatment of severe traumatic hemorrhagic shock; however, there remains controversy whether AO should be accomplished via resuscitative thoracotomy (RT) or via endovascular balloon occlusion of the aorta (REBOA) in zone 1. Objective: To compare outcomes of AO via RT vs REBOA zone 1. Design, Setting, and Participants: This was a comparative effectiveness research study using a multicenter registry of postinjury AO from October 2013 to September 2021. AO via REBOA zone 1 (above celiac artery) was compared with RT performed in the emergency department of facilities experienced in both procedures and documented in the prospective multicenter Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry. Propensity score matching (PSM) with exact institution matching was used, in addition to subgroup multivariate analysis to control for confounders. The study setting included the ED, where AO via RT or REBOA was performed, and participants were adult trauma patients 16 years or older. Exposures: AO via REBOA zone 1 vs RT. Main Outcomes and Measures: The primary outcome was survival. Secondary outcomes were ventilation-free days (VFDs), intensive care unit (ICU)-free days, discharge Glasgow Coma Scale score, and Glasgow Outcome Score (GOS). Results: A total of 991 patients (median [IQR] age, 32 [25-48] years; 808 male individuals [81.9%]) with a median (IQR) Injury Severity Score of 29 (18-50) were included. Of the total participants, 306 (30.9%) had AO via REBOA zone 1, and 685 (69.1%) had AO via RT. PSM selected 112 comparable patients (56 pairs). REBOA zone 1 was associated with a statistically significant lower mortality compared with RT (78.6% [44] vs 92.9% [52]; P = .03). There were no significant differences in VFD greater than 0 (REBOA, 18.5% [10] vs RT, 7.1% [4]; P = .07), ICU-free days greater than 0 (REBOA, 18.2% [10] vs RT, 7.1% [4]; P = .08), or discharge GOS of 5 or more (REBOA, 7.5% [4] vs RT, 3.6% [2]; P = .38). Multivariate analysis confirmed the survival benefit of REBOA zone 1 after adjustment for significant confounders (relative risk [RR], 1.25; 95% CI, 1.15-1.36). In all subgroup analyses (cardiopulmonary resuscitation on arrival, traumatic brain injury, chest injury, pelvic injury, blunt/penetrating mechanism, systolic blood pressure ≤60 mm Hg on AO initiation), REBOA zone 1 offered an either similar or superior survival. Conclusions and Relevance: Results of this comparative effectiveness research suggest that REBOA zone 1 provided better or similar survival than RT for patients requiring AO postinjury. These findings provide the ethically necessary equipoise between these therapeutic approaches to allow the planning of a randomized controlled trial to establish the safety and effectiveness of REBOA zone 1 for AO in trauma resuscitation.

Criteria Restricting Inappropriate Meropenem Empiricism (CRIME): a quasi-experimental carbapenem restriction pilot at a large academic medical centre.

The broad-spectrum activity of carbapenems makes them appealing for empirical use; however, they are associated with development of Clostridioides difficile infection (CDI) and multidrug resistance. Selective carbapenem use is vital in maintaining their effectiveness. We examined the impact of meropenem restriction criteria on utilisation and patient outcomes. This quasi-experimental study was conducted at a single academic medical centre after medication use evaluation found frequent inappropriate meropenem utilisation. Antimicrobial stewardship-led restriction criteria were developed and implemented in February 2022. Investigators aimed to determine how restriction criteria affected meropenem utilisation across 8 weeks in the pre- (February-April 2020) versus post-implementation period (February-April 2022). The primary outcome was inappropriateness of meropenem utilisation. Secondary outcomes included days of therapy per 1000 patient-days (DOT/1000 PD), hospital length of stay (LOS), CDI Standardized Infection Ratio (SIR), and acquisition cost. Across the 8-week timeframes, reductions in inappropriate meropenem use (64.5% vs. 12.8%; P < 0.001), duration of therapy [5.8 (3.2-7.3) vs. 2.4 (1.0-5.5) days; P < 0.001] and utilisation (30.5 vs. 8.3 DOT/1000 PD; P < 0.001) pre- versus post-implementation were observed. Total meropenem orders decreased by 65% (P < 0.001). Median hospital LOS also decreased between periods [11.9 (7.8-20.4) vs. 9.2 (5.4-15.2) days], although not statistically significant (P = 0.051). There was no difference in CDI SIR (0.1 vs. 0.1; P = 0.99). Projected annual cost savings were ∼US$57 300. Implementation of antimicrobial stewardship-initiated restriction criteria can reduce inappropriate meropenem utilisation, overall number of orders, and total duration of therapy.

Alerting Clinicians to 1-Year Mortality Risk in Patients Hospitalized With Heart Failure: The REVEAL-HF Randomized Clinical Trial.

Importance: Heart failure is a major cause of morbidity and mortality worldwide. The use of risk scores has the potential to improve targeted use of interventions by clinicians that improve patient outcomes, but this hypothesis has not been tested in a randomized trial. Objective: To evaluate whether prognostic information in heart failure translates into improved decisions about initiation and intensity of treatment, more appropriate end-of-life care, and a subsequent reduction in rates of hospitalization or death. Design, Setting, and Participants: This was a pragmatic, multicenter, electronic health record-based, randomized clinical trial across the Yale New Haven Health System, comprising small community hospitals and large tertiary care centers. Patients hospitalized for heart failure who had N-terminal pro-brain natriuretic peptide (NT-proBNP) levels of greater than 500 pg/mL and received intravenous diuretics within 24 hours of admission were automatically randomly assigned to the alert (intervention) or usual-care groups. Interventions: The alert group had their risk of 1-year mortality calculated using an algorithm that was derived and validated using similar historic patients in the electronic health record. This estimate, including a categorical risk assessment, was presented to clinicians while they were interacting with a patient's electronic health record. Main Outcomes and Measures: The primary outcome was a composite of 30-day hospital readmissions and all-cause mortality at 1 year. Results: Between November 27, 2019, through March 7, 2021, 3124 patients were randomly assigned to the alert (1590 [50.9%]) or usual-care (1534 [49.1%]) group. The alert group had a median (IQR) age of 76.5 (65-86) years, and 796 were female patients (50.1%). Patients from the following race and ethnicity groups were included: 13 Asian (0.8%), 324 Black (20.4%), 136 Hispanic (8.6%), 1448 non-Hispanic (91.1%), 1126 White (70.8%), 6 other ethnicity (0.4%), and 127 other race (8.0%). The usual-care group had a median (IQR) age of 77 (65-86) years, and 788 were female patients (51.4%). Patients from the following race and ethnicity groups were included: 11 Asian (1.4%), 298 Black (19.4%), 162 Hispanic (10.6%), 1359 non-Hispanic (88.6%), 1077 White (70.2%), 13 other ethnicity (0.9%), and 137 other race (8.9%). Median (IQR) NT-proBNP levels were 3826 (1692-8241) pg/mL in the alert group and 3867 (1663-8917) pg/mL in the usual-care group. A total of 284 patients (17.9%) and 270 patients (17.6%) were admitted to the intensive care unit in the alert and usual-care groups, respectively. A total of 367 patients (23.1%) and 359 patients (23.4%) had a left ventricular ejection fraction of 40% or less in the alert and usual-care groups, respectively. The model achieved an area under the curve of 0.74 in the trial population. The primary outcome occurred in 619 patients (38.9%) in the alert group and 603 patients (39.3%) in the usual-care group (P = .89). There were no significant differences between study groups in the prescription of heart failure medications at discharge, the placement of an implantable cardioverter-defibrillator, or referral to palliative care. Conclusions and Relevance: Provision of 1-year mortality estimates during heart failure hospitalization did not affect hospitalization or mortality, nor did it affect clinical decision-making. Trial Registration: ClinicalTrials.gov Identifier NCT03845660.

Holography, application, and string theory's changing nature.

Based on string theory's framework, the gauge/gravity duality, also known as holography, has the ability to solve practical problems in low energy physical systems like metals and fluids. Holographic applications open a path for conversation and collaboration between the theory-driven, high energy culture of string theory and fields like nuclear and condensed matter physics, which in contrast place great emphasis on the empirical evidence that experiment provides. This paper takes a look at holography's history, from its roots in string theory to its present-day applications that are challenging the cultural identity of the field. I will focus on two of these applications: holographic QCD and holographic superconductivity, highlighting some of the (often incompatible) historical influences, motives, and epistemic values at play, as well as the subcultural shifts that help the collaborations work. The extent to which holographic research - arguably string theory's most successful and prolific area - must change its subcultural identity in order to function in fields outside of string theory reflects its changing nature and the uncertain future of the field. Does string theory lose its identity in the low-energy applications that holography provides? Does holography still belong under string theory's umbrella, or is it destined to form new subcultures with each of its fields of application? I find that the answers to these questions are dynamic, interconnected, and highly dependent on string theory's relationship with its field of application. In some cases, holography can maintain the goals and values it inherited from string theory. In others, it instead adopts the goals and values of the field in which it is applied. These examples highlight a growing need for the STS community to expand its treatment of string theory regarding its relationship with empiricism and role as a theory of quantum gravity.1.

Kant's pragmatic use of reason from a sociological point of view: Third way or methodological impasse?

The paper focuses on the relevance of Kant's anthropologically oriented idea of the pragmatic use of reason for specific theoretical approaches in sociology. As I show in the first part, Kant's explicit presence in 20th-century sociology does not refer much to his anthropology and specifically to its cornerstone - the pragmatic use of reason which establishes a subtle connection between the theoretical and practical functions of reason. As an instrument for gaining systematic knowledge about the social world and ourselves as beings both passively and actively involved in this process, Kant's pragmatic use of reason serves a specific form of the theoretical use of reason. At the same time, it embodies a kind of practical reasoning concerning the "general welfare" in the social sphere. Building on the key arguments in the first part, I then address the question of whether we can view Kant's pragmatic approach as a possible third way for sociology today, beyond the simplifying opposition of 'theoretical' normativity and 'realistic' empiricism, and whether this third way can help us in clearing specific sociological issues. Here, I focus on two examples, namely the use of Kant's notion of "unsocial sociability" in Ralf Dahrendorf's conflict theory and on the criticism of Kant's cosmopolitanism in Ulrich Beck's reformed sociology of cosmopolitanism.

[Therapeutic injections and manual medicine in low-back pain : Bimodal synergies between evidence and empiricism]. / Therapeutische Injektion und Manuelle Medizin beim tiefen Rückenschmerz : Bimodale Synergien zwischen Evidenz und Empirie.

BACKGROUND: Oriented towards the therapy planning and management of rheumatic patients, and based on the differentiated therapeutic principles of manual medicine (MM) with knowledge on evidence of therapeutic local infiltration techniques (TLI), the author pleads for the establishment of a structured, mechanism-based therapy concept in the sense of "treat to target" (T2T) for patients with (chronic) degenerative low-back pain (LBP) in outpatient pain therapy care. DIAGNOSTICS: This requires a consistent (primary) diagnosis with pain analysis under the premise that LBP is always specific if it is structurally and functionally conditioned. A broad bio-psycho-social anamnesis and structure-based clinical diagnosis (imaging) with functional differentiation according to MM principles and, if necessary, interventional blocks, should result in the expression of a three-level diagnosis as a prerequisite for a mechanism-based, hierarchic step therapy in LBP. In this article, this is presented in a pragmatic, case-oriented manner, with the implementation of techniques and evidence of TLI and MM.

TTP: From empiricism for an enigmatic disease to targeted molecular therapies.

The 100th anniversary of the first description of Thrombotic Thrombocytopenic Purpura (TTP) as a disease by Dr. Eli Moschcowitz approaches. For many decades, TTP remained mostly a mysterious fatal condition, where diagnosis was often post-mortem. Initially a pentad of symptoms was identified, a pattern that later revealed to be fallible. Sporadic observations led to empiric interventions that allowed for the first impactful breakthrough in TTP treatment, almost 70 years after its first description: the introduction of plasma exchange and infusions as treatments. The main body of knowledge within the field was gathered in the latest three decades: patient registries were set and proved crucial for advancements; the general mechanisms of disease have been described; the diagnosis was refined; new treatments and biomarkers with improvements on prognosis and management were introduced. Further changes and improvements are expected in the upcoming decades. In this review, we provide a brief historic overview of TTP, as an illustrative example of the success of translational medicine enabling to rapidly shift from a management largely based on empiricism to targeted therapies and personalized medicine, for the benefit of patients. Current management options and present and future perspectives in this still evolving field are summarized.

Scientific realism and empirical confirmation: A puzzle.

Scientific realism driven by inference to the best explanation (IBE) takes empirically confirmed objects to exist, independent, pace empiricism, of whether those objects are observable or not. This kind of realism, it has been claimed, does not need probabilistic reasoning to justify the claim that these objects exist. But I show that there are scientific contexts in which a non-probabilistic IBE-driven realism leads to a puzzle. Since IBE can be applied in scientific contexts in which empirical confirmation has not yet been reached, realists will in these contexts be committed to the existence of empirically unconfirmed objects. As a consequence of such commitments, because they lack probabilistic features, the possible empirical confirmation of those objects is epistemically redundant with respect to realism.