Transfer and templates in scientific modelling.

The notion of template has been advocated by Paul Humphreys and others as an illuminating unit of analysis in the philosophy of scientific modelling. Templates are supposed to have the dual functions of representing target systems and of facilitating quantitative manipulation. A resulting worry is that wide-ranging cross-disciplinary use of templates might compromise their representational function and reduce them to mere formalisms. In this paper, we argue that templates are valuable units of analysis in reconstructing cross-disciplinary modelling. Central to our discussion are the ways in which Lotka-Volterra models are used to analyse processes of technology diffusion. We illuminate both the similarities and differences between contributions to this case of cross-disciplinary modelling by reconstructing them as transfer of a template, without reducing the template to a mere formalism or a computational model. This requires differentiating the interpretation of templates from that of the models based on them. This differentiation allows us to claim that the LV models of technology diffusion that we review are the result of template transfer - conformist in some contributions, creative in others.

[Epiglottitis in adults in general practice: difficult to recognise and life-threatening]. / Epiglottitis bij volwassenen in de huisartsenpraktijk: lastig te herkennen en levensbedreigend.

Epiglottitis is a rare and life-threatening cause of acute sore throat. Usually, epiglottitis is caused by a bacterium, such as Haemophilus influenzae type b. Symptoms of epiglottitis are acute and rapidly progressive sore throat, a hoarse voice, fever, and drooling. We present two adult patients with acute sore throat who were diagnosed with epiglottitis. In adults with symptoms compatible with epiglottitis, it is justified to look down the throat with a light. Only if the view is impeded should a spatula be used but carefully. If there is a discrepancy between the severity of symptoms and few or no abnormal findings on examination of the throat, epiglottitis should be considered. If epiglottitis is suspected, referral to an ENT specialist is always indicated. Symptoms of upper airway obstruction, such as drooling, dyspnoea, inspiratory stridor and fear or anxiety, are an indication for emergency referral by ambulance.

[Unexpected good news after major surgery: a lesson in communication]. / Onverwacht goed nieuws na ingrijpende operatie: een les in communicatie.

When dealing with choices concerning life-threatening or major surgery shared decision making, continuous tuning in with colleagues and monitoring direction is a necessity. The gastroenterologist detected a pancreatic tumour in a 53-year-old man. The patient was told that this tumour was almost surely malignant and that he would die within a year. A pylorus-preserving pancreatoduodenectomy was advised and performed. However, the final outcome was an IgG4-mediated autoimmune pancreatitis. The patient felt betrayed by the doctors. Crucial episodes of communication were analysed and we concluded the following. First, in decision-making on life and death, most doctors unconsciously assume a paternalistic attitude, which is not always preferred by the patient. Second, excessive emotional distress of the patient impedes counselling. Third, even in a case of perceived medical urgency, most patients should be allowed some time for reflection. Finally, multidisciplinary consultation may lead to an indistinct ownership of responsibilities by the doctors.

Modeling for fairness: A Rawlsian approach.

In this paper we introduce the overlapping design consensus for the construction of models in design and the related value judgments. The overlapping design consensus is inspired by Rawls' overlapping consensus. The overlapping design consensus is a well-informed, mutual agreement among all stakeholders based on fairness. Fairness is respected if all stakeholders' interests are given due and equal attention. For reaching such fair agreement, we apply Rawls' original position and reflective equilibrium to modeling. We argue that by striving for the original position, stakeholders expel invalid arguments, hierarchies, unwarranted beliefs, and bargaining effects from influencing the consensus. The reflective equilibrium requires that stakeholders' beliefs cohere with the final agreement and its justification. Therefore, the overlapping design consensus is not only an agreement to decisions, as most other stakeholder approaches, it is also an agreement to their justification and that this justification is consistent with each stakeholders' beliefs. For supporting fairness, we argue that fairness qualifies as a maxim in modeling. We furthermore distinguish values embedded in a model from values that are implied by its context of application. Finally, we conclude that for reaching an overlapping design consensus communication about properties of and values related to a model is required.

[Imminent peritonsillar abscess: when should a general practitioner refer?]. / Dreigend peritonsillair abces: wanneer moet de huisarts verwijzen?

Antimicrobial management of an imminent peritonsillar abscess is still under debate. Clinical experience shows that early administration of amoxicillin-clavulanic acid could prevent unilateral peritonsillitis from developing into an abscess. Here we describe two patients who initially received penicillin V treatment. They both recovered but only after the ENT specialist switched their antibiotic treatment to amoxicillin-clavulanic acid. Although sound evidence is lacking, we suggest that the Practice Guidelines should be revised. In the primary health care setting, amoxicillin-clavulanic acid should become the first drug of choice for patients presenting with unilateral peritonsillar swelling and trismus in situations where the patient is still able to eat and drink and can be seen again within 24 hours.

The problem of many hands: climate change as an example.

In some situations in which undesirable collective effects occur, it is very hard, if not impossible, to hold any individual reasonably responsible. Such a situation may be referred to as the problem of many hands. In this paper we investigate how the problem of many hands can best be understood and why, and when, it exactly constitutes a problem. After analyzing climate change as an example, we propose to define the problem of many hands as the occurrence of a gap in the distribution of responsibility that may be considered morally problematic. Whether a gap is morally problematic, we suggest, depends on the reasons why responsibility is distributed. This, in turn, depends, at least in part, on the sense of responsibility employed, a main distinction being that between backward-looking and forward-looking responsibility.

A network approach for distinguishing ethical issues in research and development.

In this paper we report on our experiences with using network analysis to discern and analyse ethical issues in research into, and the development of, a new wastewater treatment technology. Using network analysis, we preliminarily interpreted some of our observations in a Group Decision Room (GDR) session where we invited important stakeholders to think about the risks of this new technology. We show how a network approach is useful for understanding the observations, and suggests some relevant ethical issues. We argue that a network approach is also useful for ethical analysis of issues in other fields of research and development. The abandoning of the overarching rationality assumption, which is central to network approaches, does not have to lead to ethical relativism.

Penicillin for acute sore throat in children: randomised, double blind trial.

OBJECTIVE: To assess the effectiveness of penicillin for three days and treatment for seven days compared with placebo in resolving symptoms in children with sore throat. DESIGN: Randomised, double blind, placebo controlled trial. SETTING: 43 family practices in the Netherlands. PARTICIPANTS: 156 children aged 4-15 who had a sore throat for less than seven days and at least two of the four Centor criteria (history of fever, absence of cough, swollen tender anterior cervical lymph nodes, and tonsillar exudate). Interventions Patients were randomly assigned to penicillin for seven days, penicillin for three days followed by placebo for four days, or placebo for seven days. MAIN OUTCOME MEASURES: Duration of symptoms, mean consumption of analgesics, number of days of absence from school, occurrence of streptococcal sequelae, eradication of the initial pathogen, and recurrences of sore throat after six months. RESULTS: Penicillin treatment was not more beneficial than placebo in resolving symptoms of sore throat, neither in the total group nor in the 96 children with group A streptococci. In the groups randomised to seven days of penicillin, three days of penicillin, or placebo, one, two, and eight children, respectively, experienced a streptococcal sequela. CONCLUSION: Penicillin treatment had no beneficial effect in children with sore throat on the average duration of symptoms. Penicillin may, however, reduce streptococcal sequelae.