Explanatory pluralism in the medical sciences: Theory and practice

Explanatory pluralism is the view that the best form and level of explanation depends on the kind of question one seeks to answer by the explanation, and that in order to answer all questions in the best way possible, we need more than one form and level of explanation. In the first part of this article, we argue that explanatory pluralism holds for the medical sciences, at least in theory. However, in the second part of the article we show that medical research and practice is actually not fully and truly explanatory pluralist yet. Although the literature demonstrates a slowly growing interest in non-reductive explanations in medicine, the dominant approach in medicine is still methodologically reductionist. This implies that non-reductive explanations often do not get the attention they deserve. We argue that the field of medicine could benefit greatly by reconsidering its reductive tendencies and becoming fully and truly explanatory pluralist. Nonetheless, trying to achieve the right balance in the search for and application of reductive and non-reductive explanations will in any case be a difficult exercise.     

A Learning Theory Approach to Attachment Theory: Exploring Clinical Applications

Clinical Child and Family Psychology Review - Although clinicians typically acknowledge the importance of insecure attachment as one factor that can contribute to children’s psychopathology,...     

Kant,Reichenbach, and the Fate of A Priori Principles

Abstract: This article contends that the relation of early logical empiricism to Kant was more complex than is often assumed. It argues that Reichenbach's early work on Kant and Einstein, entitled The Theory of Relativity and A Priori Knowledge (1920) aimed to transform rather than to oppose Kant's Critique of Pure Reason. One the one hand, I argue that Reichenbach's conception of coordinating principles, derived from Kant's conception of synthetic a priori principles, offers a valuable way of accounting for the historicity of scientific paradigms. On the other hand, I show that even Reichenbach, in line with Neo‐Kantianism, associated Kant's view of synthetic a priori principles too closely with Newtonian physics and, consequently, overestimated the difference between Kant's philosophy and his own. This is even more so, I point out, in the retrospective account logical empiricism presented of its own history. Whereas contemporary reconstructions of this history, including Michael Friedman's, tend to endorse this account, I offer an interpretation of Kant's conception of a priori principles that contrasts with the one put forward by both Neo‐Kantianism and logical empiricism. On this basis, I re‐examine the early Reichenbach's effort to accommodate these principles to the paradigm forged by Einstein.     

The feasibility,reliability and validity of the EORTC QLQ-C30 in assessing the quality of life of patients with a symptomatic HIV infection or AIDS (CDC IV)

Abstract

The objective of this study was to evaluate the feasibility, reliability and validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (the QLQ-C30) in a longitudinal study of the quality of life (QoL) of patients with a symptomatic HIV infection or AIDS. The OLQ-C30 is a 30-item questionnaire composed of five functional subscales. 3 symptom subscales, an overall QoL subscale, and a number of additional single item symptom measures. The questionnaire was administered serially to a sample of 156 Dutch patients. The average time to complete the questionnaire was less than 11 minutes, with most patients requiring no assistance. With one exception (role functioning subscale), the data supported the hypothesized scale structure of the questionnaire. Eight of the 9 subscales met or approached the minimal criterion for reliability (Cronbach's alpha ≤ .70) at baseline and/or follow-up. The validity of the QLQ-C30 was supported by 3 findings: (1) the correlations observed among the subscales. while statistically significant, were of only a moderate magnitude, indicating that distinct components of QoL are being assessed; (2) a number of the subscales could discriminate clearly between patients differing in stage of disease and in Karnofsky Performance Status; and (3) significant changes in QLQ-C30 scores in the expected direction, were observed over time. These results lend support to the QLQ-C30 as a reasonably reliable and valid instrument for assessing the QoL of patients with HIV infection. Additional research is needed to improve the role functioning subscale. to evaluate the QLQ-C30's concurrent validity by comparing it with other available QoL instruments, and to examine more thoroughly its responsiveness to clinically important changes in patients' health status over the entire disease and treatment trajectory.     

Observed need-supportive and need-thwarting teaching behavior in physical education: Do teachers' motivational orientations matter?

ObjectivesThe behaviors physical education (PE) teachers engage in affect a number of important student outcomes. Therefore, it is essential to study the antecedents of these teaching behaviors.Design and methodGrounded in Self-Determination Theory, this cross-sectional study explored the relations between PE teachers' autonomous and controlled motivational orientations and a variety of observed need-supportive and need-thwarting teaching behaviors in 79 PE classes by means of regression analyses.ResultsControl-oriented teachers made less use of an overall need-supportive teaching style and provided less structure during the activity in particular, while they engaged in more need-thwarting teaching behavior in general and in more controlling and cold teaching behavior in particular.ConclusionAlthough autonomy-oriented teachers tended to display the opposite pattern of correlates, these associations were non-significant. As the current findings suggest that teachers' actual teaching behavior is rooted at least partly in their own dispositional motivational orientation, they may inform the design of effective continuous professional development programs and interventions aimed at enhancing teachers' need-supportive teaching. Directions for future research are discussed.