Does the philosophy of medicine exist?

There has been a great deal of discussion, in this journal and others, about obstacles hindering the evolution of the philosophy of medicine. Such discussions presuppose that there is widespread agreement about what it is that constitutes the philosophy of medicine.Despite the fact that there is, and has been for decades, a great deal of literature, teaching and professional activity carried out explicitly in the name of the philosophy of medicine, this is not enough to establish that consensus exists as to the definition of the field. And even if consensus can be obtained as to what constitutes the philosophy of medicine, this does not mean that it exists as a field.     

Theory change in immunology part II: The clonal selection theory

This two-part article examines the competition between the clonal selection theory and the instructive theory of the immune response from 1957–1967. In Part I the concept of a temporally extended theory is introduced, which requires attention to the hitherto largely ignored issue of theory individuation. Factors which influence the acceptability of such an extended theory at different temporal points are also embedded in a Bayesian framework, which is shown to provide a rational account of belief change in science. In Part II these factors, as elaborated in the Bayesian framework, are applied to the case of the success of the clonal selection theory and the failure of the instructive theory.     

Making peace in gestational conflicts

Mary Anne Warren's claim that there is room for only one person with full and equal rights inside a single human skin ([1], p. 63) calls attention to the vast range of moral conflict engendered by assigning full basic moral rights to fetuses. Thereby, it serves as a goad to thinking about conflicts between pregnant women and their fetuses in a way that emphasizes relationships rather than rights. I sketch out what a care orientation might suggest about resolving gestational conflicts. I also argue that the care orientation, with its commitment to the significance of the partial and the particular, cannot be absorbed within standard, impartialist moral theory.     

The utilization of genetic counselors within a newborn screening program

Genetic counselors have participated in the Michigan Newborn Screening Program on a contractual basis since 1988. Their role includes newborn screening education and training, newborn nursery site visits, and monitoring newborn screening in hospitals. Their impact has been to improve the quality of newborn screening services by reducing errors and increasing completion of data fields on newborn screening cards, improving hospital nursery cooperation and problem solving, and enhancing health department response to specific problems.     

Developmental sequences in the age of onset of disruptive child behaviors

Retrospective and prospective reports of the onset of disruptive child behaviors were analyzed in a sample of clinic-referred boys. The younger boys (ages 7–9 years), compared with the older boys (ages 10–12 years), showed the highest level of disruptive behavior and, judging from mothers' reports, had the fastest progression of onsets from less serious to more serious problem behaviors. Despite some overlap, developmental sequences in problem behavior within the domains of hyperactivity/inattention, oppositional behavior, and conduct problems were similar across the two age groups. This was also the case for developmental sequences of overt or confrontive problem behaviors and covert or concealing conduct problems. Sequences of the onset of oppositional behavior and conduct problems were validated through prospective data, based on the information from mothers, teachers, and boys themselves. The implications of the findings are discussed for the formulation of developmental pathways of behavior and the analysis of causal factors.     

Minimizing the number of observations: A generalization of the spearman-brown formula

A new method for determining the minimum number of observations per subject needed to achieve a specific generalizability coefficient is presented. This method, which consists of a branch-and-bound algorithm, allows for the employment of constraints specified by the investigator.     

Ordinal consistency and ordinal true scores

This paper argues that test data are ordinal, that latent trait scores are only determined ordinally, and that test data are used largely for ordinal purposes. Therefore it is desirable to develop a test theory based only on ordinal assumptions. A set of ordinal assumptions is presented, including an ordinal version of local independence. From these assumptions it is first shown that the gamma-correlation between two tests is the product of their gamma-correlations with the true latent order. The theory is generalized to allow for heterogeneous tests by defining a weighted average local independence. The tau-correlations between total score and the latent order can be found in both homogeneous and heterogeneous cases, and a system of differential item weighting to maximize the tau-correlation between weighted items and the latent order is provided. Thus a purely ordinal test theory seems possible.Part of this work was done while the author was a Visiting Fellow at Macquarrie University. The paper has benefitted from discussions with Professors Thomas J. Reynolds and Roderick P. McDonald and from the comments of several anonymous reviewers.     

Criterion-related construct validity

Established results on latent variable models are applied to the study of the validity of a psychological test. When the test predicts a criterion by measuring a unidimensional latent construct, not only must the total score predict the criterion, but the joint distribution of criterion scores and item responses must exhibit a certain pattern. The presence of this population pattern may be tested with sample data using the stratified Wilcoxon rank sum test. Often, criterion information is available only for selected examinees, for instance, those who are admitted or hired. Three cases are discussed: (i) selection at random, (ii) selection based on the current test, and (iii) selection based on other measures of the latent construct. Discriminant validity is also discussed.This work was supported in part by Grant SES-87-01890 from the Measurement Methods and Data Improvement Program of the U.S. National Science Foundation.     

Influential observations in principal factor analysis

We propose a method for detecting influential observations in iterative principal factor analysis. For this purpose we derive the influence functionsI(x; LL ^T ) andI(x; ) for the common variance matrixT =LL ^T and the unique variance matrix , respectively, in the common factor decomposition =LL ^T + . A numerical example is given for illustration.The authors are grateful to Tomoyuki Tarumi and Atsuhiro Hayashi for their kind permission to use their software Seto/B for drawing Figures 1 and 2 and to anonymous reviewers for comments on the paper.     

Using item-specific instructional information in achievement modeling

The problem of detecting instructional sensitivity (item basis) in test items is considered. An illustration is given which shows that for tests with many biased items, traditional item bias detection schemes give a very poor assessment of bias. A new method is proposed instead. This method extends item response theory (IRT) by including item-specific auxiliary measurement information related to opportunity-to-learn. Item-specific variation in measurement relations across students with varying opportunity-to-learn is allowed for.This paper was presented at the 1987 AERA meeting in Washington, DC. This research was supported by grant OERI-G-86-003 from the Office of Educational Research and Improvement, Department of Education. The author thanks Michael Hollis and Chih-fen Kao for valuable research assistance, and appreciates valuable comments made by an anonymous reviewer.