Pragmatic Questions Research Articles

Modern trials are most useful when they are pragmatic and explanatory - there is no continuum

Over half a century ago, the terms “pragmatic” and “explanatory” were introduced to biomedicine by Schwartz and Lellouch, presenting two distinct conceptual approaches to trial design. Today, we frequently say that there are pragmatic trials and there are explanatory trials. Pragmatic trials inform decision-making in practice, explanatory trials aim to understand the mechanism of an intervention. They are often perceived as diametral extremes of a continuum.In this commentary, we argue that with the digitalization of health care and clinical research ways for modern trial designs were were paved and new avenues opened, and that there is no such continuum. Since the groundbreaking work of Schwartz and Lellouch, new approaches and methods have become available that allow researchers to address pragmatic and explanatory questions in parallel in the same trial. Emerging availability of routinely collected “real-world” data, development of decentralized trial techniques, and creation of digital biomarkers allow to observe health outcomes with minimal or no interference in real-world care. This overcomes previous limitations to study mechanisms of interventions in routine care and makes the idea of a continuum obsolete. We argue that pragmatism and explanatorism need to be understood as two distinct but compatible conceptual dimensions to open new perspectives for using novel technologies to design the most informative clinical trials and making better clinical and regulatory decisions.We base our argument on an analysis of the concept of a continuum and highlight its limitations. We review key trial design features and introduce a new concept that sees explanatory design features as fundamental, invasive or non-invasive, sufficient or insufficient. We describe their impact on pragmatism and explanatorism and show how multidimensional pragmatic-explanatory trials that are most useful are possible today.

From reliability to pragmatism: Hospital management in the context of radical uncertainty

AbstractThe COVID‐19 pandemic presented a scenario of radical uncertainty that hospitals had to manage. Two strands of research can illuminate this management. The first puts forward the high‐reliability organization (HRO) principles that the hospital sector has applied for two decades. The second is based on pragmatism and underscores experimental, trial‐and‐error strategies appropriate for radical uncertainty. This strategy, utilized primarily in the political governance of crises, can be applied in hospital management as well. The results of our qualitative research into French hospitals (109 online interviews over 2020–2021) highlight the importance of pragmatic rationality in crisis management based on organizing collective inquiries. This concept of pragmatic rationality questions the notion of reliability, sticking to pre‐existing performance standards not applicable in such contexts. It invites to propose the concept of high pragmatic organization based on five principles that partially integrate those of an HRO.

Adhipati, Yogācāra Intersubjectivity, and Soteriology in Kuiji’s Commentaries

AbstractThis study sheds light on a key concept of Yogācāra intersubjectivity that played a significant role in medieval Chinese Yogācāra. Specifically, it analyzes how Kuiji 窺基 (632–682) reinterprets adhipati (activating and amplifying influence; Ch: zengshang 增上 or zengshang li 增上力 or zengshang yuan 增上緣) to account for intersubjective karmic interactions across different lifeworlds in the events of teaching and killing.As this line of investigation shows, Kuiji’s theory of adhipati attempts to sidestep the entanglement of the problems of intersubjectivity and incommensurable worlds in Yogācāra. Extant scholarship on intersubjectivity often presumes one spatio-temporal world populated by sentient beings and insentient objects, which is fundamentally at odds with the Yogācāra tenet that each mental stream generates its distinct lifeworld. To address the pragmatic question of how different mental continuums of consciousnesses can impinge into each other’s lifeworlds, Kuiji employed adhipati in a specific way to account for intersubjective interplay across different, potentially incommensurable worlds. In this framing of intersubjectivity, the problem of one world or many worlds is explained non-dualistically: these lifeworlds are neither the same nor different, neither one nor many, but karmically interconnected.Expanding on recent discussions of the puzzle of intersubjectivity in Yogācāra, this paper shows that Kuiji’s deployment of adhipati provides an account of genuine intersubjectivity in which different mental continuums are recognized as subjects and engage in causal interactions among different spatio-temporal worlds. In Kuiji’s framing, this genuine intersubjectivity gives rise to the sense of one shared world.

SELECTED ASPECTS OF THE USE OF ARTIFICIAL INTELLIGENCE IN PUBLIC ADMINISTRATION

Artificial intelligence grows ever more impactful in various social and economic domains. Public administration is among increasingly prominent fields undergoing technology-driven transformations. Today’s administration bodies, local and central both, are facing the challenge of accommodating new outlooks brought by artificial intelligence. This dynamic metamorphosis entails both benefits and difficulties worth investigating. The primary research problem here is the use of artificial intelligence in public administration and potential future changes in this regard. The main research goal of the article is to analyse the benefits of employing artificial intelligence in public administration followed by an analysis of any relevant ethical and pragmatic questions. The article further presents selected aspects of the problem, focusing on the application of data science in public health care.

Attitudes on Artificial Intelligence use in Pediatric Care From Parents of Hospitalized Children

IntroductionArtificial intelligence (AI) may benefit pediatric healthcare, but it also raises ethical and pragmatic questions. Parental support is important for the advancement of AI in pediatric medicine. However, there is little literature describing parental attitudes toward AI in pediatric healthcare, and existing studies do not represent parents of hospitalized children well. MethodsWe administered the Attitudes toward Artificial Intelligence in Pediatric Healthcare, a validated survey, to parents of hospitalized children in a single tertiary children’s hospital. Surveys were administered by trained study personnel (11/2/2021-5/1/2022). Demographic data were collected. An Attitudes toward Artificial Intelligence in Pediatric Healthcare score, assessing openness toward AI-assisted medicine, was calculated for seven areas of concern. Subgroup analyses were conducted using Mann–Whitney U tests to assess the effect of race, gender, education, insurance, length of stay, and intensive care unit (ICU) admission on AI use. ResultsWe approached 90 parents and conducted 76 surveys for a response rate of 84%. Overall, parents were open to the use of AI in pediatric medicine. Social justice, convenience, privacy, and shared decision-making were important concerns. Parents of children admitted to an ICU expressed the most significantly different attitudes compared to parents of children not admitted to an ICU. ConclusionsParents were overall supportive of AI-assisted healthcare decision-making. In particular, parents of children admitted to ICU have significantly different attitudes, and further study is needed to characterize these differences. Parents value transparency and disclosure pathways should be developed to support this expectation.

Prawo europejskie a polska tożsamość konstytucyjna (aspekty prawno-polityczne)

The article’s research aims to answer whether constitutional identity (as well as numerous doctrinal studies concerning constitutional identity) may substantially help solve problems regarding the relationship between European law and national law. The article discusses the hypothesis that the identity and the studies multiply doubts and uncertainty rather than answer the pragmatic questions in constitutional law. The author deals with identity as a social construct and convention created by academics and constitutional courts. Identity belongs primarily to the dictionary of academic language. It is rarely used in normative acts, in particular in constitutional provisions. The constitutional identity seems to be also vague and controversial for the author. Nevertheless, studies on identity may – as the article suggests – realise at least one (constitutionally important) aim. It is a better self-consciousness of constitutional law scholars, which may help them – at the end of the day – to discuss the relationship between European law and national law in more and more precise terms.

Heritable genome editing: ethical aspects of a developing domain.

In the past decade, scientific developments in human germline genome editing (GGE) have reinvigorated questions about research ethics, responsible innovation, and what it means to do good in the field of reproductive biology and medicine. In recent years, it has become part of the ethical debate on GGE whether categorical objections about (un)naturalness, dignity, respect for the gene pool as common heritage, are and should be supplemented by more pragmatic questions about safety, utility, efficacy, and potential 'misuse', which seem to become more dominant in the moral discussion. This mini-review summarizes the morally relevant aspects of the rapidly developing domain of GGE, focusing on reproductive applications and with special attention to the ethical questions pertaining to how this technology may affect the interests of those that come to be by means of it. While vital, this encompasses more than safety considerations. Taking this perspective, it will be crucial to engage with normative questions about how GGE maps on the importance of accommodating future parents' preference to have genetically related children, and how far we should go to facilitate this. Similarly, a comprehensive ethical debate about 'appropriate application' of GGE cannot shake off the more fundamental question about how notions like 'normalcy', 'quality of life', and 'disability' can be conceptualized. This is crucial in view of respecting persons whichever traits they have and in view of acceptable boundaries to parental responsibilities.

Facing Progress with Pragmatism: Telemedicine and Family Medicine.

The singular expertise of family physicians is the ability to manage complexity with pragmatism, both clinically and ethically. Telemedicine raises multiple questions about the nature of the patient-physician relationship as manifested in clinical encounters. Some of these questions are concerning, underscoring the need to assess whether medical care is better with this new technology-or if it is just different or maybe even worse. It seems clear, however, that, regardless of its limitations, telemedicine is here to stay. The pragmatic complex ethical question, then, is how all of us together-both medical professionals and society at large-will manage it.

Research objectives and general considerations for pragmatic clinical trials of pain treatments: IMMPACT statement.

Many questions regarding the clinical management of people experiencing pain and related health policy decision-making may best be answered by pragmatic controlled trials. To generate clinically relevant and widely applicable findings, such trials aim to reproduce elements of routine clinical care or are embedded within clinical workflows. In contrast with traditional efficacy trials, pragmatic trials are intended to address a broader set of external validity questions critical for stakeholders (clinicians, healthcare leaders, policymakers, insurers, and patients) in considering the adoption and use of evidence-based treatments in daily clinical care. This article summarizes methodological considerations for pragmatic trials, mainly concerning methods of fundamental importance to the internal validity of trials. The relationship between these methods and common pragmatic trials methods and goals is considered, recognizing that the resulting trial designs are highly dependent on the specific research question under investigation. The basis of this statement was an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) systematic review of methods and a consensus meeting. The meeting was organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership. The consensus process was informed by expert presentations, panel and consensus discussions, and a preparatory systematic review. In the context of pragmatic trials of pain treatments, we present fundamental considerations for the planning phase of pragmatic trials, including the specification of trial objectives, the selection of adequate designs, and methods to enhance internal validity while maintaining the ability to answer pragmatic research questions.

Елементи організації операційних технологій в рослинництві з урахуванням аграрних ризиків

The topic of the presented article covers the systematic evaluation of operational technologies in the field of crop production, where one of the key factors is the probability of failure to achieve the planned final production results under the influence of agrarian risks. Justification and selection of the optimal technology for growing and harvesting a certain group of agricultural crops is a complex multi-criteria technical and organizational task. At the same time, an urgent practical and pragmatic question arises: is it expedient in the difficult economic and political conditions of the country's economy to use the maximum of resource, technical and technological support of production processes in crop production, if the ratio "costs - the obtained result" can be much less than the expected planned indicators, and, at the same time, there is a significant influence of non-human-controlled factors regarding the cultivation and harvesting of agricultural crops. In this publication, we will consider the planning of production processes regarding the organization of operational technologies in crop production as an example of comparing and choosing the optimal option, considering agro-climatic risks, using the example of growing and harvesting winter wheat. When carrying out the production implementation of the recommendations described in the article on the topic of this study, it should be noted that when making an organizational and economic decision to determine the best relative resistance to agro-climatic risks of the system of operational mechanized technologies, the impact of risks is minimized and not excluded. If the occurrence of a complete crop loss event is critical for a given enterprise and leads to irreparable losses, then it is necessary to apply the system of index agricultural insurance with mandatory consideration of the specifics of the agro-climatic conditions of the region where agricultural production is carried out.

Metadrama and Language (Language and Metadrama in Major Barbara and Pygmalion: Shavian Sisters)

Metadrama and Language (Language and Metadrama in <i>Major Barbara</i> and <i>Pygmalion:</i> Shavian Sisters)

The experience of conducting collaborative and intensive pragmatic qualitative (CLIP-Q) research to support rapid public health and healthcare innovation.

A key challenge for qualitative methods in applied health research is the fast pace that can characterize the public health and health and care service landscape, where there is a need for research informed by immediate pragmatic questions and relevant findings are required quickly to inform decision-making. The COVID-19 pandemic accelerated the pace at which evidence was needed to inform urgent public health and healthcare decision-making. This required qualitative researchers to step up to the challenge of conducting research at speed whilst maintaining rigor and ensuring the findings are credible. This article illustrates how working with multidisciplinary, collaborative teams and the tailoring of qualitative methods to be more pragmatic and efficient can provide timely and credible results. Using time-limited case studies of applied qualitative health research drawn from the work of the Behavioral and Qualitative Science Team from the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), we illustrate our collaborative and intensive pragmatic qualitative (CLIP-Q) approach. CLIP-Q involves (i) collaboration at all stages of the design, conduct and implementation of projects and, where possible, co-production with people with lived experience, (ii) an intensive team-based approach to data collection and analysis at pace, and (iii) pragmatic study design and efficient strategies at each stage of the research process. The case studies include projects conducted pre COVID-19 and during the first wave of the pandemic, where urgent evidence was required in weeks rather than months to inform rapid public health and healthcare decision making.

HEROIC Trials to Answer Pragmatic Questions for Hospitalized Children.

Although the number of randomized controlled trials (RCTs) published each year involving adult populations is steadily rising, the annual number of RCTs published involving pediatric populations has not changed since 2005. Barriers to the broader utilization of RCTs in pediatrics include a lower prevalence of disease, less available funding, and more complicated regulatory requirements. Although child health researchers have been successful in overcoming these barriers for isolated diseases such as pediatric cancer, common pediatric diseases are underrepresented in RCTs relative to their burden. This article proposes a strategy called High-Efficiency RandOmIzed Controlled (HEROIC) trials to increase RCTs focused on common diseases among hospitalized children. HEROIC trials are multicenter RCTs that pursue the rapid, low-cost accumulation of study participants with minimal burden for individual sites. Five key strategies distinguish HEROIC trials: (1) dispersed low-volume recruitment, in which a large number of sites (50-150 hospitals) enroll a small number of participants per site (2-10 participants per site), (2) incentivizing site leads with authorship, training, education credits, and modest financial support, (3) a focus on pragmatic questions that examine simple, widely used interventions, (4) the use of a single institutional review board, integrated consent, and other efficient solutions to regulatory requirements, and (5) scaling the HEROIC trial strategy to accomplish multiple trials simultaneously. HEROIC trials can boost RCT feasibility and volume to answer fundamental clinical questions and improve care for hospitalized children.

Evaluating environmental and inhibitory control strategies to improve outcomes in a widely available weight loss program

BackgroundAlthough many people try to lose weight, a large proportion of individuals do not achieve clinically significant weight loss. Nonresponse and relapse rates in lifestyle interventions are largely explained by challenges in avoiding or resisting temptation in the context of omnipresent food access. Innovative enhancement strategies are needed to help individuals manage temptation in evidence-based lifestyle interventions. MethodsThis prospective, four-parallel-arm, randomized controlled trial tests the efficacy of two weight management enhancement strategies on weight and dietary outcomes among individuals with overweight or obesity: (1) an environmental control strategy combining modification of the home food environment and grocery delivery (AVOID) and (2) an impulse control strategy involving daily, gamified inhibitory control training (RESIST). Women and men (n = 500) with overweight or obesity (Body Mass Index between 25 and 40.0 kg/m2) will be enrolled in a 12-month commercial weight-loss program (WW, formerly Weight Watchers©) and randomly assigned to one of four conditions: (1) WW alone, (2) WW + AVOID, (3) WW + RESIST, or (4) WW + AVOID + RESIST. Anthropometric, dietary, cognitive, and household food environment assessments will be conducted in English or Spanish at enrollment and at 6- and 12-month follow-up. DiscussionThis research addresses the pragmatic question of how to best optimize behavior change: Should we modify the choice environment, strengthen individuals' self-regulation, or both, to maximize behavior change? This work can inform the development of enhancement strategies to promote adherence to lifestyle recommendations and other impulse control challenges.

Scaling Up Patient-Centered Psychological Treatments for Perinatal Depression in the Wake of a Global Pandemic.

There is a call to action to reduce the public health burden of perinatal depression worldwide. The COVID-19 pandemic has further highlighted significant gaps in perinatal mental health care, especially among women who identify as Black, Indigenous, People of Color (BIPOC). While psychotherapeutic (cognitive, behavioral and interpersonal) interventions are endorsed for perinatal mood disorders, barriers to access and uptake contribute to inequitable access to treatment at the population level. To effectively address these barriers and increase the scalability of psychotherapy among perinatal women, we suggest four pragmatic questions to be answered from a patient-centered lens; namely, “who,” “what,” “how,” and “when.” Promising avenues include task-sharing among mental health non-specialists, an emphasis on culturally sensitive care, web-based delivery of psychotherapy with some caveats, and a lifespan approach to perinatal mental health. Innovative research efforts are seeking to validate these approaches in diverse contexts across North America and the UK, lending optimism toward scalable and long-term solutions for equitable perinatal mental health care.

On the Risks of Ethical Decision-Making from the History of the Political Thought

Introduction: We are interested in the theoretical considerations of the actual pragmatic questions about ethical worldview meaning of understanding of the innovation dealings world, the nature of its conceptual risk dilemmas and problems and sententious thinking in the sphere of political business industry. Our viewpoint is dedicated to the most important aspects of the essence and peculiarities of the social moral standards of innovation approaches in the context of a political solution through methodology of modern mental technology - especially: cognitive methods with gnostic wisdom research and utilitarian creative knowledge and axiological methodology with overestimation ethical values and demonstrating intellectual concepts. Into the framework of the main goal of the research are reviewed the basic theoretical paradigms on the background of ethical worldview analysis (through comparative historical technique of thinking) of the leading-edge conceptual theories of the famous contemporary Russian, American and European thinkers. The purpose of the article is to prove, substantiate and confirm the following thesis. In order for the ethical of timely paroemiac responsibility and political freedom to be able to fulfill its axiological tasks, it is necessary to reach some worldview ideas: ??to create an universal model of moral consciousness and high valuable behavior; overcome mental and sociocultural biases regarding the debatable assessment of the convincingness of events and determine the relevant logical reaction of society not only to a certain risk of eatable technical thinking, but also to uncertainty regarding their intellectual decision in relation to approved ethical, operational, empirical and principled notions, proposals, expression views and suggestions. The results. Scientific conceptual alternatives of optimization of practical and urgent ethical valuable dilemmas are given. The issues of the possibility of formation of a worldview system through practical ethical requirements that standard regulates the reactionary politics of intellectual reality to probabilistic hazards are discussed. The ethical standards of universal prohibitions, the moral responsibility of human nature and the ethics of virtue make a conflict of social and political interests through insurmountable cognitive, discussible, reviewable and discursive difficulties are demonstratively shown. Conclusions. Taking into dominant the essence of the main backgrounds of the existential specific theoretical approaches for worldview methods solving moral political problems is integrated some innovation decisions through valuable considerations. The fundamental ethical concepts of utilitarian thought of historical reminiscences synthesize the possibility problematic circumstances into the logical model of making morally important and useful decisions much easier are analyzed, but through in the valuating pragmatic context needs a main transformation in mental formation of ideological metric and social-political structure. Keywords: ethical worldview decision, political industry, innovation approaches, moral values, mental technologies, risk decision methods, conceptual risk dilemmas.

The translation field in Serbia 1960-1990

The paper presents a chronological overview of diverse translation related activity in Serbia be­tween 1960 and 1990 that led to a successful interplay of four types of perspectives on translation enquiry: Policy, Public, Scientific and Critical (Koskinen 2010). It is based on the data available in periodicals, conference proceedings and other publications issued by two major translator associa­tions and book-length publications on translation theory in Serbia during this period. The analysis presents the events, topics, participants and publications on translation as well as the role of state ideology in the promotion of translation activities. Finally, it is argued that the continuous dialogue between practitioners and scholars on numerous pragmatic questions (translator training, develop­ment of terminologies, the status of the profession and others), as well as on theoretical ones (on the nature of translation theory) led to the emergence of theoretical discourse on translation in Serbia.

Algorithmic branding through platform assemblages: core conceptions and research directions for a new era of marketing and service management

PurposeContemporary branding transpires in a complex technological and media environment whose key contextual characteristics remain largely unexplained. The article provides a conceptual understanding of the elements of contemporary branding as they take place using networked platforms and explains them as an increasingly important practice that affects customer and manager experience.Design/methodology/approachThis article draws on a variety of recent sources to synthesize a model that offers a more contextualized, comprehensive and up-to-date understanding of how branding has become and is being altered because of the use of branded service platforms and algorithms.FindingsCore terminology about technoculture, technocultural fields, platform assemblages, affordances, algorithms and networks of desire set the foundation for a deeper conceptual understanding of the novel elements of algorithmic branding. Algorithmic branding transcended the mere attachment of specific “mythic” qualities to a product or experience and has morphed into the multidimensional process of using media to manage communication. The goal of marketers is now to use engagement practices as well as algorithmic activation, amplification, customization and connectivity to drive consumers deeper into the brand spiral, entangling them in networks of brand-related desire.Practical implicationsThe model has a range of important managerial implications for brand management and managerial relations. It promotes a understanding of platform brands as service brands. It underscores and models the interconnected role that consumers, devices and algorithms, as well as technology companies and their own service brands play in corporate branding efforts. It suggests that consumers might unduly trust these service platforms. It points to the growing importance of platforms' service brands and the consequent surrender of branding power to technology companies. And it also provides a range of important ethical and pragmatic questions that curious marketers, researchers and policy-makers may examine.Originality/valueThis model provides a fresh look at the important topic of branding today, updating prior conceptions with a comprehensive and contextually grounded model of service platforms and algorithmic branding.

New-Onset Refractory Status Epilepticus (NORSE): The Queen Square Neuro-ICU experience

The introduction and widespread adoption of the term ‘NORSE’ – new-onset refractory status epilepticus – raises both fundamental conceptual and pragmatic questions. We studied a cohort of patients with ‘NORSE’ at the National Hospital for Neurology and Neurosurgery to investigate the clinical features, treatment responses, and outcomes with a focus on sub-group analysis. We identified 26 cases of ‘NORSE’. There was no difference in prognosis between ‘NORSE’ and non-‘NORSE’ RSE, nor in any sub-analysis in the ‘NORSE’ cohort. We discuss the utility and validity of the term NORSE as a descriptor for a subgroup with RSE in whom the underlying etiologies are heterogeneous and pathophysiological mechanisms are unknown.

Invited Perspective: How Can Studies of Chemical Mixtures and Human Health Guide Interventions and Policy?

Invited Perspective: How Can Studies of Chemical Mixtures and Human Health Guide Interventions and Policy?