In this study, we argue that contemporary nursing care has been overtaken by new public management strategies aimed at curtailing budgets in the public hospital sector in Australia. Drawing on qualitative interviews with 15 nurses from one public acute hospital with supporting documentary evidence, we demonstrate what happens to nursing work when management imposesroundingas a risk reduction strategy. In the case study outlined rounding was introduced across all wards in response to missed care, which in turn arose as a result (...) of work intensification produced by efficiency, productivity, effectiveness and accountability demands. Rounding is a commercially sponsored practice consistent with new public management. Our study illustrates the impact that new public management strategies such as rounding have on how nurses work, both in terms of work intensity and in who controls their labour. (shrink)

Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified (...) four strategies associated with NPM which add to workload after‐hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care. (shrink)

Approaches to self‐management traditionally focus upon individual capacity to make behavioural change. In this paper, we use Bourdieu's concepts of habitus and capital to demonstrate the impact of structural inequalities upon chronic illness self‐management through exploring findings from 28 semi‐structured interviews conducted with people from a lower socioeconomic region of Adelaide, South Australia who have type 2 diabetes. The data suggests that access to capital is a significant barrier to type 2 diabetes self‐management. While many participants described having sufficient cultural (...) capital to access and assess health information, they often lacked economic capital and social capital in the form of support networks who promote health. Participants were often involved in social networks in which activities which are contrary to self‐management have symbolic value. As a consequence, they entered relationships with health professionals at a disadvantage. We conclude that structural barriers to self‐management arising from habitus resulting in the performance of health behaviours rooted in cultural and class background and limited access to capital in the form of economic resources, social networks, health knowledge and prestige may have a negative impact on capacity for type 2 diabetes self‐management. (shrink)

This paper explores labour negotiations between nurses and government in the public health sector in Australia between 1996 and 2005. During this period, industrial negotiations between nurses and government in the public health sector moved from centralized wage determinations to agreements made at the level of the enterprise through the Workplace Relations Act 1996. Simultaneously, public sector nurses reported increased work intensification, a result of new public management strategies. This led to the Australian Nursing Federation negotiating enterprise agreements that included (...) the introduction of highly specified workload algorithms in an attempt to de‐intensify nurses’ labour. The irony of this strategy is that these calculations and tools operate as both a human resource mechanism for maximizing productivity as well as an industrial relations tool for reducing work intensification. (shrink)

Hierarchical Bayesian models (HBMs) provide an account of Bayesian inference in a hierarchically structured hypothesis space. Scientific theories are plausibly regarded as organized into hierarchies in many cases, with higher levels sometimes called ‘paradigms’ and lower levels encoding more specific or concrete hypotheses. Therefore, HBMs provide a useful model for scientific theory change, showing how higher‐level theory change may be driven by the impact of evidence on lower levels. HBMs capture features described in the Kuhnian tradition, particularly the idea that (...) higher‐level theories guide learning at lower levels. In addition, they help resolve certain issues for Bayesians, such as scientific preference for simplicity and the problem of new theories. *Received July 2009; revised October 2009. †To contact the authors, please write to: Leah Henderson, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 32D‐808, Cambridge, MA 02139; e‐mail: [email protected]. (shrink)

Rosenberg argues that intentional generalizations in the human sciences cannot be law-like because they are not amenable to significant empirical refinement. This irrefinability is said to result from the principle that supposedly controls in intentional explanation also serving as the standard for successful interpretation. The only credible evidence bearing on such a principle would then need conform to it. I argue that psychological generalizations are refinable and can be nomic. I show how empirical refinement of psychological generalizations is possible by (...) considering concrete cases. A sufficiently detailed view of the role of psychological generalizations in interpretation allows us to find in psychological investigations instances of bootstrap testing. (shrink)

An important volume connecting classical studies with feminism, Feminism and Ancient Philosophy provides an even-handed assessment of the ancient philosophers' discussions of women and explains which ancient views can be fruitful for feminist theorizing today. The papers in this anthology range from classical Greek philosophy through the Hellenistic period, with the predominance of essays focusing on topics such as the relation of reason and the emotions, the nature of emotions and desire, and related issues in moral psychology. The volume contains (...) some new, ground-breaking essays on Plato, Aristotle, and the Stoics, as well as previously published pieces by established scholars like Martha Nussbaum and Julia Annas. It promises to be of interest to an interdisciplinary audience including those working in classics, ancient philosophy, and feminist theory. (shrink)

This is an overview of Davidson's theory of anomalous monism. Objections and replies are also detailed.

In this paper, I examine a heretofore ignored critic of Descartes on the heterogeneity problem: Anton Wilhelm Amo. Looking at Amo’s critique of Descartes reveals a very clear case of a thinker who attempts to offer a causal system that is not a solution to the mind-body problem, but rather that transcends it. The focus of my discussion is Amo’s 1734 dissertation: The Apathy [ἀπάθεια] of the Human Mind or The Absence of Sensation and the Faculty of Sense in the (...) Human Mind and their Presence in our Organic and Living Body. Amo’s discussion of the interaction, or lack thereof, of the mind and body hinges on the essential feature he identifies for the human mind—apathy, that is, impassivity. In this work, Amo engages explicitly with Descartes’s writing, which allows us to more precisely see the nature of his agreement and disagreement with the Cartesian metaphysics of mind. I proceed by treating Amo’s five stated criteria for spirit-hood which, in turn, reveal the kinds of causal connections that are possible for embodied spirits on his view. My aim is threefold: To lay out what I take to be Amo’s view of and arguments for the five criteria he takes to be required for a substance to be spirit. To locate Amo’s agreement and disagreement with Descartes. To suggest that Amo’s view on mind-body interaction involves a kind of occasional causation. (shrink)

The dictum ‘“ought” implies “can”’ has a status in moral philosophy in some respects like that of ‘a good player needs good co-ordination’ in talk about ball-games. Clearly, you say something important but not conclusive about proficiency in playing a ball-game when you say that it requires good co-ordination: similarly, you say something important but not conclusive about obligation when you say that it implies a certain possibility or power or ability. Each dictum is a reminder: the one about such (...) courses of physical instruction, the other about such exhortations to duty, as are worth persevering with. It would be hopeless to keep on teaching a boy the moves and tricks of rugby football if he could never co-ordinate well enough to get his eye in, so to speak. Correspondingly, it would be meaningless to recommend that someone ought to do something the specification of which involved a contradiction, and pointless to suggest that he ought to do something which, for quite general reasons, was not, and was certain to remain not, within his power. So each dictum expresses a bluff, no-nonsense wisdom which we should count on before involving ourselves in certain more detailed commitments. But probably this is as far as the comparison between the two sayings can well be taken. (shrink)

This article discusses what is involved in having full moral status, as opposed to a lesser degree of moral status and surveys different views of the grounds of moral status as well as the arguments for attributing a particular degree of moral status on the basis of those grounds.

The application of machine learning algorithms to healthcare data can enhance patient care while also reducing healthcare worker cognitive load. These algorithms can be used to detect anomalous physiological readings, potentially leading to expedited emergency response or new knowledge about the development of a health condition. However, while there has been much research conducted in assessing the performance of anomaly detection algorithms on well-known public datasets, there is less conceptual comparison across unsupervised and supervised performance on physiological data. Moreover, while (...) heart rate data are both ubiquitous and noninvasive, there has been little research specifically for anomaly detection of this type of data. Considering that heart rate data are indicative of both potential health complications and an individual’s physical activity, this is a rich source of largely overlooked data. To this end, we employed and evaluated five machine learning algorithms, two of which are unsupervised and the remaining three supervised, in their ability to detect anomalies in heart rate data. These algorithms were then evaluated on real heart rate data. Findings supported the effectiveness of local outlier factor and random forests algorithms in the task of heart rate anomaly detection, as each model generalized well from their training on simulated heart rate data to real world heart rate data. Furthermore, results support that simulated data can help configure algorithms to a degree of performance when real labeled data are not available and that this type of learning might be especially helpful in initial deployment of a system without prior data. (shrink)

This essay deals with plague and plagues in renaissance and early modern Europe over the longue durée, principally from a methodological perspective. I shall combine an historiographical approach with an historical account of developing reactions to plague and in passing compare measures to cope in the early sixteenth century with reactions to the impact of the Great Pox or the Mal de Naples. I shall concentrate on southern Europe and in particular on Italy and my aim is to re-assess the (...) historiography of plague through the lens of some of the more recent Anglo-Saxon literature in this field. In the process I shall outline some of the debates within the field and end with some general methodological observations drawn from early modern Italy. (shrink)

Doctors’ survival predictions for terminally ill patients have been shown to be inaccurate and there has been an argument for less guesswork and more use of carefully constructed statistical indices. As statisticians, the authors are less confident in the predictive value of statistical models and indices for individual survival times. This paper discusses and illustrates a variety of measures which can be used to summarise predictive information available from a statistical model. The authors argue that models and statistical indices can (...) be useful at the group or population level, but that human survival is so uncertain that even the best statistical analysis cannot provide single-number predictions of real use for individual patients. (shrink)

The word “beautiful” plays a surprisingly unimportant part in the language of sophisticated artistic appreciation; I mean in the informed criticism and comparison of specific works of art. Though in ordinary conversation it can be used naturally and easily, it does not serve readily as a technical term in expert writing or discussion. To become a technical term of this kind it would have to be definable, and definable in terms which commanded sufficient agreement: but attempts to define “beauty” and (...) “beautiful” may well have become restrained by the popularity of philosophical discussion about the significance of these words. No philosophical question is discussed more commonly or from more firmly held opposite positions than the question whether beauty is “objective” or not. Discussion of this and related topics, however, not being the monopoly of professed philosophers but being familiar amongst artists and art critics themselves, tends to remove all shadow of technicality from the crucial terms discussed. Other terms come to serve for the “objective” features of works of art, and others again for the impressions which works of art may make upon us: “beauty” and “beautiful” tend to fall away between these two classes. (shrink)

I want to explore the possibility of an a posteriori approach to the elucidation of certain moral notions. These are: (a) the notion of a duty, some specific thing which it is incumbent on me to do, and (b) the notion of something that is a good thing for me to do. I want to consider these notions, so far as I can, independently of rules. There is a certain sense in which having a duty to do this or that (...) is a function of circumstances, and in which this or that's being a good thing to do is likewise a function of circumstances. I shall suggest specific examples in which this is a conspicuous feature of ‘my duty’ or of what I can, beneficially, do. In these examples what I ought to do, and what it is good to do, can be represented as special ways in which what I am to do presents itself. (shrink)

In the course of his life a man surrounds himself with questions, much as he surrounds himself with furniture, books or pictures. Personality is expressed not only by the selection of a Chippendale chair, the amassing of early colour-plate books, or the purchase of a Renoir, but also by the kind of questions which a man “collects”-raises, without necessarily solving. Some questions, like some books, are to be brooded over and studied; some are introduced only to be contemplated from time (...) to time, like fine bindings; and some occur so casually as hardly to rouse any attention at all. There is an obvious difference between a man who bids carefully at a book auction or forces himself on to his knees to identify a dust-covered quarto in a slum bookshop, and a man whose library is inherited from parents or grandparents; acceptances and not choices will distinguish the casual possessor from the bookman. Similarly, there are many questions which sit lightly on a man's mind, which are as little the object of sustained wondering or bafflement as his ancestors” well bound volumes of theology or game-shooting are the reflection of his own tastes or interests. These may be questions of any sort: they may be factual questions, important or trivial, or they may be theoretical questions, philosophical perhaps, or religious or scientific. A student of literature, for instance, has been known to congratulate himself on his ignorance of modern science, ignorance so deliberate that any scientific question raised in his presence fails even to make him wonder. For any person, however, there are ranges of questions which barely touch his mind: he may be aware that he does not know how to derive answers to them for himself, but his inability will not cause him concern. The memory, the practical or the reasoning skill of the kind that would be required are perhaps so much out of proportion to what he possesses that to bemoan the lack of them is unrealistic -as it is often idle and merely conventional for one who is tone-deaf to say how much he wishes he could sing an aria . Other questions altogether, important or trivial, he takes seriously and troubles to answer, because they touch his own special interests directly: he may pride himself on never neglecting a newspaper problem in bridge or chess, or he may never fail to answer correctly a question about the construction of some instrument or machine. The same person, however, will also get the length of raising many questions which remain mere questions. He may be troubled and puzzled about certain political or social question which circumstances do not compel him to answer: but he will not be hypocritical in professing an interest in them. Some of these questions, of course, may become solved after a fashion, if he listens to the voice of politician, statistician, priest or psychologist and is lucky enough to get an answer which satisfies him. But many will survive with just enough recurrences of wondering about them to make them, as you might say, chronic. This is the intermediate class of questions. (shrink)

This paper examines three medical student poems about death to explore how medical students use poetry to understand their encounters with dying patients and to discuss how these poems function as elegies in the context of medical culture.

ABSTRACT:What more can be said about COVID-19 and the social determinants of health? This article describes neglected perspectives that derive from the history of social epidemiology, a field that identifies the social etiology of disease and variations in disease incidence among people differentially located in the social structure. The "discovery" of social determinants of diseases like COVID-19 is nothing new for epidemiology: debate over how to analyze structural determinants versus individual-level risk factors persisted throughout the 19th and 20th centuries. By (...) the late 20th century, research had highlighted fundamental causes of health disparities, such as social conditions and structural racism; these are structural factors, embedded in the social fabric of life. Measurement of structured inequalities within systems faces complex and challenging problems, as research aims to better account for these lived realities at different levels of analysis and as multiple factors merge to influence outcomes (revealed in intersectionality theory). At each of these intersections, there are opportunities for bioethicists to consider their ethical implications. It is imperative to understand the social and ethical roots of our present conversations about health inequalities, in order to partner intelligently with researchers on the forefront of advocating for change. (shrink)

We propose the Selfish Goal model, which holds that a person's behavior is driven by psychological processes called goals that guide his or her behavior, at times in contradictory directions. Goals can operate both consciously and unconsciously, and when activated they can trigger downstream effects on a person's information processing and behavioral possibilities that promote only the attainment of goal end-states (and not necessarily the overall interests of the individual). Hence, goals influence a person as if the goals themselves were (...) selfish and interested only in their own completion. We argue that there is an evolutionary basis to believe that conscious goals evolved from unconscious and selfish forms of pursuit. This theoretical framework predicts the existence of unconscious goal processes capable of guiding behavior in the absence of conscious awareness and control (theautomaticity principle), the ability of the most motivating or active goal to constrain a person's information processing and behavior toward successful completion of that goal (thereconfiguration principle), structural similarities between conscious and unconscious goal pursuit (thesimilarity principle), and goal influences that produce apparent inconsistencies or counterintuitive behaviors in a person's behavior extended over time (theinconsistency principle). Thus, we argue that a person's behaviors are indirectly selected at the goal level but expressed (and comprehended) at the individual level. (shrink)

In a recent article in this journal, Brian Alters argued that, given the many ways in which the nature of science is described and poor student responses to NOS instruments such as Nature of Scientific Knowledge Scale, Nature of Science Scale, Test on Understanding Science, and others, it is time for science educators to reconsider the standard lists of tenets for the NOS. Alters suggested that philosophers of science are authorities on the NOS and that consequently, it would be wise (...) to investigate their views of current NOS tenets. To that end, he conducted a survey of members of the Philosophy of Science Association, and, via various statistical techniques, made claims about the nature and extent of variation among philosophers of science regarding basic beliefs about the NOS. As three philosophers of science, we laud Alters’ attempt to understand philosophers of science’ view on the NOS. We believe, however, that his techniques for investigating this question are inappropriate and that consequently, several of his conclusions are unwarranted. In this comment, we will substantiate these criticisms. In addition, we will address some of the important questions that motivate Alters’ research and attempt to unravel the “byzantine complexity” of philosophical views about the NOS. We begin with our concerns regarding Alters’ research. We then provide a taxonomy of philosophic issues; and finally, we suggest some roles for philosophy of science in science teaching and the education of science teachers. (shrink)

The National Institutes of Health and other federal health agencies are considering establishing a national biobank to study the roles of genes and environment in human health. A preliminary public engagement study was conducted to assess public attitudes and concerns about the proposed biobank, including the expectations for return of individual research results. A total of 141 adults of different ages, incomes, genders, ethnicities, and races participated in 16 focus groups in six locations across the country. Focus group participants voiced (...) a strong desire to be able to access individual research results. Recognizing the wide range of possible research results from a large cohort study, they repeatedly and spontaneously suggested that cohort study participants be given ongoing choices as to which results they received. (shrink)

When we consider early modern philosophers who engage with sceptical arguments, Nicolas Malebranche is not usually among the first names to come to mind. But, while Malebranche does not spend much time with this topic, the way in which he responds to it when he does is nevertheless valuable. This is because his response underlines the central role of a particular principle in his system: the utter dependence of all created things on God. In this paper, I argue that the (...) end of Malebranche’s engagement with scepticism in general is to show that it is a position, like atheism, that is only possible if one has a disordered imagination. And, importantly, one feature of a disordered imagination is the questioning or denial of what Malebranche takes to be a foundational principle of human knowledge: that we, and all other finite things, utterly depend on God for everything. (shrink)

BackgroundChildhood abuse increases risk for high levels of distress in response to future stressors. Interpersonal social support is protective for health, particularly during stress, and may be particularly beneficial for individuals who experienced childhood abuse.ObjectiveInvestigate whether childhood abuse predicts levels of posttraumatic stress disorder (PTSD) symptoms related to the COVID-19 pandemic, and test whether the perceived availability of social companionship preceding the pandemic moderates this relationship.MethodsDuring Phase 1, adults (N= 120; AgeM[SD] = 19.4 [0.94]) completed a retrospective measure of childhood (...) adversity along with a measure of perceived availability of opportunities for social engagement immediately preceding the pandemic. Two weeks after the COVID-19 pandemic declaration, participants completed the Impact of Event Scale-Revised (IES-R) with respect to the pandemic. Hierarchical linear regression analyses examined the interaction between childhood abuse and the perceived availability of social companionship preceding the pandemic as a predictor of PTSD symptoms.ResultsAdjusting for covariates, the interaction between childhood abuse and perceived availability of others to engage with before the onset of the pandemic was a significant predictor of IES-hyperarousal (β = −0.19,t= −2.06,p= 0.04, ΔR2= 0.032, CI: [−0.31 to −0.01]).ConclusionLevels of perceived opportunities for social companionship before the pandemic associates with levels of hyperarousal related to the pandemic, particularly for individuals who experienced high levels of childhood abuse. More research is needed to understand how to mitigate the higher levels of distress related to the pandemic for these individuals in order to reduce risk for future psychiatric disorders. (shrink)

“I am not mad, most noble Festus, but speak the words of truth and soberness.” In this cry of Paul's we hear the idealist in all ages making his agonized claim to realism in face of the Powers that Be. Festus and Agrippa represent the ex-officio history-makers in this scene. Paul is proclaiming fundamental facts and possibilities that those who have power fail to see. And so, in claiming to be sane, he becomes the spokesman for all who see the (...) Not-Yet as stronger than the Now, and behold What is Meant to Be as more powerful than What Is. (shrink)

He upon whom has descended the “amor intellectualis Dei” must make up his mind to walk much alone. In the world of “intellectuals” he is at present “out of the swim,” and his work must be done against the prevailing current. And among the generality of religious people, he is regarded as rather a disturbing presence in matters of faith, apt to fall short, apparently, of their own standards in the service of God. “The love of the mind for God” (...) has little popular esteem in English-speaking Christianity. The nineteenth century valued feeling as the chief element in religion, and the emphasis of to-day is on the practical service of the will. But in our tradition, from Colet and the Cambridge Platonists to Westcott and von Hiigel, the “amor intellectualis Dei” has produced a line of great men of God, and surely will never be without its witnesses. Their message is a two-fold one. First that every experience of life can be “produced” into an experience of God by an effort of personality in which creative thought and constructive imagination has its part, second that this “love of the mind” is natural in some degree to all men, and an end in itself, giving to each lover an original vision. “It is Origen,” writes Dean Inge, “who in words thrilling alike by their humility and confidence, proclaims that ‘as the eye seeks the light, as our body craves for food, so our mind is impressed with the natural desire of knowing the truth of God and the causes of what we observe.’”. (shrink)

The last decades have seen major advances in the study of gestures both in humans and non-human primates. In this paper, we seriously examine the idea that there may be gestural form types that are shared across great ape species, including humans, which may underlie gestural universals, both in form and meaning. We focus on one case study, the hand fling gesture common to chimpanzees and humans, and provide a semantic analysis of this gesture.

Over the past 30 years, the Australian state of Victoria has made numerous reforms to a set of jury directions purporting to address concerns that rape trials do not adequately respond to the reality of sexual offending in the community. Building on work identifying the predominant narratives mobilised in rape trials, in this article we consider whether the way in which a jury consumes information during a trial explains why the jury directions, positioned and utilised as they are, appear to (...) have been inadequate to the task of enabling juries to re-imagine evidence through alternative narrative frameworks. (shrink)

Recent debates about inequality have focused almost exclusively on the distribution of wealth and disparities in income, but little notice has been paid to the distribution of free time. Free time is commonly assumed to be a matter of personal preference, a good that one chooses to have more or less of. Even if there is unequal access to free time, the cause and solution are presumed to lie with the resources of income and wealth. In Free Time, Julie (...) Rose argues that these views are fundamentally mistaken. First, Rose contends that free time is a resource, like money, that one needs in order to pursue chosen ends. Further, realizing a just distribution of income and wealth is not sufficient to ensure a fair distribution of free time. Because of this, anyone concerned with distributive justice must attend to the distribution of free time. On the basis of widely held liberal principles, Rose explains why citizens are entitled to free time—time not committed to meeting life's necessities and instead available for chosen pursuits. The novel argument that the just society must guarantee all citizens their fair share of free time provides principled grounds to address critical policy choices, including work hours regulations, Sunday closing laws, public support for caregiving, and the pursuit of economic growth. Delving into an original topic that touches everyone, Free Time demonstrates why all citizens have, in the words of early labor reformers, a right to "hours for what we will.". (shrink)

This collection of papers investigates the most recent debates about individualism and holism in the philosophy of social science. The debates revolve mainly around two issues: firstly, whether social phenomena exist sui generis and how they relate to individuals. This is the focus of discussions between ontological individualists and ontological holists. Secondly, to what extent social scientific explanations may and should, focus on individuals and social phenomena respectively. This issue is debated amongst methodological holists and methodological individualists. -/- In social (...) science and philosophy, both issues have been intensively discussed and new versions of the dispute have appeared just as new arguments have been advanced. At present, the individualism/holism debate is extremely lively and this book reflects the major positions and perspectives within the debate. This volume is also relevant to debates about two closely related issues in social science: the micro-macro debate and the agency-structure debate. -/- This book presents contributions from key figures in both social science and philosophy, in the first such collection on this topic to be published since the 1970s. -/- . (shrink)