Reconstructive allografts using Vascularized Composite Allotransplantation are providing individuals living with upper limb loss and facial disfigurement with new opportunities for a sensate, esthetically acceptable, and functional alternative to current treatment strategies. Important research attention is being paid to how best to assess and screen candidates for VCA, measure optimal patient outcomes, and support patient adherence to lifelong behaviors and medical regimens. Far less attention, however, has been dedicated to the team science required for these complex VCA teams to form, (...) prepare, and provide the highest quality clinical and psychosocial care to those receiving VCA. VCA teams are unique in that they require specialized team members whose scope of practice may not otherwise overlap. The team also needs to constantly negotiate balancing patient safety with multiple risks throughout the transplant process. This study aimed to elucidate the team science needed for this highly innovative and complex area of medicine. Using in-depth qualitative interviews with 14 VCA team members and observations at team meetings, we found that careful consideration of team composition, team structure, and organizational commitment influences team performance and patient outcomes, but that to be efficient and truly effective, teams need to commit to developing processes that foster collaboration. These processes are action-oriented, strategic and interpersonal. Dedication and commitment to team science allows teams to manage conflict under stress and exercise ways to leverage strengths to provide optimal performance or patient psychosocial and clinical outcomes. This study can provide insight into quality improvement efforts for VCA teams and guidance for other transplant programs that wish to consider expansion into VCA. (shrink)

The goals of vascular composite allotransplantation for hand are to maximize functional status and psychosocial wellbeing and to improve quality of life. Candidates are carefully vetted by transplant programs through an extensive evaluation process to exclude those patients with contraindications and to select those that are most likely to attain functional or quality of life benefit from transplant. Patient choice for any treatment, however, requires that candidates be able to understand the risks, benefits, and alternatives before choosing to proceed. This (...) study aimed to understand patients’ knowledge and perceptions about treatment options for hand loss, including hand transplant. This study will be used to inform a standardized education approach and develop conversation aids for use by clinicians and patients throughout the treatment decision process. Ten individuals who had experienced hand amputation or had congenital limb loss were interviewed to better understand previous and current decisions about treatment, experiences in adjusting to their treatment, and perceptions about hand VCA. From this qualitative interview data, four findings emerged: knowledge and education around VCA as a treatment option; adaptation of individuals with limb loss; fear of risk associated with transplantation; issues of aging and overuse injuries to existing limbs. Results suggests that there is opportunity for expanding education about all treatment options for patients with new loss, long-term loss, and congenital limb loss. Establishing a baseline of knowledge about all options–prosthetics, rehabilitative strategies, and VCA—can help patients evaluate their values and goals of treatment. Issues associated with aging, including overuse and injury, and adaptability over the life course should be included in considerations about treatment choices. Data indicate the need for routinely assessing patient preferences about treatment choice so patients can plan for their future as they adapt and age and as technology for treatments change. To assure that thorough information is provided for current and future decision-making, education about treatment choices and selection procedures for VCA should be standardized. (shrink)

A crisis continues to brew within the pharmaceutical research and development (R&D) enterprise: productivity continues declining as costs rise, despite ongoing, often dramatic scientific and technical advances. To reverse this trend, we offer various suggestions for both the expansion and broader adoption of modeling and simulation (M&S) methods. We suggest strategies and scenarios intended to enable new M&S use cases that directly engage R&D knowledge generation and build actionable mechanistic insight, thereby opening the door to enhanced productivity. What M&S requirements (...) must be satisfied to access and open the door, and begin reversing the productivity decline? Can current methods and tools fulfill the requirements, or are new methods necessary? We draw on the relevant, recent literature to provide and explore answers. In so doing, we identify essential, key roles for agent-based and other methods. We assemble a list of requirements necessary for M&S to meet the diverse needs distilled from a collection of research, review, and opinion articles. We argue that to realize its full potential, M&S should be actualized within a larger information technology framework—a dynamic knowledge repository—wherein models of various types execute, evolve, and increase in accuracy over time. We offer some details of the issues that must be addressed for such a repository to accrue the capabilities needed to reverse the productivity decline. (shrink)

This is the first book to offer the best essays, articles, and speeches on ethics and intelligence that demonstrate the complex moral dilemmas in intelligence collection, analysis, and operations. Some are recently declassified and never before published, and all are written by authors whose backgrounds are as varied as their insights, including Robert M. Gates, former Director of the Central Intelligence Agency; John P. Langan, the Joseph Cardinal Bernardin Professor of Catholic Social Thought at the Kennedy Institute of Ethics, (...) Georgetown University; and Loch K. Johnson, Regents Professor of Political Science at the University of Georgia and recipient of the Owens Award for contributions to the understanding of U.S. intelligence activities. Creating the foundation for the study of ethics and intelligence by filling in the gap between warfare and philosophy, this is a valuable collection of literature for building an ethical code that is not dependent on any specific agency, department, or country. (shrink)

Bazzocchi disposes the text of the Tractatus in a user-friendly manner, exactly as Wittgenstein's decimals advise. This discloses the logical form of the book by distinct reading units, linked into a fashioned hierarchical tree. The text becomes much clearer and every reader can enjoy, finally, its formal and literary qualities.

The optimal design of cables under selfweight and concentrated loads is considered and the maximum feasible span for a given permissible stress is evaluated. All solutions are obtained in a closed analytical form.

Since the BBS article in which Premack and Woodruff (1978) asked “Does the chimpanzee have a theory of mind?,” it has been repeatedly claimed that there is observational and experimental evidence that apes have mental state concepts, such as “want” and “know.” Unlike research on the development of theory of mind in childhood, however, no substantial progress has been made through this work with nonhuman primates. A survey of empirical studies of imitation, self-recognition, social relationships, deception, role-taking, and perspective-taking suggests (...) that in every case where nonhuman primate behavior has been interpreted as a sign of theory of mind, it could instead have occurred by chance or as a product of nonmentalistic processes such as associative learning or inferences based on nonmental categories. Arguments to the effect that, in spite of this, the theory of mind hypothesis should be accepted because it is more parsimonious than alternatives or because it is supported by convergent evidence are not compelling. Such arguments are based on unsupportable assumptions about the role of parsimony in science and either ignore the requirement that convergent evidence proceed from independent assumptions, or fail to show that it supports the theory of mind hypothesis over nonmentalist alternatives. Progress in research on theory of mind requires experimental procedures that can distinguish the theory of mind hypothesis from nonmentalist alternatives. A procedure that may have this potential is proposed. It uses conditional discrimination training and transfer tests to determine whether chimpanzees have the concept “see.” Commentators are invited to identify flaws in the procedure and to suggest alternatives. Key Words: apes; associative learning; concepts; convergence; deception; evolution of intelligence; folk psychology; imitation; mental state attribution; monkeys; parsimony; perspective-taking; primates; role-taking; self-recognition; social cognition; social intelligence; theory of mind. (shrink)

Features include a comprehensive review of existing material, combined with new perspectives to equip students for the challenges in the work environment; chapter overviews and student learning objectives offer a solid and useful framework in which to organise study; diagrams and charts present overviews and contexts for the subject to act as useful revision aids; effective pedagogy including a review of the arguments considered, a menu of seminar topics, and questions in every chapter, serving as an ideal basis for seminar (...) study; and additional open-ended simulations to allow students to work through unfolding scenarios. (shrink)

Sleep onset is associated with marked changes in behavioral, physiological, and subjective phenomena. In daily life though subjective experience is the main criterion in terms of which we identify it. But very few studies have focused on these experiences. This study seeks to identify the subjective variables that reflect sleep onset. Twenty young subjects took an afternoon nap in the laboratory while polysomnographic recordings were made. They were awakened four times in order to assess subjective experiences that correlate with the (...) (1) appearance of slow eye movement, (2) initiation of stage 1 sleep, (3) initiation of stage 2 sleep, and (4) 5 min after the start of stage 2 sleep. A logistic regression identified control over and logic of thought as the two variables that predict the perception of having fallen asleep. For sleep perception, these two variables accurately classified 91.7% of the cases; for the waking state, 84.1%. (shrink)

Principles and the context, by J. C. Bennett.--Love monism, by J. M. Gustafson.--Responsibility in freedom, by E. C. Gardner.--The new morality, by G. Fackre.--When love becomes excarnate, by H. L. Smith.--Situational morality, by R. W. Gleason.--The nature of heresy, by G. Kennedy.--Situation ethics under fire, by J. Fletcher.

Most liberals agree that governments should protect certain basic liberties, such as freedom of speech, freedom of religion and freedom of the person. Liberals disagree, however, about whether free market rights should also be protected. By “free market rights,” we mean those rights typically associated with laissez-faire economic systems such as freedom of contract, a right to market returns, and claims to privately own the means of production.We do not use the phrase “economic liberties,” as Tomasi does, because it does (...) not distinguish between the “economic rights” defended by classical liberal and those defended by socialists. Those on the right often see such freedoms as core liberal commitments, while those on the left argue that an economic system should be organized to protect the interests of the less advantaged members of society. If free market rights should be protected, then most existing societies are unjust. These societies fail the liberal standard in the same ways as th .. (shrink)

This third edition offers increased coverage of sustainability and more chances for illustration and discussion of ethics in the messy day to day practicalities ...

To be a conventionalist about a specific obligation or right is to believe that the obligation or right is dependent on the existence of a social practice. A conventionalist about property, for example, believes that a moral right to property is generated by conventional norms rather than by any natural right. One problem with dominant conventionalist theories is that they do not adequately justify conventional moral claims. They can justify why it is wrong to steal, for example, but they do (...) not justify the claim that you have on me to not steal from you. As a remedy, this article develops and defends the Principle of Legitimate Expectations. Suggested by John Rawls, this principle grants individuals a moral claim to what the rules of morally justified practices entitle them. This article addresses common objections to the principle to show how it can ground a wide range of conventional moral claims. (shrink)

Convinced that "the role of philosophy in the advancement of science is to make trouble," Erwin Straus has led an informal group of college professors, permanent research staffs of the Lexington's psychiatric hospitals, and a parade of young government doctors, to challenge the foundations of their disciplines to come up with a synoptic view of psychiatry. In this book a French psychiatrist and an American philosopher join Straus in issuing the call to a wider audience. Straus finds that psychiatry grew (...) up within the mechanist tradition, with its split between mind and body. He urges the replacement of this model by a phenomenological one. This point of view is one link among the essays of the book. Another link is their prior publication in Psychiatrie der Gegenwart, Band 1/2, an international work intended to breach the walls between Continental and Anglo-Saxon psychiatries. Straus' paper is translated from the German by E. Eng, and Ey's from the French by S. C. Kennedy. Ey contributes a summary of his thirty-years work: to formulate an organodynamic conception of mental disease. Nathanson considers such questions as, What is the epistemic root for the concept of "normalcy" which psychiatry uses and builds upon?, and How is it possible that human reality has as one of its major expressions, the "abnormal"?--M. B. M. (shrink)

In The Tyranny of the Ideal, Gerald Gaus gives an extended argument on behalf of the “Open Society.” Instead of claiming that it is uniquely best from some privileged moral perspective, he argues for the Open Society by showing why it is acceptable to many perspectives. In this way, Gaus argues for a liberal market-based society in a way that treats deep diversity as a fundamental feature of social life. However, the argument falters at four important points. When taken together, (...) these four problems significantly limit the significance of Gaus’s conclusions. (shrink)

Background If trials of therapeutic interventions are to serve society's interests, they must be of high methodological quality and must satisfy moral commitments to human subjects. The authors set out to develop a clinical - trials compendium in which standards for the ethical treatment of human subjects are integrated with standards for research methods. Methods The authors rank-ordered the world's nations and chose the 31 with >700 active trials as of 24 July 2008. Governmental and other authoritative entities of the (...) 31 countries were searched, and 1004 English-language documents containing ethical and/or methodological standards for clinical trials were identified. The authors extracted standards from 144 of those: 50 designated as ‘core’, 39 addressing trials of invasive procedures and a 5% sample of the remainder. As the integrating framework for the standards we developed a coherent taxonomy encompassing all elements of a trial's stages. Findings Review of the 144 documents yielded nearly 15 000 discrete standards. After duplicates were removed, 5903 substantive standards remained, distributed in the taxonomy as follows: initiation, 1401 standards, 8 divisions; design, 1869 standards, 16 divisions; conduct, 1473 standards, 8 divisions; analysing and reporting results, 997 standards, four divisions; and post-trial standards, 168 standards, 5 divisions. Conclusions The overwhelming number of source documents and standards uncovered in this study was not anticipated beforehand and confirms the extraordinary complexity of the clinical trials enterprise. This taxonomy of multinational ethical and methodological standards may help trialists and overseers improve the quality of clinical trials, particularly given the globalisation of clinical research. (shrink)

This article challenges a reductive analysis of social practices by distinguishing five kinds of reason for following the rules of conventional practices. Depending on one’s preferred intellectual tradition, conventional practices enable coordination, facilitate cooperation, constitute activities, fulfil reciprocity, or specify abstract rights. Instead of being rival theories of social practices, these different models complement one another in a normative analysis of social practices. By distinguishing five kinds of reasons to follow conventional rules, this paper supports a more dynamic conventionalist analysis (...) of subjects like property, the law, professional obligation, civic responsibility, and culture. (shrink)

Few historical subjects have generated such intense and sustained interest in recent decades as Britain's imperial past. What accounts for this preoccupation? Why has it gained such purchase on the historical imagination? How has it endured even as its subject slips further into the past?In seeking to answer these questions, the proposed volume brings together some of the leading figures in the field, historians of different generations, different nationalities, different methodological and theoretical perspectives and different ideological persuasions. Each addresses the (...) relationship between their personal development as historians of empire and the larger forces and events that helped to shape their careers. The result is a book that investigates the connections between the past and the present, the private and the public, the professional practices of historians and the political environments within which they take shape. This intellectual genealogy of the recent historiography of empire will be of great value to anyone studying or researching in the field of imperial history. (shrink)

The dominant conventionalist view explains the wrong of breaking a promise as failing to do our fair share in supporting the practice of promise-keeping. Yet, this account fails to explain any unique moral standing that a promisee has to demand that the promisor keep the promise. In this paper, I provide a conventionalist response to this problem. In any cooperative practice, participants stand as both beneficiary and contributor. As a beneficiary, they are morally required to follow the rules of the (...) practice. As a contributor, they have claims on other participants to follow the rules. According to the rules of promise-keeping, a promisee has a unique claim on the promisor, and the personal wrong of breaking a promise should be understood as the violation of this unique and practice-dependent claim. (shrink)

Rawlsians argue for principles of justice that apply exclusively to the basic structure of society, but it can seem strange that those who accept these principles should not also regulate their choices by them. Valid moral principles should seemingly identify ideals for both institutions and individuals. What justifies this nonintuitive distinction between institutional and individual principles is not a moral division of labor but Rawls’s dual commitments to conventionalism and constructivism. Conventionalism distinguishes the relevant ideals for evaluating institutions from those (...) for evaluating actions, while constructivism explains why this distinction is morally fundamental. (shrink)

In Grimes v. Kennedy Krieger Institute, the Maryland Court of Appeals considered whether it is possible for investigators or research entities to have a special relationship with subjects, thereby creating a duty of care that could, if breached, give rise to an action in negligence. The research under review, the Lead Abatement and Repair & Maintenance Study, was conducted from 1993 to 1996 by investigators at the Kennedy Krieger Institute, an affiliate of Johns Hopkins University.After briefly discussing the (...) case at the center of this ruling, I consider how ambiguities within the federal research regulations at 45 C.F.R. § 46 contribute to disagreements among reasonable and informed people of good will about what studies should be approved. I argue that Grimes may be understood as placing restrictions on how these regulations may be interpreted and used. (shrink)

I argue that acknowledging Hume as a doxastic naturalist about belief in a deity allows an elegant, holistic reading of his Dialogues. It supports a reading in which Hume's spokesperson is Philo throughout, and enlightens many of the interpretive difficulties of the work. In arguing this, I perform a comprehensive survey of evidence for and against Philo as Hume's voice, bringing new evidence to bear against the interpretation of Hume as Cleanthes and against the amalgamation view while correcting several standard (...) mistakes. I ultimately isolate the interpretation of Philo's Reversal at the end of the Dialogues as of paramount importance, and show how my naturalistic interpretation makes this, and other notoriously difficult passages, unproblematic. (shrink)

In Grimes v. Kennedy Krieger Institute, the Maryland Court of Appeals considered whether it is possible for investigators or research entities to have a special relationship with subjects, thereby creating a duty of care that could, if breached, give rise to an action in negligence. The research under review, the Lead Abatement and Repair & Maintenance Study, was conducted from 1993 to 1996 by investigators at the Kennedy Krieger Institute, an affiliate of Johns Hopkins University.After briefly discussing the (...) case at the center of this ruling, I consider how ambiguities within the federal research regulations at 45 C.F.R. § 46 contribute to disagreements among reasonable and informed people of good will about what studies should be approved. I argue that Grimes may be understood as placing restrictions on how these regulations may be interpreted and used. (shrink)

In his own writings, Rawls purposively used only a loose characterization of the basic structure, but two prominent misinterpretations highlight the current need for a more detailed account. First, G.A. Cohen argues that the Rawlsian focus on the basic structure is arbitrary due to the Rawlsian appeal to profound effects. Second, some theorists conflate the justification of coercion with the assessment of a basic structure by defining the basic structure as the coercive structure. Both misinterpretations can be corrected by carefully (...) specifying what social institutions are and explaining which social institutions come together to form the basic structure of society. (shrink)

Most criticism and exposition of John Rawls’s political theory has focused on his account of distributive justice rather than on his support for liberalism. Because of this, much of his argument for protecting the basic liberties remains under explained. Specifically, Rawls claims that representative citizens would agree to guarantee those social conditions necessary for the exercise and development of the two moral powers, but he does not adequately explain why protecting the basic liberties would guarantee these social conditions. This gap (...) in his argument leads to two problems. First, the Rawlsian argument for the priority of liberty would fail if the gap could not be filled. His argument would still support the protection of individual freedoms, but these freedoms would be treated like other primary goods and regulated by the difference principle. Second, without a full argument, there is not sufficient reason to favor Rawls’s left-liberal conception of the basic liberties over a more right-leaning conception that would prioritize the protection of free-market rights. To address these two problems, this paper fills in the gap in order to better explain Rawls’s full argument for egalitarian liberalism. (shrink)

Objective: To examine the current ethical review process of ethics committees in a non-pharmacological trial from the perspective of a clinical investigator.Design: Prospective collection of data at the Study Centre of the German Surgical Society on the duration, costs and administrative effort of the ERP of a randomised controlled multicentre surgical INSECT Trial between November 2003 and May 2005.Setting: Germany.Participants: 18 ethics committees, including the ethics committee handling the primary approval, responsible overall for 32 clinical sites throughout Germany. 8 ethics (...) committees were located at university medical schools and 10 at medical chambers. Duration was measured as days between submission and receipt of final approval, costs in euros and administrative effort by calculation of the product of the total number of different types of documents and the mean number of copies required .Results: The duration of the ERP ranged from 1 to 176 days. The median duration was 26 days at MSUs compared with 34 days at medical chambers. The total cost was €2947. 1 of 8 ethics committees at universities and 8 of 10 at medical chambers charged a median fee of €162 . The administrative effort for primary approval was 30. Four ethics committees required a higher administrative effort for secondary approval .Conclusion: The ERP for non-pharmacological multicentre trials in Germany needs improvement. The administrative process has to be standardised: the application forms and the number and content of the documents required should be identical or at least similar. The fees charged vary considerably and are obviously too high for committees located at medical chambers. However, the duration of the ERP was, with some exceptions, excellent. A centralised ethics committee in Germany for multicentre trials such as the INSECT Trial can simplify the ERP for clinical investigators in and outside the country. (shrink)

The precise position to be assigned to the Categories in the Aristotelian system has always been somewhat of a puzzle. On the one hand, they seem to be worked into the warp of its texture, as in the classification of change, and Aristotle can argue from the premiss that they constitute an exhaustive division of the kinds of Being . On the other hand, both in the completed scheme of his logic and in his constructive metaphysic they retire into the (...) background, giving place to other notions, such as causation, change, actuality and potentiality. Investigation has, moreover, been hampered, especially in Germany, by attempts to correlate them with the Kantian Categories, with which they have obvious points of contact. But Kant's formal a priori concepts by which the mind makes for itself a world, to use Mr. Bosanquet's phrase, imply an attitude to knowledge and reality so utterly opposed to the Aristotelian that the comparison has tended to confusion rather than elucidation. Scholars now realize better that the Aristotelian Categories can only be understood in connexion with the problems of Aristotle's own age. (shrink)

In Strategic Justice, Peter Vanderschraaf introduces a “Baseline Consistency” criterion for Justice as Mutual Advantage. This criterion requires assessing how well individuals fare under existing conventions with how well they would fare under hypothetical social conditions. However, this comparison requires the impossible. Under different social conditions, individuals would have different preferences and different interests. As such, we cannot make any direct comparison between how well an individual fares across the two social conditions. The standard of assessment would change from one (...) context to the other. In order to apply the Baseline Consistency criterion, Vanderschraaf would need to justify an interpersonally valid standard for individual welfare, but this is incompatible with his Neo-Hobbesian method. If he abandoned the Baseline Consistency criterion, however, Vanderschraaf faces the “too many equilibria” problem. Conventions that are clearly objectionable would be considered just. (shrink)

The history of the dyestuffs industry during the period 1775–1860 is interesting for three reasons. In the first place it was in connection with the manufacture of synthetic dyestuffs, begun in 1856, that the industrial research laboratory and the organization scientist first unmistakably appeared in the last decades of the nineteenth century. Secondly, there are the enigmas of W. H. Perkin, the man who discovered and manufactured the first coal-tar colours, but who retired somewhat abruptly from the industry in 1874: (...) just after the synthesis of alizarine. Thirdly, the dyestuffs industry was in intimate association with the textile industries which had for a long time been subject to frequent radical scientific and technological innovation. Among the most important of these we may mention John Smeaton's classic paper of 1759 on the maximum work obtainable from a given fall of water: a problem important not only for the abstract science of mechanics, but also for the design of waterwheels—the main source of power for the early textile mills. (The waterwheel was not, during the eighteenth century, the epitome of the quaint and picturesque: it was in the van of scientific and technical progress.) Again, the textile industries were quick to employ the Watt rotative engine; previously a two cylinder Newcomen engine had been tried out. Bleaching powders, based on Scheele's discovery of chlorine and its properties, were rapidly adopted: in this context one cannot help contrasting the indifference of medical science to Davy's early suggestion of using nitrous oxide as an anaesthetic; or Faraday's comment in 1818 on the anaesthetic power of sulphuric ether. The textile industries saw, over this period, a rapid succession of new machines, the pace of invention being so hot that in 1832 Charles Babbage reported that machines became obsolete long before they wore out. A Salford cotton mill was the first industrial establishment to use gas lighting: James Thomson, calico printer, introduced gas lighting to the town of Clitheroe when he installed it in his works. And there were many other important technical and scientific innovations. It was to supply these industries, so well accustomed to change, that the synthetic coal-tar dyestuffs were introduced from 1856 onwards. It is interesting that, so far as we can see, the appearance of these synthetic dyestuffs was the last in the series of major innovations in the textiles and related industries: at least until recent times. (shrink)