This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the protocol, summarize the protocol, and discuss the major ethical challenges (...) encountered, along with our answers to the challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments.We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the pandemic and similar public health emergencies. (shrink)

Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

Consumer concern for “ethical products”, or ethical aspects of the goods which they purchase, is a subject of increasing interest and research,which is here illustrated by an examination of the Fair Trade movement, with special reference to coffee as an indicative commodity. Kate Bird, is currently Lecturer in the Development Administration Group, School of Public Policy, Birmingham University, Birmingham B15 2TT, England, having previously worked abroad and written her MSc dissertation at Wye College on fair trade in coffee products. Dr (...) Hughest holds the Sainsbury Chair in Agribusiness and Food Marketing at Wye College, University of London, Wye, Ashford, Kent TN25 5AH, England (email: D.Hughes@wye.ac.uk), where he is also Director of the Food Industry Management Group. He has wide international experience of food management issues. (shrink)

Consumer concern for “ethical products”, or ethical aspects of the goods which they purchase, is a subject of increasing interest and research,which is here illustrated by an examination of the Fair Trade movement, with special reference to coffee as an indicative commodity. Kate Bird, is currently Lecturer in the Development Administration Group, School of Public Policy, Birmingham University, Birmingham B15 2TT, England, having previously worked abroad and written her MSc dissertation at Wye College on fair trade in coffee products. Dr (...) Hughest holds the Sainsbury Chair in Agribusiness and Food Marketing at Wye College, University of London, Wye, Ashford, Kent TN25 5AH, England (email: D.Hughes@wye.ac.uk), where he is also Director of the Food Industry Management Group. He has wide international experience of food management issues. (shrink)

Quite rightly, philosophers of physics examine the theories of physics, theories like Quantum Mechanics, Quantum Field Theory, the Special and General Theories of Relativity, and Statistical Mechanics. Far fewer, however, examine how these theories are put to use; that is to say, little attention is paid to the practices of theoretical physicists. In the early 1950s David Bohm and David Pines published a sequence of four papers, collectively entitled, ‘A Collective Description of Electron Interaction.’ This essay uses that quartet as (...) a case study in theoretical practice. In Part One of the essay, each of the Bohm-Pines papers is summarized, and within each summary an overview is given, framing a more detailed account. In Part Two theoretical practice is broken into six elements: (a) the use of models, (b) the use of theory, (c) modes of description and narrative, (d) the use of approximations, (e) experiment and theory, (f) the varied steps employed in a deduction. The last element is the largest, drawing as it does from the earlier ones. Part Three enlarges on the concept of ‘theoretical practice,’ and briefly outlines the subsequent theoretical advances which rendered the practices of Bohm and Pines obsolete, if still respected. (shrink)

In Classical Quarterly N.S. ix , 80 ff. Professor Hugh Lloyd-Jones published an article on the closing scenes of Seven Against Thebes. In it he directed an assault on the orthodox belief that these scenes are, in whole or in part, not authentic. The movement in favour of authenticity seemed all the stronger when independently, and in the same year, Walter Potscher put forward arguments in Eranos in defence of some parts of the disputed passages.

Uncoupling proteins (UCPs) regulate mitochondrial function, and thus cellular metabolism. Angiotensin‐converting enzyme (ACE) is the central component of endocrine and local tissue renin–angiotensin systems (RAS), which also regulate diverse aspects of whole‐body metabolism and mitochondrial function (partly through altering mitochondrial UCP expression). We show that ACE expression also appears to be regulated by mitochondrial UCPs. In genetic analysis of two unrelated populations (healthy young UK men and Scandinavian diabetic patients) serum ACE (sACE) activity was significantly higher amongst UCP3‐55C (rather than (...) T) and UCP2 I (rather than D) allele carriers. RNA interference against UCP2 in human umbilical vein endothelial cells reduced UCP2 mRNA sixfold (P < 0·01) whilst increasing ACE expression within a physiological range (<1·8‐fold at 48 h; P < 0·01). Our findings suggest novel hypotheses. Firstly, cellular feedback regulation may occur between UCPs and ACE. Secondly, cellular UCP regulation of sACE suggests a novel means of crosstalk between (and mutual regulation of) cellular and endocrine metabolism. This might partly explain the reduced risk of developing diabetes and metabolic syndrome with RAS antagonists and offer insight into the origins of cardiovascular disease in which UCPs and ACE both play a role. (shrink)

In this paper we investigate some families of decision problems associated with a restricted class of Post canonical forms, specifically, those defined over one-letter alphabets whose productions have single premises and contain only one variable. For brevity sake, we call any such form an RPCF (Restricted Post Canonical Form). Constructive proofs are given which show, for any prescribed nonrecursive r.e. many-one degree of unsolvability D, the existence of an RPCF whose word problem is of degree D and an RPCF with (...) axiom whose decision problem is also of degree D. Finally, we show that both of these results are best possible in that they do not hold for one-one degrees. (shrink)

Catalogue of the Hugh Nevill Collection of Sinhalese Manuscripts in the British Library. K. D. Somadasa. Pali Text Society and the British Library. Vol. 1, 1987. xi, 440 pp. £22.00. Vol. 2, 1989. vii, 316 pp. £24.95.

"By combining recent advances in the physical sciences with some of the novel ideas, techniques, and data of modern biology, this book attempts to achieve a new and different kind of evolutionary synthesis. I found it to be challenging, fascinating, infuriating, and provocative, but certainly not dull."--James H, Brown, University of New Mexico "This book is unquestionably mandatory reading not only for every living biologist but for generations of biologists to come."--Jack P. Hailman, Animal Behaviour , review of the first (...) edition "An important contribution to modern evolutionary thinking. It fortifies the place of Evolutionary Theory among the other well-established natural laws."--R.Gessink, TAXON. (shrink)

This article examines the meaning and role of conscience in the political theology of John Calvin. It argues that the focus in Calvin scholarship on whether conscience makes political order possible without the aid of scripture is misplaced. Although Calvin views conscience as a providential gift that restrains evil to some degree, he puts forth this claim only as part of his defence of God's right to punish all humans eternally. Conscience, that is, renders humans 'inexcusable' before God. Thus, to (...) ask whether conscience makes political order possible in and of itself is to ask a question with which Calvin does not concern himself. Doing so obscures the real significance of conscience for Calvin's political theory: conscience as the starting point for the construction of a Christian polity. The torments of conscience prompt individuals to seek relief, driving them to Christ for salvation and forgiveness of their sins. This, in turn, leads them to submit willingly to the 'external aids' or 'outward helps' of the church and civil government in order to live just and virtuous lives. (shrink)

Ethical guidelines for conducting clinical trials have historically been based on a perceived therapeutic obligation to treat and benefit the patient-participants. The origins of this ethical framework can be traced to the Hippocratic oath originally written to guide doctors in caring for their patients, where the overriding moral obligation of doctors is strictly to do what is best for the individual patient, irrespective of other social considerations. In contrast, although medicine focuses on the health of the person, public health is (...) concerned with the health of the entire population, and thus, public health ethics is founded on the societal responsibility to protect and promote the health of the population as a whole. From a public health perspective, research ethics should be guided by giving due consideration to the risks and benefits to society in addition to the individual research participants. On the basis of a duty to protect the population as a whole, a fiduciary obligation to realise the social value of the research and the moral responsibility to distribute the benefits and burdens of research fairly across society, how a public health perspective on research ethics results in fundamental re-assessments of the proper course of action for two salient topical issues in research ethics is shown: stopping trials early for reasons of efficacy and the conduct of research on less expensive yet less effective interventions. (shrink)

Currently, an emphasis is being placed on the integration of ethical issues into the business curriculum. This paper investigates the viability of using student group interaction to induce an upward movement in the stages of moral development as advanced by Kohlberg. The results of a classroom experiment using graduate business law students suggest that formulating groups that mix stages of moral development can provide a robust environment for upward movement. In addition, the results suggest strategies for formulating effective groups, based (...) upon entry levels as measured by the Defining Issues Test. (shrink)

Offers a comprehensive nonmathematical treatment regarding the design and analysis of experiments, focusing on basic concepts rather than calculation of technical details. Much of the discussion is in terms of examples drawn from numerous fields of applications. Subjects include the justification and practical difficulties of randomization, various factors occurring in factorial experiments, selecting the size of an experiments, different purposes for which observations may be made and much more.

In this paper I contend that the 'superfluity' of triangles is only apparent; all those specified are indeed required for the smallest sub-units, so long as the symmetry of the final body to be constructed is taken into account at earlier stages.