IntroductionApproaches to improve heart rate variability and reduce stress such as breathing retraining are more frequently being integrated into psychotherapy but little research on their effectiveness has been done to date. Specifically, no studies to date have directly compared using a breathing pacer at 6 breaths per minute with compassion focused soothing rhythm breathing.Current StudyIn this randomized controlled experiment, 6 breaths per minute breathing using a pacer was compared with compassion focused soothing rhythm breathing, with a nature video being used (...) as a control group condition.MethodsHeart rate variability measures were assessed via electrocardiogram and respiration belt, and an automated blood pressure machine was used to measure systolic diastolic blood pressure, and heart rate. A total of 96 participants were randomized into the three conditions. Following a 5-min baseline, participants engaged in either 6 breath per minute breathing, soothing rhythm breathing, or watched a nature video for 10 min. To induce a stressful state, participants then wrote for 5 min about a time they felt intensely self-critical. Participants then wrote for 5 min about a time they felt self-compassionate, and the experiment ended with a 10-min recovery period.ResultsConditions did not significantly differ at baseline. Overall, HRV, as measured by standard deviation of NN intervals, low frequency HRV, and LF/HF ratio, increased during the intervention period, decreased during self-critical writing, and then returned to baseline levels during the recovery period. High frequency HRV was not impacted by any of the interventions. The participants in the 6 breath per minute pacer condition were unable to consistently breathe at that rate and averaged about 12 breaths per minute. Time by Condition analyses revealed that both the 6 breaths per minute pacer and soothing breathing rhythm conditions lead to significantly higher SDNN than the nature video condition during breathing practice but there were no significant differences between conditions in response to the self-critical and self-compassionate writing or recovery periods. The 6 breath per minute pacer condition demonstrated a higher LF HRV and LF/HF ratio than the soothing rhythm breathing condition, and both intervention conditions had a higher LF HRV and LF/HF ratio than the nature video.ConclusionsAlthough the 6 breath per minute pacer condition participants were not able to breath consistently at the low pace, both the participants attempting to breathe at 6 breaths per minute as well as those in the soothing rhythm breathing condition effectively increased HR variability as measured by SDNN, and attempting to breathe at 6 breaths per minute led to the highest LF HRV and LF/HF ratio. Both breathing approaches impacted HRV more than watching a relaxing nature video and can potentially be used as key adjuncts in psychotherapy to aid in regulating physiological functioning, although it appears that consistent breathing practice would be needed. (shrink)

Public health care interventions—regarding vaccination, obesity, and HIV, for example—standardly take the form of information dissemination across a community. But information networks can vary importantly between different ethnic communities, as can levels of trust in information from different sources. We use data from the Greater Pittsburgh Random Household Health Survey to construct models of information networks for White and Black communities--models which reflect the degree of information contact between individuals, with degrees of trust in information from various sources correlated with (...) positions in that social network. With simple assumptions regarding belief change and social reinforcement, we use those modeled networks to build dynamic agent-based models of how information can be expected to flow and how beliefs can be expected to change across each community. With contrasting information from governmental and religious sources, the results show importantly different dynamic patterns of belief polarization within the two communities. (shrink)

Patrick Turmel,François Boucher,Marie-Noëlle Carré.

Objectives To review the extant literature on HIV criminal laws, and to determine the impact of these laws on public health practice.Methods The available research on this topic was obtained and reviewed.Results The extant literature addressed three main topics: people's awareness of HIV criminal laws; people's perceptions of HIV criminal laws; and the potential effects of HIV criminal laws on people's sexual, HIV-status disclosure and healthcare-seeking practices. Within these categories, the literature demonstrated a high level of awareness of HIV criminal (...) laws, but a poor comprehension of these laws. For perceptions, on the whole, the quantitative research identified support for, while the qualitative literature indicated opposition to, these laws. Lastly, the behavioural effects of HIV criminal laws appear to be complex and non-linear.Conclusions A review of the extant literature from a public health perspective leads to the conclusion that HIV criminal laws undermine public health. (shrink)

Recently, focus groups and qualitative interviews with nurses who provide frontline care for persons living with HIV highlighted the contentiousness surrounding the seemingly innocuous activity of counselling clients about HIV‐status disclosure, hereafter disclosure counselling. These empirical studies highlighted that while some nurses felt they should instruct clients to disclose their HIV‐positive status if HIV transmission were possible, other nurses were equally adamant that such counselling was outside the nursing scope of practice. A review of these opposing perceptions about disclosure counselling, (...) including an examination of the empirical evidence which supports each point, revealed that the dichotomous arguments needed to be nuanced. The empirical evidence about serostatus disclosure neither supported nor refuted either of these assertions; rather, it substantiated parts of each. To create this understanding, both empirical and theoretical works are used. First, the results of empirical studies about serostatus disclosure, or lack thereof and HIV transmission is presented; as part of this, Marks and Crepaz's HIV disclosure and exposure framework is examined. Second, the work of Michel Foucault on disciplinary and pastoral power is drawn from. The outcome is a nuanced understanding about the interrelationships between disclosure counselling and nursing practice and a final interpretation about what this understanding means for public health practice. (shrink)

There is a need for empirically based research on social and ethical challenges related to informed consent processes, particularly in studies focusing on adolescent sexual and reproductive health. In a pilot study of a school-based pregnancy prevention intervention in rural Zambia, the majority of the guardians who were asked to consent to their daughters’ participation, refused. In this paper we explore the reasons behind the low participation in the pilot with particular attention to challenges related to the community engagement and (...) informed consent process. The pilot was implemented in two schools and examined the acceptability of a package of interventions including economic support to families to keep their girls in school, pocket money for girls, youth club meetings on reproductive health, and community meetings to sensitize the community. Focus group discussions were conducted with girls who participated in the pilot, boys in their class and with parents. Individual semi-structured interviews were conducted with teachers, peer educators and community health workers involved in the coordination of the intervention as well as with religious and traditional leaders. Data were analyzed through thematic analysis. The findings indicate that inadequate use of recognized community communication channels during the community engagement process and dissemination of information about the pilot resulted in limited understanding of the pilot concept by the community. This surfaced through uncertainty and fear that the intervention may result in loss of control over daughters, worries about why money was provided unconditionally to girls, and suspicion of links to satanism. The sense of insecurity appeared to be exacerbated by low literacy levels, poverty, fear of loss of bride wealth, perceived disregard for local perceptions of social status, and scanty trust in the actors implementing the pilot. Inadequate use of locally appropriate channels in the dissemination of information created room for interpretation and facilitated development of mistrust, undermining the conditions for community engagement and actual informed consent. A key lesson learnt is the importance of taking seriously the complexity of local values and structures that may impact people’s capability to consent or not consent to a study in an informed manner. (shrink)

Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. (...) A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom -based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician’s duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to. (shrink)

Ethical issues in physician-industry and academia-industry relationships have focused largely on the financial nature of these relationships. It took very little time after solutions to transparenc...

Medicine is often thought of as a science of the body, but it is also a science of data. In some contexts, it can even be asserted that data drive health. This article focuses on a key piece of data technology central to contemporary practices of medicine: the medical record. By situating the medical record in the perspective of its history, we inquire into how the kinds of data that are kept at sites of clinical encounter often depend on informational (...) requirements that originate well outside of the clinic, in particular in health insurance records systems. Although this dependency of today's electronic medical records on billing requirements is widely lamented by clinical providers, its history remains little studied. Following the archaeology of medicine developed by Michel Foucault in The Birth of the Clinic and expanding his methodology in light of more recent contributions to the field of media archaeology, this article excavates some of the underexplored technological conditions that help constitute today's electronic medical record. If in some contexts, it is true that data drive health, then an archaeology of medical records helps reveal how health insurance records often impact clinical care and, by extension, health and disease. (shrink)

The genetically manipulated organism crisis demonstrated that technological development based solely on the law of the marketplace and State protection against serious risks to health and safety is no longer a warrant of ethical acceptability. In the first part of our paper, we critique the implicitly individualist social-acceptance model for State regulation of technology and recommend an interdisciplinary approach for comprehensive analysis of the impacts and ethical acceptability of technologies. In the second part, we present a framework for the analysis (...) of impacts and acceptability, devised—with the goal of supporting the development of specific nanotechnological applications—by a team of researchers from various disciplines. At the conceptual level, this analytic framework is intended to make explicit those various operations required in preparing a judgement about the acceptability of technologies that have been implicit in the classical analysis of toxicological risk. On a practical level, we present a reflective tool that makes it possible to take into account all the dimensions involved and understand the reasons invoked in determining impacts, assessing them, and arriving at a judgement about acceptability. (shrink)

Preparing the Next Generation of Oral Historians is an invaluable resource to educators seeking to bring history alive for students at all levels. Filled with insightful reflections on teaching oral history, it offers practical suggestions for educators seeking to create curricula, engage students, gather community support, and meet educational standards. By the close of the book, readers will be able to successfully incorporate oral history projects in their own classrooms.

This is one of four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and nineteen multi-disciplinary partner organizations. Each of the action agenda papers deals with one of the four core elements of public health legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by (...) policymakers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.This paper focuses on the fourth core element: information that can be used in shaping and applying law as a public health tool, specifically in the context of public health emergencies. (shrink)

This is one of four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and nineteen multi-disciplinary partner organizations. Each of the action agenda papers deals with one of the four core elements of public health legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by (...) policymakers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.This paper focuses on the fourth core element: information that can be used in shaping and applying law as a public health tool, specifically in the context of public health emergencies. (shrink)

ObjectiveOverweight and obesity [body mass index ≥ 25 kg/m2] are associated with poorer prognosis among women with breast cancer, and weight gain is common during treatment. Symptoms of depression and anxiety are also highly prevalent in women with breast cancer and may be exacerbated by post-diagnosis weight gain. Altered brain function may underlie psychological distress. Thus, this secondary analysis examined the relationship between BMI, psychological health, and resting state functional connectivity among women with breast cancer.MethodsThe sample included 34 post-menopausal women (...) newly diagnosed with Stage 0-IIa breast cancer who were enrolled in a 6-month randomized controlled trial of aerobic exercise vs. usual care. At baseline prior to randomization, whole-brain analyses were conducted to evaluate the relationship between BMI and seed-to-voxel rsFC of the hippocampus and amygdala. Connectivity values from significant clusters were then extracted and examined as predictors of self-reported depression and anxiety.ResultsMean BMI was in the obese range. For both seeds examined, higher BMI was associated with lower rsFC with regions of prefrontal cortex, including ventrolateral PFC, dorsolateral PFC, and superior frontal gyrus. Hippocampal connectivity with the vlPFC was negatively correlated with self-reported anxiety.ConclusionHigher BMI was associated with lower hippocampal and amygdala connectivity to regions of PFC implicated in cognitive control and emotion regulation. BMI-related differences in hippocampal and amygdala connectivity following a recent breast cancer diagnosis may relate to future worsening of psychological functioning during treatment and remission. Additional longitudinal research exploring this hypothesis is warranted. (shrink)

This volume explores how Catholicism began and continues to open its doors to the wider world and to other confessions in embracing ecumenism, thanks to the vision and legacy of the Second Vatican Council. It explores such themes as the twentieth century context preceding the council; parallels between Vatican II and previous councils; its distinctively pastoral character; the legacy of the council in relation to issues such as church-world dynamics, as well as to ethics, social justice, economic activity. Several chapters (...) discuss the role of women in the church before, during, and since the council. Others discern inculturation in relation to Vatican II. The book also contains a wide and original range of ecumenical considerations of the council, including by and in relation to Free Church, Reformed, Orthodox, and Anglican perspectives. Finally, it considers the Council’s ongoing promise and remaining challenges with regard to ecumenical issues, including a groundbreaking essay on the future of ecumenical dialogue by Cardinal Walter Kasper. (shrink)

The volume contains a collection of papers presented at the International Symposium, which took place in Hvar, Croatia, in 2006. In recent years there has been an upsurge of interest in the study of Plato, Platonism and Neoplatonism. Taking the position that it is of vital importance to establish an ongoing dialogue among scientists, artists, academics, theologians and philosophers concerning pressing issues of common interest to humankind, this collection of papers endeavours to bridge the gap between contemporary research in Platonist (...) philosophy and other fields where insights gained from the study of Plato and Platonist philosophy can be of consequence and benefit. Authors: Werner Beierwaltes, Luc Brisson, Amber Carpenter, John Dillon, Jonathan Doner, Franco Ferrari, Francesco Fronterotta, F.A.J. de Haas, Aaron Hughes, Byron Kaldis, Daniel Kolak, Thomas Leinkauf, Dionysis Mentzeniotis, Jean-Marc Narbonne, Giannis Stamatellos, Vladimir Stoupel, Patrick Quinn, Jure Zovko and Marie-Élize Zovko. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.4 (2004) 411-425 [Access article in PDF] Vulnerability, Vulnerable Populations, and Policy Mary C. Ruof "Special justification is required for inviting vulnerable individuals to serve as research subjects and, if they are selected, the means of protecting their rights and welfare must be strictly applied."Guideline 13: Research Involving Vulnerable Persons International Ethical Guidelines for Biomedical Research Involving Human Subjects Council for International Organizations (...) of Medical Sciences (CIOMS) and World Health Organization (WHO) Geneva, Switzerland, 2002 Within medical research and healthcare certain groups are afforded special protections and services because of their designation as vulnerable. The vulnerable require special justification to participate in human subject research in order to eliminate potential human rights abuses. The Nuremberg Code of 1947 was written in response to the extreme human subject abuses that occurred under the Nazi regime, and, although the intent of the 1947 Code was to protect human rights, rigid voluntary consent requirements deprived some individuals of the right to participate in clinical trials. Recent human research guidelines, such as the CIOMS/WHO guidelines referenced above and the guidelines referenced in Section V of this Scope Note, attempt to balance both protection from abuse in research and access to new, experimental treatments for the vulnerable.Although various protective guidelines stipulate special protections for vulnerable populations, the concept of vulnerability and consequently the criteria designating vulnerable populations remain vague. Precisely who are the vulnerable? The word "vulnerability" stems from the Latin vulnerare, "to wound." (Oxford Encyclopedic English Dictionary 1995). In clinical research, the term [End Page 411] vulnerable generally is applied to individuals who are unable to give informed consent or who are susceptible to coercion. The Common Rule (45 CFR 46, Subpart A) includes as vulnerable research subjects: children, prisoners, pregnant women, and persons who are handicapped, mentally disabled, economically disadvantaged, or educationally disadvantaged. Although the Common Rule specifies certain vulnerable categories, the guidelines were not intended to be exclusive, leaving open the interpretation of vulnerability.In medical research and health policy, vulnerability is an abstract concept that has concrete effects both for those labeled vulnerable and for those not. Clinical researchers, healthcare workers, ethical reviewers, and policymakers must be able to identify vulnerable subjects to establish how healthcare resources will be allocated and who will qualify for special protections and socialized benefits. Attempts to quantify vulnerability in clear, measurable ways have met little if any consensus. As Alexander Morawa (II, 2003, p. 150) states, "There is no single approach to definition of vulnerability. In fact, there is no purposeful categorisation at all."Difficulties in defining vulnerability have prompted discourse surrounding its utility as a qualifying factor in the allocation of health resources and its appropriateness as a guiding principle in bioethics. Some of the authors cited in this Scope Note argue against the labeling and categorization of vulnerable individuals and populations. "Labeling individuals as 'vulnerable' risks viewing vulnerable individuals as 'others' worthy of pity, a view rarely appreciated" (III, Danis and Patrick 2002, p. 320). The categories of vulnerable groups listed under the Common Rule have been the source of controversy, "for example, many find the suggestion that pregnant women are vulnerable to be quite sexist" (IV, DeBruin 2001, p. 7). Instead of creating categories of vulnerable populations, would it not be better to derive an account of just treatment from a just social policy at large that encompasses human vulnerabilities (II, Brock 2002, p. 283).For some of the authors listed here, the concept of vulnerability is essential to bioethics. Robert Goodin (I, 1985, p. 107) writes that the vulnerability of other human beings is the source of our special responsibilities to them. In contrast to the four American principles of biomedical ethics—autonomy, nonmaleficence, beneficence, and justice—the four principles of European bioethics and biolaw include vulnerability along with autonomy, dignity, and integrity. According to, Jacob Dahl Rendtorff and Peter Kemp (I, 2000, p. 274) "the principle of vulnerability is ontologically prior to the other [European] principles, it expresses better than all of the other ethical principles... the finitude of the human condition."Some of the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Montaigne Among the Moderns: Receptions of the “Essais”Patrick HenryMontaigne Among the Moderns: Receptions of the “Essais,” by Dudley M. Marchi; xiii & 334 pp. Providence, Rhode Island: Berghahn Books, 1994, $49.95.This ambitious project is not a study of the Essais per se, but rather an analysis of their receptions from the seventeenth century to the present. Written by a comparativist with access to German, French, and English literature (...) and philosophy, it deals with authors from diverse backgrounds and time periods and pays careful attention throughout both to intertextuality and to the particular “horizons-of-experience” in which the Essais were received. “Reception” here does not mean some un-Mont aigne-like passive acceptance, but rather the assimilation and reactivation of the essayist’s concept of literature, writerly project, and theories of reading and writing in the works of later writers, mainly “premodernists” (Emerson and Nietzsche), “high modernists” (Pater and Woolf), and “postmodernists” (Butor, Chaillou, Sollers). In the most general sense, what Montaigne shares with all these authors is the need to make central in the form and substance of his work the paradox of a rupture with the pa st and its simultaneous continuation. Here modernism is less a period concept than a recurring literary phenomenon whereby the essayist not only influences the moderns and the postmoderns but is one of them. This enables us, finally, to perceive in the Essais a dialogical process that resists closure and reenacts the literary and philosophical debates of our own historical situation.Chapter One schematizes the history of the receptions of the Essais in France from 1580 to 1950 focusing mainly on the stylistic and religious readings of major figures in French literature. While much of this has already been done, Marchi syn thesizes well, makes his own original points, and offers us exceedingly interesting pages on the essayist’s covenant daughter and most active literary executrix, Marie le Jars de Gournay. Throughout he depicts how the shifting nature of the Essais’ textuality (their “hermeneutic undecidability” [p. 74]) allows them to assume various identities in the minds of different interpreters through the ages, thus problematizing the very act of reception and granting the reader a role in the production of me aning.The next chapters constitute the most original parts of the study and analyze the reception of the Essais in the works of Emerson, Nietzsche, Pater, Woolf, Butor, Chaillou, and Sollers. In Emerson and Nietzsche, we find reactivated the Montaig nean dialogue between the unique self and cultural tradition. Emerson read the Essais in the Cotton translation and wrote about Montaigne in Representative Men but only relied on the essayist to help him reach his own intellectual independen ce, finally moving from a more ego-centered position to the security of past models and rejecting skepticism in favor of dialectical resolution. Nietzsche read Montaigne in the original and knew him through Emerson. Marchi finds “an active inter textual Montaignean dimension” (p. 124) [End Page 140] in Nietzsche’s work and underscores their mutual preoccupation with radical skepticism, self-cultivation, self-portraiture, mutability, the instability of language, and the crisis of representa tion. He discovers two sides to Nietzsche’s reception of the Essais: the Apollonian “Socrantic optimism” and the Dionysian “libertine transgression” (p. 165) and indicates how the essayist’s concreteness and acceptance of human limitations tempered respectively Nietzsche’s propensity toward abstract metaphysics and Schopenhaurean pessimism.The third chapter unveils the aesthetic and thematic elements of the Essais in the critical and creative works of Pater and Woolf who went beyond the philosophical essaying of Emerson and Nietzsche, were the first to extend aspects of the E ssais in narrative works since Marie de Gournay, and created Montaigne the modernist “by insisting on the qualities of his textuality most akin to their own” (p. 186). The most interesting pages here delineate, on the one hand, Pater’s failed attempt to reconcile the religion of Pascal and the aesthetics of Montaigne and the essayist’s presence in Pater’s Gaston de Latour and, on the other, Woolf’s Montaigne-like essayistic techniques of weighing probabilities, suspending dogmatic judgment, and breaking of narrative sequentiality and her concomitant assimilation... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.2 (2002) 127-129 [Access article in PDF] Linguistic Markers of Recovery:Underpinnings of First Person Pronoun Usage and Semantic Positions of Patients Patrick Suppes Keywords: association, freedom, habits, psychotherapy, roles, semantics. USING LINGUISTIC EVIDENCE to evaluate recovering psychotherapy patients is an attractive and useful idea. I agree with much of Dr. van Staden's proposals for doing so. The purpose of this commentary is to give some (...) comments and criticisms on points of detail. Roles, Not Semantics A fair amount of Dr. van Staden's article is concerned with the semantics of relations. The focus on relations is a good thing. Restricting discourse about patients to properties is not sufficient, for everyone regards how a person is relating to others, and even to other things, as an important feature of normal behavior and mental health. We do not want just to report, "John was upset," but consider it definitely more informative to say, "John was upset by his father's criticisms." The English language and all other natural languages are rich in verbs for expressing relations with emotional affect between two or more persons, or a person and an event or thing. Staden's article focuses on the interesting and important case of first person pronouns. To go from saying, "She made me do it" to "I did it" is, for reasons that need not be spelled out, a sign of progress. A way to describe this change is that the speaker has indicated that in the implicit context assumed he or she has shown signs of moving from the role of being a patient to that of being an actor, from being a recipient of actions to being a performer of acts.van Staden concentrates on the semantics of relations to bring out what I call the change of roles. I would certainly agree that such change of roles is important to the semantics of affective or action verbs and verb phrases. We have no disagreement at all about this. Yet I am critical of his wanting to range much wider in his analysis of semantics. The logical or formal treatment of relations is a large topic, full of many distinctions and subtleties that seem to me not too relevant to his main theme. In a very general way he wants to say that what is usually thought of as [End Page 127] the first position in a relation, what he calls the alpha position, is occupied by the owner of the relation, and the second position, in a binary relation—the main case discussed—is occupied by the accidental to that particular relation. This second position is called the omega position.This runs contrary to much of the mathematical literature on relations, which occupy an important place in many parts of mathematics such as geometry. So when we say that one triangle is larger than another, it seems positively weird to say the second triangle is somehow accidental to the relation. But this is true and confusing even for the familiar and classical kinds of actions often cited by van Staden. In analyzing the sentence "Brutus killed Caesar intentionally" it sounds really strange to say that Caesar occupied the accidental position in the expressed relation of killing.Moreover, in the conceptual and philosophical discussion of relations, it is common practice to stress that even if the natural grammar of a sentence has a subject-predicate structure, as in "Elizabeth is the mother of Charles," no special logical force is given to what van Staden calls the first or alpha position in most mathematical relations, such as "The number 2 is less than the number 3," expressed in ordinary mathematical notation as "2 < 3."On the other hand, I stress that it is natural to distinguish in a relational sentence expressing an action between the role of actor and the role of patient, no matter which is the grammatical subject of the sentence, as in the following pair "John hurt Mary" and "Mary was hurt by John." The roles of actor... (shrink)