Having a serious illness like breast cancer is a calamity for individuals and families. Along with the pain, discomfort, and dislocation comes the issue of how to pay the medical expenses for the care and treatment of the disease. If the seriously ill person has inadequate or no insurance, these problems are aggravated.Stories abound about seriously ill people losing private health insurance following diagnosis with a catastrophic disease, remaining in jobs just to maintain health insurance, or facing financial hardship because (...) of gaps in coverage. Yet surprisingly little research has focused on the problems that people with serious illness face with health coverage and, in particular, how concerns about access to health insurance coverage shape their lives.Further, despite profoundly moving anecdotes of cancer victims and other seriously ill people about their problems with health insurance and despite recent federal and state efforts to reform the private health insurance market in ways discussed below, neither the federal government, states, nor the private sector has crafted comprehensive strategies to enhance health coverage for the seriously ill. (shrink)

Having a serious illness like breast cancer is a calamity for individuals and families. Along with the pain, discomfort, and dislocation comes the issue of how to pay the medical expenses for the care and treatment of the disease. If the seriously ill person has inadequate or no insurance, these problems are aggravated.Stories abound about seriously ill people losing private health insurance following diagnosis with a catastrophic disease, remaining in jobs just to maintain health insurance, or facing financial hardship because (...) of gaps in coverage. Yet surprisingly little research has focused on the problems that people with serious illness face with health coverage and, in particular, how concerns about access to health insurance coverage shape their lives.Further, despite profoundly moving anecdotes of cancer victims and other seriously ill people about their problems with health insurance and despite recent federal and state efforts to reform the private health insurance market in ways discussed below, neither the federal government, states, nor the private sector has crafted comprehensive strategies to enhance health coverage for the seriously ill. (shrink)

There have always been medical standards of care in the American health-care sector. However, never before have they been so deeply incorporated in the delivery of health care as they are today. With the increased delivery of care through integrated delivery systems, as well as the development of the computerized patient record, medical standards of care are now used in innovative ways by providers and health plans in delivering health care to individual patients. There is great potential for even more (...) innovative uses of medical standards of care in the future.This article first presents a taxonomy of the medical standards of care that are involved in health-care delivery today Next, the article traces the historical evolution of medical standards of care since the early 1980s. Included in this discussion are the origins of the standard-setting movement as well as the developments that led to the way standards of care are currently used by large institutional providers and managed care plans to improve the quality of their health-care services. The article concludes with a brief analysis of the key legal issues that affect how standards of care can be used to improve the health care of patients. (shrink)

There have always been medical standards of care in the American health-care sector. However, never before have they been so deeply incorporated in the delivery of health care as they are today. With the increased delivery of care through integrated delivery systems, as well as the development of the computerized patient record, medical standards of care are now used in innovative ways by providers and health plans in delivering health care to individual patients. There is great potential for even more (...) innovative uses of medical standards of care in the future.This article first presents a taxonomy of the medical standards of care that are involved in health-care delivery today Next, the article traces the historical evolution of medical standards of care since the early 1980s. Included in this discussion are the origins of the standard-setting movement as well as the developments that led to the way standards of care are currently used by large institutional providers and managed care plans to improve the quality of their health-care services. The article concludes with a brief analysis of the key legal issues that affect how standards of care can be used to improve the health care of patients. (shrink)

Today, public health regulation at all levels faces unprecedented challenges both at home and abroad. The September 11, 2001 attacks on New York and Washington, D.C., by the Al Qaeda terrorist network and the anthrax bioterrorism that followed shortly thereafter have put public health regulation at the forefront of homeland security. The anthrax scare, in particular, has greatly tested the American public health system, calling into question whether the United States and its component states and localities are prepared to handle (...) a major outbreak of infectious disease, such as smallpox, in a future bioterrorist action. While the response of public health agencies was commendable, especially in light of the magnitude of the assaults, it is manifestly clear that the American public health system will be hard pressed to meet similar challenges that may lie ahead.The events of fall 2001 follow a period of major challenges for public health. The AIDS pandemic has killed millions of people throughout the globe, especially in Africa and other parts of the developing world. (shrink)

Today, public health regulation at all levels faces unprecedented challenges both at home and abroad. The September 11, 2001 attacks on New York and Washington, D.C., by the Al Qaeda terrorist network and the anthrax bioterrorism that followed shortly thereafter have put public health regulation at the forefront of homeland security. The anthrax scare, in particular, has greatly tested the American public health system, calling into question whether the United States and its component states and localities are prepared to handle (...) a major outbreak of infectious disease, such as smallpox, in a future bioterrorist action. While the response of public health agencies was commendable, especially in light of the magnitude of the assaults, it is manifestly clear that the American public health system will be hard pressed to meet similar challenges that may lie ahead.The events of fall 2001 follow a period of major challenges for public health. The AIDS pandemic has killed millions of people throughout the globe, especially in Africa and other parts of the developing world. (shrink)

With the North American Free Trade Agreement , the health care sectors of the United States, Canada, and Mexico are becoming more economically integrated. NAFTA poses major challenges to the realization of the international human right. These include: Cross Border Trade in Medical Products, Cross Border Trade in Medical Services, and the attendant investment protections, Portability and Comparability of Health Insurance Coverage, and Protection of Public Health Insurance Programs. The United States, Mexico, and Canada all provide public health insurance programs (...) either to the entire population as in Canada or to vulnerable groups as in the United States. In none of these countries have private, for-profit providers and insurers been able to provide universal and affordable health coverage and care in a truly free market. Private insurers and for-profit providers should not profit from the care of the healthy and wealthy in ways that compromise the public programs that serve the poor and seriously ill. Nor should they be allowed to use NAFTA processes to compromise public programs. Policy makers must consider implications of NAFTA and move toward assuring access to affordable health care for all people on the North American continent. (shrink)

During World War II, the Allies created the United Nations and its associated international institutions to stabilize the post-war world. The Allies envisioned a coordinated world in which human rights for all were respected, economic and social progress for all promoted, and global warfare prevented. This was a phenomenally fantastic vision that seemed unattainable in the wake of the most devastating global war in history.Today, the world is witnessing some of the fruits of these mid-20th century events and aspirations, especially (...) since the collapse of Communism in 1989. Economic integration and free trade has become much more prevalent as exemplified by astounding developments such as the European Union. And there is a greater appreciation of human rights, including the international human right to health. This article examines the evolution of trade policy and the impact of free trade policies on the health care sectors of the three countries of North America and the realization of the human right to health in North America. (shrink)

The key to wealth in health care is the physician, who certifies to third-party payers that health care items and services are necessary for patient care. To compete more effectively for this wealth, physician specialists are organizing their practices into for-profit corporations and employing other physicians. Focusing on neonatology, this article describes the prevailing business model of these for-profit medical groups as controlling employed physicians through restrictive employment contract provisions, e.g., non-compete and mandatory arbitration clauses. With this business model and (...) because of deficiencies in current law, for-profit medical groups eliminate competition from other physician specialists to the detriment of patients and consumers. (shrink)

With new, effective, and expensive health care services, the American health care sector has become an even greater source of business and wealth opportunities. All kinds of health care providers and suppliers are competing for patients and dollars. The key to wealth in today’s health care sector is the physician. Only physicians can certify to third-party payers that health care services, medical devices, or pharmaceutical products are necessary for patient care. That certification initiates the process by which the item, service, (...) or treatment modality is ordered, delivered, and paid for. Thus, organizations that can exert control over physicians stand to gain financially. (shrink)

Does telling a story imply a fictional world in which that story takes place? In contemporary philosophy, “fictional worlds” are one solution to the problem of how there can be true and false judgments about fictional characters. Fictional-world accounts generally disregard whether facts are explicitly stated in the story or not; it is enough for them to be logically implied. And yet, as Ruth Lorand has observed, whether a fact is stated or merely implied changes the meaning of a story. (...) “Imagine that the original text contains the following sentence: ‘Daisy Miller is human and as such she was born to human parents.’ Wouldn’t.. (shrink)

There is a sense in which poetry can re-inscribe humans in their natural surroundings, but language—even poetic language—is also always problematic. In conversation with and in response to recent works by David Abram, I will delineate at least two ways in which poetic language separates and distinguishes humans from nature. I also argue for the importance of what is implicit or invisible (as opposed to tangible and sensuous). Language is a mode of human responsibility for the world, not just a (...) sign or result of being part of it. (shrink)

Discussions of research involving vulnerable populations have left the homeless comparatively ignored. Participation by these subjects in drug studies has the potential to be upsetting, inconvenient, or unpleasant. Participation occasionally produces injury, health emergencies, and chronic health problems. Nonetheless, no ethical justification exists for the categorical exclusion of homeless persons from research. The appropriate framework for informed consent for these subjects of pharmaceutical research is not a single event of oral or written consent, but a multi-staged arrangement of disclosure, dialogue, (...) and permission-giving. Payments and other rewards in biomedical research raise issues of whether it is ethical to offer inducements to the homeless in exchange for participation in drug studies. Such inducements can influence desperate persons who are seriously lacking in resources. The key is to strike a balance between a rate of payment high enough that it does not exploit subjects by underpayment and low enough that it does not create an irresistible inducement. This proposal does not underestimate the risks of research, which are often overestimated and need to be appraised in light of the relevant empirical literature. (shrink)

Pandemics challenge the law and often highlight its strengths or expose its limits. The novel strain of influenza A virus that emerged in the spring of 2009 and rapidly spread around the globe was no exception. The H1N1 pandemic prompted the first significant application of a number of international legal and policy mechanisms that have been developed in the last decade to respond to this kind of event. Furthermore, it presented a considerable test for public health systems at all levels, (...) from global to local.Although initial predictions forecasting high morbidity and mortality from this virus overestimated its eventual impact, the human toll of the pandemic was nevertheless significant. The World Health Organization reported approximately 1.5 million people were infected worldwide in 214 countries, resulting in over 25,000 confirmed deaths, but the actual health impact of the outbreak was certainly much higher. (shrink)

Pandemics challenge the law and often highlight its strengths or expose its limits. The novel strain of influenza A virus that emerged in the spring of 2009 and rapidly spread around the globe was no exception. The H1N1 pandemic prompted the first significant application of a number of international legal and policy mechanisms that have been developed in the last decade to respond to this kind of event. Furthermore, it presented a considerable test for public health systems at all levels, (...) from global to local.Although initial predictions forecasting high morbidity and mortality from this virus overestimated its eventual impact, the human toll of the pandemic was nevertheless significant. The World Health Organization reported approximately 1.5 million people were infected worldwide in 214 countries, resulting in over 25,000 confirmed deaths, but the actual health impact of the outbreak was certainly much higher. (shrink)

Growth mindset is an important aspect of children’s socioemotional development and is subject to change due to environmental influence. Orchestral music education may function as a fertile context in which to promote growth mindset; however, this education is not widely available to children facing economic hardship. This study examined whether participation in a program of orchestral music education was associated with higher levels of overall growth mindset and greater change in levels of musical growth mindset among children placed at risk (...) by poverty. After at least 2 years of orchestral participation, students reported significantly higher levels of overall growth mindset than their peers; participating students also reported statistically significant increases in musical growth mindset regardless of the number of years that they were enrolled in orchestral music education. These findings have implications for future research into specific pedagogical practices that may promote growth mindset in the context of orchestral music education and more generally for future studies of the extra-musical benefits of high-quality music education. (shrink)

Ethics networks have emerged over the last few decades as a mechanism for individuals and institutions over various regions, cities and states to converge on healthcare-related ethical issues. However, little is known about the development and nature of such networks. In an effort to fill the gap in the knowledge about such networks, a survey was conducted that evaluated the organizational structure, missions and functions, as well as the outcomes/products of ethics networks across the country. Eighteen established bioethics networks were (...) identified via consensus of three search processes and were approached for participation. The participants completed a survey developed for the purposes of this study and distributed via SurveyMonkey. Responses were obtained from 10 of the 18 identified and approached networks regarding topic areas of: Network Composition and Catchment Areas; Network Funding and Expenses; Personnel; Services; and Missions and Accomplishments. Bioethics networks are designed primarily to bring ethics education and support to professionals and hospitals. They do so over specifically defined areas—states, regions, or communities—and each is concerned about how to stay financially healthy. At the same time, the networks work off different organizational models, either as stand-alone organizations or as entities within existing organizational structures. (shrink)

Ce recueil offre à ses lecteurs diverses pistes d’interprétation. Elles se distinguent tant par le contenu de ses chapitres que par la question plus large de la place essentielle des études touchant à l’éducation. L’ouvrage, véritablement interdisciplinaire, remet en question la relation entre l’éducation et le genre grâce aux contributions d’historiens, de spécialistes en science de l’éducation, de sociologues, de psychologues et d’enseignants allant de la maternelle à l’université. Le livre...

Dans ce volume collectif, J. Albisetti, J. Goodman et Rebecca Rogers nous emmènent dans un tour européen du développement de l’enseignement secondaire pour les filles. Les contributeurs proposent deux pistes principales : une vue d’ensemble des histoires nationales de l’enseignement des filles ; et une présentation des pistes de recherche à suivre. Bien que Girls’ Secondary Education in the Western World soit organisé par pays, les directeurs et les auteurs soulignent les multiples connexions...

I look at the ‘flavour-oscillation clocks’ proposed by D. V. Ahluwalia and two of his arguments suggesting that such clocks might behave in a way that threatens the geometricity of general relativity (GR). The first argument states that the behaviour of these clocks in the vicinity of a rotating gravitational source implies a non-geometrical element of gravity. I argue that the phenomenon is best seen as an instance of violation of the ‘clock hypothesis’ and therefore does not threaten the geometrical (...) nature of gravitation. Ahluwalia’s second argument, for the ‘incompleteness’ of general relativity, involves the idea that flavour-oscillation clocks can detect constant gravitational potentials. I argue that the purported ‘incompleteness-establishing’ result is in fact one that applies to all clocks. It is entirely derivable from general relativity, does not result in the observability of the potential, and is not at odds with any of general relativity’s foundations. (shrink)

We review here the data indicating a role for epidermal growth factor receptor (EGF receptor) signalling in early mouse development. Embryonic development of the metazoan embryo generally begins with the formation of a cystic structure and epithelial layers that subsequently form anlagen of the definitive body parts and organs. For the mammalian embryo, this cystic structure is a blastocyst whose wall consists of trophectoderm, the first epithelium to develop during mammalian embryogenesis. The onset of expression and function of EGF receptors (...) is coincident with the onset of trophectoderm development. Modulating EGF receptor expression and function modulates trophectoderm differentiation, leading to the hypothesis that functional EGF receptors participate in the induction of trophectoderm development and perhaps of other embryonic epithelial derivatives such as nervous tissues. (shrink)

This article identifies a papyrus in Warsaw, P.Vars. 6, as a fragment of the large Latin–Greek glossary known as Ps.-Philoxenus. That glossary, published in volume II of G. Goetz's Corpus Glossariorum Latinorum on the basis of a ninth-century manuscript, is by far the most important of the bilingual glossaries surviving from antiquity, being derived from lost works of Roman scholarship and preserving valuable information about rare and archaic Latin words. It has long been considered a product of the sixth century (...) a.d., but the papyrus dates to c.200, and internal evidence indicates that the glossary itself must be substantially older than that copy. The Ps.-Philoxenus glossary is therefore not a creation of Late Antiquity but of the Early Empire or perhaps even the Republic. Large bilingual glossaries in alphabetical order must have existed far earlier than has hitherto been believed. (shrink)

Quatorze ans après la publication de son ouvrage pionnier Archaeologies of Sexuality (New York, Routledge, 2000), Barbara L. Voss a codirigé avec Eleanor Conlin Casella cet ouvrage collectif, The Archaeology of Colonialism: Intimate Encounters and Sexual Effects. Remarquant un manque d’intérêt pour les politiques sexuelles impériales au sein de la recherche archéologique, les différents contributeurs ont cherché à saisir la dimension matérielle des expressions et des expériences sexuelles et...

Deleuze, The Dark Precursor is organized around three themes that critically overlap: dialectic, structure, and being.

As honey bee colonies continue to perish at high rates, beekeepers are divided on how best to keep bees healthy and productive. In this article, I describe the tensions between conventional beekeepers and a new wave of beekeepers hoping to “save the bees” through a more “natural” approach to beekeeping. Drawing on animal studies and multispecies literature, I show how beekeepers in both camps are constrained by the reality of the Anthropocene: novel ecologies, shifting baselines, and the hybridity of honey (...) bees themselves—part wild animal subject to environmental change, part industrial organism, embedded in circuits of migratory pollination. Beekeepers on both sides are investing in genetics as a solution to honey bee health problems. Thinking with bees helps deepen the literature on multispecies encounters and interrogate the idea of sustainability in agriculture, while thinking with the Anthropocene prompts us to ask what “saving the bees” even means in today’s changing world. (shrink)

Background People who are at elevated risk of suicide stand to benefit from internet-based interventions; however, research in this area is likely impacted by a range of ethical and practical challenges. The aim of this study was to examine the ethical issues and practical barriers associated with clinical studies of internet-based interventions for suicide prevention. Method This was a mixed-methods study involving two phases. First, a systematic search was conducted to identify studies evaluating internet-based interventions for people at risk of (...) suicide, and information pertaining to safety protocols and exclusion criteria was extracted. Second, investigators on the included studies were invited to complete an online survey comprising open-ended and forced-choice responses. Quantitative and qualitative methods were used to analyse the data. Results The literature search identified 18 eligible studies, of which three excluded participants based on severity of suicide risk. Half of the 15 suicide researchers who participated in the survey had experienced problems obtaining ethics approval, and none had encountered adverse events attributed to their intervention. Survey respondents noted the difficulty of managing risk in online environments and the limitations associated with implementing safety protocols, although some also reported increased confidence resulting from the ethical review process. Respondents recommended researchers pursue a collaborative relationship with their research ethics committees. Conclusion There is a balance to be achieved between the need to minimise the risk of adverse events whilst also ensuring interventions are being validated on populations who may be most likely to use and benefit from them. Further research is required to obtain the views of research ethics committees and research participants on these issues. Dialogue between researchers and ethics committees is necessary to address the need to ensure safety while also advancing the timely development of effective interventions in this critical area. (shrink)

This paper looks at the relationship between spacetime functionalism and Harvey Brown’s dynamical relativity. One popular way of reading and extending Brown’s programme in the literature rests on viewing his position as a version of relationism. But a kind of spacetime functionalism extends the project in a different way, by focussing on the account Brown gives of the role of spacetime in relativistic theories. It is then possible to see this as giving a functional account of the concept of spacetime (...) which may be applied to theories that go beyond relativity. This paper explores the way in which both the relationist project and the functionalist project relate to Brown’s work, despite being incompatible. Ultimately, these should not be seen as two conflicting readings of Brown, but two different directions in which to take his project. (shrink)

Miranda Fricker’s influential concept of epistemic injustice has recently seen application to many areas of interest, with an increasing body of healthcare research using the concept of epistemic injustice in order to develop both general frameworks and accounts of specific medical conditions and patient groups. This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one’s predicament and treat it accordingly. Work on epistemic injustice is (...) therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as those classed as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice. (shrink)

I argue that the best spacetime setting for Newtonian gravitation (NG) is the curved spacetime setting associated with geometrized Newtonian gravitation (GNG). Appreciation of the ‘Newtonian equivalence principle’ leads us to conclude that the gravitational field in NG itself is a gauge quantity, and that the freely falling frames are naturally identified with inertial frames. In this context, the spacetime structure of NG is represented not by the flat neo-Newtonian connection usually made explicit in formulations, but by the sum of (...) the flat connection and the gravitational field. 1 Introduction2 Newtonian Gravity: The Orthodox Approach3 Newtonian Gravity: Additional Symmetries4 Cosmological Considerations5 A Newtonian Equivalence Principle: Inertial Frames in Newtonian Gravitation6 Theory Equivalence?7 Conclusion. (shrink)

I argue that the need to understand spacetime structure as emergent in quantum gravity is less radical and surprising it might appear. A clear understanding of the link between general relativity's geometrical structures and empirical geometry reveals that this empirical geometry is exactly the kind of thing that could be an effective and emergent matter. Furthermore, any theory with torsion will involve an effective geometry, even though these theories look, at first glance, like theories with straightforward spacetime geometry. As it's (...) highly likely that there will be a role for torsion in quantum gravity, it's also highly likely that any theory of quantum gravity will require us to get to grips with emergent spacetime structure. (shrink)