A growing body of research has demonstrated significant heterogeneity of hospital ethics committee (HEC) size, membership and training requirements, length of appointment, institutional support, clinical and policy roles, and predictors of self identified success. Because these studies have focused on HECs at a single point in time, however, little is known about how the composition of HECs changes over time and what impact these changes have on committee utilization. The current study presents 20 years of data on the evolution of (...) the Massachusetts General Hospital HEC. Between 1993 and 2012, the average number of committee members per year was 38 ± 3 and the average length of membership was 4.8 ± 0.4 years. During that time, the committee performed 934 consults, averaging 47 ± 3 per year. Attendance rates fell from 61.5 to 23.8 % over the study period and were inversely correlated with the total number of members. Between 1993 and 2012, the committee saw substantial growth in the diversity of the professional backgrounds of its members. Multivariate analysis, however, suggests that substantial changes in committee composition did not impact its utilization and that other factors are more likely to explain fluctuations in consultation volume. (shrink)

Thucydides is an important author for any discussion of the possibilities for an ancient Greek democratic peace. Though democratic peace did not, in fact, seem to function in classical Greece, a number of passages in Thucydides show that an affinity did exist among democratic factions and city-states in the context of hostile competition between democratic and oligarchic regimes. Thucydides remarked on this competition and was aware of the inter-democratic affinities, but did not seem to think them salient in city-state decisions (...) of war and peace. The failure of democratic peace to develop may relate to the environment of the Greek city-state, which privileged local interests over broader constitutional ideals. (shrink)

We describe the structure, operation, and experience of the Massachusetts General Hospital ethics committee, formally called the Edwin H. Cassem Optimum Care Committee, from January 2007 through December 2013. Founded in 1974 as one of the nation’s first hospital ethics committees, this committee has primarily focused on the optimum use of life-sustaining treatments. We outline specific sociodemographic and clinical characteristics of consult patients during this period, demographic differences between the adult inpatient population and patients for whom the ethics committee was (...) consulted, and salient features of the consults themselves. We include three case studies that illustrate important consult themes during this period. Our findings expand knowledge about the structure and workings of hospital ethics committees and illustrate how one ethics committee has developed and utilized policies on end-of-life care. More generally, we model a sociological approach to the study of clinical ethics consultation that could be utilized to contextualize institutional practices over time. (shrink)

Suicide among Veterans experiencing or at risk for homelessness remains a significant public health concern. Conducting research to understand and meet the needs of this at-risk population remains challenging due to myriad factors. To address this challenge, the United States Department of Veterans Affairs convened the Health Services Research and Development Suicide Prevention in Veterans Experiencing Homelessness: Research and Practice Development meeting, bringing together subject-matter experts in the fields of homelessness and suicide prevention, both from within and outside of VA. (...) During the meeting, attendees identified 10 potential research priorities at the intersection of suicide prevention and homelessness. After the meeting, Delphi methodology was used to achieve consensus on the relative importance of the identified research domains. Through this iterative Delphi process, agreement was reached regarding the need to increase understanding of barriers and facilitators to suicide risk assessment and emergency intervention for Veterans experiencing homelessness by examining the perspectives of both Veterans and healthcare providers. Elucidating the complex relationships between risk periods, subgroups, suicide means, and drivers of suicide among Veterans experiencing homelessness was also considered a top priority. This article documents the Delphi process and provides a research agenda for researchers, funding agencies, and policymakers to prioritize the most relevant and potentially impactful research domains aimed at preventing suicide among Veterans experiencing or at risk for homelessness. (shrink)

This paper reexamines the long-standing problem of the nature and magnitude of the catastrophic Hellenic expedition to Egypt c. 460-454. An uneasy scholarly consensus posits that many fewer than the 200 triremes implied by Thucydides were involved in the momentous defeat, yet the arguments employed by proponents and detractors of this hypothesis have not been decisive. This paper attempts to develop a better understanding of the final stages of the campaign in order to settle the question of losses. Thucydides offers (...) the most reliable narrative of the events in Egypt , but the compressed nature of the pentekontaetia has left us with a brief, lacunary text. Examination of the verbs poliorkein and kataklēiein and the noun poliorkia in appropriate contexts throughout Thucydides' history reveals that the words connote a tight blockade that seeks to deny all supplies to the besieged; the terms do not normally convey less stringent varieties of military harassment. Application of this understanding to the passages in question shows that the 200 triremes initially mentioned by Thucydides could not possibly have been engaged in Egypt when the siege of Prosopitis island began: a force of such size under a tight blockade could never have held out for 18 months. This conclusion is supported by an economic and demographic survey of the fifth-century B.C. Egyptian Delta, which suggests that resources would not have been plentiful in the region. A much smaller Greek force, perhaps 40 to 50 triremes, must have been involved in the final siege. (shrink)

Bullying often results in negative coping in victims, including an increased consumption of alcohol. Recently, however, an increase in alcohol use has also been reported among perpetrators of bullying. The factors triggering this pattern are still unclear. We investigated the role of empathy in the interaction between bullying and alcohol use in an adolescent sample (IMAGEN) at age 13.97 (±0.53) years (baseline (BL), N = 2165, 50.9% female) and age 16.51 (±0.61) years (follow-up 1 (FU1), N = 1185, 54.9% female). (...) General empathic distress served as a significant moderator of alcohol use in perpetrators (F9, 493 = 17.978, p < 0.01), which was specific for males and FU1. Male perpetrators, who are generally less sensitive to distress, might thus be more vulnerable to alcohol abuse. (shrink)

Background: The bioethics literature contains speculation but little data about sociodemographic differences between patients for whom ethics committees (EC) are consulted for conflict about life-sustaining treatment (LST) and the broader hospital population that these committees serve. To provide an empirical context for this discussion, we examined differences in five sociodemographic factors between patients for whom an EC was consulted for conflict over LST and the general inpatient population, hypothesizing that nonwhite patients were most likely to be disproportionately represented. Methods: This (...) was a retrospective cohort study comparing self-reported race/ethnicity, household income, insurance status, primary language, and religious affiliation between patients involved in EC consultations for conflict over LST and the general adult inpatient population at a large academic hospital from January 1, 2007, through December 31, 2013. Results: There were 169 EC consultations involving conflict over LST and 243,197 adult inpatient admissions over the study period. On bivariate analysis, patients for whom the EC was consulted for conflict over LST were more likely to be nonwhite, low-income, and to speak a primary language other than English. They were not more likely to be underinsured or to report a religious affiliation. On multivariate analysis, patients for whom the EC was consulted for conflict over LST were more likely to be nonwhite (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.7–3.7; p <.001). They were also more likely to be low income (OR, 1.8; 95% CI, 1.1–3.0; p =.02). They were not more likely to speak a primary language other than English (OR, 1.4; 95% CI, 0.9–2.1; p =.17). None of the assessed variables were associated with conflict over LST requiring additional meetings beyond the first EC consultation. Conclusions: Nonwhite and low-income status patients are disproportionately represented in EC committee consultation for conflict over LST compared to the general inpatient population. (shrink)

There are eleven previously unpublished letters between James Hutton and James Watt in the Doldowlod collection, which Birmingham City Archives acquires from Lord Gibson-Watt in 1994. They were written between 1774 and 1795. Very little of Hutton's other correspondence survives, so these letters add significantly to our knowledge. The earliest letters together with two letters from Hutton to George Clerk-Maxwell , describe geological tours that Hutton made through Wales, the Midlands, and the south-west of England in 1774. The correspondence after (...) 1774 reveals Watt's expertise in geology, and also discusses meteorology, varnish making, Symington's steam engines, the first experiments with steam navigation, pneumatic medicine, and other topics. (shrink)

(1994). The correspondence between James Hutton (1726–1797) and James Watt (1736–1819) with two letters from Hutton to George Clerk-Maxwell (1715–1784): Part I. Annals of Science: Vol. 51, No. 6, pp. 637-653.

Gadamer's book extends and codifies the main hermeneutical concepts of Bultmann, Heidegger, and their adherents, and can be considered a summa of what Robinson calls "The New Hermeneutic." By Robinson and other theologians, and by Continental literary critics, Wahrheit und Methode has been welcomed as a philosophical justification for "vital and relevant" interpretations that are unencumbered by a concern for the author's original intention. On this point "The New Hermeneutic" reveals its affinities with "The New Criticism" and the (...) newer "Myth Criticism." All three have impugned the author's prerogative to be the determiner of textual meaning. Gadamer, however, grounds his anti-intentionalism only partially in aesthetics and not at all in the collective unconscious but primarily in the radical historicism of Martin Heidegger. (shrink)

Metaphysics, morals and science -- The classics : value -- The neo-classics : utility -- The Keynesian revolution -- Development and under-development -- What are the rules of the game?

I address a question in moral metaphysics: How are conflicts between moral obligations possible? I begin by explaining why we cannot give a satisfactory answer to this question simply by positing that such conflicts are conflicts between rules, principles, or reasons. I then develop and defend the “Dispositional Account,” which posits that conflicts between moral obligations are conflicts between the manifestations of obligating dispositions (obligating powers, capacities, etc.), just as conflicts between physical forces are conflicts between the manifestations of (certain) (...) causal dispositions (causal powers, capacities, etc.). This account combines the so-called “moral forces” interpretation of prima facie obligations with a dispositional moral metaphysic according to which the metaphysical grounds of moral obligations are not rules or laws, but rather real, irreducibly dispositional properties (or powers) of moral agents and patients. My principal aims are to offer a theoretically attractive and suitably metaphysical account of conflicts of obligation, and to show that the dispositional moral metaphysic that grounds the Dispositional Account can explain and accommodate plausible normative views that rule- and law-based alternatives cannot, as well as to answer objections that have been pressed against other accounts of moral conflict (especially Ross’s) that appeal to moral dispositions or forces. (shrink)

Introduction -- The ethics of care and global politics -- Rethinking human security -- 'Women's work' : the global care and sex economies -- Humanitarian intervention and global security governance -- Peacebuilding and paternalism : reading care through postcolonialism -- Health and human security : gender, care and HIV/AIDS -- Gender, care, and the ethics of environmental security -- Conclusion. Security through care.

This book gives a descriptive analysis of specific Madhyamika texts. It compares the ideology of Kumarajiva (a translator of the four Madhyamika treatises 400 A.D.) with the ideologies of the three Chinese contemporaries - HuiYuan, Seng-Jui and Seng-Chao. It envisages an intercultural transmission of religious and philosophical ideas from India to China.