Background Encounters of moral distress have long-term consequences on healthcare workers’ physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. Research Objective The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic (...) medical center. Participants & Research Context Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. Research Design Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine’s National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. Ethical Considerations Ethics approval was obtained from the university and medical center institutional review boards. Findings Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. Conclusion Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being. (shrink)

The thymus is a unique primary lymphoid organ that supports the production of self‐tolerant T‐cells essential for adaptive immunity. Intrathymic microenvironments are microanatomically compartmentalised, forming defined cortical, and medullary regions each differentially supporting critical aspects of thymus‐dependent T‐cell maturation. Importantly, the specific functional properties of thymic cortical and medullary compartments are defined by highly specialised thymic epithelial cells (TEC). For example, in the medulla heterogenous medullary TEC (mTEC) contribute to the enforcement of central tolerance by supporting deletion of autoreactive T‐cell (...) clones, thereby counterbalancing the potential for random T‐cell receptor generation to contribute to autoimmune disease. Recent advances have further shed light on the pathways and mechanisms that control heterogeneous mTEC development and how differential mTEC functionality contributes to control self‐tolerant T‐cell development. Here we discuss recent findings in relation to mTEC development and highlight examples of how mTEC diversity contribute to thymus medulla function. (shrink)

An explanatory gap exists between physics and experience, raising the hard problem of consciousness: why are certain physical systems associated with an experience of an external world from an internal perspective? The living mirror theory holds that consciousness can be understood as arising from the computational interaction between a living system and its environment that is required for the organism's existence and survival. Maintaining a boundary that protects the system against destructive forces requires an interaction between the organism and its (...) outside world that can be cast in terms of Bayesian inference. The living mirror theory holds that this computational interaction results in statistical properties of the material world that are, in the absence of life, only implicit, becoming explicit in informational terms. This is held to give rise to the beliefs in qualities that constitute consciousness. Consciousness is therefore a necessary feature of all living systems as, in a world governed by the second law of thermodynamics, survival depends on the construction of beliefs regarding the potentially destructive forces in the outside world. From this perspective, consciousness is shown to be not a property of the brain in particular but instead to be a necessary feature of the life process itself. (shrink)

James E Cooper¹, Uwe Christians², Alexander C Wiseman¹¹Division of Renal Diseases and Hypertension, Transplant Center, ²iC42 Integrated Solutions in Systems Biology for Clinical Research and Development, University of Colorado Denver, Aurora, CO, USA: Everolimus is a novel target of rapamycin -I analog that has recently been approved in combination with cyclosporine A and steroids for use in the prevention of organ rejection in kidney transplant recipients. Compared with rapamycin, everolimus is characterized by a shorter half-life and improved bioavailability. Prior to (...) US Food and Drug Administration approval, a number of Phase II and III clinical trials were undertaken to evaluate the effectiveness of everolimus in combination with calcineurin inhibitors for preventing acute rejection and promoting allograft survival in kidney transplant recipients. In this report, we review the pharmacokinetic properties of everolimus, the clinical efficacy studies that led to its approval for use in kidney transplantation, as well as reported data on patient safety and tolerability associated with its use.Keywords: mTOR inhibitors, kidney transplantation, everolimus. (shrink)

The opening chapter of this work is a comprehensive “Historical Overview of the Hereditary Puzzle.” Goldie Morgentaler's analysis of theories of heredity before Mendel will interest students of biological science. She admits that “resurrecting such theories without contamination from subsequent knowledge often requires an imaginative leap.” Very true. There have been such profound advances in the science of genetics since that time, with the avalanche of discoveries during the past half century, that much of the previous thought now falls in (...) the realm of philosophical fantasy.These early concepts were those to which Charles Dickens was exposed for most of his life. His literary reaction to them is exhaustively analyzed in the subsequent two parts of the book. The first of these is entitled “Heredity and the Individual,” and the second is “The Public Face of Heredity.” The latter includes interesting discussion of class and race, with analyses of the last three novels. These indicate that Dickens's views on heredity changed during his later life, perhaps influenced by Darwin, whose work he had read … and vice versa.The author is to be admired for her detailed knowledge of Dickens's works and his characters. For a reviewer who has been steeped in evidence‐based medicine and science for most of his career, it seems that much of the speculation regarding heredity in the nineteenth century is tenuous and far‐fetched. While Dickens engaged the topic of heredity many times, he appears to have followed the general trend of that era by showing little consistency in his views. This is not surprising in light of the paucity of scientific evidence at that time.While the title implies a study of Dickens and heredity, the substance covers a much wider field, with ventures into ethics, morality, religion, psychology, philosophy, sociology, and more. The appended notes tell of assiduous research and concentration. To the pragmatic reader it sometimes appears that Morgentaler makes observations and draws conclusions that are more profound than Dickens himself might have achieved, or admitted. This is, of course, a common diversion in revisionist studies of well‐known authors and other celebrities.It is inevitable that the perennial question of the relative strength of nature and nurture must have prominence in this study. In his earlier novels Dickens implied support for the notion that goodness and virtue were heritable traits allied to beauty and good physical appearance. Morgentaler returns repeatedly to this question in many aspects. In her final chapter she points out that Dickens's views changed, paradoxically, after The Origin of Species was published, toward the end of his life. He then gave less weight to the influence of heredity. She has, perhaps, missed an opportunity of recording that Dickens noticed hereditary factors in alcoholism and longevity. In the case of Jenny Wren's family, Mr. Cleaver was “like his own father, a weak wretched trembling creature, falling to pieces, never sober” . The Wardle family in Pickwick Papers showed familial longevity in that “only one member hasn't lived to eighty‐five, and he was beheaded by one of the Henrys.”The relationship of some of the discussion to heredity is profound, often remote, even cryptic. To those who are hybrids of a scientific historian and an obsessive Dickens aficionado, this work will be absorbing. Unfortunately for the author and the publisher, such hybrids are probably rare—but I hope not extinct. To the pure scientist this work might be an uphill exercise. The production of the book is faultless. (shrink)

The subject is in both cases the voyage of the Argo, and therefore the use of the same words is not likely to be coincidental, even though the words themselves are scarcely uncommon. One would hesitate to deny, however, that such reminiscence might be unconscious; that Lucan had famous tags in his head is suggested by another allusion to famous opening lines.

Limits to Action: The Allocation of Individual Behavior presents the ideas and methods in the study of how individual organisms allocate their limited time and energy and the consequences of such allocation. The book is a survey of individual resource allocation, emphasizing the relationships of the concepts of utility, reinforcement, and Darwinian fitness. The chapters are arranged beginning with plants and general evolutionary considerations, through animal behavior in nature and laboratory, and ending with human behavior in suburb and institution. Topics (...) discussed include operant conditioning; the principle of diminishing returns; and issues in relation to mating strategies. Biologists, sociologists, economists, and psychologists will find the book interesting. (shrink)

What are physical quantities, and in particular, what makes them quantitative? This book presents an original answer to this question through the novel position of substantival structuralism, arguing that quantitativeness is an irreducible feature of attributes, and quantitative attributes are best understood as substantival structured spaces.

In his contribution, the author discusses the deep and surprising similarities between the philosophies of David Hume and Friedrich Nietzsche. The author argues that these stem from their shared conception of naturalism. Their naturalism is primarily an explanatory one and primarily aimed at explaining human thought and practice. In Nietzsche, this form of naturalism is expressed in his adoption of a genealogical approach to various topics, most famously that of morality. The author shows that Hume’s naturalism is similarly genealogical. The (...) author also argues that their conceptions of morality and the self are closer than popular images of the two philosophers might have it. (shrink)

Although Professor of Philosophy at Calvin College, Alvin Plantinga has developed a theodicy that is fundamentally Arminian rather than Calvinistic. Anthony Flew, although the son of an Arminian Christian minister, regards the Arminian view of ‘free will’ to be both unacceptable on its own terms and incompatible with classical Christian theism. In this paper I hope to disentangle some of the involved controversy regarding theodicy which has developed between Plantinga and Flew, and between Flew and myself. The major portion of (...) this paper is devoted to showing that Plantinga's theodicy contains some serious flaws and undesirable implications. (shrink)

Measurement realism, the view that measurement targets quantitative attributes and that not all attributes are quantitative, has come under attack both from metrologists and philosophers. In this paper, I take a close look at two influential arguments against measurement realism: the argument from obsolescence and the argument from coordination. I concede that these arguments do challenge the epistemological position traditionally taken by measurement realists, but argue that the metaphysical core of measurement realism survives the challenge posed by these arguments. This (...) metaphysical core is vital to maintaining a clear and ambitious standard for successful measurement. (shrink)

Recent literature on causation invokes a distinction between deviant and default behavior to account for token causation. Critical examination of two prominent attempts to employ a distinction between deviants and defaults reveals that the distinction is far from clear. I clarify and develop the distinction by appeal to the notion of a modally robust process, and show how the distinction can be employed by causal process theorists to respond to cases of causation by omission. This shows that the default/deviant distinction (...) is not so much a tool for counterfactual accounts of causation, but rather for causal process theory. (shrink)

This book is available either individually, or as part of the specially-priced Arguments of the Philosphers Collection.

'To think often, and never to retain it so much as one moment, is a very useless sort of thinking' In An Essay concerning Human Understanding, John Locke sets out his theory of knowledge and how we acquire it. Eschewing doctrines of innate principles and ideas, Locke shows how all our ideas, even the most abstract and complex, are grounded in human experience and attained by sensation of external things or reflection upon our own mental activities. A thorough examination of (...) the communication of ideas through language and the conventions of taking words as signs of ideas paves the way for his penetrating critique of the limitations of ideas and the extent of our knowledge of ourselves, the world, God, and morals. Locke's masterpiece laid the foundation of British empiricism and is of enduring interest to anyone exploring the development of philosophical thought. This sensitive abridgement uses P. H. Nidditch's authoritative text, and together with an illuminating introduction and other features, makes Locke's arguments more accessible. (shrink)

Manuscript Add. 3965, section 13, folios 541r–542r and 545r–546r is in the Portsmouth Collection of manuscripts and housed in the University Library, Cambridge. These drafts contain a careful account, in Newton's hand, of his views on place, time, and God. They are part of a large number of drafts relating to the three official editions of the Principia published in Newton's lifetime.

This study considers Newton's views on space and time with respect to some important ontologies of substance in his period. Specifically, it deals in a philosophico-historical manner with his conception of substance, attribute, existence, to actuality and necessity. I show how Newton links these “features” of things to his conception of God's existence with respect of infinite space and time. Moreover, I argue that his ontology of space and time cannot be understood without fully appreciating how it relates to the (...) nature of Divine existence. In order to establish this, the ontology embodied in Newton's theory of predication is analysed, and shown to be different from the presuppositions of the ontological argument. From the historical point of view Gassendi's influence is stressed, via the mediation of Walter Charleton. Furthermore, Newton's thought on these matters is contrasted with Descartes's and Spinoza's. In point of fact, in his earliest notebook Newton recorded observations on Descartes's version of the ontological argument. Soon, however, he was to oppose the Cartesian conception of the actuality of Divine existence by means of arguments similar to those of Gassendi. Lastly, I suggest that the nature and extent of Henry More's influence on Newton's conception of how God relates to absolute space and time bears further examination. (shrink)