Institutional ethics committees (IECs) are part of a growing phenomenon in the American health care system. Although a major force driving hospitals to establish IECs is the desire to resolve difficult clinical dilemmas in a quick and systematic way, in this paper we argue that such a goal is naive and, to some extent, misguided. We assess the growing trend of these committees, analyse the theoretical assumptions underlying their establishment, and evaluate their strengths and shortcomings. We show how the 'medical (...) consultation' model is often inappropriately applied to IECs and suggest that IECs must operate under a different framework. Finally, we argue that IECs should be valued for the process they facilitate, and not for the product that they are, often unreasonably, expected to deliver. (shrink)

IThe so-called enterprise or commercial-bureaucratic university has been with us for some time. To its advocates, it has set higher education on a rational footing and demystified the folkways of cosseted intellectuals. To its detractors, it galls the kibe. For observers and stakeholders alike, the age of the office has introduced a new way of thinking and speaking in campus boardrooms and action sessions. The idiom of markets and corporations—How competitive are we? What are the anticipated returns on investment? Where (...) can payroll efficiencies be found?—frames an instrumental, quantifiable understanding of the vita academica. Corporate clients need to decide…. (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)

Nous considérons la structure dans son rapport au temps : sous ce rapport, la structure est normative, et l’avenir aide à constituer le présent et le passé. Des exemples sont empruntés à l’embryologie et à la géologie. On explique pourquoi il est difficile de concevoir une structure cosmique spatio-temporelle, et comment le développement récent de la physique nous y aide ; dans cette physique, la notion de structure cosmique a un rôle éminent. Il en résulte que seules sont viables les (...) combinaisons qui sont dans La ligne historique de la nature. (shrink)