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)

Centuries of scientific progress have been devoted to reducing uncertainty. Newtonian physics, introduced over 300 years ago, allowed for precise prediction of planetary and tidal motion, falling bodies and infinitely more, in addition to allowing the construction of the material world. The 20th century witnessed a revolution in our understanding of organ and cellular function and dysfunction, elucidation of pathways, mediators, receptors, and molecular interactions, and breakthroughs in the characterization of replication, transcription, and translation, all of which has been integral (...) to our understanding of human physiology and pathophysiology. Clinical epidemiology has had a revolutionary impact on our .. (shrink)

“Nobody owns healing, you don’t own our culture. You can’t take it from us. We deserve respect.”-Angela Beers, a person of Indigenous Mexican (Zacatecas and Coahuila) heritage, speaking in protest...

This chapter contains sections titled: Faith and reason God's existence The names of God Theology and metaphysics How we know Universals Individuation Conclusion.

The claim that metaphysics is fundamental has frequently been voiced in the history of the discipline. However, the usual ways in which this claim is justified do not appear to be effective. This article aims to fill this gap in meta-metaphysical theory by providing a credible justification of the fundamentality of metaphysics in two steps. The first consists in establishing a set of five conditions of fundamentality for the discipline. The second consists in showing that these conditions are satisfied when (...) the object of study of metaphysics is identified with an ontologically neutral object, namely categories, and the task of the discipline is taken to be the determination of the number and identity of the most general categories and the relation of less general categories to the most general ones. (shrink)

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

In the last decade the enterprise of formal semantics has been under attack from several philosophical and linguistic perspectives, and it has certainly suffered from its own scattered state, which hosts quite a variety of paradigms which may seem to be incompatible. It will not do to try and answer the arguments of the critics, because the arguments are often well-taken. The negative conclusions, however, I believe are not. The only adequate reply seems to be a constructive one, which puts (...) several pieces of formal semantics, in particular dynamic semantics, together again.In this paper I will try and sketch an overview of tasks, techniques, and results, which serves to at least suggest that it is possible to develop a coherent overall picture of undeniably important and structural phenomena in the interpretation of natural language. The idea is that the concept of meanings as truth conditions after all provides an excellent start for an integrated study of the meaning and use of natural language, and that an extended notion of goal directed pragmatics naturally complements this picture. None of the results reported here are really new, but we think it is important to re-collect them. (shrink)

Desmosomes are junctions involved in intercellular adhesion of epithelial cells and hemidesmosomes are junctions involved in adhesion of epithelia to basement membranes. Both are characterised at the ultrastructural level by dense cytoplasmic plaques which are linked to the intermediate filament cytoskeleton of the cells. The plaques strongly resemble each other suggesting a relationship between the two kinds of junctions, as implied by their names. Recent characterisation of the molecular components of the junctions shows they are, in fact, quite unrelated implying (...) that structural similarity is fortuitous. The molecular biology raises many fascinating problems relating to their structure and function. (shrink)

Citing of previous publications is an important factor in knowledge development. Because of the great amount of publications available, only a selection of studies gets cited, for varying reasons. If the selection of citations is associated with study outcome this is called citation bias. We will study determinants of citation in a broader sense, including e.g. study design, journal impact factor or the funding source of the publication. As a case study we assess which factors drive citation in the human (...) literature on phthalates, specifically the metabolite mono phthalate. A systematic literature search identified all relevant publications on human health effect of MEHP. Data on potential determinants of citation were extracted in duplo. Specialized software was used to create a citation network, including all potential citation pathways. Random effect logistic regression was used to assess whether these determinants influence the likelihood of citation. 112 Publications on MEHP were identified, with 5684 potential citation pathways of which 551 were actual citations. Reporting of a harmful point estimate, journal impact factor, authority of the author, a male corresponding author, research performed in North America and self-citation were positively associated with the likelihood of being cited. In the literature on MEHP, citation is mostly driven by a number of factors that are not related to study outcome. Although the identified determinants do not necessarily give strong indications of bias, it shows selective use of published literature for a variety of reasons. (shrink)

Recent discussions of this issue have centered on the definition of the of philosophy in American public life and the ways of increasing philosophy's influence in the public arena.' This emphasis is prompted by the fact philosophers are worried about the future of the profession. After a tremendous expansion in the sixties, there has been a steady decline in the number college-teaching positions open to newly graduated philosophers. The market is bloated and Ph.D.'s in philosophy have increasing difficulty securing permanent (...) jobs. The American Philosophical Association has tried to address this situation in various ways and discussions of the state and future of the profession, once rare, are becoming common. I am quite sure that part of the motivation for this panel involved these reasons. Today, however, I am not going to address the issue of jobs, or the ways which we can increase the influence of philosophy. Rather, I am going concentrate on only two questions: First, Does philosophy have a place contemporary American public life? Second, Should philosophy have a place American public life? Because my answer to the first question is going to be negative, I am also going to discuss some of the reasons why I believe philosophy does not play a role in American public life. (shrink)

Background and objectives: Physicians are exposed to matters of existential character at work, but little is known about the personal impact of such issues. Methods: To explore how physicians experience and cope with existential aspects of their clinical work and how such experiences affect their professional identities, a qualitative study using individual semistructured interviews has analysed accounts of their experiences related to coping with such challenges. Analysis was by systematic text condensation. The purposeful sample comprised 10 physicians (including three women), (...) aged 33–66 years, residents or specialists in cardiology or cardiothoracic surgery, working in a university hospital with 24-hour emergency service and one general practitioner. Results: Participants described a process by which they were able to develop a capacity for coping with the existential challenges at work. After episodes perceived as shocking or horrible earlier in their career, they at present said that they could deal with death and mostly keep it at a distance. Vulnerability was closely linked to professional responsibility and identity, perceived as a burden to be handled. These demands were balanced by an experience of meaning related to their job, connected to making a difference in their patients’ lives. Belonging to a community of their fellows was a presupposition for coping with the loneliness and powerlessness related to their vulnerable professional position. Conclusions: Physicians’ vulnerability facing life and death has been underestimated. Belonging to caring communities may assist growth and coping on exposure to existential aspects of clinical work and developing a professional identity. (shrink)

(1979). The Effect of Extraversion, Detail Importance and Interference on the Recall of Prose by Eleven‐year Old Children. Educational Studies: Vol. 5, No. 1, pp. 15-22.