Objectives—To evaluate a departmental computer system.Design—a. Direct comparison of the time taken to use a manual system with the time taken to use a computer system for lung function evaluation, loan of equipment and production of correspondence. b. Analysis of the accuracy of data capture before and after the introduction of the computer system. c. Analysis of the comparative running costs of the manual and computer systems.Setting—Within a department of respiratory medicine serving a hospital of 1323 beds.Main Outcome Measures—a. Time (...) taken to perform functions with the assistance of computerised methods, in comparison to the manual method used alone. b. Accuracy of data capture. c. Relative running costs.Results—a. The computer system was significantly faster than the manual system for lung function evaluation, loan of equipment, and checking for overdue equipment. The production of correspondence was slightly slower with the computer. b. All outpatient episodes, but only 43 of 65 of inpatient episodes, were captured. Lung function and managerial report data were accurate using both manual and computerised methods. The manual system for equipment loans was inefficient, and use of the computer resulted in the recovery of 221 nebulisers. c. Development costs for 1988–1990 were high. Only £1200 to £1845 per year was recovered directly from staff time saved by the computer but larger savings resulted from changes in work practice. After 10 years the projected deficit is £10 000 per annum in running costs.Conclusions—In comparison with the manual methods, the computer system has shown significant advantages which provide accurate information, with significant favourable effects on working practices. In evaluating computer systems used in clinical practice it is essential to ensure that the projected work practice benefits are achieved without unacceptable costs in staff time, inaccurate data and high financial outlay. (shrink)

Objectives—To evaluate a departmental computer system.Design—a. Direct comparison of the time taken to use a manual system with the time taken to use a computer system for lung function evaluation, loan of equipment and production of correspondence. b. Analysis of the accuracy of data capture before and after the introduction of the computer system. c. Analysis of the comparative running costs of the manual and computer systems.Setting—Within a department of respiratory medicine serving a hospital of 1323 beds.Main Outcome Measures—a. Time (...) taken to perform functions with the assistance of computerised methods, in comparison to the manual method used alone. b. Accuracy of data capture. c. Relative running costs.Results—a. The computer system (CS) was significantly faster than the manual system (MS) for lung function evaluation (CS=7.63 min/test, MS=12.25 min/test), loan of equipment (CS=0.40 min/loan, MS=2.07 min/loan), and checking for overdue equipment (CS=0.49 s/record, MS=9 s/record). The production of correspondence was slightly slower with the computer (CS=9.30 min/letter, MS=8.54 min/letter). b. All outpatient episodes, but only 43 of 65 (66%) of inpatient episodes, were captured. Lung function and managerial report data were accurate using both manual and computerised methods. The manual system for equipment loans was inefficient, and use of the computer resulted in the recovery of 221 nebulisers. c. Development costs for 1988–1990 were high (£72 178). Only £1200 to £1845 per year was recovered directly from staff time saved by the computer but larger savings resulted from changes in work practice (£4049–4765). After 10 years the projected deficit is £10 000 per annum in running costs.Conclusions—In comparison with the manual methods, the computer system has shown significant advantages which provide accurate information, with significant favourable effects on working practices. In evaluating computer systems used in clinical practice it is essential to ensure that the projected work practice benefits are achieved without unacceptable costs in staff time, inaccurate data and high financial outlay. (shrink)

A child poverty rate of ten percent could mean that every tenth child is always poor, or that all children are in poverty for one month in every ten. Knowing where reality lies between these extremes is vital to understanding the problem facing many countries of poverty among the young. This unique study goes beyond the standard analysis of child poverty based on poverty rates at one point in time and documents how much movement into and out of poverty by (...) children there actually is, covering a range of industrialised countries - the USA, UK, Germany, Ireland, Spain, Hungary and Russia. Five main topics are addressed: conceptual and measurement issues associated with a dynamic view of child poverty; cross-national comparisons of child poverty rates and trends; cross-national comparisons of children's movements into and out of poverty; country-specific studies of child poverty dynamics; and the policy implications of taking a dynamic perspective. (shrink)

Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need (...) to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent. (shrink)

The esteemed psychologist and thinker John Dewey headed for previously unexplored philosophical territory with this influential work. Written shortly after World War I, it embodies Dewey's system of pragmatic humanism and maintains that individuals can attain "a more ordered and intelligent happiness" by reconsidering the ultimate effects of their deepest beliefs and feelings. With its promise of achieving an understanding of the past and attaining a brighter future, Reconstruction in Philosophy remains ever relevant. "A modern classic." — Philosophy and (...) Phenomenological Research. (shrink)

The author draws on the policy analysis literature to delineate the linkage between conceptualization of risk and the formulation and proposed solution of risk-related policy problems. Two concepts of risk are identified: a concept of risk as a physically given attribute of hazardous technologies and a concept of risk as a socially constructed attribute. The argument is advanced that the social construction of risk provides a firm, theoretical basis for the design of policy. The discussion links the perception, manage ment, (...) and communication of risk to the more fundamental issue of the nature and role of science and technology. (shrink)

With precision and profundity born of 30 years of devoted study, John Boyle offers an essential introduction to St. Thomas Aquinas on Scripture, shedding helpful light on the goals, methods, and commitments that animate the Angelic Doctor's engagement with the sacred page. Because the genius of St. Thomas's approach to the Bible lies not so much in its novelty but rather in the fidelity and clarity with which he recapitulates the riches of the preceding interpretive Tradition, this initiation into (...) St. Thomas's vision of Scripture is itself an orientation to the Church's vision of Scripture, from the Fathers through and beyond the Middle Ages. St. Thomas's embeddedness within the Church's Tradition and his own historical context is integral to his approach to Scripture, yet it sets him at some distance from modern readers, for whom his interpretive vision may seem perplexing or even impenetrable. In this Primer, Boyle first provides an acclimation to this medieval context through a survey and explanation of pertinent technical terminology used by St. Thomas and characteristic of the scholastic theology of the time. With an eye to the medieval practice of considering Scripture according to the fourfold division of causes, Boyle builds on this initial foundation by exploring in turn St. Thomas's accounts of the end or use of Scripture (final cause), its divine and human authorship (efficient cause), its order and division (material cause), and its literary styles or genres (formal cause). Drawing on writings from across St. Thomas's corpus, but especially his work On the Commendation and Division of Sacred Scripture and the prologues to his biblical commentaries, Boyle masterfully elucidates both the hermeneutical principles and deep wisdom of the Angelic Doctor's approach to Scripture, imparting invaluable guidance not only for reading and understanding St. Thomas and other great masters of the Tradition, but also-and ultimately-for understanding Scripture in light of this Tradition and reading it with greater benefit and joy. (shrink)

Despite recurring efforts, a gap exists across a variety of contexts between the protection of patients' safety in theory and in practice. This timely Research Handbook highlights these critical issues and suggests both legal and policy changes are necessary to better protect patients' safety. Multidisciplinary in nature, this Research Handbook features contributions from eminent academics, policy makers and medical practitioners from the Global North and South, discussing the essential facets concerning patient safety and the law. It highlights how the role (...) of legislation and case law has the potential to influence, both positively and negatively, medical practice and the quality of care. Chapters explore patient safety and the global health agenda; physiotherapy; 'non-therapeutic' clinical research with children; patient safety awareness in healthcare education; and the increasing use of robotics and artificial intelligence in healthcare. Outlining a wide range of international perspectives on patient safety and the law, this Research Handbook will appeal to academics and researchers specialising in health and medical law, human rights and healthcare regulation. It will also serve as a valuable resource for legal and medical practitioners alike, as well as clinicians and professionals working in healthcare governance. (shrink)

The notion of proof is central to mathematics yet it is one of the most difficult aspects of the subject to teach and master. In particular, undergraduate mathematics students often experience difficulties in understanding and constructing proofs. Understanding Mathematical Proof describes the nature of mathematical proof, explores the various techniques that mathematicians adopt to prove their results, and offers advice and strategies for constructing proofs. It will improve students’ ability to understand proofs and construct correct proofs of their own. The (...) first chapter of the text introduces the kind of reasoning that mathematicians use when writing their proofs and gives some example proofs to set the scene. The book then describes basic logic to enable an understanding of the structure of both individual mathematical statements and whole mathematical proofs. It also explains the notions of sets and functions and dissects several proofs with a view to exposing some of the underlying features common to most mathematical proofs. The remainder of the book delves further into different types of proof, including direct proof, proof using contrapositive, proof by contradiction, and mathematical induction. The authors also discuss existence and uniqueness proofs and the role of counter examples. (shrink)

During the eukaryotic cell cycle, chromosomes undergo large structural transitions and spatial rearrangements that are associated with the major cell functions of genome replication, transcription and chromosome condensation to metaphase chromosomes. Eukaryotic cells have evolved cell cycle dependent processes that modulate histone:DNA interactions in chromosomes. These are; (i) acetylations of lysines; (ii) phosphorylations of serines and threonines and (iii) ubiquitinations of lysines. All of these reversible modifications are contained in the well‐defined very basic N‐ and C‐ terminal domains of histones. (...) Acetylations and phosphorylations markedly affect the charge densities of these domains whereas ubiquitination adds a bulky globular protein, ubiquitin, to lysines in the C‐terminal tails of H2A and H2B. Histone acetylations are strictly associated with genome replication and transcription; histone H1 and H3 phosphorylations correlate with the process of chromosome condensation. The subunits of histone H1 kinase have now been shown to be cyclins and the p34CDC2 kinase product of the cell cycle control gene CDC2. It is probable that all of the processes that control chromosome structure:function relationships are also involved in the control of the cell cycle. (shrink)

This paper describes the experience of an academic institution, the Queensland University of Technology (QUT), developing training courses about research integrity practices in authorship, publication, and Journal Peer Review. The importance of providing research integrity training in these areas is now widely accepted; however, it remains an open question how best to conduct this training. For this reason, it is vital for institutions, journals, and peak bodies to share learnings.We describe how we have collaborated across our institution to develop training (...) that supports QUT’s principles and which is in line with insights from contemporary research on best practices in learning design, universal design, and faculty involvement. We also discuss how we have refined these courses iteratively over time, and consider potential mechanisms for evaluating the effectiveness of the courses more formally. (shrink)

Aims:The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress.Background:Moral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon.Design:Systematic literature review and narrative synthesis (November (...) 2015–March 2016).Data sources:Ovid MEDLINE®In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO®1967–Present, CINAHL®Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education Abstracts.Review methods:Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis.Results:In all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity.Conclusion:We suggest the combination of (1) the experience of a moral event, (2) the experience of ‘psychological distress’ and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress. (shrink)

This chapter is a science fiction story about a hunter named Eckels, who pays money to join a hunting party that will travel back to the late Jurassic Era, on a guided safari to kill a Tyrannosaurus rex. Although Eckels is initially excited about the hunt, when the monstrous Tyrannosaur approaches, he loses his nerve. Travis tells him he cannot leave, but Eckels panics, steps off the path and runs into the forest. Realizing that Eckels has fallen off the path, (...) Travis threatens to leave him in the past unless he removes the bullets from the dinosaur's body, as they cannot be left behind. He frantically pleads with Travis to take him back into the past to undo the damage, but Travis explains that the time machine cannot return to any point in time that has already been visited. Travis raises his gun, and there is “a sound of thunder”. (shrink)

Domestic abuse is a worldwide public health issue with long‐term health and social consequences. Nurses play a key role in recognizing and responding to domestic abuse. Yet there is considerable evidence that their responses are often inappropriate and unhelpful, such as trivializing or ignoring the abuse. Empirical studies have identified several reasons why nurses' responses are sometimes wanting. These include organizational constraints, e.g. lack of time and privacy; and interpersonal factors such as fear of offending women and lack of confidence. (...) We propose, however, that these factors present only a partial explanation. Drawing on the work of Julia Kristeva, we suggest that alternative understandings may be derived through applying the concept of abjection. Abjection is a psychological defence against any threat (the abject) to the clean and proper self that results in rejection of the abject. Using examples from our own domestic abuse research, we contend that exposure of nurses to the horror of domestic abuse evokes a state of abjection. Domestic abuse (the abject) transgresses established social boundaries of clean and proper. Thus when exposed to patients' and clients' experiences of it, some nurses subconsciously reject domestic abuse as a possibility (abjection). They do this to protect themselves from the horror of the act, but in so doing, render themselves unable to formulate appropriate responses. Rather than understanding the practice of some nurses as wilfully neglectful or ignorant, we argue that through a state of abjection, they are powerless to act. This does not refute existing evidence about nurses' responses to domestic abuse. Rather, as a relatively unknown concept in nursing, abjection provides an additional explanatory layer that accounts for why some nurses respond the way they do. Crucially, it elucidates the need for nurses to be supported emotionally when faced with the transgressive practice of abuse. (shrink)

BackgroundThe phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice.Research aimTo explore the concept of moral (...) distress in nursing both empirically and conceptually.MethodologyFeminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis.Ethical considerationsThe study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom.FindingsThe empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas.DiscussionWe suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress.ConclusionThe empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’. (shrink)

There has been increasing debate in recent years about the conceptualization of moral distress. Broadly speaking, two groups of scholars have emerged: those who agree with Jameton’s ‘narrow definition’ that focuses on constraint and those who argue that Jameton’s definition is insufficient and needs to be broadened. Using feminist empirical bioethics, we interviewed critical care nurses in the United Kingdom about their experiences and conceptualizations of moral distress. We provide our broader definition of moral distress and examples of data that (...) both challenge and support our conceptualization. We pre‐empt and overcome three key challenges that could be levelled at our account and argue that there are good reasons to adopt our broader definition of moral distress when exploring prevalence of, and management strategies for, moral distress. (shrink)

This article analyses the ambiguous intimacies generated by the competition that permeates desire in Lisa Aschan’s She Monkeys (2011). The article argues that in a new corpus of films about adolescence, the queerness of lesbian desire is evoked as a series of affects outside of figurative norms. Desire meets and is confused with other affects such as envy and disgust, all of which attach, sometimes simultaneously, to objects that do not always seem to recognise or permit them. Slow and languid (...) scenes reveal desire’s potential but rarely its achievement. The article explores the erotic potential of those intimacies that reside in the spaces between bodies, asking what happens to that potential when it is generated but immediately contained by the negotiations of control. In dialogue with psychoanalytic work on the ambivalent relations between desire, envy, attachment and idealisation, the article advances a reading of an affective mode of filmmaking that is saturated with desire but not defined by desire’s labelling. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 64-65, December 2011.

Austerity, by its very nature, imposes constraints by limiting the options for action available to us because certain courses of action are too costly or insufficiently cost effective. In the context of healthcare, the constraints imposed by austerity come in various forms; ranging from the availability of certain treatments being reduced or withdrawn completely, to reductions in staffing that mean healthcare professionals must ration the time they make available to each patient. As austerity has taken hold, across the United Kingdom (...) and Europe, it is important to consider the wider effects of the constraints that it imposes in healthcare. Within this paper, we focus specifically on one theorised effect—moral distress. We differentiate between avoidable and unavoidable ethical challenges within healthcare and argue that austerity creates additional avoidable ethical problems that exacerbate clinicians’ moral distress. We suggest that moral resilience is a suitable response to clinician moral distress caused by unavoidable ethical challenges but additional responses are required to address those that are created due to austerity. We encourage clinicians to engage in critical resilience and activism to address problems created by austerity and we highlight the responsibility of institutions to support healthcare professionals in such challenging times. (shrink)

If you work in the early years, you have probably heard of Montessori and Bronfenbrenner - but have you heard of Bavolek or Fisher? Contemporary theorists and theories of early childhood learning have much to teach us. It is often forgotten that this learning is still evolving and that new voices are joining the discussion every year. This book introduces early years practitioners to some contemporary theorists and explores their work alongside more well-known thinkers. It demonstrates how these theories relate (...) to everyday practice in the early years and that discussion of them can support ongoing professional learning. (shrink)

Theories of discourse bring to realism new ideas about how knowledge develops and how representations of reality are influenced. We gain an understanding of the conceptual aspect of social life and the processes by which meaning is produced. This collection reflects the growing interest realist critics have shown towards forms of discourse theory and deconstruction. The diverse range of contributions address such issues as the work of Derrida and deconstruction, discourse theory, Eurocentrism and poststructuralism. What unites all of the contributions (...) is a sense that it is essential to provide a realist alternative to the hitherto dominance of social constructionism, hermeneutics and postmodernism, over many of the issues discussed. By developing a realist perspective the different authors attempt to embed discourse within the structured nature of the reality of the world. Realism can situate language, discourse and ideology within context specific, or 'causally efficacious' circumstances. Realism can help to uncover issues of power, representation, and subjectivity and how discursive and other social practices produce real effects. This can help us understand the manner in which social structures are reproduced through various forms of ideology and discourse. And by knowing this, we can start to address questions concerning human emancipation and how the world is to be transformed. (shrink)

This vital study offers a new interpretation of Hume's famous "Of Miracles," which notoriously argues against the possibility of miracles. By situating Hume's popular argument in the context of the 18th century debate on miracles, Earman shows Hume's argument to be largely unoriginal and chiefly without merit where it is original. Yet Earman constructively conceives how progress can be made on the issues that Hume's essay so provocatively posed about the ability of eyewitness testimony to establish the credibility of marvelous (...) and miraculous events. (shrink)

Though the revised edition of A Theory of Justice, published in 1999, is the definitive statement of Rawls's view, so much of the extensive literature on Rawls's theory refers to the first edition. This reissue makes the first edition once again available for scholars and serious students of Rawls's work.

Previous edition, 1st, published in 1971.

Part One reviews some recent history of epistemology, focusing on ways in which the intellectual virtues have been invoked to solve specific epistemological problems. This part gives a sense of the contemporary landscape that has emerged and clarifies some of the disagreements among those who invoke the virtues in epistemology. Part Two explores some problems about knowledge in greater detail, and defends a externalist approach in virtue epistemology.

This book continues and revises the ideas of justice as fairness that John Rawls presented in _A Theory of Justice_ but changes its philosophical interpretation in a fundamental way. That previous work assumed what Rawls calls a "well-ordered society," one that is stable and relatively homogenous in its basic moral beliefs and in which there is broad agreement about what constitutes the good life. Yet in modern democratic society a plurality of incompatible and irreconcilable doctrines--religious, philosophical, and moral--coexist within (...) the framework of democratic institutions. Recognizing this as a permanent condition of democracy, Rawls asks how a stable and just society of free and equal citizens can live in concord when divided by reasonable but incompatible doctrines? This edition includes the essay "The Idea of Public Reason Revisited," which outlines Rawls ' plans to revise _Political Liberalism,_ which were cut short by his death. "An extraordinary well-reasoned commentary on _A Theory of Justice_...a decisive turn towards political philosophy." --_Times Literary Supplement_. (shrink)

A Norton Library edition of Locke's Second Treatise of Government, edited by A. John Simmons.

Much as we would like to conceive empirical thought as rationally grounded in experience, pitfalls await anyone who tries to articulate this position, and ...

John Dupre warns that our understanding of human nature is being distorted by two faulty and harmful forms of pseudo-scientific thinking. Not just in the academic world but in everyday life, we find one set of experts who seek to explain the ends at which humans aim in terms of evolutionary theory, while the other set uses economic models to give rules of how we act to achieve those ends. Dupre demonstrates that these theorists' explanations do not work and (...) that, if taken seriously, their theories tend to have dangerous social and political consequences. For these reasons, it is important to resist scientism: an exaggerated conception of what science can be expected to do for us. Dupre restores sanity to the study of human nature by pointing the way to a proper understanding of humans in the societies that are our natural and necessary environments. Anyone interested in science and human life will enjoy this book--unless they are its targets. (shrink)