Outpatient services are increasingly recognised as an important component of health care provision and may be improved through the application of modern management techniques. We have performed a time and role audit of consultation and waiting times in two medical clinics using different queuing systems: namely, a serial processing clinic where patients wait in a single queue and a quasi-parallel processing clinic where patients are directed to the shortest queue to maintain clinic flow. Data collected were used to construct a (...) computer simulation of patient flows in clinic. Assessment of patient satisfaction in the clinic process was determined using a self-administered questionnaire. Mean waiting time was shorter in the quasi-parallel processing clinic: 26 (SD 17) minutes compared with 36(24) minutes in the serial processing clinic. In the serial processing clinic 61% of patients waited more than 30 minutes compared with 41% in the quasi-parallel processing clinic. In the serial processing clinic 8% of 142 patients surveyed complained of the time spent waiting. The computer simulation we produced was able to determine waiting times with different clinic structures. The simulation showed that reductions in waiting time up to 30% might be achieved by changing our serial processing clinic to a quasi-parallel processing one. Performance of medical outpatient clinics can be improved by examining and changing clinic management. Computer simulation of outpatient clinics offers a means of assessing the impact of such changes on waiting time in clinic and on waiting lists. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Receiving the Gift of Life: My Kidney Transplant StoryJudith W. RyanAs one of three siblings who all inherited an unfortunate gene from our mother, I was born with polycystic kidney disease (PKD). None of us knew of this, however, until later middle age, and my mother not until she was 76. I was the last sibling diagnosed at the age of 56. My brothers had been diagnosed some years (...) before and jokingly started to look at me as a universal donor. Since I had a 50-50 chance of having PKD and with a mother who was one of eight children with none of her siblings known to have the disease, I had not felt an urgency to be tested. Besides, I had no signs or symptoms. But now there was a reason. I made an appointment for a renal ultrasound and while having the procedure, I tipped the screen so that I could see the results. Although the technician was not happy with this, I was repaid with the view of my kidneys looking full of bubbles. Yes, our family was three for three in the genetic game of roulette.I knew immediately how I was going to navigate this health issue. As an adult nurse practitioner I had a very good understanding of what was to come. I knew my blood type “O” was the most common and would mean the longest wait for a deceased donor transplant, at least five years if I were lucky and only after enduring several years of progressing renal failure. In addition, I had cared for dialysis patients and watched my mother endure with difficulty both peritoneal and hemodialysis prior to her death a year before my diagnosis. Knowing I would not choose dialysis left me hoping for a miracle of a living donor or, more realistically, managing my disease as best I could until I died.The next step was managing PKD symptoms and issues as my kidneys continued to fail. One of the errors in my thinking during this time turned out to be that because I had two brothers who had the same disease and were ahead of me in their disease progression, I could follow their lead. It turned out that we manifested our disease very differently. My younger brother, who was diagnosed first, had to deal with significant pain from persistent cyst ruptures, monthly, biweekly then weekly. This continued even after his transplant until he had his native kidneys removed. The other two of us did not have to deal with cyst ruptures. Additionally, anemia was no problem for my younger brother but was for us older siblings. Significant fatigue and weariness were a problem for both of my brothers but not for me.And so it went, as we compared our blood test results, that the idea of a living donor entered the conversation. I knew this would be a problem for me because how do you ask people to consider being a donor? I had difficulty asking friends for a ride to the airport. This is where the grace and kindness of others and divine intervention enter [End Page 107] our story—word about our medical dilemma spread through the visibility of my younger brother, a minister in New England.Fortunately for me, my much beloved younger brother had dozens of people who wanted to be his donor. About 12 of these potential donors were actually tested before finding a match. One of his unmatched donors became the donor for my older brother (our first family transplant). Two years later, my other brother received his transplant. Three years later, after being told he was not a good match for my brother, this dear man came forward to be a possible donor for me. Hence, I got my transplant from an unused donor from my younger brother’s group. Overall, we had living donors from three different churches located within an hour of each other in New England. I even lucked out and acquired the minister of one of the churches as my donor. All three of us received kidneys over five years from living donors who did not know my older brother... (shrink)

The development of genomic technologies has seemed almost magical. Excitement about it, both in medicine and among the public, stems from the belief that genomic techniques will illuminate the causes of health and disease, will lead to effective interventions for both rare and common genetic conditions, and will inform reproductive decision‐making. Novel diagnostic tools, however, are often deployed before targeted therapies are developed, tested, or available and before their psychosocial implications are explored. Newer technologies such as prenatal whole exome screening (...) are seen as offering “decisional autonomy” to expectant parents, although such technologies identify information about genetic sequencing that may not have clear meaning. The “therapeutic gap” between the ability to conduct genetic sequencing and the ability to fully understand what the test results mean, much less what treatments to offer, leaves families with complex and unclear information they cannot act upon with confidence during pregnancy. In this essay, we will consider the psychosocial and ethical implications of such assumptions—and of the uncertain information produced by these technologies—for individuals and families and for societal aspects such as medical service usage and demographic inequities. (shrink)

A workshop in Philosophy for Children was offered this summer at Viterbo College with generous support from the Wisconsin Humanities Committee. Dr. Ronald Reed and the author conducted the week long workshop. The workshop was promoted primarily by distribution of brochures to regional schools. Four questions were addressed in the brochure: What is Philosophy for Children?, How will Philosophy for Children work in your classroom?, Why teach Philosophy for Children?, and Who should attend?. This approach was taken as part (...) of an effort at making teachers, principals and parents informed about the basic nature fo a Philosophy for Children program. (shrink)

ObjectiveThe novel coronavirus is linked to increases in emotional distress and may be particularly problematic for those with pre-existing mental and physical conditions, such as chronic pain and posttraumatic stress disorder. However, little empirical research has been published on resilience factors in these individuals. The present study aims to examine authenticity as a resilience factor among those with chronic pain and/or PTSD.MethodsPrior to the national response to the pandemic, participants were screened for pain-related disability and PTSD symptoms, and on the (...) basis of those responses were categorized into one of four groups: healthy, chronic pain only, PTSD only, or comorbid chronic pain and PTSD. During the CV-19 pandemic, participants responded again to the ODI and PCL-5, in addition to the Wood Authenticity Scale, Brief Pain Inventory, and items related to the CV-19 pandemic.ResultsA total of 110 participants, aged 42.19, completed the survey during the pandemic. The comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Authenticity moderated this relationship relevant to CV-19 Threat among those in the chronic pain only group, and not in any other group.ConclusionThe comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Importantly, greater authenticity was associated with less CV-19 Threat in the chronic pain only group, and not in any other group. The present study also highlights the importance of engaging authentically for those with chronic pain during the pandemic. (shrink)

Re-Reading: Judith Jarvis Thompson, 'A Defense of Abortion'.

Kant’s 3rd Critique claims that the concept of purposiveness bridges the chasm between nature and freedom. This concept derives from the reflecting power of judgment’s demand for a system of particular laws. The published Introduction represents this system as grounded on the Idea of a divine understanding. According to Tuschling, this divinity is the intuitive understanding of §§76-77. According to Allison, this divinity is discursive and purposive and, thus, numerically distinct from §§76-77’s intuitive understanding. I argue that this debate between (...) Tuschling and Allison fails to appreciate the varied ways in which Kant predicates divine attributes. The 3rd Critique refers to a single God but does so in various ways. First, Kant literally ascribes an intuitive understanding to God on analytic grounds. Second, Kant analogically ascribes a discursive, purposive mind to this same God. Finally, Kant ascribes moral predicates to this analogical representation of God on practical grounds. (shrink)

Revisiting Edward Said's late proposals for a one-state solution, Butler has come to a startling suggestion: Jewish ethics not only demand a critique of Zionism, but must transcend its exclusive Jewishness in order to realize the ethical ...

The unlivable is the most extreme point of human suffering and injustice. But what is it exactly? How do we define the unlivable? And what can we do to prevent and repair it? These are the intriguing questions Judith Butler and Frédéric Worms discuss in a captivating dialogue situated at the crossroads of contemporary life and politics. Here, Judith Butler criticizes the norms that make life precarious and unlivable, while Frédéric Worms appeals to a "critical vitalism" as a (...) way of allowing the hardship of the unlivable to reveal what is vital for us. For both Butler and Worms, the difference between the livable and the unlivable forms the critical foundation for a contemporary practice of care. Care and support, in all their aspects, make human life livable, that is, "more than living." To understand it, we must draw on the concrete practices of humans who are confronted with the unlivable: the refugees of today and the witnesses and survivors of past violations and genocide. They teach us what is intolerable but also undeniable about the unlivable, and what we can do to resist it. Crafted with critical rigor, mutual respect, and lively humor, the compelling dialogue transcribed and translated in this book took place at the École Normale Supérieure (ENS) on April 11, 2018, at a time when close to two thousand migrants were living in nearby makeshift camps in northern Paris. The Livable and the Unlivable showcases this 2018 dialogue in the context of Butler's and Worms's ongoing work and the evolution of their thought, as presented by Laure Barillas and Arto Charpentier in their equally engaging introduction. It concludes with a new afterword that addresses the crises unfolding in our world and the ways a philosophically rigorous account of life must confront them. While this book will be of keen interest to readers of philosophy and cultural criticism, and those interested in vitalism, new materialism, and critical theory, it is a far from merely academic text. In the conversation between Butler and Worms, we encounter questions we all grapple with in confronting the distress and precarity of our times, marked as it is by types of survival that are unlivable, from concentration camps to prisons to environmental toxicity, to forcible displacement, to the Covid pandemic. The Livable and the Unlivable at once considers longstanding philosophical questions around why and how we live, while working to retrieve a philosophy of life for today's Left. (shrink)

The development of atomic bombs under the auspices of the U.S. Army's Manhattan Project during World War II is considered to be the outstanding news story of the twentieth century. In this book, a physicist and expert on the history of the Project presents a comprehensive overview of this momentous achievement. The first three chapters cover the history of nuclear physics from the discovery of radioactivity to the discovery of fission, and would be ideal for instructors of a sophomore-level "Modern (...) Physics" course. Student-level exercises at the ends of the chapters are accompanied by answers. Chapter 7 covers the physics of first-generation fission weapons at a similar level, again accompanied by exercises and answers. For the interested layman and for non-science students and instructors, the book includes extensive qualitative material on the history, organization, implementation, and results of the Manhattan Project and the Hiroshima and Nagasaki bombing missions. The reader also learns about the legacy of the Project as reflected in the current world stockpiles of nuclear weapons. This second edition contains important revisions and additions, including a new chapter on the German atomic bomb program and new sections on British and Canadian contributions to the Manhattan project and on feed materials. Several other sections have been expanded; reader feedback has been helpful in introducing minor corrections and improved explanations; and, last but not least, the second edition includes a detailed index. (shrink)

This volume frames the question of responsibility as a problem of agency in relation to the systems and structures of globalization. According to Ricoeur responsibility is a “shattered concept” when considered too narrowly as a problem of act, agency and individual freedom. To examine this Esther Reed develops a short genealogy of modern liberal and post-liberal concepts of responsibility in order to understand better the relationship dominant modern framings of the meanings of responsibility. Reed engages with writings by (...) major modern (Schleiermacher, Hegel, Marx, Weber) and post-liberal (Buber, Levinas, Derrida, Badiou, Butler, Young, Critchley) theorists to illustrate the shift from an ethnic responsibility built on notions of accountability and attributions to an ethic responsibility that starts variously from the 'other'. Reed sees Dietrich Bonhoeffer as the most promising partner of this theological dialogue, as his learning of responsibility from the risen Christ present now in the (global) church is a welcome provocation to new thinking about the meaning of responsibility learned from land, distant neighbour, (global) church and the bible. Bonhoeffer's reflections on the centre, boundaries and limits of responsibility remain helpful to Christian people struggling with an increasingly exhausted concept of accountability. (shrink)

The development of nuclear weapons during the Manhattan Project is one of the most significant scientific events of the twentieth century. This revised and updated 3rd edition explores the challenges that faced the scientists and engineers of the Manhattan Project. It gives a clear introduction to fission weapons at the level of an upper-year undergraduate physics student by examining the details of nuclear reactions, their energy release, analytic and numerical models of the fission process, how critical masses can be estimated, (...) how fissile materials are produced, and what factors complicate bomb design. An extensive list of references and a number of exercises for self-study are included. Links are given to several freely-available spreadsheets which users can use to run many of the calculations for themselves. (shrink)

Challenging clich's of Japanism as a feminine taste, Bachelor Japanists argues that Japanese aesthetics were central to contests over the meanings of masculinity in the West. Christopher Reed draws attention to the queerness of Japanist communities of writers, collectors, curators, and artists in the tumultuous century between the 1860s and the 1960s. Reed combines extensive archival research; analysis of art, architecture, and literature; the insights of queer theory; and an appreciation of irony to explore the East-West encounter through (...) three revealing artistic milieus: the Goncourt brothers and other japonistes of late-nineteenth-century Paris; collectors and curators in turn-of-the-century Boston; and the mid-twentieth-century circles of artists associated with Seattle's Mark Tobey. The result is a groundbreaking integration of well-known and forgotten episodes and personalities that illuminates how Japanese aesthetics were used to challenge Western gender conventions. These disruptive effects are sustained in Reed's analysis, which undermines conventional scholarly investments in the heroism of avant-garde accomplishment and ideals of cultural authenticity. (shrink)

This book brings together a group of Judith Butler's philosophical essays written over two decades that elaborate her reflections on the roles of the passions in subject formation through an engagement with Hegel, Kierkegaard, Descartes, Spinoza, Malebranche, Merleau-Ponty, Freud, Irigaray, and Fanon. Drawing on her early work on Hegelian desire and her subsequent reflections on the psychic life of power and the possibility of self-narration, this book considers how passions such as desire, rage, love, and grief are bound up (...) with becoming a subject within specific historical fields of power. Butler shows in different philosophical contexts how the self that seeks to make itself finds itself already affected and formed against its will by social and discursive powers. And yet, agency and action are not necessarily nullified by this primary impingement. Primary sense impressions register this dual situation of being acted on and acting, countering the idea that acting requires one to overcome the situation of being affected by others and the linguistic and social world. This dual structure of sense sheds light on the desire to live, the practice and peril of grieving, embodied resistance, love, and modes of enthrallment and dispossession. Working with theories of embodiment, desire, and relationality in conversation with philosophers as diverse as Hegel, Spinoza, Descartes, Merleau-Ponty, Freud, and Fanon, Butler reanimates and revises her basic propositions concerning the constitution and deconstitution of the subject within fields of power, taking up key issues of gender, sexuality, and race in several analyses. Taken together, these essays track the development of Butler's embodied account of ethical relations. (shrink)

In this paper, we present a survey of the development of the technique of argument diagramming covering not only the fields in which it originated - informal logic, argumentation theory, evidence law and legal reasoning – but also more recent work in applying and developing it in computer science and artificial intelligence. Beginning with a simple example of an everyday argument, we present an analysis of it visualised as an argument diagram constructed using a software tool. In the context of (...) a brief history of the development of diagramming, it is then shown how argument diagrams have been used to analyze and work with argumentation in law, philosophy and artificial intelligence. (shrink)

This essay argues that a restatement of Thomistic natural law reasoning is increasingly necessary in jurisprudential debate about international law. Mindful of Pope John Paul II's call for a renewal of international law, the essay engages with the present-day tension between Morgenthau-type realism and neo-Kantian discourse-oriented cosmopolitanism. The essay addresses whether the former is sufficiently realistic in our global 21st century context, and whether the latter is adequately cosmopolitan. Attention is drawn to Aquinas's understanding of the relation between custom, consent (...) and political authority in order to expose some of the limits of present-day statism, and to suggest that Thomistic natural law reasoning is, potentially at least, better able to cope with the intractable disagreement that characterises 21st century global relations than some forms of neo-Kantian jurisprudence. (shrink)

The Liberating art of philosophy: a foundational anthology provides students with seminal texts and articles that pique their philosophical curiosity, encourage critical thought, and invite questioning.

In this profound appraisal of post-September 11, 2001 America, Judith Butler considers the conditions of heightened vulnerability and aggression that followed from the attack on the US, and US retaliation. Judith Butler critiques the use of violence that has emerged as a response to loss, and argues that the dislocation of first-world privilege offers instead a chance to imagine a world in which that violence might be minimized and in which interdependency becomes acknowledged as the basis for a (...) global political community. (shrink)

People are unable to report how they decide whether to move backwards or forwards to catch a ball. When asked to imagine how their angle of elevation of gaze would change when they caught a ball, most people are unable to describe what happens although their interception strategy is based on controlling changes in this angle. Just after catching a ball, many people are unable to recognise a description of how their angle of gaze changed during the catch. Some people (...) confidently choose incorrect descriptions that would guarantee failure of interception demonstrating unconscious knowledge co-existing with systematically different conscious beliefs. Where simple solutions to important evolutionary problems exist, unconscious perception needs to be impervious to conscious beliefs. (shrink)

Questioning the dominant view that Deleuze and Merleau-Ponty have little of substance in common, Judith Wambacq draws on unpublished primary sources and current scholarship in English and French to bring them into a compelling dialogue to reveal a shared concern with the transcendental conditions of thought.

In this paper I propose a new theoretical framework to analyse socio‐technical epistemic practices and systems on the Web and beyond, and apply it to the topic of web‐based scientific publishing. This framework is informed by social epistemology, science and technology studies (STS) and feminist epistemology. Its core consists of a tripartite classification of socio‐technical epistemic systems based on the mechanisms of closure they employ to terminate socio‐epistemic processes in which multiple agents are involved. In particular I distinguish three mechanisms (...) of closure, integration, aggregation and selection, and argue that they correspond to three different types of epistemic sociality. Different systems can employ different mechanism of closure or combinations thereof. Yet each mechanism has its own epistemic merits, depends on specific social, technical and epistemic prerequisites, has different strengths and weaknesses, and is optimal for different epistemic tasks. The aim of my analysis is twofold. Distinguishing different modes of epistemic sociality is a way for me not only to put forward a more nuanced framework for analysing socio‐epistemic practices, such as web‐based scientific publishing and scholarly communication. It can also serve as the theoretical basis for improving them. (shrink)

Ehrenamt - Facetten eines komplexen Phänomens -- Moralische Dignität und Ehrenamt - eine theologisch-ethische Analyse -- Zusammenschau von Theorie und Praxis -- Konklusion. Aspekte einer zukunftsfähigen und nachhaltigen Gestalt des Ehrenamtes.

The West has lost its traditional spiritual anchors following the rise of science and the social revolution of the sixties. Healing and wholeness begins with reclaiming the spiritual forms that gave rise to Western culture to provide grounding to meet the challenges of meaning in the era global cultural interchange.

Toute oeuvre veut tenir l'attention, la diriger et produire de l'effet. Mais l'attention et l'effet ne sont pas les memes selon que l'oeuvre en dit plus ou en dit moins c'est-a-dire selon sa densite. Le developpe ou le concis, l'emphatique ou l'elude, le riche ou l'austere ne produisent pas les memes intensites. En explorant les variations de la densite litteraire, on retrouve directement des enjeux essentiels. Que vise l'ideal du complet face a l'ideal du pur? Comment la litterature se rapporte-t-elle (...) au langage ordinaire? Quel peut etre le minimum artistique qui subsiste au bord du silence? Comment comprendre l'echec de la lecture, l'interet perdu et l'ennui? (shrink)

Martin Heidegger’s existential account of care in _Being and Time_ (2010) provides us with an opportunity to reimagine what the proper theoretical grounding of an ethic of care might be. Heidegger’s account of care serves to deconstruct the two primary foundations that an ethic of care is often based upon. Namely, that we are inevitably interdependent upon one another and/or possess an innate disposition to care for fellow humans in need. Heidegger’s account reveals that both positions are founded upon an (...) ontic (meaning factual existence), as opposed to an ontological (which refers to the nature of being), understanding of care. The distinctions between an ontic and ontological understanding of care are significant. Yet, I maintain that they are not completely incompatible. Both Heidegger and care ethicists contend that our existence with others is understood through a relational ontology. Furthermore, there are certain ontological structures from Heidegger which resonate with an ethic of care. Two key existential structures are leaping-ahead and being-guilty. These existential structures are latent in care ethics, and by explicitly revealing them I reinforce the connection between Heidegger’s account and care theory. Lastly, I develop the theoretical foundations of care ethics by proposing an existential ethic of care. (shrink)

T.J. Reed's study has long established itself as the standard work in English on Thomas mann, and offers as comprehensive a view of Mann's fiction and thought as is available in any language. It is based on a coherent close reading of Mann's oeuvre, literary and political, and also on manuscripts and sources, and was part of the first phase of literary scholarship that opened up the resources of the Zurich Thomas Mann Archive. Further documents that have appeared since (...) then - Mann's diaries, notebooks, and other correspondences - have not fundamentally altered the individual interpretations or the overall picture the study offers, and in some respects have emphatically confirmed them. A further chapter added to this edition covers the new documentation, gives a vigorous account of the main curents in Mann scholarship and criticism over the last two decades suggesting how we should now see the writer, the man, and the political figure, and above all the complex relationship between the three. (shrink)