Background Policy instruments based on the working of markets have been introduced to empower consumers of healthcare. However, it is still not easy to become a critical consumer of healthcare. Objectives The aim of this study is to analyse the possibilities of the state to strengthen the position of patients with the aid of a new financial regime, such as personal health budgets. Methods Data were collected through in-depth interviews with executives, managers, professionals and client representatives of six long-term care (...) institutions. Results With the introduction of individual budgets the responsibility for budgetary control has shifted from the organisational level to the individual level in the caregiver-client relationship. Having more luxurious care on offer necessitates a stronger demarcation of regular care because organisations cannot simultaneously offer extra care as part of the standard care package. New financial instruments have an impact on the culture of receiving and giving care. Distributive justice takes on new meaning with the introduction of financial market mechanisms in healthcare; the distributing principle of ‘need’ is transformed into the principle of ‘economic demand’. Conclusion Financial instruments not only act as a countervailing power against providers insufficiently client-oriented, but are also used by providers to reinforce their own positions vis-à-vis demanding clients. Tailor-made finance is not the same as tailor-made care. (shrink)

This essay explores the aspects of the Aristotelian psuchē that accounts for its contemporary appeal. The poverty of the notion of the mind is discussed. The superiority of the psuchē over the mind is emphasized.

De Marco et al 1 argue that the standard account of medical ‘invasiveness’ (as ‘incision’ or ‘insertion’) fails to capture three aspects of its existing use, namely that invasiveness can come in degrees, often depends on features of alternative medical interventions and can be non-physical. They propose a new schematic account that suggests that medical interventions can possess ‘basic invasiveness’ (which can come in degrees and of which they suggest at least two types: physical and mental), and ‘threshold invasiveness’ which (...) can depend on the alternatives a specific intervention is being compared with. While we agree that the standard account of invasiveness fails to capture existing use and are supportive of their aim, here we express scepticism about the practical utility of De Marco et al ’s revised account. Our scepticism concerns the application of De Marco et al’s revised account in the narrow context of clinician–patient communication and deliberation about medical interventions within clinical practice, which we see as a crucial context for its use. While De Marco et al do not specify the contexts in which their revised account could be used, we assume from their discussion of treatment interventions (e.g. non-invasive prenatal testing, ventilation) and their comparison to ‘more or less invasive’ options, that at least one of the purposes in mind for …. (shrink)

BackgroundThe emphasis on impact factors and the quantity of publications intensifies competition between researchers. This competition was traditionally considered an incentive to produce high-quality work, but there are unwanted side-effects of this competition like publication pressure. To measure the effect of publication pressure on researchers, the Publication Pressure Questionnaire (PPQ) was developed. Upon using the PPQ, some issues came to light that motivated a revision.MethodWe constructed two new subscales based on work stress models using the facet method. We administered the (...) revised PPQ (PPQr) to a convenience sample together with the Maslach Burnout Inventory (MBI) and the Work Design Questionnaire (WDQ). To assess which items best measured publication pressure, we carried out a principal component analysis (PCA). Reliability was sufficient when Cronbach’s alpha > 0.7. Finally, we administered the PPQr in a larger, independent sample of researchers to check the reliability of the revised version.ResultsThree components were identified as ‘stress’, ‘attitude’, and ‘resources’. We selected 3 × 6 = 18 items with high loadings in the three-component solution. Based on the convenience sample, Cronbach’s alphas were 0.83 for stress, 0.80 for attitude, and 0.76 for resources. We checked the validity of the PPQr by inspecting the correlations with the MBI and the WDQ. Stress correlated 0.62 with MBI’s emotional exhaustion. Resources correlated 0.50 with relevant WDQ subscales. To assess the internal structure of the PPQr in the independent reliability sample, we conducted the principal component analysis. The three-component solution explains 50% of the variance. Cronbach’s alphas were 0.80, 0.78, and 0.75 for stress, attitude, and resources, respectively.ConclusionWe conclude that the PPQr is a valid and reliable instrument to measure publication pressure in academic researchers from all disciplinary fields. The PPQr strongly relates to burnout and could also be beneficial for policy makers and research institutions to assess the degree of publication pressure in their institute. (shrink)

The ability to memorize changes in the environment is present at all biological levels, from social groups and individuals, down to single cells. Trans‐generational memory is embedded subcellularly through genetic and epigenetic mechanisms. Evidence that cells process and remember features of the immediate environment using protein sensors is reviewed. It is argued that this mnemonic ability is encapsulated within the protein conformational space and lasts throughout its lifetime, which can overlap with the lifespan of the organism. Means to determine diachronic (...) changes in protein activity are presented. (shrink)

Over the past decades, science funding shows a shift from recurrent block funding towards project funding mechanisms. However, our knowledge of how project funding arrangements influence the organizational and epistemic properties of research is limited. To study this relation, a bridge between science policy studies and science studies is necessary. Recent studies have analyzed the relation between the affordances and constraints of project grants and the epistemic properties of research. However, the potentially very different affordances and constraints of funding arrangements (...) such as awards, prizes and fellowships, have not yet been taken into account. Drawing on eight case studies of funding arrangements in high performing Dutch research groups, this study compares the institutional affordances and constraints of prizes with those of project grants and their effects on organizational and epistemic properties of research. We argue that the prize case studies diverge from project-funded research in three ways: 1) a more flexible use, and adaptation of use, of funds during the research process compared to project grants; 2) investments in the larger organization which have effects beyond the research project itself; and 3), closely related, greater deviation from epistemic and organizational standards. The increasing dominance of project funding arrangements in Western science systems is therefore argued to be problematic in light of epistemic and organizational innovation. Funding arrangements that offer funding without scholars having to submit a project-proposal remain crucial to support researchers and research groups to deviate from epistemic and organizational standards. (shrink)

ÖZ “Tanzanya’da Leibzig Misyoner Cemiyeti Misyonerliği, Karşılaşılan Zorluklar ve Kullanılan Yöntemler” isimli makale “Tanzanya’da Misyonerlik Faaliyetler Lutheran Kilise Örneği” isimli yüksek lisans tezine dayanmaktadır. Makale, Lutheran misyonerliğinin Tanzanya’da faaliyetlerine nasıl başladıkları, ilerleme yöntemleri ve karşılaşılan güçlükleri anlama noktasında önem arz etmektedir. Makalede ana konuya odaklanmadan önce, Tanzanya hakkında genel bir bilgilendirme yapılmış, ardından Leibzig Misyon Cemiyeti’nin (LMS) faaliyetlerine nasıl başladığı, kronolojik bir şekilde açmış olduğu istasyonlar, bu istasyonlarda karşılaşmış olduğu zorluklar ve kullanılan yöntemler hakkında bilgi verilmiştir. Ayrıca, Tanzanya’da Lutheran misyoner (...) cemiyetlerinin, Tanzanya Evanjelik Lutheran Kilisesi (Tanzania Evangelical Lutheran Church in Tanzania) ELCT ile tek bir kilise çatı altında toplanması ele alınmıştır. Son olarak, ELCT’nin kabul etmiş olduğu ilkeler ve Martin Luther’in öğretilerinin Afrika’daki yansımaları üzerinde durulmuştur. Makale, sadece misyonerleri ve misyonerlik faaliyetlerini değil, ayrıca muhatap olunan ve yüzyıllardır sömürgeleştirilen Afrika halkını anlamamıza da yardımcı olmaktadır. Araştırma, Lutheran misyonerliğinin Tanzanya’da başlamış olduğu 19. yüzyıl sonu ve yoğunlaştığı 20. yüzyıl ile sınırlandırılmıştır. Otto von Bismarck’ın (1815-1898) katkılarıyla gerçekleşen Berlin Konferansı sayesinde, batılı ülkelerin bayrakları ile haçları da sömürge topraklarına girmiştir. Tanzanya'da Lutheran Misyon, Johann Ludwig Krapf (1810-1881) ve Johannes Rebmann'ın (1820-1876) CMS tarafından görevlendirilmeleri sonucu başlamıştır. LMS, CMS'den 1892 tarihinde görevi devralmıştır ve Machame, Mamba, Old Moshi, Pare, Meru'da faaliyet göstermiştir. Misyon faaliyetleri süresince, savaşlar, kıtlık ve salgın, çok eşlilik, sünnet uygulaması, tanrı anlayışı gibi birçok zorlukla karşılaşılmıştır. Zorluklar, onları ortadan kaldırmaya yardımcı olacak; eğitim, sağlık, bütüncül hizmet, ortak dil (lingua franca), Kutsal Kitap çevirileri, ev ziyaretleri, yerli yardımcılar ve yerlileştirme gibi yöntemleri de beraberinde getirmiştir. Tanzanya’da LMS dışında; Katolik Kutsal Ruh Babaları (Holy Ghost Father/ Spiritanlar), Katolik Beyaz Babalar (Peres Blancs), Katolik Benediktinler, Anglikan Kilise Misyon Topluluğu (Chuch Missionary Society) CMS, Anglikan Üniversitelerin Orta Afrika Misyonu (The Universities’ Mission to Central Africa) UMCA gibi misyon grupları mevcuttur. Tanzanya'da bulunan Lutheran Misyon toplulukları, Evanjelik Lüteriyen Kilisesi (ELCT) adı altında 1963 yılında tek bir çatı altında toplanmıştır. ELCT bugün 5,2 milyon üyesi ile Tanzanya nüfusu içinde hatırı sayılır bir yere sahiptir. Bu çalışmada, deskriptif yöntem kullanılmıştır. Ulaşılabilen tüm ilk kaynaklara inilerek Lutheran misyonerler ve Tanzanya hakkında bilgi verilmiştir. Çalışmada Türkçe kaynaklara yer verilmekle birlikte yabancı kaynak kullanımına ve misyon topluluklarının bilinen kısaltmalarının kullanılmasına önem gösterilmiştir. Anahtar Kelimeler; Tanzanya, Hıristiyanlık, Misyonerlik, Lutheranizm, Leipzig Misyon Cemiyeti. (shrink)

The analysis of the measurement of gravitational fields leads to the Rosenfeld inequalities. They say that, as an implication of the equivalence of the inertial and passive gravitational masses of the test body, the metric cannot be attributed to an operator that is defined in the frame of a local canonical quantum field theory. This is true for any theory containing a metric, independently of the geometric framework under consideration and the way one introduces the metric in it. Thus, to (...) establish a local quantum field theory of gravity one has to transit to non-Riemann geometry that contains (beside or instead of the metric) other geometric quantities. From this view, we discuss a Riemann–Cartan and an affine model of gravity and show them to be promising candidates of a theory of canonical quantum gravity. (shrink)

The analysis of the measurement of gravitational fields leads to the Rosenfeld inequalities. They say that, as an implication of the equivalence of the inertial and passive gravitational masses of the test body, the metric cannot be attributed to an operator that is defined in the frame of a local canonical quantum field theory. This is true for any theory containing a metric, independently of the geometric framework under consideration and the way one introduces the metric in it. Thus, to (...) establish a local quantum field theory of gravity one has to transit to non-Riemann geometry that contains (beside or instead of the metric) other geometric quantities. From this view, we discuss a Riemann–Cartan and an affine model of gravity and show them to be promising candidates of a theory of canonical quantum gravity. (shrink)

We invite systematic consideration of the metaphors of cycles and circulation as a long-term theme in the history of the life and environmental sciences and medicine. Ubiquitous in ancient religious and philosophical traditions, especially in representing the seasons and the motions of celestial bodies, circles once symbolized perfection. Over the centuries cyclic images in western medicine, natural philosophy, natural history and eventually biology gained independence from cosmology and theology and came to depend less on strictly circular forms. As potent ‘canonical (...) icons’, cycles also interacted with representations of linear and irreversible change, including arrows, arcs, scales, series and trees, as in theories of the Earth and of evolution. In modern times life cycles and reproductive cycles have often been held to characterize life, in some cases especially female life, while human efforts selectively to foster and disrupt these cycles have harnessed their productivity in medicine and agriculture. But strong cyclic metaphors have continued to link physiology and climatology, medicine and economics, and biology and manufacturing, notably through the relations between land, food and population. From the grand nineteenth-century transformations of matter to systems ecology, the circulation of molecules through organic and inorganic compartments has posed the problem of maintaining identity in the face of flux and highlights the seductive ability of cyclic schemes to imply closure where no original state was in fact restored. More concerted attention to cycles and circulation will enrich analyses of the power of metaphors to naturalize understandings of life and their shaping by practical interests and political imaginations. (shrink)

L'auteur discute le critérium de la supériorité biologique. Il voit ce critérium dans la mesure, dans laquelle un être vivant est capable d'explorer et d'exploiter le milieu; c'est-à-dire la capacité de se créer les conditions internes nécessaires, les conditions externes étant données. Cette capacité devient plus grande au fur et à mesure que les êtres gagnent une indépendence relative envers le mileu, par le développement de l'homéostasie.Pour pouvoir réagir d'une manière plus efficace envers les facteurs du milieu, il est nécessaire (...) que les fonctions de l'organisme soient plus précises. Cette précision est dimensionnelle et quantitative . L'auteur discute en détail seulement l'aspect de la précision dimensionnelle des fonctions, considérant celle-ci comme la mesure proprement dite de l'évolution morpho-physiologique.Il montre, que le coté spacial-morphologique et celui temporel-physiologique de cette évolution sont non seulement parallèles, mais encore analogues selon leur nature: sous les deux aspects, l'évolution signifie une augmentation de la complexité, une réduction des dimensions relatives des éléments composants; sous l'aspect physiologique, cela veut dire une augmentation de la vitesse des processus. Dans cette augmentation des vitesses voit l'auteur l'aspect physiologique de l'évolution du monde animal.On discute ensuite le problème des dimensions relatives: du „temps propre“ et de l'„espace propre“.En conclusion, l'auteur montre l'insuffisance des études comparatives morphologiques pour élucider la marche de l'évolution, le progrès biologique. L'évolution a de même un aspect physiologique, aussi important que celui morphologique. Seulement l'étude combinée des deux aspects permettra les recherches précises, quantitatives sur l'évolution.Der Verfasser bespricht das Kriterium der biologischen Superiorität ; er sieht dieses Kriterium in dem Mass, in dem ein Lebewesen fähig ist die Umwelt zu erforschen und auszunützen, d.h. sich die nötigen inneren Bedingungen an Hand der äusseren Bedingungen zu schaffen. Das Wachsen dieser Fähigkeit ist mit dem allmählichen Erlangen einer relativen Unabhängigkeit der Lebewesen der Umwelt gegenüber, durch die Entwicklung der Homöostasie, verbunden.Damit die Reaktionen der Lebewesen auf die Umweltsfaktoren möglichst wirksam sind, ist eine grösstmögliche Genauigkeit der Funktionen erforderlich. Diese Genauigkeit ist dimensionell und quantitativ . Der Verfasser bespricht ausführlich nur den dimensionellen Genauigkeitsaspekt der Funktionen, da er diesen als das eigentliche Mass der morpho-physiologischen Evolution betrachtet. Er zeigt, dass zwischen der räumlich-morphologischen und der zeitlichphysiologischen Seite dieser Evolution nicht nur ein Parallelismus besteht, sondern auch eine Wesensanalogie: beide Aspekte der Evolution bedeuten eine Steigerung der Komplexität, eine Verkleinerung der relativen Dimensionen der zusammensetzenden Elemente; vom physiologischen Standpunkte aus, bedeutet dieses eine Geschwindigkeitssteigerung der Vorgänge. In dieser Geschwindigkeitssteigerung, die in der phylogenetischen Reihe vor allem auf dem Gebiete der „animalische“ Funktionen festgestellt wurde, sieht der Verfasser den physiologischen Aspekt der Tierweltevolution.Dann wird das Problem der relativen Dimensionen besprochen: der „eigenen Zeit“ und des „eigenen Raumes“.Abschliessend, zeigt der Verfasser, dass die vergleichenden morphologischen Studien nicht genügen um den Gang der Evolution, den biologischen Fortschritt, zu klären. Die Evolution hat auch seinen physiologischen Aspekt, der genau so wichtig ist wie der morphologische. Nur das gleichzeitige Studium beider Aspekte wird eine genaue, quantitative Erforschung der Evolution ermöglichen.The author discusses the criterion of the biological superiority ; he sees this criterion in the measure in which a being is able to explore and to make use of its environment, that means to create for itself the necessary internal conditions on account of the external ones. The increase of this capacity is dependent of a gradual gaining of a relative independence of the beings towards the environment, by the development of homoiostasy.In order that the reactions towards the factors of the environment shall be more efficatious, a greater precision of the functions is necessary. This precision is dimensional and quantitative . The author discusses in detail only the aspect of the dimensional precision of the functions, meaning that this is the real measure of the morpho-physiological evolution. He shows that between the spatial-morphological aspect of this evolution and the temporal-physiological one there is not only a parallelism, but an analogy of nature: under the two aspects evolution means an increase of complexity, a reduction of relative dimensions of component elements; under physiological aspect this means an increase of the speed of processes. In this increase of speed the author views the physiological aspect of the evolution of the animal kingdom.Than the problem of relative dimensions is discussed: of the “own time” and “own space”.In conclusion the author shows that comparative morphological studies are not sufficient to elucidate the way of evolution, the biological progress. Evolution also has a physiological aspect, as important as the morphological one. Only the concomitent study of both aspects will permit a precise, quantitative research on evolution. (shrink)

A partir de las propuestas metodológicas de los Estudios del Imaginario, este trabajo busca mostrar que algunas de las principales tramas ideadas por Philip K. Dick tienen un sustrato gnóstico. Para ello, en primer lugar, mencionamos algunos datos biográficos que muestran el interés de Dick por el gnosticismo; en segundo lugar, identificamos mitemas idénticos entre ambos corpus (“este mundo es un engaño”; “este mundo es una prisión de hierro”; “el iniciado tiene un doble”; etc.). Con ello, esta investigación contribuye al (...) debate científico en torno a la recepción y reutilización de antiguos mitos en la literatura de ciencia ficción. (shrink)

This paper tries to argue that at least some alluring, trendy or fashionable problems to do with thought and language — several of which are discussed in this volume — are in fact alluring, trendy or fashionable red herrings or cul-de-sacs. I shall primarily be concerned with the ascription of thought and intelligence to non-language-users; but, en route to that, will need to brood over our ascriptions of such terms quite generally.

A directory of archives and manuscript repositories, with links to web pages for the repositories and to online finding aids. Searchable by: collection name; city; state; National Inventory of Documentary Sources (NIDS) number; and National Union Catalog of Manuscript Collections (NUCMC) number.

A new theory of spacetime is proposed in which translations are considered as a part of the de Sitter gauge group. The theory is built along the general principles of classical gauge field theories, which are outlined. Applications of gauge principles to linear and affine connections are also given in order to make the presentation self-sufficient. A de Sitter invariant Lagrangian is constructed, which yields approximately Einstein's vacuum equations when it is subjected to variation with respect to gauge potentials and (...) the result expressed in a specific gauge class. As a difference from the usual use of de Sitter groups, the radius of its translations must be small in the present approach, which probably has the meaning of an elementary subatomic length. The solution of the equations describing flat spacetime is not the trivial zero-curvature connection of the conventional approach. (shrink)