Scholars and professional organizations in bioethics describe various approaches to “quality assessment” in clinical ethics. Although much of this work represents significant contributions to the literature, it is not clear that there is a robust and shared understanding of what constitutes “quality” in clinical ethics, what activities should be measured when tracking clinical ethics work, and what metrics should be used when measuring those activities. Further, even the most robust quality assessment efforts to date are idiosyncratic, in that they represent (...) evaluation of single activities or domains of clinical ethics activities, or a range of activities at a single hospital or healthcare system. Countering this trend, in this article we propose a framework for moving beyond our current ways of understanding clinical ethics quality, toward comprehensive quality assessment. We first describe a way to conceptualize quality assessment as a process of measuring disparate, isolated work activities; then, we describe quality assessment in terms of tracking interconnected work activities holistically, across different levels of assessment. We conclude by inviting future efforts in quality improvement to adopt a comprehensive approach to quality assessment into their improvement practices, and offer recommendations for how the field might move in this direction. (shrink)

In this Matters Arising article, we outline how the recent article “The impact on patients of objections by institutions to assisted dying: a qualitative study of family caregivers’ perceptions” (White et al., 2023 Mar 13;24(1):22) informed Voluntary Assisted Dying (VAD) implementation in our large Australian public health setting, where objections do not emanate from, but within, the institution. In reporting the harms to patients and caregivers created by institutional objection, White et al. provide an evidenced-based road map for potential potholes (...) or risks associated with VAD implementation. We discuss the complexities emerging from the diverse views of health professionals and the ethical tensions arising from such, especially within certain specialties, and how we developed systemic strategies that support patients, caregivers and staff alike. We highlighted the need to shift from “Do you support VAD?“ to “How can we support you as healthcare professionals to integrate VAD into your practice, in a way that complies with the legislation, meets the needs of patients and caregivers, and feels safe and does not compromise your moral stance?“. (shrink)

Ecclesiazusae, the first surviving work of Aristophanes from the fourth centuryb.c.e., has often been dismissed as an example of Aristophanes’ declining powers and categorized as being less directly rooted in politics than its fifth-century predecessors owing to the after-effects of Athens’ defeat in the Peloponnesian War. Arguing against this perception, which was largely based on the absence of ad hominem attacks characterizing Aristophanes’ earlier works, this paper explores howEcclesiazusaeengages with contemporary post-war Athenian politics in a manner which, while different to (...) his earlier comedies, remained closely rooted in the political and cultural concerns of the 390s. By examining the figure of Praxagora, I will first consider recent suggestions thatEcclesiazusaehints at the possibility of an anti-democratic coup. I will then examine how contemporary discussions of constitutional and legal reforms (including the invocation of ‘founding fathers’ such as Solon and Lycurgus) are incorporated into both Praxagora's language and the scenes featuring the Selfish Man and Hags that follow the establishment of Praxagora's regime. Examining these final scenes, I conclude thatEcclesiasuzaedoes not suggest that the idea of democratic equality itself is fundamentally flawed, but instead argues that Athens needs a suitable leader, well suited to the rough and tumble of assembly rhetoric, in order to successfully function. In the world ofEcclesiazusae,the men of Athens have failed too often to inspire any hope, putting their own interest above the state, and the new leader must be someone different. Thus Aristophanes sets up Praxagora as a female Solon to remake the state and lead the democracy. The second half of the play demonstrates this need for a strong leader, as problems arise both from the quarter of critical bystanders (the Selfish Man and Epigenes, the Young Man in the ‘hag scene’) and from over-zealous enforcers (the Old Women). (shrink)

© 2015 Elsevier Inc.Postnatal organogenesis occurs in an immune competent environment and is tightly controlled by interplay between positive and negative regulators. Innate immune cells have beneficial roles in postnatal tissue remodeling, but roles for the adaptive immune system are currently unexplored. Here we show that adaptive immune responses participate in the normal postnatal development of a non-lymphoid epithelial tissue. Since the mammary gland is the only organ developing predominantly after birth, we utilized it as a powerful system to study (...) adaptive immune regulation of organogenesis. We found that antigen-mediated interactions between mammary antigen-presenting cells and interferon-γ -producing CD4+ T helper 1 cells participate in MG postnatal organogenesis as negative regulators, locally orchestrating epithelial rearrangement. IFNγ then affects luminal lineage differentiation. This function of adaptive immune responses, regulating normal development, changes the paradigm for studying players of postnatal organogenesis and provides insights into immune surveillance and cancer transformation. Plaks et al. (shrink)

Historians agree that the second half of the twentieth century saw widespread changes in the structure of biological science in universities. This shift was, and continues to be, characterized by the de-differentiation of nineteenth and early twentieth century disciplines, with increasing emphasis on the methods and authority of molecular fields. Yet we currently lack appreciation of the dynamics that underpinned these changes, and of their tangible effects on the working practices of those involved. In this article we examine the wholesale (...) reform of biological science at the University of Manchester, England, that occurred in two successive steps in 1986 and 1993. We examine how reform was enabled by economic and political factors, as staff seized upon national pressures; in so doing, we emphasize how this reform was shaped by a generational view of the biological sciences as a one field, unified by molecular techniques. We assess how the success of these reforms was tied to new management policies that rewarded research activity in molecular fields, and refigured teaching as a punishment for research inactivity. We close by showing how our analysis fits amongst, and can contribute to, ‘big picture’ debates in the history and sociology of knowledge. (shrink)

En prenant appui sur des textes de Descartes et de philosophes post-cartésiens comme Géraud de Cordemoy, ou encore des théoriciens de Port-Royal, tels Lancelot, Arnauld et Nicole, nous nous intéressons au statut double et paradoxal que revêt la parole dans la philosophie classique, au moment où se construit la question de l’union psychophysique et où sont proposées diverses « réponses » à cette question, dans la perspective d’une conceptualisation nouvelle d’une identité humaine rendue problématique. Le paradoxe tient au fait (...) que l’activité de langage est d’abord manifestation de la pensée, indice publiquement observable ou témoignage extérieur de l’existence d’un esprit à l’origine des actes linguistiques, conformément à la théorie cartésienne à ce sujet ; mais la parole dénote aussi, dans la philosophie même de Descartes, une faculté spécifiquement humaine, propre au « vrai homme », en tant qu’il est indissolublement esprit et corps. Nous tentons de montrer que ce qui est en jeu dans les études brèves et éparses que Descartes consacre au langage, puis dans les développements ultérieurs de la Grammaire générale et raisonnée et de la Logique de Port-Royal, à travers la théorie du signe linguistique et de la signification, c’est la compréhension de la relation, nécessairement postulée et pourtant constamment renvoyée à l’ordre d’un lien contre-nature, et par là arbitraire, fruit d’une institution, entre la parole comme phénomène physique et la parole comme activité symbolique par excellence ; si bien que le prodige du phénomène humain du langage, comme expression publique des pensées, donne la mesure de l’énigme que constitue l’unité en l’homme du corps et de l’esprit. (shrink)

Book Reviews in this article Baptism and Resurrection: Studies in Pauline Theology against its Graeco‐Roman Background. By A.J.M. Wedderburn. Meaning and Truth in 2 Corinthians. By Frances Young and David Ford. Jesus and God in Paul's Eschatology. By L. Joseph Kreitzer. The Acts of the Apostles : By Hans Conzelmann. The Genesis of Christology: Foundations for a Theology of the New Testament. By Petr Pokorny. The Incarnation of God: An Introduction to Hegel's Theological Thought as Prolegomena to a Future Christology. (...) By Hans Küng, translated by J.R. Stephenson. The Incarnation: Collected Essays in Christology. By Brian Hebblethwaite. Models for God: Theology for an Ecological, Nuclear Age. By Sallie McFague. Pp. xv, 224, London, SCM Press, 1987, £8.50 Symbol and Sacrament: A Contemporary Sacramental Theology. By Michael G. Lawler. The Sacrifice We Offer: The Tridentine Dogma and its Reinterpretation. By David N. Power. New Eucharistic Prayers: An Ecumenical Study of their Development and Structure. Edited by Frank C. Senn. To Join Together: The Rite of Marriage. By Kenneth W. Stevenson. Company of Voices: Daily Prayer and the People of God. By George Guiver. The Long‐Legged Fly. By Don Cupitt. Approaches to Auschwitz. By Richard L. Rubenstein and John K. Roth. Natural Law and Justice. By Lloyd L. Weinreb. Christian Morality: The Word Becomes Flesh. By Josef Fuchs S.J., translated by Brian McNeil. Medicine in Contemporary Society: King's College Studies 1986–87. Edited by Peter Byrne. Military Ethics: Guidelines for Peace and War. By N. Fotion and G. Elfstrom. Choice: The Essential Element in Human Action. By Alan Donagan. Persons and Personality: A Contemporary Inquiry. Edited by Arthur Peacocke and Grant Gillet. The Rationality of Emotion. By Ronald de Sousa. The Psychology of Personality: An Epistemological Inquiry. By James T. Lamiell. Aesthetics: An Introduction to the Philosophy of Art. By Anne Sheppard. The Ascetic Element in Culture and Criticism. By Geoffrey Gait Harpham. Electric Language: A Philosophical Study of Word Processing. By Michael Heim. Education and Philosophical Anthropology: Toward a New View of Man for the Humanities and English. By David Holbrook. Evolution and the Humanities. By David Holbrook. Further Studies in Philosophical Anthropology. By David Holbrook. Women in Western Political Philosophy. Edited by Ellen Kennedy and Susan Mendus. The Light of the Soul: Theories of Ideas in Leibniz, Malebranche and Descartes. By Nicholas Jolley. Arnauld and the Cartesian Philosophy of Ideas. By Stephen M. Nadler. Later Medieval Philosophy : An Introduction. By John Marenbon. Either/Or. By Søren Kierkegaard, translated by Howard and Edna Hong, Princeton University Press, 1987: Vol. One, Wittgenstein. By A.C. Grayling. Questions on Wittgenstein. By Rudolf Haller. The False Prison: A Study of the Development of Wittgenstein's Philosophy. By David Pears, Oxford, Clarendon Press. Vol. One, The Later Wittgenstein: The Emergence of a New Philosophical Method. By S. Stephen Hilmy. Knowledge of God: Calvin, Einstein and Polanyi. By Iain Paul. Conceptual Change and Religious Practice with Special Reference to Jews in Britain and Israel. By Janice Williams. The World's Religions. Edited by Stewart Sutherland, Leslie Houlden, Peter Clarke and Friedhelm Hardy. Religions in Conversation: Christian Identity and Religious Pluralism. By Michael Barnes. Theravāda Buddhism, A Social History from Ancient Benares to Modem Colombo. By Richard Gombrich. Mahāyāna Buddhism, The Doctrinal Foundations. By Paul Williams. Hinduism in Great Britain: The Perpetuation of Religion in an Alien Cultural Milieu. Edited by Richard Burghart. The Way of the Black Messiah. By Theo Witvliet. The Meaning of Religious Conversion in Africa. By Cyril C. Okorocha. Common Ground: Christianity, African Religion and Philosophy. By Emmanuel K. Twesigye. Islamic Spirituality I: Foundations. Edited by Seyyed Hossein Nasr. The Great Cosmic Mother: Rediscovering the Religion of the Earth. By Monica Sjöö and Barbara Mor. Judaism and Christianity in the Age of Constantine. By J. Neusner. Language and the Worship of the Church. Edited by David Jasper and R.C.D. Jasper. The Urban Character of Christian Worship: The Origins, Development and Meaning of Stational Liturgy. By John E. Baldovin. Leontii Presbyteri Constantinopolitani Homiliae. Edited by Cornells Datema and Pauline Allen. Law, Sex and Christian Society in Medieval Europe. By James A. Brundage. Melchior Hoffman: Social Unrest and Apocalyptic Visions in the Age of Reformation. By Klaus D Alonso de Zorita: RoyalJudge and Christian Humanist, 1512–1585. By Ralph H. Vigil. Pedro Moya de Contreras: Catholic Reform and Royal Power in New Spain, 1571–1591. By Stafford Poole. Archbishop William Laud. By Charles Carlton. The Social History of Religion in Scotland since 1730. By Callum G. Brown. Pastors and Pluralism in Württemberg, 1918–1933. By David J. Diephouse. The Churches and the Third Reich, Vol. One: Preliminary History and the Time of Illusions, 1918–1934. By Klaus Scholder. Reforming Fundamentalism. Fuller Seminary and the New Evangelicalism. By George M. Marsden. The Hellenistic Philosophers Vol. II: Greek and Latin Texts with Notes and Bibliography. By A.A. Long and D.N. Sedley. Prayers of the Eucharist: Early and Reformed. Edited by R.C.D. Jasper and G. J. Cuming. The Way of Paradox: Spiritual Life as Taught by Meister Eckhart. By Cyprian Smith. Meister Eckhart: The Man from whom God Hid Nothing. Edited by Ursula Fleming. The Spiritual Exercises of St Ignatius Loyola: A New Translation. Translated by Elisabeth Meier Tetlow. Courtfield and the Vaughans: An English Catholic Inheritance. By Mary Vaughan. Trinity College, Washington D.C.: The First Eighty Years, 1897–1977. By Columba Mullaly. John Henry Newman on the Idea of Church. By Edward Jeremy Miller. Journey from Paradise: Aft Athos and the Interior Life. By Ralph Harper. (shrink)

Emotions play a prominent role in social life, yet the direct impact of emotions on behavior and judgment remains a point of disagreement. The current investigation used meta-analysis to test two theoretical perspectives. The emotion-as-direct-causation perspective asserts that current emotions guide behavior and judgment, whereas the emotion-as-feedback perspective asserts that anticipated emotions guide behavior and judgment. Although the emotion-as-direct-causation perspective was frequently tested, only 22% of tests were significant. Although the emotion-as-feedback perspective was rarely tested, 87% of tests were significant. (...) Our findings suggest that empirical evidence is weak for the default assumption that emotion is the proximal cause of behavior and judgment. Our preliminary findings also suggest that anticipated emotion reliably impacts social behavior and judgment. (shrink)

Local food systems can have economic and social benefits by providing income for producers and improving community connections. Ongoing global climate change and the acute COVID-19 pandemic crisis have shown the importance of building equity and resilience in local food systems. We interviewed ten stakeholders from organizations and institutions in a U.S. midwestern city exploring views on past, current, and future conditions to address the following two objectives: 1) Assess how local food system equity and resilience were impacted by the (...) COVID-19 pandemic, and 2) Examine how policy and behavior changes could support greater equity and resilience within urban local food systems. We used the Community Capitals Framework to organize interviewees’ responses for qualitative analyses of equity and resilience. Four types of community capital were emphasized by stakeholders: cultural and social, natural, and political capital. Participants stated that the local food system in this city is small; more weaknesses in food access, land access, and governance were described than were strengths in both pre- and post-pandemic conditions. Stakeholder responses also reflected lack of equity and resilience in the local food system, which was most pronounced for cultural and social, natural and political capitals. However, local producers’ resilience during the pandemic, which we categorized as human capital, was a notable strength. An improved future food system could incorporate changes in infrastructure (e.g., food processing), markets (e.g., values-based markets) and cultural values (e.g., valuing local food through connections between local producers and consumers). These insights could inform policy and enhance community initiatives and behavior changes to build more equitable and resilient local food systems in urban areas throughout the U.S. Midwest. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Mismapping the Underworld: Daring and Error in Dante’s ‘Comedy’Edward Donald KennedyMismapping the Underworld: Daring and Error in Dante’s ‘Comedy,’ by John Kleiner; 182 pp. Stanford: Stanford University Press, 1994, $32.50.Critics once emphasized the unity and apparent perfection of Dante’s Divine Comedy. In Mismapping the Underworld, John Kleiner emphasizes instead the imperfections, the inconsistencies, and inaccuracies in Dante’s work both to give a more accurate assessment of Dante’s artistry (...) and, as he remarks, to help readers “learn to enjoy” the imperfections (p. 2).The five chapters of the book are devoted to various cruces in the Vita nuova and the Comedy. The first chapter considers numerology in the Vita nuova: pointing out that scholars’ arguments for that work’s numerological symmetry have been flawed, Kleiner asks if Dante had as much “passion for order” as scholars have assumed. The second chapter, from which the title of the book is taken, considers earlier scholars’ attempts to draw accurate maps of Dante’s vision of Hell and inaccuracies and inconsistencies in that vision. Probably not many readers, for example, have realized that Satan, partially buried in the ice of Cocytus at the bottom of Hell, must be about 2,500 feet tall, if one calculates his height from the evidence Dante has given us, and even the part of his body extending above the ice must approximate “the height of the World Trade Center.” One must then ask how Dante, the narrator in the poem, is able to give such detailed descriptions of the tormented bodies of Cassius, Brutus, and Judas dangling from Satan’s mouth: “at their height they should be as insignificant a sight as a trio of deluded tourists waving from the top of the Empire State Building” (p. 44). One of the reasons why scholars have attempted to map the underworld so precisely is, as Kleiner points out, that Dante makes it seem so much more concrete than the “dreamlike” surface of earth. (Here C. S. Lewis may have taken a clue from Dante, in his notion that the concrete belongs to Heaven, that things on earth are only “shadowlands.”)The third chapter concerns Dante’s reputation as a student of classical literature. Here, focusing on two cantos of the Inferno and the Purgatorio, Kleiner considers Dante’s inaccurate citations from Virgil, Statius, and other [End Page 415] classical writers and his intentional use of “masterful distortions” to create the effect he wanted. In the fourth chapter, Kleiner discusses Dante’s use of scientific material, such as his precise description of the duration of a lunar eclipse that no one on earth would have been able to gauge and his design of an impossible experiment concerning reflected light. The final chapter associates Dante’s interest in Geryon, the monster who appears in Canto 16 of the Inferno, with the medieval fascination with the grotesque. Moreover, the Ovidian allusions in this canto, Kleiner believes, make the encounter with Geryon a meditation on poetry and show “fiction’s proximity to fraud, its perilous attractiveness, and its susceptibility to perversion” (p. 132). Thus the Geryon episode represents Dante’s concern with the dangers inherent in reading, dangers depicted earlier in the Inferno in, for example, the Francesca and Paolo episode of Canto V, in which the lovers had been seduced into committing adultery after reading the story of Lancelot and Guinevere. In such episodes, Dante reminds us of the power a writer has over his readers and of his duty not to use that power irresponsibly.Because of the post-Renaissance emphasis on the importance of unity in a work of art and the later emphasis on realism, earlier critics naturally emphasized the unity and consistency of Dante’s work. A great work, they assumed, had to have these qualities. As Kleiner’s book reminds us, however, earlier writers did not always prize them as highly as modern critics do, and some inconsistencies and errors (some deliberate, some not) seem to have been acceptable. Inaccurate citations of classical works are due in part to the fact that medieval writers often knew earlier works only from commonplace books and in part to... (shrink)

The realist interpretations of quantum theory, proposed by de Broglie and by Bohm, are re-examined and their differences, especially concerning many-particle systems and the relativistic regime, are explored. The impact of the recently proposed experiments of Vigier et al. and of Ghose et al. on the debate about the interpretation of quantum mechanics is discussed. An indication of how de Broglie and Bohm would account for these experimental results is given.

Reporting peers’ counterproductive work behaviors (CWBs) is important for maintaining an ethical organization, but is a significant and potentially risky action. In Bandura’s Theory of Moral Thought and Action (Bandura, 1991) he states that such acts require significant moral agency, which is generated when an individual possesses adequate moral self-regulatory capacities to address the issue and is in a context that activates and reinforces those capacities. Guided by this theory, we assess moral potency (i.e., moral courage, moral efficacy, and moral (...) ownership) as key capacities predicting peer reporting intentions and assess three contextual factors influencing the generation and effects of moral potency: whether a potential informant (1) works for an ethical leader, (2) is embedded in a psychologically safe climate promoting interpersonal risk-taking, and (3) operates in a more normal or extreme context. We assess the proposed model across three field studies entailing both normal and extreme (i.e., firefighting units) contexts. Results show that ethical leaders raise employees’ moral potency, promoting greater willingness to report their peers’ CWBs. In normal work contexts, psychological safety positively moderated both the relationship between ethical leadership and moral potency and between moral potency and peer reporting intentions. However, psychological safety had the opposite effects in more extreme work contexts. Whereas psychological safety strengthens the positive association between moral potency and peer reporting intentions in normal work contexts, in contexts where individuals are more frequently exposed to extreme events, psychological safety weakens this relationship, thus highlighting the unforeseen downsides of psychological safety in extreme contexts. (shrink)

Chapter One Triadomany defined You shall bind them in Three Classes; according to their Classes. William Blake, Milton In a manuscript of The Quest for ...

Priority setting is inevitable to control expenditure on expensive medicines, but citizen support is often hampered by the workings of the ‘identified victim effect’, that is, the greater willingness to spend resources helping identified victims than helping statistical victims. In this paper we explore a possible cognitive debiasing strategy that is being employed in discussions on healthcare priority setting, which we call ‘empathy counterbalancing’ (EC). EC is the strategy of directing attention to, and eliciting empathy for, those who might be (...) harmed as a result of one-sided empathy for the very ill who needs expensive treatment. We argue that governments have good reasons to attempt EC because the identified victim effect distorts priority setting in ways that undermine procedural fairness. We briefly outline three areas of application for EC and suggest some possible mechanisms that might explain how EC might work, if at all. We then discuss four potential ethical concerns with EC. First, EC might have the counterproductive effect of reducing overall citizen support for public funding of expensive medical treatments, thereby undermining solidarity. Second, EC may give rise to a ‘competition in suffering’, which may have unintended side effects for patients who feature in attempts at EC. Third, there may be doubts about whether EC is effective. Fourth, it may be objected that EC comes down to emotional manipulation, which governments should avoid. We conclude that insofar these concerns are valid they may be adequately addressed, and that EC seems a promising strategy that merits further investigation. (shrink)

The US neutrino community gathered at the Workshop on the Intermediate Neutrino Program at Brookhaven National Laboratory February 4-6, 2015 to explore opportunities in neutrino physics over the next five to ten years. Scientists from particle, astroparticle and nuclear physics participated in the workshop. The workshop examined promising opportunities for neutrino physics in the intermediate term, including possible new small to mid-scale experiments, US contributions to large experiments, upgrades to existing experiments, R&D plans and theory. The workshop was organized into (...) two sets of parallel working group sessions, divided by physics topics and technology. Physics working groups covered topics on Sterile Neutrinos, Neutrino Mixing, Neutrino Interactions, Neutrino Properties and Astrophysical Neutrinos. Technology sessions were organized into Theory, Short-Baseline Accelerator Neutrinos, Reactor Neutrinos, Detector R&D and Source, Cyclotron and Meson Decay at Rest sessions.This report summarizes discussion and conclusions from the workshop. (shrink)