Evidence-based medicine (EBM), by its ability to decrease irrational variations in health care, was expected to improve healthcare quality and outcomes. The utility of EBM principles evolved from individual clinical decision-making to wider foundational clinical practice guideline applications, cost containment measures, and clinical quality performance measures. At this evolutionary juncture one can ask the following questions. Given the time-limited exigencies of daily clinical practice, is it tenable for clinicians to follow guidelines? Whose or what interests are served by applying performance (...) assessments? Does such application improve medical care quality? What happens when the best interests of vested parties conflict? Mindful of the constellation of socially and clinically relevant variables influencing health outcomes, is it fair to apply evidence-based performance assessment tools to judge the merits of clinical decision-making? Finally, is it fair and just to incentivize clinicians in ways that might sway clinical judgment? To address these questions, we consider various clinical applications of performance assessment strategies, examining what performance measures purport to measure, how they are measured and whether such applications demonstrably improve quality. With attention to the merits and frailties associated with such applications, we devise and defend criteria that distinguish between justice-sustaining and justice-threatening performance-based clinical protocols. (shrink)

Do terminally ill patients who have exhausted all other available, government-approved treatment options have a constitutional right to experimental treatment that may prolong their lives? On May 2, 2006, a divided panel of the U.S. Court of Appeals for the District of Columbia, in a startling opinion, Abigail Alliance for Better Access to Developmental Drugs v. Von Eschenbach, held “Yes.” The plaintiffs, Abigail Alliance for Better Access to Developmental Drugs and Washington Legal Foundation, sought to enjoin the Food and Drug (...) Administration from refusing to allow the sale of investigational new drugs that had not yet received FDA approval. The terminally ill plaintiffs contended that they quite literally could not wait that long for the drugs. With no other treatment options available, the plaintiffs urged the court to recognize a fundamental, constitutional right to take potentially life-saving or life-prolonging drugs, even though the treatment had not been fully tested through human trials for safety and effectiveness and could not be legally marketed to the public. (shrink)

Snap‐shots of live theatre: the use of photography to research governance in operating room nursingThe use of photography is an underreported method of research in the nursing literature. This paper explores its use in an ethnographic research project, the fieldwork of which was undertaken by the first author. The aim was to examine the governance of operating room nursing in the clinical setting and the theoretical orientation was the work of Michel Foucault. The focus of this paper is on how (...) photography was used as a means of data generation. To establish some context we begin by drawing on writers from sociology and anthropology to provide an overview of the status of vision and visual research methods in contemporary social research. We then move to a brief discussion of the uses of photography in social research and the limitations imposed by ethical considerations of its use in clinical nursing settings. As well, the process and approach involved in this research project, and issues of analysis are discussed. Three ‘snap‐shots’ of operating room nursing, taken by participants, are presented. Each is analysed in terms of its contributions to the research process as well as its substantive contribution to the theoretical framework and the research aims. (shrink)

The Patient Protection and Affordable Care Act represents the most significant reform of the United States health care system in decades. ACA also substantially amplifies the federal role in health care regulation. Among other provisions, ACA expands government health care programs, imposes detailed federal standards for commercial health insurance policies, creates national requirements on employers and individuals, and enlists state administrative capacity to implement various federal reforms. In response, a persistent voice in the protracted, contentious debate surrounding ACA was, and (...) continues to be, resistance from states. The rhetoric of federalism — states’ rights, reserved powers, state sovereignty, limited government, and local diversity — resonates deeply even around provisions of ACA that do not specifically implicate state interests. For example, the loudest and most persistent state objections target the new mandate that individuals maintain health insurance, a requirement imposed by ACA and enforced through federal tax penalties. (shrink)

In long Midwestern winters, two things are certain: snow and basketball. But two things that you cannot count on are snow day school closures and a home-team collegiate basketball championship. In Kansas last winter, we had both. Winter precipitation was much above average, resulting in a rare invocation of the University's inclement weather policy to cancel classes in early February. And the Kansas Jayhawks basketball team brought home the National Collegiate Athletic Association championship trophy for the first time in two (...) decades. The Chancellor commemorated the achievement with a campuswide celebration, including all-day class cancellation. This is all well and good. I am all for respecting Mother Nature's forces and celebrating remarkable athletic accomplishments.But the combination of events does leave law professors nearing the end of the semester in a bit of a quandary. How to make up the cancelled classes to ensure compliance with American Bar Association accreditation instructional hours requirements? How to cover the missed course content? How to find mutually agreeable make-up class times and locations with a group of busy, upper-level law students? (shrink)

Suicide among Veterans experiencing or at risk for homelessness remains a significant public health concern. Conducting research to understand and meet the needs of this at-risk population remains challenging due to myriad factors. To address this challenge, the United States Department of Veterans Affairs convened the Health Services Research and Development Suicide Prevention in Veterans Experiencing Homelessness: Research and Practice Development meeting, bringing together subject-matter experts in the fields of homelessness and suicide prevention, both from within and outside of VA. (...) During the meeting, attendees identified 10 potential research priorities at the intersection of suicide prevention and homelessness. After the meeting, Delphi methodology was used to achieve consensus on the relative importance of the identified research domains. Through this iterative Delphi process, agreement was reached regarding the need to increase understanding of barriers and facilitators to suicide risk assessment and emergency intervention for Veterans experiencing homelessness by examining the perspectives of both Veterans and healthcare providers. Elucidating the complex relationships between risk periods, subgroups, suicide means, and drivers of suicide among Veterans experiencing homelessness was also considered a top priority. This article documents the Delphi process and provides a research agenda for researchers, funding agencies, and policymakers to prioritize the most relevant and potentially impactful research domains aimed at preventing suicide among Veterans experiencing or at risk for homelessness. (shrink)

Scholars explore from many fresh angles the interweavings of two of the richest strands of human culture-music and esotericism-with examples from the medieval period to the modern age. Music and esotericism are two responses to the intuition that the world holds hidden order, beauty, and power. Those who compose, perform, and listen to music have often noted that music can be a bridge between sensory and transcendent realms. Such renowned writers as Boethius expanded the definition of music to encompass not (...) only sounded music but also the harmonic fabric of human and cosmic life. Those who engage in pursuits called "esoteric," from ancient astrology, magic, and alchemy to recent and more novel forms of spirituality, have also remarked on the relevance of music to their quests. Esotericists have composed music in order to convey esoteric meaning, performed music to create esoteric influences, and listened to music to raise their esoteric awareness. The academic study of esotericism is a young field, and few researchers have probed the rich interface between the musical and esoteric domains. In Explorations in Music and Esotericism, scholars from numerous fields introduce the history of esotericism and current debates about its definition and extent. The book's sixteen chapters present rich instances of connections between music and esotericism, organized with reference to four aspects of esotericism: as a form of thought; as the keeping and revealing of secrets; as an identity; and as a signifier. Edited by Marjorie Roth and Leonard George. Contributors: Elizabeth Abbate, Malachai Komanoff Bandy, Adam Bregman, Charles E. Brewer, Benjamin Dobbs, Anna Gawboy, Pasquale Giaquinto, Adam Knight Gilbert, Joscelyn Godwin, Virginia Christy Lamothe, Andrew Owen, Christopher Scheer, Codee Ann Spinner, Woodrow Steinken, and Daphne Tan. (shrink)

Dr Brandwood's book presents a factual and critical account of the more important of the various attempts that have been made to establish the order of composition of Plato's dialogues by analysing his diction and prose style. Plato's literary activity covered fifty years and there is almost no direct evidence, either external or internal, to help in establishing the relative order of his writings. Until the middle of the nineteenth century people were dependent on personal interpretation of the probable line (...) of development of Plato's thought and doctrines, but then a less subjective method was discovered, which relied instead on the observation of changes in Plato's prose style. Dr Brandwood examines the investigations of each scholar individually, checking the correctness of the methodology and the accuracy of the statistics, before arriving at fairly definite conclusions of his own, at least as far as the works of Plato's middle and old age are concerned. (shrink)

The book highlights important research strategies in the quest to find thecause of SLI and to develop methods of prevention and treatment.

First published in 1998. Routledge is an imprint of Taylor & Francis, an informa company.

Lawlor’s investigations of the work of Jean Cavaillès, Tran-Duc-Thao, and Jean Hyppolite, as well as recent texts by Derrida, reveal the depth of Derrida’s relationship to Husserl’s phenomenology.

The first reader to offer a comprehensive view of Maurice Merleau-Ponty’s work, this selection collects in one volume the foundational essays necessary for understanding the core of this critical twentieth-century philosopher’s thought. Arranged chronologically, the essays are grouped in three sections corresponding to the major periods of Merleau-Ponty’s work: First, the years prior to his appointment to the Sorbonne in 1949, the early, existentialist period during which he wrote important works on the phenomenology of perception and the primacy of perception; (...) second, the years of his work as professor of child psychology and pedagogy at the Sorbonne, a period especially concerned with language; and finally, his years as chair of modern philosophy at the Collège de France, a time devoted to the articulation of a new ontology and philosophy of nature. The editors, who provide an interpretive introduction, also include previously unpublished working notes found in Merleau-Ponty’s papers after his death. Translations of all selections have been updated and several appear here in English for the first time. By contextualizing Merleau-Ponty’s writings on the philosophy of art and politics within the overall development of his thought, this volume allows readers to see both the breadth of his contribution to twentieth-century philosophy and the convergence of the various strands of his reflection. (shrink)

Arising and emptiness are the two essential Buddhist concepts, which when understood, lead to the highest school of Buddhist philosophy.

The volume explores the hitherto uncharted late medieval religious landscape of Northern Germany. Through discussion of a rich, varied selection of mystical and devotional texts, also translated into English, a fascinating regional "mystical culture" with a far-reaching impact is revealed.

Homologous recombination (HR) is essential for the accurate repair of DNA double‐strand breaks and damaged replication forks. However, inappropriate or aberrant HR can also result in genome rearrangements. The maintenance of cell viability is, therefore, a careful balancing act between the benefits of HR (the error‐free repair of DNA strand breaks) and the potential detrimental outcomes of HR (chromosomal rearrangements). Two papers have recently provided a mechanistic insight into how HR may be tempered by RecQ helicases to prevent genome instability (...) and diseases that are a consequence of this, such as cancer.1,2 BioEssays 30:291–295, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

When parents must rely on public assistance and family shelters to provide for their children's most basic needs, they lose autonomy. Within a system of public assistance that already stigmatizes and isolates its beneficiaries, their family lives become subject to public scrutiny and criticism. They are _parenting in public._ This book is an in-depth examination of the realities of life for parents and their children in family shelters. The author uses the Massachusetts family shelter system to explore the impact of (...) asset and deficit-oriented help-giving approaches as they are experienced by mothers and service providers. The format of the book is unique. Following each chapter are the "reflections" of a mother who has parented in a shelter, a front-line worker, and a shelter director. The author and contributors propose a "Power With" policy and practice framework that runs counter to the prevailing "Power Over" cultural policy trends. Contributors include Rosa Clark, Brenda Farrell, Deborah Gray, Michele Kahan, Margaret A. Leonard, Mary T. Lewis, Nancy Schwoyer, and Elizabeth Ward. (shrink)