In this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions. Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct (...) achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains – the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains. Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context. Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context-driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning. (shrink)

This paper examines the relationship between university mission statements and sustainability practices by institutions of higher education. We examine mission statement constructs and the degree to which higher educational institutions meet specific sustainability criteria in line with the College Sustainability Report Card. Our sample consists of 347 universities from the Sustainable Endowment Institute's (2011) Green Report Card. Previous research suggests that mission statements are essential for superior organizational performance outcomes. We examine the relationship between university mission statement content and sustainability (...) practices. Findings indicate that the greater the number of specific terms used in the university mission statements, the higher the statistical likelihood that those universities had higher sustainability ratings. Findings also indicate that private institutions and nonreligious‐affiliated institutions are more likely to include sustainability constructs in their mission statements than colleges and universities with religious affiliation and public institutions. Several propositions to guide future research are discussed. (shrink)

We are never illness or disease, but, rather, always their sum in the world of day-to-day experience. Disease and illness are not closed systems, but mutually constitutive and continuously interacting worlds. In the patient’s case it is always experience as well. Pain, sickness and death help make that particular experienced identity unavoidable, and at some level ultimately inaccessible to medicine’s changing understanding of disease and tools for managing it. Health—rather than cost containment, specific conditions, or technologies—should be the central focus (...) for health care and health-care reform. A compelling reason to focus on health comes from the observation that the prevalence of disease over the .. (shrink)

Background Metaphors are central to the human understanding of complex issues; through the immediate associations they evoke and frame problems and suggest solutions. Our suggestion of Music in the Park as a metaphor for health systems reform brings to the forefront the environmentally diverse but bounded spaces of health services that offer a variety of attractors within their confines, while pushing into the background organizational and economic concerns.Reflections Parks, like health services, are embedded in their local landscape, serving their communities, (...) but most importantly parks are public spaces, publically funded, ideally offering universal access and equity and to be shared by all who want to go there.Music, like health, is tangible, technical and scientific, yet ultimately experiential and based on meaning. While it encompasses a wide range of styles and approaches, music making requires as its most important skill active listening which brings with it to be ‘in the moment’, to take personal risks and to draw energy and inspiration from the participants. Hence ‘audiences’ are equally active participants because music only has meaning if it internally resonates with the listener and only can exist in what is a co-constructed experience.Conclusions Music in the Park is a metaphor for primary health care systems based on shared values of experts and unique local communities. Health professionals are players in this arena, who develop and practise the full range of their skills in response to individual and community needs and preferences. Their leadership works through inspiration and empowerment, making patients ‘co-producers’ of their own health and ‘co-shapers’ of their health services. (shrink)

Background The American Association of Medical Colleges has called for incorporation of the health humanities into medical education, and many medical schools now offer formal programs or content in this field. However, there is growing recognition among educators that we must expand beyond empathy and wellness and apply the health humanities to questions of social justice – that is, critical health humanities. In this paper we demonstrate how this burgeoning field offers us tools for integrating social justice into medical education, (...) utilizing the frameworks of critical consciousness and structural competency. Practice of health humanities Critical health humanities can be applied at multiple levels of learners, and in a variety of contexts. We are two physician-writers who have developed several educational programs that demonstrate this. We taught a seminar that introduced first-year and second-year undergraduates to concepts such as social determinants of health, intergenerational trauma, intersectionality, resilience, and cross-cultural care through works of fiction, poetry, film, podcasts, stand-up comedy, and more. Through creative projects and empathic reflection, students engaged with the complexities of structural forces that create and maintain health disparities. Medical students in their clinical years can engage in critical health humanities learning experiences as well. We teach several multidisciplinary electives that address social (in)justice in medicine, as well as mentor fourth-year students engaged in independent electives that foster critical awareness around health equity and ethics. Beyond the classroom, we have actively engaged in critical health humanities practices through story slams, literary journal clubs, conference presentations, and Grand Rounds. Through these activities we have included learners at GME and CME levels. These examples also demonstrate how community engagement and multidisciplinary partnerships can contribute to the practice of critical health humanities. Conclusion In this paper, we explore the growing field of critical health humanities and its potential for teaching health equity through narrative practices. We provide concrete examples of educational activities that incorporate critical consciousness and structural competency – frameworks we have found useful for conceptualizing critical health humanities as a pedagogical practice. We also discuss the strengths and challenges of this work and suggest future directions. (shrink)

The Gibbs states of binary lattice systems can be characterized by their stability with respect to certain microscopic transitions which have a simple physical interpretation. A detailed analysis is provided for the case of a one-dimensional lattice gas with nearest-neighbor interactions.

During the past four decades the governance of environmental problems – the definition of issues and their political and practical resolution – has evolved to include a wider range of stakeholders in more extensive open discussions. In the introduction to this issue of Environmental Values on 'Environment, Policy and Participation' , we outline some features of these recent developments in participatory environmental governance, indicate some key questions that arise, and give an overview of the collection of papers in this special (...) issue. (shrink)

ABSTRACTThe proportion of the American electorate that is “constrained” by ideology has risen dramatically since Philip E. Converse suggested, in the early 1960s, that ideology is the province of only a small fraction of the mass public. In part, the rise of ideological voters has been obscured by the tendency of scholars after Converse to equate them with those who use terms referring to ideological concepts, such as liberal and conservative, in open-ended interviews. These “concept ideologues,” however, are not the (...) only members of the public whose political opinions show evidence of ideological constraint. There is also a growing segment of the public, the “policy ideologues,” who take positions on three or more policy issues but do not happen to mention ideological concepts. Policy ideologues prove to be as politically knowledgeable as concept ideologues; their attitudes are nearly as constrained across issues and over time; and their policy stances usually “make sense” as liberal or conservative—not surprisingly, as they are almost as willing as concept ideologues to label themselves ideologically, when asked. By 2012, the portion of the public consisting of concept and policy ideologues had reached 42 percent. It declined to 38 percent in 2016, but was still a far cry from the 12 percent of the electorate whom Converse identified as ideologues or near ideologues as of 1956. (shrink)

Prior to the COVID-19 pandemic, the United States housed 2.3 million inmates in 7,147 incarceration structures that, because of age, overcrowding, and poor ventilation, exacerbated the spread of airborne infections. The flow of individuals into and out of correctional facilities compounded the challenges in keeping them COVID-free. This article focuses on the work of the health and administrative leadership, in partnership with judicial and police personnel, to prevent COVID-19 inside the Albemarle-Charlottesville Regional Jail and to mitigate its spread when the (...) jail population and/or its staff became infected. From the onset, implementing science-based policies and upholding the human right to health and healthcare for all were priorities. (shrink)

Charting new routes for film ethics, _Transformational Ethics of Film_ develops a critical account of the ethics of personal transformation at work within the ‘film as philosophy’ debate.

Knight has shown how the moral growth of medical students involves a spiritual journey. He may, however, present too sanguine a portrayal of the extent to which the medical education environment promotes this moral and spiritual growth. Medical school may indeed be more abusive than supportive. Admitting more women to medical school and teaching more humanities courses, while worthwhile, will not necessarily promote the goals that Knight appropriately advocates.

This paper deals with three topics: types of rights, the development of the terminology of rights, and the question of the primacy of welfare rights. Because these topics are interrelated, my exposition does not observe rigid boundaries among them. There is no pretence at all that any of these subjects is fully covered here; nor is it proposed, except for one writer, to touch upon the contemporary literature on rights, as noteworthy as some of that literature is. In order to (...) gain entrance into the field, on which the writing has grown to massive proportions, I shall begin with an interesting historical phenomenon, some of whose philosophical import I want to explore. I should say at the outset, however, that the general motivation of this paper is the problem of the significance of the language of “rights.” Does it really make a difference, for instance, to speak of the “rights of man” rather than the “common duties of humanity”? Does the term “rights” add anything of special significance or is its only significance rhetorical and ideological? Can we dispense with the language of rights and still say everything we need to say about our moral relations? I confess to a moderate skepticism about the necessity of the language of rights in the last analysis. At any rate, this paper is intended as a contribution, however small, to this problem. The historical phenomenon with which I am going to begin will enable us to bring into focus the issue of the meaning of “rights.”. (shrink)

The principle of bivalence is the assertion that every statement is either true or else false. Its legal analog, however, must be formulated relative to particular legal systems and in terms of validity rather than truth. It asserts that every statement of law that can be formulated in the vocabulary of a given legal system is valid or else invalid in that system. A line of New York cases is traced, beginning with Thomas v. Winchester . This case, which involved (...) a poison mislabeled as a medicine, established an exception to the rule that a manufacturer or supplier is never liable for negligence to a remote purchaser. The court made an exception because a poison is an “imminently dangerous” thing. How far may this exception be applied to other fact‐situations? Some subsequent cases are examined, and it is considered whether there is no correct answer in these instances and, more dramatically, whether more than one correct answer is tenable. In either event the legal analog of bivalence would seem to fail. (shrink)