We are printing in its entirety the discussion document which sets out a code of professional conduct for nurses published by the Royal College of Nursing in November 1976 together with commentaries by the Assistant Secretary of the British Medical Association, a professor of nursing studies, student nurses and a lawyer. The image of the nurse is still that of one of Florence Nightingale's young ladies or of a member of a religious order who is wholly dedicated to caring for (...) the sick. Today, as this document and the comments upon it show, 'dedication' is still part of the motive which leads a man or woman to become a nurse but in addition, and this is where the public may be ignorant or choose to be ignorant, nursing offers a career where intellectual achievement and the satisfaction of a demanding job bring their proper financial reward and place in the professional community. We are grateful to the Royal College of Nursing for permission to publish this document. (shrink)

If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

There are wide individual differences in the ability to detect a stimulus contingency embedded in a complex paradigm. The present study used a cognitive masking paradigm to better understand individual differences related to contingency learning. Participants were assessed on measures of electrodermal arousal and on working memory capacity before engaging in the contingency learning task. Contingency awareness was assessed both by trial-by-trial verbal reports obtained during the task and by a short post-task recognition questionnaire. Participants who became aware had fewer (...) non-specific skin conductance responses and tended to score higher on a digit span assessment. Skin conductance level was not significantly lower in the aware group than in the unaware group. These findings are consistent with studies showing that lower arousal and greater cognitive processing capacity facilitate conscious perception of a greater breadth of information within a scene or a task. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

Eyal et al have recently argued that researchers should consider conducting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human challenge studies to hasten vaccine development. We have conducted (J. L.) and overseen (L. D.) human challenge studies and agree that they can be useful in developing anti-infective agents. We also agree that adults can autonomously choose to undergo risks with no prospect of direct benefit to themselves. However, we disagree that SARS-CoV-2 challenge studies are ethically appropriate at this time, for (...) 3 reasons: (1) current scientific knowledge of SARS-CoV-2 infection is insufficient to manage risks; (2) autonomous decision making, while necessary, does not override concerns about risk; and (3) undertaking challenge studies now would imperil confidence in the research enterprise, potentially undermining the global response to the coronavirus disease 2019 (COVID-19) pandemic. (shrink)

We present a one per cent measurement of the cosmic distance scale from the detections of the baryon acoustic oscillations in the clustering of galaxies from the Baryon Oscillation Spectroscopic Survey, which is part of the Sloan Digital Sky Survey III. Our results come from the Data Release 11 sample, containing nearly one million galaxies and covering approximately 8500 square degrees and the redshift range 0.2 < z < 0.7. We also compare these results with those from the publicly released (...) DR9 and DR10 samples. Assuming a concordance Λ cold dark matter cosmological model, the DR11 sample covers a volume of 13 Gpc3 and is the largest region of the Universe ever surveyed at this density. We measure the correlation function and power spectrum, including density-field reconstruction of the BAO feature. The acoustic features are detected at a significance of over 7σ in both the correlation function and power spectrum. Fitting for the position of the acoustic features measures the distance relative to the sound horizon at the drag epoch, rd, which has a value of rd,fid = 149.28 Mpc in our fiducial cosmology. We find DV = at z = 0.32 and DV = at z = 0.57. At 1.0 per cent, this latter measure is the most precise distance constraint ever obtained from a galaxy survey. Separating the clustering along and transverse to the line of sight yields measurements at z = 0.57 of DA = and H =. Our measurements of the distance scale are in good agreement with previous BAO measurements and with the predictions from cosmic microwave background data for a spatially flat CDM model with a cosmological constant. © 2014 The Author Published by Oxford University Press on behalf of the Royal Astronomical Society. (shrink)

In the summer of 1979, a group of experts on law, medicine, and ethics assembled in Siracusa, Sicily, under the auspices of the International Commission of Jurists and the International Institute of Higher Studies in Criminal Science, to draft guidelines on the rights of persons with mental illness. Sitting across the table from me was a quiet, proud man of distinctive intelligence, William J. Curran, Frances Glessner Lee Professor of Legal Medicine at Harvard University. Professor Curran was one of the (...) principal drafters of those guidelines. Many years later in 1991, after several subsequent re-drafts by United Nations Rapporteur Erica-Irene Daes, the text was adopted by the U.N. General Assembly as the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. This was the kind of remarkable achievement in the field of law and medicine that Professor Curran repeated throughout his distinguished career. (shrink)

Georges J. D. Moyal - Deux notes sur l' «imparfaite science» du geometre athee - Journal of the History of Philosophy 43:3 Journal of the History of Philosophy 43.3 277-300 Deux notes sur l'« imparfaite science » du géomètre athée Georges J. D. Moyal Deux questions. La Ve Méditation de Descartes vise à démontrer que l'existence d'un Dieu vérace est la condition nécessaire de toute science. En effet, Descartes y écrit ceci : « . . . je remarque que la (...) certitude de toutes les autres choses en dépend si absolument [sc. de l'existence de Dieu], que sans cette connaissance il est impossible de pouvoir jamais rien savoir parfaitement. » Ce qui le mène, bien entendu, d'abord à reconnaître que « . . . si j'ignorais qu'il y eût un Dieu [ . . . ] je n'aurais jamais une vraie et certaine science d'aucune chose que ce soit, mais seulement de vagues et inconstantes opinions » et par là même, à refuser ensuite cette parfaite science au géomètre athée : « Or, qu'un athée puisse connaître clairement que les trois angles d'un triangle sont égaux à deux droits, je ne le nie pas ; mais je maintiens seulement qu'il ne le connaît pas par une vraie et certaine science, parce que toute connaissance qui peut être rendue douteuse ne doit pas être appelée science . . . » Il faut reconnaître qu'il y a à nos yeux, aujourd'hui, quelque chose de surprenant à ce que le géomètre athée se voie ainsi refuser cette parfaite science.. (shrink)

The focus of this study was on adolescent mental health. More specifically, the relationship between strength-based parenting (SBP) and subjective wellbeing (SWB) during adolescence, as assessed by a sample of adolescents, was examined at three time points over 14 months (N = 202, Mage = 12.97, SDage =.91, 48% female). SBP was positively related to life satisfaction and positive affect at each of the three time points, and was negatively related to negative affect. SBP and SWB both declined significantly over (...) time. When examining the causal relationships between SBP and SWB, two different statistical models were applied: latent growth-curve models (LGM) and random-intercept cross-lagged panel models (RI-CLPM). The LGM revealed a strong positive relationship between changes in SBP and SWB. Specifically, this model showed that SBP at one time point predicted adolescent SWB at future time points. However, when the more stringent statistical test was completed through RI-CLPMs, no cross-lagged paths reached significance. Thus, while parenting is a significant predictor of wellbeing for pre-teens and teens in real time, it is not predictive of wellbeing at future time points. Parents, thus, cannot assume that their current levels of SBP are ‘banked’ by their children to support future wellbeing. Instead, SBP needs to be an ongoing, contemporary parenting practice. Furthermore, the fact that perceptions of SBP decline in this age bracket suggest that SBP interventions may be helpful in supporting adolescent mental health. (shrink)

The present contribution to the continuing translation of the works of Heidegger into English under the editorship of J. Glenn Gray is one of the most valuable. The first-rate translation, preceded by an excellent Introduction, is by Albert Hofstadter, whose popular anthology, Philosophies of Art and Beauty, had included his translation of Heidegger's 1935 essay, "The Origin of the Work of Art." That essay, along with six other pieces, hitherto untranslated, make up the present volume--including the first essay of Unterwegs (...) zur Sprache, which was not included in the English translation, On the Way to Language. The volume also contains a translation of Heidegger's poem "Aus der Erfahrung des Denkens," under the title "The Thinker as Poet." Found here too are the two important essays "Building, Dwelling and Thinking," and "The Thing," which together represent the most important of Heidegger's all too brief but very suggestive treatments of the "world" as the "Foursome". Readers of Being and Time who consult these later essays will be surprised to discover what has come of the "world" in Heidegger's later thought, and in particular of the relationship of God to the world, a theme which was bracketed in Being and Time. As a whole this very valuable collection deals with the later Heidegger's highly aesthetic, highly poetic, view of Being and of Dasein's relationship to Being. These essays represent the final outcome of his use of the phenomenological method to approach Being; and they contain, if anything does, what Heidegger means by "overcoming metaphysics." If Heidegger's later thought is, as has been suggested, a Seinsmystik, it is no less a Seinsdichtung.--J. D. C. (shrink)

This translation of Heidegger's 1929 essay, Vom Wesen des Grundes, is overdue and will be gratefully received by the English-speaking student of Heidegger. The essay is quite technical as it works out the theme of Dasein's ability to transcend beings and comprehend them in their Being. The German text is exceptionally rugged going, even for Heidegger. For example, the important transition that Heidegger makes from umwillen to Wille, has no real correlate in English, but Malick handles such difficulties quite well. (...) One can, however, quarrel with two points in this edition. Malick's assertion that the essay is fundamentally concerned with the theme of the "world" is only quantitatively true. Its deeper interest is surely to go beyond the world and to explain its roots in transcendence and freedom. The most important part of the book is Part III in which the finite and groundless character of Dasein's freedom-transcendence is thematized. The translation of "Grund" as "Reasons" in the title is misleading as it lacks the necessary connotation of "foundation," "basis," "soil." Thus, although unwieldy, "The Essence of Ground" would perhaps be a more accurate translation.--J. D. C. (shrink)

A well argued plea for the establishment of a capital insurance organization on the model of the F. H. A. which would guarantee loans to small investors. Such an organization, the authors argue, would stem the tide towards increasing concentration of capital in our society and would provide for a more equitable distribution of wealth. --J. D. T., Jr.

The present volume is one of the few recent works to devote its attention to the "early" Heidegger, yet it contributes significantly to our understanding of Heidegger's later development. "Transcendence" means crossing beyond the being to the horizon within which the being appears. The "transcendental" make-up of Dasein, which is the power of Dasein to make this crossing, is the principal theme of Kant und das Problem der Metaphysik and Vom Wesen des Grundes. "Difference" is the "ontological difference" between Being (...) and beings which is discussed again in Vom Wesen des Grundes and--since Being is not-any-being--in the analysis of the Nothing in Was ist Metaphysik? The pivotal element in Rosales' interpretation is the radical finitude of Dasein's "transcendence." For transcendental-horizonal thinking is unequipped to explain the radical concealment of Being which Dasein experiences. While providing the horizon within which things appear, transcendental-horizonal thinking does not offer an explanation for the recalcitrant hiddenness of Being. Hence Being must be experienced as a-letheia, as the original, independent process of concealing itself, and of revealing itself. And a break with the early transcendental-horizonal or Kantian, and so "subjectivistic" or "metaphysical" perspective of Sein und Zeit is necessitated. While the author owes a clear debt to Marx and Schulz, his interpretation is impressive and a contribution.--J. D. C. (shrink)

Kierkegaard’s work Purity of Heart is To Will One Thing, signed in his own name, was meant as a private preparation for public confession. To be pure of heart meant to have a single-minded dedication to the will of God, a dedication from which all other foreign motives had been filtered out. A pure heart does good not out of fear of punishment or the hope of a reward but solely because it is God’s will. There is thus a Kantian (...) rigorism in this work: every overt or concealed form of self-love must be purged in order that an act be truly moral. Jeremy Walker, who has also written a book on Frege, and whose book reads faintly like a work in analytic ethics, has written not an exhaustive commentary on Purity of Heart but a set of "reflections" on some philosophical themes that run through the work. He takes up the question of Kierkegaard’s Kantian conception of morality and argues that the dynamic of Kierkegaard’s notion of ethical choice leads straight to an absolute commitment to the absolute good, God. Thus purity of heart is only possible if the will is directed towards an absolute good. Kierkegaard’s true view is a Christian synthesis of Kant and Plato. It also follows that the opposition of the ethical and the religious is false. Such a view, which belongs to the doctrine of the three stages, is not Kierkegaard’s but that of the pseudonymous authors. It is actually opposed to the view that Kierkegaard signs in his own name. Walker’s book is brief, clear and addressed to an important point, not only for Kierkegaardian scholarship, but also for ethics.—J.D.C. (shrink)

This issue of Mélusine pursues the research initiated in 1982 on the surrealist book, without giving the last word on such a complex subject. Demonstrating erudition worthy of La Revue d'histoire littéraire de la France, the contributors propose new ideas and points of view. By the sheer abundance of technical terms, the articles would have astonished the avant-garde poets and artists in question, who were so very fond of entertainment. Some contributors examine the illustrated book, the artist's book and the (...) book-object in general as surrealist publications, while others focus on a single book or even on the non-book imagined by André Breton.In her introduction, editor Andrea Oberhuber describes the evolution of .. (shrink)

Scientific realism has been advanced as an interpretation of the natural sciences but never the behavioral sciences. This book introduces a novel version of scientific realism, Measured Realism, that characterizes the kind of theoretical progress in the social and psychological sciences that is uneven but indisputable. It proposes a theory of measurement, Population-Guided Estimation, that connects natural, psychological, and social scientific inquiry. Presenting quantitative methods in the behavioral sciences as at once successful and regulated by the world, the book will (...) engage philosophers of science, historians of science, sociologists of science, and scientists interested in the foundations of their own disciplines. Part I introduces measured realism beginning with a novel realist theory of measurement (Population-Guided Estimation, or PGE). It examines two other versions of scientific realism — minimal (Hacking) and robust (Boyd, Putnam, and Newton-Smith) — and advances measured realism as best supported by the evidence in the behavioral sciences. It also critically evaluates the anti-realist arguments of van Fraassen, Laudan, and Fine. Part II formulates and develops a version of epistemological naturalism most appropriate to measured realism. Drawing upon the realist theory of measurement developed earlier, it favorably appraises a variety of statistical methods in the behavioral sciences against selected criticisms. It concludes that traditional, narrative methods in the behavioral and social sciences are unreliable by the measures of epistemological naturalism. (shrink)

The aim of this systematic review was to summarize and assess the quality of asthma intervention health economic studies from 2002 to 2007, compare the study findings with clinical management guidelines, and suggest avenues for future improvement of asthma health economic studies. Forty of the 177 studies met our inclusion criteria. We assessed the quality of studies using The Quality of Health Economic Studies validated instrument (total score range: 0-100). Six studies (15%) had quality category 2, 26 studies (65%) achieved (...) quality category 3, and the remaining eight (20%) studies were scored as the highest quality level, category 4. Overall, the findings from this review are in line with the Global Initiative for Asthma clinical guidelines. Many asthma health economic studies lacked appropriate long term time horizons to match the chronic nature of the disease and suffered from using effectiveness measures that did not capture all disease related risks and benefits. We recommend that new asthma simulation models: be flexible to allow for long term time horizons, focus on using levels of asthma control in their structure, and estimate both long term asthma specific outcomes like well-controlled time as well as generic outcomes such as quality adjusted survival. (shrink)

Einstein proclaimed that we could discover true laws of nature by seeking those with the simplest mathematical formulation. He came to this viewpoint later in his life. In his early years and work he was quite hostile to this idea. Einstein did not develop his later Platonism from a priori reasoning or aesthetic considerations. He learned the canon of mathematical simplicity from his own experiences in the discovery of new theories, most importantly, his discovery of general relativity. Through his neglect (...) of the canon, he realised that he delayed the completion of general relativity by three years and nearly lost priority in discovery of its gravitational field equations. (shrink)

In Not God Enough, J.D. Greear explains that the thing between you and the vibrant faith you want isn't answers to all our spiritual questions, but an escape from the small God we've imagined in place of an actual encounter with the real, awesome, glorious God of the Bible.

Defining terms -- The real world -- The news -- Reading as vacation -- Uses of culture -- The postmodern smirk -- The corporate gallery -- Icons and idols -- Man as Romanian -- Dowsing and science -- Origin myths -- Diplomatic memoir -- A syndrome of simile and metaphor -- Three dreams, one trip -- My obituaries -- Salt water -- My coronation -- Representations -- The pornographic dream -- Against art fairs -- Rescuing the subject from the picture (...) -- Branding the arts -- The end of the affair -- A defense of virtuosity -- Mere esthetics. (shrink)