We describe and analyse how large herbivores strongly diminished a woody vegetation, dominated by the unpalatable shrub Sambucus nigra L. and changed it into grassland. Density of woody species and cover of vegetation were measured in 1996, 2002 and 2012 in the grazed Oostvaardersplassen. In 2002 and 2012 we also measured density and cover in an ungrazed control site. In 2002 we measured intensity of browsing and bark loss of Sambucus shrubs in the grazed and control sites. In (...) the grazed site the density of Sambucus and Salix spp. declined significantly between 1996 and 2012, and large areas changed into grassland. In the control site the density of Sambucus increased significantly during this period, the density of Salix spp. did not change, and the vegetation consisted of a mixture of woody species and a field layer dominated by tall herbs. In 2002 and 2012 the percentages of dead Sambucus shrubs were significantly higher in the grazed site than in the control site. In 2002 the percentages of twigs browsed and ring barked stems of Sambucus shrubs were significantly higher in the grazed site than in the control site. Our results show that debarking caused mature Sambucus shrubs to die, but that heavy browsing may have helped this process. Our results also point to a significant neighbour effect on the break down of Sambucus, suggesting that Aggregational Resistance and Associational Palatability were both active. Essential conditions for the break down of this woody vegetation were the presence of large herbivores, the low ratio between the areas of summer and winter feeding habitats and the competition amongst herbivores. Browsing may have been responsible for seedling death, as seedlings were found only in the control site and not on the old and newly established grasslands in the grazed site. (shrink)

The aim of this research was to gain insight into the experiences and perspectives of individual members of a Medical Research Ethics Committee regarding their individual roles and possible tensions within and between these roles. We conducted a qualitative interview study among members of a large MREC, supplemented by a focus group meeting. Respondents distinguish five roles: protector, facilitator, educator, advisor and assessor. Central to the role of protector is securing valid informed consent and a proper risk-benefit analysis. The role (...) of facilitator implies that respondents want to think along with and assist researchers in order to help medical science progress. As educators, the respondents want to raise ethical and methodological awareness of researchers. The role of advisor implies that respondents bring in their own expertise. The role of assessor points to contributing to the overall evaluation of the research proposal. Various tensions were identified within and between roles. Within the role of protector, a tension is experienced between paternalism and autonomy. Between the role of protector and facilitator tensions occur when the value of a study is questioned while risks and burdens for the subjects are negligible. Within the role of assessor, a tension is felt between the implicit nature of judgments and the need for more explicit formulations. Awareness of various roles and responsibilities may prevent one-sided views on MREC work, not only by members themselves, but also by researchers. Tensions within and between the roles require reflection by MREC members. (shrink)

Protection of human participants is a fundamental facet of biomedical research. We report the activities of a health service research study in which there were three institutional review boards (IRBs), three legal departments and one research administration department providing recommendations and mandating changes in the study methods. Complying with IRB requirements can be challenging, but can also adversely affect study outcomes. Multiple protocol changes mandated from multiple IRBs created a research method that was not reflective of how substance use screening (...) would be performed in a clinical setting. There was direct conflict between the IRBs' perceptions of participants' protection with the researchers' need to use research methodology that assures the clinical relevancy of results. (shrink)

Esprit, l’un des mots clés des Pensées, reçoit chez Pascal deux significations : la raison et le souffle intérieur. Si l’esprit en tant que mens rationalis appartient au deuxième ordre, l’esprit en tant que mens spiritualis relève du troisième ordre. Deux dualismes se croisent dans la distinction pascalienne des trois ordres : le premier de nature philosophique, cartésienne, oppose le premier ordre, voué au corps, et les deuxième et troisième ordres, voués à la mens ; le second, de nature éthico-religieuse, (...) oppose le premier et le deuxième ordres, ordres de la cupidité, au troisième ordre, celui de la charité. Au-dessus de l’esprit/raison se tient l’esprit/amour. Pascal tisse, au sein du troisième ordre, un lien entre l’esprit et le cœur. Dans la notion de spiritus cordialis, d’esprit cordial, se situe l’apport essentiel de l’auteur des Pensées.« Esprit », one of the key-words of Pascal’s Pensées, has two meanings according to Pascal : i.e. reason and interior creative inspiration. If esprit as mens rationalis belongs to the second order, esprit as mens spiritualis refers to the third order. Two dualisms cross themselves within the Pascalian distinction of three orders. The former – of a philosophical nature, i.e. Cartesian – opposes the first order, devoted to the body and the second and third order devoted to the mens ; the latter – of an ethico-religious nature – opposes both the first and second order, i.e. the orders of cupidity to the third order, i.e. that of charity. The esprit as love rests above the esprit as reason. Pascal weaves, amid the third order a link between the esprit and the heart. The major contribution of the author of the Pensées rests in the concept of spiritus cordialis. (shrink)

Health care reform poses numerous challenges. A core challenge is to make health care more efficient and effective without causing more harm than benefit. Additionally, those fashioning health-care policy must encourage patients to exercise caution and restraint when expending scarce resources; restrict the ability of politicians to advance their careers by promising alluring but costly entitlements, many of which they will not be able to deliver; face the demographic challenges of an aging population; and avoid regulations that create significant inefficiencies (...) and restrict access to health care. Given such real-world challenges, how should health care be reformed in the United States or elsewhere? This number of The Journal of Medicine and Philosophy examines many of the complex issues that must be considered in reforming a health-care system. (shrink)