BackgroundThe expectation of pandemic-induced severe resource shortages has prompted authorities to draft and update frameworks to guide clinical decision-making and patient triage. While these documents differ in scope, they share a utilitarian focus on the maximization of benefit. This utilitarian view necessarily marginalizes certain groups, in particular individuals with increased medical needs.Main bodyHere, we posit that engagement with the disability critique demands that we broaden our understandings of justice and fairness in clinical decision-making and patient triage. We propose the capabilities (...) theory, which recognizes that justice requires a range of positive capabilities/freedoms conducive to the achievement of meaningful life goals, as a means to do so. Informed by a disability rights critique of the clinical response to the pandemic, we offer direction for the construction of future clinical triage protocols which will avoid ableist biases by incorporating a broader apprehension of what it means to be human.ConclusionThe clinical pandemic response, codified across triage protocols, should embrace a form of justice which incorporates a vision of pluralistic human capabilities and a valuing of positive freedoms. (shrink)

Open peer commentary on the article “Making Sense and Meaning: On the Role of Communication and Culture in the Reproduction of Social Systems” by Raivo Palmaru. Upshot: The author addresses implications arising from socializing observer-dependent heuristics. Above all, Palmaru’s terminology is called into question since its conceptual deficiencies with regard to the relation between an observing system and its environments cause naturalistic fallacy. The author’s reply espouses a concise reanalysis of the complementary relations of fundamentally incomparable domains, namely the observer (...) and the social system. (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)

A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients’ perception of material risks, by trained interviewers. Patients’ demographics were obtained. Mann–Whitney U (...) test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education, being employed and younger age group are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea, Drowsiness and Surgical Wound Pain. Patients ranked Heart Attack, Death and Stroke as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist, instead of letting the doctor decide or deciding for themselves. Discussion with the anaesthetist is the preferred medium of communication compared to reading a pamphlet or watching a video. Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship. (shrink)

© 2016 Regents of the University of California.The Review summarizes much of particle physics and cosmology. Using data from previous editions, plus 3,062 new measurements from 721 papers, we list, evaluate, and average measured properties of gauge bosons and the recently discovered Higgs boson, leptons, quarks, mesons, and baryons. We summarize searches for hypothetical particles such as supersymmetric particles, heavy bosons, axions, dark photons, etc. All the particle properties and search limits are listed in Summary Tables. We also give numerous (...) tables, figures, formulae, and reviews of topics such as Higgs Boson Physics, Supersymmetry, Grand Unified Theories, Neutrino Mixing, Dark Energy, Dark Matter, Cosmology, Particle Detectors, Colliders, Probability and Statistics. Among the 117 reviews are many that are new or heavily revised, including those on Pentaquarks and Inflation. The complete Review is published online in a journal and on the website of the Particle Data Group. The printed PDG Book contains the Summary Tables and all review articles but no longer includes the detailed tables from the Particle Listings. A Booklet with the Summary Tables and abbreviated versions of some of the review articles is also available. (shrink)

This is a collection of four essays by Tillich emphasizing in various ways the basic point that the future of man must involve the religious dimension and perspective. It includes his last public lecture, "The Significance of the History of Religions for the Systematic Theologian," in which he rejects the reductionism both of orthodoxy, which locates revelation only in its own religion, and of a theology of the secular, which has no room for the sacred. He favors instead a "dynamic-typological" (...) approach to the theology of the history of religions that discovers elements in the experience of the Holy in all religions, whose unity and telos will be in a "Religion of the Concrete Spirit." The three other lectures complement the thrust of this lecture. In "The Decline and Validity of the Idea of Progress," Tillich finds the proper perspective toward history and progress in kairoi, moments of partial but creative fulfillment. In "Frontiers" he speaks of crossing and reversing boundaries as the way to peace. And in "The Effects of Space Exploration on Man's Condition" he notes the emergence of a new ideal of human existence and affirms it doesn't change the divine-human relationship. The book also includes tributes by Jerald C. Brauer, Wilhelm Pauck, and Mircea Eliade, and a set of photographs by Archie Lieberman.--R. G. K. (shrink)

Prior apparently left a substantially completed manuscript dealing with the objects of thought when he died in 1969. Geach and Kenny have edited this material, supplementing it with both published and unpublished other writings, including an appendix on names in lieu of Prior's intended final chapter. The result is an interesting, often non-standard, discussion of many issues central to philosophical logic. There are two major concerns treated--what is it that we think?, and what is it that we think about?. These (...) are the two principle ways in which 'thinking of' can occur as a relation for Prior. An examination of the first sense results in a defense of the view that propositions, as language-independent logical constructions, are the objects of thought. In doing so, a large number of related issues are discussed to include criticisms of extentionalist [[sic]] theses, a sympathetic version of the assertive redundancy theory of truth, and an account of non-assertoric logic. Prior also devotes chapters to paradoxes such as that of the liar, and to Tarskian and alternative semantics. Perhaps the most interesting section of the book is that devoted to discussing what sentences are about, especially when their ostensible subjects are non-existent, e.g., "The King of France is bald." It is not clear just what his positive views are, but Prior has a number of criticisms directed against current intentionalistic views of names as well as against Russellian names. His chief worry seems to concern oratio obliqua constructions in which a reporter does not believe in the existence of that of which/whom a reportee speaks. Although critical of writers influenced by either the early Brentano or the later Russell, Prior appears to be sympathetic to both schools in that he seems to view non-demonstrative sentences as never being directly about their subjects. Thus, neither "Gustavus is bald" nor "The King of Sweden is bald" would be about the King of Sweden, i.e., Gustavus. However, since Gustavus is the King of Sweden, the sentences are indirectly about him. Presumably, such a move precludes a reporter's being committed to the reportee's ontology, thereby avoiding the difficulty. An interesting but undeveloped aspect of his view is the role of background stories in our use of names. While some use is made of formal logic in the Polish notation, unfamiliarity with either is not a bar to following the text as English translations and keys are provided. It is unfortunate that we cannot look forward to further elucidation of Prior's views.--K. T. (shrink)

Using the Epicurean position on death as a starting point, this article re-examines the basic assumptions of philosophers regarding their views on whether death should be seen as a bad. It questions the positions of philosophers such as Thomas Nagel and Derek Parfit by applying Wittgenstein’s notion of grammar as developed by G. P. Baker and P. M. S. Hacker. While philosophers may characterize questions such as ‘What is the nature of death?’ and ‘Is death a bad?’ as metaphysical, I (...) propose that such questions can be better characterized as grammatical. The failure to understand the grammatical character of such questions creates the illusion that questions concerning the nature of death can be adequately tackled with reference to empirical or metaphysical ‘facts’. If the arguments in this article are substantiated, some philosophical puzzles about death can be dissolved. (shrink)

The history of contemporary modal logic dates back to the writings of C. S. Lewis in the early part of this century. Since then, a growing body of literature has attested to professional interest in the area, and in a number of related issues in philosophical logic which have received wide attention. The recent development of powerful formal techniques for modal system building, together with an increasing interest in modal logic as a tool for philosophical analysis, have created a need (...) for an up-to-date text to introduce students to this material. Snyder's book attempts to answer this need. Assuming an understanding of elementary propositional logic, Snyder introduces a reductive technique called cancellation for detecting the theorems of a system of logic. This technique, analogous to the construction of Smullyan trees but more compact, is extended to modal and quantified contexts. Cancellation versions of the systems M and Mn of G. H. von Wright, and S4 and S5 of Lewis are developed. Snyder uses a Hintikka type of semantics, showing how the various formal systems are differentiated at the semantic level by differing conditions which must be imposed on the model systems used as interpretations for them. These model systems, and the conditions imposed upon them, are in turn described by means of a metalanguage which is essentially first-order quantificational logic. The power of this technique stems from the fact that for every object language formula of a system, there is a corresponding formula in the metalanguage which describes the conditions an interpretation must meet in order to satisfy the original formula. The conditions that the interpretations of a given system of logic must meet are reflected in this metalanguage as "antecedent assumptions," and these in turn correspond to cancellation rules for the object language. This correspondence is constructed in such a way that the metalinguistic counterpart of each theorem of the system will be a theorem of first-order logic. Snyder's primary interest is in showing how modal logic can be used, with the help of these techniques, to build a large variety of formal systems and to "tailor" such systems to meet a variety of analytical tasks. Simple modal systems are developed for the articulation of a number of modal concepts, in addition to the classic alethic ones. Examples are taken from temporal, deontic, and epistemic logic to show how specific interpretations of the meanings of the relevant operators lead to the incorporation of appropriate conditions in the formal systems used to articulate them. An entire chapter is devoted to a discussion of the paradoxes of material and strict implication, and to an attempt to articulate the notion of entailment through the development of formal systems which include a dyadic modal operator that is free of these paradoxes. The final chapter discusses such classical issues as proper names, reference, fictional entities, definite descriptions, and existence presuppositions. Appendices deal with such matters as the equivalence of the cancellation systems to more classical axiomatic-deduction systems, and the sketch of a proof of soundness and completeness for all the modal systems presented. While designed as a text, this volume should be of interest to both logicians and those working in metaphysics and language analysis, since the primary concern of the author is to develop techniques that will facilitate the usefulness of modal logic as a tool for philosophical analysis. The instructor's manual contains many suggestions derived from the author's experience in teaching this non-standard treatment of the subject.--K. T. (shrink)

The article is devoted to the communicative competence of a doctor as a component of professional ethics. Knowledge of norms of the modern Russian literary language, compliance with these standards in the oral and written speech of a medical worker helps to establish contact between doctor and a patient. To identify the level of knowledge of Russian language norms, readiness for professional speech a scientific research was made, during which the most typical mistakes were revealed:orthoepic, morphological, lexical, stylistic. Following the (...) norms of the language and ethics of communication contributes to the achievement of the main aim of a medical activity – recovering of a patient. (shrink)

The objectives of this study were to develop a high-density chromosome bin map of homoeologous group 7 in hexaploid wheat, to identify gene distribution in these chromosomes, and to perform comparative studies of wheat with rice and barley. We mapped 2148 loci from 919 EST clones onto group 7 chromosomes of wheat. In the majority of cases the numbers of loci were significantly lower in the centromeric regions and tended to increase in the distal regions. The level of duplicated loci (...) in this group was 24% with most of these loci being localized toward the distal regions. One hundred nineteen EST probes that hybridized to three fragments and mapped to the three group 7 chromosomes were designated landmark probes and were used to construct a consensus homoeologous group 7 map. An additional 49 probes that mapped to 7AS, 7DS, and the ancestral translocated segment involving 7BS also were designated landmarks. Landmark probe orders and comparative maps of wheat, rice, and barley were produced on the basis of corresponding rice BAC/PAC and genetic markers that mapped on chromosomes 6 and 8 of rice. Identification of landmark ESTs and development of consensus maps may provide a framework of conserved coding regions predating the evolution of wheat genomes. (shrink)

This chapter introduces the edited volume, The Oxford Handbook of Philosophy and Psychiatry. Published in 2013, the centenary of Karl Jaspers' General Psychopathology, the chapter draws lessons from the last hundred years for the coming century. No predictions are made. Instead, five 'conditions for flourishing' are set out: 1) Particular Problems - the importance of focussing on well-defined particular problems rather than general theory building, 2) Product- orientation - remaining always responsibly product oriented in the specific sense that both sides (...) put in the work necessary to 'go deep' with each other's fields, 3) Partnership - working in partnerships of one kind or another, 4) Process - constant reflection on process based on peer review but leaving scope for the occasional rogue voice to cut innovatively against the grain, and 5) Q - a condition of a different kind, Q is an empirically derived measure of the balance between in-group cohesion and out-group openness required to support creativity. Illustrations are given of how these five conditions for flourishing have underpinned the rapid expansion of philosophy and psychiatry in the closing decades of the twentieth century, and, correspondingly, are also reflected in the Handbook as a whole. Overviews and commentaries on individual contributions to the Handbook are given in extended editorial introductions to each of its eight sections. (shrink)

Ethical decision-making frameworks assist in identifying the issues at stake in a particular setting and thinking through, in a methodical manner, the ethical issues that require consideration as well as the values that need to be considered and promoted. Decisions made about the use, sharing, and re-use of big data are complex and laden with values. This paper sets out an Ethics Framework for Big Data in Health and Research developed by a working group convened by the Science, Health and (...) Policy-relevant Ethics in Singapore Initiative. It presents the aim and rationale for this framework supported by the underlying ethical concerns that relate to all health and research contexts. It also describes a set of substantive and procedural values that can be weighed up in addressing these concerns, and a step-by-step process for identifying, considering, and resolving the ethical issues arising from big data uses in health and research. This Framework is subsequently applied in the papers published in this Special Issue. These papers each address one of six domains where big data is currently employed: openness in big data and data repositories, precision medicine and big data, real-world data to generate evidence about healthcare interventions, AI-assisted decision-making in healthcare, public-private partnerships in healthcare and research, and cross-sectoral big data. (shrink)

Our study analyses the nature, quality and extent of human resource disclosures of UK Financial Times Stock Exchange 100 firms by relying on a novel disclosure index measuring the depth and breadth of disclosures. Contextually, we focus on the 5-year period following the then Labour government’s attempts to encourage firms to formally report on their human resource management practices and to foster deeper employer–employee engagement. First, we evaluate the degree to which companies report comprehensively on a number of HRD items (...) that we classify as “procedural” or “sustainable.” Second, we hypothesise that a company’s employee relation ideology is positively associated with HRD. Our results indicate that: whilst there has been an increase in the breadth of HRD in terms of procedural and sustainable items being disclosed, the evolution towards a more comprehensive and in-depth form of HRD remains rather limited; and there is a positive association between a company’s employee relation ideology and the level of HRD. Theoretically, we conceive of HRD both as a reflection of an organisation’s orientation towards a key stakeholder and a legitimacy seeking exercise at a time of changing societal conditions. We contribute to the scant literature on the extent and determinants of HRD since prior research tends to subsume employee-related disclosures within the broader concept of social, ethical or intellectual capital disclosures. We also propose a disclosure checklist to underpin future HRD research. (shrink)

This section concerns the question of how best to understand the scientific status of mental health care in general and psychiatry in particular. On the assumption that psychiatry is based, in part at least, on natural science, what is the nature or the general shape of that science? Some of the chapters aim at shedding light on component parts of a scientific world view: causation, explanation, natural kinds, models of medicine, etc. Others concern potentially fruitful scientific approaches to mental health (...) care, drawing on brain imaging results, phenomenology, enactivism and what can be learnt from debate of the status of psychoanalysis. One overall lesson is that twenty-first-century psychiatry needs twenty-first-century philosophy of science. (shrink)

This Section examines several moral dilemmas and epistemological aporias in clinical practice and shows how clinicians can benefit from the introduction of philosophical methods and discourse. The authors develop these issues having in mind emblematic mental disorders and typical clinical situations. One important claim shared by the Authors is that a great effort has been made to ground psychiatry on evidence-based science, and to tie it to our growing understanding of the human brain. This is obviously an exceedingly important project, (...) but it would be a mistake to assume that the central questions of psychiatry can be completely resolved through scientific inquiry. Science offers guidance for clinical practice only in light of our concepts and normative judgments. (shrink)

In the editorial introduction the stage is set for the chapters in the section by a brief discussion of the relationship between the disciplines of philosophy and psychiatry. Then each chapter briefly is summarized or highlighted.

In this introduction to the Section II, the thrust of the component chapters is described. An important strand in the philosophy of psychiatry since its beginnings has been sociopolitical critiques: criticism which aims to improve and humanize psychiatric practice and mental health systems. From this standpoint, the introduction provides an overview of this tradition, including considerations of "postpsychiatry," value commitments in psychiatry, the recovery movement, racism and sexism in the field, and technology.

A cross-disciplinary discussion of the basis of interpersonal relating is of interest to philosophers and psychiatrists for several reasons. The development of successful clinical practice may depend, at least partly, on having an accurate understanding of the basic character of unimpaired interpersonal relating because such understanding can shed light on the nature and source of its disturbed forms. How we think about the basis of "mind-minding" competencies influences how we think about the prognosis and possible treatment of dysfunctional interpersonal relating. (...) Another reason is that philosophical frameworks influence the way we think about and evaluate possible psychiatric disorders and philosophical discussions may be of direct practical importance to psychiatry given that different theories suggest different potential ways of devising therapies. (shrink)

The editorial introduction sets the stage for the chapter by identifying the roles that concepts and categories play not just in the field of mental health medicine but in the human mind itself. Then, each chapter is summarized or highlighted.

Following on from Section IV on summoning concepts, this section of the Handbook presents theoretically informed descriptions of psychopathologies. The topics of the chapters range from anxiety, depression, and body image disorders, through emotion and affective disorders, to delusion, thought insertion, and the fragmentation of consciousness. These phenomena call, not only for assessment and diagnosis, but also for understanding on the part of both the engaged clinician and the philosophical commentator. They also provide case studies for general philosophical questions about (...) different levels of description and conceptualisation and the relationships between them, and about the contributions to psychological understanding that are made by phenomenology, clinical expert knowledge, and the sciences of the mind. (shrink)

In this introduction to Section VI, the thrust of the component chapters is described. The classification and diagnosis of mental disorders collects a number of philosophical challenges to the field that call for responses from a variety of philosophical resources: hermeneutics, phenomenology, philosophy of mind, narrative theory, philosophy of science, epistemology-to name a few. The authors in this section address the general challenges in the classification of psychopathology, as well as address particular kinds of mental disorders, including autism, dementia, mania, (...) psychotic disorders, and personality disorders. (shrink)