In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 26.1 (2002) 143-156 [Access article in PDF] The Vicious Habits of Entirely Fictitious People: Hume on the Moral Evaluation of Art Eva M. Dadlez DAVID HUME'S ESSAY, "Of the Standard of Taste," identifies aesthetic merits and defects of narrative works of art. 1 There is a passage toward the end of this essay that has aroused considerable interest among philosophers. In it, Hume writes of (...) cases in which "vicious manners are described, without being marked with the proper characters of blame and disapprobation" ("ST," p. 246). He maintains that works which include such descriptions are aesthetically flawed, adding that we neither can nor should enter into their writers' sentiments or "bear an affection to characters, which we plainly discover to be blameable" ("ST," p. 246).There is no reason to ascribe to Hume a Platonic moralism that condemns art's disinhibition of emotion. Neither does Hume advocate some extravagant form of political correctness that evaluates art by looking to the propriety of its subject matter. As later examples in the quoted essay make clear, Hume is speaking of cases in which fiction not only depicts vicious manners, but endorses them. I will argue that such endorsements are stigmatized neither because a low estimation of depicted behavior infects the estimation of a work's merit nor because we take the endorsement to be mistaken or unwarranted. Fictional endorsements of conduct otherwise regarded as vicious constitute defects because they curtail the aesthetic experience. Hume's claim, then, is as much about human psychology as it is about morality. We cannot divorce morality from narrative art because, for Hume, morality finds its basis in the very sentiments such art is intended to arouse. The content of the works under fire is objectionable because it prompts the [End Page 143] imaginative disengagement of the reader or viewer just when engagement and emotional participation are necessary for full appreciation. As Noël Carroll maintains in his objection to autonomism, a moral defect "will count as an aesthetic defect when it actually deters a response to which a work aspires." 2 This is a view for which I will endeavor to offer an explanation based on Hume's philosophy, and that I will attempt to defend against typical objections. I It would be a mistake to associate the position ventured above with some of those appearing in the recent critical literature. There, a work is sometimes taken to endorse any character's behavior which is not explicitly condemned or which is accompanied by some depiction of positive traits. Thus Nabokov's Lolita is suspected of subtle endorsement of Humbert's behavior mainly because Humbert is described as urbane and intelligent. There is a clear mistake here about what it is that can be taken to constitute an endorsement on the part of a work of fiction. To suggest that Lolita endorses child molesting because we are occasionally allowed to glimpse a sympathetic side of the molester is on a par with claiming that Shakespeare's Macbeth endorses killing for personal gain because we are allowed to glimpse a sympathetic side of the title character. Our reactions to complex characters can be, and usually are, correspondingly complex. We can admire one trait and deplore another without being forced into the kind of all-or-nothing evaluation that writers of serious fiction seldom want to elicit. In any case, it seems clear that the endorsement of a character in toto would probably involve a good deal more than the depiction of a few attractive traits. The grim undoing of the two characters under consideration, coupled with their misery and hopelessness, hardly suggests endorsement. Similarly, an aesthetically pleasing depiction of an event we consider tragic should not be taken as an endorsement of that event. Aesthetic and distressed responses are not mutually exclusive. They can constitute distinct responses to distinct aspects of the same state of affairs. The graceful arrangement of the bodies of Romeo and Juliet is surely not an endorsement of their tragic death or their suicide... (shrink)

Songs that combine happy music and sad, violent, or morally disturbing lyrics raise questions about the relationship between music and lyrics in song, including the question of how such songs affect the listener, and of the ethical implications of listening – and perhaps singing along with – such songs. To explore those perplexing cases in which the affective impact of music and lyrics seem entirely incompatible, we first examine how song music – and the sympathetic musical affects it elicits – (...) can influence listener attention to lyrics. We propose that ‘happy’ music and mood in particular may discourage close attention to the semantic contents of lyrics in some cases, and impart a ‘positive glow’ to them in others. We also mine the kinds of moral questions to which emotional and imaginative immersion in fiction can give rise for their potential applicability to songs with disturbing narratives. We then explore how performance and performer may influence the understanding and interpretations of lyrics. This investigation of the complexities of such songs will use Tom Jones’ murder ballad “Delilah” as a template, taking into account both its impact and its presentation. (shrink)

The goal of this dissertation is to demonstrate that construals of our emotional responses to fictions as irrational or merely pseudo-emotional are not the only explanations available to us, and that necessary and sufficient conditions for an emotional response to a fiction can be established without abandoning either its intentionality or the assignment of a causal role to our beliefs. ;Colin Radford's claim that our emotional responses to fictions are irrational and inconsistent is challenged in two ways. First, distinctions can (...) be drawn between our reactions to fiction and indisputably irrational emotional reactions which preclude arriving at Radford's conclusion via an argument from analogy. Further, the conditions for rationality put forward in several analyses of emotion, ranging from that of David Hume to that of Ronald de Sousa, are not violated by our emotional responses to fictions. ;Kendall Walton's contention that such affective reactions are merely quasi-emotions is contested on the ground that the absence of the existentially committed beliefs which Walton allies with all genuine emotional responses does not demonstrate an absence of cognitive content. Existentially uncommitted evaluative beliefs, thoughts, and even beliefs about the world can be linked to our emotional experience of fictions, and can serve a function necessary to the identification of the emotion, a function which Walton assigns to the existentially committed belief. ;In our experience of fictions, the objects of our emotion are various. However, a direct response to a fictional entity or event is characterized in terms of Peter Lamarque's account: as a response to the content of a thought, a response to what has been thought or imagined rather than to the thought itself. The roles played both by evaluative beliefs and beliefs about what can occur in the world are investigated and found to constitute necessary conditions for an emotional response to a fiction. An account of the role of the imagination, which borrows from Boruah, David Novitz, and Susan Feagin, provides another condition which, together with the two preceding, appears sufficient for such a response. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume 30, Number 2, November 2004, pp. 213-236 Pleased and Afflicted: Hume on the Paradox of Tragic Pleasure E. M. DADLEZ How fast can you run? As fast as a leopard. How fast are you going to run? A whistle sounds the order that sends Archie Hamilton and his comrades over the top of the trench to certain death. Racing to circumvent that order and arriving (...) seconds too late, Archie's friend Frank screams in rage and despair. Archie is cut down before he has run twenty yards. Peter Weir's film Gallipoli is a chronicle of the disastrous Dardanelles campaign of the first World War, but it is also a film about racing. Archie is trained by his uncle Jack to run "as fast as a leopard." The film begins as it ends, with Archie sprinting in response to a whistle. Frank is first shown racing after a train, along with friends who are on their way to enlist. Archie and Frank meet while competing in a race, they race in Cairo once they have enlisted, and they finally race death. From the beginning, Archie has been faster; even at the end he is the first to die. And from the beginning he has swept Frank along in his wake, encouraging him, pushing him, inspiring him, and helping him to positions for which he is inadequately qualified. In the end, Archie's compassion and kindness prompt a decision which has grim consequences both for himself and for hundreds of others. Knowing that his friend fears death in the trenches, Archie recommends Frank as a substitute for himself, a designated message runner. But Frank is not fast enough, and falls short by mere seconds which Archie would not have lost. This is what leads to the failure of the one real effort to countermand the fatal charge. E. M. Dadlez is Professor of Humanities and Philosophy, University of Central Oklahoma, Edmond, OK 73034, USA. e-mail: [email protected] 214 E. M. Dadlez I am an emotional wreck by the time the movie is over, though I should admit that most of my tears are the result of sheer rage. Both my dogs exited the room in some haste once I began to shout at the television and the unpardonably dimwitted British officers who sat sipping tea at a comfortable distance as they gave the order for soldiers to commit suicide. But it isn't just the scope of the real human disaster, or the enormity of the blunder, or the pointlessness of the entire enterprise, or even my renewed conviction that stupidity is, in fact, evil, that is so unsettling. The film unnerves with respect to personal as well as global concerns, focusing attention on the chance of vanity's leading one to undertake responsibilities beyond one's competence, the possibility of advancement or security being achievable only at the expense of another, and the realization of how easy it might be to let those things happen. Gallipoli is a sad, disturbing film, and the spectator is grieved and disturbed in the course of watching it. Yet, having said that, I must own to having a copy in my possession, and to having watched it more than once. I recommend it to friends, offering to lend them my videotape. In fact, I press it on them. I say that it is a terrific, rewarding work which they should take the time to see. How is it that I can describe my experience of the film in such glowing terms and at the same time acknowledge the extreme distress I felt in the course of watching it? How can I reconcile the discordant aspects of my experience? David Hume explores some possible answers in his essay "Of Tragedy."1 He begins by calling attention to the paradox of tragic pleasure: It seems an unaccountable pleasure, which the spectators of a well written tragedy receive from sorrow, terror... and other passions, which are in themselves disagreeable and uneasy. The more they are touched and affected, the more are they delighted with the spectacle.... The whole art of the poet is employed in rousing and supporting the compassion and... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Aesthetics and Humean Aesthetic Norms in the Novels of Jane AustenEva M. Dadlez (bio)IntroductionThe eighteenth century, Paul Oskar Kristeller tells us, in addition to crystallizing what we now call the fine arts, is also marked by an increased lay interest both in the arts and in criticism.1 Amateurs as well as philosophers ventured critical commentary on the arts. Talk concerning taste or beauty or the sublime was so (...) much a part of general discourse that even novelists of that era incorporated such subjects in their work. Henry Fielding "was able to construct a novel on the true and false sublime in art," according to Samuel Monk, "and to draw an analogy between the sublime in art and the sublime in character."2 So we shouldn't find it surprising that perspectives on aesthetics are sometimes presented in the novels of Jane Austen.3 This subject matter ranges from descriptions of skill in the execution and sensitivity in the appreciation of particular arts to general observations about beauty and taste and what is requisite for the apprehension of the former and the possession of the latter.Consider the following catalog of arts and beauties. Mansfield Park, Sense and Sensibility, and Northanger Abbey contain many references to the beauties of nature, both cultivated and wild. Taste in music is a topic in Persuasion, Mansfield Park, Pride and Prejudice, and Lady Susan. A taste for poetry and literature is the lot of the heroines of Persuasion, Northanger Abbey, Mansfield Park, and Sense and Sensibility. Taste and talent for drawing is exhibited by characters in Sense and Sensibility, Emma, and Northanger Abbey. Both Sense and Sensibility and Mansfield Park contain discussions of the merits of effective reading, that is, reading well aloud. Mansfield Park even comments on [End Page 46] acting ability, albeit rather disapprovingly. More general reflections on taste and beauty, as well as their connection to morality, are equally typical.It is possible to venture several different arguments about the philosophical perspective into which such observations best fit. Kantian analyses have already been ventured in the literature. Anne Crippen Ruderman calls our attention to the Kantian flavor of the connection Austen draws between a sensitivity to natural beauty and one's moral disposition, for instance, and David Kaufman compares Austen to Kant, though primarily in regard to ethics.4 Nonetheless, in this article I will argue that the strongest correlations and correspondences are in fact between Austen's and Hume's positions on aesthetics. Evidence in support of a Kantian analysis will first be canvassed and later compared with claims in favor of a Humean alternative.I will establish that the positions on taste and beauty and delicacy that are explicitly stated in or can be inferred from Austen's novels fit a Humean model—and fit it with a fair degree of precision. In doing so, I hope to demonstrate a correspondence strong enough to serve as the staging area for the further speculations that constitute the second thesis of this article. A great deal has already been said by philosophers about the capacity of literature to elicit moral reactions from the reader. Fictions can present ethical endorsements and invite us to adopt ethical perspectives by making it true in the world of the work that some course of action is right or some character is laudable. They can do this not by telling us that an act is right or a person meritorious but by showing us the rightness of the action and the commendability of the individual—by asking us to imagine traits that call forth our own approval and commendation. I will contend that aesthetic norms can be treated in much the same way as moral norms. That is, I will claim that the fiction of Jane Austen, in addition to evidencing the conscription of a Humean aesthetic, so engages and educates us that we are led imaginatively to adopt certain aesthetic perspectives in the course of its contemplation: not just by being told what is aesthetically pleasing or commendable, but by being made to feel pleasure and to experience commendation; not just by being told what constitutes discriminating taste, but by being led... (shrink)

Carolyn Korsmeyer has offered some compelling arguments for the role of disgust in aesthetic appreciation. In the course of this project, she considers and holds up for justifiable criticism the account of emotional conversion proposed by David Hume in “Of Tragedy”. I will consider variant interpretations of Humean conversion and pinpoint a proposal that may afford an explanation of the ways in which aesthetic absorption can depend on and be intensified by the emotion of disgust.

What has Emma Woodhouse to say to a discipline like philosophy? The minutia of daily living on which Jane Austen's Emma concentrates our attention permit a closer look at human emotions and motives. Emma shows how friendships can affect one's ways of dealing with the world, how shame can reconfigure self-understanding. That is, Emma leads us to think philosophically.

Conscientious objection has spurred impassioned debate in many Western countries. Some Norwegian general practitioners (GPs) refuse to refer for abortion. Little is know about how the GPs carry out their refusals in practice, how they perceive their refusal to fit with their role as professionals, and how refusals impact patients. Empirical data can inform subsequent normative analysis.

Illuminates childrens experiences of embodiment, inter-subjectivity, place, thing, time, and language through a dialogue between developmental research and ...

Sophisticated senator and legislative onion. Whether or not you have ever heard of these things, we all have some intuition that one of them makes much less sense than the other. In this paper, we introduce a large dataset of human judgments about novel adjective-noun phrases. We use these data to test an approach to semantic deviance based on phrase representations derived with compositional distributional semantic methods, that is, methods that derive word meanings from contextual information, and approximate phrase meanings (...) by combining word meanings. We present several simple measures extracted from distributional representations of words and phrases, and we show that they have a significant impact on predicting the acceptability of novel adjective-noun phrases even when a number of alternative measures classically employed in studies of compound processing and bigram plausibility are taken into account. Our results show that the extent to which an attributive adjective alters the distributional representation of the noun is the most significant factor in modeling the distinction between acceptable and deviant phrases. Our study extends current applications of compositional distributional semantic methods to linguistically and cognitively interesting problems, and it offers a new, quantitatively precise approach to the challenge of predicting when humans will find novel linguistic expressions acceptable and when they will not. (shrink)

The intent of this chapter is to suspend the belief in the goodness of literacy -- our chirographic bias -- in order to gain a deeper understanding of how the engagement with texts structures human consciousness, and particularly the minds of children. In the following pages literacy (a term which in this chapter refers to the ability to read and produce written text) is discussed as a consciousness altering technology. A phenomenological analysis of the act of reading shows the child’s (...) engagement with texts as a perceptual as well as a symbolic event that builds upon but also alters children’s speech acts. Speaking and reading are both forms of language use, but with different configurations of perceptual and symbolic qualities. Children’s literature uses textual technology and, intentionally or not, participates in structuring children’s pre-literate minds. Some of its forms, such as picture books and early readers, are directly intended to bridge the gap between the pre-literate listener and the literate reader and ease the transition into the literate state. It is my hope that the phenomenological analysis of the experiences of speaking and reading might help us understand more clearly how children’s literature impacts the minds of children. Such an analysis can awaken a critical awareness of the power that letters wield as they shape the reader’s psychological reality, and it can sharpen our sense of wonder about the metamorphosis of language from speaking to writing. (shrink)

In light of scientific advances such as genomics, predictive diagnostics, genetically engineered agriculture, nuclear transfer cloning, and the manipulation of stem cells, the idea that genes carry predetermined molecular programs or blueprints is pervasive. Yet new scientific discoveries—such as rna transcripts of single genes that can lead to the production of different compounds from the same pieces of dna—challenge the concept of the gene alone as the dominant factor in biological development. Increasingly aware of the tension between certain empirical results (...) and interpretations of those results based on the orthodox view of genetic determinism, a growing number of scientists urge a rethinking of what a gene is and how it works. In this collection, a group of internationally renowned scientists present some prominent alternative approaches to understanding the role of dna in the construction and function of biological organisms. Contributors discuss alternatives to the programmatic view of dna, including the developmental systems approach, methodical culturalism, the molecular process concept of the gene, the hermeneutic theory of description, and process structuralist biology. None of the approaches cast doubt on the notion that dna is tremendously important to biological life on earth; rather, contributors examine different ideas of how dna should be represented, evaluated, and explained. Just as ideas about genetic codes have reached far beyond the realm of science, the reconceptualizations of genetic theory in this volume have broad implications for ethics, philosophy, and the social sciences. Contributors. Thomas Bürglin, Brian C. Goodwin, James Griesemer, Paul Griffiths, Jesper Hoffmeyer, Evelyn Fox Keller, Gerd B. Müller, Eva M. Neumann-Held, Stuart A. Newman, Susan Oyama, Christoph Rehmann-Sutter, Sahotra Sarkar, Jackie Leach Scully, Gerry Webster, Ulrich Wolf. (shrink)

Nietzsche’s cardinal ideas - God is Dead, Übermensch and Eternal Return of the Same - are approached here from the perspective of psychiatric phenomenology rather than that of philosophy. A revised diagnosis of the philosopher’s mental illness as manic-depressive psychosis forms the premise for discussion. Nietzsche conceived the above thoughts in close proximity to his first manic psychotic episode, in the summer of 1881, while staying in Sils-Maria (Swiss Alps). It was the anniversary of his father’s death, and also of (...) the break-up of his friendship with Wagner, the most important relationship in his life. Despite having been acquainted with these ideas from reading philosophy and literature, Nietzsche created them de novo and imbued them with very personal meaning. Surprisingly, he never defined or explained his cardinal thoughts in his published writings, perhaps because rationally he could not. A resultant hermeneutic vacuum provoked an avalanche of interpretations in secondary literature. But could these ideas be delusions? A current definition of delusion is challenged, and an attempt is made at a limited comparison between delusion, scientific/philosophical doctrine and poetic creation. It is also argued that psychosis is a way of re-living trauma, and delusions can therefore be seen as a form of reasoning that helps to make sense of the world in a state of psychotic disintegration. Far from being false beliefs, delusions are a true expression of one’s innermost feelings and pain, albeit indirectly. The relationship between early parental loss and repeated trauma, psychosis and creativity is also explored. Indo-Pacific Journal of Phenomenology , Volume 8, Edition 1 May 2008. (shrink)

This essay, the last in a series, focuses on the relationship between Nietzsche’s mental illness and his philosophical art. It is predicated upon my original diagnosis of his mental condition as bipolar affective disorder, which began in early adulthood and continued throughout his creative life. The kaleidoscopic mood shifts allowed him to see things from different perspectives and may have imbued his writings with passion rarely encountered in philosophical texts. At times hovering on the verge of psychosis, Nietzsche was able (...) to gain access to unconscious images and the music of language, usually inhibited by the conscious mind. He reached many of his linguistic, psychological and philosophical insights by willing suspension of the rational. None of these, however, could have been communicated had he not tamed the subterranean psychic forces with his impressive discipline and hard work. (shrink)

The paper deals with the question of religious tolerance in Europe’s past and present. Tolerance within Christianity (and within the other so called “Abrahamitic” or “Biblical” Religions) is one of the main points. However, the reader is also invited to take a brief look at Europe’s pre-christian past. To some extent, the religious situation of the Roman Empire in particular rather seems to resemble our own experiences with pluralistic societies in today’s Europe than medieval and early modern circumstances would do. (...) Even the ancient problems with “religious freedom” can be linked with modern counterparts. So this paper will avoid long retrospectives at the well known facts of Europe’s Christian past such as inquisition and European religious wars in order to deal with some more hidden perspectives of European religious his- tory, which were often obscured by the main historiographical narrative. (shrink)

Antimicrobial resistance (AMR) describes the evolution of treatment‐resistant pathogens, with potentially catastrophic consequences for human medicine. AMR is driven by the over‐prescription of antibiotics, and could be reduced through consideration of the ethical dimensions of the dilemma faced by doctors. This dilemma involves balancing apparently opposed interests of current and future patients, and unique contextual factors in different countries, which may modify the core dilemma. We describe three example countries with different economic backgrounds and cultures—South Africa, Sri Lanka and the (...) United Kingdom. Then we discuss how country‐specific factors impact on the prominence of various ethical dimensions of the dilemma (visibility and moral equality of future generations; Rule of Rescue; prescribing autonomy and conflicts of interest; consensus on collective action). We conclude that a nuanced understanding of national prescribing dilemmas is critical to inform the design of effective stewardship approaches. (shrink)

ObjectiveLoss of control eating has been directly related to the core aspects of the psychopathology of eating disorders and to different dimensions of emotion and behavior regulation and self-criticism. This study investigates a model representing the interplay between these dimensions to understand LOC eating among a nonclinical sample.MethodsA total of 341 participants, recruited in a college campus, completed a set of self-report measures assessing LOC eating, weight suppression, psychopathology of eating disorders, depression, negative urgency, emotion regulation difficulties, and self-criticism. Path (...) analysis modeling tested a hypothesized model with 3 paths for LOC eating as follows: psychopathology of eating disorders; emotion and behavior regulation; and interplay between these paths.ResultsWe found goodness-of-fit indexes to our data: χ2 = 17.11, df = 10, Comparative Fit Index = 0.99, Tucker-Lewis index = 0.98, Root Mean Square Error Approximation = 0.045, Standardized Root Mean Square Residual = 0.041, suggesting that: participants with higher weight suppression showed higher degrees of the psychopathology of eating disorders, which was linked to higher levels of LOC eating; self-criticism was a mediator between emotion regulation and depression/negative urgency; self-criticism was a mediator between emotion regulation and disorder eating, which was significantly associated with LOC eating via increased negative urgency.ConclusionOur model shows that LOC eating occurs for individuals with the psychopathology of higher eating disorders who experience depressive symptoms and act rashly under distress for their inability to cope adequately with negative feelings of self-devaluation. These findings point to the importance of negative self-evaluations and feelings of inadequacy or worthlessness to understand LOC eating among college students. (shrink)

It is important to understand the processes behind how and why individuals emerge as leaders, so that the best and most capable individuals may occupy leadership positions. So far, most literature in this area has focused on individual characteristics, such as personality or cognitive ability. While interactions between individuals and context do get research attention, we still lack a comprehensive understanding of how the social context at work may help individuals to emerge as leaders. Such knowledge could make an important (...) contribution toward getting the most capable, rather than the most dominant or narcissistic individuals, into leadership positions. In the present work, we contribute toward closing this gap by testing a mediation chain linking a leader's leader self-awareness to a follower's leadership emergence with two time-lagged studies (nstudy1 = 449, nstudy2 = 355). We found that the leader's leader self-awareness was positively related to (a) the follower's leadership emergence and (b) the follower's nomination for promotion and that both relationships were serially mediated by the follower's self-leadership and the follower's leader self-efficacy. We critically discuss our findings and provide ideas for future research. (shrink)

The aim of this study is to investigate how patterns of collaboration and scholarly independence are related to early stage researchers’ development in two multidisciplinary learning environments at a Swedish university. Based on interviews with leaders, supervisors, doctoral students, and post docs, results show how early stage researchers’ development is conditioned by their relative positions in time and space. Through the theoretical notions of ‘epistemic living space’ and ‘developmental networks’, four ways of experiencing the multidisciplinary learning environment were distinguished. Overall, (...) the environments provided a world of opportunities, where the epistemic living space entailed many possibilities for cross-disciplinary collaboration and development of scholarly independence among peers. However, depending on the members’ relative positions in time and space, this world became an alien world for the post docs who had been forced to become “over-independent” and find collaborators elsewhere. Moreover, it became an avoided world for absent mono-disciplinary supervisors and students who embodied “non-collective independence”, away from the environments’ community. By contrast, a joint world emerged for doctoral students located in the environment, which promoted their “independent positioning” and collaborative ambitions. Thus, early stage researchers’ collaboration and development of scholarly independence were optimised in a converged learning space, where the temporal and spatial conditions were integrated and equally conducive for learning. Based on these results, the authors provide suggestions for how to improve the integration of scholars who tend to develop away from the community because of their temporal and spatial positions. (shrink)

BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...) practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA. (shrink)

For all of the emphasis on quality improvement—as well as the acknowledged overlap between assessment of the quality of healthcare services and clinical ethics—the quality of clinical ethics consultation has received scant attention, especially in terms of empirical measurement. Recognizing this need, the second edition of Core Competencies for Health Care Ethics Consultation identified four domains of ethics quality: (1) ethicality, (2) stakeholders’ satisfaction, (3) resolution of the presenting conflict/dilemma, and (4) education that translates into knowledge. This study is the (...) first, to our knowledge, to directly measure all of these domains. Here we describe the quality improvement process undertaken at a tertiary care academic medical center, as well as the tools developed to measure the quality of ethics consultation, which include post-consultation satisfaction surveys and weekly case conferences. The information gained through these tools helps to improve not only the process of ethics consultation, but also the measurement and assurance of quality. (shrink)

Inflammatory immune cells, when activated, display much the same metabolic profile as a glycolytic tumor cell. This involves a shift in metabolism away from oxidative phosphorylation towards aerobic glycolysis, a phenomenon known as the Warburg effect. The result of this change in macrophages is to rapidly provide ATP and metabolic intermediates for the biosynthesis of immune and inflammatory proteins. In addition, a rise in certain tricarboxylic acid cycle intermediates occurs notably in citrate for lipid biosynthesis, and succinate, which activates the (...) transcription factor Hypoxia‐inducible factor. In this review we take a look at the emerging evidence for a role for the Warburg effect in the immune and inflammatory responses. The reprogramming of metabolic pathways in macrophages, dendritic cells, and T cells could have relevance in the pathogenesis of inflammatory and metabolic diseases and might provide novel therapeutic strategies. (shrink)