Although there is a long-standing international debate concerning the privatization and corporatization of health services, there has been relatively little systematic analysis of the ways these types of reform manifest. We examine the impact of privatization and corporatization on public hospitals, and in particular on hospitals’ autonomy and accountability, with two aims: to uncover the key themes in the literature, and to consider implementation issues. The review of 2,319 articles was conducted using content analysis and a discussion of selected key (...) issues. Several major themes appear in the privatization and corporatization literature, including their use as tools in health systems reform, and the role of governments in sponsoring the processes. We show that much of the underlying argument is ideological rather than evidence based. Those who promote versions of privatization or corporatization claim that decreased government involvement in the management of hospitals leads inter alia to benefits such as greater efficiency, better quality services, and increased choice for patients. Those who argue against say that increased privatization leads to deleterious outcomes such as decreased equity, compromised efficiency and poorer quality of care. The evidence is often weak and at times conflicting. Privatization and corporatization are difficult to implement, and at best produce mixed results, and their impact seems to depend more on the motivation of the evaluator than the standard of the results. These debates are of a type that is to a large extent only resolvable ideologically. (shrink)

OBJECTIVE: To ascertain attitudes to different methods of obtaining informed consent for randomised clinical trials (RCTs). DESIGN: Structured interviews with members of the public, medical secretaries and medical students. SETTING: The public were approached in a variety of public places. Medical secretaries and students were approached in their place of work. SUBJECTS: Fifty members of the public, 25 secretaries and 25 students. MAIN OUTCOME MEASURES: Views on RCTs were elicited, with particular emphasis on how subjects thought the concept of randomisation (...) should be explained. Each participant was presented with descriptions of proposed clinical trials and asked to select his or her preference from a range of options. RESULTS: Written information was preferred over verbal information in 91% of replies. Most respondents (86%) would prefer to sign a consent form. Of the seven statements explaining randomisation, a significant difference was found in favour of explanations that were less explicit about the play of chance (ANOVA; p = 0.0004). Eighty-three per cent of participants thought that randomised trials were morally acceptable when there was no prior medical preference between treatments. However, over half (55%) thought they would find it upsetting to be offered entry in such a trial and a quarter thought the outcome of treatment might be adversely affected. CONCLUSIONS: Our results offer some support for the idea that "economy with truth" is less unsettling than a frank description of the stark reality of what randomisation means. It is a matter of debate as to whether, if we are correct, autonomy should have precedence over beneficence. The offer of entry in a clinical trial is likely to affect the experience of care for many people, especially if the process of randomisation is described explicitly. Potential participants should be given a detailed written explanation of the rationale for the trial and be asked to sign a consent form if they agree to take part. (shrink)

Recognising and responding appropriately to emotions is critical to adaptive psychological functioning. Psychopathic traits (e.g. callous, manipulative, impulsive, antisocial) are related to differences in recognition and response when emotion is conveyed through facial expressions and language. Use of emotional music stimuli represents a promising approach to improve our understanding of the specific emotion processing difficulties underlying psychopathic traits because it decouples recognition of emotion from cues directly conveyed by other people (e.g. facial signals). In Experiment 1, participants listened to clips (...) of emotional music and identified the emotional content (Sample 1, N = 196) or reported on their feelings elicited by the music (Sample 2, N = 197). Participants accurately recognised (t(195) = 32.78, p <.001, d = 4.69) and reported feelings consistent with (t(196) = 7.84, p <.001, d = 1.12) the emotion conveyed in the music. However, psychopathic traits were associated with reduced emotion recognition accuracy (F(1, 191) = 19.39, p <.001) and reduced likelihood of feeling the emotion (F(1, 193) = 35.45, p <.001), particularly for fearful music. In Experiment 2, we replicated findings for broad difficulties with emotion recognition (Sample 3, N = 179) and emotional resonance (Sample 4, N = 199) associated with psychopathic traits. Results offer new insight into emotion recognition and response difficulties that are associated with psychopathic traits. (shrink)

As we begin our exploration of our relationship with animals, we come face to face with Peter Singer and his insistence that speciesism is a vice. It is important to come to know what he means by speciesism, why he regards it as a moral mistake.

This landmark work provides a systematic introduction to systems of modal logic and stands as the first presentation of what have become central ideas in philosophy of language and metaphysics, from the "new theory of reference" and non-linguistic necessity and essentialism to "Kripke semantics.".

Bonnie Steinbock argues that Peter Singer has made an important contribution to remind us that animals deserve very special consideration, but that he fails to make a compelling case against "speciesism.".

Appearing in English for the first time, Schelling’s 1842 lectures develop the idea that many philosophical concepts are born of religious-mythological notions.

Despite the accumulation of substantial cognitive science research relevant to education, there remains confusion and controversy in the application of research to educational practice. In support of a more systematic approach, we describe the Knowledge-Learning-Instruction (KLI) framework. KLI promotes the emergence of instructional principles of high potential for generality, while explicitly identifying constraints of and opportunities for detailed analysis of the knowledge students may acquire in courses. Drawing on research across domains of science, math, and language learning, we illustrate the (...) analyses of knowledge, learning, and instructional events that the KLI framework affords. We present a set of three coordinated taxonomies of knowledge, learning, and instruction. For example, we identify three broad classes of learning events (LEs): (a) memory and fluency processes, (b) induction and refinement processes, and (c) understanding and sense-making processes, and we show how these can lead to different knowledge changes and constraints on optimal instructional choices. (shrink)

With precision and profundity born of 30 years of devoted study, John Boyle offers an essential introduction to St. Thomas Aquinas on Scripture, shedding helpful light on the goals, methods, and commitments that animate the Angelic Doctor's engagement with the sacred page. Because the genius of St. Thomas's approach to the Bible lies not so much in its novelty but rather in the fidelity and clarity with which he recapitulates the riches of the preceding interpretive Tradition, this initiation into St. (...) Thomas's vision of Scripture is itself an orientation to the Church's vision of Scripture, from the Fathers through and beyond the Middle Ages. St. Thomas's embeddedness within the Church's Tradition and his own historical context is integral to his approach to Scripture, yet it sets him at some distance from modern readers, for whom his interpretive vision may seem perplexing or even impenetrable. In this Primer, Boyle first provides an acclimation to this medieval context through a survey and explanation of pertinent technical terminology used by St. Thomas and characteristic of the scholastic theology of the time. With an eye to the medieval practice of considering Scripture according to the fourfold division of causes, Boyle builds on this initial foundation by exploring in turn St. Thomas's accounts of the end or use of Scripture (final cause), its divine and human authorship (efficient cause), its order and division (material cause), and its literary styles or genres (formal cause). Drawing on writings from across St. Thomas's corpus, but especially his work On the Commendation and Division of Sacred Scripture and the prologues to his biblical commentaries, Boyle masterfully elucidates both the hermeneutical principles and deep wisdom of the Angelic Doctor's approach to Scripture, imparting invaluable guidance not only for reading and understanding St. Thomas and other great masters of the Tradition, but also-and ultimately-for understanding Scripture in light of this Tradition and reading it with greater benefit and joy. (shrink)

Journal Name: Cognitive Linguistics Issue: Ahead of print.

Due to their consolidated nature, corporate sustainability reports often mask the evolution of organizations’ sustainability initiatives. Thus, to more fully understand the environmental performance of an organization, it is essential to examine the experiences of specific projects and how they relate to corporate sustainability. Based on case studies of green projects in four different organizations, we find that it is difficult to determine the environmental impact of a project a priori, even in cases where environmental considerations are included as part (...) of the initial project scope. Instead, the decision to integrate environmentally favorable elements into projects is a dynamically occurring interaction between competing institutional logics and organizational identities, which create windows of opportunity for individual agency. During these windows, individuals may engage in reinforcing microprocesses that support traditional practices, or invoke enabling microprocesses to facilitate green decision-making, consistent with ecosystem logics. The process model developed in this paper provides a new perspective on the temporal and contextual dimensions of environmental championship behaviors, and sheds light on otherwise puzzling results such as why organizations with strong environmental orientations continue to struggle with delivering projects with strong positive environmental impacts. (shrink)

A post-modernist analysis of human-centred technology (HCT) suggests the ideology which informs the theoretical and practical development of HCT resonates with ideological representations of machine intelligence portrayed in science fiction (sf) films. It is argued that such an ideology reflects and reinforces ontological dualisms which constrain our ability to imagine and realise our future relations with technology. This paper invites proponents of HCT to meet their shadows, to transgress, the cultural and discursive borders constructed in the name of modernism, and (...) to reflect on what is taken-for-granted and peripheralised within their own work. (shrink)

The goal of this paper is to review and describe the characteristics and outcomes of ethics consultations on a gastrointestinal oncology service and to identify areas for systems improvement and staff education. This is a retrospective case series derived from a prospectively-maintained database of the ethics consultation service at Memorial Sloan Kettering Cancer Center. The study analyzed all ethics consultations requested for patients on the gastrointestinal medical oncology service from September 2007 to January 2016. A total of 64 patients were (...) identified. The most common primary ethical issue was the DNR order, followed by medical futility. The most common contextual issues were dispute/conflict between staff and family, dispute/conflict intra-family, and cultural/ethnic/religious issues. The majority of ethical issues leading to consultation were resolved ; i.e., the patient, surrogate, and/or healthcare team followed the recommendation of the ethics consultant. 22% had a DNR order prior to the ethics consult and 69% had a DNR order after the consult. In this population of patients on a gastrointestinal oncology service, ethics consultations are most often called regarding patients with advanced cancers and the most common ethical conflicts arose between families and the health care team over goals of care at the end of life, specifically related to the DNR order and perceived futility of continued/escalation of treatment. Ethics consultations assisted with conflict resolution. Conflicts might be reduced with improved communication about prognosis and earlier end of life care planning. (shrink)

There is much public focus in North America today on issues of corporate governance and ethics due mainly to the malpractice of several high profile corporate leaders and the negative impact of this on their corporation's stakeholders, employees and communities. This has caused a crisis of trust in the public and lead to much discussion on ways to prevent such unethical behavior by adopting new approaches through legislation and the structure of corporations. This article is not about introducing a new (...) approach to corporate ethics and governance as there is much change already taking place. The National Quality Institute in Canada offers a demonstrated and proven way, through the application of the Excellence Frameworks, of providing for good corporate guidance and ethical leadership practices. Organizations, which adopt a strategic focus on Excellence, attain great results and become healthy organizations, as their leaders understand the dynamic relationship and the balance that exists between "employees, customers, and stakeholders". These organizations build trust by acting responsibly. NQI works with many organizations in Canada that have a strategic leadership focus on organizational excellence utilizing the criteria in the NQI Canadian Excellence Frameworks for Quality and for Healthy Workplace. Organizations that take an integrated approach to Excellence also perform well in such areas as corporate social responsibility, employee health and customer satisfaction. This article has specific references to three organizations that have achieved Canada's prime recognition the Canada Awards for Excellence. (shrink)

The geometry of the state space of a finite-dimensional quantum mechanical system, with particular reference to four dimensions, is studied. Many novel features, not evident in the two-dimensional space of a single spin, are found. Although the state space is a convex set, it is not a ball, and its boundary contains mixed states in addition to the pure states, which form a low-dimensional submanifold. The appropriate language to describe the role of the observer is that of flag manifolds.

New entrant policy, literature, and research offers an important angle for exploring where dominant agrarianism is reproduced and contested. As new entrants seek access to land, finance, and expertise, their credibility is filtered through a cultural and policy environment that favors some farming models over others. Thus, seemingly apolitical policy tools geared at getting new people into farming may carry implicit norms of who these individuals should be, how they should farm, and what their values should entail. A normative gaze (...) of farming often masks the financial, cultural, labor relation, and land tenure dimensions that are the underlying drivers of agrarian change. This paper applies social reproduction theory to explore a diversity of social labor processes that new entrant farmers practice to arrive at the point of agricultural production. Interviews with new entrant and successor farmers in Britain (excluding Northern Ireland) are presented first, followed by an analysis of new entrant policy instruments over the last two decades in Scotland. We find that new entrant policy fails to engage with a crisis of social reproduction in the food system because of a commitment to agrarian ideals of the self-sufficient and entrepreneurial farmer. By inviting newcomers into a dynamic of increasing precarious and uncompensated labor, very often by way of family relations, new entrant policy may act as a form of “predatory inclusion.” We argue that to be successful in reproducing the agricultural sector, new entrant farmer policy must be first a policy at attending to relations in the social sphere. Recognizing and supporting the diversified strategies farmers take on to assemble land for production would not only drive more just policy, but set the conditions for a more adaptive food system. (shrink)

This chapter examines the role of shopfloor knowledge in the operation of advanced manufacturing systems. Design trends towards full automation are contrasted with those toward hybrid, human-centred systems with particular emphasis on job design and the development and reproduction of knowledge. The chapter concludes with a short discussion of the problems inherent in hybrid design.

Is it coherent to defend nuclear deterrence from an ethical and just-war point of view, given the likely devastating effects of an actual nuclear exchange? This article holds that the salutary effe...

Volume 18, Issue 3, October 2019, Page 263-265.

The double slit experiment for a massive scalar particle is described using intuitionistic logic with quantum real numbers as the numerical values of the particle's position and momentum. The model assigns physical reality to single quantum particles. Its truth values are given open subsets of state space interpreted as the ontological conditions of a particle. Each condition determines quantum real number values for all the particle's attributes. Questions, unanswerable in the standard theories, concerning the behaviour of single particles in the (...) experiment are answered. (shrink)

This paper looks how health systems can go beyond clinical care to address the social determinants of health and considers why this approach might be particularly relevant for Accountable Care Organizations touted by the Affordable Care Act. ACOs make profits by reducing the medical expenses of patient populations. The leading causes of death in the United States are tobacco use, insufficient physical activity, and an unhealthy diet. These risk factors are linked to increased incidence of a wide range of chronic (...) diseases, the treatment of which places a tremendous financial burden on our health care system. Health care delivery and access are just a small part of the solution to our chronic disease crisis. Increasingly, strategies that address the social determinants of health —“the conditions into which people are born, grow, live, work, and age”— are the ones that hold the most promise. In Massachusetts, Steward Health Care System supports a number of initiatives to address the social determinants of health in its patient population. Steward provides an example of how a hospital system can address the health of its patient population by moving beyond clinical care. The varied initiatives have also resulted in cost savings for the system. (shrink)

The Affordable Care Act and other federal initiatives are fostering the emergence of a coherent vision for chronic disease prevention that has never before existed in the United States. This investment in population health and prevention comes not a moment too soon. Health care costs are proving very difficult to control and are rising at an unsustainable rate, driven in part by sky-rocketing chronic disease rates.This article looks at how a health system can engage in prevention activities beyond the clinical (...) setting and makes a strong case that these interventions will result in documented cost savings. We first examine an individually targeted strategy that helps patients obtain health insurance coverage. This strategy furthers a hospital's goal of receiving reimbursement for care while also having the social benefit of increasing patients’ economic stability. (shrink)

Research into entries and rules based on English is hampered by the fact that crucial factors coincide. Clahsen avoids this problem and demonstrates his claims by working on German. Seen against the background of the immense variety of the world's languages, this successful move is potentially the first of many possible ones: Several languages offer promising configurations of the factors relevant to Clahsen, and others present new challenges.

We show how trajectories can be reintroduced in quantum mechanics provided that its spatial continuum is modelled by a variable real number (qr-number) continuum. Such a continuum can be constructed using only standard Hilbert space entities. In this approach, the geometry of atoms and subatomic objects differs from that of classical objects. The systems that are non-local when measured in the classical space-time continuum may be localized in the quantum continuum. We compare trajectories in this new description of space-time with (...) the corresponding Bohmian picture. (shrink)

This article considers the experiences of health consumers who have undergone testing for human immunodeficiency virus antibodies, T cells, and viral load. These HIV-related tests are deployed for the purposes of making definitive diagnoses; yet some test consumers experience ambiguous outcomes. Drawing on an analysis of differing end-user experiences of these tests, where consumers' knowledge reflected the multiplicity and heterogeneity in test design, the author explores how these experiences reflect particular knowledges about these tests. The article contributes to efforts analyzing (...) how health consumers are active end users co-constructing the social meaning of technologies in mutual relationship with other users. The author discusses how this new knowledge can be used to delineate a greater role for consumer evaluation of medical testing within a broader understanding of test design and performance. Relevant links are made to issues such as genetic testing and assessing claims about the efficacy of medical tests. (shrink)

Bibliographical references included in "Notes on part 1" (p. [223]).

A defective word is defined by paradigm as incomplete compared with the major class it belongs to. Defectiveness signifies the unwanted intrusion of morphological idiosyncrasy into syntax. Although this phenomenon has been a constant subject of studies, it has been ill incorporated into the theories of language. This present volume brings together scholars from various theoretical schools for an overdue typological view of defectiveness. It concentrates on some samples of idiosyncratic gaps which are assumed as indicative of the phenomenon of (...) defectiveness. Before delving into the specified topics of each chapter, this introductory chapter presents a typology of defective paradigms. It discusses terms used to describe defectiveness in synchronotic terms, and the possible diachrony of defective paradigms. (shrink)