Background Metaphors are central to the human understanding of complex issues; through the immediate associations they evoke and frame problems and suggest solutions. Our suggestion of Music in the Park as a metaphor for health systems reform brings to the forefront the environmentally diverse but bounded spaces of health services that offer a variety of attractors within their confines, while pushing into the background organizational and economic concerns.Reflections Parks, like health services, are embedded in their local landscape, serving their communities, (...) but most importantly parks are public spaces, publically funded, ideally offering universal access and equity and to be shared by all who want to go there.Music, like health, is tangible, technical and scientific, yet ultimately experiential and based on meaning. While it encompasses a wide range of styles and approaches, music making requires as its most important skill active listening which brings with it to be ‘in the moment’, to take personal risks and to draw energy and inspiration from the participants. Hence ‘audiences’ are equally active participants because music only has meaning if it internally resonates with the listener and only can exist in what is a co-constructed experience.Conclusions Music in the Park is a metaphor for primary health care systems based on shared values of experts and unique local communities. Health professionals are players in this arena, who develop and practise the full range of their skills in response to individual and community needs and preferences. Their leadership works through inspiration and empowerment, making patients ‘co-producers’ of their own health and ‘co-shapers’ of their health services. (shrink)

In this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions. Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct (...) achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains – the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains. Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context. Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context-driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning. (shrink)

We are never illness or disease, but, rather, always their sum in the world of day-to-day experience. Disease and illness are not closed systems, but mutually constitutive and continuously interacting worlds. In the patient’s case it is always experience as well. Pain, sickness and death help make that particular experienced identity unavoidable, and at some level ultimately inaccessible to medicine’s changing understanding of disease and tools for managing it. Health—rather than cost containment, specific conditions, or technologies—should be the central focus (...) for health care and health-care reform. A compelling reason to focus on health comes from the observation that the prevalence of disease over the .. (shrink)

BACKGROUND AND RATIONALE: Evidence based medicine is the present backbone of rational and objective, modern medical problem solving and is a meeting ground for quantitative and qualitative researchers alike as it culminates into applying the fruits of clinical research to the individual patient. A systematic enquiry into the evolving paradigms in EBM is a need of the hour. AIMS AND METHODS: A qualitative enquiry examining the impact of different methodologies in EBM and their role in generating meaning interpretable at individual (...) levels. RESULTS: Present day outcome based research deals less with patients as individuals than as populations. Evidence based medicine struggles to apply the fruits of population based research to individuals who are often not as predictable as linear quantitative research would like them to be. The present EBM literature neglects a lot of events it doesn't believe to be statistically significant and perhaps here is an area that needs to be improved on - it assumes that because associations are demonstrated between interventions and outcomes in RCTs/meta-analysis, these associations are linear and causal in the real world. While they may be demonstrated repeatedly in highly controlled environments, in the real 'uncontrolled' world of clinical practice with real people, their validity breaks down. CONCLUSIONS: One needs to make the EBM standard model patient-individual (a projection of collective patient event data) resemble the real human individual patient so that optimal EBM individual data that matches our query can be easily and quickly spotted from the dense jungle of information that has grown over the years. This hints at rethinking our entire research methodology and modifying it to suit the needs of the individual patient. (shrink)

We introduce and study a natural extension of Marcus external contextual grammars. This mathematically simple mechanism which generates a proper subclass of simple matrix languages, known to be mildly context-sensitive ones, is still mildly context-sensitive. Furthermore, we get an infinite hierarchy of mildly context-sensitive families of languages. Then we attempt to fill a gap regarding the linguistic relevance of these mechanisms which consists in defining a tree structure on the strings generated by many-dimensional external contextual grammars, and investigate some related (...) issues. Several open problems are finally discussed. (shrink)

Dispositions are essential to our understanding of the world. Dispositions: A Debate is an extended dialogue between three distinguished philosophers - D.M. Armstrong, C.B. Martin and U.T. Place - on the many problems associated with dispositions, which reveals their own distinctive accounts of the nature of dispositions. These are then linked to other issues such as the nature of mind, matter, universals, existence, laws of nature and causation.

In all cultures, ethnomedical practices are largely the same for animals and people, whether in mode of administration of materia medica, in the materials themselves, or in surgical, mechanical, behavioral, medico-religious, and other realms. Below, parallels between veterinary and human ethnomedical techniques are outlined. Taken together, they suggest that a number of benefits could be gained by closer collaboration between veterinary and human medicine in the delivery of basic healthcare information and services.

Theoretical arguments regarding the effect of corporate social responsibility (CSR) on firm liability risk are abundant; however, empirical evidence about this relationship is scarce. We investigate the relationship between CSR and the personal liability risk of a firm’s directors and officers. We argue that companies with better CSR performance represent a better underwriting risk for directors’ and officers’ (D&O) insurance providers and, therefore, have a lower cost of insurance. Our results show that firms with better CSR performance are more likely (...) to purchase D&O insurance and have a lower premium-to-coverage ratio, known as the insurance rate-on-line. We also show that this risk-reduction effect is stronger for firms that operate in a high-risk environment and have higher sales growth. These results provide evidence that CSR can be used as a risk management tool to mitigate liability risk and suggest which firms benefit most from this effect. (shrink)

'Norito, traducción y análisis de las plegarias sintoístas japonesas' contempla el estudio de las oraciones que tan bien representan el espíritu del shinto, 'el Camino del kami', la religión propia del país del Sol Naciente; mediante una traducción detallada de cuatro de ellas. De esta manera, se pueden leer con facilidad al mismo tiempo que sirven como vehículo para comenzar a entender la espiritualidad japonesa. Los norito son piezas asombrosas de la literatura japonesa, pensadas para ser recitadas y cantadas en (...) honor a la divinidad a la que van dirigidas, muchas veces incluso en nombre del Emperador durante las grandes festividades, de manera que lleguen tanto al corazón del oferenciante como al del kami. Ello supondrá todo tipo de bendiciones para el pueblo japonés, 'los hijos de la Gran Deidad' y que a la vez permite, sin duda, que se dé una relación de tan íntima convivencia con la Naturaleza del archipiélago nipón. (shrink)

A fundamental aspect of human beings is that they learn. The process of learning and what is learned are impacted by a number of factors, both cognitive and social; that is, humans are boundedly rational. Cognitive and social limitations interact, making it difficult to reason about how to provide information to impact what humans know, believe, and do. Herein, we use a multi‐agent dynamic‐network simulation system, Construct, to conduct such reasoning. In particular, we ask, What media should be used to (...) provide information to most impact what people know, believe, and do, given diverse social structures? All simulated agents are boundedly rational both at the cognitive and social level, and so are subject to factors such as literacy, education, and the breadth of their social network. We find that there is no one most effective intervention; rather, to be effective, messages and the media used to spread the message need to be selected for the population being addressed. Typically, a multimedia campaign is critical. (shrink)

This brief text assists students in understanding Ockham's philosophy and thinking so they can more fully engage in useful, intelligent class dialogue and improve their understanding of course content. Part of the Wadsworth Notes Series, (which will eventually consist of approximately 100 titles, each focusing on a single "thinker" from ancient times to the present), ON OCKHAM is written by a philosopher deeply versed in the philosophy of this key thinker. Like other books in the series, this concise book offers (...) sufficient insight into the thinking of a notable philosopher, better enabling students to engage in reading and to discuss the material in class and on paper. (shrink)

Throughout their history, symbolic interactionism and critical perspective have been viewed as divergent theoretical perspectives with different philosophical underpinnings. A review of their historical and philosophical origins reveals both points of divergence and areas of convergence. Their underlying philosophies of science and views of human freedom are different as is their level of focus with symbolic interactionism having a micro perspective and critical perspective using a macro perspective. This micro/macro difference is reflected in the divergence of their major concepts, goals (...) and basic tenets. While their underlying philosophies are different, however, they are not necessarily contradictory and areas of convergence may include the concepts of reference groups and looking glass self within symbolic interactionism and ideological hegemony within critical perspective. By using a pragmatic approach and combining symbolic interactionism and critical perspectives, both micro and macro levels come into focus and strategies for change across individual and societal levels can be developed and applied. Application of both symbolic interactionism and critical perspective to nursing research and scholarship offers exciting new opportunities for theory development and research methodologies. In nursing education, these two perspectives can give students added insight into patients' and families' problems at the micro level while, at the same time, giving them a lens to see and tools to apply to problems at the macro level in health care. In nursing practice, a combined symbolic interactionism/critical perspective approach assists nurses to give high-quality care at the individual level while also working at the macro level to address the manufacturers of illness. New research questions emerge from this combination of perspectives with new possibilities for theory development, a transformation in nursing education, and the potential for new practice strategies that can address individual client and larger system problems through empowerment of clients and nurses. (shrink)

A long-standing theme in discussion of perception and thought has been that our primary cognitive contact with individual objects and events in the world derives from our perceptual contact with them. When I look at a duck in front of me, I am not merely presented with the fact that there is at least one duck in the area, rather I seem to be presented withthisthing (as one might put it from my perspective) in front of me, which looks to (...) me to be a duck. Furthermore, such a perception would seem to put me in a position not merely to make the existential judgment that there is some duck or other present, but rather to make a singular, demonstrative judgment, that that is a duck. My grounds for an existential judgment in this case derives from my apprehension of the demonstrative thought and not vice versa. (shrink)

What exactly is hope and how does it influence our decisions? In How We Hope, Adrienne Martin presents a novel account of hope, the motivational resources it presupposes, and its function in our practical lives. She contends that hoping for an outcome means treating certain feelings, plans, and imaginings as justified, and that hope thereby involves sophisticated reflective and conceptual capacities. Martin develops this original perspective on hope--what she calls the "incorporation analysis"--in contrast to the two dominant philosophical (...) conceptions of hope: the orthodox definition, where hoping for an outcome is simply desiring it while thinking it possible, and agent-centered views, where hoping for an outcome is setting oneself to pursue it. In exploring how hope influences our decisions, she establishes that it is not always a positive motivational force and can render us complacent. She also examines the relationship between hope and faith, both religious and secular, and identifies a previously unnoted form of hope: normative or interpersonal hope. When we place normative hope in people, we relate to them as responsible agents and aspire for them to overcome challenges arising from situation or character. Demonstrating that hope merits rigorous philosophical investigation, both in its own right and in virtue of what it reveals about the nature of human emotion and motivation, How We Hope offers an original, sustained look at a largely neglected topic in philosophy. (shrink)

Richard Martin's thoroughly philosophical as well as thoroughly tech nical investigations deserve continued and appreciative study. His sympathy and good cheer do not obscure his rigorous standard, nor do his contemporary sophistication and intellectual independence obscure his critical congeniality toward classical and medieval philosophers. So he deals with old and new; his papers, in his neat self-descriptions, consist of reminders, criticisms, and constructions. They might also be seen as studies in the understanding of truth, ramifying as widely in mathematics, (...) logic, and epistemology as well as metaphysics, as such understanding has required. For us it is a pleasant occasion to welcome Richard Martin's new Boston Studies, and to note his continuously con collection to the structive and critical interventions at the Boston Colloquium for the of Science. Philosophy Boston University Center for the R. S. COHEN Philosophy and History of Science M. W. WARTOFSKY July 1979 vii TABLE OF CONTENTS EDITORIAL PREFACE vii PREFACE xi ACKNOWLEDGEMENTS xv I. Truth and Its Illicit Surrogates II. Some Reminders concerning Truth, Satisfaction, and Reference 17 III. On Disquotation and Intensionality 30 IV. On Truth, Belief, and Modes of Description 42 V. The Pragmatics of Self-Reference 55 VI. On Suppositio and Denotation 72 VII. Of Time and the Null Individual 82 VIII. Existence and Logical Form 95 IX. Tense, Aspect, and Modality 110 X. Of 'Of' 130 XI. Events and Actions: Brand and Kim 144 XII. Why I Am Not a Montague Grammarian 160 XIII. (shrink)

Hegel's very first acknowledged publication was, among other things, an attack on Fichte. In 1801, Hegel was still laboring in almost complete obscurity, while Fichte was an international sensation, though already somewhat past the peak of his meteoric career. In the 1801 Differenzschrift, Hegel cut his teeth by criticizing Fichte's already widelycriticised Wissenschaftslehre, and by demonstrating that Schelling's philosophical system was not simply to be equated with it. Fichte himself never bothered to respond to Hegel's criticisms; indeed he never publicly (...) acknowledged their existence. This was not because he was unconcerned with criticisms of his views; quite the contrary. But at the time he had bigger fish to fry. He responded to Jacobi's criticisms, and to Schelling's; he replied in great detail to critical questions raised by Reinhold, and with vituperative intensity to objections raised by skeptics and purportedly loyal Kantians. But Hegel's Differenzschrift was left without a Fichtean rebuttal. This is a pity, both because of the missed opportunity to illuminate by controversy central issues at stake in the post-Kantian period, but also because it made it easier for Hegel simply to reiterate his youthful criticism as if it were the last word. And reiterate it he did: in one form or another Hegel's early criticisms of Fichte reappear at every subsequent stage of his career: in the Phenomenology, in the Science of Logic, in the Encyclopaedia, as the final chapter in Hegel's History of Philosophy, and in countless other minor works and documents from the Nachlass and correspondence. (shrink)

The origin and early evolution of animals marks an important event in life's history. This event is historically associated with an important variable in Earth history – oxygen. One view has it that an increase in oceanic oxygen levels at the end of the Neoproterozoic Era (roughly 600 million years ago) allowed animals to become large and leave fossils. How important was oxygen for the process of early animal evolution? New data show that some modern sponges can survive for several (...) weeks at low oxygen levels. Many groups of animals have mechanisms to cope with low oxygen or anoxia, and very often, mitochondria – organelles usually associated with oxygen – are involved in anaerobic energy metabolism in animals. It is a good time to refresh our memory about the anaerobic capacities of mitochondria in modern animals and how that might relate to the ecology of early metazoans. (shrink)