Rationing health care is not new. As governments world wide struggle to contain the costs of health care, health policy analysts debate how rationing should be done. However, they too often neglect how the mechanisms for funding and allocating health care resources are themselves vehicles for rationing treatment. In the UK, where health care rationing debates currently abound, there has been no formal evaluation of the role of the market in allocating scarce health care resources.The market in health care has (...) increased administration, fragmented services, eroded local accountability, and decreased choice.This fragmentation, and the associated competition between purchasers and providers, means that resource allocation can no longer be monitored and evaluated in a national context. The loss of a population focus has left a vacuum in planning. Services cannot be planned rationally, and so are not able consistently to avoid duplication or to respond cogently to estimates of need.The loss of accountability means that decisions about the allocation of health care resources are no longer open to scrutiny by local people. Increasingly, especially in social and long term care the cost of care is being transferred to the individual. The new mechanisms for resource allocation are distributing resources unfairly: away from the poor, the sick and the elderly.The great myth of the market is that it has enabled decision-making to become explicit. This is not the case. To make health care resource allocation appear rational and acceptable to the public, health authorities have resorted to exercises in consumer consultation, and value laden guidelines where clinical cloaks are used to disguise political decisions on funding. In the UK, until the true role of the internal market is acknowledged, myths and subterfuge will conceal the winners and losers in the new system of rationing health care. (shrink)

Diauxie is at the origin of research that led Jacques Monod, François Jacob, and André Lwoff to win the Nobel Prize in Physiology or Medicine in 1965 for their description of the first genetic regulatory model. Diauxie is a term coined by Jacques Monod in 1941 in his doctoral dissertation that refers to microbial growth in two phases. In this article, we first examine Monod’s thesis to demonstrate how and why Monod interpreted diauxie as a phenomenon of enzyme inhibition or (...) suppression of adaptive enzymes. We also briefly investigate prior enzyme suppression studies, before Monod’s work, which indicate that he is the first person to observe diauxic growth. Second, we analyse Monod’s post-thesis publications throughout his scientific career, revealing that diauxic inhibition was a significant part of Monod’s scientific activities and greatly fascinated Monod until the end of his life. Paradoxically, Monod’s work and interest on diauxic inhibition are still neglected in historical recounts, focused mostly on Monod’s enzymatic adaptation studies. Indeed, we uncovered a statement by Monod’s colleague, Lwoff, who transformed a quotation from Monod by replacing the word phenomenon with enzymatic adaptation, which we believe has influenced historians. Finally, we offer hypotheses to explain why Lwoff altered Monod’s statement. (shrink)

The use of law enforcement officers in American schools has rapidly expanded since its inception in the 1950s. This growth can in part be attributed to the Safe Schools Act of 1994, the establishment of the Community Oriented Policing Services Office, and tragic events that have occurred in our nation's schools. Law enforcement officers in the school environment traditionally have primary roles of protection and enforcement, although many have ancillary roles of educating and mentoring students. However, the use of police (...) in schools has also been associated with the formalization of student discipline and the criminalization of minor misconduct. Specifically, an increase in the number of officers in schools has mirrored an increase in the number of arrests and citations for relatively minor offenses. We argue that officers' socialization and training create role conflict in that the duty to enforce the law competes with other duties to mentor and nurture students. We present several hypothetical dilemmas and then illustrate how the “right thing to do” is determined by the perceived duties of the school safety officer. We conclude by presenting some modest suggestions on how to address the potential role conflict experienced by law enforcement officers working in schools. (shrink)

The idea that the mass m of an elementary particle is explained in the semi-classical approximation by quantum-mechanical zero-point vacuum fluctuations has been applied previously to spin-1/2 fermions to yield a real and positive constant value for m, expressed through the spinorial connection Γ i in the curved-space Dirac equation for the wave function ψ due to Fock. This conjecture is extended here to bosonic particles of spin 0 and spin 1, starting from the basic assumption that all fundamental fields (...) must be conformally invariant. As a result, in curved space-time there is an effective scalar mass-squared term $m_{0}^{2}=-R/6=2\varLambda_{\mathrm{b}}/3$ , where R is the Ricci scalar and Λ b is the cosmological constant, corresponding to the bosonic zero-point energy-density, which is positive, implying a real and positive constant value for m 0, through the positive-energy theorem. The Maxwell Lagrangian density $\mathcal{L} =- \sqrt{-g}F_{ij}F^{ij}/4$ for the Abelian vector field F ij ≡A j,i −A i,j is conformally invariant without modification, however, and the equation of motion for the four-vector potential A i contains no mass-like term in curved space. Therefore, according to our hypothesis, the free photon field A i must be massless, in agreement with both terrestrial experiment and the notion of gauge invariance. (shrink)

Does economic globalization create a “race to the bottom” or a “race to the top” in labor rights practices? Despite significant research on the possible impact of economic globalization on labor conditions, little consensus exists as to whether and what forms of economic openness might help or undermine labor rights. In this study, we illustrate the significance of considering the two distinct processes of de facto and de jure globalization. We argue that whereas de facto globalization in the form of (...) trade and financial transactions is likely to result in worse labor rights practices, de jure globalization that entails regulations to facilitate these transactions is likely to have a positive effect on labor conditions. Combining time-series, cross-national data on labor rights with data on economic globalization, we find significant evidence of the divergent effects of de facto and de jure globalization on labor rights practices. Results also indicate that the labor rights effects of de facto and de jure globalization are stronger for trade than financial globalization. We further show that the effects of economic globalization apply to both collective and substantive labor rights practices. (shrink)

The Schrödinger equation for a particle of rest mass $m$ and electrical charge $ne$ interacting with a four-vector potential $A_i$ can be derived as the non-relativistic limit of the Klein–Gordon equation $\left( \Box '+m^2\right) \varPsi =0$ for the wave function $\varPsi $ , where $\Box '=\eta ^{jk}\partial '_j\partial '_k$ and $\partial '_j=\partial _j -\mathrm {i}n e A_j$ , or equivalently from the one-dimensional action $S_1=-\int m ds +\int neA_i dx^i$ for the corresponding point particle in the semi-classical approximation $\varPsi \sim (...) \exp {(\mathrm {i}S_1)}$ , both methods yielding the equation $\mathrm {i}\partial _0\varPsi \approx \left( \frac{1}{2m}\eta ^{\alpha \beta }\partial '_{\alpha }\partial '_{\beta } + m + n e\phi \right) \varPsi $ in Minkowski space–time , where $\alpha ,\beta =1,2,3$ and $\phi =-A_0$ . We show that these two methods generally yield equations that differ in a curved background space–time $g_{ij}$ , although they coincide when $g_{0\alpha }=0$ if $m$ is replaced by the effective mass $\mathcal{M}\equiv \sqrt{m^2-\xi R}$ in both the Klein–Gordon action $S$ and $S_1$ , allowing for non-minimal coupling to the gravitational field, where $R$ is the Ricci scalar and $\xi $ is a constant. In this case $\mathrm {i}\partial _0\varPsi \approx \left( \frac{1}{2\mathcal{M}'} g^{\alpha \beta }\partial '_{\alpha }\partial '_{\beta } + \mathcal{M}\phi ^{(\mathrm g)} + n e\phi \right) \varPsi $ , where $\phi ^{(\mathrm g)} =\sqrt{g_{00}}$ and $\mathcal{M}'=\mathcal{M}/\phi ^{(\mathrm g)} $ , the correctness of the gravitational contribution to the potential having been verified to linear order $m\phi ^{(\mathrm g)} $ in the thermal-neutron beam interferometry experiment due to Colella et al. Setting $n=2$ and regarding $\varPsi $ as the quasi-particle wave function, or order parameter, we obtain the generalization of the fundamental macroscopic Ginzburg-Landau equation of superconductivity to curved space–time. Conservation of probability and electrical current requires both electromagnetic gauge and space–time coordinate conditions to be imposed, which exemplifies the gravito-electromagnetic analogy, particularly in the stationary case, when div ${{\varvec{A}}}=\hbox {div}{{\varvec{A}}}^{(\mathrm g)}=0$ , where ${{\varvec{A}}}^{\alpha }=-A^{\alpha }$ and ${{\varvec{A}}}^{(\mathrm g)\alpha }=-\phi ^{(\mathrm g)}g^{0\alpha }$ . The quantum-cosmological Schrödinger (Wheeler–DeWitt) equation is also discussed in the $\mathcal{D}$ -dimensional mini-superspace idealization, with particular regard to the vacuum potential $\mathcal V$ and the characteristics of the ground state, assuming a gravitational Lagrangian $L_\mathcal{D}$ which contains higher-derivative terms up to order $\mathcal{R}^4$ . For the heterotic superstring theory , $L_\mathcal{D}$ consists of an infinite series in $\alpha '\mathcal{R}$ , where $\alpha '$ is the Regge slope parameter, and in the perturbative approximation $\alpha '|\mathcal{R}| \ll 1$ , $\mathcal V$ is positive semi-definite for $\mathcal{D} \ge 4$ . The maximally symmetric ground state satisfying the field equations is Minkowski space for $3\le {\mathcal {D}}\le 7$ and anti-de Sitter space for $8 \le \mathcal {D} \le 10$. (shrink)

In a previous paper by Pollock and Singh, it was proven that the total entropy of de Sitter space-time is equal to zero in the spatially flat case K=0. This result derives from the fundamental property of classical thermodynamics that temperature and volume are not necessarily independent variables in curved space-time, and can be shown to hold for all three spatial curvatures K=0,±1. Here, we extend this approach to Schwarzschild space-time, by constructing a non-vacuum interior space with line element (...) ds 2=e2λ(r) dt 2−e−2λ(r) dr 2−r 2(dθ 2+sin2 θdϕ 2), where $\mathrm{e}^{2{\lambda }(r)}=-\frac{1}{2}(1-\frac{r^{2}}{R_{0}^{2}})$ , which matches onto the vacuum exterior Schwarzschild metric in such a way that e2λ and d(e2λ )/dr are both continuous at the Schwarzschild radius R 0=2M. Then we show that the volume entropy is equal to A/4, where $A\equiv 4\pi R_{0}^{2}$ is the area of the apparent horizon, as found by Hawking. (shrink)

The magnetic dipole moment of the Kerr–Newman metric, defined by mass \, electrical charge \ and angular momentum \, is \, corresponding, for all values of \, to a gyromagnetic ratio \, which is also the value of the intrinsic gyromagnetic ratio of the electron, as first noted by Carter. Here, we argue that this result can be understood in terms of the particle-wave complementarity principle. For \ can only be defined at asymptotic spatial infinity, where the metric appears to (...) describe a spinning point particle, and therefore setting \, \, we necessarily have a model of the electron. From the Dirac equation we can construct a covariantly conserved four-current \ that is the source of the electromagnetic field generated by the charge \. The result \ then follows from the minimal gauge principle \ which is implicit in the formulation of the spinorial wave equation, and which can also be justified from the line action for a spin-1/2 point particle interacting with an external electromagnetic field, due to Berezin and Marinov. By contrast, analysis of the gyrogravito-magnetic effect, investigated classically by Wald and quantum mechanically by Adler et al., yields the result \ in all non-relativistic cases, which can be explained from the principle of equivalence. The results are in accord with the correspondence principle. (shrink)

Background This article describes the issues encountered when designing a study to evaluate recruitment of minority ethnic groups into clinical cancer research in order to monitor adherence to the principles for good practice set out in the Department of Health, Research Governance Framework, England. Methods (i) A review of routine data sources to determine whether their usefulness as a source of data on prevalence of cancer in the population by ethnic category. (ii) A local case study at one hospital trust (...) to ascertain whether the ethnicity of cancer trial participants was representative of admitted cancer patients. Results (i) The lack of a comparator population makes it problematic to assess recruitment levels by ethnic group in clinical research. (ii) The odds of being in a trial were 30% lower for a member of a minority ethnic group compared to a white cancer patient after adjusting for disease, age and gender, OR 0.70 (0.53 to 0.94). These results differed for each ethnic group; Asian patients did not appear under-represented while Black and Chinese did so. However, there are important caveats to the findings based on the limited recording of ethnicity. Conclusions The lack of available data on the ethnicity of participants in clinical research and the prevalence of cancer in the population according to ethnicity makes it difficult to design a study to monitor representation of minority ethnic groups. This information is necessary to assess adherence to the Research Governance Framework principle that research evidence reflects the diversity of the population. (shrink)

This paper is devoted to theoretical and methodical considerations on our study and understanding of macroscopic transitions in the world of Sanskrit intellectuals from the sixteenth to the eighteenth century (cf. Pollock, Indian Economic and Social History Review 38(1):3–31, 2001). It is argued that compared to his immediate predecessors Bhaṭṭoji Dīkṣita’s contribution to Prakriyā grammars was modest. It was to a large extent on account of changed circumstances—over the centuries mainly a slow but steady decline—in the position of Sanskrit (...) and the general public’s need for a simple definition of authoritatively correct Sanskrit that Bhaṭṭoji’s grammar met with success so quickly, so widely, and so solidly. I once knew a little boy in England who asked his father, “Do fathers always know more than sons?” and the father said “Yes.” The next question was, “Daddy, who invented the steam engine?” and the father said “James Watt.” And then the son came back with “But why didn’t James Watt’s father invent it?” Gregory Bateson (1972, p. 21). (shrink)

In virtually all the developed countries of the Western world, people are living longer and reproducing less. At the same time, costs for the care of the elderly and infirm continue to rise dramatically. Given these facts, it should come as no surprise that we are experi encing an ever-increasing concern with questions relating to the proper care and treatment of the aged. What responsibilities do soci eties have to their aging citizens? What duties, if any, do grown chil dren (...) owe their parents? What markers should we use to determine one's status as "elderly"? Does treatment of pain in aged patients present special medical and/or moral problems? How can the com peting claims of autonomy and optimal medical care be reconciled for elderly persons who require assisted living? When, if ever, should severely demented patients be included in nontherapeutic clinical tri als? These questions, and others of similar interest to those con cerned with the proper treatment of the aged, are discussed in depth in the articles included in this text. The essays in this volume of Biomedical Ethics Reviews fall loosely into two broad categories. The first four articles-those con tributed by Sheila M. Neysmith, Allyson Robichaud, Jennifer Jackson, and Susan McCarthy-raise general questions concerning the propri ety of Western society'S current mechanisms for dealing with and treat ing elderly citizens. The remaining four articles-those by Simon Woods and Max Elstein, Marshall B. (shrink)

Lewis' argument against the Limit Assumption and Pollock's Generalized Consequence Principle together suggest that "minimal-change" theories of counterfactuals are wrong. The "small-change" theories presented by Nute do not say enough. While these theories rely on closeness between possible worlds, I base an alternative on the ceteris paribus concept. My theory solves a problem that the above cannot, and is more relevant to the philosophy of science. Ceteris paribus conditions should normally include the causes, but exclude the effects, of the (...) negated antecedent. An example from community ecology, the debate over null models in island-biogeographical studies of competition, supports these arguments. (shrink)

Lewis' argument against the Limit Assumption and Pollock's Generalized Consequence Principle together suggest that "minimal-change" theories of counterfactuals are wrong. The "small-change" theories presented by Nute do not say enough. While these theories rely on closeness between possible worlds, I base an alternative on the ceteris paribus concept. My theory solves a problem that the above cannot, and is more relevant to the philosophy of science. Ceteris paribus conditions should normally include the causes, but exclude the effects, of the (...) negated antecedent. An example from community ecology, the debate over null models in island-biogeographical studies of competition, supports these arguments. (shrink)

The availability of willing providers of medical assistance in dying in Canada has been an issue since a Canadian Supreme Court decision and the subsequent passing of federal legislation, Bill C14, decriminalised MAiD in 2016. Following this legislation, Hamilton Health Sciences in Ontario, Canada, created a team to support access to MAiD for patients. This research used a qualitative, mixed methods approach to data collection, obtaining the narratives of providers and supporters of MAiD practice at HHS. This study occurred at (...) the outset of MAiD practice in 2016, and 1 year later, once MAiD practice was established. Our study reveals that professional identity and values, personal identity and values, experience with death and dying, and organisation context are the most significant contributors to conscientious participation for MAiD providers and supporters. The stories of study participants were used to create a model that provides a framework for values clarification around MAiD practice, and can be used to explore beliefs and reasoning around participation in MAiD across the moral spectrum. This research addresses a significant gap in the literature by advancing our understanding of factors that influence participation in taboo clinical practices. It may be applied practically to help promote reflective practice regarding complex and controversial areas of medicine, to improve interprofessional engagement in MAiD practice and promote the conditions necessary to support moral diversity in our institutions. (shrink)

In debates about the proper analysis of demonstrative expressions, ostensive gestures and speaker intentions are often seen as competing for primary importance in securing reference. Underlying some of these debates is the mistaken assumption that ostensive gestures always make the demonstrated object maximally salient to interlocutors. When we abandon this assumption and focus on an object’s mutually-recognized salience itself, rather than on how the object came to be salient, we can work towards a more promising analysis with a uniform treatment (...) of demonstrative reference whether or not there is an ostensive gesture, and whether reference is ordinary or deferred. (shrink)

Fashion design is a feminized occupation, but there is a widespread perception that gay male designers are advantaged in receiving awards, publicity, and praise. This article develops the notion of a “glass runway” to explain this inequality. First, using design canons and lists of award recipients, I show that men, especially gay men, receive more consecration than women. Second, I show how men and women are consecrated differently by analyzing the content of 157 entries in Voguepedia’s design canon and 96 (...) fashion media articles. Attributions of value and legitimacy construct a gendered image of the ideal fashion designer through discourses of art and culture that reinforce essentialist ideas about gender difference. Because cultural value is ambiguous, processes of valorization are shaped by gender essentialism, pushing male cultural producers down the glass runway and into the spotlight of fame, consecration, and legitimation. Finally, the case of fashion design offers insights into how intersecting inequalities can shape the glass runway. Gay designers experience both valorization and discrimination from intersections of gender and sexuality. (shrink)

Within the class of indexicals, a distinction is often made between “pure” or “automatic” indexicals on one hand, and demonstratives or “discretionary” indexicals on the other. The idea is supposed to be that certain indexicals refer automatically and invariably to a particular feature of the utterance context: ‘I’ refers to the speaker, ‘now’ to the time of utterance, ‘here’ to the place of utterance, etc. Against this view, I present cases where reference shifts from the speaker, time, or place of (...) utterance to some other object, time, or place. I consider and reject the claim that these counterexamples to the automatic indexical theory all involve non-literal uses of indexicals and argue that they cannot be explained away on the grounds that they involve conversational implicature or pretense. (shrink)

There is an expectation that all researchers will act ethically and responsibly in the conduct of research involving humans and animals. While research ethics is mentioned in quality indicators and codes of responsible researcher conduct, it appears to have little profile in doctoral assessment. There seems to be an implicit assumption that ethical competence has been achieved by the end of doctoral candidacy and that there is no need for candidates to report on the ethical dimensions of their study nor (...) for examiners to assess this integral aspect of researcher development. In the context of ensuring that institutions are fulfilling their responsibility of producing ethically sensitive and competent researchers, it is salient to investigate whether doctoral thesis examiners make comment about ethical issues in their reports. This study analysed an archive of examiner reports to identify the frequency, magnitude and nature of examiner comment about ethics. Although comment was rare examiners provided: prescriptive instruction on ethical review processes; formative instruction on the design, conduct, and reporting of research projects; and positive or negative judgments about a candidate's ethical competence, the latter often aligned with meeting, or not meeting, 'doctoral standards'. The scarcity of ethics in examination criteria and examiner reports implies a silence that needs to be addressed to ensure graduating candidates are prepared to conduct ethical and responsible research. (shrink)

Princeton University Press, 984. This book is out of print, but can be downloaded as a pdf file (3.9 MB).

This essay examines the symbolic significance of blood in the twentieth century and its role in determining the composition of a national community along racial lines. By drawing parallels between Nazi notions of blood and racial purity and historically contemporaneous U.S. policies regarding blood and blood products, Polsky reveals a disturbing proximity in discourse and policy. While the Nazis attempted to locate Jewish racial essence and inferiority in blood and instituted eugenic measures and laws forbidding racial admixture, similar policies existed (...) in the U.S. based on the so-called one drop rule that systematically discriminated against African Americans. (shrink)

Denunciations of child sexual abuse in the sport context have been increasing in the last decades. Studies estimate that between 14 and 29% of athletes have been victim of at least one form of sexual violence in sport before the age of 18. However, studies suggest that many do not disclose their experience of CSA during childhood. This finding is alarming since studies have shown that the healing process usually starts with disclosure. Moreover, little is known about the healing process (...) of CSA experienced in the sport context. The aim of the study is to present a single case study of a CSA in sport to better understand the global experience over time from the perspective of the athlete. A narrative inquiry approach was adopted. Three non-structured interviews were conducted with the participant. Three pathways in the survivor journey have been identified through inductive thematic analysis: pathway to understanding, pathway to disclosure, and pathway to healing. These pathways represent distinct processes but are intertwined as they are dynamic and iterative. Indeed, the survivor explained how she had been, and is still, going back and forth between them. Results are consistent with those found in the literature on CSA in the general population. It suggests that theoretical models of CSA in the general population could be applied to CSA in sport. Practical implications include a need for education and clearer boundaries in the coach-athlete relationship. Sport stakeholders also need to be better equipped to recognize the signs of sexual violence in sport. Our results indicate that qualitative research could be a potential avenue to help victims heal from CSA. It gives them the chance to talk about and make sense of their abuse in a safe space. Finally, our results demonstrate the importance of reviewing the current justice system for victims. It should be based on a trauma-informed approach that places the victim at the center of the judicial process. (shrink)

Empathy is widely touted as a springboard for social change. Within the academy, ‘identification’ is often used to promote the social value of literary and cultural studies. But to what degree have scholars, in seeking to defend the value of literary and cultural studies, conceived the act of reading in problematic ways? ‘An Ethics of Reading’ argues that adopting a Lacanian paradigm of self (reader) and text (other) to discuss the act of textual interpretation reduces a complex event involving multiple (...) actors to a simple dualism, while ineluctably consigning any act of interpretation to simple projection. Turning instead to psychoanalyst Jean Laplanche’s concept of the enigmatic signifier, this article rethinks the relation between reader and cultural text – reconceiving the act of interpretation by situating it within a dynamic of transference, as opposed to projection. When conceived via this Laplanchian framework, reading becomes not only an effective path to cognition and knowledge, but a radical means of subjective transformation. (shrink)

Core indexicals like ‘I’, ‘here’, and ‘now’ sometimes appear to refer to an object, place, or time other than the speaker, location, or time of utterance. This presents well-known problems for Kaplan's view, which treats reference shifting as a violation of the character rules that give the meaning of indexicals. I propose a view according to which indexical reference is essentially a matter of the mutually-accepted perspective of interlocutors. It follows that contexts need not be ‘proper’ in Kaplan's sense, and (...) a successful convergence of perspectives is needed for indexical reference to succeed. I provide reasons for embracing these conclusions. (shrink)

Princeton University Press, 1982. This book is out of print, but can be downloaded as a pdf file (5 MB).