When clinical services aspire to quality improvement, creative and innovative approaches to old problems are needed to drive such change. Whilst new ef orts should be applauded, information on this topic can be somewhat grey from an ethical and research point of view. Within the mental health profession there is currently an expectation to routinely evaluate care and disseminate i ndings. The notion of service enhancements under the guise of routine practice is an interesting and untested ethical issue. Should clinical (...) innovation continue to enjoy such impunity as patient autonomy is often compromised as they are often compelled to accept treatment under the coercion of mental health legislation? We believe that it should not. All involvement in any form of research is voluntary, thus patients should also have the right to decline participation in quality projects if they wish to do so. (shrink)

In acute inpatient mental health services, patients commonly demonstrate extreme behaviours. A number of coercive practices, such as locked doors, enforced medication and seclusion, are used in these settings to control such behaviours. The aim of this report is to explore briefly some of the contemporary debates pertaining to seclusion. A perusal of the literature reveals a clarion call to end the practice of seclusion, without consideration of feasible alternatives. It is hoped that this brief report will encourage further evidence-based (...) discussion and research initiatives on this important ethical topic. (shrink)

Locked inpatient units are an increasing phenomenon, introduced in response to unforseen abscondences and suicides of patients. This paper identifies some value issues concerning the practice of locked psychiatric inpatient units. Broad strategies, practicalities and ethical matters that must be considered in inpatient mental health services are also explored. The authors draw on the published research and commentary to derive relevant information to provide to patients and staff regarding the aims and rationales of locked units. Further debate is warranted in (...) relation to best practice. Inpatient staff need to be aware of their practice values, be able to access education and supervision and negotiate apparent contradictions. Further patient/clinician focused enquiry is necessary to mitigate the negative and stigmatising effects of locked mental health units. (shrink)

Understanding terrestrial carbon metabolism is critical because terrestrial ecosystems play a major role in the global carbon cycle. Furthermore, humans have severely disrupted the carbon cycle in ways that will alter the climate system and directly affect terrestrial metabolism. Changes in terrestrial metabolism may well be as important an indicator of global change as the changing temperature signal. Improving our understanding of the carbon cycle at various spatial and temporal scales will require the integration of multiple, complementary and independent methods (...) that are used by different research communities. Tools such as air sampling networks, inverse numerical methods, and satellite data allow us to study the strength and location of the global- and continental-scale carbon sources and sinks. Bottom-up studies provide estimates of carbon fluxes at finer spatial scales and examine the mechanisms that control fluxes at the ecosystem, landscape, and regional scales. Bottom-up approaches include comparative and process studies that provide the necessary mechanistic information to develop and validate terrestrial biospheric models. An iteration and reiteration of top-down and bottom-up approaches will be necessary to help constrain measurements at various scales. We propose a major international effort to coordinate and lead research programs of global scope of the carbon cycle. (shrink)

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, Sjöberg, (...) Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

Shakespeare in The Winter’s Tale in describing the annual year names only three seasons—Spring, Summer, and Winter. This tripartite scheme is not unprecedented in Shakespeare’s sonnets and plays, e.g. Sonnet 5.5-6; Sonnet 6.1-2, 2 Henry 6 2.4. 1-3; The Tempest 4.1.114-15. What is unique to The Winter’s Tale involves Shakespeare’s correlation of three seasons to a tripartite division of humankind’s age, with a stress on the climacteric years when one season passes to the next. An assumption and a fact undergird (...) this scheme: that a lifetime is 70 years (Psalm 90, verse 10), and that 23 is an important recurring number in this play. Humankind passes from Spring to Summer at age 23 and from Summer to Winter at age 46. Given the possible calculation of major characters’ ages in The Winter’s Tale, one discovers that Leontes after a sixteen-year gap of time is 44, while—in 1610 (the likely date of the play)—Shakespeare himself is 46. This correspondence is richly evocative of figurative final harvests. (shrink)

The usual way for new cells to come into being is by division of old cells. So the zygote, which is a—new—single cell formed from two, the sperm and ovum, is an exception. Textbooks of human genetics usually say that this new cell is beginning of a new human individual. What this indicates is that they suddenly forget about identical twins.

I want to suggest that Plato arrived at a revised theory of forms in the later dialogues. Or perhaps I might rather say that he constructed a new underpinning for the theory. This can be discerned, I believe, in the Sophist, taken together with certain parts of the dialectic of the Parmenides which use the same language as the Sophist.

This book comprises material on colour which was written by Wittgenstein in the last eighteen months of his life. It is one of the few documents which shows him concentratedly at work on a single philosophical issue. The principal theme is the features of different colours, of different kinds of colour and of luminosity—a theme which Wittgenstein treats in such a way as to destroy the traditional idea that colour is a simple and logically uniform kind of thing. This edition (...) consists of Wittgenstein's basic German text, together with an English translation. (shrink)

The usual way for new cells to come into being is by division of old cells. So the zygote, which is a—new—single cell formed from two, the sperm and ovum, is an exception. Textbooks of human genetics usually say that this new cell is beginning of a new human individual. What this indicates is that they suddenly forget about identical twins.

One of the ways of dividing all philosophers into two kinds is by saying of each whether he is an ordinary man's philosopher or a philosophers' philosopher. Thus Plato is a philosophers' philosopher and Aristotle an ordinary man's philosopher. This does not depend on being easy to understand: a lot of Aristotle's Metaphysics is immensely difficult. Nor does being a philosophers' philosopher imply that an ordinary man cannot enjoy the writings, or many of them. Plato invented and exhausted a form: (...) no one else has written such dialogues. So someone with no philosophical bent, or who has left his philosophical curiosity far behind may still enjoy reading some of them. (shrink)