Outpatient services are increasingly recognised as an important component of health care provision and may be improved through the application of modern management techniques. We have performed a time and role audit of consultation and waiting times in two medical clinics using different queuing systems: namely, a serial processing clinic where patients wait in a single queue and a quasi-parallel processing clinic where patients are directed to the shortest queue to maintain clinic flow. Data collected were used to construct a (...) computer simulation of patient flows in clinic. Assessment of patient satisfaction in the clinic process was determined using a self-administered questionnaire. Mean waiting time was shorter in the quasi-parallel processing clinic: 26 (SD 17) minutes compared with 36(24) minutes in the serial processing clinic. In the serial processing clinic 61% of patients waited more than 30 minutes compared with 41% in the quasi-parallel processing clinic. In the serial processing clinic 8% of 142 patients surveyed complained of the time spent waiting. The computer simulation we produced was able to determine waiting times with different clinic structures. The simulation showed that reductions in waiting time up to 30% might be achieved by changing our serial processing clinic to a quasi-parallel processing one. Performance of medical outpatient clinics can be improved by examining and changing clinic management. Computer simulation of outpatient clinics offers a means of assessing the impact of such changes on waiting time in clinic and on waiting lists. (shrink)

On July 27th, 2013, Sammy Yatim was shot and killed by Toronto Police Services’ Constable James Forcillo during a verbal confrontation on a streetcar as Yatim brandished a switchblade knife. Forcillo was charged, initially with second degree murder, and later attempted murder—a decision that confused media commentators as attempted murder is a lesser-and-included offense to second degree murder in Canadian law. In January 2016, Forcillo was found not guilty of second degree murder and guilty of attempted murder. Video evidence, recovered (...) from the streetcar’s onboard security cameras, was described by the presiding judge, Justice Edward Then, as proving beyond a reasonable doubt that Forcillo’s testimony was unreliable, especially in light of other evidence. This paper examines the use of video evidence to arrive at a ‘compromise verdict’ and the paradox of being convicted of attempting to murder someone who was killed. (shrink)

During embryogenesis, the basic axon scaffold of the nervous system is formed by special axons that pioneer pathways between groups of cells. To find their way, the pioneer growth cones detect specific cues in their extracellular environment. One of these guidance cues is netrin. Observations and experimental manipulations in vertebrates and nematodes have shown that netrin is a bifunctional guidance cue that can simultaneously attract and repel axons. During the formation of this basic axon scaffold in Caenorhabditis elegans, the netrin (...) UNC‐6 is expressed by neuroglia and pioneer neurons, providing hierarchical guidance cues throughout the animal. Each cue has a characteristic role depending on the cell type, its position and the developmental stage. These roles include activities as global, decussation and labeled‐pathway cues. This hierarchical model of UNC‐6 netrin‐mediated guidance suggests a method by which guidance cues can direct formation of basic axon scaffolds in developing nervous systems. (shrink)

As we go to press, the threat of biological or chemical warfare in the Persian Gulf is no longer imminent. Yet the questions raised by the proposed use of “investigational drugs,” without informed consent, to protect U.S. troops remain. The article by Edmund G. Howe and Edward D. Martin presents the arguments that informed the Pentagon's thinking on the subject. It and the commentaries, by George J. Annas and Michael A. Grodin, and Robert J. Levine, explore, among others, issues of (...) informed consent, of distinguishing ‘research’ and ‘treatment,’ and of the nature and extent of the autonomy of military personnel.—B‐JC, HLN. (shrink)

Why should the work of the ancient and the medievals, so far as it relates to nature, still be of interest and an inspiration to us now? The contributions to this enlightening volume explore and uncover contemporary scholarship's debt to the classical and medieval past. Thinking About the Environment synthesizes religious thought and environmental theory to trace a trajectory from Mesopotamian mythology and classical and Hellenistic Greek, through classical Latin writers, to medieval Christian views of the natural world and our (...) relationship with it. The work also offers medieval Arabic and Jewish views on humanity's inseparability from nature. The volume concludes with a study of the breakdown between science and value in contemporary ecological thought. Thinking About the Environment will be a invaluable source book for those seeking to address environmental ethics from a historical perspective. (shrink)

Objective: Ethical guidelines are designed to ensure benefits, protection and respect of participants in clinical research. Clinical trials must now be registered on open-access databases and provide details on ethical considerations. This systematic survey aimed to determine the extent to which recently registered clinical trials report the use of standard of care and post-trial obligations in trial registries, and whether trial characteristics vary according to setting. Methods: We selected global randomized trials registered on http://www.clinicaltrials.gov and http://www.controlled-trials.com. We searched for intervention (...) trials of HIV/AIDS, malaria, and tuberculosis from 9 October 2004, the date of the most recent version of the Helsinki Declaration, to 10 April 2007. Results: We collected data from 312 trials. Fifty-eight percent (58%, 95% CI = 53 to 64) of trial protocols report informed consent. Fifty-eight percent (58%, 95% CI = 53 to 64) of trials report active controls. Almost no trials (1%, 95% CI = 0.5 to 3) mention post-trial provisions. Most trials measure surrogate outcomes. Twenty percent (20%, 95% CI = 16 to 25) of trials measure patient-important outcomes, such as death; and the odds that these outcomes are in a low income country are five times greater than for a developed country (odds ratio (OR) 5.03, 95% CI = 2.70 to 9.35, p = < 0.001). Pharmaceutical companies are involved in 28% (CI = 23 to 33) of trials and measure surrogate outcomes more often than nonpharmaceutical companies (OR 2.45, 95% CI = 1.18 to 5.09, p = 0.31). Conclusion: We found a large discrepancy in the quality of reporting and approaches used in trials in developing settings compared to wealthier settings. (shrink)

We have conducted an experimental study of V-type electromagnetically induced transparency in sodium. Its principles are elucidated by a simple model. Measurements show decreased fluorescence and absorption depending on the detuning of the driving and probe fields, which is in agreement with the results of numerical simulation.

Recent work on the ethics of love may be divided into norm-centered and affective-centered approaches. Norm-centered approaches, exemplified by Hallett and Outka, argue for either moral parity between self and other or for self-subordination; they regard self-love as legitimate within strict boundaries; and they sharply distinguish agape from other forms of love. Affective-centered approaches, exemplified by Vacek and Post, con- centrate on love for God as the central context for neighbor-love; they ac- cord a high status to friendship, marriage, and (...) other primary relationships; and they regard all forms of love as Christian in that they are transformed by grace and constitute cooperation with God. The re- maining agenda for both approaches is primarily theological, including especially the need to develop an extended application of the doctrines of creation and grace for the status of "special relations" in the ethics of love. (shrink)

In this book, Patrick G. Stefan argues that the subversive message of resurrection was instrumental in Christianity’s expansion. Using Foucault’s analysis of how material conditions shape and create individual subjects, Stefan shows how the idea of resurrection undermined Caesar’s control over those living in his domain.

Mind and Body in Early China critiques Orientalist accounts of early China as a radical "holistic" other, which saw no qualitative difference between mind and body. Drawing on knowledge and techniques from the sciences and digital humanities, Edward Slingerland demonstrates that seeing a difference between mind and body is a psychological universal, and that human sociality would be fundamentally impossible without it. This book has implications for anyone interested in comparative religion, early China, cultural studies, digital humanities, or science-humanities integration.

A collection of more than 40 case studies covering diverse topics such as genetic engineering, aesthetics, pollution, animal rights, population, and resource management, Case Studies in Environmental Ethics is intended as a supplemental book for college courses primarily in environmental ethics. Each case presents factual information on a particular topic, followed by a discussion of the ethical implications of each topic and several insightful discussion questions.

BackgroundAlthough the number of reporting guidelines has grown rapidly, few have gone through an updating process. The STARD statement (Standards for Reporting Diagnostic Accuracy), published in 2003 to help improve the transparency and completeness of reporting of diagnostic accuracy studies, was recently updated in a systematic way. Here, we describe the steps taken and a justification for the changes made.ResultsA 4-member Project Team coordinated the updating process; a 14-member Steering Committee was regularly solicited by the Project Team when making critical (...) decisions. First, a review of the literature was performed to identify topics and items potentially relevant to the STARD updating process. After this, the 85 members of the STARD Group were invited to participate in two online surveys to identify items that needed to be modified, removed from, or added to the STARD checklist. Based on the results of the literature review process, 33 items were presented to the STARD Group in the online survey: 25 original items and 8 new items; 73 STARD Group members (86 %) completed the first survey, and 79 STARD Group members (93 %) completed the second survey.Then, an in-person consensus meeting was organized among the members of the Project Team and Steering Committee to develop a consensual draft version of STARD 2015. This version was piloted in three rounds among a total of 32 expert and non-expert users. Piloting mostly led to rewording of items. After this, the update was finalized. The updated STARD 2015 list now consists of 30 items. Compared to the previous version of STARD, three original items were each converted into two new items, four original items were incorporated into other items, and seven new items were added.ConclusionsAfter a systematic updating process, STARD 2015 provides an updated list of 30 essential items for reporting diagnostic accuracy studies. (shrink)

The emergence of shared symbol systems is considered to be a pivotal moment in human evolution and human development. These changes are normally explained by reference to changes in people's internal cognitive processes. We present 2 experiments which provide evidence that changes in the external, collaborative processes that people use to communicate can also affect the structure and organization of symbol systems independently of cognitive change. We propose that mutual‐modifiability—opportunities for people to edit or manipulate each other's contributions—is a key (...) constraint on the emergence of complex symbol systems. We discuss the implications for models of language development and the origins of compositionality. (shrink)

By any measure, Oliver Wendell Holmes, Jr., led a full and remarkable life. He was tall and exceptionally attractive, especially as he aged, with piercing eyes, a shock of white hair, and prominent moustache. He was the son of a famous father, a thrice-wounded veteran of the Civil War, a Harvard-educated member of Brahmin Boston, the acquaintance of Longfellow, Lowell, and Emerson, and for a time a close friend of William James. He wrote one of the classic works of American (...) legal scholarship, The Common Law, and he served with distinction on the Supreme Court of the United States. He was actively involved in the Court's work into his nineties. In Justice Oliver Wendell Holmes, G. Edward White, the acclaimed biographer of Earl Warren and one of America's most esteemed legal scholars, provides a rounded portrait of this remarkable jurist. We see Holmes's early life in Boston and at Harvard, his ambivalent relationship with his father, and his harrowing service during the Civil War. White examines Holmes's curious, childless marriage and he includes new information on Holmes's relationship with Clare Castletown. White not only provides a vivid portrait of Holmes's life, but examines in depth the inner life and thought of this preeminent legal figure. There is a full chapter devoted to The Common Law, for instance, and throughout the book, there is astute commentary on Holmes's legal writings. Indeed, White reveals that some of the themes that have dominated 20th-century American jurisprudence--including protection for free speech and the belief that "judges make the law"--originated in Holmes's work. Perhaps most important, White suggests that understanding Holmes's life is crucial to understanding his work, and he continually stresses the connections between Holmes's legal career and his personal life. For instance, his desire to distinguish himself from his father and from the "soft" literary culture of his father's generation drove him to legal scholarship of a particularly demanding kind. White's biography of Earl Warren was hailed by Anthony Lewis on the cover of The New York Times Book Review as "serious and fascinating," and The Los Angeles Times noted that "White has gone beyond the labels and given us the man." In Justice Oliver Wendell Holmes, White has produced an equally serious and fascinating biography, one that again goes beyond the labels and gives us the man himself. (shrink)

Healey et al. use experiments with chat dialogues to test the hypothesis that language co‐ordination is driven by ‘running repairs’. They replace signals of understanding such as “okay” with weaker, ‘spoof’ signals like “ummm”, and replace specific requests for clarification like “on the left?” with signals that suggest a higher degree of misunderstanding like “what?”. The latter manipulation causes participants to switch rapidly to more abstract forms of referring expression.

When Heidegger's influence was at its zenith in Germany from the early fifties to the early sixties, most serious students of philosophy in that country were deeply steeped in his thought. His students or students of his students filled many if not most of the major chairs in philosophy. A cloud of reputedly Black Forest mysticism veiled the perspective of many of his critics and admirers at home and abroad. Droves of people flocked to hear lectures by him that most (...) could not understand, even on careful reading, much less on one hearing. He loomed so large that Being and Time frequently could not be seen as a highly imaginative, initial approach to a strictly limited set of questions, but was viewed either as an all-embracing first order catastrophy incorporating at once the most feared consequences of Boehme, Kierkegaard, Rilke, and Nietzsche, or as THE ANSWER. But most of that has past. Heidegger's dominance of German philosophy has ceased. One can now brush aside the larger-than-life images of Heidegger, the fears that his language was creating a cult phenomenon, the convictions that only those can understand him who give their lives to his thought. His language is at times unusually difficult, at times simple and beautiful. Some of his insights are obscure and not helpful, others are exciting and clarifying. One no longer expects Heidegger to interpret literature like a literary critic or an academic philologist. (shrink)

The idea that the world, not only of man but also of nature, was subject to a continuous process of change has taken strong root since the beginning of the nineteenth century. In 1859, Charles Darwin demonstrated that these changes were the result of immutable, eternal laws - although everything was subject to change, it was only in accordance with these laws. from the second half of the nineteenth century down to the First World War, this vision of change and (...) determination was interpreted in many different ways, both pessimistically and optimistically. It is striking that a fear of degeneration often went hand in hand with a belief in an upward evolutionary process and was not confined to any particular political spectrum. This volume, number XIV in the series, contains the papers presented at a workshop on the reception and interpretation of the theory of evolution, organised by the editors in April 2003. It covers the many, often irreconcilable faces, of the theory of evolution concerning not only the concrete substantive interpretation but also the many different fields of late nineteenth century thought by concentrating on cultural life in the broadest sense - political, social, scientific and artistic, both literature and the visual arts. This volume illustrates the versatility of the concept of evolution, and of degeneration as well, with the emphasis on the Netherlands. It not only presents the contradictions and many-sidedness of the post-Darwinian world, but also the continuity with the world before 1860. Moreover, it reveals one clear co-ordinating theme, namely that the theory of evolution was used as justification for many different ideologies and practices. (shrink)