The ethical obligation to provide a reasonably safe discharge option from the inpatient setting is often confounded by the context of homelessness. Living without the security of stable housing is a known determinant of poor health, often complicating the safety of discharge and causing unnecessary readmission. But clinicians do not have significant control over unjust distributions of resources or inadequate societal investment in social services. While physicians may stretch inpatient stays beyond acute care need in the interest of their patients (...) who are experiencing homelessness, they must also consider the implications of using an inpatient hospital bed for someone without the attendant level of medical need. Caring for patients in an inpatient setting when they no longer require acute care means fewer beds for acute care patients. And when a patient who is experiencing homelessness declines a medically safer option such as a skilled nursing facility, then clinicians may be faced with the sole option of discharge to the street, which raises troubling questions of nonmaleficence and social justice. Here we investigate the different forms of injustice that play out when patients are discharged to the street, and offer a map of the interwoven ethical responsibilities of clinicians, hospitals, and skilled nursing facilities. (shrink)

For a long time, linguists more or less denied the existence of individual differences in grammatical knowledge. While recent years have seen an explosion of research on individual differences, most usage-based research has failed to address this issue and has remained reluctant to study the synergy between individual and community grammars. This paper focuses on individual differences in linguistic knowledge and processing, and examines how these differences can be integrated into a more comprehensive constructionist theory of grammar. The examination is (...) guided by the various challenges and opportunities that may be extracted from scattered research that exists across disciplines touching on these matters, while also presenting some new data that illustrate how differentiation between individuals can improve models of long-term language change. The paper also serves as the introduction to this special issue of Cognitive Linguistics, which collects seven contributions from various linguistic disciplines focusing on key aspects of individuals’ grammars. (shrink)

I outline a pragmatic account of evidence, arguing that it allows us to underwrite two implications of feminist scholarship: that knowledge is socially constructed and constrained by evidence, and that social relations, including gender, race, and class, are epistemologically significant. What makes the account promising is that it abandons any pretense of a view from nowhere, the view of evidence as something only individuals gather or have, and the view that individual theories face experience in isolation.

The author has previously shown that for a certain class of structures $\mathcal {I}$, $\mathcal {I}$-indexed indiscernible sets have the modeling property just in case the age of $\mathcal {I}$ is a Ramsey class. We expand this known class of structures from ordered structures in a finite relational language to ordered, locally finite structures which isolate quantifier-free types by way of quantifier-free formulas. This result is applied to give new proofs that certain classes of trees are Ramsey. To aid this (...) project we develop the logic of EM-types. (shrink)

The persistence, and international expansion, of food banks as a non-governmental response to households experiencing food insecurity has been decried as an indicator of unacceptable levels of poverty in the countries in which they operate. In 1998, Poppendieck published a book, Sweet charity: emergency food and the end of entitlement, which has endured as an influential critique of food banks. Sweet charity‘s food bank critique is succinctly synthesized as encompassing seven deadly “ins” (1) inaccessibility, (2) inadequacy, (3) inappropriateness, (4) indignity, (...) (5) inefficiency, (6) insufficiency, and (7) instability. The purpose of this paper is to examine if and how the contemporary food bank critique differs from Sweet charity’s “ins” as a strategy for the formulation of synthesizing arguments for policy advocacy. We used critical interpretive synthesis methodology to identify relationships within and/or between existing critiques in the peer-reviewed literature as a means to create “‘synthetic constructs’ (new constructs generated through synthesis)” of circulating critiques. We analyzed 33 articles on food banks published since Sweet charity, with the “ins” as a starting point for coding. We found that the list of original “ins” related primarily to food bank operations has been consolidated over time. We found additional “ins” that extend the food bank critique beyond operations (ineffectiveness, inequality, institutionalization, invalidation of entitlements, invisibility). No synthetic construct emerged linking the critique of operational challenges facing food banks with one that suggests that food banks may be perpetuating inequity, posing a challenge for mutually supportive policy advocacy. (shrink)

Scotland is usually portrayed as being a country that had weak and terrible queens, like Margaret Tudor and Mary Queen of Scots. Saint Margaret is the only queen who is constantly portrayed positively. However, that is not because of her actions as queen consort, but because she was a devote Christian. Scotland is also portrayed for not producing well known or strong female rulers. This essay will examine two contemporary female rulers from the mid-fifteenth century, one from Scotland, Eleanor of (...) Scotland, and one imported to Scotland, Mary of Gueldres. Using these case studies it will be demonstrated that Scotland did produce strong female rulers along with acquiring them. (shrink)

Used in China as a book of divination and source of wisdom for more than three thousand years, the _I Ching_ has been taken up by millions of English-language speakers in the nineteenth century. The first translation ever to appear in English that includes one of the major Chinese philosophical commentaries, the Columbia _I Ching_ presents the classic book of changes for the world today. Richard Lynn's introduction to this new translation explains the organization of _The Classic of Changes_ (...) through the history of its various parts, and describes how the text was and still is used as a manual of divination with both the stalk and coin methods. For the fortune-telling novice, he provides a chart of trigrams and hexagrams; an index of terms, names, and concepts; and a glossary and bibliography. Lynn presents for the first time in English the fascinating commentary on the _I Ching_ written by Wang Bi, who was the main interpreter of the work for some seven hundred years. Wang Bi interpreted the _I Ching_ as a book of moral and political wisdom, arguing that the text should not be read literally, but rather as an expression of abstract ideas. Lynn places Wang Bi's commentary in historical context. For beginners and devotees alike, Columbia's _I Ching_ is the clearest and most authoritative translation of this ancient classic. (shrink)

We have conducted a retrospective study of deaths on a paediatric medical intensive care unit over a two-year period and reviewed similar series from outside the UK. There were 89 deaths out of 651 admission (13.7% mortality). In almost two-thirds of the cases death occurred with a decision to limit medical treatment or withdraw mechanical ventilation, implying that additional or further therapy was considered futile. We highlight this as a crucially important issue in the practice of intensive care. More comprehensive (...) studies are needed to help clinicians derive consensus on what constitutes a futile intervention, and therefore when such an intervention should be withheld. This will help families and society better understand the limitations of intensive care. (shrink)

: Some commentators have recently proposed that "clinical equipoise," although widely accepted, is not necessary for morally acceptable research on human subjects. If this concept is rejected, however, we may find that trials not in the best medical interests of their subjects--bad deal trials--could be justified. To avoid exploiting participants, we must find a way to distribute the risks fairly, even if it means embracing radical changes in the way clinical research is conducted.

In this article, we critique two theoretical positions that analyze the place of emotions in education: the psychological strand and the cultural feminist strand. First of all, it is shown how a social control of emotions in education is reflected in the combination of psychological and cultural feminist discourses that function to govern one’s self effectively and efficiently. These discourses perpetuate an assumed divide between the rational and the emotional, and reinforce the existing power hierarchies and the status quo of (...) stereotypes about the role of emotion in education. Then we use the Foucauldian notions of parrhesia and care of the self to suggest alternative ways of thinking about emotions in education. Instead of campaigning for one side or the other of the rational/emotional divide, we suggest that it may be more interesting and fruitful to examine the particular ways discourses of emotion in education construct their own brand of parrhesia. (shrink)

Usage-based linguistics postulates that multi-word expressions constitute a substantial part of language structure and use, and are formed through repeated chunking and stored as exemplar wholes. They are also re-used to produce new sequences by means of schematization. While there is extensive research on multi-word expressions in many spoken languages, little is known about the status of multi-word expressions in the mainstream U.S. variety of American Sign Language. This paper investigates recurring multi-word expressions, or sequences of multiple signs, that involve (...) a high-frequency sign of visual perception glossed as look and the family of ‘look’ signs. The look sign exhibits two broad functions: look/‘vision’ references literal or metaphorical vision and look/‘reaction’ signals a person’s reaction to a visual stimulus. Data analysis reveals that there are recurring sequences in distinct syntactic environments associated with the two functions of look, suggesting that look is in the process of grammaticalization from a verb of visual perception to a stance verb. The sequences demonstrate the emergence of linguistic structure from repeated use through the domain-general cognitive process of chunking in ASL. (shrink)

This study compares involuntary and voluntary autobiographical memories in depressed and never depressed individuals. Twenty depressed and twenty never depressed individuals completed a memory diary; recording their reactions to 10 involuntary and 10 voluntary memories over 14–30 days. Psychiatric status , psychopathology, rumination and avoidance were assessed. For both groups, involuntary memories more frequently lead to strong reactions than voluntarily memories. For both modes of retrieval, depressed individuals reported more frequent negative reactions than never depressed individuals and rated memories as (...) more central to identity with higher levels of rumination and avoidance. Depressed individuals retrieved both positive and negative memories during involuntary retrieval. These findings support the view that involuntary memory retrieval represents a basic mode of retrieval during healthy and disordered cognition, and that during depression, both involuntary and voluntary memories are central to identity and associated with rumination and avoidance. (shrink)

Edwin, a person contemplating a career in teaching, has a conversation with Phyllis, a teacher and amateur theorist, about reasons to become a teacher.

The mouse t-complex, located on chromosome 17, contains genes known to influence male, but not female, fertility. Although some t-complex genes are recessive lethals, t-chromosomes are maintained in the population by transmission ratio distortion. When male mice heterozygous for the t-chromosome mate with wild-type females, most offspring will possess the t-chromosome, indicating a link between t-complex genes and sperm function. Several proteins coded for by t-complex genes have been localised in the sperm flagellum, suggesting roles relating to motility. Another t-complex (...) protein appears able to regulate the adenylyl cyclase/cAMP signal transduction pathway, known to play an important role in capacitation. Defective motility and/or failure to capacitate (“switch on”) would result in poorly fertile or infertile spermatozoa. Given the existence of human homologues for many genes in the t-complex and the prevalence of “male factor” infertility, information obtained about the t-complex not only will provide insight into basic biological mechanisms but may be of future clinical relevance as well. BioEssays 21:304–312, 1999. © 1999 John Wiley & Sons, Inc. (shrink)

The major aim of this research is to reopen the study of the subjective experience of upward mobility and to incorporate race and gender into our vision of the process. It examines evidence from a social science study of upward mobility among 200 Black and white professional-managerial women in the Memphis, Tennessee metropolitan area. The experiences of the women paint a different picture from the image of the mobility process that remains from scholarship conducted 20 to 30 years ago on (...) white males. Relationships with family of origin, partners, children, friends, and the wider community shaped the way these women envision and accomplish mobility and the way they sustain themselves as professionals and managers. (shrink)

Some commentators have recently proposed that “clinical equipoise,” although widely accepted, is not necessary for morally acceptable research on human subjects. If this concept is rejected, however, we may find that trials not in the best medical interests of their subjects—”bad deal trials”—could be justified. To avoid exploiting participants, we must find a way to distribute the risks fairly, even if it means embracing radical changes in the way clinical research is conducted.

One of the lessons we ought to have learned from the history of philosophy and science is that it is rarely, if ever, useful in dealing with challenges from a new movement or in distinguishing one’s position from a different school of thought, to “draw a line in the sand” and claim that everything on this side is legitimate and that everything on that side is not, and can therefore be dismissed without serious consideration or discussion. On some analyses, Plato (...) sought to dismiss all of natural science in this way, by claiming that since it dealt with change it can yield at best belief, not knowledge. The logical positivists, building on the work of Hume, tried to use the analytic/synthetic distinction and various forms of verificationism to dismiss as nonsense everything but science, logic, mathematics, and the philosophy of science. Neither of these moves succeeded in banishing what was placed on that side of the line to intellectual never-never land. More recently, critics of creationism have dismissed the views they are attacking as “not science at all” and therefore of neither concern nor interest to the scientific communities. These maneuvers tend to be unsuccessful not just because they rely on distinctions which cannot, in the end, be sustained—or can be drawn and maintained only after all the hard work which they are frequently claimed to make unnecessary has been done—but because they refuse to deal with the specific evidence and arguments advanced by the challengers, bad as those might be. (shrink)

Philosophy has a complicated relationship with nursing practice. Selected concepts from Hans‐Georg Gadamer's Truth and Method specifically prejudice, conversation, and language are articulated. An exemplar involving nursing practice at an outpatient clinic for women seeking pre‐ and postbreast cancer care is offered to explicate these concepts. We considered the fit of Gadamer's philosophy, particularly the concept of conversation, within a public health nursing practice context in home and community settings of the client/family and offered tentative conclusions. To extend the discussion (...) of the relationship between philosophy and nursing practice, we posed questions developed to provide deeper insight into this complicated relationship. (shrink)