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)

The popular belief that religion is the same everywhere or that all religions are ‘at bottom’ identical in essentials is a widespread falsehood that is saved from being completely worthless by the fact that religion does exhibit a universal or common structure wherever it appears. This structure is intimately related to the structure of human life in the world. The enduring pattern that enables us to understand religions widely separated in both time and space depends largely on the fact that (...) man and the process of human life in the world have their own structures which remain, despite the undeniable variety introduced by vast differences of culture, ethnic features, geographical location, climate etc. Structure means pattern or form; it is reality significantly organised. It can be grasped as that which endures above and beyond changing historical details. Because human life has a structure, we are able to understand the wrath of Achilles or sympathise with the love of Abélard for Héloïse although we are separated from both by centuries of time. (shrink)

Several recent articles raise an issue long unaddressed in the medical literature: physician compliance with patient or family requests for futile or ineffectice therapy. Although they agree philosophically that such treatment ought not be given, most physicians have followed the course described by Stanley Fiel, in which a young patient dying of cystic fibrosis was accepted “for evaluation” by a transplant center even though he has already passed the threshold of viability as a candidate for a heart-lung transplant. Dr. Fiel (...) reported this action was taken not in the hope of doing the transplant but so that the family could assure themselves they had done “everything possible.” The patient, after a long and stressful cross-country flight, arrived at the hospital in respiratory failure. He died soon thereafter far from home and familiar surroundings. (shrink)

Burt formulates her critique at a general level of abstraction that highlights the methodological deficiencies of sociogenomics without also calling attention to precisely the same deficiencies in the social science model she seeks to defend against its encroachments. What might have been a methodological bulwark against the excesses of sociogenomics is instead a one-sided critique that merely renews its charter.

The crisis of 2008–2009 has been viewed primarily as a financial one, which has spilled over into the economy more generally. I want to argue that there is a much deeper crisis, of which the present one is a result. The deeper crisis is political: more specifically, it is a crisis in the ideology and social ethos of the American people. I refer to what has happened to the thinking of United States citizens since the Second World War, and the (...) dangers that that transformation entails for world peace and cooperation—let alone the creation of an economic regime in which deep financial crises do not occur. Short of a change in the ideology of a many of its citizens, I do not believe the United States can succeed in preventing a repeat performance, perhaps many encores, which become increasingly severe. (shrink)

As a work of a scholarship it seems to me to compare favourably with the best books on the subject, including those by Marcus Singer and Onora Nell.' Prof.

Paternalism in the medical care of children is appropriate and ethically justifiable. However, dilemmatic disagreement by paternalistic agents as to which clinical choice is in the child's best interest may occur because of the underlying conflict between two rival standards for the moral value of life: longevity versus quality. Neither standard is unreasonable. Either could be the basis for choice of medical care by the parents or by the pediatrician. Having the child choose between options disputed by his parents and (...) the pediatrician is unlikely to resolve their conflict. Exercise of informed consent by the adolescent requires agreement by his parents to relinquish their paternalistic veto. The probable best-interest choice by the child when he has matured could be reasonably made from either standard. Therefore, the longevity/quality of life question ought not ordinarily to be foreclosed by paternalistic authority which opts for one standard to the exclusion of the other. Medical interventions, paternalistically determined, are justified in the face of deteriorating quality, but only as long as the interventions themselves do not cause deterioration. Application of this limitation of paternalism to the zone of agreement between the rival life standards is made to clinical case examples. Multiple extrinsic criteria may measure the quality of life. Three quality factors, sensation of pain, capacity to communicate and physical functioning are considered. The extent of the zone of agreement between the two life standards varies because quality of life is a relative good, contingent both upon which extrinsic criteria are selected to assess it and upon the priorities which are set among these criteria. (shrink)

In the first comprehensive biography of Ferdinand de Saussure, John E. Joseph restores the full character and history of a man who is considered the founder of modern linguistics and whose ideas have influenced literary theory, philosophy, cultural studies, and virtually every other branch of humanities and the social sciences.

The evolution of life on Earth has produced an organism that is beginning to model and understand its own evolution and the possible future evolution of life in the universe. These models and associated evidence show that evolution on Earth has a trajectory. The scale over which living processes are organized cooperatively has increased progressively, as has its evolvability. Recent theoretical advances raise the possibility that this trajectory is itself part of a wider developmental process. According to these theories, the (...) developmental process has been shaped by a yet larger evolutionary dynamic that involves the reproduction of universes. This evolutionary dynamic has tuned the key parameters of the universe to increase the likelihood that life will emerge and produce outcomes that are successful in the larger process (e.g. a key outcome may be to produce life and intelligence that intentionally reproduces the universe and tunes the parameters of ‘offspring’ universes). Theory suggests that when life emerges on a planet, it moves along this trajectory of its own accord. However, at a particular point evolution will continue to advance only if organisms emerge that decide to advance the developmental process intentionally. The organisms must be prepared to make this commitment even though the ultimate nature and destination of the process is uncertain, and may forever remain unknown. Organisms that complete this transition to intentional evolution will drive the further development of life and intelligence in the universe. Humanity’s increasing understanding of the evolution of life in the universe is rapidly bringing it to the threshold of this major evolutionary transition. (shrink)

John E. Smith; XI—Radical Empiricism, Proceedings of the Aristotelian Society, Volume 65, Issue 1, 1 June 1965, Pages 205–218, https://doi.org/10.1093/aristotel.

Professor Roemer's goal in this book is to give a rigorous view of classical Marxian economic theory by presenting specific analytic models. The theory is not extended to deal with new problems, but it is deepened: Marxian theory is given micro-foundations and upon those foundations the author begins to rebuild a tightly constructed Marxian economics. The book begins, after a methodological introduction, with an examination of the Marxian notion of equilibrium and the theory of exploitation, and goes on to deal (...) with the theory of the falling rate of profit. The next section explores one of the points made in the first section of the book, that the Marxian theory of exploitation can be constructed completely independently of the labor theory of value as a theory of exchange. Technical study of this problem allows comment on various issues, such as the relative importance of 'marginal utilities' and 'class struggle' in determining relative prices. The final part examines models of various Marxian concepts. (shrink)

Public and private -- Ownership and liberalism -- Applied ethics -- NASSP Book Award: Gerald Cohen.

In these previously uncollected essays, Smith argues that American philosophers like Peirce, James, Royce, and Dewey have forged a unique philosophical tradition—one that is rich and complex enough to represent a genuine alternative to the analytic, phenomenological, and hermeneutical traditions which have originated in Britain or Europe. "In my judgment, John Smith has no equal today in combining two scholarly qualities: the analysis of philosophical texts with penetration and rigor, and the discernment of what it is in these texts (...) that matters. These qualities are in evidence throughout the essays in _America's Philosophical Vision._ Whether he is evaluating Rorty's view of Dewey; the pragmatic theory of experience and truth; theories of freedom, creativity, and the self; Royce's conception of community; or synoptic philosophic visions, Smith always succeeds in uniting a comprehensive understanding of philosophic writings with a sure grasp of their import for human culture and aspiration. It is a great benefit to students of American thought that these papers have now been collected into one volume."—James Gouinlock, Emory University. (shrink)

Is morality too difficult for human beings? Kant said that it was, except with God's assistance. Contemporary moral philosophers have usually discussed the question without reference to Christian doctrine, and have either diminished the moral demand, exaggerated human moral capacity, or tried to find a substitute in nature for God's assistance. This book looks at these philosophers--from Kant and Kierkegaard to Swinburne, Russell, and R.M. Hare--and the alternative in Christianity.

Anthromes, or anthropogenic biomes, characterize the globally significant ecological patterns shaped by sustained direct human interactions with ecosystems, including agriculture, urbanization, and other land uses. The emergence of anthromes has literally paved the way for the Anthropocene, and now cover more than three quarters of Earth’s ice-free land surface, including dense settlements, villages, croplands, rangelands, and cultured lands; wildlands untransformed by agriculture and settlements cover the remaining area.

John E Olford; The Concept of Creativity, Journal of Philosophy of Education, Volume 5, Issue 1, 30 May 2006, Pages 77–95, https://doi.org/10.1111/j.1467-9752.1.

Continuous recordings of brain electrical activity were obtained from a group of 176 patients throughout surgical procedures using general anesthesia. Artifact-free data from the 19 electrodes of the International 10/20 System were subjected to quantitative analysis of the electroencephalogram (QEEG). Induction was variously accomplished with etomidate, propofol or thiopental. Anesthesia was maintained throughout the procedures by isoflurane, desflurane or sevoflurane (N = 68), total intravenous anesthesia using propofol (N = 49), or nitrous oxide plus narcotics (N = 59). A set (...) of QEEG measures were found which reversibly displayed high heterogeneity of variance between four states as follows: (1) during induction; (2) just after loss of consciousness (LOC); (3) just before return of consciousness (ROC); (4) just after ROC. Homogeneity of variance across all agents within states was found. Topographic statistical probability images were compared between states. At LOC, power increased in all frequency bands in the power spectrum with the exception of a decrease in gamma activity, and there was a marked anteriorization of power. Additionally, a significant change occurred in hemispheric relationships, with prefrontal and frontal regions of each hemisphere becoming more closely coupled, and anterior and posterior regions on each hemisphere, as well as homologous regions between the two hemispheres, uncoupling. All of these changes reversed upon ROC. Variable resolution electromagnetic tomography (VARETA) was performed to localize salient features of power anteriorization in three dimensions. A common set of neuroanatomical regions appeared to be the locus of the most probable generators of the observed EEG changes. (shrink)

Author John E. Rexine expounds on the theologies of the great Roman thinkers Plato and Cicero in this essay.

This paper describes and defends two arguments connecting ethics and religion that Kant makes in Religion within the Boundaries of Mere Reason. The first argument is that the moral demand is too high for us in our natural capacities, and God's assistance is required to bridge the resulting moral gap. The second argument is that because humans desire to be happy as well as to be morally good, morality will be rationally unstable without belief in a God who can bring (...) happiness and virtue together. The paper states and replies to three objections to each argument. (shrink)