During the past three decades, there has been an ongoing debate on the quality of health care. Defining quality is an important part of it. This paper offers a review of definitions and a conceptual analysis in order to understand and explain the differences between them. The analysis results in a semantic rule, expressing the meaning of quality as an optimal balance between possibilities realised and a framework of norms and values. This rule is postulated as a formal criterion of (...) meaning, e.g. when (correctly) applied people understand each other. The rule suits the abstract nature of the term quality. Quality doesn't exist as such. It is constructed in an interaction between people. This interaction is guided by rules in order to transfer information, e.g. communicate on quality. The rule improves our ability to discuss the debate on quality and to develop a theory grounding actions such as quality assurance or quality improvement. (shrink)

BackgroundTriggered by a series of controversies and diversifying expectations of editorial practices, several innovative peer review procedures and supporting technologies have been proposed. However, adoption of these new initiatives seems slow. This raises questions about the wider conditions for peer review change and about the considerations that inform decisions to innovate. We set out to study the structure of commercial publishers’ editorial process, to reveal how the benefits of peer review innovations are understood, and to describe the considerations that inform (...) the implementation of innovations.MethodsWe carried out field visits to the editorial office of two large academic publishers housing the editorial staff of several hundreds of journals, to study their editorial process, and interviewed editors not affiliated with large publishers. Field notes were transcribed and analysed using coding software.ResultsAt the publishers we analysed, the decision-making structure seems to show both clear patterns of hierarchy and layering of the different editorial practices. While information about new initiatives circulates widely, their implementation depends on assessment of stakeholder’s wishes, impact on reputation, efficiency and implementation costs, with final decisions left to managers at the top of the internal hierarchy. Main tensions arise between commercial and substantial arguments. The editorial process is closely connected to commercial practices of creating business value, and the very specific terms in which business value is understood, such as reputation considerations and the urge to increase efficiency. Journals independent of large commercial publishers tend to have less hierarchically structured processes, report more flexibility to implement innovations, and to a greater extent decouple commercial and editorial perspectives.ConclusionOur study demonstrates that peer review innovations are partly to be understood in light of commercial considerations related to reputation, efficiency and implementations costs. These arguments extend beyond previously studied topics in publishing economics, including publishers’ choice for business or publication models and reach into the very heart of the editorial and peer review process. (shrink)

Background: A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians’ consideration in daily clinical prioritisation in healthcare services for the aged is scarce.Objectives: To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients.Design: A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style.Participants: 20 (...) physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.Results and interpretations: Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients’ needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations.Conclusion: The interviews in this study indicate that considerations of justice and patients’ perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients. (shrink)

In a recent article in this journal our unit was accused of a number of errors of judgment in applying covert video surveillance (CVS) to infants and children suspected of life-threatening abuse. The article implied, that on moving from the Royal Brompton Hospital in London to North Staffordshire Hospital, we failed to present our work to the Research Ethics Committee (REC). We did send our protocol to the REC though we did not consider that, after a total of 16 patients (...) had been documented as being the subject of life-threatening abuse, this was research. The REC in Staffordshire agreed with us. We were also accused of undertaking work that should be pursued by the Police. We agree with this. However, unlike the Metropolitan Police the Staffordshire Police would not undertake CVS. We fail to agree that 'working together' with parents is necessarily practical or safe when trying to protect children from life-threatening abuse of this kind. (shrink)

This qualitative cross-sectional survey, undertaken in the antenatal booking clinics of a hospital in central London, explores pregnant women’s responses to routine HIV testing, examines their reasons for declining or accepting the test, and assesses how far their responses fulfil standard criteria for informed consent. Of the 32 women interviewed, only 10 participants were prepared for HIV testing at their booking interview. None of the women viewed themselves as being particularly at risk for HIV infection. The minority of the participants (...) who declined testing differed from those who accepted, by interpreting test acceptance as risky behaviour, privileging the negative outcomes of HIV positivity and expressing an inability to cope with these, should they occur. Troublingly, only a minority of women had a broad understanding of the rationale for the test, and none fulfilled the standard criteria for informed consent. This study suggests that, although routine screening combined with professional recommendation may be successful in increasing uptake, this may be at the cost of eroding informed consent. Protecting third parties from a preventable disease may outweigh the moral duty of respecting autonomy, enshrined in Western bioethical tradition. Nevertheless, such a policy should be made transparent, debated in the public domain and negotiated with women seeking antenatal care. (shrink)

This article discusses the relation between environment and participation in the context of different stages of political modernisation. We focus on the dynamics of environmental policy on the one hand, and the organisation of political participation on the other. The central argument is that participation is inextricably linked to environmental issues, but that their relation differs substantially over the various stages of the institutionalisation of environmental policy. While in the 1970s supplementary forms of participation dominated, the societalisation and marketisation of (...) environmental policies from the late 1980s has given rise to new opportunities for participation, implying a more rule-altering potential. (shrink)

In our rapidly changing environment, both profit and non-profit organizations confront an increasing demand for technological, economic, and social innovation. In response to this demand, organizations are taking on the role of “change agents” by transforming existing practices into innovative action. Libraries, as centers that accumulate and disperse knowledge, can support these organizations in their “change agent” roles. This paper delineates the way public libraries can help organizations meet the increasing need for external information associated with innovation. Policy issues concerned (...) with efficient information transfer to user organizationss are specified, and two concrete examples of information transfer systems are described. In order to best utilize existing knowledge,personal-professional assistance in selecting potentially innovative,impersonal written materials is recommended. (shrink)

In this exploratory study, we present findings from semi-structured interviews with 11 self-identified lesbian and gay (LG) humanitarian aid workers of Doctors without Borders (MSF). We investigate their perceptions of workplace inclusion in terms of perceived satisfaction of their needs for authenticity and belonging within two organizational settings, namely office and field. Through our combined deductive and inductive approach, based on grounded theory, we find that perceptions of their colleagues’ and supervisors’ attitudes and behaviors, as well as organizational inclusiveness practices (...) play a role in LGs’ perceived authenticity, but not belonging, in the workplace. However, these organization-level characteristics do not account for between-participant differences in perceived authenticity. Therefore, we inductively construct a typology of three groups, which we coined conscious first-missioners, authentic realists, and idealistic activists, based on how LG humanitarian aid workers assess and deal with not being able to be their authentic selves when they are in the field, because homosexuality is illegal in many project countries. Conscious first-missioners are separated from the other two groups based on having gone to the field once, whereby they felt in control over the decision on how to manage their sexuality. Alternatively, authentic realists and idealistic activists alike felt they did not really have a choice in how to manage their sexuality, but handled that differently. We find the importance of one’s sexuality as well as adherence to the overarching organizational mission relevant individual-level factors herein. Furthermore, we find disclosure of sexual identity to be strongly context-dependent, as participants are ‘out of the closet’ in the office, but go back into the closet when they enter the field, with different country contexts even leading to different decisions concerning self-disclosure, thus demonstrating the importance of careful sexual identity management. This so-called disclosure dilemma, we find, may not be merely an individual choice, but rather a shared dilemma involving multiple stakeholders, such as the organization and fellow team members. We discuss the findings’ contributions to existing literature on LGs’ workplace experiences and implications for future research on inclusion of sexual and other invisible minorities in the workplace. (shrink)

Inactivation of the Ca2+ extrusion mode of the retinal rod Na- Ca + K exchanger is suggested to be the mechanism that prevents lowering of cytosolic free Ca2+ to < 1 nM when rod cells are saturated for a prolonged time under bright light conditions. Under these conditions, Ca2+ fluxes across disk membranes can contribute significantly to Ca2+ homeostasis in rods.

After a brief review of pragmatic arguments against emotivism, the author of this monograph proceeds to outline and criticize two conflicting concepts of the morally right in Dewey's writings. A third interpretation, involving an "interaction of the factual and the normative" is advanced as more conformable to the spirit of instrumentalism.--A. D. P. M.

This is a new edition of the first volume of G.P.Baker and P.M.S. Hacker’s definitive reference work on Wittgenstein’s _Philosophical Investigations_. Takes into account much material that was unavailable when the first edition was written. Following Baker’s death in 2002, P.M.S. Hacker has thoroughly revised the first volume, rewriting many essays and sections of exegesis completely. Part One – the Essays – now includes two completely new essays: 'Meaning and Use' and 'The Recantation of a Metaphysician'. Part Two – Exegesis (...) §§1–184 – has been thoroughly revised in the light of the electronic publication of Wittgenstein’s _Nachlass_, and includes many new interpretations of the remarks, a history of the composition of the book, and an overview of its structure. The revisions will ensure that this remains the definitive reference work on Wittgenstein’s masterpiece for the foreseeable future. (shrink)

This major new study by one of the most penetrating and persistent critics of philosophical and scientific orthodoxy, returns to Aristotle in order to examine the salient categories in terms of which we think about ourselves and our nature, and the distinctive forms of explanation we invoke to render ourselves intelligible to ourselves. The culmination of 40 years of thought on the philosophy of mind and the nature of the mankind Written by one of the world’s leading philosophers, the co-author (...) of the monumental 4 volume _Analytical Commentary on the Philosophical Investigations_ Uses broad categories, such as substance, causation, agency and power to examine how we think about ourselves and our nature Platonic and Aristotelian conceptions of human nature are sketched and contrasted Individual chapters clarify and provide an historical overview of a specific concept, then link the concept to ideas contained in other chapters. (shrink)

This major study examines the most fundamental categories in terms of which we conceive of ourselves, critically surveying the concepts of substance, causation, agency, teleology, rationality, mind, body and person, and elaborating the conceptual fields in which they are embedded. The culmination of 40 years of thought on the philosophy of mind and the nature of the mankind Written by one of the world’s leading philosophers, the co-author of the monumental 4 volume _Analytical Commentary on the Philosophical Investigations_ Uses broad (...) categories, such as substance, causation, agency and power to examine how we think about ourselves and our nature Platonic and Aristotelian conceptions of human nature are sketched and contrasted Individual chapters clarify and provide an historical overview of a specific concept, then link the concept to ideas contained in other chapters. (shrink)

This major new study by one of the most penetrating and persistent critics of philosophical and scientific orthodoxy, returns to Aristotle in order to examine the salient categories in terms of which we think about ourselves and our nature, and the distinctive forms of explanation we invoke to render ourselves intelligible to ourselves. The culmination of 40 years of thought on the philosophy of mind and the nature of the mankind Written by one of the world’s leading philosophers, the co-author (...) of the monumental 4 volume _Analytical Commentary on the Philosophical Investigations_ Uses broad categories, such as substance, causation, agency and power to examine how we think about ourselves and our nature Platonic and Aristotelian conceptions of human nature are sketched and contrasted Individual chapters clarify and provide an historical overview of a specific concept, then link the concept to ideas contained in other chapters. (shrink)

Writing from a scientifically and philosophically informed perspective, the authors provide a critical overview of the conceptual difficulties encountered in many current neuroscientific and psychological theories.

P. M. S. Hacker 1. The ‘confusion of psychology’ On the concluding page of what is now called ‘Part II’ of the Investigations, Wittgenstein wrote.

... 243-) INTRODUCTION §§243- constitute the eighth 'chapter' of the book. Its point of departure is a natural query with respect to the conclusion of the ...

The place of the emotions among the passions -- The analytic of the emotions I -- The analytic of the emotions II -- The dialectic of the emotions -- Pride, arrogance, and humility -- Shame, embarrassment, and guilt -- Envy -- Jealousy -- Anger -- Love -- Friendship -- Sympathy and empathy.

Davidson’s explanation of first‐person authority in utterance of sentences of the form ‘I V that p’ derives first‐person authority from the requirements of interpretation of speech. His account is committed to the view that utterance sentences are truth‐bearers, that believing that p is a matter of holding true an utterance sentence, and that a speaker’s knowledge of what he means gives him knowledge of what belief he expresses by his utterance. These claims are here faulted. His explanation of first‐person authority (...) by reference to the requirements of interpretability is committed to the view that all understanding involves interpretation. This is argued to be a misconception of understanding and of speaker’s meaning. Davidson’s account involves acceptance of the cognitive assumption that normally when a person Vs that p, he knows that he does. This assumption is challenged. Throughout, Davidson’s conception is compared and contrasted with Wittgenstein’s. (shrink)

Law, Morality and Society Essays in Honour of H.L.A Hart.