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)
Several debates in contemporary metaphysics provoke us to ask what an event is. One theory, Pioneered by chisholm, Develops the analogy between the occurrence of events and the truth of corresponding propositions. I call these propositional analyses. It is unclear whether their adherents wish to jettison our event-Concepts, And replace them with concepts from another category, Such as semantics. The other theory of what events are that I scrutinize, Namely kim's and goldman's property-Exemplification analysis, Seems reductive. My suspicion is that (...) if you attempt to boil down the occurrence of an event to the "obtaining" or "taking place" of a proposition-Like "state of affairs"--Or to the "exemplification" of a property by an "object"--At some "time", We have a residual event: a mysterious episode of "obtaining" or "exemplifying" in which either states of affairs or properties and objects participate. Reduction is unlikely. (shrink)
There has been much first-rate work done in recent years both by way of criticizing Humean assumptions and explicating alter native concepts of causal explanation and non-logical necessity. Roderick Chisholm early showed the inadequacies of neo-Humean views of explanation in his articles on counterfactual inference, and C. J. Ducasse, Sterling Lamprecht, William Kneale, Nicholas Maxwell, Richard Taylor, G. E. M. Anscombe, P. T. Geach, Milton Fisk, Baruch Brody, Peter Alexander, R. Harré, and William Wallace, among others, have articulated interesting (...) alternative views to the Humean ones they have so trenchantly criticized. We will be concerned with the recent work of Harré and Wallace in this study. Harré has not only launched a fresh attack but has also presented what is probably the most fully developed neorealistic [[sic]] alternative. Wallace’s work is basically historical but has an intentional systematic import also. The books of the two authors are mutually supportive. (shrink)
Few people will easily admit to taking pleasure in the misfortunes of others. But who doesn't enjoy it when an arrogant but untalented contestant is humiliated on American Idol, or when the embarrassing vice of a self-righteous politician is exposed, or even when an envied friend suffers a small setback? The truth is that joy in someone else's pain--known by the German word schadenfreude--permeates our society. In The Joy of Pain, psychologist Richard Smith, one of the world's foremost authorities (...) on envy and shame, sheds much light on a feeling we dare not admit. Smith argues that schadenfreude is a natural human emotion, one worth taking a closer look at, as it reveals much about who we are as human beings. We have a passion for justice. Sometimes, schadenfreude can feel like getting one's revenge, when the suffering person has previously harmed us. But most of us are also motivated to feel good about ourselves, Smith notes, and look for ways to maintain a positive sense of self. One common way to do this is to compare ourselves to others and find areas where we are better. Similarly, the downfall of others--especially when they have seemed superior to us--can lead to a boost in our self-esteem, a lessening of feelings of inferiority. This is often at the root of schadenfreude. As the author points out, most instances of schadenfreude are harmless, on par with the pleasures of light gossip. Yet we must also be mindful that envy can motivate, without full awareness, the engineering of the misfortune we delight in. And envy-induced aggression can take us into dark territory indeed, as Smith shows as he examines the role of envy and schadenfreude in the Nazi persecution of the Jews. Filled with engaging examples of schadenfreude, from popular reality shows to the Duke-Kentucky basketball rivalry, The Joy of Pain provides an intriguing glimpse into a hidden corner of the human psyche. (shrink)
Investigation of neural and cognitive processes underlying individual variation in moral preferences is underway, with notable similarities emerging between moral- and risk-based decision-making. Here we specifically assessed moral distributive justice preferences and non-moral financial gambling preferences in the same individuals, and report an association between these seemingly disparate forms of decision-making. Moreover, we find this association between distributive justice and risky decision-making exists primarily when the latter is assessed with the Iowa Gambling Task. These findings are consistent with neuroimaging studies (...) of brain function during moral and risky decision-making. This research also constitutes the first replication of a novel experimental measure of distributive justice decision-making, for which individual variation in performance was found. Further examination of decision-making processes across different contexts may lead to an improved understanding of the factors affecting moral behaviour. (shrink)
We focus on the recent non-causal theory of reasons explanationsof free action proffered by a proponent of the agency theory, Timothy O'Connor. We argue that the conditions O'Connor offersare neither necessary nor sufficient for a person to act for a reason. Finally, we note that the role O'Connor assigns toreasons in the etiology of actions results in further conceptual difficulties for agent-causalism.
David Hume is an ardent supporter of the practice of religions toleration. For Hume, toleration forms part of the background that makes progress in philosophy possible, and it accounts for the superiority of philosophical thought in England in the eighteenth century. As he puts it in the introduction to the Treatise: “the improvements in reason and philosophy can only be owing to a land of toleration and of liberty” (T Intro.7; SBN xvii).1 Similarly, the narrator of part 11 of the (...) First Enquiry comments: -/- Our conversation began with my admiring the singular good fortune of philosophy, which, as it requires entire liberty above all other privileges, and chiefly flourishes from the free opposition of sentiments and argu mentation, received its first birth in an age and country of freedom and toleration. (EHU 11.2; SBN 132) -/- The toleration to which Hume refers is broader than religious toleration, but in the context of the eighteenth century, religious toleration is clearly the paradigm case. Indeed, religious toleration represents one of the key accomplishments of the culminating event of Hume’s History of England: the Glorious Revolution of 1688. -/- Yet even though religious toleration forms the background of philosophy in general—or perhaps just because it does so—Hume offers precious few arguments for it, and they are, for the most part, given implicitly rather than as formal argu ments. Nevertheless, we can distinguish three different, though interrelated, lines of support for toleration in Hume’s thought: (i) an argument based on a general skepticism; (ii) an argument based on a contempt for organized religion; and (iii) a pragmatic argument based on the need for peace and orderly government. From our point of view, what is striking about all of these argument is how un-Lockean they are: Hume does not rely on the idea of a fundamental conceptual separation of church and state, nor on a natural right to freedom of conscience that characterizes writers working in the Lockean tradition. However, of the arguments he gives, only the last, I will argue, has any hope to provide a useful case for toleration. (shrink)
At the forefront of international concerns about global legislation and regulation, a host of noted environmentalists and business ethicists examine ethical issues in consumption from the points of view of environmental sustainability, economic development, and free enterprise.
BOOK REVIEWS 297 to and 21o), Receuil ~ l'usage des prkdicateurs in an Auxerre manuscript , and a Latin-Arabic Glossary preserved in a single Leiden manuscript . The estimate to be made of this Work must be all but totally positive. The complex organization of the volume can make difficulties, despite a useful index; Tolan's refer- ence to "five" authentic works perhaps includes the De Machometo since only four, Dialogi, Zij al-Sindhind, Epistola ad peripateticos and Disciplina clericalis have survived his (...) scrutiny. Tolan has conveyed deftly the fluid quality of a mediaeval book. Copied and recopied for readers whose varied interests might inspire additions and omissions, a mediaeval treatise might be reworked by the author himself and no longer be the book that it was. Alfonsian studies have been advanced by Tolan's urbane estimate of these works and of their reception by Latin Europe in the twelfth-century struggle to share the scientific and cultural achievements of Judaism and Islam. EDWARD A. SYNAN Pontifical Institute of Mediaeval Studies and University of Toronto Raymond B. Waddington and Arthur H. Williamson, editors. The Expulsion of the Jews: r492 andAfler. Garland Studies in the Renaissance, Volume 2. New York: Garland Publishing, t994. Pp. x + ~96. Cloth, $48.oo. In t992 there were many conferences commemorating the expulsion of the Jews from Spain five.. (shrink)
The major tenets of the recent hypothesis of punctuated equilibrium are explicit in Darwin's writing. His notes from 1837–1838 contain references to stasis and rapid change. In the first edition of the Origin (1859), Darwin described the importance of isolation of local varieties in the process of speciation. His views on the tempo of speciation were influenced by Hugh Falconer and also, perhaps, by Edward Suess (1831–1914). It is paradoxical that, although both topics were recorded in his unpublished notes of (...) 1837–1838, the second was not explicitly and fully discussed until the fourth edition of the Origin (1866). While no wholly satisfactory explanation of this paradox suggests itself, it seems probable that Falconer's work on the persistence of fossil species of elephant helped Darwin to see the wider significance of the tempo of evolution for his general theory. (shrink)