Increasing ethical attention and debate is focusing on whether individuals who take part in clinical trials should be given access to post-trial care. However, the main focus of this debate has been upon drug trials undertaken in low-income settings. To broaden this debate, we report findings from interviews with individuals (n = 24) who participated in a clinical trial of a closed-loop system, which is a medical device under development for people with type 1 diabetes that automatically adjusts blood glucose (...) to help keep it within clinically recommended ranges. Individuals were recruited from UK sites and interviewed following trial close-out, at which point the closed-loop had been withdrawn. While individuals were stoical and accepting of the requirement to return the closed-loop, they also conveyed varying degrees of distress. Many described having relaxed diabetes management practices while using the closed-loop and having become deskilled as a consequence, which made reverting back to pre-trial regimens challenging. Participants also described unanticipated consequences arising from using a closed-loop. As well as deskilling, these included experiencing psychological and emotional benefits that could not be sustained after the closed-loop had been withdrawn and participants reevaluating their pre- and post-trial life in light of having used a closed-loop and now perceiving this life much more negatively. Participants also voiced frustrations about experiencing better blood glucose control using a closed-loop and then having to revert to using what they now saw as antiquated and imprecise self-management tools. We use these findings to argue that ethical debates about post-trial provisioning need to be broadened to consider potential psychological and emotional harms, and not just clinical harms, that may result from withdrawal of investigated treatments. We also suggest that individuals may benefit from information about potential nonclinical harms to help make informed decisions about trial participation. (shrink)

This study investigates the impact of Securities and Exchange Commission enforcement actions on individuals holding Certified Public Accountant accreditation. While prior research has investigated both the characteristics of companies that have been investigated by the SEC and litigation against audit firms, it has not addressed the ways in which SEC investigations impact CPAs. Using a sample of 262 CPAs, we find that the most common CPA breach was associated with overstating revenues/income or earnings. The study finds serious consequences for CPAs (...) in terms of employment restrictions and SEC actions, incorporating suspension, which is often permanent. We find that the primary factors relating to the severity of actions by the SEC is whether the CPA intentionally breached the professional code of conduct, the age of the CPA, whether the CPA is still a member of the AICPA with CPA status and whether the CPA was operating as an external auditor or in a corporate accounting role. Our findings have implications for accounting practitioners, the AICPA and boards of directors. (shrink)

Rosamond Kent Sprague’s translations of the _Laches and Charmides_ are highly regarded, and relied on, for their lucidity and philosophical acuity. This edition includes notes by Sprague and an updated bibliography.

This paper challenges nurses to join together as a collective in order to facilitate ongoing analysis of the issues that arise for nurses and patients when nursing care is harnessed for health care efficiencies. It is a call for nurses to respond with a collective strategy through which we can ‘talk back’ and ‘act back’ to the powerful rationality of current thinking and practices. The paper uses examples from an institutional ethnographic (IE) research project to demonstrate how dominant approaches to (...) understanding nursing position nurses to overlook how we activate practices of reform that reorganize how we nurse. The paper then describes two classroom strategies taken from my work with students in undergraduate and graduate programs. The teaching strategies I describe rely on the theoretical framework that underpin the development of an IE analysis. Taken into the classroom (or into other venues of nursing activism) the tools of IE can be adapted to inform a pedagogical approach that supports nurses to develop an alternate analysis to what is happening in our work. (shrink)

In this article, we discuss how we used institutional ethnography (Institutional ethnography as practice, Rowman & Littlefield, Lanham, MD and 2006) to map out powerful ruling relations that organize nurses’ wound care work. In recent years, the growing number of people living with wounds that heal slowly or not at all has presented substantial challenges for those managing the demands on Canada's publicly insured health‐care system. In efforts to address this burden, Canadian health‐care administrators and policy‐makers rely on scientific evidence (...) about how wounds heal and what treatments are most effective. Advanced wound care exemplifies the growing authorization of particular forms of evidence that change the ways in which nurses come to know about and conduct their work. The focus of this paper's nursing inquiry is a critique of registered nurses’ wound work as it arises within the established uptake of scientific evidence. (shrink)

To be truly provocative and outrageous the superior philosophical sophistry will commonly possess four somewhat adventitious features. I shall rate it as classic if it has all four. First, and least adventitiously, the argument will be crisp and initially seductive. Second, by the standard the sophistry sets direct rebuttal will be laborious and diffuse. Third, the recipe for the latter will prescribe that we pick out some hitherto unarticulated logical principle such that if the principle be true then the sophistical (...) argument must be invalid, and then, on the strength of that consequence assume the principle to be true. Consequently and fourth, as an antidote parody is supreme. With a persuasive absence of fuss and bias we can turn the tables if we show that, if the sophistical argument were really valid, then some structurally similar argument would prove just as consummately far too much. In short, from the rhetorical point of view at least, Gaunilo is more lethal than Kant. Even if the similarity is defective, the sophist will lose some of his adventitious and insufferable poise, if he ventures to show why. (shrink)

‘Patient satisfaction’: Knowledge for ruling hospital reform — An institutional ethnography Driven by funding restraint, Canadian health‐care has undergone over a decade of significant reform. Hospitals are being restructured, as text‐based practices of accountability bring a new business‐orientation into hospital and clinical management. New forms of knowledge, generated through records of various sorts, are a necessary resource for managing care in the new environment. This paper's research uses Canadian sociologist Dorothy E. Smith's institutional ethnographic methodology to critically analyse one instance (...) of text‐based management. I analyse information about ‘patient satisfaction’ as it is generated through a patient survey (in which I was implicated through my involvement with a hospitalized family member). Subsequently, I have studied the management environment into which that information would be entered. I argue that in the instance analysed, the information becomes part of a dominant consumer oriented healthcare discourse that subordinates concerns about ‘what actually happened’ as a professional caregiver would have known it. On this basis, I contend that this sort of taken‐for‐granted approach to making decisions about quality care in hospitals may be seriously, even dangerously, flawed. (shrink)

The Ethics Code of the American Psychological Association is a bedrock of the profession. The contextual factors of society affect the Ethics Code of the APA, resulting in an ever-changing document. The context of the reorganization of the APA after World War II created an initial impetus toward a formalized code. A key contextual feature of the Code's development was the use of the Critical Incident Technique, which was based in the empirical aspirations of the psychological field. This article explores (...) the historical context around the APA's decision to draft an ethics code, reviews its development, and discusses its role for psychologists today. (shrink)

Athenagoras : philosopher and theologian -- Athenagoras' Corpus -- Athenagoras and contemporary theological and philosophical conversations -- How do we know about God? : epistemology -- What do we know about God? : first principles -- Subordinate topics -- Influences on Athenagoras -- Conclusions.

Worldwide, the literature reports that many residents in long‐term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations (...) with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add‐on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC. (shrink)

To understand the tma we should follow a rule of polemical force as well as a rule of validity. Following just the latter vlastos renders the explicit theory of forms and the two suppressed premises as an inconsistent triad. But the rule of polemical force indicates that the explicit theory is ambivalent. Just one f-Ness must be the basis, Either for any f thing being f, Or for any set of f things being just that set. It cannot be the (...) basis for all f things being f. (shrink)

Emergency care in large urban hospitals across the country is in the midst of major redesign intended to deliver quality care through improved access, decreased wait times, and maximum efficiency. The central argument in this paper is that the conceptualization of quality including the documentary facts and figures produced to substantiate quality emergency care is socially organized within a powerful ruling discourse that inserts the interests of politics and economics into nurses' work. The Canadian Triage and Acuity Scale figures prominently (...) in the analysis as a high‐level organizer of triage work and knowledge production that underpins the way those who administer the system define, measure and evaluate emergency care processes, and then use this information for restructuring. Managerial targets and thinking not only dominate the way emergency work is understood, determined, and controlled but also subsume the actual work of health‐care providers in spaces called ‘wait times’, where it is systematically rendered ‘unknowable’. The analysis is supported with evidence from an extensive institutional ethnography that shows what nurses actually do to manage the safe passage of patients through their emergency care process starting with the work of triage nurses. (shrink)

Within the literature that circulates in the discourses organizing nursing education, there are embedded assumptions that link student performance on maths examinations to safe medication practices. These assumptions are rooted historically. They fundamentally shape educational approaches assumed to support safe practice and protect patients from nursing error. Here, we apply an institutional ethnographic lens to the body of literature that both supports and critiques the emphasis on numeracy skills and medication safety. We use this form of inquiry to open an (...) alternate interrogation of these practices. Our main argument posits that numeracy skills serve as powerful distraction for both students and teachers. We suggest that they operate under specious claims of safety and objectivity. As nurse educators, we are captured by taken‐for‐granted understandings of practices intended to produce safety. We contend that some of these practices are not congruent with how competency actually unfolds in the everyday world of nursing practice. Ontologically grounded in the materiality of work processes, we suggest there is a serious disjuncture between educators' assessment and evaluation work where it links into broad nursing assumptions about medication work. These underlying assumptions and work processes produce contradictory tensions for students, teachers and nurses in direct practice. (shrink)

In this paper, we examine the practicalities of nurse managers’ work. We expose how managers’ commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. We (...) learned how nurse managers’ responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers’ responsibilities are shaped to conform to institutional purposes. (shrink)

Taking Parenting Public makes a compelling case that parenting has become dangerously undervalued in America today. It calls for a new investment—both personal and public—into the work of raising children and argues that we are all 'stockholders' in the next generation. With a foreword by Sylvia Ann Hewlett and Cornel West, Taking Parenting Public crosses boundaries to bring together thinkers from diverse fields spanning the political spectrum. It features contributions from distinguished experts in economics, political science, public policy, child development, (...) public health, history, and the media. While recent books have focused on working mothers or absent fathers, Taking Parenting Public is the first volume to take a comprehensive look at the common struggles of parents. These essays go beyond the usual chest-beating about busy parents torn between work and family demands to suggest bold solutions. Instead of the typical call for 'parent replacement'—more child care, more after school programs and more mentors—the contributors offer fresh strategies for 'parent replenishment,' ways to put mothers and fathers back into the lives of their children not only as economic providers, but also as emotional and moral providers. (shrink)

As mental health nursing roles expand, is education expanding mental health nurses? an emotionally intelligent view towards preparation for psychological therapies and relatedness Mental health nurses (MHN) in the UK currently occupy a challenging position. This positioning is one that offers a view of expanding roles and responsibilities in both mental health act legislation and the delivery of psychological therapies, while simultaneously generic pre‐registration training is being considered. Clearly, the view from this position, although not without challenge and internal discipline (...) dispute, can also offer growing professional prestige, influence and respect from other health disciplines, as well as the wider public. Conversely, if the training, education and strategic enactment for new MHN roles is formulated and delivered from predominantly non‐MHN axiomatic and epistemological stances, MHN identity can be seriously and potentially permanently diminished. This paper offers the construct of emotional intelligence as a framework to respond to these future challenges through making individual MHN enablement a primacy. This enablement of MHNs through enhanced emotional intelligence competencies is argued as requiring priority over the standard approach of enhancing strategies alone. (shrink)

A mirror image is not an image of a thing seen, but that thing seen in a different perspective.

This series will include monographs and collections of studies devoted to the investigation and exploration of knowledge, information and data-processing systems of all kinds, no matter whether human, (other) animal or machine. Its scope is intended to span the full range of interests from classical problems in the philosophy of mind and phi losophical psychology through issues in cognitive psychology and socio biology (concerning the mental capabilities of other species) to ideas related to artificial intelligence and computer science. While primary (...) emphasis will be placed upon theoretical, conceptual and epistemologi cal aspects of these problems and domains, empirical, experimental and methodological studies will also appear from time to time. Among the most challenging and difficult projects within the scope of artificial intelligence is the development and implementation of com puter programs suitable for processing natural language. Our purpose in compiling the present volume has been to contribute to the foundations of this enterprise by bringing together classic papers devoted to crucial problems involved in understanding natural language, which range from issues of formal syntax and logical form to those of possible-worlds and situation semantics. The book begins with a comprehensive introduc tion composed by Jack Kulas, the senior editor of this work, which pro vides a systematic orientation to this complex field, and ends with a selected bibliography intended to promote further research. If our efforts assist others in dealing with these problems, they will have been worthwhile. J. H. F. (shrink)

Recent work indicates that there are distinct response habituation mechanisms that can be recruited by different stimulation rates and that can underlie different components (e.g., the duration or speed) of a single behavioral response. These findings raise the question: why is “the simplest form of learning” so complicated mechanistically? Beyond evolutionary selection for robustness of plasticity in learning to ignore, it is proposed in this article that multiple mechanisms of habituation have evolved to streamline shifts in ongoing behavioral strategy. Then, (...) speculations are offered regarding the implications of this reconceptualization of habituation for approaching the analysis of mechanisms of more complex forms of learning and memory. (shrink)

The Centers for Disease Control and Prevention’s goal is to develop a surveillance system of public health laws that would both support research and analysis among policymakers and legislators, and support the scientific basis for public health law. This session was convened, in part, to discuss the value of creating an electronic system to track public health legal information. Public health surveillance is the “ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public (...) health action to reduce morbidity and mortality and to improve health. Data disseminated by a public health surveillance system can be used for immediate public health action, program planning and evaluation, and formulating research hypotheses.” There is currently no system available that meets the goals of this definition of “surveillance” for public health laws. (shrink)

As a way of contributing to bioethics' understanding of itself, and, more particularly, to invigorate conversation about how we can best educate future colleagues, we present here a sketch of the quarter-century-old graduate concentration in medical ethics housed in the Department of Philosophy at the University of Tennessee, Knoxville. Our hope is to incite other programs to share their histories, strategies, problems, and aspirations, so as to help the field as a whole get a clearer sense of how we are (...) putting together our future, and of how we might best go about this important job. (shrink)