Chapters on the nature and beginnings of tragedy introduce a survey of Greek, Elizabethan, Neo-Classical, and Modern tragedy. The theoretical portions attempt to remedy Aristotle's "rather strange neglect of the philosophical and religious implications of tragedy," or "the tragic sense of life." Rather than a fresh theory of tragedy, the book presents a critical synthesis of the leading theories of cultural anthropology and psychology; of the work of the modern critics of archetypal forms and ideas ; and the "heroic humanism" (...) of critics like Cedric Whitman. The central sections have the vivid sweep of Muller's The Uses of the Past and give much of its indispensable background material.--R. B. S. (shrink)

Background: The traditional approach to resolving ethics concerns may not address underlying organisational issues involved in the evolution of these concerns. This represents a missed opportunity to improve quality of care “upstream”. The purpose of this study was to understand better which organisational issues may contribute to ethics concerns. Methods: Directed content analysis was used to review ethics consultation notes from an academic children’s hospital from 1996 to 2006 (N = 71). The analysis utilised 18 categories of organisational issues derived (...) and modified from published quality improvement protocols. Results: Organisational issues were identified in 68 of the 71 (96%) ethics consult notes across a range of patient settings and reasons for consultation. Thirteen of the 18 categories of organisational issues were identified and there was a median of two organisational issues per consult note. The most frequently identified organisational issues were informal organisational culture (eg, collective practices and approaches to situations with ethical dimensions that are not guided by policy), policies and procedures (eg, staff knows policy and/or procedural guidelines for an ethical concern but do not follow it) and communication (eg, communication about critical information, orders, or hand-offs repeatedly does not occur among services). Conclusions: Organisational issues contribute to ethical concerns that result in clinical ethics consults. Identifying and addressing organisational issues such as informal culture and communication may help decrease the recurrence of future similar ethics concerns. (shrink)

Endothelial cells, when cultured on gelled basement membrane matrix exert forces of tension through which they deform the matrix and at the same time they aggregate into clusters. The cells eventually form a network of cord-like structures connecting cell aggregates. In this network, almost all of the matrix has been pulled underneath the cell cords and cell clusters. This phenomenon has been proposed as a possible model for the growth and development of planar vascular systems in vitro. Our hypothesis is (...) that the matrix is reorganized and the cellular networks form as a result of traction forces exerted by the cells on the matrix and the latter's elasticity. We construct and analyze a mathematical model based on this hypothesis and examine conditions necessary for the formation of the pattern. We show cell migration is not necessary for pattern formation and that isotropic, strain-stimulated traction is sufficient to form the observed patterns. (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)

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)

Background: Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians’ considerations in clinical prioritisation within this field is scarce. Objectives: To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. Design: A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. Participants: 20 physicians and 25 nurses working in public hospitals and nursing homes (...) in different parts of Norway. Results and interpretations: The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians’ role. Conclusion: Distributing healthcare services in a fair way is generally not described as integral to the clinicians’ role in clinical prioritisations. If considerations of justice are not included in clinicians’ role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions. (shrink)

A stimulating, detailed study of a most important aspect of Peirce's pragmaticism. In developing the "problem of universals" as it arises in the writings of Peirce, Boler presents the most informative analysis yet to appear of Peirce's indebtedness to the realist-nominalist controversy of the school-men. The author, taking seriously Peirce's characterization of himself as a "Scotistic Realist," uses Scotus as a model for constructing a systematic interpretation of Peirce's realism. In stressing Peirce's dependence upon, as well as divergence from, Scotus, (...) Boler provides a context in which realist, pragmatic, and idealist strands in Peirce's thought emerge, not as incompatible emphases, but as interdependent responses to different aspects of the "problem of universals." The author introduces a vast array of well-known Peircian themes and explicates their relation to Peirce's realism and to one another. The present study is excitingly developed and well worth the reader's serious attention.--B. G. R. (shrink)

Peirce's theory of belief and doubt, his theory of meaning, and his theory of truth and reality serve as the point of departure for a study of his Pragmatism. What the present essay lacks in freshness of approach is partly offset by an interesting defense of the essential unity of Peirce's thought. By imaginatively interpreting the above theories in their early formulations Wennerberg is able to argue for a continuity with later formulations as they appeared in essays written after 1890. (...) The chapter on "Peirce's Theory of Belief and Doubt" is particularly successful in this respect. For the most part Wennerberg's own criticisms of Peirce are much less forceful than his defenses.--B. G. R. (shrink)

These lectures, delivered as part of the 1962 St. Augustine Lecture Series at Villanova University, develop the Thomistic conception of man as an "intellectual soul" which itself is both a self-subsisting substance and a substantial form. So viewed, man's unity consists in being a composite reality, not in the sense of a soul and a body functioning as co-parts of a whole, but in the sense of an intelligible substance which requires an organic body to realize its own nature. The (...) lectures neither criticize nor explicitly defend these claims but rather present them as a novel interpretation of man. This Aquinas was able to construct by drawing the conceptual tools of form, matter and substance from Aristotelian metaphysics and the view of man as an historical pilgrim from Augustinian theology.--B. G. R. (shrink)

Frank Arntzenius has recently suggested that we should reject the standard view that the instantaneous state in classical mechanics consists of both the position and the velocity. In his view, the velocity as ordinarily defined-as the derivative of position with respect to time-cannot be genuinely instantaneous, and, thus, it should be excluded from the instantaneous state. After reviewing Bertrand Russell's traditional objections to the notion of an instantaneous velocity and suggesting that Russell's concerns can be effectively answered, I argue that (...) Arntzenius' attempt to show that the standard definition of velocity fails to yield an instantaneous property is not compelling either. Although I review several suggestions that Arntzenius makes against the existence of instantaneous velocity, much of his case rests upon an intuition, which has also appeared in the work of David Albert, about what is required of genuine instantaneous states. I argue in part that there is no reason to accept this intuition, and, thus, no reason to revise standard physical practice when it comes to the classical, instantaneous state. (shrink)