The image of the hospital is presented to the public as a place of healing. Though the oft‐criticized total institutions of the past have been notably dismantled, the totalizing practices therein are now operationalized in the health care system. Through the lens of Erving Goffman, this article offers ways in which health care institutions operationalize totalizing practices, contributing to the mortification of patients and nurses alike in service to the bureaucratic machine. This article examines the ways in which totalizing (...) practices may disrupt the agency of both patients and nurses alike. (shrink)

Drawing on Deleuze’s ‘Postscript on Control Societies’, our initial focus in this article will be on the role of institutions within societies of control, an analysis which brings Deleuze into the orbit of Ervin Goffman’s famous ethnographic work on total institutions. This cross-comparative analysis of Deleuze and Goffman will allow us to show how institutions of control function by sequencing ‘dividuals’ across institutional domains in a continual process of totalization. Inspired by James Williams’s recent work on the ‘process philosophy (...) of signs’, we then argue that a critique of totalizing institutions can be positively articulated as a process-oriented challenge to algorithmic technologies and as a counter-sequencing of institutional control. We conclude with some reflections on the emergent modes of resistance that challenge both institutional and technological control, and we will proffer criteria for assessing such practices in relation to the two-sided nature of critique they enact, both processual and counter-sequential. (shrink)

In 2010, a cluster of suicides at the electronics manufacturing giant Foxconn Technology Group sparked worldwide outcry about working conditions at its factories in China. Within a few short months, 14 young migrant workers jumped to their deaths from buildings on the Foxconn campus, an all-encompassing compound where they had worked, eaten, and slept. Even though the language of workplace dignity was invoked in official responses from Foxconn and its business partner Apple, neither of these parties directly examined workers’ dignity (...) in their ensuing audits. Based on our analysis of media accounts of life at Foxconn, we argue that its total institution structure imposed unique indignities on its workers that both raised questions of their self-respect and self-worth, as well as gave rise to multiple episodes of disrespectful communication. We interpret our findings in light of the larger cultural context and meanings of work in China to understand more fully the experience of dignity of Foxconn’s migrant workforce. (shrink)

Healthcare under the auspices of late‐stage capitalism is a total institution that mortifies nurses and patients alike, demanding conformity, obedience, perfection. This capture, which resembles Deleuze's enclosure, entangles nurses in carceral systems and gives way to a postenclosure society, an institution without walls. These societies of control constitute another sort of total institution, more covert and insidious for their invisibility (Deleuze, 1992). While Delezue (1992) named physical technologies like electronic identification badges as key to understanding (...) these societies of control, the political economy of late‐stage capitalism functions as a total institution with no cohesive, centralized, connected material apparatus required. In this manuscript, we outline the ways in which the healthcare industrial complex demands nurse conformity and how that, in turn, operationalizes nurses in service to the institution. This foundation leads to the assertion that nursing must foster a radical imagination for itself, unbound by reality as it presently exists, in order that we might conjure more just, equitable futures for caregivers and care receivers alike. To tease out what a radical imagination might look like, we dwell in paradox: getting folks the care they need in capitalist healthcare systems; engaging nursing's deep history to inspire alternative understandings for the future of the discipline; and how nursing might divest from extractive institutional structures. This paper is a jumping‐off place to interrogate the ways institutions telescope and where nursing fits into the arrangement. (shrink)

The aim of this research is to analyze the effects of innovation strategies, Total Quality Management dimensions, and internationalization strategies that Higher Education Institutions might adopt, and their effects on their organizational performance. Due to globalization and the constant changes and demands that have taken place today, HEIs are forced to seek new quality assurance instruments in higher education, to ensure greater competitiveness in the markets and their survival. To examine the association between the independent variables, namely, TQM dimensions, (...) innovation strategies, and internationalization strategies with the dependent variable, that is organizational performance of HEIs, we have chosen to use multiple linear regression analysis. A nine-predictor multiple linear regression model was proposed. The nine predictor variables are Communication, Involvement/teacher empowerment, Development/Teacher training, Continuous improvement, Leadership/Administration’s Commitment, Data analysis/Measurement of results, Focus on students, Innovation Strategies, and Internationalization strategy. We conclude that some TQM variables have a significant association with the organizational performance of HEIs, namely, Involvement/teacher empowerment, and Development/teacher training. On the other hand, also the Innovation strategies and Internationalization strategy have a significant association with the organizational performance of HEIs. This research is of enormous importance for the study of HEIs, considering their role in the development of any country and its impact on society as creators of knowledge and science. Since these institutions increasingly must deal with extremely competitive market environments, knowledge of the factors that can assist in increasing the organizational performance of HEIs is of great relevance. (shrink)

Algerian universities rely on total quality management. TQM is one of the most successful strategic options for improving the quality of higher education. In addition, achieving academic accreditation and progress in international rankings. The study aims to address relevant contemporary issues by examining the impact of total quality management on the quality of higher education. The data were analyzed using a mixed-method approach; the study was done as a survey, with data collected via questionnaires issued to 610 students. (...) The questionnaire included Likert scale items that were quantitatively evaluated and modeled using structural equation modeling using Amos to accomplish the path analysis of the research model. Furthermore, qualitative data were acquired through interviews with 24 professors who are members of the Quality Cells, and qualitative data were evaluated using content analysis with NVivo. The study findings revealed that TQM has a direct and significant impact on the quality of graduates, scientific research, and community service in Algerian universities. The main results have been presented, and recommendations for future research are made. (shrink)

ABSTRACT:This study examines whether the empirical evidence on the relationship between corporate social performance (CSP) and corporate financial performance (CFP) differs depending on the publication outlet in which that evidence appears. This moderator meta-analysis, based on a total sample size of 33,878 observations, suggests that published CSP-CFP findings have been shaped by differences in institutional logics in different subdisciplines of organization studies. In economics, finance, and accounting journals, the average correlations were only about half the magnitude of the findings (...) published in Social Issues in Management, Business Ethics, or Business and Society journals (mean corrected correlation coefficientof.22 vs..49, respectively). Specifically, economists did not find null or negative CSP-CFP correlations, and average findings published in general management outlets (=.41) were closer to Social Issues in Management, Business Ethics, and Business and Society results than to findings reported in economics, finance, and accounting journals. (shrink)

This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total QualityManagement, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and (...) the patient, and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system. (shrink)

The development and international diffusion of total quality management as a normative theory are examined. It is shown that the main concepts associated with TQM contain an implicit Darwinist view of society made up only of institutions struggling to survive against increasingly ruthless competition. It is also shown that their development was the result of a process in which universities, large corporations, and government interacted to develop a response to the increasingly serious economic challenge that Japan presented to the (...) United States from the 1960s to the mid-1980s. The TQM paradigm was taken up by U.S. multinational corporations and the leading business and management schools of the United States and disseminated throughout the world. It is concluded that TQM has an ideological dimension designed to help diffuse to private and public service institutions throughout the world the dominant U.S. view of society and economy at the end of the twentieth century. (shrink)

For six decades, scholars have relied on Erving Goffman’s (1961) theory of total institutions to understand prison culture. Viewing prisons as total institutions offers insights into role performance and coercive control. However, mounting evidence suggests that prisons are not, in fact, total institutions. In this article, I first trace two credible challenges to the idea of prison as a total institution based on existing data: that prison gates open daily and that prisons operate within a (...) context of overlapping surveillance and punishment supported by broader political and economic interests. Second, I draw on empirical findings from my own yearlong ethnographic study inside one U.S. state women’s prison to illuminate a third challenge to the total institution paradigm. Using religion in prison as a case study, I describe the process of institutional infusion, in which an outside institution proffers attitudes, practices, and resources that individuals may draw on to shape their material and interpretive experiences within a host institution. Prisons are structured to accommodate institutional infusion, further calling their totality into question. I conclude that we can learn far more about the realities and inequalities of the prison experience by viewing prisons as porous institutions. (shrink)

Hegel’s philosophy has witnessed periods of revival and oblivion, at times considered to be an unrivalled and all-embracing system of thought, but often renounced with no less ardour. This book renews the dialogue with Hegel by looking at his legacy as a source of insight and judgement that helps us rethink contemporary economics. This book focuses on a concept of institution which is equally important for Hegel's political philosophy and for economic theory to date. The key contributions of this (...) Hegelian perspective on economics lead us to the synthesis of traditional approaches and new ideas gained in economic experiments and advanced by neuroeconomists, sociologists and cognitive scientists. The proper account of contemporary 'civil society' involves comprehending it as a historically evolving totality of individual minds, ideas and intersubjective structures that are mutually dependent, tied by recognitive relations, and assert themselves as a whole in the ongoing performative movement of 'objective spitit'. The ethics of recognition is paired with the ethics of associations that supports moral principles and gives them true, concrete universality. This unusual constellation of seemingly remote fields suggests that Hegel, read in a pragmatist mode, anticipated the new theories and philosophies of extended mind, social cognition and performativity. By providing a new conceptual apparatus and reformulating the theory of institutions in the light of this new synthesis, this book claims to give new meaning both to Hegel as interpreted from today, and to the social sciences. Seen from this perspective, such phenomena as cooperation in games, personal identity or justice in the version of Amartya Sen's 'realization-focused comparisons' are reinscribed into the logic of institutional theory. This 'Hegel' clearly goes beyond the limits of philosophical discussion and becomes a decisive reference for economists, sociologists, political scientists and other scholars who study the foundations and consequences of human sociality and try to explore and design the institutions necessary for a worthy common life. (shrink)

Emmanuel Levinas's early work inaugurated a tradition of thinking about alterity as at odds with generalized forms of knowledge that characterize political institutions. However, in his later work Levinas broaches but leaves underdeveloped the provocative idea that institutional modes of reasoning can provide a welcome home for alterity if they follow the wisdom of love. Against this backdrop, I argue that reading G. W. F. Hegel's early writings on neighbor love alongside his mature philosophy of the state offers us important (...) resources for articulating an institutional approach to alterity that offers a compelling solution to Levinas's concern with letting the other(s) be seen by institutions in a non‐totalizing manner. Across his early writings, Hegel positions love as the vehicle through which one comes to be at home in the institutions of one's community and the vehicle through which one can revise and expand the institutions of one's community in novel ways. My aim is to demonstrate that Hegel's early account of love provides an indispensable blueprint for understanding his mature account of the relation between the individual qua infinitely unique and modern political institutions. In turn, this will enable us to discern the institutional approach to alterity embedded in his thought. (shrink)

Originally presented to Roy Bhaskar’s postgraduate seminar at the Institute of Education, London, in 2012, this article situates and delineates the concept of totality and the cluster of related concepts in dialectical critical realism.

This book presents an analysis of the institutional development of selected social science and humanities disciplines in Argentina, France, Germany, Hungary, Italy, the Netherlands, Sweden and the United Kingdom. Where most narratives of a scholarly past are presented as a succession of ‘ideas,’ research results and theories, this collection highlights the structural shifts in the systems of higher education, as well as institutions of research and innovation within which these disciplines have developed. This institutional perspective will facilitate systematic comparisons between (...) developments in various disciplines and countries. Across eight country studies the book reveals remarkably different dynamics of disciplinary growth between countries, as well as important interdisciplinary differences within countries. In addition, instances of institutional contractions and downturns and veritable breaks of continuity under authoritarian political regimes can be observed, which are almost totally absent from narratives of individual disciplinary histories. This important work will provide a valuable resource to scholars of disciplinary history, the history of ideas, the sociology of education and of scientific knowledge. (shrink)

With increasing complexity of the networks of social interaction new and more abstract forms of trust are in need. A conceptual analysis of different forms of trust, namely interpersonal trust, trust in groups and institutional trust is given. It is argued that institutional trust cannot totally replace interpersonal trust. Institutional trust rather builds on more personal forms of trust in that it is primarily formed in personal encounters with salient representatives of the institution and presupposes trust in others trusting (...) in the institution. Any form of trust is grounded in some normative foundation. A trusting person can make herself vulnerable to the action of other individuals because she perceives those others as acting from shared aims or values. Thus, some sort of virtue is a prerequisite of any form of genuine trust. While institutional trust may in some respect be more easily acquired than interpersonal trust in general it may bear a fundamental problem: institutional trust may be extraordinary robust with regard to a wide range of behavioral experiences; thus, it may be enduringly maintained although in fact unjustified. In a concluding section the general analysis is illustrated by some reflections on the problem of trust in government. (shrink)

Violence can be physical and psychological. It can characterize personal actions, forms of group activity, and abiding social and political policy. This book includes all of these aspects within its focus on institutional forms of violence. Institution is also a broad category, ranging from formal arrangements such as the military, the criminal code, the death penalty and prison system, to more amorphous but systemic situations indicated by parenting, poverty, sexism, work, and racism. Violence is as complex as the human (...) beings who resort to it; its institutional forms pervade our relational lives. We are all participants in it as victims and perpetrators. The chapters in this book were written in the hope that violence can be explicated, even if not fully understood, and that such clarification can help us in devising less violent forms of living, even if it does not lead to its total abolition. The studies bring new aspects of violence to light and offer a number of suggestions for its remedy. (shrink)

In three parts, this volume in the AP-LS series explores the phenomena of captivity and risk management, guided and informed by the theory, method, and policy of psychological jurisprudence. The authors present a controversial thesis that demonstrates how the forces of captivity and risk management are sustained by several interdependent "conditions of control." These conditions impose barriers to justice and set limits on citizenship for one and all. Situated at the nexus of political/social theory, mental health law and jurisprudential ethics, (...) the book examines and critiques constructs such as offenders and victims; self and society; therapeutic and restorative; health; harm; and community. So, too, are three "total confinement" case law data sets on which this analysis is based. The volume stands alone in its efforts to systematically "diagnose" the moral reasoning lodged within prevailing judicial opinions that sustain captivity and risk management practices impacting: (1) the rights of juveniles found competent to stand criminal trial, the mentally ill placed in long-term disciplinary isolation, and sex offenders subjected to civil detention and community re-entry monitoring; (2) the often unmet needs of victims; and (3) the demands of an ordered society. Carefully balancing sophisticated insights with concrete and cutting-edge applications, the book concludes with a series of provocative, yet practical, recommendations for future research and meaningful reform within institutional practice, programming, and policy. (shrink)

The following is a short introduction to this special issue, which builds on and significantly extends and updates the research published recently in the Iwanami Series on Japanese economic history. First, we offer a modern interpretation of four institutional elements that are particularly important for understanding the growth path of the Japanese economy. These are (a) ownership; (b) regulation of factor markets; (c) labor mobility and (d) the judiciary. These four elements properly clarify the incentive structure behind economic institutions. We (...) then briefly explain how the four articles in this special issue—two at the macro level providing updated estimates of long-run rates of growth in gross domestic product (GDP) and total factor productivity (TFP), and two at the micro level examining institutional changes in specific markets—build on this unified framework, and deepen our understanding of Japanese economic history. (shrink)

The Institutional Animal Care and Use Committee is entrusted with assessing the ethics of proposed projects prior to approval of animal research. The role of the IACUC is detailed in legislation and binding rules, which are in turn inspired by the Three Rs: the principles of Replacement, Reduction, and Refinement. However, these principles are poorly defined. Although this provides the IACUC leeway in assessing a proposed project, it also affords little guidance. Our goal is to provide procedural and philosophical clarity (...) to the IACUC without mandating a particular outcome. To do this, we analyze the underlying logic of the Three Rs and conclude that the Three Rs accord animals moral standing, though not necessarily “rights” in the philosophical sense. We suggest that the Rs are hierarchical, such that Replacement, which can totally eliminate harm, should be considered prior to Reduction, which decreases the number of animals harmed, with Refinement being considered last. We also identify the need for a hitherto implicit fourth R: Reject, which allows the IACUC to refuse permission for a project which does not promise sufficient benefit to offset the pain and distress likely to be caused by the proposed research. (shrink)

When I was an undergraduate in Oxford, we were taught economics almost as though it were a natural science. The subject matter of economics might be different from physics, but only in the way that the subject matter of chemistry or biology is different from physics. The actual results were presented to us as if they were scientific theories. So when we learned that savings equals investment, it was taught in the same tone of voice as one teaches that force (...) equals mass times acceleration. And we learned that rational entrepreneurs sell where marginal cost equals marginal revenue in the way that we once learned that bodies attract in a way that is directly proportional to the product of their mass and inversely proportional to the square of the distance between them. At no point was it ever suggested that the reality described by economic theory was dependent on human beliefs and other attitudes in a way that was totally unlike the reality described by physics or chemistry. Some years ago, when I published The Construction of Social Reality, I was aware that it had implications for the ontology of economics, but I was not aware that there had already been an important revival of the tradition of institutional economics. It would be an understatement to say that I welcome this interest in institutions; I enthusiastically support it. But I think that in the institutional literature there is still an unclarity about what exactly an institution is. What is the ontology, the mode of existence, of institutional reality? This article tries to add to this discussion. Economics as a subject matter, unlike physics or chemistry, is largely concerned with institutional facts. Facts about money and interest rates, exchange and employment, corporations and the balance of payments, form the very heart of the subject of economics. When Lionel Robbins, in a classic work, tells us that “Economics is a study of the disposal of scarce commodities,”2 he takes for granted a huge invisible institutional.... (shrink)

Sustainable development is often framed as a social issue to which corporations should pay attention because it offers both opportunities and challenges. Through the use of institutional theory and the resource-based view of the firm, we shed some light on why, more than 20 years after sustainable development was first introduced, we see neither the adoption of this business model as dominant nor its converse, that is the total abandonment of the model as unworkable and unprofitable. We focus on (...) multinational corporations (MNCs) because they were among the organizations first called to take action. In order to illustrate the institutional pressures MNCs face and their strategic response to these pressures, we analysed four major oil and gas multinationals subject to similar sustainable development pressures – climate change, biodiversity, renewable energy development and social investment. We argue that normative and coercive isomorphism does not occur at the global level because sustainable development is largely a stakeholder-driven rather than a broad social pressure. That is, host country interpretation of sustainable development pressures varies across an MNC’s subsidiary network. Based on the analysis of the four major MNCs’ annual reports from 2000 to 2005, we argue that mimetic isomorphism may occur, but since it implies the use of complex and intangible resources, mimetic processes are slow, rare and discretionary. (shrink)

This issue’s “Legal Briefing” column covers recent legal developments involving total brain failure. Death determined by neurological criteria (DDNC) or “brain death” has been legally established for decades in the United States. But recent conflicts between families and hospitals have created some uncertainty. Clinicians are increasingly unsure about the scope of their legal and ethical treatment duties when families object to the withdrawal of physiological support after DDNC. This issue of JCE includes a thorough analysis of one institution’s (...) ethics consults illustrating this uncertainty. This experience is not unique. Hospitals across the country are seeing more DDNC disputes. Because of the similarity to medical futility disputes, some court cases on this topic were reviewed in a prior “Legal Briefing” column. But a more systematic review is now warranted. I categorize recent legal developments into the following nine categories: 1. History of Determining Death by Neurological Criteria2. Legal Status of Determining Death by Neurological Criteria3. Legal Duties to Accommodate Family Objections4. Protocols for Determining Death by Neurological Criteria5. Court Cases Seeking Physiological Support after DDNC6. Court Cases Seeking Damages for Intentionally Premature DDNC7. Court Cases Seeking Damages for Negligently Premature DDNC8. Court Cases Seeking Damages for Emotional Distress9. Pregnancy Limitations on DDNC. (shrink)

Total Quality Management (TQM) is an overall management philosophy that includes a set of principles whose application is increasing. In fact, the business world and public institutions, such as hospitals, universities or city councils, are implementing quality programs. However, despite the wide diffusion of TQM, the success rate of this type of initiative is limited and the results, heterogeneous. Academics and professionals are therefore trying to identify the keys that explain the success or failure of this kind of initiative. (...) Different explanations have been given, but most of the literature agrees that managerial commitment, implication and leadership are indispensable elements in a successful implementation of TQM. Nevertheless, a study on the specialised literature shows a terminological confusion between managerial commitment and managerial leadership. Is it the same to have a committed manager in the implementation process as to have a leader of the implementation process? The author of this paper defends the thesis that "commitment" and "leadership" are not synonymous, and states that only managerial leadership is able to promote and sustain profound organisational changes. The paper will show that, to understand the previous distinction, it is necessary to consider the ethical dimension of leadership. While committed managers may lead the process by using exclusively their power (with the necessary resource assignment), those who are leaders need authority. Authority goes further than power by generating a kind of confidence (trust) that is able to influence the members of the organisation and bring about profound changes, more than power alone can do. (shrink)

Cet article propose d’abord une analyse de la représentation de la personne souffrant de handicap ou de troubles mentaux telle qu’elle existe dans l’appel à la désinstitutionnalisation lancé par le Comité des droits des personnes handicapées (ONU). Il montre ensuite comment cette anthropologie, exigeante et parfaitement en phase avec les idéaux d’une société où l’autonomie individuelle est un droit et un devoir de chacun, est négociée en pratique sur le terrain d’un établissement de santé mentale qui accompagne les sorties de (...) l’institution de leurs patients au terme de leur séjour. Il prend pour objet empirique un dispositif central de ce processus, les “réunions-partenaires” et les échanges qui s’y tiennent entre le patient et d’autres acteurs. Le chapitre montre que, loin de l’abstraction des textes juridiques, la perception par les soignants du patient comme un partenaire est un processus fragile. Le partenariat est toujours conditionné au fait que les soignants soient non pas inquiets par l’incapacité d’une personne à se prendre en charge, mais rassurés par la démonstration de son appétence et de ses compétences pour l’autonomie. Dans ces négociations, le patient en santé mentale est toujours potentiellement, mais jamais totalement le partenaire de sa sortie de l’institution. (shrink)

Animal feeding operations have come under increased scrutiny as sources of water pollution. Due to the concentration of animals at individual locations and in certain regions, the local environment may not be able to use all of the nutrients contained in the manure. Particularly, problematic are waters being impaired by nitrogen and phosphorus from animal manure. Since federal and state regulations have not been totally successful in precluding water contamination from manure nutrients, scientists and policymakers might seek ways to encourage (...) the use of manure as a resource for crop production. By analyzing diverse state regulations, this paper identifies several strategies that would treat animal waste as a recyclable production input rather than a production byproduct. Citizens and regulators can encourage more sustainable livestock production by proffering regulations that mandate selected production requirements or practices. Agronomic rate regulations, limitations on manure application and timing, lagoon safety requirements, closure mandates, and alternative uses of manure constitute possibilities to remedy some pollution problems. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:DHARMA AND DESTRUCTION: BUDDHIST INSTITUTIONS AND VIOLENCE Christopher Ives Stonehill College Photographs ofgentle monks in saffron, the cottageindustry ofbooks on mindfulness, and the Dalai Lama's response to the Chinese invasion of Tibet have all helped portray Buddhism as the "religion of nonviolence." This representation ofBuddhism finds support in Buddhist texts, doctrines, and ritual practices, which often advocate ahimsa, nonharming or non-violence. The historical record, however, belies the portrayal of (...) Buddhism as a "religion of nonviolence." By reinterpreting early doctrines of ahimsa, Buddhist thinkers have legitimated violence in particular situations, practitioners have committed acts of violence, and Buddhist institutions have lent support to other institutions—social, political, and governmental —engaged in violence. In this paper I will examine Buddhist perpetration andjustifications ofviolence,1 with particularfocus on Japan, arguing that, historically, Buddhists' desire for institutional security has taken precedence over total rejection of violence. 1 I have restricted my discussion to the killing of other human beings. I do not consider suicide andthe killing ofnon-human animals. For a discussion ofBuddhism, (self-)sacrifice, and suicide in relation to Girard's theory, see Charles D. Orzech, '"Provoked Suicide' and the Victim's Behavior." 152Christopher Ives Non-violence The doctrine of ahimsa figures prominently in early and Theravadan Buddhism. The first ofthe five moral precepts (panca silani) in Buddhism is ahimsa, and in the Dhammapada the historical Buddha purportedly states, All are afraid of the rod. Of death all are afraid. Having made oneself the example, One should neither slay nor cause to slay. (Ross 202) The Buddhaalso sketches the consequences ofhurting orharming (himsa): Who with a rod does hurt Beings who desire ease [of nibbana], While himself looking for ease— He, having departed, ease does not get. Theravadan monastic codes and practices, such as the uposatha biweekly confession of moral transgressions and recitation of the 227 rules in the Patimokkha (Skt. Pratimoksa), are closely tiedto ahimsa. One ofthe Patimokkha's four "offenses of defeat" (parajika dharmas), for which the punishment is immediate expulsion of the monk or nun from the order, is killing another human being (Prebish 11). Mahayana texts continue this exhortation against violence. For example, in the Dasabhimika-sutra we read that a Buddhist "must not hate any being and cannot kill a living creature even in thought."2 Early Buddhist texts include depictions ofthe ideal Buddhist king, the cakravartin-raja or "monarch who turns the wheel [of the Dharma],"3 as an exemplar of nonviolence. Contemporary Buddhist activist Sulak Sivaraksa expresses it, this king is a "an ideal ruler, a world-conquering monarch, who subdued the earth through righteousness rather than war" (Sulak 129), and whose ten main duties include striving for peace and ruling with nonviolent benevolence (129). For well over 2000 years 2 Cited in Har Dayal, The Bodhisattva Doctrine, p. 199; quoted by Kraft, 5. In much ofthe first section of this paper I am indebted to Ken Kraft's introduction to his volume. 3 The metaphor ofturning the wheel refers to the historical Buddha's teaching ofthe Dharma and the later propagation of it by others. Dharma and Deconstruction153 Buddhists have lifted up Indian king Ashoka (c. 272-236) as an instantiation of this ideal. The early Buddhist doctrine of ahimsa should not, however, be construed as compassionate altruism. Luis Gómez and other scholars have delineated how ahimsa at first did not express some sort of underlying altruistic concern for the well-being of others. Vegetarianism and other ways of avoiding himsa, harming or violence, derived from ancient Indian ritual taboos againstblood and otherbodily liquids (Gómez 36). Buddhists ethicized and psychologized earlier notions of physical pollution, and advocated abstention fromviolenceprimarily as ameans ofself-cultivation, as a way to keep the mind pure, like an unstained cloth (36). (Scholars have even argued that the positive expression oíahimsa, the practice ofdirecting metta (loving-kindness) to others, originally had as much or more to do with the spiritual benefits accrued by the person directing the metta as it did with the well-being of the person receiving it. Only later was ahimsa furtherreinterpreted as positive regard forothers, as seen in the bodhisattva ideal of Mahayana Buddhism. Violence in Buddhist History At numerous times over... (shrink)

. Our ideas of disease try to explain it, and they aim at facilitating cures. In the process, they become entwined in sociocultural networks that have totalizing effects. Disease, however, counters this totalizing effect by revealing to us that our lives are fragments. Unless we engage this fragment character of disease and of our lives, we cannot properly understand disease or deal with it. HIV/AIDS clarifies these issues in an extraordinarily powerful fashion. Medical, legal, commercial, political, and institutional approaches to (...) disease overlook the fragment character of disease in favor of totalizing world- views. A theology of disease is necessary in order to maintain the focus on fragments. Unless we recognize this fragment character, we do not really understand our lives, and we do not really understand either disease or healing. (shrink)

With the development of the globalization of science and technology, innovation has become an important driving force for regional economic development. As a core element of regional innovation, financial R&D resources have also become a key element to enhance national innovation capabilities and national economic competitiveness. National and regional innovation capabilities have a direct impact. There are also many deep-seated problems behind the world-renowned achievements, such as irrational industrial structure, insufficient independent innovation capabilities, low resource utilization efficiency, and the service (...) quality and efficiency of financial institutions for the transformation of total factor productivity. These problems extremely restrict the efficiency upgrade and further development of our country’s total factor productivity. This study uses the DEA-Malmquist index model to measure the efficiency of fiscal R&D resource allocation in 28 provinces and regions in China in the past 10 years and uses Mapinfo12.0 software to analyze regional differences in the efficiency of fiscal R&D resource allocation in China from a spatial perspective. During the year, the overall R&D resource allocation efficiency of 28 provinces and autonomous regions in China has shown an upward trend. The efficiency of fiscal R&D resource allocation and the concentration of financial factors have had a positive impact on total factor productivity, transform and upgrade factors, increase total factor productivity, and provide empirical evidence for building a strong country. (shrink)

BackgroundInstitutional review boards (IRBs) are formally designated to review, approve, and monitor biomedical research. They are responsible for ensuring that researchers comply with the ethical guidelines concerning human research participants. Given that IRBs might face different obstacles that cause delays in their processes or conflicts with investigators, this study aims to report the functions, roles, resources, and review process of IRBs in Saudi Arabia.MethodThis was a cross-sectional self-reported survey conducted from March 2021 to March 2022. The survey was sent to (...) 53 IRB chairpersons and the administration directors (or secretary) across the country through email after receiving verbal consent. The validated survey consisted of eight aspects: (a) organizational aspects, (b) membership and educational training, (c) submission arrangements and materials, (d) minutes, (e) review procedures, (f) communicating a decision, (g) continuing review, and (h) research ethics committee (REC) resources. A total of 200 points indicated optimal IRB functions.ResultsTwenty-six IRBs across Saudi Arabia responded to the survey. Overall, the IRBs in this study scored a total of 150/200 of the points on the self-assessment tool. Relatively newer IRBs (established less than ten years ago) conducted meetings at least once in a month, had annual funding, had more balanced gender representation, tended to score higher than older IRBs. The organizational aspect score was the lowest among all items in the survey (14.3 score difference, p-value < 0.01). The average turnaround time for expedited research from proposal submission to final decision was 7 days, while it was 20.5 days for the full committee review.ConclusionSaudi IRBs performed generally well. However, there is room for focused improvement with respect to extra resources and organizational issues that require closer evaluation and guidance from the regulatory bodies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Memory and the Instituting Social ImaginaryNancy Nyquist Potter*, PhD (bio)Emily Walsh's Article on the way that colonialism is perpetuated in psychiatry through dominant collective memory is simultaneously exciting and challenging, and merits active engagement toward making changes (Walsh, 2022). This presents a challenge to clinicians to address entrenched, often subconscious, ways of being with and helping racialized people with historical memories and current experiences.Such changes are necessary in that (...) dominant collective memory is contributory to mental illness, as Walsh writes. It also contributes to what Walsh calls a traumatic loop, whichinvolves feeling unwell due to racist abuse or the effects racialization has on the psyche, then being unable to voice these concerns to the practitioners who desire to help you. Not having the opportunity to voice these concerns can make patients feel as though these memories are not important, thereby invalidating their own negative experiences of racialization.(Walsh, 2022, p. 232)For these reasons, it is crucial that psychiatrists fully understand the harm they can do by reproducing dominant collective memories and work to change this in themselves and in the institutional systems in which they see patients/service users.I focus on one question briefly and then turn to the heart of active engagement.The question concerns what the content of dominant collective memory is and how it might play out in a particular interaction in psychiatry. This is important for clinicians who want to learn what sorts of changes need to be made in order not to continue to enact colonialism and to avoid doing harm. Walsh does a fine job setting out forms of memory and how Fanon (and she) suggest that clinicians can assist patients toward liberation from dominant collective memory. Yet I am left with uncertainty about what sorts of dominant memory serve to deny the violence in the colonized. A bit of filling out on this idea would help the motivated to move toward change.A pressing question is how to facilitate such changes. Both the limitations and the possibilities of the social imaginary can help us understand why change is so difficult and yet how it nevertheless is possible and, in fact, necessary. The social imaginary, as Code explains it, "refers to implicit but effective systems" of values, meanings, interpretations of reality, norms for living, what counts as knowing and who can be knowers, that are found in a social-political order in ways that shape our sense of self, our ways of relating to others, our responsibilities, and a sense of place (Code, 2008, pp. 31–32). The instituted social imaginary, then, tells us what sorts of persons we should be and [End Page 241] how we should see and treat others. It shapes memories and limits which memories—and whose memories—get acknowledged and which ones and whose memories are erased or ignored. It is difficult to see for what it is because it is implicit and assumed to be fixed and natural. However, this is the instituted social imaginary, where the content of the imaginary is taken as given and is naturalized. It trades in stereotypes of Black and Indigenous and other people of color as well as stereotypes of queers, people living with disabilities, the homeless, and others. It is harmful in that it perpetuates those stereotypes, controls patients/ service users, negates their own personal and community identities, and erases episodic memory. It is difficult to change because it is entrenched and often not questioned. Nevertheless, the instituted social imaginary is not totalizing. There is hope, and energy, and excitement to be found in active engagement with an instituting social imaginary. Here, we find people and communities working to critique the given, the naturalized, and even ourselves: "Imaginatively initiated counterpossibilities interrogate the social structure to destabilize its pretensions to naturalness and wholeness, to initiate a new making" (Code, 2008, pp. 34–35). In the final section, I begin to fill out these moves in relation to Walsh's work on memory and psychiatry.Clinicians are trained to be good listeners, and many of them already practice good listening skills in interacting with their patients/service users. However, many patients' experiences... (shrink)

OBJECTIVE: Following two randomized controlled trials that demonstrated reduced mortality and better neurological outcome in cardiac arrest patients, mild therapeutic hypothermia was implemented in many intensive care units. Up to now, no large observational studies have confirmed the beneficial effects of mild therapeutic hypothermia. DESIGN: Internet-based survey combined with a retrospective, observational study. PATIENTS: All patients admitted to an intensive care unit in The Netherlands after cardiac arrest from January 1, 1999 until January 1, 2009. DATA SOURCE: Dutch National Intensive (...) Care Evaluation database. METHODS: The moment of implementation of mild therapeutic hypothermia for each hospital participating in the Dutch National Intensive Care Evaluation database was determined with an Internet survey. To compare mortality before and after implementation of mild therapeutic hypothermia, the odds ratio adjusted for Simplified Acute Physiology Score II score, age, gender, propensity score, and in- or out-of-hospital cardiac arrest was calculated. Patients were excluded if 1) they were admitted to an intensive care unit that did not respond to the survey, 2) they were admitted within 3 months after implementation of mild therapeutic hypothermia, 3) they had a Glasgow Coma Scale score of >8, or 4) they did not satisfy the Simplified Acute Physiology Score II inclusion criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 13,962 patients were admitted to an intensive care unit following cardiac arrest. In total 8,645 patients were excluded, 5,544 because of a Glasgow Coma Scale score of >8. Of the resultant 5,317 patients, 1,547 patients were treated before and 3,770 patients after implementation of mild therapeutic hypothermia. Patients admitted after implementation of mild therapeutic hypothermia had lower minimal and maximal temperatures (p < .0001) during the first 24 hrs on the intensive care unit compared to patients admitted before implementation of mild therapeutic hypothermia. The adjusted odds ratio of the hospital mortality of patients treated after implementation of mild therapeutic hypothermia was 0.80 (95% confidence interval of 0.65-0.98, p = .029). CONCLUSION: The results of this retrospective, observational survey suggest that implementation of mild therapeutic hypothermia in Dutch intensive care units is associated with a 20% relative reduction of hospital mortality in cardiac arrest patients. (shrink)

Research integrity is fundamental to the validity and reliability of scientific findings, and for ethical conduct of research. As part of PRINTEGER (Promoting Integrity as an Integral Dimension of Excellence in Research), this study explores the views of researchers, research managers, administrators, and governance advisors in Estonia, Italy, Norway and UK, focusing specifically on their understanding of institutional and organisational influences on research integrity.A total of 16 focus groups were conducted. Thematic analysis of the data revealed that competition is (...) pervasive and appeared in most themes relating to integrity. The structural frameworks for research such as funding, evaluation and publication were thought to both protect and, more commonly, undermine integrity. In addition, institutional systems, including workload and research governance, shaped participants’ day-to-day work environment, also affecting research integrity. Participants also provided ideas for promoting research integrity, including training, and creating conditions that would be supportive of research integrity.These findings support a shift away from individual blame and towards the need for structural and institutional changes, including organisations in the wider research environment, for example funding bodies and publishing companies. (shrink)

The paper shows different approaches to creativity, i.e. emergence of new meanings, in Merleau-Ponty and Patočka. The comparison is based mainly on Merleau-Ponty’s lectures L’institution dans l’histoire personnelle et publique (1954/55) and Patočka’s project Negative Platonism (1953). Despite some similarities evident in the key concepts “institution” and “transcendence”, there is a decisive difference between the two approaches concerning the temporality of creation. Whereas Merleau-Ponty likens the temporality of institution to future perfect tense, emphasizing the intertwining of present (...) and future events, Patočka understands novelty as something totally different from the present state of affairs. In his eyes, the question of how something new can arise equals the question of how an attitude of distance to existing traditions can be achieved. Contrary to Patočka, Merleau-Ponty argues that any living tradition tends towards its own transformation and presents a case of self-transcendence because it is governed by the principle of divergence (écart). Finally, we argue that some aspects of these two approaches both complement each other, and also show the limits of each other. (shrink)

It is widely believed to be permissible for a physician to discontinue any treatment upon the request of a competent patient. Many also believe it is never permissible for a physician to intentionally kill a patient. I argue that the prospect of deactivating a patient’s artificial heart presents us with a dilemma: either the first belief just mentioned is false or the second one is. Whichever horn of the dilemma we choose has significant implications for contemporary medical ethics.

Total Quality Management (TQM) is an overall management philosophy that includes a set of principles whose application is increasing. In fact, the business world and public institutions, such as hospitals, universities or city councils, are implementing quality programs. However, despite the wide diffusion of TQM, the success rate of this type of initiative is limited and the results, heterogeneous. Academics and professionals are therefore trying to identify the keys that explain the success or failure of this kind of initiative. (...) Different explanations have been given, but most of the literature agrees that managerial commitment, implication and leadership are indispensable elements in a successful implementation of TQM.Nevertheless, a study on the specialised literature shows a terminological confusion between managerial commitment and managerial leadership. Is it the same to have a committed manager in the implementation process as to have a leader of the implementation process? The author of this paper defends the thesis that "commitment" and "leadership" are not synonymous, and states that only managerial leadership is able to promote and sustain profound organisational changes. (shrink)

BackgroundThe Catalan Institute of Health is the largest health services public provider in Catalonia. “CIH Code of Ethics Virtual Forum”, was created within the Intranet of the CIH to facilitate participation among their employees. The current study aims to: a) Analyse the CIH workers’ assessment of their own, their colleagues’ and the organization’s observance of ethical values; b) Identify the opinions, attitudes, experiences and practices related to the ethical values from the discourse of the workers that contributed voluntarily to the (...) CEVF.MethodsMixed methods study with convergent parallel design:1.Cross sectional study by means of a self-administered, ad hoc, anonymous questionnaire to assess the observance of the ethical values of the CIH according to the participants. A total of 712 workers responded to the questionnaire. A descriptive, bivariate analysis of the results was carried out. 2.Qualitative study to determine the meaning for the workers of the ethical values put forward by the organization. Their individual opinions and experiences were explored by means of a thematic contents analysis of 225 comments posted in the CEVF. The study was conducted between May and December 2008.ResultsThe average score for observance of the CE by the respondents themselves was high, between 3.5-4/5 for the observance by their colleagues and close to 3/5 for the CIH management. These results do not change when we compare by gender, age group and professional discipline. The comments on the values are information-rich, they mirror the ethical environment of the institution and show various ethical dilemmas and suggestions.ConclusionsResults show that it is feasible for a publicly funded health care organization to develop a CE with the participation of employees and the support of the management. Results underscore the relevance of this strategy for the implementation, improvement and update of the CE as a responsibility shared by all workers. Practices consistent with ethical values are rewarded by social approval, enhance employee’s confidence and coherence in decision-making and improve public engagement and institutional policies. (shrink)

Background The European Union aims to optimize patient protection and efficiency of health-care research by harmonizing procedures across Member States. Nonetheless, further improvements are required to increase multicenter research efficiency. We investigated IRB procedures in a large prospective European multicenter study on traumatic brain injury, aiming to inform and stimulate initiatives to improve efficiency. Methods We reviewed relevant documents regarding IRB submission and IRB approval from European neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury. (...) Documents included detailed information on IRB procedures and the duration from IRB submission until approval. They were translated and analyzed to determine the level of harmonization of IRB procedures within Europe. Results From 18 countries, 66 centers provided the requested documents. The primary IRB review was conducted centrally or locally and primary IRB approval was obtained after one, two or three review rounds with a median duration of respectively 50 and 98 days until primary IRB approval. Additional IRB approval was required in 55% of countries and could increase duration to 535 days. Total duration from submission until required IRB approval was obtained was 114 days and appeared to be shorter after submission to local IRBs compared to central IRBs. Conclusion We found variation in IRB procedures between and within European countries. There were differences in submission and approval requirements, number of review rounds and total duration. Research collaborations could benefit from the implementation of more uniform legislation and regulation while acknowledging local cultural habits and moral values between countries. (shrink)