Filozofia antyczna wobec problemu interpretacji. Rozwój alegorezy od przedsokratyków do Arystotelesa

The present work examines the beginnings of ancient hermeneutics. More specifically, it discusses the connection between the rise of the practice of allegoresis, on the one hand, and the emergence of the first theory of figurative language, on the other. Thus, this book investigates the specific historical and cultural circumstances that enabled the ancient Greeks not only to discover the possibility of allegorical interpretation, but also to treat figurative language as a philosophical problem. By posing difficulties in understanding the enigmatic sense of various esoteric doctrines, poems, oracles and riddles, figurative language created the context for theoretical reflection on the meaning of these “messages”. Hence, ancient interpreters began to ponder over the nature and functions of figurative (“enigmatic”) language as well as over the techniques of its proper use and interpretation. Although the practice of allegorical interpretation was closely linked to the development of the whole of ancient philosophy, the present work covers only the period from the 6th to the 4th century B.C. It concentrates, then, on the philosophical and cultural consequences of allegoresis in the classical age. The main thesis advocated here has it that the ancient Greeks were in-clined to regard allegory as a cognitive problem rather than merely as a stylistic or a literary one. When searching for the hidden meanings of various esoteric doc-trines, poems, oracles and riddles, ancient interpreters of these “messages” assumed allegory to be the only tool suitable for articulating certain matters. In other words, it was their belief that the use of figurative language resulted from the necessity of expressing things that were otherwise inexpressible. The present work has been organized in the following manner. The first part contains historical and philological discussions that provide the point of departure for more philosophical considerations. This part consists of two introductory chapters. Chapter one situates the practice of allegorical interpretation at the borderline of two different traditions: the rhetorical-grammatical and the hermeneutical. In order to clearly differentiate between the two, chapter one distinguishes between allegory and allegoresis, on the one hand, and allegoresis and exegesis, on the other. While pointing to the conventionality (and even arbitrariness) of such distinctions, the chapter argues, nevertheless, for their heuristic usefulness. The remaining part of chapter one focuses on a historical and philological reconstruction of the most important conceptual tools of ancient hermeneutics. Discussing the semantics of such terms as allēgoría, hypónoia, ainigma and symbolon proves important for at least two crucial reasons. Firstly, it reveals the mutual affinity between allegoresis and divination, i.e., practices that are inherently connected with the need to discover the latent meaning of the “message” in question (whether poem or oracle). Secondly, these philological analyses bring to light the specificity of the ancient understanding of such concepts as allegory or symbol. It goes without saying that antiquity employed these terms in a manner quite disparate from modernity. Chapter one concludes with a discussion of ancient views on the cognitive value of figurative (“enigmatic”) language. Chapter two focuses on the role that allegoresis played in the process of transforming mythos into logos. It is suggested here that it was the practice of allegorical interpretation that made it possible to preserve the traditional myths as an important point of reference for the whole of ancient philosophy. Thus, chapter two argues that the existence of a clear opposition between mythos into logos in Preplatonic philosophy is highly questionable in light of the indisputable fact that the Presocratics, Sophists and Cynics were profoundly convinced about the cognitive value of mythos (this conviction was also shared by Plato and Aristotle, but their attitude towards myth was more complex). Consequently, chapter two argues that in Preplatonic philosophy, myth played a function analogous to the concepts discussed in chapter one (i.e., hidden meanings, enigmas and symbols), for in all these cases, ancient interpreters found tools for conveying issues that were otherwise difficult to convey. Chapter two concludes with a classification of various types of allegoresis. Whilst chapters one and two serve as a historical and philological introduction, the second part of this book concentrates on the close relationship between the development of allegoresis, on the one hand, and the flowering of philosophy, on the other. Thus, chapter three discusses the crucial role that allegorical interpretation came to play in Preplatonic philosophy, chapter four deals with Plato’s highly complex and ambivalent attitude to allegoresis, and chapter five has been devoted to Aristotle’s original approach to the practice of allegorical interpretation. It is evident that allegoresis was of paramount importance for the ancient thinkers, irrespective of whether they would value it positively (Preplatonic philosophers and Aristotle) or negatively (Plato). Beginning with the 6th century B.C., the ancient practice of allegorical interpretation is motivated by two distinct interests. On the one hand, the practice of allegorical interpretation reflects the more or less “conservative” attachment to the authority of the poet (whether Homer, Hesiod or Orpheus). The purpose of this apologetic allegoresis is to exonerate poetry from the charges leveled at it by the first philosophers and, though to a lesser degree, historians. Generally, these allegorists seek to save the traditional paideia that builds on the works of the poets. On the other hand, the practice of allegorical interpretation reflects also the more or less “progressive” desire to make original use of the authority of the poet (whether Homer, Hesiod or Orpheus) so as to promote a given philosophical doctrine. The objective of this instrumental allegoresis is to exculpate philosophy from the accusations brought against it by the more conservative circles. Needless to say, these allegorists significantly contribute to the process of the gradual replacing of the mythical view of the world with its more philosophical explanation. The present book suggests that it is the philosophy of Aristotle that should be regarded as a sort of acme in the development of ancient hermeneutics. The reasons for this are twofold. On the one hand, the Stagirite positively values the practice of allegoresis, rehabilitating, thus, the tradition of Preplatonic philosophy against Plato. And, on the other hand, Aristotle initiates the theoretical reflection on figurative (“enigmatic”) language. Hence, in Aristotle we encounter not only the practice of allegoresis, but also the theory of allegory (although the philosopher does not use the term allēgoría). With the situation being as it is, the significance of Aristotle’s work cannot be overestimated. First of all, the Stagirite introduces the concept of metaphor into the then philosophical considerations. From that moment onwards, the phenomenon of figurative language becomes an important philosophical issue. After Aristo-tle, the preponderance of thinkers would feel obliged to specify the rules for the appropriate use of figurative language and the techniques of its correct interpretation. Furthermore, Aristotle ascribes to metaphor (and to various other “excellent” sayings) the function of increasing and enhancing our knowledge. Thus, according to the Stagirite, figurative language is not only an ornamental device, but it can also have a significant explanatory power. Finally, Aristotle observes that figurative expressions cause words to become ambiguous. In this context, the philosopher notices that ambiguity can enrich the language of a poet, but it can also hinder a dialectical discussion. Accordingly, Aristotle is inclined to value polysemy either positively or negatively. Importantly, however, the Stagirite is perfectly aware of the fact that in natural languages ambiguity is unavoidable. This is why Aristotle initiates a syste-matic reflection on the phenomenon of ambiguity and distinguishes its various kinds. In Aristotle, ambiguity is, then, both a problem that needs to be identified and a tool that can help in elucidating intricate philosophical issues. This unique approach to ambiguity and figurative (“enigmatic”) language enabled Aristotle to formulate invaluable intuitions that still await appropriate recognition.

Medicação Intracanalar em Endodontia

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

Litigation-Generated Science: Why Should We Care?

BACKGROUND: In a 1994 Ninth Circuit decision on the remand of Daubert v. Merrell Dow Pharmaceuticals, Inc., Judge Alex Kosinski wrote that science done for the purpose of litigation should be subject to more stringent standards of admissibility than other science. OBJECTIVES: We analyze this proposition by considering litigation-generated science as a subset of science involving conflict of interest. DISCUSSION: Judge Kosinski's formulation suggests there may be reasons to treat science involving conflict of interest differently but raises questions about whether litigation-generated science should be singled out. In particular we discuss the similar problems raised by strategically motivated science done in anticipation of possible future litigation or otherwise designed to benefit the sponsor and ask what special treatment, if any, should be given to science undertaken to support existing or potential future litigation. CONCLUSION: The problems with litigation-generated science are not special. On the contrary, they are very general and apply to much or most science that is relevant and reliable in the courtroom setting.

Horsham Properties Group Ltd v Clark: possession - mortgagee's right or discretionary remedy?

Comments on the Chancery Division decision in Horsham Properties Group Ltd v Clark on whether a mortgagee's exercise of its contractual right, on the mortgagor falling into arrears, to appoint receivers such that the property could be sold and possession obtained without triggering the court's discretionary powers pursuant to the Administration of Justice Act 1970 s.36 infringed the mortgagor's rights under the European Convention on Human Rights 1950 Protocol 1 art.1. Considers the implications of proposed reforms recasting the mortgagee's right to possession as a discretionary remedy. [From Legal Journals Index]

Wide Variation in Adenoma Detection Rates at Screening Flexible Sigmoidoscopy

Background & Aims: Wide between-center variation in adenoma detection rates (ADRs) was observed in the U.K. Flexible Sigmoidoscopy Screening Trial (overall, 12.1%; range, 8.6%-15.9%; P <0.0001). The aim of this study was to determine whether the observed differences could be attributed to varying performance by endoscopists, to examine the effect of experience on performance, and to identify an attainable, standard ADR to which endoscopists could aspire. 

Methods: Thirteen medical endoscopists, one per trial center, each performed about 3000 examinations (200 per month) using the same equipment and protocol. Overall and monthly ADRs were compared using multivariable logistic regression. 

Results: Differences in ADRs were not explained by patient characteristics, incidence of colorectal cancer in the local population, or the endoscopists' medical specialty or previous experience. Average ADRs increased significantly with screening experience (up to 400 examinations). Endoscopists were classified as higher, intermediate, or lower adenoma detectors, and performance levels were maintained over time. Higher detectors had ADRs of 15% overall (men, 20%; women, 10%) and also detected more adenomas per case (higher/lower detectors, 21.7/10.4 adenomas per :100 examinations). 

Conclusions: The differences in ADRs were due to variation in performance of the endoscopists. Long-term follow-up will determine whether this variation is clinically important. We suggest that the standards in higher detecting centers should be achievable by all endoscopists screening unscreened populations aged older than 55 years. Endoscopists should aim to stay above the lower 95% confidence interval band for 200 examinations (10% overall; 5% in women, 15% in men).

Participation of 8-12 year old children with cerebral palsy: a cross-sectional European Survey

Objectives
To evaluate how involvement in life situations (participation) in children with cerebral palsy varies with type and severity of impairment and to investigate geographical variation in participation.

Design
Cross sectional study. Trained interviewers visited parents of children with cerebral palsy; multilevel multivariable regression related participation to impairments, pain, and sociodemographic characteristics.

Setting
Eight European regions with population registers of children with cerebral palsy; one further region recruited children from multiple sources.

Participants
1174 children aged 8-12 with cerebral palsy randomly selected from the population registers, 743 (63%) joined in the study; the further region recruited 75 children.

Main outcome measure
Children’s participation assessed by the Life-H questionnaire covering 10 main areas of daily life. Scoring ignored adaptations or assistance required for participation.

Results
Children with pain and those with more severely impaired walking, fine motor skills, communication, and intellectual abilities had lower participation across most domains. Type of cerebral palsy and problems with feeding and vision were associated with lower participation for specific domains, but the sociodemographic factors examined were not. Impairment and pain accounted for up to a sixth of the variation in participation. Participation on all domains varied substantially between regions: children in east Denmark had consistently higher participation than children in other regions. For most participation domains, about a third of the unexplained variation could be ascribed to variation between regions and about two thirds to variation between individuals.

Conclusions
Participation in children with cerebral palsy should be assessed in clinical practice to guide intervention and assess its effect. Pain should be carefully assessed. Some European countries facilitate participation better than others, implying some countries could make better provision. Legislation and regulation should be directed to ensuring this happens.

New Technology and Researchers’ Access to Court and Tribunal Information: the need for European analysis

We discuss the limitations and rights which may affect the researcher’s access to and use of digital, court and administrative tribunal based information. We suggest that there is a need for a European-wide investigation of the legal framework which affects the researcher who might wish to utilise this form of information. A European-wide context is required because much of the relevant law is European rather than national, but much of the constraints are cultural. It is our thesis that research improves understanding and then improves practice as that understanding becomes part of public debate. If it is difficult to undertake research, then public debate about the court system – its effectiveness, its biases, its strengths – becomes constrained. Access to court records is currently determined on a discretionary basis or on the basis of interpretation of rules of the court where these are challenged in legal proceedings. Anecdotal evidence would suggest that there are significant variations in the extent to which court documents such as pleadings, transcripts, affidavits etc are made generally accessible under court rules or as a result of litigation in different jurisdictions or, indeed, in different courts in the same jurisdiction. Such a lack of clarity can only encourage a chilling of what might otherwise be valuable research. Courts are not, of course, democratic bodies. However, they are part of a democratic system and should, we suggest – both for the public benefit and for their proper operation – be accessible and criticisable by the independent researcher. The extent to which the independent researcher is enabled access is the subject of this article. The rights of access for researchers and the public have been examined in other common law countries but not, to date, in the UK or Europe.

Moments of Recognition:The Four Semester Studio in QUB

It is a legitimate assertion that the common ground of work of worth in architecture, whether theoretical or built comes from a firmly held position on the part of the author. In addition to delivery key competencies architectural education should act to support the formation of such a position in the student, or to make students aware of the possibility of holding such a position.

It is with this in mind perhaps that intensive unit-based diploma and masters structures are increasingly becoming the standard structure for for schools of architecture across the UK. The strengths of such a structure are most evident when the school, either by virtue of financial strength or geographic location is able to attract a diverse range of contrasting positions to bear in the formation of these units. In effect the offering to the student is a short, intensive immersion into a clear line of thought based on the position of those running the unit. Research is channeled by those running the unit to the work of the students. A single cohort of students therefore is able to observe and understand a wide range of ways of thinking about the subject whether or not they are participants in a unit or not. It is axiomatic that where this structure is applied in the absence of these resources the result can be less helpful, individual units are differentiated not to reflect the interests of those running the unit but for the sake of difference as its own end.

In structuring the M.Arch programme in Queens University Belfast the reality of our somewhat peripheral location was placed at the forefront of our considerations. A single 4 semester studio is offered. The first three semesters are carefully structured to offer a range of directed and self directed projects to the students. By interrogation of these projects, and work undertaken at undergraduate level the aim is to assist the students to identify a personal position on architecture, which is then developed in the thesis in semester four. Research and design outputs are emergent from the interest of the student body, cultivated by staff who have the time over the four semesters to get to know all aspects of a students interests.

This paper will lay out this structure and some of the projects run within it. Now having delivered two graduating years the successes and challenges of the system will be laid out by reference to several case studies of individual student experiences of the structure.

Robust food supply supply chains:An integrated framework for vulnerability assessment and disturbance management

The operation of supply chains (SCs) has for many years been focused on efficiency, leanness and responsiveness. This has resulted in reduced slack in operations, compressed cycle times, increased productivity and minimised inventory levels along the SC. Combined with tight tolerance settings for the realisation of logistics and production processes, this has led to SC performances that are frequently not robust. SCs are becoming increasingly vulnerable to disturbances, which can decrease the competitive power of the entire chain in the market. Moreover, in the case of food SCs non-robust performances may ultimately result in empty shelves in grocery stores and supermarkets.
The overall objective of this research is to contribute to Supply Chain Management (SCM) theory by developing a structured approach to assess SC vulnerability, so that robust performances of food SCs can be assured. We also aim to help companies in the food industry to evaluate their current state of vulnerability, and to improve their performance robustness through a better understanding of vulnerability issues. The following research questions (RQs) stem from these objectives:
RQ1: What are the main research challenges related to (food) SC robustness?
RQ2: What are the main elements that have to be considered in the design of robust SCs and what are the relationships between these elements?
RQ3: What is the relationship between the contextual factors of food SCs and the use of disturbance management principles?
RQ4: How to systematically assess the impact of disturbances in (food) SC processes on the robustness of (food) SC performances?
To answer these RQs we used different methodologies, both qualitative and quantitative. For each question, we conducted a literature survey to identify gaps in existing research and define the state of the art of knowledge on the related topics. For the second and third RQ, we conducted both exploration and testing on selected case studies. Finally, to obtain more detailed answers to the fourth question, we used simulation modelling and scenario analysis for vulnerability assessment.
Main findings are summarised as follows.
Based on an extensive literature review, we answered RQ1. The main research challenges were related to the need to define SC robustness more precisely, to identify and classify disturbances and their causes in the context of the specific characteristics of SCs and to make a systematic overview of (re)design strategies that may improve SC robustness. Also, we found that it is useful to be able to discriminate between varying degrees of SC vulnerability and to find a measure that quantifies the extent to which a company or SC shows robust performances when exposed to disturbances.
To address RQ2, we define SC robustness as the degree to which a SC shows an acceptable performance in (each of) its Key Performance Indicators (KPIs) during and after an unexpected event that caused a disturbance in one or more logistics processes. Based on the SCM literature we identified the main elements needed to achieve robust performances and structured them together to form a conceptual framework for the design of robust SCs. We then explained the logic of the framework and elaborate on each of its main elements: the SC scenario, SC disturbances, SC performance, sources of food SC vulnerability, and redesign principles and strategies.
Based on three case studies, we answered RQ3. Our major findings show that the contextual factors have a consistent relationship to Disturbance Management Principles (DMPs). The product and SC environment characteristics are contextual factors that are hard to change and these characteristics initiate the use of specific DMPs as well as constrain the use of potential response actions. The process and the SC network characteristics are contextual factors that are easier to change, and they are affected by the use of the DMPs. We also found a notable relationship between the type of DMP likely to be used and the particular combination of contextual factors present in the observed SC.
To address RQ4, we presented a new method for vulnerability assessments, the VULA method. The VULA method helps to identify how much a company is underperforming on a specific Key Performance Indicator (KPI) in the case of a disturbance, how often this would happen and how long it would last. It ultimately informs the decision maker about whether process redesign is needed and what kind of redesign strategies should be used in order to increase the SC’s robustness. The VULA method is demonstrated in the context of a meat SC using discrete-event simulation. The case findings show that performance robustness can be assessed for any KPI using the VULA method.
To sum-up the project, all findings were incorporated within an integrated framework for designing robust SCs. The integrated framework consists of the following steps: 1) Description of the SC scenario and identification of its specific contextual factors; 2) Identification of disturbances that may affect KPIs; 3) Definition of the relevant KPIs and identification of the main disturbances through assessment of the SC performance robustness (i.e. application of the VULA method); 4) Identification of the sources of vulnerability that may (strongly) affect the robustness of performances and eventually increase the vulnerability of the SC; 5) Identification of appropriate preventive or disturbance impact reductive redesign strategies; 6) Alteration of SC scenario elements as required by the selected redesign strategies and repeat VULA method for KPIs, as defined in Step 3.
Contributions of this research are listed as follows. First, we have identified emerging research areas - SC robustness, and its counterpart, vulnerability. Second, we have developed a definition of SC robustness, operationalized it, and identified and structured the relevant elements for the design of robust SCs in the form of a research framework. With this research framework, we contribute to a better understanding of the concepts of vulnerability and robustness and related issues in food SCs. Third, we identified the relationship between contextual factors of food SCs and specific DMPs used to maintain robust SC performances: characteristics of the product and the SC environment influence the selection and use of DMPs; processes and SC networks are influenced by DMPs. Fourth, we developed specific metrics for vulnerability assessments, which serve as a basis of a VULA method. The VULA method investigates different measures of the variability of both the duration of impacts from disturbances and the fluctuations in their magnitude.
With this project, we also hope to have delivered practical insights into food SC vulnerability. First, the integrated framework for the design of robust SCs can be used to guide food companies in successful disturbance management. Second, empirical findings from case studies lead to the identification of changeable characteristics of SCs that can serve as a basis for assessing where to focus efforts to manage disturbances. Third, the VULA method can help top management to get more reliable information about the “health” of the company.
The two most important research opportunities are: First, there is a need to extend and validate our findings related to the research framework and contextual factors through further case studies related to other types of (food) products and other types of SCs. Second, there is a need to further develop and test the VULA method, e.g.: to use other indicators and statistical measures for disturbance detection and SC improvement; to define the most appropriate KPI to represent the robustness of a complete SC. We hope this thesis invites other researchers to pick up these challenges and help us further improve the robustness of (food) SCs.

The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma:A systematic review and economic evaluation

Objectives: To assess whether open angle glaucoma (OAG) screening meets the UK National Screening Committee criteria, to compare screening strategies with case finding, to estimate test parameters, to model estimates of cost and cost-effectiveness, and to identify areas for future research. Data sources: Major electronic databases were searched up to December 2005. Review methods: Screening strategies were developed by wide consultation. Markov submodels were developed to represent screening strategies. Parameter estimates were determined by systematic reviews of epidemiology, economic evaluations of screening, and effectiveness (test accuracy, screening and treatment). Tailored highly sensitive electronic searches were undertaken. Results: Most potential screening tests reviewed had an estimated specificity of 85% or higher. No test was clearly most accurate, with only a few, heterogeneous studies for each test. No randomised controlled trials (RCTs) of screening were identified. Based on two treatment RCTs, early treatment reduces the risk of progression. Extrapolating from this, and assuming accelerated progression with advancing disease severity, without treatment the mean time to blindness in at least one eye was approximately 23 years, compared to 35 years with treatment. Prevalence would have to be about 3-4% in 40 year olds with a screening interval of 10 years to approach cost-effectiveness. It is predicted that screening might be cost-effective in a 50-year-old cohort at a prevalence of 4% with a 10-year screening interval. General population screening at any age, thus, appears not to be cost-effective. Selective screening of groups with higher prevalence (family history, black ethnicity) might be worthwhile, although this would only cover 6% of the population. Extension to include other at-risk cohorts (e.g. myopia and diabetes) would include 37% of the general population, but the prevalence is then too low for screening to be considered cost-effective. Screening using a test with initial automated classification followed by assessment by a specialised optometrist, for test positives, was more cost-effective than initial specialised optometric assessment. The cost-effectiveness of the screening programme was highly sensitive to the perspective on costs (NHS or societal). In the base-case model, the NHS costs of visual impairment were estimated as £669. If annual societal costs were £8800, then screening might be considered cost-effective for a 40-year-old cohort with 1% OAG prevalence assuming a willingness to pay of £30,000 per quality-adjusted life-year. Of lesser importance were changes to estimates of attendance for sight tests, incidence of OAG, rate of progression and utility values for each stage of OAG severity. Cost-effectiveness was not particularly sensitive to the accuracy of screening tests within the ranges observed. However, a highly specific test is required to reduce large numbers of false-positive referrals. The findings that population screening is unlikely to be cost-effective are based on an economic model whose parameter estimates have considerable uncertainty, in particular, if rate of progression and/or costs of visual impairment are higher than estimated then screening could be cost-effective. Conclusions: While population screening is not cost-effective, the targeted screening of high-risk groups may be. Procedures for identifying those at risk, for quality assuring the programme, as well as adequate service provision for those screened positive would all be needed. Glaucoma detection can be improved by increasing attendance for eye examination, and improving the performance of current testing by either refining practice or adding in a technology-based first assessment, the latter being the more cost-effective option. This has implications for any future organisational changes in community eye-care services. Further research should aim to develop and provide quality data to populate the economic model, by conducting a feasibility study of interventions to improve detection, by obtaining further data on costs of blindness, risk of progression and health outcomes, and by conducting an RCT of interventions to improve the uptake of glaucoma testing. © Queen's Printer and Controller of HMSO 2007. All rights reserved.

Views of pharmacy graduates and pharmacist tutors on evidence-based practice in relation to over-the-counter consultations: a qualitative study

RATIONALE, AIMS AND OBJECTIVES: Health care services offered to the public should be based on the best available evidence. We aimed to explore pharmacy tutors' and trainees' views on the importance of evidence when making decisions about over-the-counter (OTC) medicines and also to investigate whether the tutor influenced the trainee in practice.

METHODS: Following ethical approval and piloting, semi-structured interviews were conducted with pharmacy graduates (trainees) and pharmacist tutors. Transcribed interview data were entered into the NVivo software package (version 10), coded and analysed via thematic analysis.

RESULTS: Twelve trainees (five males, seven females) and 11 tutors (five males, six females) participated. Main themes that emerged were (in)consistency and contradiction, confidence, acculturation, and continuation and perpetuation. Despite having an awareness of the importance and potential benefits, an evidence-based approach did not seem to be routinely or consistently implemented in practice. Confidence in products was largely derived from personal use and patient feedback. A lack of discussion about evidence was justified on the basis of not wanting to lessen patient confidence in requested product(s) or possibly negating the placebo effect. Trainees became acculturated to 'real-life' practice; university teaching and evidence was deemed less relevant than meeting customer expectations. The tutor's actions were mirrored by their trainee resulting in continuation and perpetuation of the same professional attitudes and behaviours.

CONCLUSIONS: Evidence appeared to have limited influence on OTC decision making. The tutor played a key role in the trainee's professional development. More work could be performed to investigate how evidence can be regarded as relevant and something that is consistently implemented in practice.

How should teaching on whole person medicine, including spiritual issues, be delivered in the undergraduate medical curriculum in the United Kingdom?

Background

Although the General Medical Council recommends that United Kingdom medical students are taught ‘whole person medicine’, spiritual care is variably recognised within the curriculum. Data on teaching delivery and attainment of learning outcomes is lacking. This study ascertained views of Faculty and students about spiritual care and how to teach and assess competence in delivering such care.

A questionnaire comprising 28 questions exploring attitudes to whole person medicine, spirituality and illness, and training of healthcare staff in providing spiritual care was designed using a five-point Likert scale. Free text comments were studied by thematic analysis. The questionnaire was distributed to 1300 students and 106 Faculty at Queen’s University Belfast Medical School.

351 responses (54 staff, 287 students; 25 %) were obtained. >90 % agreed that whole person medicine included physical, psychological and social components; 60 % supported inclusion of a spiritual component within the definition. Most supported availability of spiritual interventions for patients, including access to chaplains (71 %), counsellors (62 %), or members of the patient’s faith community (59 %). 90 % felt that personal faith/spirituality was important to some patients and 60 % agreed that this influenced health. However 80 % felt that doctors should never/rarely share their own spiritual beliefs with patients and 67 % felt they should only do so when specifically invited. Most supported including training on provision of spiritual care within the curriculum; 40-50 % felt this should be optional and 40 % mandatory. Small group teaching was the favoured delivery method. 64 % felt that teaching should not be assessed, but among assessment methods, reflective portfolios were most favoured (30 %). Students tended to hold more polarised viewpoints but generally were more favourably disposed towards spiritual care than Faculty. Respecting patients’ values and beliefs and the need for guidance in provision of spiritual care were identified in the free-text comments.

Students and Faculty generally recognise a spiritual dimension to health and support provision of spiritual care to appropriate patients. There is lack of consensus whether this should be delivered by doctors or left to others. Spiritual issues impacting patient management should be included in the curriculum; agreement is lacking about how to deliver and assess.

The Intersection of Religious Autonomy and Religious Symbols: Setting the Stage

Two sets of issues in the area of law and religion have generated a large share of attention and controversy across a wide number of countries and jurisdictions in recent years. The first set of issues relates to the autonomy of churches and other religiously affiliated entities such as schools and social service organisations in their hiring and personnel decisions, involving the question of how far, if at all, such entities should be free from the influence and oversight of the state. The second set of issues involves the presence of religious symbols in the public sphere, such as in state schools or on public lands, involving the question of how far the state should be free from the influence of religion. Although these issues – freedom of religion from the state, and freedom of the state from religion – could be viewed as opposite sides of the same coin, they are almost always treated as separate lines of inquiry, and the implications of each for the other have not been the subject of much scrutiny. In this Introduction, we consider whether insights might be drawn from thinking about these issues both from a comparative law perspective and also from considering these two lines of cases together.

Pine wilt disease: global issues, trade and economic impact

Pine wilt disease (PWD) is perhaps the most serious threat to pine forests worldwide. Since it´s discovery in the early XXth century by Japanese forest researchers, and the relationship with its causative agent, the pinewood nematode (PWN) Bursaphelenchus xylophilus, in the 1970s, PWD has wreaked havoc wherever it appears. Firstly in the Far East (Japan, China and Korea) and now, more recently in 1999, in the EU (Portugal). The forest sector in Portugal plays a major role in the Portuguese economy with a 12% contribution to the industrial gross domestic product, 3.2% of the gross domestic product, 10% of foreign trade and 5% of national employment. Maritime pine (Pinus pinaster) is one of the most important pine productions, and industrial activity, such as the production of wood and resin, as well as coastal protection associated with sand dunes. Also, stone pine (Pinus pinea) plays an important role in the economy with a share derived from the exports of high-quality pineon seed. Thus, the tremendous economical and ecological impact of the introduction of a pest and pathogen such as the PWN, although as far as is known, the only species susceptible to the nematode is maritime pine. Immediately following detection, the research team involved (Univ. Évora, INIAP) informed the national plant quarantine and forest authorities, which relayed the information to Brussels and the appropriate EU authorities. A task force (GANP), followed by a national program (PROLUNP) was established. Since then, national surveys have been taking place, involving MADRP (Ministry of Agriculture), the University of Évora and several private corporations (e.g. UNAC). Forest growers in the area are particularly interested and involved since the area owned by the growers organizations totals 700 000 ha, largely affected by PWD. Detection of the disease has led to serious consequences and restrictions regarding exploration and commercialization of wood. A precautionary phytosanitary strip, 3 km-wide, has been recently (2007) established surrounding the affected area. The Portuguese government, through its national program PROLUNP, has been deeply involved since 1999, and in conjunction with the EU (Permanent Phytosanitary Committee, and FVO) and committed to controlling this nematode and the potential spread to the rest of the country and to the rest of the EU. The global impact of the presence of Bursaphelenchus xylophilus or the threat of its introduction and the resulting pine wilt disease in forested areas in different parts of the world is of increasing concern economically. The concern is exacerbated by the prevailing debate on climate change and the putative impact this could have on the vulnerability of the world’s pine forests to this disease. The scientific and regulatory approach taken in different jurisdictions to the threat of pine wilt disease varies from country to country depending on the perceived vulnerability of their pine forests to the disease and/or to the economic cost due to lost trade in wood products. Much of the research surrounding pine wilt disease has been located in the northern hemisphere, especially in southern Europe and in the warmer, coastal, Asian countries. However, there is an increased focus on this problem also in those countries in the southern hemisphere where plantations of susceptible pine have been established over the years. The forestry sector in Australia and New Zealand are on “high alert” for this disease and are practicing strict quarantine procedures at all ports of entry for wood products. As well, there is heightened awareness, as there is worldwide, for the need to monitor wood packaging materials for all imported goods. In carrying out the necessary monitoring and assessment of products for B. xylophilus and its vectors substantial costs are incurred especially when decisions have to be made rapidly and regardless of whether the outcome is positive or negative. Australia’s response recently to the appearance of some dying pines in a plantation illustrated the high sensitivity of some countries to this disease. Some $200,000 was spent on the assessment in order to save a potential loss of millions of dollars to the disease. This rapid, co-ordinated response to the report was for naught, because once identified it was found not to be B. xylophilus. This illustrates the particular importance of taking the responsibility at all levels of management to secure the site and the need of a rapid, reliable diagnostic method for small nematode samples for use in the field. Australia is particularly concerned about the vulnerability of its 1million hectares of planted forests, 80% of which are Pinus species, to attack from incursions of one or more species of the insect vector. Monochamus alternatus incursions in wood pallets have been reported from Brisbane, Queensland. The climate of this part of Australia is such that the Pinus plantations are particularly vulnerable to the potential outcome of such incursions, and the state of Queensland is developing a risk management strategy and a proactive breeding programme in response to this putative threat. New Zealand has 1.6 million hectares of planted forests and 89% of the commercial forest is Pinus radiata. Although the climate where these forests are located tends to be somewhat cooler than that in Australia the potential for establishment and development of the disease in that country is believed to be high. The passage alone of 200,000 m³/year of wood packaging through New Zealand ports is itself sufficient to require response. The potential incursion of insect vectors of pinewood nematode through the port system is regarded as high and is monitored carefully. The enormous expansion of global trade and the continued use of unprocessed/inadequately-processed wood for packaging purposes is a challenge for all trading nations as such wood packaging material often harbours disease or pest species. The extent of this problem is readily illustrated by the expanding economies and exports of countries in south-east Asia. China. Japan and Korea have significant areas of forestland infested with B. xylophilus. These countries too are among the largest exporting countries of manufactured goods. Despite the attempts of authorities to ensure that only properly treated wood is used in the crating and packaging of goods B. xylophilus and/or its insect vector infested materials is being recorded at ports worldwide. This reminds us, therefore, of the ease with which this nematode pest can gain access to forest lands in new geographic locations through inappropriate use, treatment or monitoring of wood products. It especially highlights the necessity to find an alternative to using low-grade lumber for packaging purposes. Lest we should believe that all wood products are always carriers of B. xylophilus and its vectors, it should be remembered that international trade of all kinds has occurred for thousands of years and that lumber-born pests and diseases do not have worldwide distribution. Other physico-biological factors have a significant role in the occurrence, establishment and sustainability of a disease. The question is often raised as to why the whole of southern Europe doesn’t already have B. xylophilus and pine wilt disease. European countries have traded with countries that are infested with B. xylophilus for hundreds of years. Turkey is an example of a country that appears to be highly vulnerable to pine wilt disease due to its extensive forests in the warm, southern region where the vector, Monochamus galloprovincialis, occurs. However, there is no record of the presence of B. xylophilus occurring there despite the importation of substantial quantities of wood from several countries In many respects, Portugal illustrates both the challenge and the dilemma. In recent times B. xylophilus was discovered there in the warm coastal region. The research, administrative and quarantine authorities responded rapidly and B. xylophilus appears to have been confined to the region in which it was found. The rapid response would seem to have “saved the day” for Portugal. Nevertheless, it raises again the long-standing questions, how long had B. xylophilus been in Portugal before it was found? If Lisbon was the port of entry, which seems very likely, why had B. xylophilus not entered Lisbon many years earlier and established populations and the pine wilt disease? Will the infestation in Portugal be sustainable and will it spread or will it die out within a few years? We still do not have sufficient understanding of the biology of this pest to know the answers to these questions.

The Contribution of Academic Scholarship to Management Development.

Purpose: This paper explores the impact of academic scholarship on the development and practice of experienced managers. Design / Methodology: Semi-structured interviews with experienced managers, modelled on the critical incident technique. ‘Intertextuality’ and framework analysis technique are used to examine whether the use of academic scholarship is a sub-conscious phenomenon. Findings: Experienced managers make little direct use of academic scholarship, using it only occasionally to provide retrospective confirmation of decisions or a technique they can apply. However, academic scholarship informs their practice in an indirect way, their understanding of the ‘gist’ of scholarship comprising one of many sources which they synthesise and evaluate as part of their development process. Practical implications: Managers and management development practitioners should focus upon developing skills of synthesising the ‘gist’ of academic scholarship with other sources of data, rather than upon the detailed remembering, understanding and application of specific scholarship, and upon finding / providing the time and space for that ‘gisting’ and synthesis to take place. Originality / Value: The paper addresses contemporary concerns about the appropriateness of the material delivered on management education programmes for management development. It is original in doing this from the perspective of experienced managers, and in using intertextual analysis to reveal not only the direct but also the indirect uses of they make of such scholarship. The finding of the importance of understanding the ‘gist’ rather than the detail of academic theory represents a key conceptual innovation.