Confrontation and conflict in the poetry of John Donne

In tracing the heritage of the concern over the relative values of the material and the immaterial, one can see that the problem was considerably significant in Medieval thought as a great deal of the philosophical writings of the Age were dedicated to the problem of the universals. The question of whether reality existed in the form or the particular, however, was not a speculation peculiar to the Middle Ages. The academic controversy, as far as one can determine, found its germination in the Hellenic tradition of Plato and Aristotle; a brief recall of its ancient history, then, would seem to be in order

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Institutions and individuals : Interaction and evolution

“The final, definitive version of this article has been published in the Journal, Organization Studies, 28 (1) 2007, Copyright SAGE Publications Ltd, SAGE Journals Online: http://online.sagepub.com/ "The conceptualization of the relation between individual and structure is central to social science. After making some key definitions, this paper overviews some recent developments in the social theory of structure and agency, and makes a novel addition, based on a concept of habit derived from pragmatism and Veblenian institutional economics. Processes of habituation provide a mechanism of ‘reconstitutive downward causation’ where institutional circumstances may affect individual preferences. Finally, special characteristics of organizations are discussed, endorsing an evolutionary analytical approach that combines insights from both evolutionary economics and organization science.Peer reviewe