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Background: The Comprehensive Post-Acute Stroke Services (COMPASS) Study is one of the first large pragmatic randomized-controlled clinical trials using comparative effectiveness research methods, funded by the Patient-Centered Outcomes Research Institute. In the COMPASS Study, we compare the effectiveness of a patient-centered, transitional care intervention versus usual care for stroke patients discharged home from acute care. Outcomes include stroke patient post-discharge functional status and caregiver strain 90 days after discharge, and hospital readmissions. A central tenet of Patient-Centered Outcomes Research Institute-funded research is stakeholder engagement throughout the research process. However, evidence on how to successfully implement a pragmatic trial that changes systems of care in combination with robust stakeholder engagement is limited. This combination is not without challenges. Methods: We present our approach for broad-based stakeholder engagement in the context of a pragmatic trial with the participation of patients, caregivers, community stakeholders, including the North Carolina Stroke Care Collaborative hospital network, and policy makers. To maximize stakeholder engagement throughout the COMPASS Study, we employed a conceptual model with the following components: (1) Patient and Other Stakeholder Identification and Selection; (2) Patient and Other Stakeholder Involvement Across the Spectrum of Research Activities; (3) Dedicated Resources for Patient and Other Stakeholder Involvement; (4) Support for Patient and Other Stakeholder Engagement Through Organizational Processes; (5) Communication with Patients and Other Stakeholders; (6) Transparent Involvement Processes; (7) Tracking of Engagement; and (8) Evaluation of Engagement. Conclusion: In this paper, we describe how each component of the model is being implemented and how this approach addresses existing gaps in the literature on strategies for engaging stakeholders in meaningful and useful ways when conducting pragmatic trials.
This chapter treats the extent to which there was a defined role for counsellors in the service of good governance in fourteenth-century England. It focuses, first, not on what may be called high or abstract ethical and political theory. Rather, it looks at documents especially from the end of the fourteenth century which made explicit what was then judged to constitute good or bad government under specific kings, and most importantly, during the reign of Richard II. It was said at the time, and many centuries later, that Richard was deposed for his vices, most notorious among which was thought to be his deceitful rejection of those considered his ‘natural counsellors’. In contrast, I will attempt to construct a catalogue of what his virtues should have been, taking as ‘princely virtues’ and ‘good governance’ those qualities enumerated in coronation oaths, in documents found in the Statutes of the Realm, in the Modus Tenendi Parliamentum, and in ‘literature of social complaint’, and compare these with what Richard's critical contemporaries described in the ‘Record and Process’ against him. This narration of his vices came to be entered into the Rolls of Parliament. Furthermore, I hope to show that the normative theory of good governance by the end of the fourteenth century in England had come to be ‘scripted’ by an ‘aristocratic/oligarchic’ small group of powerful men at the expense of any active involvement of ‘the people’.
What, if anything, do historians and theorists of international relations owe to the theories and practices of the Middle Ages? This paper traces a number of themes that were intensely debated by theologians during the fourteenth century, tracking especially two different approaches to ‘the political’ on the part of neo-Augustinian voluntarists on the one hand and neo-Aristotelian intellectualists on the other. In the scholastic attempts to answer the question: ‘What are we presumed to be? And, in consequence, what is the scope of politics?’, their different views concerning the consequences of what Christians call ‘Original Sin’ and ‘the Fall’ are highlighted. Especially, the position of the voluntarists is shown to have been taken up not least by the Master of the Modern: Hobbes. The neo-Augustinian voluntarists can thereafter be seen to have provided some of the same arguments that have recently been rehearsed by contemporary ‘realist’ critics of modern liberalism who, it is argued, are negotiating the medieval in the modern.
Having recently completed two volumes treating those political theorists who are most frequently discussed in university courses dealing with the history of Western political thought from the ancient Greeks to the sixteenth-century Renaissance, I have been aware, from the beginning, of being faced with a number of problems that required resolution. During the past thirty years we have witnessed methodological debates concerning the proper way to study the history of political thought. Questions have been raised as to the very nature of a discipline that seeks to study political theorising as an activity that depends on its being engaged at discrete and contingent historical moments. In effect, this raises a very old question: is political theorising a cognitive activity of agents who, as a consequence of their socio-historical contexts, must engage a prudential form of reasoning in what are always taken to be changing circumstances? Or is political theorising some timeless activity of minds engaged in clarifying a necessary and unchanging truth about politics that is judged to be somehow independent of the particularities of agents' lived lives and the conventional languages they use to reveal their thoughts about it? In what follows, I propose some of my own conclusions in response to questions concerning what we should take the history of political thought to be for us today, why political theorising is thought to have a history, and of what it is a history. In consequence, I propose what appear to me to be the most satisfactory methods of studying old texts that are held to be important, not least because they reveal a variety of paths taken on the winding road to ‘state’ formation in the Western European tradition.
The writings of St Augustine (ad354–430) exercised a massive influence not only on the Western literary imagination but also on the development of medieval scholastic philosophy and theology,and the emergence of the Western mystical tradition. His doctrines also became central to the Renaissance and the Reformation. As the product of the Roman education system of the fourth century, he was one of a generation that absorbed in a highly eclectic fashion the themes that had been on the philosophical and theological agenda of pagan and Christian thinkers for more than four centuries and which stretched back to pre-Christian Stoicism and Hellenistic Judaism. During this period a kind of Platonism continued to be developed roughly contemporaneously with the rise and development of Christianity. Indeed, the early history of Christianity and the evolution of Christian asceticism can be described as the story of a selective incorporation of a range of Platonic insights into a Christian doctrine that explained the relationship between man and the created world and man and God. But we must be aware of the eclectic nature of both Christianity and Platonism in this period. Just as what scholars now call Neoplatonism was not a fixed quantity, neither was Christianity from its inception to c.ad600. Indeed, the term ‘Christian Platonism’ for the first 1000 years ad covers so wide a variety of differences that it is difficult to define it accurately as a single thing. By focusing on Augustine's Platonism, which was only one kind of Platonically influenced Christian thought, we intend to highlight what, arguably, became the most influential rendering of the Platonic tradition for the Christian Latin West.
Memory cannot be treated separately from a more inclusive theory of knowing. There appears to be a tendency in some but not all modern discussions to try to extract remembering from other operations of mind. Personally, I do not believe this should be pursued if we are ever to give a satisfactory account of what memory is for us and how it works. At any rate, it must by now be clear that ancient and medieval theories of memory are intricately linked to an epistemology. And we now are in a position to discuss one of the most sophisticated theories of knowing and remembering to have emerged from the medieval concern to describe how man uses language to understand both the present and the past: that of Peter Abelard. Even if the ancients and medievals located memory in one of the temporal lobes of the brain (the medieval version of Penfield's experiments), its function could not be dealt with meaningfully without informing memory with reason. Perhaps what is most startling in the writings of Abelard is his ability to elucidate knowing and remembering primarily by means of an analysis of the logic of language and how it works. Meaning is generated by the mind's activities through the use of signs or universals, be they images, words or ideas. Mind's present active attention enables us to consider the past through words and images, so that the past is given meaning, without which attention it has none.
… Thou hast a base and brickish skirt there, sours
That neighbour-nature thy grey beauty is grounded
Best in; graceless growth, thou hast confounded
Rural rural keeping-folk, flocks, and flowers.
Yet ah! this air I gather and I release
He lived on; these weeds and waters, these walls are what
He haunted who of all men most sways my spirits to peace;
Of reality the rarest-veinèd unraveller; a not
Rivalled insight, be rival Italy or Greece…
Gerard Manley Hopkins, Duns Scotus's Oxford
What the brain does with the spoken word – and no one can say how it does it – is to extract from it an electrical pattern in time and space which is distinctive of the word ‘dog’ and common to all the ways in which it can be pronounced, so as to be recognized.
Russell Brain, ‘Speech and thought’, in The Physical Basis of Mind, ed. P. Laslett (Oxford, 1950), p. 49.
In 1255 the faculty of arts at the University of Paris placed all the known works of Aristotle on the lecture programme. The study of the authentic Aristotle, as translated into Latin, was thereafter increasingly pursued by philosophers without the theological concern to baptize him. Indeed, during the 1260s the writings of radical Aristotelians such as Siger of Brabant and Boethius of Dacia caused alarm, not least to Aquinas.
This book attempts, through a series of interrelated studies, to give an account of the range of views on memory and its uses during the middle ages. But we must begin with ancient Greek and Roman positions because these would be drawn upon, reinterpreted, even distorted by later, medieval rememberers in order that they might reach working hypotheses that served their own understanding of how men came to know their world and remember their pasts.
Medieval readers believed that the text itself was the self-sufficient object of inquiry and understanding, providing a timeless contribution to the truth of how it is to be a human knower and rememberer. For the most part, when medieval readers confronted ancient texts, they were not troubled by what for us appears to be a major methodological difficulty in understanding the meaning of past texts. Consequently, they rarely, if ever raised the issue of first having to know the social and economic context of a past text as the means of gaining access to its meaning and, so recovering the intentions of its author. Instead, they paid attention to a close analysis of the text, weighing it over and over again in order to elucidate what they took to be its timeless and universal meaning. Only gradually did they come to read a past text in the context of what they took to be the linguistic conventions of the time in which it was written.
As we have seen, Plato and Aristotle had a great deal to say about memory and most of their discussions related memory to theories of knowing and being. But it was the technique of memorising by impressing ‘places’ (loci) and ‘images (imagines) on memory, the art of mnemotechnics, that was passed on to orators in Rome and thence to the European rhetorical tradition. Before the age of printing a trained memory was, of course, vitally important. In his De Oratore, Cicero tells the story of how Simonides of Ceos had trained his memory by place images which enabled him to recall who was where at a banquet which ended in tragedy: after Simonides had departed, the roof fell in and crushed all the guests. And Cicero speaks of memory as one of the five parts of rhetoric. Whereas Aristotle the philosopher sees rhetoric as subordinate to logic or dialectic, Cicero the politician and public orator reverses their superiority: demonstration is for him ancillary to persuasion. He seems unaware of Aristotle's discussion of imagination and memory beyond what little is said explicitly in Aristotle's rhetorical and logical works.
Two other descriptions of this art of memory, both in Latin treatises on rhetoric, have come down to us: the anonymous Ad Herennium Libri IV (contemporary with Cicero but wrongly attributed to him in the middle ages) and Quintilian's Institutio Oratoria.
The mind of man, like that of an animal for that matter, is something that we cannot see or touch or stimulate. It is the faculty which is responsible for that portion of human behaviour which does not seem to be automatic… Everyone knows that the mind of man is something that depends upon the action of the brain. Things are seen, heard, felt or smelt only when electrical currents are conducted along appropriate nerve tracts to the brain. Problems are worked out by using the brain. A voluntary act is dictated somehow at a high level of organization within the cranial cavity. Then executive messages are flashed down the spinal cord… It is obvious that there must be a co-ordinating centre within the ‘house’, a sort of telephone exchange or switchboard to which messages come, and from which messages depart after appropriate decisions be reached, decisions that are based upon memories of previous experience and influenced by present desires. The brain is a large spherical organ that is divided into two partially separated halves, the right and the left hemisphere. A superficial layer of nerve cells covers the whole of the cerebral hemispheres in an outer mantle of grey matter. This is the cerebral bark, or cortex… The cortex covers the surface of the two hemispheres with a mosaic of functional areas. […]
Augustine's De Trinitate divides into two parts, the second (books 8–15) centring on the human soul's psychological experiences. Here he turns to the human soul in order to try to penetrate into the mystery of this soul being the image of God which he knows through revelation: Genesis i, 26, where it says God made man in his image. He attempts to unite the two kinds of knowledge available to man, that derived from the exterior world and that which resides in one's mind. In the process of perception where exterior sense objects are perceived, the sense does not come from the perceived body or object but from the body of the subject, the perceiver, endowed with sensation and life. Perception through this sensing body is performed by the soul in a manner proper to it and which Augustine describes as a mysterious manner of knowing (quodam miro modo contemperatur) (XI, ii, 3). But it is the object perceived which engenders vision, the object ‘informs’ the subject's senses but it cannot do this alone; it requires a perceiver. Sensation would be totally impossible if there were not produced in the sense organ some similitude of the perceived sense object, (aliqua similitudo conspecti corporis) (XI, ii, 3). He now confirms the Aristotelian mode of sense perception by drawing upon the analogy of seal and wax, the form of the seal remaining in the wax after the seal is removed.
… the anatomist is primarily concerned with the study of the brain as the material substratum of mental processes. No more than the physiologist is he able to suggest how the physico-chemical phenomenon associated with the passage of nervous impulses from one part of the brain to another can be translated into a mental experience.
W. E. Le Gros Clark, ‘The structure of the brain and the process of thinking’, The Physical Basis of Mind, ed. P. Laslett (Oxford, 1950), p. 24.
It matters a great deal whether mind is regarded as something which is distinct from and which animates the body – or whether the word is thought of as a generic term to cover such processes as feeling, thinking, remembering, perceiving and so on. If mind is conceived of as something which interacts with body – or as some parallel manifestation to body – the scientist may be misled into trying to solve problems which may prove unreal, e.g., I'm not convinced about the validity of the proposition, raised by Professor Le Gros Clark, that some parts of the brain have the special function of transforming measurable electrical impulses into consciousness… If mind is a verbal cloak for processes of perceiving, abstracting, reasoning – how far can these processes be explained in physical terms?… But because we humans use symbolic language our own memory also works independently of immediate environmental control. No one knows the physical basis of this particularly human capacity.
S. Zuckerman, ‘The mechanism of thought:the mind and the calculating machine’, in The Physical Basis of Mind, ed. Laslett, pp. 25–8.
During the decade 1230–40 in Paris, theologians judged the various competing psychological doctrines to represent a very serious problem. In effect, they were faced with three conceptions of man: one that was theological where man was understood as a morally engaged agent in the economy of salvation; another, from the Greco-Arabic tradition, which considered man as an element amongst others comprising the universe; and increasingly, a third in which man was conceived as capable of developing the habitus of virtues, a conception drawn from the rhetorical and moral treatises of Cicero and other ancients on the virtues. De Anima tracts written in this period were linked with treatises De Bono et Virtutibus whereby the classification of the virtues was closely linked with the soul and its powers. The treatise by the eighth-century monk, John of Damascus, his De Fide Orthodoxa was also drawn upon to show the connection between virtues and the soul's powers. These traditions would be combined, at first uneasily, to produce important consequences for an enlarged understanding of the memory.
On the one hand, Augustine and Peter the Lombard influenced theologians to focus on sensuality, reason and the free will, while on the other, Aristotle read through Avicennan eyes inspired them to concentrate on the external and internal senses, the appetite, the practical or potential intellect and the will.
Coming from a generation of theologians who wrote treatises on the De Anima linked with tracts De Bono et Virtutibus, Albert the Great included in his De Bono a discussion of memory, both from the standpoint of psychology and from that of Cicero's Rhetoric and the De Inventione. As was clear in earlier tracts like that of John of la Rochelle, memory and reminiscence were already linked with the virtue of prudence, following John of Damascus's classification of the virtues. Whilst memory, according to Albert, is said to pertain to the sensible part of the soul, prudence pertains to the rational part since, we are told, according to Aristotle's definition, reminiscence pertains to the rational part and hence is the type of memory which constitutes a part of prudence. By this Albert means to distinguish the stored results of the human estimative cogitation which judges the intentions of sensible experience, from the subsequent activity which leads to an attempt by reason to recall the mental similitude engendered by imagination's similitude. Prudence is for Albert a moral habitus and hence reminiscence is a psychological habitus, an active, discontinuous, syllogistic search amongst mental similitudes, whereas the recollection of impressions and events of the past is not a habitus in and of itself.
Now that these studies have been written, I must, following Pascal, decide what should be put first. I must say something about what has been done here and why. Originally trained as a physical chemist, I was equally interested in the study of history and historical explanation. I turned out to be inadequate in both domains. Dissatisfied with theories of explanation in disciplines that were held to employ opposing methods of analysis of facts, I have not come up with some universally applicable method that is more satisfying. But in devoting myself to an interdisciplinary approach to the study of the middle ages, I have, over twenty years, reaffirmed my conviction that alien patterns of thought can be investigated to some degree of satisfaction, without my ever believing that the way medieval authors described their world was the way I described mine. It has never been clear to me that there is a single truth about living, that the world is indubitably one way for all of us or throughout history, except in trivial ways. With language one crosses and intersects other ways of describing how it is in the world for human experiencers without ever quite hitting on an expression which encapsulates how it really is for this one. Some expressions come close but only just: language is limited. I think it has always been thus.