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We offer a friendly criticism of May's fantastic book on moral reasoning: It is overly charitable to the argument that moral disagreement undermines moral knowledge. To highlight the role that reasoning quality plays in moral judgments, we review literature that he did not mention showing that individual differences in intelligence and cognitive reflection explain much of moral disagreement. The burden is on skeptics of moral knowledge to show that moral disagreement arises from non-rational origins.
To demonstrate that nosocomial transmission of vancomycin-resistant enterococci (VRE) can be terminated and endemicity prevented despite widespread dissemination of an epidemic strain in a large tertiary-care referral hospital.
Two months after the index case was detected in the intensive care unit, 68 patients became either infected or colonized with an epidemic strain of vanB vancomycin-resistant Enterococcus faecium despite standard infection control procedures. The following additional interventions were then introduced to control the outbreak: (1) formation of a VRE executive group; (2) rapid laboratory identification (30 to 48 hours) using culture and polymerase chain reaction detection of vanA and vanB resistance genes; (3) mass screening of all hospitalized patients with isolation of carriers and cohorting of contacts; (4) environmental screening and increased cleaning; (5) electronic flagging of medical records of contacts; and (6) antibiotic restrictions (third-generation cephalosporins and vancomycin).
A total of 19,658 patient and 24,396 environmental swabs were processed between July and December 2001. One hundred sixty-nine patients in 23 wards were colonized with a single strain of vanB vancomycin-resistant E. faecium. Introducing additional control measures rapidly brought the outbreak under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregat-ed patients being detected in the next 2 months. The outbreak was terminated within 3 months at a cost of $2.7 million (Australian dollars).
Despite widespread dissemination of VRE in a large acute care facility, eradication was achievable by a well-resourced, coordinated, multifaceted approach and was in accordance with good clinical governance.
The Heian period opened in 794 with the building of a new capital, Heian-kyō, later known as Kyoto. The grand plan of the new city, on a larger scale than earlier capitals, expressed the ambitious vision of Emperor Kammu. No other Japanese emperor had ever taken into his own hands so decisively the absolute powers of the emperor as conceived in Chinese theory. He and some of his immediate successors not only asserted the authority of the throne; they took positive measures designed to improve the effectiveness of the central government in administering the country. Theirs was a dedicated attempt to revitalize the system of administration modeled on the governmental machinery of T'ang China and operate it effectively. Throughout the four centuries of the Heian era the imperial court continued as the only political center, but the effectiveness of its administration declined gradually. The title of emperor continued in the imperial line without dynastic change, as it does to this day, but many of the reigning emperors were reduced to figureheads, manipulated by noble families at court, notably the Fujiwara, and later by senior retired emperors. The Heian period closed in 1185 when the struggle for hegemony among the warrior families resulted in the victory of Minamoto no Yoritomo and most political initiatives devolved into his hands at his headquarters at Kamakura. The imperial court continued at Kyoto, playing a largely ceremonial and legitimizing role, while political power was exercised by military overlords until the Meiji Restoration of 1868.
During Heian times, however, there was no challenge to the central position of the imperial court; rather, there was a gradual decline in its ability to derive adequate income from the provinces to sustain itself in the style it had designed.
This chapter deals with the establishment of a new capital city in the Kyoto river basin during the reign of Emperor Kammu in the eighth century. It describes the construction of the Greater Imperial Palace, the layout of the emperor's residential compound, and the existence of public buildings, facilities and spaces. Little is known about individual residential land occupancy and use in the early days of the city; individuals who held court rank may have been entitled to varying amounts of land. The most conspicuous and best-known part of large official or courtly population was the political and social elite: the imperial clan and the court nobility. The Heian noble wife also enjoyed many customary rights that tended to give additional substance to the degree of her social and economic autonomy. The chapter also discusses the Heian officialdom's functions, and the capital city's economy and administration. The Heian city was also an intensely ceremonious and ritualistic city.
The move to Heian-kyō marked the end of a temporally long peregrination that had taken Japanese rulers and their courts from one site to another ever since the inception of the statutory system of government in the seventh century. By the time death ended the reign of Kammu's grandson Nimmyō, the Northern House of the Fujiwara clan was well on its way to complete domination of both the emperor and the organs of his statutory government. The Fujiwara regency was in many aspects simply a prolonged and institutionalized phase in the cyclically shifting balance of power between the imperial line and the noble clans. Japan's relations with the other countries of East Asia during the Heian period were driven by the familiar twin engines of fear of external power, on the one hand, and desire for material and cultural gain on the other.
This volume provides the most comprehensive treatment of the Heian period, the golden age of the Japanese imperial court, in any Western language. From Heian-kyo, founded in 794, the Japanese emperor ruled over an elaborate government modelled on China's absolute monarchy. Ambassadors to the T'ang court and students studying in China brought back laws, ideas, Buddhism, temple architecture, sculpture, and wall-painting. Chinese influences blended with native Japanese elements in courtly painting, calligraphy, poetry and prose. The world's first novel, The Tale of Genji, was completed about 1020. In 1185 the elegant and peaceful world of the court was shattered by the struggle of the Taira and Minamoto warrior clans, who usurped real political power and left the emperor with a symbolic, legitimizing role. Contributors to this volume emphasize political history, the land system, provincial administration, the capital and its society, aristocratic culture, and the acceptance of Buddhism and popular religious practices.
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