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To enhance the understanding of matrix cracking and damage progression on the macroscopic scale, within a 0/90° fibre reinforced SiC f /SiC ceramic matrix composite (CMC), X-ray computed tomography (XCT) imaging and analysis have been performed in conjunction with a commercially available in-situ mechanical loading device. CMC test coupons were subjected to tensile cyclic loads and inspected using XCT without removal from the tensile loading device. Attempts to measure and quantify the resulting damage using volumetric image analysis techniques are presented, by characterising the crack network from XCT images acquired at both the maximum and minimum load condition during selected fatigue cycles. The XCT detection of significant crack development within the first loading half-cycle shows good agreement with cumulative acoustic emission energy data recorded under similar test conditions. The results are seen as an important step towards correlating the damage behaviour detected via different NDE and health monitoring techniques. [ABSTRACT FROM AUTHOR]

Presents three articles dealing with the safety of the MMR (mumps, measles, and rubella) vaccine and how doctors' can decide whether to vaccinate. General practitioner Tom Heller's questions about the safety of the vaccine; Professor Dick Heller's discussion about lack of evidence for the dangers of the vaccine; Stephen Pattison's views on moral judgment and rational thinking in the choices of doctors.

[Display omitted] • Fatigue damage accumulation model based on the memory surface concept. • Flight representative loading cycle of out-of-phase thermomechanical fatigue type. • Scatter in the material parameters effect on obtained crack initiation lives. • Monte-Carlo analysis in conjunction with singular value decomposition. For critical component application, such as aerospace turbine rotors, it is imperative to be able to make accurate in-service material behaviour and component life predictions for both design and monitoring of component life. The development of such predictive capability is dependent on the quality of the experimental data from which the material parameters are derived. This paper shows the effect that scatter which may be present within experimental data, manifesting itself within the constitutive parameters derived from this data, has on the resulting fatigue crack initiation life of the nickel-based superalloy RR1000. Industrial relevance was added to this investigation by the use of flight representative thermomechanical fatigue loading cycles and state of the art material behaviour and fatigue crack initiation models used within the finite element simulations conducted. The effect of the 'scatter in' to the modelling approach on the outcoming predictions is made via a Monte-Carlo analysis. This analysis consisted of running the same simulation several times, but with the experimentally determined and validated 'baseline' constitutive parameters varied via correction factors built into the model, for each run via a singular value decomposition procedure. It was found that small 'scatter in' has only a very localised 'scatter out' effect on the crack initiation predictions under the flight representative loading. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to offer an account of 'flourishing' that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as 'happiness', 'well-being' or 'quality of life', 'flourishing' uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is argued that humans are at once beings who are autonomous and thereby capable of making sense of their lives, but also subject to the contingencies of their bodies and environments. To flourish requires that one engages, imaginatively and creatively, with those contingencies. The experience of illness, highlighting the vulnerability of the human being, thereby becomes an important experience, stimulating reflection in order to make sense of one's life as a narrative. To flourish, it is argued, is to tell a story of one's life, realistically engaging with vulnerability and suffering, and thus creating a framework through which one can meaningful and constructively go on with one's life.

This paper raises some issues about understanding religion, religions and spirituality in health care to enable a more critical mutual engagement and dialogue to take place between health care institutions and religious communities and believers. Understanding religions and religious people is a complex, interesting matter. Taking into account the whole reality of religion and spirituality is not just about meeting specific needs, nor of trying to ensure that religious people abandon their distinctive beliefs and insights when they engage with health care institutions and policies. Members of religious groups and communities form an integral part of the structure and fabric of health care delivery, whether as users or in delivery capacities. Religion is both facilitator and resistor, friend and critic, for health care institutions, providers and workers.

In this paper, we reflect upon shame and humiliation as threats to personal and professional integrity and moral agency within contemporary health care. A personal narrative, written by a nurse about a particular shift in a British National Health Service Accident and Emergency Department, is provided as a case study. This is critically reflected and commented upon in dialogue with insights into the nature of shame and humiliation. It is suggested that Accident and Emergency is a locus that is latently prone to dynamics of shame and humiliation, a potential exacerbated within a culture subject to externally-determined time targets that are enforced by a top-down system of surveillance and management. The result is that nurses may lose their sense of professional competence and responsibility, moral agency, and integrity, to their own personal detriment, as well as to the detriment of patients with whom they work. Insofar as examining a small part of a whole may suggest insights into the operation and ethos of a very large system, this very particular case study narrative/reflection has some important implications and lessons for the wider organization and provision of health care in Britain and beyond., (© 2011 Blackwell Publishing Ltd.)

The paper offers an account of integrity as the capacity to deliberate and reflect usefully in the light of context, knowledge, experience, and information (that of self and others) on complex and conflicting factors bearing on action or potential action. Such an account of integrity seeks to encompass the moral complexity and conflict of the professional environment, and the need for compromises in professional practice. In addition, it accepts that humans are social beings who must respect and engage with the moral position of others. This account is contrasted with a more traditional view of integrity as the rigid maintenance of consistency between professional practice and deeply held, but inflexible, moral principles. While this strong sense of moral conviction may be valuable as a source of moral motivation, e.g. in the case of whistle-blowers, it is equally likely to lead to dogmatism and hubris. Professionals and their organizations are encouraged to foster the more complex and reflective form of integrity., (© 2011 Blackwell Publishing Ltd.)

Spirituality is a highly contested concept. Within the nursing literature, there are a huge range and diversity of definitions, some of which appear coherent whereas others seem quite disparate and unconnected. This vagueness within the nursing literature has led some to suggest that spirituality is so diverse as to be meaningless. Are the critics correct in asserting that the vagueness that surrounds spirituality invalidates it as a significant aspect of care? We think not. It is in fact the vagueness of the concept that is its strength and value. In this paper, we offer a critique of the general apologetic that surrounds the use of the language of spirituality in nursing. With the critics, we agree that the term 'spirituality' is used in endlessly different and loose ways. Similarly, we agree that these varied definitions may not refer to constant essences or objects within people or in the world. However, we fundamentally disagree that this makes spirituality irrelevant or of little practical utility. Quite the opposite; properly understood, the vagueness and lack of clarity around the term spirituality is actually a strength that has powerful political, social, and clinical implications. We develop an understanding of spirituality as a way of naming absences and recognizing gaps in healthcare provision as well as a prophetic challenge to some of the ways in which we practise health care within a secular and sometimes secularizing context such as the National Health Service.

This article aims to challenge and expand notions of health, health care and health promotion, particularly in relation to smoking, via a consideration of the autobiographical literary work of the English playwright, Simon Gray. Gray died in 2008, having written a series of reflective autobiographical books, The Smoking Diaries. Gray was a lifelong smoker, perpetually trying to give up his habit. This article introduces Gray's diaries and their reflections on life, death, health care and smoking. It then enquires what can be learned about contemporary health care practices and assumptions from Gray's work. Finally, it reflects on the limits of views of health and health promotion when considered in the light of a fully lived life. In the life under consideration, health care risks are very differently understood to those prevalent in the medical community. Literary approaches to thinking about smoking are thus seen to place health and health care in broader, richer, and less instrumental perspectives than those that are common amongst contemporary health professionals and institutions.

In 2008 the United Kingdom Nursing and Midwifery Council (NMC) published the latest version of its code of conduct (The code: standards of conduct, performance and ethics for nurses and midwives). The new version marked a significant change of style in the Code compared with previous versions. There has been considerable controversy and the accrual of an extensive body of literature over the years in the UK and Europe criticizing nursing codes of ethics and questioning their ethical standing and their usefulness. In this article we review the current NMC Code. We argue that the NMC has been misguided in labelling the Code as a code of ethics, and suggest that the new document falls short in many respects.