Abstract Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The (...) SPI1 was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)
Let me tell you what philosophy is about, then about how Sydney does it in its own special way. Does life have a meaning, and if so what is it? What can I be certain of, and how should I act when I am not certain? Why are the established truths of my tribe better than the primitive superstitions of your tribe? Why should I do as I’m told? Those are questions it’s easy to avoid, in the rush to acquire (...) goods and prestige. Even for many of a more serious outlook, they are questions easy to dismiss with excuses like “it’s all a matter of opinion” or “let’s get on with practical matters” or “they’re too hard”. They are questions that may be ignored, but they do not go away. They’re philosophical questions. There’s a right way to approach them – you read the writings of the classical and recent philosophers and consider carefully their arguments back and forth. There are many wrong ways to approach them, such as choosing at random among the ideas your parents or friends or gurus have, or ideas that feel good. Or you can just not bother. Sydney has a certain reputation for superficiality in this regard. A character in David Williamson’s Emerald City says “No-one in Sydney ever wastes time debating the meaning of life — it’s getting yourself a water frontage”, says If you have a Writers Festival or a conference on Happiness in Sydney, you don’t normally expect philosophers to be invited. Caroline Jones’ radio series, ‘The Search for Meaning’. (shrink)
Does life have a meaning, and if so what is it? What can I be certain of, and how should I act when I am not certain? Why are the established truths of my tribe better than the primitive superstitions of your tribe? Why should I do as I'm told? Those are questions it is easy to avoid, in the rush to acquire goods and prestige. Even for many of a more serious outlook, they are questions easy to dismiss with (...) excuses like "it's all a matter of opinion" or "let's get on with practical matters" or "they're too hard". They are questions that may be ignored, but they do not go away. (shrink)
Defends the arguments for the irredicibility of dispositions to categorical properties in "Are dispositions reducible to categorical properties?" (Philosophical Quarterly 36, 1986) against the criticisms of D.M. Armstrong (Philosophical Quarterly 38, 1988).
Readers of “lives” of the famous know well the tendency of biography, and especially autobiography, to become steadily less interesting as the subject grows older. A predictable record of challenges met, enemies shafted, honours received and great men encountered often succeeds an account of a childhood that is a highly-coloured and unique emotional drama. Often the best pages are those on the subject’s schooldays, when the personality first tangles with the public realm. As Barry Oakley says of school in (...) a piece quoted in the book’s preface: “Like the stage, it’s an image of life: life accelerated, life concentrated, life more formidable.” The project of selecting just the highlights of all the stories of Australians’ schooldays promises, then, a high payoff if it is well done. It is a high-risk enterprise, though: a pointillist canvas brilliant in each fleck may easily look like mud from a distance. There are well over a hundred authors here, with only three pages or so each to paint a vignette of school. In fact, the result is an enormous success. The editors have a sure eye, and they and their research assistant, Pamela Williams, have put in the work to find the goods. Almost every piece is gripping, and quite different from the others. The total effect is additive, and is an unexampled insight into how the Australia we know came into being. The classics are there: Henry Lawson and Patrick White, Seven Little Australians and The Getting of Wisdom, Donald Horne, Barry Humphries and Clive <span class='Hi'>James</span>. So are the many unknowns whose recollections take us into obscure corners. If there is one overall theme, it is that of sameness, difference and “fitting in”. The effect of the accumulated evidence is rather more subtle than the received ideas on “identity and difference”, multiculturalism and so on. School is where the strangeness of one’s own family, or of one’s own personality, meets the social world – itself perhaps no less weird, objectively speaking, but possessed of resources for ensuring conformity.. (shrink)
The potential health risks of vegan diets specifically for women and children are discussed. Women and children are at higher risk of malnutrition from consumption of unsupplemented vegan diets than are adult males. Those who are very young, pregnant, lactating, elderly, or who suffer from poverty, disease or other environmentally induced disadvantages are at special risk. The size of these risks is difficult to quantify from existing studies. Fortunately the risk of dietary deficiency disease can be avoided and the potential (...) health benefits of vegan diets can be realized when diets for these groups are planned in line with theRecommended Dietary Allowances so that nutrient intakes reach or exceed recommended levels, and access to preventive and curative health services is assured. (shrink)
The purpose of this paper is to demonstrate how condom manufacturers and their marketers have failed to adequately promote their product to the male homosexual population (gays). Inasmuch as the AIDS syndrome constitutes a major life-threatening danger and that gays appear to be particularly vulnerable, failure to aggressively promote a known preventive such as condoms to gays constitutes negligent homicide.The method used here defines what is traditionally viewed as a viable target market, analyzes the major elements of marketing with regard (...) to gays, and examines the neglect of condom promotion by their manufacturers. (shrink)
The views of some historians and philosophers of history as to the possibility of fruitful historical generalization seem at odds with the underlying methodology of the other social sciences. A formal model of the world historical process is here presented within which this apparent contradiction is seen to be resolvable in terms of modern theories of probability and stochastic processes. This is done by giving rigorous form to procedures and statements in the social sciences. A formal treatment of the dependence (...) of an investigation in one discipline on previous studies both in that area and in other social and natural sciences then follows naturally. (shrink)
I suggest that Carter and Hestevold's arguments for L1 and L2 can be given a chance to succeed if (i) everywhere in them that we find an occurrence of the thesis Transient Time we replace it with an occurrence of Presentism, and (ii) everywhere in them that we find an occurrence of the thesis Static Time we replace it with an occurrence of Presentism's denial. I'm fairly confident that their arguments for L1 would succeed if these changes were made. (If (...) Presentism is true, nothing has temporal parts, for some at least of the temporal parts of a thing extended in time must be past or future. But if nothing has temporal parts, Endurance must be true.) I'm less confident that their arguments for L2 would succeed if those changes were made. But if the changes that I suggest are not made, the arguments for L1 and L2 certainly fail. (shrink)
Contemporary developments in American epistemology, by R. M. Chisholm.--Contemporary metaphysics in the United States, by D. F. Gustafson.--Philosophy of physics, by H. Putnam--The influence of continental philosophy on the contemporary American scene: a summons to autonomy, by G. A. Scharader, Jr.--The influence of the later Wittgenstein on American philosophy, by J. O. Nelson.--Philosophy of mind, by F. H. Donnell, Jr.--Some remarks on the philosophy of language, by J. A. Fodor.--Ethics in the United States today, by D. Kading.--Social philosophy; philosophy of (...) social science, by P. Diesing. (shrink)
No Órganon Aristóteles descreve alguns esquemas dedutivos nos quais a presença de inconsistências não acarreta a trivialização da teoria lógica envolvida. Esta tese é corroborada por três diferentes situações teóricas estudadas por ele, as quais são apresentadas neste trabalho. Analizamos o esquema de inferência utilizado por Aristóteles no Protrepticus e o método de demonstração indireta para os silogismos categóricos. Ambos os métodos exemplificam como Aristóteles emprega estratégias de redução ao absurdo logicamente clássicas. Na sequência, discutimos os silogismos válidos a partir (...) de premissas opostas (contrárias e contraditórias) estudadas pelo Estagirita no Analytica Priora (B15). De acordo com o autor, os seguintes silogismos são válidos a partir de premissas opostas, nos quais letras latinas minúsculas denotam termos como sujeito e predicado, enquanto que letras latinas maiúsculas denotam proposições categóricas tal como na notação tradicional: (i) na segunda figura, Eba,Aba ` Eaa (Cesare), Aba, Eba ` Eaa (Camestres), Eba, I ba ` Oaa (Festino), e Aba,Oba ` Oaa (Baroco); (ii) na terceira, Eab,Aab ` Oaa (Felapton), Oab,Aab ` Oaa (Bocardo) e Eab, Iab ` Oaa (Ferison). Por fim, discutimos a passagem do Analytica Posteriora (A11) no qual Aristóteles enuncia que o Princípio de Não-Contradição não é, em geral, pressuposto de toda demonstração (silogismo científico), mas apenas daquelas nas quais a conclusão deve ser provada a partir do Princípio; o Estagirita enuncia que se um silogismo da primeira figura tiver o termo maior consistente, os outros termos da demonstração podem ser separadamente inconsistentes. Estes resultados permitem-nos propor uma interpretação de sua teoria dedutiva como uma teoria paraconsistente lato sensu. Primeiramente, efetuamos uma análise hermenêutica, avaliando seu significado lógico e a correlação desses resultados com outros aspectos da filosofia de Aristóteles. Em segundo lugar, consignamos uma interpretação dos silogismos aristotélicos a partir de premissas opostas à luz dos antilogismos propostos por Christine Ladd-Franklin em 1883, e da demonstração aristotélica com termos inconsistentes nas lógicas paraconsistentes Cn, 1 n !, introduzidas por da Costa em 1963. Esses dois aspectos não parecem ter sido ainda detalhadamente analisados na literatura. DOI:10.5007/1808-1711.2010v14n1p71. (shrink)
The author reviews recent books by AlasdairMacIntyre and Garrett Barden that critique the impulse to foundational theory and transhistorical argumentation in moral theory; these arguments are then set in relation to books by Franklin Gamwell and Karl-Otto Apel that seek, in new ways, to defend that impulse. Although far more sympathetic to the latter perspective, the author maintains that all four of these second-order theoretical discussions lack an appropriate understanding of and engagement with the post-Enlightenment tradition (...) of moral theorizing. (shrink)
