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)

Purpose – To review and discuss Luciano Floridi’s 2019 book The Logic of Information: A Theory of Philosophy as Conceptual Design, the latest instalment in his philosophy of information (PI) tetralogy, particularly with respect to its implications for library and information studies (LIS). Design/methodology/approach – Nine scholars with research interests in philosophy and LIS read and responded to the book, raising critical and heuristic questions in the spirit of scholarly dialogue. Floridi responded to these questions. Findings – Floridi’s PI, including (...) this latest publication, is of interest to LIS scholars, and much insight can be gained by exploring this connection. It seems also that LIS has the potential to contribute to PI’s further development in some respects. Research implications – Floridi’s PI work is technical philosophy for which many LIS scholars do not have the training or patience to engage with, yet doing so is rewarding. This suggests a role for translational work between philosophy and LIS. Originality/value – The book symposium format, not yet seen in LIS, provides forum for sustained, multifaceted and generative dialogue around ideas. (shrink)

The ongoing cynicism about leaders and organizations calls for a new standard of ethical leadership that we have labeled “transformative leadership.” This new leadership model integrates ethically-based features of six other well-regarded leadership perspectives and combines key normative and instrumental elements of each of those six perspectives. Transformative leadership honors the governance obligations of leaders by demonstrating a commitment to the welfare of all stakeholders and by seeking to optimize long-term wealth creation. Citing the scholarly literature about leadership theory, we (...) identify key elements of the six leadership perspectives that make up transformative leadership, suggest leaders who exemplify each perspective, describe the ethical foundations and message of each perspective, and offer ten propositions that scholars and practitioners can use to test the dimensions of this new transformative leadership model. (shrink)

In a world that has become increasingly dependent upon employee ownership, commitment, and initiative, organizations need leaders who can inspire their␣employees and motivate them individually. Love, forgiveness, and trust are critical values of today’s organization leaders who are committed to maximizing value for organizations while helping organization members to become their best. We explain the importance of love, forgiveness, and trust in the modern organization and identify 10 commonalities of these virtues.

BackgroundAlthough patient advocates have developed templates for standard consent forms, evaluating patient preferences for first in human (FIH) and window of opportunity (Window) trial consent forms is critical due to their unique risks. FIH trials are the initial use of a novel compound in study participants. In contrast, Window trials give an investigational agent over a fixed duration to treatment naïve patients in the time between diagnosis and standard of care (SOC) surgery. Our goal was to determine the patient-preferred presentation (...) of important information in consent forms for these trials.MethodsThe study consisted of two phases: (1) analyses of oncology FIH and Window consents; (2) interviews of trial participants. FIH consent forms were analyzed for the location(s) of information stating that the study drug has not been tested in humans (FIH information); Window consents were analyzed for the location(s) of information stating the trial may delay SOC surgery (delay information). Participants were asked about their preferred placement of the information in their own trial’s consent form. The location of information in the consent forms was compared to the participants’ suggestions for placement. Results34 [17 FIH; 17 Window] of 42(81%) cancer patients approached participated. 25 consents [20 FIH; 5 Window] were analyzed. 19/20 FIH consent forms included FIH information, and 4/5 Window consent forms included delay information. 19/20(95%) FIH consent forms contained FIH information in the risks section 12/17(71%) patients preferred the same. Fourteen (82%) patients wanted FIH information in the purpose, but only 5(25%) consents mentioned it there. 9/17(53%) Window patients preferred delay information to be located early in the consent, before the “Risks” section. 3/5(60%) consents did this.ConclusionsDesigning consents that reflect patient preferences more accurately is essential for ethical informed consent; however, a one-size fits all approach will not accurately capture patient preferences. We found that preferences differed for FIH and Window trial consents, though for both, patients preferred key risk information early in the consent. Next steps include determining if FIH and Window consent templates improve understanding. (shrink)

Eighteenth-century England saw the rise of a "peculiarly English" art form—landscape gardening—and a corresponding change in attitudes toward the antural world. While the French, who lived under tyranny, had a tightly organized, restrictive gardens, the "free" English enjoyed gardens where they were at liberty to wander. John Dixon Hunt examines eighteenth-century letters, literary and critical works, biographies, paintings, prints, and drawings to trace the gradual movement from formal regularity toward a carefully calculated naturalness.

The ethical codes of the professional engineering bodies identify the responsibilities of the engineer. Of equal importance to the codes are the virtues which enable the engineer to fulfil these responsibilities. After briefly reviewing such virtues this paper argues that the systematic learning of virtues is possible in a formal way through learner centred learning. Central to this learning experience is the development of integrity which focuses the other major virtues and enables reflection upon them. A review of undergraduate courses (...) suggests how this can be achieved. (shrink)

Individual choice and freedom are repeatedly invoked in contemporary policy debates, including those with a focus on risk behaviors such as smoking and health insurance coverage. The idea of making the right choice with regard to health and well-being has been fortified by the neoliberal discourse of self-reliance, personal autonomy, and responsibility. This neoliberal view, stemming from the conceptualization of freedom of philosopher John Stuart Mill justifying the freedom of the individual in opposition to unlimited state control, holds that success, (...) good health, and favorable educational outcomes are largely due to individual effort. Correspondingly, so too is failure, including failure of.. (shrink)

The study seeks to elucidate the nature of early Dhamma-transmission. While Buddhism has achieved broad geographical dissemination, sometimes earning the epithet ‘missionary’, P?li sources are ambivalent regarding approaches to potential followers. The Buddha’s final words do not instruct the sangha to spread the message; the exhortation, ‘walk, monks … for the blessing of the manyfolk’, rather appears to be an early, isolated episode. The Buddha’s own hesitation to teach provides the paradigm for the renunciant sangha, whose members rarely initiate teaching (...) episodes, preferring to wait for specific questions, an approach still formalised in modern practice. Following brahmanical norms, excessive eagerness to communicate would have devalued the message. Capacity to understand varied between individuals, and intelligent questions indicated preparedness. Given the dependence upon lay-followers, the alms-round ensured regular sangha visibility. Embodied serenity, closely regulated by the Vinaya, both excited curiosity and proved beneficial to onlookers – an affecting dar?ana. Frequently d?na, meal offerings, provided the locus for communicating Dhamma in a graduated, step-by-step manner, according to the capacity of the listeners. Kindness and generosity thus provided the point of departure, while miraculous displays were generally eschewed. In the proposed model, the alms-round is viewed as being undertaken to occasion generosity, making available a merit-field to generate benefits for the givers, rather than promotionally. The infrequent hints of greater assertion are confined to lay-followers, who, building on friendships, may occasionally draw attention to Dhamma. Arguably, this complements the role of the renunciant sangha, the guardian of the tradition, for whom teaching was not in fact obligatory. Though some lay-followers instructed others, their practice focussed on generosity and devotion. Some commentators have suggested that the original zeal waned over the centuries. However, the broadly reticent approach emerges as authentic in underlining the importance of the teachings, valuing goodness in other traditions, and accepting progression across multiple lifetimes. Most significantly, it underlines that coercion sits uneasily within a tradition which insists on exploration and personal transformation. (shrink)

PREFACE I AM greatly indebted to my friends, Professor Dewar of Reading and Miss Maude G. May of Glasgow, for many corrections and suggestions while the following pages were passing through the press. W. M. D. PART I I INTRODUCTION Y. D.H.S. The most singular and deepest themes in the History of the Universe and Mankind, to which all the rest are subordinate, are those in which there is a conflict between Belief and Unbelief, and all epochs, wherein Belief prevails, (...) under, what form it will, are splendid, heart-elevating and fruitful. (shrink)

Lexical Semantics is about the meaning of words. Although obviously a central concern of linguistics, the semantic behaviour of words has been unduly neglected in the current literature, which has tended to emphasize sentential semantics and its relation to formal systems of logic. In this textbook D. A. Cruse establishes in a principled and disciplined way the descriptive and generalizable facts about lexical relations that any formal theory of semantics will have to encompass. Among the topics covered in depth are (...) idiomaticity, lexical ambiguity, synonymy, hierarchical relations such as hyponymy and meronymy, and various types of oppositeness. Syntagmatic relations are also treated in some detail. The discussions are richly illustrated by examples drawn almost entirely from English. Although a familiarity with traditional grammar is assumed, readers with no technical linguistic background will find the exposition always accessible. All readers with an interest in semantics will find in this original text not only essential background but a stimulating new perspective on the field. (shrink)

A comprehensive introduction to the ways in which meaning is conveyed in language. Alan Cruse covers semantic matters, but also deals with topics that are usually considered to fall under pragmatics. A major aim is to highlight the richness and subtlety of meaning phenomena, rather than to expound any particular theory. Rich in examples and exercises, Meaning in Language provides an invaluable descriptive approach to this area of linguistics for undergraduates and postgraduates alike.

The sounds that make up spoken words are heard in a series and must be mapped rapidly onto words in memory because their elements, unlike those of visual words, cannot simultaneously exist or persist in time. Although theories agree that the dynamics of spoken word recognition are important, they differ in how they treat the nature of the competitor set—precisely which words are activated as an auditory word form unfolds in real time. This study used eye tracking to measure the (...) impact over time of word frequency and 2 partially overlapping competitor set definitions: onset density and neighborhood density. Time course measures revealed early and continuous effects of frequency (facilitatory) and on set based similarity (inhibitory). Neighborhood density appears to have early facilitatory effects and late inhibitory effects. The late inhibitory effects are due to differences in the temporal distribution of similarity within neighborhoods. The early facilitatory effects are due to subphonemic cues that inform the listener about word length before the entire word is heard. The results support a new conception of lexical competition neighborhoods in which recognition occurs against a background of activated competitors that changes over time based on fine-grained goodness-of-fit and competition dynamics. (shrink)

A three-valued propositional logic is presented, within which the three values are read as ?true?, ?false? and ?nonsense?. A three-valued extended functional calculus, unrestricted by the theory of types, is then developed. Within the latter system, Bochvar analyzes the Russell paradox and the Grelling-Weyl paradox, formally demonstrating the meaninglessness of both.

The popular view of non-directive genetic counseling limits the counselor's role to providing information to clients and assisting families in making decisions in a morally neutral fashion. This view of non-directive genetic counseling is shown to be incomplete. A fuller understanding of what it means to respect autonomy shows that merely respecting client choices does not exhaust the duty. Moreover, the genetic counselor/client relationship should also be governed by the counselor's commitment to the principle of beneficience. When non-directive counseling is (...) reexamined in light of both these principles, it becomes clear that there are cases in which counselors should attempt to persuade clients to reconsider their decisions. Such attempts are consistent with non-directive counseling because, while respecting the clients' decision-making authority, they insure that clients act with full knowledge of the moral consequences of their decisions. (shrink)

Bainbridge’s well known “Ironies of Automation” Analysis, design and evaluation of man–machine systems. Elsevier, Amsterdam, pp 129–135, 1983. https://doi.org/10.1016/B978-0-08-029348-6.50026-9) laid out a set of fundamental criticisms surrounding the promises of automation that, even 30 years later, remain both relevant and, in many cases, intractable. Similarly, a set of ironies in technologies for sensor driven self-quantification is laid out here, spanning from instrumental problems in human factors design to much broader social problems. As with automation, these ironies stand in the way (...) of many of the promised benefits of these wearable technologies. It is argued here that without addressing these ironies now, the promises of wearables may not come to fruition, and instead users may experience outcomes that are opposite to those which the designers seek to afford, or, at the very least, those which consumers believe they are being offered. This paper describes four key ironies of sensor driven self-quantification: know more, know better versus no more, no better; greater self-control versus greater social control; well-being versus never being well enough; more choice versus erosion of choice. (shrink)

I wish to present a codi cation of syntactic approaches to dealing with ergative languages and argue for the correctness of one particular approach, which I will call the Inverse Grammatical Relations hypothesis.1 I presume familiarity with the term `ergativity', but, brie y, many languages have ergative case marking, such as Burushaski in (1), in contrast to the accusative case marking of Latin in (2). More generally, if we follow Dixon (1979) and use A to mark the agent-like argument (...) of a transitive verb, O to mark the patient-like argument of a transitive verb, and S to mark the single argument of an intransitive verb, then we can call ergative any subsystem of a language that groups S and O in contrast to A, as shown in (3). (shrink)

Previous ed. by : Lord Lloyd of Hampstead and M.D.A. Freeman.

Signals to the brain from the flows of energy around the body, varied primarily by declining amounts of food energy in the stomach, can explain the pattern of meals in the laboratory rat, the differences between dark and light phases, and the development of obesity ion the rat wioth VMH lesions but normal sating.

Objectives: To discover the current state of opinion and practice among doctors in Victoria, Australia, regarding end-of-life decisions and the legalisation of voluntary euthanasia. Longitudinal comparison with similar 1987 and 1993 studies.Design and participants: Cross-sectional postal survey of doctors in Victoria.Results: 53% of doctors in Victoria support the legalisation of voluntary euthanasia. Of doctors who have experienced requests from patients to hasten death, 35% have administered drugs with the intention of hastening death. There is substantial disagreement among doctors concerning the (...) definition of euthanasia.Conclusions: Disagreement among doctors concerning the meaning of the term euthanasia may contribute to misunderstanding in the debate over voluntary euthanasia. Among doctors in Victoria, support for the legalisation of voluntary euthanasia appears to have weakened slightly over the past 17 years. Opinion on this issue is sharply polarised. (shrink)

Primordial emotions are the subjective element of the instincts which are the genetically programmed behaviour patterns which contrive homeostasis. They include thirst, hunger for air, hunger for food, pain and hunger for specific minerals etc.There are two constituents of a primordial emotion—the specific sensation which when severe may be imperious, and the compelling intention for gratification by a consummatory act. They may dominate the stream of consciousness, and can have plenipotentiary power over behaviour.It is hypothesized that early in animal evolution (...) complex reflex mechanisms in the basal brain subserving homeostatic responses, in concert with elements of the reticular activating system subserving arousal, melded functionally with regions embodied in the progressive rostral development of the telencephalon. This included the emergent limbic and paralimbic areas, and the insula. This phylogenetically ancient organization subserved the origin of consciousness as the primordial emotion, which signalled that the organisms existence was immediately threatened. Neuroimaging confirms major activations in regions of the basal brain during primordial emotions in humans. The behaviour of decorticate humans and animals is discussed in relation to the possible existence of primitive awareness.Neuroimaging of the primordial emotions reveals that rapid gratification of intention by a consummatory act such as ingestion causes precipitate decline of both the initiating sensation and the intention. There is contemporaneous rapid disappearance of particular regions of brain activation which suggests they may be part of the jointly sufficient and severally necessary activations and deactivations which correlate with consciousness [Crick, F. & Koch, C. . A framework for consciousness. NatureNeuroscience,6, 119–126]. (shrink)

In a published exchange, Richard Robinson and Roy A. Sorenson debate the matter of whether begging the question is a fallacy; Robinson thinks it is not, but Sorenson argues that it is. Norman Ten attempts to resolve this debate by making a distinction between begging the question and fallaciously begging the question. While Teng is right to note that Robinson and Sorenson are talking past each other, he incorrectly diagnoses the source of this miscommunication. In this paper, then, I offer (...) what I take to be a more illuminating distinction 3; viz. that between logical and rhetorical fallacies 3; and employ that distinction to resolve the debate. (shrink)

Recently, commentators close to and within the UK government have claimed that patient choice can increase equity in the context of the National Health Service. This article critically examines the basis for this claim through analysis of recent speeches and publications authored by secretaries of state for health and their policy advisers. It is concluded that this claim has not developed prospectively from an analysis of the causes of healthcare inequity, or even with a consistent normative definition of equity. The (...) limited justification that is “framed in causal explanations” of inequity has suffered from an apparent disregard of the available evidence. (shrink)

Traditional explanations of multistable visual phenomena (e.g. ambiguous figures, perceptual rivalry) suggest that the basis for spontaneous reversals in perception lies in antagonistic connectivity within the visual system. In this review, we suggest an alternative, albeit speculative. explanation for visual multistability - that spontaneous alternations reflect responses to active, programmed events initiated by brain areas that integrate sensory and non-sensory information to coordinate a diversity of behaviors. Much evidence suggests that perceptual reversals are themselves more closely related to the expression (...) of a behavior than to passive sensory responses: (1) they are initiated spontaneously, often voluntarily, and are influenced by subjective variables such as attention and mood; (2) the alternation process is greatly facilitated with practice and compromised by lesions in non- visual cortical areas; (3) the alternation process has temporal dynamics similar to those of spontaneously initiated behaviors; (4) functional imaging reveals that brain areas associated with a variety of cognitive behaviors are specifically activated when vision becomes unstable. In this scheme, reorganizations of activity throughout the visual cortex, concurrent with perceptual reversals, are initiated by higher, largely non- sensory brain centers. Such direct intervention In the processing of the sensory input by brain structures associated with planning and motor programming might serve an important role in perceptual organization, particularly in aspects related to selective attention. (shrink)

Objections to the use of assistive technologies in elite sports are generally raised when the technology in question is perceived to afford the user a potentially “unfair advantage,” when it is perceived as a threat to the purity of the sport, and/or when it is perceived as a precursor to a slippery slope toward undesirable changes in the sport. These objections rely on being able to quantify standards of “normal” within a sport so that changes attributed to the use of (...) assistive technology can be judged as causing a significant deviation from some baseline standard. This holds athletes using assistive technologies accountable to standards that restrict their opportunities to achieve greatness, while athletes who do not use assistive technologies are able to push beyond the boundaries of these standards without moral scrutiny. This paper explores how constructions of fairness and “normality” impact athletes who use assistive technology to compete in a sporting venue traditionally populated with “able-bodied” competitors. It argues that the dynamic and obfuscated construction of “normal” standards in elite sports should move away from using body performance as the measuring stick of “normal,” toward alternate forms of constructing norms such as defining, quantifying, and regulating the mechanical actions that constitute the critical components of a sport. Though framed within the context of elite sports, this paper can be interpreted more broadly to consider problems with defining “normal” bodies in a society in which technologies are constantly changing our abilities and expectations of what normal means. (shrink)