Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires (...) researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)

Psalm 73 is a challenging Psalm in which the Psalmist draws on rich imagery to juxtapose doctrine and experience and to juxtapose the goodness of God with divine retribution. Drawing on data provided by 15 theological educators within the Anglican Diocese of Cyprus and the Gulf, this study tests the thesis that the imagery of Psalm 73 will be perceived differently by sensing types and by intuitive types and that the issue ‘Is God really good to the upright?’ will be (...) judged differently by feeling types and by thinking types. The findings from this study are consistent with the broader hermeneutical theory that the psychological type profile of the reader, in terms of perceiving preference and judging preference, plays a formative part in shaping the interpretation of biblical material.Contribution: Situated within the reader-perspective approach to biblical hermeneutics, the SIFT method is concerned with identifying the influence of the psychological type of the reader in shaping the interpretation of text. The present study demonstrates that this theory holds true for the way in which theological educators read Psalm 73. (shrink)

We have good reason to believe that Nicomachean Ethics VI. 2 is a Nicomachean revision of an originally Eudemian text. Aristotle seems to have inserted lines 1139a31-b11 by means of a marginal note, which the first editor then mistakenly added in the wrong place, and I propose that we move these lines so that they follow the word κοινωνεῖν at 1139a20. The suggested note appears to be Nicomachean for several reasons but most importantly because it contains a desire-based account of (...) the practical intellect as teleologically oriented to action. The NE articulates consequences of this account regarding practical philosophy’s methodology and teleological orientation to action. The EE does not articulate such consequences, and instead seems to assume an object-based account of the practical intellect. Consequently, it would seem that, between the EE and the NE, Aristotle revised his conception of the practical intellect and consequently his conception of practical philosophy. (shrink)

A total of 1918 loci, detected by the hybridization of 938 expressed sequence tag unigenes from 26 Triticeae cDNA libraries, were mapped to wheat homoeologous group 4 chromosomes using a set of deletion, ditelosomic, and nulli-tetrasomic lines. The 1918 EST loci were not distributed uniformly among the three group 4 chromosomes; 41, 28, and 31% mapped to chromosomes 4A, 4B, and 4D, respectively. This pattern is in contrast to the cumulative results of EST mapping in all homoeologous groups, as reported (...) elsewhere, that found the highest proportion of loci mapped to the B genome. Sixty-five percent of these 1918 loci mapped to the long arms of homoeologous group 4 chromosomes, while 35% mapped to the short arms. The distal regions of chromosome arms showed higher numbers of loci than the proximal regions, with the exception of 4DL. This study confirmed the complex structure of chromosome 4A that contains two reciprocal translocations and two inversions, previously identified. An additional inversion in the centromeric region of 4A was revealed. A consensus map for homoeologous group 4 was developed from 119 ESTs unique to group 4. Forty-nine percent of these ESTs were found to be homoologous to sequences on rice chromosome 3, 12% had matches with sequences on other rice chromosomes, and 39% had no matches with rice sequences at all. Limited homology was found between wheat ESTs on homoeologous group 4 and the Arabidopsis genome. Forty-two percent of the homoeologous group 4 ESTs could be classified into functional categories on the basis of blastX searches against all protein databases. (shrink)

According to Aristotle, the medical art aims at health, which is a virtue of the body, and does so in an unlimited way. Consequently, medicine does not determine the extent to which health should be pursued, and “mental health” falls under medicine only via pros hen predication. Because medicine is inherently oriented to its end, it produces health in accordance with its nature and disease contrary to its nature—even when disease is good for the patient. Aristotle’s politician understands that this (...) inherent orientation can be systematically distorted, and so would see the need for something like the Hippocratic Oath. (shrink)

Scholars have often thought that a monistic reading of Aristotle’s definition of the human good – in particular, one on which “best and most teleios virtue” refers to theoretical wisdom – cannot follow from the premises of the ergon argument. I explain how a monistic reading can follow from the premises, and I argue that this interpretation gives the correct rationale for Aristotle’s definition. I then explain that even though the best and most teleios virtue must be a single virtue, (...) that virtue could in principle be a whole virtue that arises from the combination of all the others. I also clarify that the definition of the human good aims at capturing the nature of human eudaimonia only in its primary case. (shrink)

In Nicomachean Ethics 1. 7, Aristotle gives a definition of the human good, and he does so by means of the “ ergon argument.” I clear the way for a new interpretation of this argument by arguing that Aristotle does not think that the ergon of something is always the proper activity of that thing. Though he has a single concept of an ergon, Aristotle identifies the ergon of an X as an activity in some cases but a product in (...) others, depending on the sort of thing the X is—for while the ergon of the eye is seeing, the ergon of a sculptor is a sculpture. This alternative interpretation of Aristotle’s concept of an ergon allows the key explanatory middle term of the ergon argument to be what, I argue, it ought to be: “the best achievement of a human.”. (shrink)

Over 40 years of research have shown that traumatic brain injury affects brain volume. However, technical and practical limitations made it difficult to detect brain volume abnormalities in patients suffering from chronic effects of mild or moderate traumatic brain injury. This situation improved in 2006 with the FDA clearance of NeuroQuant®, a commercially available, computer-automated software program for measuring MRI brain volume in human subjects. More recent strides were made with the introduction of NeuroGage®, commercially available software that is based (...) on NeuroQuant® and extends its utility in several ways. Studies using these and similar methods have found that most patients with chronic mild or moderate traumatic brain injury have brain volume abnormalities, and several of these studies found—surprisingly—more abnormal enlargement than atrophy. More generally, 102 peer-reviewed studies have supported the reliability and validity of NeuroQuant® and NeuroGage®. Furthermore, this updated version of a previous review addresses whether NeuroQuant® and NeuroGage® meet the Daubert standard for admissibility in court. It concludes that NeuroQuant® and NeuroGage® meet the Daubert standard based on their reliability, validity, and objectivity. Due to the improvements in technology over the years, these brain volumetric techniques are practical and readily available for clinical or forensic use, and thus they are important tools for detecting signs of brain injury. (shrink)

The advances in treatment of HIV and the introduction of polymerase chain reaction assay for the virus now make it acceptable for HIV discordant couples where the male partner is seropositive to attempt to conceive through artificial insemination by husband or via in vitro fertilisation. With undetectable viral load and washed sperm, there is minimal risk of transmission of HIV to the female partner, children, other patients, or staff. We describe the development of a programme of AIH for HIV discordant (...) couples and the reasoning behind offering such a programme. (shrink)

We can clarify a certain difficulty with regard to the phrase ‘the best and most perfect virtue’ in Aristotle’s definition of the human good in Nicomachean Ethics I 7 if we make use of two related distinctions: Donnellan’s attributive–referential distinction and Kripke’s distinction between speaker’s reference and semantic reference. I suggest that Aristotle is using the phrase ‘the best and most perfect virtue’ attributively, not referentially, and further that even though the phrase may refer to a specific virtue (semantic reference), (...) Aristotle is not using the phrase to refer to a specific virtue (speaker’s reference). (shrink)

Several ant species are known with genetic effects on caste determination but, for termites, the role of environment has been assumed to be omnipotent. Now Hayashi et al. report that commitment to the nymph and worker pathways in Reticulitermes speratus follows a simple model involving two alleles at a sex‐linked locus.1 The spread of this system of genetic caste determination seems best explained by selection at the colony level. This remarkable system may be widely applicable throughout termites, although it cannot (...) be universal, and may provide a window into causal aspects of the molecular biology of caste determination. BioEssays 30:299–302, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

v. 1. Nicomachean ethics. Politics. The Athenian Constitution. Rhetoric. On Poetics.--v. 2. Logic.--v. 3. Physics. Metaphysics. On the soul. Short physical treaties.--v. 4. On the heavens. On generation and corruption. Meteorology. Biological treatises.

The value of any kind of data is greatly enhanced when it exists in a form that allows it to be integrated with other data. One approach to integration is through the annotation of multiple bodies of data using common controlled vocabularies or ‘ontologies’. Unfortunately, the very success of this approach has led to a proliferation of ontologies which itself creates obstacles to integration. The Open Biomedical Ontologies (OBO) consortium has set in train a strategy to overcome this problem. Existing (...) OBO ontologies, including the Gene Ontology, are undergoing a process of coordinated reform and new ontologies being created on the basis of an evolving set of shared principles governing ontology development. The result is an expanding family of ontologies designed to be interoperable, logically well-formed, and to incorporate accurate representations of biological reality. We describe the OBO Foundry initiative, and provide guidelines for those who might wish to become involved. (shrink)

Relational experiences shape emergent social understanding, and two influences deserve particular attention. First, parent-child conversation about shared experiences incorporates both implicit and explicit information about mental states that catalyzes the social construction of understanding, especially in juxtaposition with the child's direct experience. Second, emotion infuses the contexts and cognitions about social experiences that provoke the child's constructivist efforts.

What is a human body? Some reasons are given for thinking that, in the primary case, it is a body that is both of and suitable to a rational animal.