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)

We argue that abduction does not work in isolation from other inference mechanisms and illustrate this through an inference scheme designed to evaluate multiple hypotheses. We use game theory to relate the abductive system to actions that produce new information. To enable evaluation of the implications of this approach we have implemented the procedures used to calculate the impact of new information in a computer model. Experiments with this model display a number of features of collective belief-revision leading to consensus-formation, (...) such as the influence of bias and prejudice. The scheme of inferential calculations invokes a Peircian concept of ‘belief’ as the propensity to choose a particular course of action. (shrink)

The religious and philosophical doctrine of L. Silenko is the canonical basis of the doctrine of the religious organization of the Sons and Daughters of Ukraine of the Native Ukrainian National Faith in the Western Diaspora and religious organizations that emerged on the basis of RUNVira in independent Ukraine. This doctrine became final in the early 1980's and is in this form the most famous in modern Ukraine. RUNVira is the most studied denomination of the Ukrainian denominational religious movement in (...) the diaspora. (shrink)

Originally published in 1955. The Madhyamika philosophy is, in the author's view, the philosophy which created a revolution in Buddhism and through that in the whole range of Indian philosophy. This volume is a study of the Madhyamika philosophy in all its important aspects and is divided into three parts: Historical: this traces the origin and development of the Madhyamika philosophy. The second part concentrates on a full and critical exposition of the Madhyamika philosophy, the structure of its dialectic, its (...) conception of the Absolute and its ethics and religion. The last part of the book compares the Madhyamika with some of the well-known dialectical systems of the West (Kant, Hegel and Bradley) and undertakes a short study of the different absolutisms (Madhyamika, Vijnanavada and the Vedanta). (shrink)

The lively debate over the constitutional foundations of judicial review has been marred by a formalism which obscures its point and value.ed from genuine issues of substance, the rival positions offer inadequate accounts of the legitimacy of judicial review; constitutional theory must regain its connection with questions of political principle and moral value. Although the critics of ultra vires have rightly emphasized the foundational role of the common law, they have misconceived its nature and implications. On the one hand, they (...) have invited the charge of judicial supremacism by marginalizing the role of legislative intent; on the other, their affirmation of absolute parliamentary sovereignty (within the context of this debate) undermines the critique of ultra vires. In substance, therefore, the rival camps occupy essentially the same ground, equally trapped by a formalism that entrenches a stark confrontation between parliamentary sovereignty and the rule of law. A conception of shared sovereignty, or interdependent sovereignties, provides a better foundation for judicial review. (shrink)

Ronald Dworkin's theory of law forges a close connection between questions about the truth of propositions of law and the question of political obligation: law as integrity is a theory of legal practice that purports to explain, not only how the content of law is determined, but also why the law—in ordinary cases—imposes an obligation of obedience. The theory (as presented) is ultimately incoherent. If we accept Dworkin's theory of the grounds of law we are obliged to reject his claims (...) about its force; alternatively, if we accept his view of the force of law, we must reject his theory about its grounds: he cannot be correct about both force and grounds. Dworkin supposes that, in extraordinary cases, the force of law is cancelled or overridden; but the relevant considerations of justice are wholly internal to our identification of the content of law. Consistently elaborated, integrity denies the offending requirements legal status: lex injusta non est lex. (shrink)

What is sexual orientation? The contemporary consensus among philosophers is that it is a disposition. Unsurprisingly, recent debates about the metaphysics of sexual orientation are almost entirely intramural. Behavioral dispositionalists argue that sexual orientation is a disposition to behave sexually. Desire dispositionalists argue that it is a disposition to desire sexually. We argue that sexual orientation is not best understood in terms of dispositions to behave or dispositions to desire before arguing that dispositions tout court fail to illuminate sexual orientation. (...) We then introduce and defend the idea that sexual orientation is best understood in terms of categorical phenomenal properties of sexual arousal. (shrink)

When legal practice satisfies certain modest conditions of legitimacy, affirming the equal dignity of persons, the law is what it ought to be. It provides the morally appropriate basis for the reso...

My analysis of the constitutional foundations of judicial review has been criticized by Paul Craig; but his objections confuse the ‘constructive’ account of legislative intent I defend with the ‘literal’ conception (reflecting the views of individual legislators) I expressly repudiate. He thinks we must choose between legislative intent, literally conceived, and common law principle. This mistake exemplifies the peculiar character of Craig's ‘common law model’ of judicial review, in which the requirements of the rule of law, on one hand, and (...) the relevant statute, on the other, exist in separate mental worlds. That model is conceptually confused, rejecting the doctrine of ultra vires that (unqualified) legislative supremacy entails, and ultimately grounded in a wholly implausible view of the relationship between common law and statute. It subordinates both statutory text and purpose to common law doctrine, treated as largely self-contained and impervious to context. It ignores the interdependence of legislative and judicial power, impeding a genuine integration of statutory command and common law principle. (shrink)

The Sovereignty of Law presents Trevor Allan's most recent and fully elaborated defence of common law constitutionalism - an account of the unwritten or non-codified constitution as a complex articulation of legal and moral principles, defining what in the British context are the requirements of the rule of law. The British constitution is conceived as a coherent set of fundamental principles of the rule of law, legislative supremacy, and separation of powers. These principles.

The religious ideology of contemporary communities of Ukraine and the diaspora that belong to different currents of the Ukrainian mother-tongue movement cannot bypass the figure of Volodymyr Shayan. He holds the leading position in the conscious proclamation of a new religion in Ukraine, based on the revived and rethought pre-Christian beliefs of the ancestors of the Ukrainians and in the creation of the first religious organizations in this area. The figure of V. Shayan is ambiguous, but his ideology has a (...) significant influence on the religious movement of both the Diaspora and Ukraine and imposes a certain imprint on all its movements. (shrink)

The figure of Myroslav Shkavrytko as an active figure and ideologist of the Ukrainian religious movement is virtually unknown to modern scholars. Also unknown are the doctrines and activities of the Holy Faith - Native Faith created by M. Shkavrytko.

Description: The present monograph is based on Professor Anantharaman's studies and researches for over two decades in the field of classical Yoga. It is the outcome of a sincere attempt by a scientist-technologist to understand and interpret ancient Yoga in today's idiom as well as in the light of recent findings of modern science in the realms of material transformations and human consciousness.

Various attempts have been made in recent years to present Christianity in such a way that no use is made of the traditional dichotomy between the ‘natural’ and the ‘supernatural’. Braithwaite, Hare, and van Buren, for instance, appear to have no use for the dichotomy; and I think that, without too much distortion, one can say the same of Bultmann, Tillich, and Robinson. I am not, however, concerned in this paper with the work of any one thinker as such, but (...) rather with a general climate of opinion. What I want to do is to examine the grounds on which it might be argued that belief in the supernatural is discredited. The issue seems to me of special importance at the present time, since, if these grounds are inadequate, programmes of reform under the general heading ‘Christianity without the supernatural’lose much of their point; if, on the other hand, the grounds are compelling, then reform of some kind is forced upon us whatever the accompanying difficulties. (shrink)