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)

The spatial organization of the genome is intimately linked to its biological function, yet our understanding of higher order genomic structure is coarse, fragmented and incomplete. In the nucleus of eukaryotic cells, interphase chromosomes occupy distinct.

People live and age together in social groups. Across a range of outcomes, research has identified interdependence in the cognitive and health trajectories of ageing couples. Various types of memory decline with age and people report using a range of internal and external, social, and material strategies to compensate for these declines. While memory compensation strategies have been widely studied, research so far has focused only on single individuals. We examined interdependence in the memory compensation strategies reported by spouses within (...) 58 older couples. Couples completed the Memory Compensation Questionnaire, as well as an open-ended interview about their memory compensation practices. We found that internal, intra-individual memory compensation strategies were not associated within couples, but external, extra-individual strategies showed interdependence. Individuals’ scores on material/technological compensation strategies were positively correlated with their partners’. Reported reliance on a spouse was higher for men and increased with age. Our open-ended interviews yielded rich insights into the complex and diverse resources that couples use to support memory in day-to-day life. Particularly evident was the extent of interaction and coordination between social and material compensation, such that couples jointly used external compensation resources. Our results suggest that individuals’ reports of their compensation strategies do not tell the whole story. Rather, we propose that older couples show interdependence in their memory compensation strategies, and adopt complex systems of integrated material and social memory compensation in their day-to-day lives. (shrink)

Public health and service delivery programmes, interventions and policies are typically developed and implemented for the primary purpose of effecting change rather than generating knowledge. Nonetheless, evaluations of these programmes may produce valuable learning that helps determine effectiveness and costs as well as informing design and implementation of future programmes. Such studies might be termed ‘opportunistic evaluations’, since they are responsive to emergent opportunities rather than being studies of interventions that are initiated or designed by researchers. However, current ethical guidance (...) and registration procedures make little allowance for scenarios where researchers have played no role in the development or implementation of a programme, but nevertheless plan to conduct a prospective evaluation. We explore the limitations of the guidance and procedures with respect to opportunistic evaluations, providing a number of examples. We propose that one key missing distinction in current guidance is moral responsibility: researchers can only be held accountable for those aspects of a study over which they have control. We argue that requiring researchers to justify an intervention, programme or policy that would occur regardless of their involvement prevents or hinders research in the public interest without providing any further protections to research participants. We recommend that trial consent and ethics procedures allow for a clear separation of responsibilities for the intervention and the evaluation. (shrink)

The title of this work may seem to beg an important question, since it rests on the assumption that Diderot has a 'concept of physical energy'. Indeed the aim of the study is, in part, to assemble evidence in support of the acte de foi implicit in its title. I am using 'physical energy' in a loose sense, as a convenient term to denote 'what matter can do' as distinct from 'what matter is made of'. Hence it may be taken (...) as broadly synonymous with 'power' or 'force', encompassing both active and potential forms, and thus corresponding to a combination of the fourth and fifth senses identified by the Oxford English Dictionary: 4. Power actively and efficiently displayed or exerted. 5. Power not necessarily manifested in action; ability or capacity to produce an effect. Modern subatomic physics, of course, recognises no such distinction between 'being' and 'doing'; at a fundamental level, matter-as-substance and matter-as-energy are interchangeable (and, as I shall argue towards the end of the study, Diderot himself comes close to a similar position). Nevertheless, the division is both justifiable and useful within the context of eighteenth-century philosophies of nature. For, as many scholars have pointed out, the trend towards nature as an integrated, active phenomenon, in place of the cartesian view of passive tendue only incidentally endowed with motion, was crucial to the development of scientific thought in the mid-eighteenth century. Debate and development on such issues as Newtonian attraction, inertia, electricity and magnetism, chemical reactions, not only contributed directly to the advancement of physics and chemistry, but also (like cartesian mechanism) impinged upon the perennial biological questions, themselves being investigated from a new and exciting angle. As a philosopher rather than a practising scientist, Diderot was ideally placed to draw freely and creatively on all these areas, and his speculations on what we might call 'the nature of nature' are highly characteristic of the new approach. He comes increasingly to discuss and define natural phenomena (organic and inorganic alike) from the point of view of nature's powers - in the spirit of Renaissance naturalism, but from the perspective of up-to-date scientific findings. It is in this sense that I refer to a 'concept of physical energy'. Given the organic quality of Diderot's thought, it is not surprising to find the idea of energy recurring in other areas of his works. If man is composed of matter - active matter - than all human activity, be it moral, political, aesthetic, becomes capable of interpretation in terms of energy. I share Chouillet's conviction that this is a crucial aspect of Diderot's overall philosophy, which deserves to be more widely recognised and more fully understood. (shrink)

The complex-systems approach to cognitive science seeks to move beyond the formalism of information exchange and to situate cognition within the broader formalism of energy flow. Changes in cognitive performance exhibit a fractal (i.e., power-law) relationship between size and time scale. These fractal fluctuations reflect the flow of energy at all scales governing cognition. Information transfer, as traditionally understood in the cognitive sciences, may be a subset of this multiscale energy flow. The cognitive system exhibits not just a single power-law (...) relationship between fluctuation size and time scale but actually exhibits many power-law relationships, whether over time or space. This change in fractal scaling, that is, multifractality, provides new insights into changes in energy flow through the cognitive system. We survey recent findings demonstrating the role of multifractality in (a) understanding atypical developmental outcomes, and (b) predicting cognitive change. We propose that multifractality provides insights into energy flows driving the emergence of cognitive structure. (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)

Thomas Jefferson and Philosophy: Essays on the Philosophical Cast of Jefferson’s Writings is a collection of essays on topics that relate to philosophical aspects of Jefferson’s thinking over the years. Much historical insight is given to ground the various philosophical strands in Jefferson’s thought and writing on topics such as political philosophy, moral philosophy, slavery, republicanism, wall of separation, liberty, educational philosophy, and architecture.

Cheating and rule violations in intercollegiate athletics continue to be relevant issues in many institutions of higher education because they reflect upon the integrity of the institutions in which they are housed, causing concern among many faculty members, administrators, and trustees. Although a great deal of research has documented the numerous rule violations in NCAA intercollegiate athletics, much of it has failed to combine sound theory with practical solutions. The purpose of this study was to examine the possible extensions of (...) the organizational justice framework to the problem of rule violations in intercollegiate athletics. In doing so, the current study examined (a) perceived areas of injustice among coaches at NCAA Division I institutions, (b) avenues by which coaches resolve these injustices, and (c) potential solutions for resolving injustices in an attempt to reduce NCAA violations. Six NCAA Division I basketball coaches from various parts of the country (four from men's teams and two from women's teams) were interviewed using a semi-structured format. Despite the NCAA's efforts to create parity, results showed that coaches perceived several areas of inequities in recruiting, including financial resources and academic standards. The interviewed coaches described several means that are currently used to resolve these inequities and offered recommendations for changes to reduce injustice in the future. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Philosophy and the Modern African American Freedom Struggle: A Freedom Gaze by Anthony Sean NealKordell DixonPhilosophy and the Modern African American Freedom Struggle: A Freedom Gaze Anthony Sean Neal. Rowman & Littlefield, 2022.Philosophy and the Modern African American Freedom Struggle begins with a clear and concise establishment of its aim: to analyze and expand upon those figures mentioned when discussing the academic project of studying black people. Neal (...) broadens the account of black scholars examining racialized existence by centering his work on the modern era and its initiator W. E. B Du Bois. Neal develops an ethnic reflective canon that documents the long history of black thinkers attempting to define their blackness and advance the conception of freedom. This book does an excellent job of capturing the genealogical structure of the struggle for freedom. Within the work, Neal denotes that all relevant figures in this tradition are freedom gazers. These gazers are spectators of a radically imagined future liberated from the oppressive systems that encumber the persecuted. Du Bois's approach to freedom gazing uses academic training to examine his blackness and inevitably to solve the "race problem." What Neal provides the reader is a road map of the intellectual work of black scholars. This road map details the common themes among black thinkers and how these themes relate to Du Bois. Neal's intricate network of philosophers uses their experience and their expertise to write about what is necessary for black people to obtain freedom. Neal composes a complex and remarkable catalog of black scholars that demonstrates the interconnectedness and progression of black thought on oppression and liberation.In the second chapter, Neal elucidates why Du Bois is chosen as the inaugurator of the modern era. As a formally educated black man, Du Bois questions his experience and what tethers him to oppression. Neal uses Du Bois as a focal point, not because Du Bois is the first black person to document their struggle with their racialized existence, but because he believes that Du Bois is the first scholar to analyze the black experience completely. The holistic nature of Du Bois's study of the existential conflict that race can manifest within its subjects allows Du Bois's analysis to be used as a tool to unify other works that discuss race and the struggle for freedom. Neal expresses how other scholars such as Frederick Douglass, Martin Delany, and Anna Julia Cooper all had work that takes up a similar task as Du Bois's but lacks the fullness of Du Bois's study. Here, Neal does not articulate clearly [End Page 87] how these figures are inadequate with respect to their work. It could be argued that each scholar named could be said to have accomplished a task similar to that of Du Bois. However, how these figures are studied throughout different disciplines gives the impression that their examination of race and freedom is much more focused on one specific field. This point speaks to how we interpret the work of these scholars and not to these scholars' work itself. Neal proceeds to describe Du Bois as a freedom gazer and explains how Du Bois's imagining of black persons as freed would allot a perceptual framework that motivates them to proclaim their right to mental and physical freedom. Further, Neal establishes that Du Bois's position as a freedom gazer allows him to expand the ethnic reflective canon. This canon includes Ida B. Wells, whose journalism on the lynching of black people during the Reconstruction era made headway on what social sciences could contribute to the struggle against injustice. Anna Julia Cooper is included in this canon; her radically imagined future was thought to be achieved through education. Wells and Cooper proceeded and directly influenced the work of Du Bois, creating a lineage of radical social thought. Neal maps his transition through the intellectual work of black scholars by using conceptions of peace, rebellion, revolution, and freedom as relational markers. The reader can identify the relationships among the varied work of freedom gazers despite the vast range of their spatiotemporal placement.In the third chapter, Neal examines the subjects Hubert Harrison, William H... (shrink)

This study reexamines a lynchpin of Neo-Babylonian Levantine Phoenician historiography: Nebuchadnezzar II’s purported thirteen-year siege of Tyre in the early sixth century bce. This detail about the length of the siege can be found only in Josephus’ (first century ce) writings, but this study’s new assessment of the (sixth-fifteenth century ce) manuscript evidence shows that the more commonly transmitted length of the siege was “three years and ten months.” Other manuscript variations further illustrate that there was little continuous cultural memory (...) of the length of the event. When coupled with (a) other chronological problems in Josephus’ works, (b) a review of the complex Biblical, Mesopotamian, and Classical relevant literary sources, and (c) the lack of current evidence for any destruction levels or siegeworks at the site of Tyre, the case for insisting other sources be synchronized with this thirteen-year framework weakens. Shorter sieges or raids, blockades of the island or inland ports, and periodic Babylonian military presence to extract personnel and resources are all likely scenarios for Tyre and other Levantine sites during Nebuchadnezzar’s 43-year reign. Discarding a single “thirteen-year siege” as a reliable historical detail allows scholars of the Neo-Babylonian period in the central coastal Levant to shift their attention to more interesting questions, including exploring the causes and impacts of the evident changes in Tyre’s seaward and inland trading patterns in the sixth-fifth centuries. (shrink)

The late Jacob Klein’s important book is, remarkably, a lucid presentation of esoteric argument. Dealing with the famed Platonic triad, Theaetetus, Sophist, and Statesman, Klein settles the dispute about the missing dialogue, "The Philosopher," by first denying that it is missing and second showing that it is unnecessary. He argues, in short, that the triad is a dyad. That argument is reinforced by the distinction Klein strongly implies between the Socratic Theaetetus and the Eleatic Sophist and Statesman. "We can now (...) understand why the conversations of the ‘trilogy’ occur in two, not three, days and why the Sophist, the Statesman, and the Philosopher are dealt with in two, not three, dialogues". (shrink)

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)

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)

This new edition of Introduction to Lattices and Order presents a radical reorganization and updating, though its primary aim is unchanged. The explosive development of theoretical computer science in recent years has, in particular, influenced the book's evolution: a fresh treatment of fixpoints testifies to this and Galois connections now feature prominently. An early presentation of concept analysis gives both a concrete foundation for the subsequent theory of complete lattices and a glimpse of a methodology for data analysis that is (...) of commercial value in social science. Classroom experience has led to numerous pedagogical improvements and many new exercises have been added. As before, exposure to elementary abstract algebra and the notation of set theory are the only prerequisites, making the book suitable for advanced undergraduates and beginning graduate students. It will also be a valuable resource for anyone who meets ordered structures. (shrink)