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)

New pedagogical visions and technological developments have brought argumentation to the fore of educational practice. Whereas students previously 'learned to 'argue', they now 'argue to learn': collaborative argumentation-based learning has become a popular and valuable pedagogical technique, across a variety of tasks and disciplines. Researchers have explored the conditions under which arguing to learn is successful, have described some of its learning potentials and have developed Internet-based tools to support such learning. However, the further advancement of this field presently faces (...) several problems, which the present book addresses. Three dimensions of analysis - historical, theoretical and empirical - are integrated throughout the book. Given the nature of its object of study - dialogue, interaction, argumentation, learning and teaching - the book is resolutely multidisciplinary, drawing on research on learning in educational and psychological sciences, as well as on philosophical and linguistic theories of dialogue and argumentation. (shrink)

We investigated people's ability to infer others’ mental states from their emotional reactions, manipulating whether agents wanted, expected, and caused an outcome. Participants recovered agents’ desires throughout. When the agent observed, but did not cause the outcome, participants’ ability to recover the agent's beliefs depended on the evidence they got. When the agent caused the event, participants’ judgments also depended on the probability of the action ; when actions were improbable given the mental states, people failed to recover the agent's (...) beliefs even when they saw her react to both the anticipated and actual outcomes. A Bayesian model captured human performance throughout, consistent with the proposal that people rationally integrate information about others’ actions and emotional reactions to infer their unobservable mental states. (shrink)

Philosophy textbooks typically treat bioethics as a form of "applied ethics"-i.e., an attempt to apply a moral theory, like utilitarianism, to controversial ethical issues in biology and medicine. Historians, however, can find virtually no cases in which applied philosophical moral theory influenced ethical practice in biology or medicine. In light of the absence of historical evidence, the authors of this paper advance an alternative model of the historical relationship between philosophical ethics and medical ethics, the appropriation model. They offer two (...) historical case studies to illustrate the ways in which physicians have "appropriated" concepts and theory fragments from philosophers, and demonstrate how appropriated moral philosophy profoundly influenced the way medical morality was conceived and practiced. (shrink)

The Cambridge World History of Medical Ethics is the first comprehensive scholarly account of the global history of medical ethics. Offering original interpretations of the field by leading bioethicists and historians of medicine, it will serve as the essential point of departure for future scholarship in the field. The volumes reconceptualize the history of medical ethics through the creation of new categories, including the life cycle; discourses of religion, philosophy, and bioethics; and the relationship between medical ethics and the state, (...) which includes a historical reexamination of the ethics of apartheid, colonialism, communism, health policy, imperialism, militarism, Nazi medicine, Nazi "medical ethics," and research ethics. Also included are the first global chronology of persons and texts; the first concise biographies of major figures in medical ethics; and the first comprehensive bibliography of the history of medical ethics. An extensive index guides readers to topics, texts, and proper names. (shrink)

The ontological argument in Anselm’s Proslogion II continues to generate a remarkable store of sophisticated commentary and criticism. However, in our opinion, much of this literature ignores or misrepresents the elegant simplicity of the original argument. The dialogue below seeks to restore that simplicity, with one important modification. Like the original, it retains the form of a reductio, which we think is essential to the argument’s great genius. However, it seeks to skirt the difficult question of whether 'exists' is a (...) genuine predicate by appealing instead to a distinction between having only mediated causal powers and having unmediated causal powers. Pegasus has no unmediated causal powers, but he has mediated causal powers through the thoughts, depictions, and literature in which he figures. This distinction allows us to argue about the existence of God without begging any questions. (shrink)

Human vision supports social perception by efficiently detecting agents and extracting rich information about their actions, goals, and intentions. Here, we explore the cognitive architecture of perceived animacy by constructing Bayesian models that integrate domain‐specific hypotheses of social agency with domain‐general cognitive constraints on sensory, memory, and attentional processing. Our model posits that perceived animacy combines a bottom–up, feature‐based, parallel search for goal‐directed movements with a top–down selection process for intent inference. The interaction of these architecturally distinct processes makes perceived (...) animacy fast, flexible, and yet cognitively efficient. In the context of chasing, in which a predator (the “wolf”) pursues a prey (the “sheep”), our model addresses the computational challenge of identifying target agents among varying numbers of distractor objects, despite a quadratic increase in the number of possible interactions as more objects appear in a scene. By comparing modeling results with human psychophysics in several studies, we show that the effectiveness and efficiency of human perceived animacy can be explained by a Bayesian ideal observer model with realistic cognitive constraints. These results provide an understanding of perceived animacy at the algorithmic level—how it is achieved by cognitive mechanisms such as attention and working memory, and how it can be integrated with higher‐level reasoning about social agency. (shrink)

Motile bacteria respond to environmental cues to move to more favorable locations. The components of the chemotaxis signal transduction systems that mediate these responses are highly conserved among prokaryotes including both eubacterial and archael species. The best‐studied system is that found in Escherichia coli. Attractant and repellant chemicals are sensed through their interactions with transmembrane chemoreceptor proteins that are localized in multimeric assemblies at one or both cell poles together with a histidine protein kinase, CheA, an SH3‐like adaptor protein, CheW, (...) and a phosphoprotein phosphatase, CheZ. These multimeric protein assemblies act to control the level of phosphorylation of a response regulator, CheY, which dictates flagellar motion. Bacterial chemotaxis is one of the most‐understood signal transduction systems, and many biochemical and structural details of this system have been elucidated. This is an exciting field of study because the depth of knowledge now allows the detailed molecular mechanisms of transmembrane signaling and signal processing to be investigated. BioEssays 28:9–22, 2006. © 2005 Wiley Periodicals, Inc. (shrink)

Anselm: I agreed that Pegasus is a flying horse according to the stories people tell, the paintings painters paint and so on . That is, Pegasus is a flying horse in the understanding of storytellers, their readers and the artists who depict Pegasus. You asked whether flying is not an unmediated causal power . Well, it could be an unmediated causal power if you or I had it, but not if a being with only mediated powers had it. And so (...) poor Pegasus, a being whose powers are only those given him by storytellers and artists, has only the mediated power of flying that they have given him. He flies in the thoughts and depictions of beings with unmediated powers. Still, Pegasus has not only the mediated power to fly but also the mediated power to entertain us, and perhaps even inspire us. Fool: But people could tell stories about you, too, about how you sprouted wings and flew onto the roof of Canterbury Cathedral. Anselm: Alas, if it were only in stories that I could do that, then flying would not be an unmediated causal power of mine. I would still have unmediated causal powers all right, and so would be greater than Pegasus. But flying is not one of my unmediated causal powers. However, something than which nothing greater can be conceived would, and does, as I have proved in my Proslogion, have unmediated causal powers – indeed, much greater unmediated causal powers than any poor mortals like you and me.1 •↵1 For …. (shrink)

: Medical ethics often is treated as applied ethics, that is, the application of moral philosophy to ethical issues in medicine. In an earlier paper, we examined instances of moral philosophy's influence on medical ethics. We found the applied ethics model inadequate and sketched an alternative model. On this model, practitioners seeking to change morality "appropriate" concepts and theory fragments from moral philosophy to valorize and justify their innovations. Goldilocks-like, five commentators tasted our offerings. Some found them too cold, since (...) they had already abandoned applied ethics; others too hot, since they still find the applied ethics model to their taste. We reply that the appropriation model offers an empirically testable account of the historical relationship between moral philosophy and medical ethics that explains why practitioners appropriate concepts and fragments from moral philosophy. In contrast, the now fashionable common morality theory neither explains moral change nor why practitioners turn to moral philosophy. (shrink)

Games and simulations--from quantitative modeling to immersive, experiential scenarios--as methods for engagement within futures studies have a substantial history. In recent years, there has been a surge of projects using a wide array of tools. As practitioners and researchers have gravitated toward more playful approaches, there is a need to review and evaluate such approaches. This chapter provides an introduction to gaming and simulations as anticipatory processes. Offering a snapshot of contemporary projects from around the world, this chapter utilizes a (...) range of voices and perspectives on gaming and simulations to explore how such tools and methods use the future. (shrink)

Background To describe the preferences for disclosure of individual biomarker results among mothers participating in a longitudinal birth cohort. Methods We surveyed 343 mothers that participated in the Health Outcomes and Measures of the Environment Study about their biomarker disclosure preferences. Participants were told that the study was measuring pesticide metabolites in their biological specimens, and that the health effects of these low levels of exposure are unknown. Participants were asked whether they wanted to receive their results and their child's (...) results. In addition, they were asked about their preferred method (letter vs in person) and format (more complex vs less complex) for disclosure of results. Results Almost all of the study participants wanted to receive their individual results (340/343) as well as their child's results (342/343). However, preferences for receiving results differed by education level. Mothers with less than a college degree preferred in-person disclosure of results more often than mothers with some college education or a college degree (34.3% vs 17.4% vs 7.9%, p<0.001). Similarly, mothers with less than a college education preferred a less complex disclosure format than mothers with some college education or a college degree (59.7% vs 79.1% vs 86.3%, p<0.0001). Conclusion While almost all study participants preferred to receive results of their individual biomarker tests, level of education was a key factor in predicting preferences for disclosure of biomarker results. To ensure effective communication of this information, disclosure of biomarker results should be tailored to the education level of the study participants. (shrink)

We report evidence further supporting homology between proteins in the F1FO‐ATP synthetase and the bacterial flagellar motor (BFM). BFM proteins FliH, FliI, and FliJ have been hypothesized to be homologous to FO‐b + F1‐δ, F1‐α/β, and F1‐γ, with similar structure and interactions. We conduct a further test by constructing a gene order dataset, examining the order offliH,fliI, andfliJgenes across the phylogenetic breadth of flagellar and nonflagellar type 3 secretion systems, and comparing this to published surveys of gene order in the (...) F1FO‐ATP synthetase, its N‐ATPase relatives, and the bacterial/archaeal V‐ and A‐type ATPases. Strikingly, thefliHIJgene order was deeply conserved, with the few exceptions appearing derived, and exactly matching the widely conserved F‐ATPase gene orderatpFHAG, coding for subunits b‐δ‐α‐γ. The V/A‐type ATPases have a similar conserved gene order. Our results confirm homology between these systems, and suggest a rare case of synteny conserved over billions of years, predating the Last Universal Common Ancestor (LUCA). (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

Two principal questions lie at the heart of the philosophy of colour perception. First: how do colour experiences represent the world? Second: do colour representations veridically represent the world? This collection of papers closely examines the various ways in which colour experience may represent the world, and the possibilities regarding the veridicality of these representations. As it turns out, close attention to the above two questions illuminates novel ways of approaching the metaphysics of colour and colour experience. Paper one distinguishes (...) different ways in which colour experience can be veridical or erroneous, and uses these distinctions to motivate realist error theories: a new class of theory regarding the perception of colour. Realist error theories say that colour experience is erroneous regarding the location and/or metaphysics of colour, but is generally veridical regarding the instantiation of colour. I argue that realist error theories provide a new approach to certain tensions between our motivated metaphysics for colour and how experience represents the colours. Paper two falls into two parts. In the first part, I argue that extant subject-dependent theories of colour fail to delineate veridical colour experiences from erroneous colour experiences. In part two, I develop novel subject-dependent theories which successfully delineate veridical colour experiences from erroneous colour experiences. I advocate for mono-minimalism: a view which says that colours are subject-dependent properties which range over at least one standard perceiver in at least one standard condition. Paper three focuses on the distinction between steady and unsteady colours. Extant proposals involve positing that steady colours are subject-independent and unsteady colours are subject-dependent. I argue that the subject-dependent theorist can explain the metaphysical difference between steady and unsteady colours in wholly subject-dependent terms. We can say that steady and unsteady colours are both subject-dependent properties, but steady colours range over a broader range of perceptual conditions compared to unsteady colours. I argue that this bifurcation in the scope of the colours is consistent with the mono-minimalist theory of colour proposed in paper two. (shrink)

The baker's transformation is one of the earliest and simplest examples of a bijective mixing transformation. By determining its cycle structure, we show that this transformation is not embeddable in any flow, i.e., one-parameter semigroup, on the nonnegative rationals and,a fortiori, not emdeddable in any flow on the reals.

In lieu of an abstract, here is a brief excerpt of the content:738 Feminist Studies 42, no. 3. © 2016 by Feminist Studies, Inc. Hannah Baker Saltmarsh Notice When I read people’s necks, waiting on the same wheels: make out the names, Rabbit, Omar, Tiny, Mark, Deedy, Soulja, like characters on a new Netflix series that uses people’s real names; or say, trace up to the teardrop on the cheek, either you murdered someone or was someone’s little b in (...) prison (the difference as slight as pushing on the door bell or tapping the door knocker); or stray to the stains on the forearm, hand, calf. Above his stab wounds in all caps: LAUGH NOW and SILENT; beneath the life-saving laser’s scar, FUCK THE WORLD. The skulls, keys, infringed-upon peacock, grim reaper, the crescent city, fire: am I really to identify the latest sex offender, crimes expired for a decade now like a plastic rack of eggs in the bachelor’s trash, by his tattoos listed on this postcard notice, mass-mailed to the surrounding neighborhoods, and angrily shredded by mothers who wouldn’t let near their child a grown man with a kite? The last time you saw a man at a bar with some woman’s name across his neck like an exaggerated noose a diamond can’t touch, you wondered how he hits on other women. If you Google your friend’s date, some pictures check out with his baseball stats. Or your other friend, Googling her landlord, sees he was arrested at a protest, the tousled, enlightened 36-hour criminal who ends up in a Michael Moore movie, and becomes her lover without end, buying her black Prada sheath dresses and a holster of antique cream Hannah Baker Saltmarsh 739 and vintage pink carnations. Every new man in anyone’s life you know makes you paranoid of dirt: even the pages not found become suspicious in your paranoia: Humvees shot to fossils by Sahara sands. What if the postcard notice had a face you knew, a man you actually knew before his mugshot.com photo op, before the teardrop tat? Him and his puppet-friend, purple, called Homer, who said Do good and share, but don’t share your underwear, showing up in the mail. Are the allegations true: the church retreat, the elementary-class sleepover, the partner in the frazzled chicken costume, the puppet as witness, gang-raping the girl with plastic teal jewelry who then peed herself? I weep, reading the file, thinking of the older girl being returned to her sleeping bag beside all of ours. We didn’t know she went anywhere but the bathroom. When the news breaks, my mother and I have the same nightmare about the underwear song. My parents remembered he liked plain M&M’s, not peanut. He told us after years of buying the wrong ones. And I felt so bad we got the wrong ones. How could we get it wrong? I can’t Google my way to knowing, or ask his wife at Starbucks, but every notice reminds me of the IZOD alligators he tickled on boys’ shirts. So ill now, and confused, what would he even say for himself, and who would care longer than the blurb’s echo? All you can do is wait for the late bus. Two hours late, the usual, and we’re still jammed into the covered bench. A goose, built like a hanger, born in the gated university’s pond, shot out so far as the university bus stop, body just out of the sheltered wait, as if anxious to start somewhere. 740 Hannah Baker Saltmarsh Index of Jobs for Women I would have been a confectioner, not Shakespeare’s sister, whirring a dozen egg whites into soft collapsible peaks for baked rice pudding with black-blue currants, stirring yeasty sourdough starter a few times a day until it ferments vigorously, quicker in summer: a week to evolve. I would have tried to find a way to the youngest Saltmarsh who lives by the brackish waters, tall sea grasses, canals by crocodiles, and sedges with their edges, whose heart is bigger than his head, whose narrow bikeway of a torso might have said, on the last... (shrink)

This paper traces an expanded ethical perspective for youth and community work (YCW) practice in response to the climate and biodiversity crises. Discussing ecological ethics, we problematise the liberal humanist emphasis on utilitarianism and reject it as inappropriate for YCW in these times. Instead, we argue for an ecocentric practice ethic which intrinsically values the non-human world. To advance an ecocentric ethical perspective for YCW we draw on decolonial and posthuman theory. Inspired by a Freirean dialogical approach, we apply these (...) theoretical domains as lenses to problematise YCW practice, seeking a generative dialogue between perspectives. Through this, we identify three emergent tasks for ecocentric YCW: (a) thinking and acting beyond the individual; (b) cultivating reciprocal care and connection and (c) practicing critical pedagogies of place. This third element builds on YCW's social pedagogic tradition and provides a practical means to incorporate ecocentric ideas into practice. We conclude that, given the unprecedented implications of climate crises and biodiversity collapse, a YCW ethics that does not consider these implications for young people is insufficient for the context of practice today. Enacting an ecocentric YCW ethics requires ongoing collective praxis and dialogue between young people, practitioners, educators, managers and students. (shrink)

Mark Schroeder has argued that all reasonable forms of inconsistency of attitude consist of having the same attitude type towards a pair of inconsistent contents (A-type inconsistency). We suggest that he is mistaken in this, offering a number of intuitive examples of pairs of distinct attitudes types with consistent contents which are intuitively inconsistent (B-type inconsistency). We further argue that, despite the virtues of Schroeder's elegant A-type expressivist semantics, B-type inconsistency is in many ways the more natural choice in developing (...) an expressivist account of moral discourse. We close by showing how to adapt ordinary formality-based accounts of logicality to define a B-type account of logical inconsistency and distinguish it from both semantic and pragmatic inconsistency. In sum, we provide a roadmap of how to develop a successful B-type expressivism. (shrink)

The American Medical Association enacted its Code of Ethics in 1847, the first such national codification. In this volume, a distinguished group of experts from the fields of medicine, bioethics, and history of medicine reflect on the development of medical ethics in the United States, using historical analyses as a springboard for discussions of the problems of the present, including what the editors call "a sense of moral crisis precipitated by the shift from a system of fee-for-service medicine to a (...) system of fee-for-system medicine, better known as 'managed care.'" The authors begin with a look at how the medical profession began to consider ethical issues in the 1800s and subsequent developments in the 1900s. They then address the sociological, historical, ethical, and legal aspects of the practice of medicine. Later chapters discuss current and future challenges to medical ethics and professional values. Appendixes display various versions of the AMA's Code of Ethics as it has evolved over time. Contributors: George J. Annas, J.D., M.P.H., Arthur Isak Applbaum, Ph.D., Robert B. Baker, Ph.D., Chester R. Burns, M.D., Ph.D., Arthur L. Caplan, Ph.D., Alexander Morgan Capron, J.D., Christine K. Cassel, M.D., Linda L. Emanuel, M.D., Ph.D., Eliot L. Freidson, Ph.D., Albert R. Jonsen, Ph.D., Stephen R. Latham, J.D., Ph.D., Susan E. Lederer, Ph.D., Florencia Luna, Ph.D., Edmund D. Pellegrino, M.D., Charles E. Rosenberg, Ph.D., Mark Siegler, M.D., Rosemary A. Stevens, Ph.D., Robert M. Tenery, Jr., M.D., Robert M. Veatch, Ph.D., John Harley Warner, Ph.D., Paul Root Wolpe, Ph.D. (shrink)

The decision-theoretic account of probability in the Everett or many-worlds interpretation, advanced by David Deutsch and David Wallace, is shown to be circular. Talk of probability in Everett presumes the existence of a preferred basis to identify measurement outcomes for the probabilities to range over. But the existence of a preferred basis can only be established by the process of decoherence, which is itself probabilistic.