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)

Hastings Center Report, Volume 52, Issue S1, Page S83-S88, March‐April 2022.

Upon entering the White House in 1933, President Franklin D. Roosevelt faced an ailing economy in the throes of the Great Depression and rushed to transform the country through recovery programs and legislative reform. By 1934, he began to send professional photographers to the state of West Virginia to document living conditions and the effects of his New Deal programs. The photographs from the Farm Security Administration Project not only introduced “America to Americans,” exposing a continued need for government (...) intervention, but also captured powerful images of life in rural and small town America.New Deal Photographs of West Virginia, 1934-1943 presents images of the state's northern and southern coalfields, the subsistence homestead projects of Arthurdale, Eleanor, and Tygart Valley, and various communities from Charleston to Clarksburg and Parkersburg to Elkins. With over one hundred and fifty images by ten FSA photographers, including Walker Evans, Marion Post Wolcott, Arthur Rothstein, and Ben Shahn, this collection is a remarkable proclamation of hardship, hope, endurance, and, above all, community. These photographs provide a glimpse into the everyday lives of West Virginians during the Great Depression and beyond. (shrink)

Summary A study of the metallurgy and manufacturing techniques of a group of eight astrolabes using non-destructive methods has produced the earliest evidence for systematic use of high-zinc brass. To produce this alloy, the brass industry supplying the Lahore instrument makers must have co-melted metallic copper and zinc. This brass-making technology was previously believed to have been developed on an industrial scale in the nineteenth century in Europe. This work hypothesizes that this technology was used in Lahore on an industrial (...) scale as early as ad 1601. In addition, this work hypothesizes that the α + β brass alloy was used specifically for its ease in manufacturing the thin sheet brass required for astrolabe-component manufacture. (shrink)

Newton's conception of time has had a profound influence upon science, particularly psychology. Five characteristics of explanation have devolved from Newton's temporal framework: objectivity, continuity, linearity, universality, and reductivity. These characteristics are outlined in the present essay and shown to be central to psychological theories and methods. Indeed, Newton's temporal framework is so central that it often goes unexamined in psychology. Examination is important, however, because recent critics of Newton's framework - including both scientists and philosophers - have questioned its (...) validity and usefulness. (shrink)

Our hospital routine requires that all new admissions must be asked about their code status. It is not uncommon for an otherwise healthy patient to request that a do-not-resuscitate order be placed in their chart. Presumably, these patients who wish to have a DNR order are acting on the belief that should an unforeseen, irreversible condition occur that leads to a cardiac arrest, they would not want to undergo resuscitation. Tragically, we have witnessed several instances in which potentially life-saving interventions (...) were withheld in viable patients in non-arrest settings for reversible conditions because the patients had a DNR order in the chart. Unfortunately, this happens when the treating physicians are not aware of the limited scope of a DNR order and instead use the order as a blanket prohibition against all components of resuscitation. This communication failure is due to misconceptions that patients and their physicians have with regard to such orders. The medical community is well overdue to improve the end-of-life decisions offered to patients beyond relying on the outdated term DNR.LIMITATIONS OF DNR ORDERSDespite the major advances in critical care medicine in the past few decades, doctors have not substantially improved their ability to address end-of-life decisions any better than by using the all-encompassing term DNR. Currently, the term is generally accepted as an order to prohibit the use of interventions to reverse a cardiac or pulmonary arrest.1 2 What is frequently forgotten with the DNR order is that …. (shrink)

Using the principles and sometimes the conclusions of his teacher Adolf Stöhr, Cleve insists that he is giving a philosophical interpretation and not simply a philological reconstruction of these Pre-Socratics. The philosophers have been divided into 1) "Religious Reformers", 2) "Philosophers of Nature", 3) "Champions of Culture Politics"—"The Glossomorphics". There will certainly be disagreement on some of Cleve's interpretations but it must be said that Cleve carries through his philosophical reconstruction with admirable lucidity and consistency though, occasionally, some of his (...) criticisms of the "philologists" are rather waspish. Nevertheless, this is a splendid and important study which is a tribute to the author's erudition and insight.—D. J. B. (shrink)

This second, more cohesive volume of Schutz's papers goes beyond the critical and inconclusive work of Volume I, to advance, not quite a theory, but certain postulates for the interpretation of social phenomena. Schutz contends that the social scientist, normally an impartial observer, must also assume the standpoint of the subject: he must ask what is the meaning and rationality of social action for the actor himself. From such a bi-polar perspective Schutz describes the situations of "The Stranger," "The Homecomer," (...) and "The Well-Informed Citizen." In the longest paper he analyzes the meaning of equality both for those who are and for those who are not equal. These papers are perceptive—the best in the volume.—A. B. D. (shrink)

This brief work valuably shows how a distinguished historian ascertains the causes of his historical facts. Koht, a Norwegian European historian, eschews any philosophy of history, claiming only that the nature of man is permanent through historical change. Drawing from his own historical research he discusses the significance of the different forces of history. These are religion, economics, class consciousness, the power of the state, war, revolt, science, and internationalism. No one force or cause is primary.—A. B. D.

Arguing from a sort of reasonable Protestant ethic, Henry offers a worthwhile and sometimes quite practical analysis of a Christian social ideal. In Henry's approach, no "prattling about love" can take the place of justice when the latter is what is needed.—D. J. B.

The two epigraphical monuments which have preserved parts of the treaties of alliance between Athens, on the one hand, and Rhegion and Leontinoi, respectively, on the other, must be studied together, for both treaties had their old preambles erased in 433/2 and their validity reaffirmed as of that year. The new preambles, both dating from the same day, were inscribed in the erasures and juxtaposed, somewhat awkwardly, before the body of the old texts thatstill remained.

This work provides an interesting, though sometimes rather sweeping, demonstration that the metaphysical problem of the same and the other is also the central problem of literature and literary criticism. The author defends the analogical imagination as the symbolic counterpart of participation in Platonic metaphysics.--D. C. B.

The author guarantees the partial truth of Socrates' reputation as a sophist by presenting the ideas of Protagoras, Gorgias and others, measuring Socrates' agreement with them, and specifying how he went beyond their relativistic humanism. All the themes in the Socratic dialogues are actually one theme: What is man? Versényi shows that the answers to this question were given as much in Socrates' life as in his teachings. Indeed, Socrates is aptly described as a Heideggerian hero whose death was an (...) authentic affirmation of his life. But such existentialist overtones are not overbearing in this very readable book.--A. B. D. (shrink)

The psychedelic psilocybin has shown promise both as treatment for psychiatric conditions and as a means of improving well-being in healthy individuals. In some jurisdictions (e.g., Oregon, USA), psilocybin use for both purposes is or will soon be allowed and yet, public attitudes toward this shift are understudied. We asked a nationally representative sample of 795 US Americans to evaluate the moral status of psilocybin use in an appropriately licensed setting for either treatment of a psychiatric condition or well-being enhancement. (...) Showing strong bipartisan support, participants rated the individual’s decision as morally positive in both contexts. These results can inform effective policy-making decisions around supervised psilocybin use, given robust public attitudes as elicited in the context of an innovative regulatory model. We did not explore attitudes to psilocybin use in unsupervised or non-licensed community or social settings. (shrink)

This first article is intended as a brief introduction to the general philosophical assumptions of Newton: namely, his mathematicism, empiricism, positivism, reductionism, and dualism. These five "isms" provide an important background to the main articles that are also briefly described.

The progression of research and scholarly inquiry does not occur in isolation and is wholly dependent on accurate reporting of methods and results, and successful replication of prior work. Without mechanisms to correct the literature, much time and money is wasted on research based on a crumbling foundation. These guidelines serve to outline the respective responsibilities of researchers, institutions, agencies, and publishers or editors in maintaining the integrity of the research record. Delineating these complementary roles and proposing solutions for common (...) barriers provide a foundation for best practices. (shrink)

Edith Stein was Husserl's student and private secretary. This study of empathy was originally her doctoral dissertation. After a reduction to pure consciousness, she describes the essence of empathy as a kind of perception sui generis, both like and unlike other acts of consciousness. Different theories of experiencing the other are briefly evaluated. The second part of the book is devoted to the role of empathy in the constitution of the psycho-physical individual and, ultimately, of the person. Written in short, (...) numbered paragraphs, the analysis tends to be jerky and without direction. But there is a sustained description of the living body, antedating Merleau-Ponty's corps vécu by thirty years. The translation seems too literal, and typographical errors abound.—A. B. D. (shrink)