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)

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)

The ongoing cynicism about leaders and organizations calls for a new standard of ethical leadership that we have labeled “transformative leadership.” This new leadership model integrates ethically-based features of six other well-regarded leadership perspectives and combines key normative and instrumental elements of each of those six perspectives. Transformative leadership honors the governance obligations of leaders by demonstrating a commitment to the welfare of all stakeholders and by seeking to optimize long-term wealth creation. Citing the scholarly literature about leadership theory, we (...) identify key elements of the six leadership perspectives that make up transformative leadership, suggest leaders who exemplify each perspective, describe the ethical foundations and message of each perspective, and offer ten propositions that scholars and practitioners can use to test the dimensions of this new transformative leadership model. (shrink)

Eighteenth-century England saw the rise of a "peculiarly English" art form—landscape gardening—and a corresponding change in attitudes toward the antural world. While the French, who lived under tyranny, had a tightly organized, restrictive gardens, the "free" English enjoyed gardens where they were at liberty to wander. John Dixon Hunt examines eighteenth-century letters, literary and critical works, biographies, paintings, prints, and drawings to trace the gradual movement from formal regularity toward a carefully calculated naturalness.

In a world that has become increasingly dependent upon employee ownership, commitment, and initiative, organizations need leaders who can inspire their␣employees and motivate them individually. Love, forgiveness, and trust are critical values of today’s organization leaders who are committed to maximizing value for organizations while helping organization members to become their best. We explain the importance of love, forgiveness, and trust in the modern organization and identify 10 commonalities of these virtues.

BackgroundAlthough patient advocates have developed templates for standard consent forms, evaluating patient preferences for first in human (FIH) and window of opportunity (Window) trial consent forms is critical due to their unique risks. FIH trials are the initial use of a novel compound in study participants. In contrast, Window trials give an investigational agent over a fixed duration to treatment naïve patients in the time between diagnosis and standard of care (SOC) surgery. Our goal was to determine the patient-preferred presentation (...) of important information in consent forms for these trials.MethodsThe study consisted of two phases: (1) analyses of oncology FIH and Window consents; (2) interviews of trial participants. FIH consent forms were analyzed for the location(s) of information stating that the study drug has not been tested in humans (FIH information); Window consents were analyzed for the location(s) of information stating the trial may delay SOC surgery (delay information). Participants were asked about their preferred placement of the information in their own trial’s consent form. The location of information in the consent forms was compared to the participants’ suggestions for placement. Results34 [17 FIH; 17 Window] of 42(81%) cancer patients approached participated. 25 consents [20 FIH; 5 Window] were analyzed. 19/20 FIH consent forms included FIH information, and 4/5 Window consent forms included delay information. 19/20(95%) FIH consent forms contained FIH information in the risks section 12/17(71%) patients preferred the same. Fourteen (82%) patients wanted FIH information in the purpose, but only 5(25%) consents mentioned it there. 9/17(53%) Window patients preferred delay information to be located early in the consent, before the “Risks” section. 3/5(60%) consents did this.ConclusionsDesigning consents that reflect patient preferences more accurately is essential for ethical informed consent; however, a one-size fits all approach will not accurately capture patient preferences. We found that preferences differed for FIH and Window trial consents, though for both, patients preferred key risk information early in the consent. Next steps include determining if FIH and Window consent templates improve understanding. (shrink)

The ethical codes of the professional engineering bodies identify the responsibilities of the engineer. Of equal importance to the codes are the virtues which enable the engineer to fulfil these responsibilities. After briefly reviewing such virtues this paper argues that the systematic learning of virtues is possible in a formal way through learner centred learning. Central to this learning experience is the development of integrity which focuses the other major virtues and enables reflection upon them. A review of undergraduate courses (...) suggests how this can be achieved. (shrink)

Individual choice and freedom are repeatedly invoked in contemporary policy debates, including those with a focus on risk behaviors such as smoking and health insurance coverage. The idea of making the right choice with regard to health and well-being has been fortified by the neoliberal discourse of self-reliance, personal autonomy, and responsibility. This neoliberal view, stemming from the conceptualization of freedom of philosopher John Stuart Mill justifying the freedom of the individual in opposition to unlimited state control, holds that success, (...) good health, and favorable educational outcomes are largely due to individual effort. Correspondingly, so too is failure, including failure of.. (shrink)

Afferent feedback can appreciably alter the pharyngeal phase of swallow. In order to measure the stability of the swallow motor pattern during several types of alterations in afferent feedback, we assessed swallow during a conventional water challenge in four anesthetized cats, and compared that to swallows induced by fixed (20 Hz) and stochastic (1-20Hz) electrical stimulation applied to the superior laryngeal nerve. The swallow motor patterns were evaluated by electromyographic activity (EMG) of eight muscles, based on their functional significance: laryngeal (...) elevators (mylohyoid, geniohyoid, and thyrohyoid); laryngeal adductor (thyroarytenoid); inferior pharyngeal constrictor (thyropharyngeus); upper esophageal sphincter (cricopharyngeus); and inspiratory activity (parasternal and costal diaphragm). Both the fixed and stochastic electrical stimulation paradigms increased activity of the laryngeal elevators, produced short-term facilitation evidenced by increasing swallow durations over the stimulus period, and conversely inhibited swallow-related diaphragm activity. Both the fixed and stochastic stimulus conditions also increased specific EMG amplitudes, which never occurred with the water challenges. Stochastic stimulation increased swallow excitability, as measured by an increase in the number of swallows produced. Consistent with our previous results, changes in the swallow motor pattern for pairs of muscles were only sometimes correlated with each other. We conclude that alterations in afferent feedback produced particular variations of the swallow motor pattern. We hypothesize that specific SLN feedback might modulate the swallow central pattern generator during aberrant feeding conditions (food/liquid entering the airway), which may protect the airway and serve as potentially important clinical diagnostic indicators. (shrink)

The study seeks to elucidate the nature of early Dhamma-transmission. While Buddhism has achieved broad geographical dissemination, sometimes earning the epithet ‘missionary’, P?li sources are ambivalent regarding approaches to potential followers. The Buddha’s final words do not instruct the sangha to spread the message; the exhortation, ‘walk, monks … for the blessing of the manyfolk’, rather appears to be an early, isolated episode. The Buddha’s own hesitation to teach provides the paradigm for the renunciant sangha, whose members rarely initiate teaching (...) episodes, preferring to wait for specific questions, an approach still formalised in modern practice. Following brahmanical norms, excessive eagerness to communicate would have devalued the message. Capacity to understand varied between individuals, and intelligent questions indicated preparedness. Given the dependence upon lay-followers, the alms-round ensured regular sangha visibility. Embodied serenity, closely regulated by the Vinaya, both excited curiosity and proved beneficial to onlookers – an affecting dar?ana. Frequently d?na, meal offerings, provided the locus for communicating Dhamma in a graduated, step-by-step manner, according to the capacity of the listeners. Kindness and generosity thus provided the point of departure, while miraculous displays were generally eschewed. In the proposed model, the alms-round is viewed as being undertaken to occasion generosity, making available a merit-field to generate benefits for the givers, rather than promotionally. The infrequent hints of greater assertion are confined to lay-followers, who, building on friendships, may occasionally draw attention to Dhamma. Arguably, this complements the role of the renunciant sangha, the guardian of the tradition, for whom teaching was not in fact obligatory. Though some lay-followers instructed others, their practice focussed on generosity and devotion. Some commentators have suggested that the original zeal waned over the centuries. However, the broadly reticent approach emerges as authentic in underlining the importance of the teachings, valuing goodness in other traditions, and accepting progression across multiple lifetimes. Most significantly, it underlines that coercion sits uneasily within a tradition which insists on exploration and personal transformation. (shrink)

PREFACE I AM greatly indebted to my friends, Professor Dewar of Reading and Miss Maude G. May of Glasgow, for many corrections and suggestions while the following pages were passing through the press. W. M. D. PART I I INTRODUCTION Y. D.H.S. The most singular and deepest themes in the History of the Universe and Mankind, to which all the rest are subordinate, are those in which there is a conflict between Belief and Unbelief, and all epochs, wherein Belief prevails, (...) under, what form it will, are splendid, heart-elevating and fruitful. (shrink)

I wish to present a codi cation of syntactic approaches to dealing with ergative languages and argue for the correctness of one particular approach, which I will call the Inverse Grammatical Relations hypothesis.1 I presume familiarity with the term `ergativity', but, brie y, many languages have ergative case marking, such as Burushaski in (1), in contrast to the accusative case marking of Latin in (2). More generally, if we follow Dixon (1979) and use A to mark the agent-like argument (...) of a transitive verb, O to mark the patient-like argument of a transitive verb, and S to mark the single argument of an intransitive verb, then we can call ergative any subsystem of a language that groups S and O in contrast to A, as shown in (3). (shrink)

A critical discussion of DAVID WILSON and WILLIAM DIXON, A History of Homo Economicus. The nature of the moral in economic theory, London and New York, Routledge, pp. xviii+123 ISBN 978-0-415-59568-1. I declare agreement with one basic idea in this book, that economic discourse is performative, or economic theory is not pure theorìa. I add several objections to the historical reconstruction carried out os such authors as Malthus and Ricardo and I object to the definition adopted of homo economicus.

В книге дается анализ основных характерных признаков русской философии, позволяющие выделить ее как нечто особенное из общего контекста философских культур.

A laboratory-testable, solid-state Maxwell demon is proposed that utilizes the electric field energy of an open-gap p-n junction. Numerical results from a commercial semiconductor device simulator (Silvaco International–Atlas) verify primary results from a 1-D analytic model. Present day fabrication techniques appear adequate for laboratory tests of principle.

Originally published in 1949. Understanding the questions is the major problem when beginning philosophy. This book does not attempt to provide the answers, but defines the questions and shows by example how they should be tackled. Subjects treated include the nature of the objects of thought and judgment; truth and error in belief; perception and knowledge of the material world; the status and function of memory.

Contributed research papers presented at National Seminar jointly organized by Somanth Sanskrit University, Veraval and Sanskrit Sahitya Akadami at Gandhinagar on February 21-22, 2022.

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)

Deformation quantisation is applied to ordinary Quantum Mechanics by introducing the star product in a configuration space combining a Riemannian structure with a Poisson one. A Hilbert space compatible with such a configuration space is designed. The dynamics is expressed by a Hermitian Hamiltonian containing a scalar potential and a one-form potential. As a simple illustration, it is shown how a particular type of non-commutativity of the star product is interpretable as generating the Zeeman effect of ordinary Quantum Mechanics.

A line of research is emerging investigating the private sector impacts and dependencies on critical biodiversity and ecosystem services, and related business risks and opportunities. While the ecosystem services narrative is being forwarded globally as a key paradigm for promoting business sustainability, there is scarce knowledge of how these issues are considered at managerial level. This study thus investigates managerial views of corporate sustainability after the ecosystem services concept. We analyse interviews conducted with 20 managers from domestic and international forestry (...) companies operating with a plantation-based business model in China. Content analysis was employed to analyse the data, with a focus on four key areas: interviewee familiarity with the ecosystem services concept; their views of corporate dependencies and impacts on ecosystem services; related business risks and opportunities; and viability of existing instruments and practices that can be employed in detecting and addressing business impacts and dependencies on ecosystem services. Through an inductive approach to the empirical findings, we refined a framework that holds operational value for developing company response strategies to ecosystem services impact/dependence assessment, ensuring that all issues are addressed comprehensively, and that related risks and opportunities are properly acknowledged. (shrink)

This title is part of UC Press's Voices Revived program, which commemorates University of California Press’s mission to seek out and cultivate the brightest minds and give them voice, reach, and impact. Drawing on a backlist dating to 1893, Voices Revived makes high-quality, peer-reviewed scholarship accessible once again using print-on-demand technology. This title was originally published in 1974.