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)

THE TITLE W. used the title 'Philosophische Untersuchungen, Versuch einer Umar- beitung' as the heading of his 1936 revision of Br. B. in Vol. ...

The world’s third largest producer of scientific research, Germany, is the origin of the research university and the independent, extra-university research institute. Its dual-pillar research policy differentiates these organizational forms functionally: universities specialize in advanced research-based teaching; institutes specialize intensely on research. Over the past decades this policy affected each sector differently: while universities suffered a lingering “legitimation crisis,” institutes enjoyed deepening “favored sponsorship”—financial and reputational advantages. Universities led the nation’s reestablishment of scientific prominence among the highly competitive European and (...) global science systems after WWII. But sectoral analysis of contributions to science, technology, engineering, mathematics, and medical and health journal publications finds that Germany’s small to medium-sized independent research institutes have made significant, growing contributions, particularly in publishing in higher impact journals proportionally more than their size. Simultaneously—despite dual-pillar policy implications—the university sector continues to be absolutely and relatively successful; not eclipsed by the institutes. Universities have consistently produced two-thirds of the nation’s publications in the highest quality journals since at least 1980 and have increased publications at a logarithmic rate; higher than the international mean. Indeed, they led Germany into the global mega-science style of production. Contrary to assumed benefits of functional differentiation, our results indicate that relative to their size, each sector has produced approximately similar publication records. While institutes have succeeded, the larger university sector, despite much less funding growth, has remained fundamental to German science production. Considering these findings, we discuss the future utility of the dual-pillar policy. (shrink)

This article surveys recent literature on Wittgenstein's "Rule-following considerations" most notably S. Kripke's, C. McGinn's, and G.P. Baker's and P.M.S. Hacker's contributions. I argue that the normativity requirement in rule-following is to be located not in transtemporal but interpersonal sameness of meaning, and that the community-view is false when viewed as a condition on correct rule-following, but true when viewed as providing criteria for the possibility of rule-following.

Reform of the federal income tax system has become a perennial item on the domestic policy agenda of the United States, although there is considerable uncertainty over specifics. Indeed the recent report of the President's Advisory Panel on Federal Tax Reform recommended not one but two divergent policy directions. In Fundamental Tax Reform, top experts in tax policy discuss a wide range of issues raised by the prospect of significant tax reform, identifying the most critical questions and considering whether the (...) answers are known, unknown--or unknowable. The debates over tax reform usually concern the advantages and disadvantages of income-based taxation as opposed to any of the several alternative forms of consumption-based taxation. The book opens with chapters that discuss the strengths, weaknesses, and political feasibility of these options. Other chapters consider the effect of tax reform on businesses, especially their investment behavior, and include a discussion of possible problems in any transition to a consumption-based tax; international taxation issues arising in an era of globalization; and individual behavioral response to tax reform, including a view of the topic from the perspective of the relatively new field of behavioral economics. ContributorsRosanne Altshuler, Alan J. Auerbach, John W. Diamond, Harry Grubert, Arnold C. Harberger, Kevin A. Hassett, Thomas J. Kniesner, Laurence J. Kotlikoff, Edward J. McCaffery, Kathryn Newmark, David Rapson, Daniel Shaviro, Joel Slemrod, James P. Ziliak, George R. ZodrowDiscussants James Alm, Henry J. Aaron, Charles L. Ballard, Leonard E. Burman, Robert S. Chirinko, Robert D. Dietz, Malcolm Gillis, Roger H. Gordon, Jane G. Gravelle, Timothy S. Gunning, James M. Poterba, Thomas S. Neubig, Alan Viard, George Yin John W. Diamond is Edward and Hermena Kelly Fellow in Tax Policy and Adjunct Professor of Economics at the Baker Institute for Public Policy, Rice University. George R. Zodrow is Professor of Economics and Rice Scholar at the Baker Institute and International Research Fellow at the Centre for Business Taxation, Oxford University. (shrink)

Heidegger affirmed traditional technology, but was opposed to science-based modern technology, in which everything (including man) is considered to be a mere “resource”. This opposition was expressed in the form of deep questioning and a suspicion of superficial evaluation, because the true nature of things was often concealed, though disclosed at times. Ways in which engineers should question technology are proposed, highlighting some of the hazards and injustices associated with technology and also its subtle sociological and psychological influences. The demands (...) of engineering ethics and the use of metaphor in design are other ways in which a narrowly rationalistic technological outlook can be confronted. (shrink)

On Philosophy and Philosophers is a volume of unpublished philosophical papers by Richard Rorty, a central figure in late-twentieth-century intellectual debates and a primary force behind the resurgence of American pragmatism. The first collection of new work to appear since his death in 2007, these previously unseen papers advance novel views on metaphysics, ethics, epistemology, philosophical semantics and the social role of philosophy, critically engaging canonical and contemporary figures from Plato and Kant to Kripke and Brandom. This book's diverse offerings, (...) which include technical essays written for specialists and popular lectures, refine our understanding of Rorty's perspective and demonstrate the ongoing relevance of the iconoclastic American philosopher's ground-breaking thought. An introduction by the editors highlights the papers' original insights and contributions to contemporary debates. (shrink)

This paper describes how some aspects of Martin Heidegger’s philosophy resonate strongly with an engineering outlook. He argued that practice was more “primordial” than theory, though preserving an important role for theoretical understanding as well, thus speaking to the gap between engineering education (highly theoretical) and engineering practice (mostly empirical). He also underlined the reality of “average” practices into which we are socialized, though affirming the potential for original work and action too, thus providing the grounds for self-actualization whether within (...) the routine or in transcending it. His notion of “thrownness” emphasizes the importance of context, with which engineers are constantly engaged. While all this relates to the idea of our “being”, Heidegger also dealt with the influence of time on our practices. Future death could be seen as spurring innovation, cultural history as a source for critiquing current practice and the present “situation” as the immediate context for corrective action. His major book is appropriately called “Being and Time”.1. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work.This work is in the public domain in (...) the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work.As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

The article is concerned with the question of how legal institutions are structured with the use of constitutive, institutive, consequential, and terminative rules. To that end, the regulation of international treaties as laid down in the Vienna Convention on the Law of Treaties of 1969 is analysed. This leads to the discovery of two additional categories of rules: content rules and invalidating rules. Finally, the special status of unique legal institutions is investigated. Unique legal institutions – for example, heads of (...) state, parliaments, and supreme courts – enjoy validity in a legal system to the exclusion of the validity of any other legal institution of the same category in that system. (shrink)

The six platinum group metals (pgms: ruthenium, rhodium, palladium, osmium, iridium and platinum) posed a number of problems for 19th-century chemists, including Mendeleev, for their Periodic classification. This account discusses the discovery of the pgms, the determination of their atomic weights and their classification.

The author investigates how the conception of legal validity as a specific mode of existence, adopted by Kelsen in Allgemeine Theorie der Normen (General Theory of Norms), can be reconciled with a conception of the legal system in which conflicts of legal norms remain of logical concern. To this end he makes use of Ludwig Wittgenstein's picture theory of the proposition as set out in the Tractatus Logico-Philosophicus. The conclusion is that in order to reconcile the two conceptions, the legal (...) system itself must be conceived of as consisting of three sub-systems, namely, (i) a sub-system of perceptible legal judgments, (ii) a sub-system of valid legal conditions, and (iii) a sub-system of observable social practices. (shrink)

Die Kritik des späten Wittgenstein am logizistischen Programm zur Begründung der Mathematik, vor allem im Blick auf die Definition der Zahl als Klasse von Klassen, und die darauf gegründete Explikation des Sinnes arithmetischer Sätze wird systematisch rekonstruiert. Entgegen einer verbreiteten Auffassung zeigen die Analysen Wittgensteins, daß Frege und Russell den Zahlbegriff nicht auf den „grundlegenderen" Begriff der eineindeutigen Zuordnung „reduzieren". Entsprechend sind Zahlen nicht mehr als durch Abstraktion erreichbare, echte Eigenschaften von Klassen zu verstehen, sondern als Formen oder Möglicfikeiten, die (...) die Beschreibung der Erfahrungswelt a priori bestimmen. Femer wird die wesentliche Selbständigkeit mathematischer Techniken gegenüber Techniken der Logistik durch einige Betrachtungen deutlich, welche die für den Fall größerer Zahlen unvermeidbare Benutzung vertrauter Bündelungssysteme, etwa der Dezimalnotation, bei Beweisen im Russellschen System zum Thema haben. (shrink)

Die Kritik des späten Wittgenstein am logizistischen Programm zur Begründung der Mathematik, vor allem im Blick auf die Definition der Zahl als Klasse von Klassen, und die darauf gegründete Explikation des Sinnes arithmetischer Sätze wird systematisch rekonstruiert. Entgegen einer verbreiteten Auffassung zeigen die Analysen Wittgensteins, daß Frege und Russell den Zahlbegriff nicht auf den „grundlegenderen" Begriff der eineindeutigen Zuordnung „reduzieren". Entsprechend sind Zahlen nicht mehr als durch Abstraktion erreichbare, echte Eigenschaften von Klassen zu verstehen, sondern als Formen oder Möglicfikeiten, die (...) die Beschreibung der Erfahrungswelt a priori bestimmen. Femer wird die wesentliche Selbständigkeit mathematischer Techniken gegenüber Techniken der Logistik durch einige Betrachtungen deutlich, welche die für den Fall größerer Zahlen unvermeidbare Benutzung vertrauter Bündelungssysteme, etwa der Dezimalnotation, bei Beweisen im Russellschen System zum Thema haben. (shrink)