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)

Originally published in 1955. The Madhyamika philosophy is, in the author's view, the philosophy which created a revolution in Buddhism and through that in the whole range of Indian philosophy. This volume is a study of the Madhyamika philosophy in all its important aspects and is divided into three parts: Historical: this traces the origin and development of the Madhyamika philosophy. The second part concentrates on a full and critical exposition of the Madhyamika philosophy, the structure of its dialectic, its (...) conception of the Absolute and its ethics and religion. The last part of the book compares the Madhyamika with some of the well-known dialectical systems of the West (Kant, Hegel and Bradley) and undertakes a short study of the different absolutisms (Madhyamika, Vijnanavada and the Vedanta). (shrink)

We argue that abduction does not work in isolation from other inference mechanisms and illustrate this through an inference scheme designed to evaluate multiple hypotheses. We use game theory to relate the abductive system to actions that produce new information. To enable evaluation of the implications of this approach we have implemented the procedures used to calculate the impact of new information in a computer model. Experiments with this model display a number of features of collective belief-revision leading to consensus-formation, (...) such as the influence of bias and prejudice. The scheme of inferential calculations invokes a Peircian concept of ‘belief’ as the propensity to choose a particular course of action. (shrink)

What is sexual orientation? The contemporary consensus among philosophers is that it is a disposition. Unsurprisingly, recent debates about the metaphysics of sexual orientation are almost entirely intramural. Behavioral dispositionalists argue that sexual orientation is a disposition to behave sexually. Desire dispositionalists argue that it is a disposition to desire sexually. We argue that sexual orientation is not best understood in terms of dispositions to behave or dispositions to desire before arguing that dispositions tout court fail to illuminate sexual orientation. (...) We then introduce and defend the idea that sexual orientation is best understood in terms of categorical phenomenal properties of sexual arousal. (shrink)

Various attempts have been made in recent years to present Christianity in such a way that no use is made of the traditional dichotomy between the ‘natural’ and the ‘supernatural’. Braithwaite, Hare, and van Buren, for instance, appear to have no use for the dichotomy; and I think that, without too much distortion, one can say the same of Bultmann, Tillich, and Robinson. I am not, however, concerned in this paper with the work of any one thinker as such, but (...) rather with a general climate of opinion. What I want to do is to examine the grounds on which it might be argued that belief in the supernatural is discredited. The issue seems to me of special importance at the present time, since, if these grounds are inadequate, programmes of reform under the general heading ‘Christianity without the supernatural’lose much of their point; if, on the other hand, the grounds are compelling, then reform of some kind is forced upon us whatever the accompanying difficulties. (shrink)

Chidambaram Ramalingam (1823 – 1874) was a nineteenth century Indian-Tamilian poet, mystic, and visionary moral thinker well-known for his seminal contributions to Tamil religious and moral literature. He initiated a new moral and spiritual community and movement, Suddha Sanmargam, or “The Pure Path to True Harmony”, in the nineteenth century in the province of Tamilnadu in Southern India. One of Ramalingam’s texts which laid the philosophical foundation for this community and movement is his great unfinished essay “The Ethic of Compassion (...) for Sentient Beings”. In this talk, I will attempt a systematic presentation of the moral vision and ethical system in his essay. Among Ramalingam’s central claims are the following: a) Compassion involves understanding or discernment of the ultimate metaphysical truth pertaining to sentient beings, b) Compassion is the foundation of all other moral virtues, c) Compassion provides the standard of the moral worth of actions, d) Compassion is the basis of morality itself, and e) Compassion is an essential condition of attaining spiritual liberation or enlightenment. In my talk, I will clarify, develop, and critically examine these five theses on compassion and consider relevant views and objections in the Western and Asian philosophical traditions. (shrink)

This paper will present an alternative to the mainstream Western approach to human development. The mainstream Western approach to human development does not countenance contemplative interiority as a means of cognitive inquiry and a domain of cognitive value. Hence, its conception of human development is narrowly confined to the domain of formal-operational thinking and its application to material exteriority. The alternative I will present is the work of the twentieth Indian philosopher Aurobindo (1872–1950) whose integral theory of human of development (...) inclusively countenances as realms of cognitive inquiry and value both contemplative interiority and formal-operational thinking and its application to material exteriority. The structure of Aurobindo’s integral theory of humandevelopment will be clarified and some of its implications for educational practice will be explored. (shrink)

In this paper I shall examine a variety of situations in which human agents make use of force. Section I will be concerned with the use of force in medical contexts, Section Ii with the use of force in defence of property, and Section in with the use of force in resolving international disputes. I shall argue that the boundary between what is and is not morally permissible needs to be, drawn more stringently than is commonly supposed. While agreeing that (...) in some medical contexts and in some situations where defence of property is involved the use of force may be necessary and even morally required, I shall suggest that in the absence of any suitably constituted world court the use of force in attempting to resolve international disputes creates a morally different situation. (shrink)

The key points in Meynell's argument seem to me to be as follows: It is logically absurd to say of an action or of a state of affairs that it is good unless at least some or other of the qualities w, x, y, z, etc. are present. Similarly it is logically absurd to talk of human flourishing unless some or other specifiable features are present in a person's life. The Heimler questionnaire shows us the sorts of ways in which (...) the notion of human flourishing might be ‘unpacked’, viz, in terms of satisfaction through friendship, etc. I am in full agreement with him over and I shall simply add some further comments on the notion of ‘evaluating’; but as far as is concerned I shall voice some doubts and reservations. (shrink)

Postmodern understandings of the god concept, based upon sociological and anthropological insights, support the ontological reality of the god concept. AII such god constructs can be understood as real but human products which come out of a situated Drama of the Holy. The reality quotient of any god concept can be seen as a function of solidarity activities within a society. Social justice concerns are, thus, the best indicators of that reality quotient while divisive, exploitative and oppressive practices in the (...) world tend to desanctify both society and nature thus justify Death of God analyses. Two interrelated solidarity activities are discussed for their efficacy in sanctification of nature and society: 1) situated Dramas of the Holy and, 2) social policies in the political economy. A variety of grand narratives are mentioned, each with differing foundational concepts, with which to institute social justice as we move into the 21st century. (shrink)

Martin Heidegger's explication of Pindar's assertion that ‘to glorify was the essence of poetry’ puts it quite well. He tells us that for Pindar the word does not derive its force from what is already complete in itself. For then man would be glorifying what is already glorious, that which already has the power to impress men. At best the word then would denote an acknowledgment or a confession of being impressed. Instead, he insists, the word denotes the power of (...) making to appear, or to extol a place. 1. (shrink)

We are now in a position to examine the claim that Pavlovian physiology and Marxist-Leninist philosophy form two complementary systems.There is certainly a similarity between the Leninist theory of reflection and Pavlov's theory of higher nervous activity. Both present so-called psychic phenomena as a reaction of the organism to the stimuli of the outer world and both insist that this reflection is not a passive reception of impressions but is an active response on the part of the organism.Again both systems (...) are monist; they are united in excluding the possibility of having recourse to a non-material substance as the basis for psychic phenomena. But for Pavlov this exclusion is a scientific axiom while for Marxism-Leninism it is founded on philosophical materialism. However, the most important difference between Pavlov's theories and Marxism-Leninism on this point is that Pavlov's approach to psychic is fundamentally mechanistic and reductionist whereas that of Marxism-Leninism is dialectical and consequently anti-reductionist and anti-mechanist. Soviet psychology is, in consequence, founded partly on a mechanist system which is not materialist in the full sense of the word, and partly on a materialist system which is definitely not mechanist. From this point of view there is a definite discrepancy between the two traditions on which Soviet psychology is founded and which goes a long way towards explaining many of the inconsistencies in Soviet psychological theory. (shrink)

This article discusses the ‘nature’ of our contemporary fascination with wildness, in light of the popular documentary “Grizzly Man.”Taking as its central point of departure the film’s central protagonist Timothy Treadwell’s fascination with wild grizzlies and director Werner Herzog’s condemnation of it as gross anthropomorphism, this paper will explore the context and basis of our contemporary fascination with wildness in terms of the current debate raging within environmental philosophy between the social constructivist or postmodern position as exemplified by Martin Drenthen (...) and the feral humanist position as articulated by Paul Shepard.The former argues that this fascination with wildness is reflective of certain historical and cultural trends within contemporary western society, while the latter argues that it is reflective of our primordial human heritage. (shrink)

When Cicero uncovered and suppressed the Catilinarian Conspiracy as consul in 63 B.c., supporters hailed him ‘father of his country’ and proposed that he be awarded the oak crown normally given to a soldier who had saved the life of a comrade in battle . Our sources connect these honours with earlier heroes such as Romulus, Camillus and Marius, but the Elder Pliny writes as if Cicero was the first before Caesar and the Emperors to be given the title pater (...) patriae. Pliny's point may revolve around Senatorial initiative, and assuming this to be the case he really should have stressed that Cicero received the informal support of a limited number of Senators only, whereas Caesar and the Emperors were honoured by formal vote of the entire Senate. Perhaps Pliny was fooled by the prominence of those who spoke on Cicero's behalf, such as Cato, Catulus and Gellius Publicola. Opponents, on the other hand, angrily rejected calls that Cicero be recognised as the saviour of the state. In their eyes his execution of the Catilinarians marked him as a cruel tyrant. Metellus Nepos proposed Pompey's recall from the East in order to free Rome from Cicero's tyranny. Aside from echoes of patria potestas, it seems obvious that the Romans were thinking in terms of the conventional Greek antithesis between the good king who is like a father to his people and the selfish tyrant who treats his subjects as slaves. The Younger Pliny employs the same basic ideas in his Panegyricus: the cruel tyrant Domitian suppressed freedom and desired honour as a god ; the gentle Trajan is a citizen and father not a tyrant and master . Tacitus has this basic distinction in mind too. Nevertheless, as is well known, Pliny regularly addresses Trajan not as ‘father’ but as ‘master’ in Book 10 of his Letters. This was plainly an acceptable practice on the social plane, if not quite yet on the political. Augustus, Tiberius and Claudius indicated their opposition to dominus as a title for themselves, evidently for its connotations of autocracy and servitude. Domitian, damned as a tyrant, was accused of demanding to be addressed as dominus et deus. The title dominus existed from at least the first century A.d. as a common form of polite address between inferiors and superiors of free birth, not only between masters and slaves. It gradually gained acceptance as an official title of the Emperor through the second century and was advertised widely by the Severi. And yet its tone throughout this period could also be critical when understood in terms of the good king/tyrant antithesis. (shrink)

T. R. Miles; IV—The “Mental” - “Physical” Dichotomy, Proceedings of the Aristotelian Society, Volume 64, Issue 1, 1 June 1964, Pages 71–84, https://doi.org/10.1.

T. R. Miles; IV—The “Mental” - “Physical” Dichotomy, Proceedings of the Aristotelian Society, Volume 64, Issue 1, 1 June 1964, Pages 71–84, https://doi.org/10.1.

SummaryThe traditional account of micro‐reductive explanations, in terms of bridge‐law derivations and attribute‐identities, is subjected to critical analysis. Formal expositions of this approach especially those of R. L. Causey, are shown to have oversimplified certain relations between micro‐parts and wholes, and between identities and explanations, and to have neglected a key difference between homogeneous and heterogeneous micro‐explanatory contexts. An alternative treatment of part‐explanation adequacy is outlined and illustrated.