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 advances in treatment of HIV and the introduction of polymerase chain reaction assay for the virus now make it acceptable for HIV discordant couples where the male partner is seropositive to attempt to conceive through artificial insemination by husband (AIH) or via in vitro fertilisation. With undetectable viral load and washed sperm, there is minimal risk of transmission of HIV to the female partner, children, other patients, or staff. We describe the development of a programme of AIH for HIV (...) discordant couples and the reasoning behind offering such a programme. (shrink)

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)

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

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)

Neuroscience of art might give us traction with aesthetic issues. However it can be seen to have trouble modeling the artistically salient semantic properties of artworks. So if meaning really matters, and it does, even in aesthetic contexts, the prospects for this nascent field are dim. The issue boils down to a question of whether or not we can get a grip on the kinds of constraints present and available to guide interpretive behavior in our engagement with works of fine (...) art. I argue that biased competition models of selective attention can be used to solve this problem, generalize to the affective content of our responses to artworks, and so show that research in cognitive neuroscience is germane to the types of problems of interest within the philosophy of art. (shrink)

This book has been written in the hopes of equipping teachers-in-training—that is, teacher candidates—with the skills needed for action research: a process that leads to focused, effective, and responsive strategies that help students succeed.

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.

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)

It is well established that single crystals of B2-structured Fe-Al change from paramagnetic to ferromagnetic upon plastic deformation. This strain-induced ferromagnetism arises mostly from Fe atoms which have three or more like nearest neighbours in antiphase-boundary tubes. Such Fe atoms carry magnetic moments according to their local environment. In this study, the saturation magnetizations, M S , of cold-rolled Fe-34 at.% Al, Fe-40 at.% Al and Fe-43 at.% Al single crystals were measured in a vibrating-sample magnetometer from 77 K to (...) room temperature and transmission electron microscopy was used to confirm the presence of APB tubes. After magnetic measurements, rolled single crystals were heated in a differential scanning calorimeter at 20 K min m 1 to 973 K and the enthalpy associated with the removal of the APB tubes measured. From the enthalpy measurement, the APB tube density and the number of Fe NNs were estimated. Hence, the M S values at 0 K were calculated. These were in good agreement with the experimentally determined values. (shrink)

It is argued that the theories of the modern cognitive psychology of perception and recognition show, under rigorous logical analysis, the same problems which arise in the philosophical theories of knowledge of Descartes and Locke and lead to relativistic and solipsistic consequences. Through examination of the approachs of D. Sanders, E. B. Goldstein and J. Fodor it is shown that the perceptible world in these theories dissolves in internal representations so that despite its realistic starting-point modern cognitive psychology runs into (...) epistemological idealism or solipsism. (shrink)

There are a growing number of publications arguing that if we had more wonder in social life, then its quality would be significantly improved, and that we therefore need an “ethics” or a “politics” of wonder. The aim of this paper is to show that that message is unfortunate, and this is for two reasons. First, wonder does not generally have the positive political and moral effects that are attributed to it, so to assume that it does may lead one (...) to adopt unrealistic social policies. Second, wonder does potentially have a number of negative moral and politicaleffects, so social policies that put a premium on wonder may bring adverse consequences. In this way, the paper makes a general case against wonder as a positive force in morality and politics. (shrink)