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)

This paper examines the perceived ethical values of Malaysian managers. It is based on the opinions of 15 hypothetical ethical/unethical business situations from the 81 managers who agreed to participate in the survey. The findings of this study showed that these Malaysian managers have high ethical values. However 53% of the respondents believed that the ethical standards of today are lower than that of 15 years ago. Apparently, this is related to the existence of many unethical business practices prevalent in (...) the modern business world. The behavior of one's immediate superior is the most important factor in influencing managers to commit unethical practices. The results also indicate only a slight variation among the managers in terms of perceived ethical values by virtue of job position, job specialization, type of business activity or the size of the business organization. (shrink)

Current textbooks in formal semantics are all versions of, or introductions to, the same paradigm in semantic theory: Montague Grammar. Knowledge of Meaning is based on different assumptions and a different history. It provides the only introduction to truth- theoretic semantics for natural languages, fully integrating semantic theory into the modern Chomskyan program in linguistic theory and connecting linguistic semantics to research elsewhere in cognitive psychology and philosophy. As such, it better fits into a modern graduate or undergraduate program in (...) linguistics, cognitive science, or philosophy. Furthermore, since the technical tools it employs are much simpler to teach and to master, Knowledge of Meaning can be taught by someone who is not primarily a semanticist. Linguistic semantics cannot be studied as a stand-alone subject but only as part of cognitive psychology, the authors assert. It is the study of a particular human cognitive competence governing the meanings of words and phrases. Larson and Segal argue that speakers have unconscious knowledge of the semantic rules of their language, and they present concrete, empirically motivated proposals about a formal theory of this competence based on the work of Alfred Tarski and Donald Davidson. The theory is extended to a wide range of constructions occurring in natural language, including predicates, proper nouns, pronouns and demonstratives, quantifiers, definite descriptions, anaphoric expressions, clausal complements, and adverbs. Knowledge of Meaning gives equal weight to philosophical, empirical, and formal discussions. It addresses not only the empirical issues of linguistic semantics but also its fundamental conceptual questions, including the relation of truth to meaning and the methodology of semantic theorizing. Numerous exercises are included in the book. (shrink)

Self-understanding is to a great extent defined by narrative: who we are as human beings is determined by the stories we, and others, tell about ourselves. Yet many are unable to compose coherent personal narratives, as their experiences do not fall within the scope of an accepted conceptual framework. Survivors of trauma are particularly apt to fall into this “narrative rift,” where there can be no words to describe, and hence can be no assimilation of, their experiences. Using the example (...) of child sexual abuse, and drawing on the work of Bass, Spence, Schafer, and Guignon, I propose an examination of the nature of narrative fragmentation itself. Philosophical counselling may succeed where psychoanalysis might not: for where the latter has theoretical commitments to specific narratives, the former, through its reluctance to force epistemological or metaphysical assumptions on the narrator, may well facilitate a more comprehensive self-understanding. (shrink)

This study is based on the 1983 Rural Health Survey of Ethiopia. Patterns and levels of child morbidity by age, sex, geographic region, and sanitary facilities are examined. Morbidity levels peak in the second year of life. Diarrhoeal diseases are of major importance, especially among infants and toddlers. Parasitic diseases, and respiratory diseases other than pneumonia, become increasingly important with age.There are no significant sex differentials in morbidity except for higher rates of diarrhoeal diseases among female children. Geographic differentials are (...) quite marked with particularly high morbidity levels from all disease types in the western mountainous regions of Ethiopia. Access to high quality drinking water, a latrine, and garbage disposal, are strongly related to reduced overall morbidity levels, though not necessarily to reduced diarrhoeal disease levels. (shrink)

Изложено понимание рассуждения как метода рационального познания, рассмотрены его разновидности: аргументативные, интерпретативные, прогностические, квалификационные и вычислительные. Для аспирантов и соискателей.

The age of a structure M is the set of all isomorphism types of finite substructures of M. We study ages of generic expansions of ω-stable ω-categorical structures.

Ethical sensitivity triggers the entire ethical decision-making process (i.e., recognition of ethical content in work situations). In this article, five factors are examined that affect tax practitioners' professional ethical sensitivity. The five factors that were examined include role conflict, role ambiguity, job satisfaction, professional commitment, and ethical orientation. Ethical content in work situations is examined in relation to professional ethics as enumerated by the American Institute of Certified Public Accountant's (AICPA) Statements on Responsibilities in Tax Practice (SRTP). Utilizing Hunt and (...) Vitell's (1986, 1993) General Theory of Ethics, a model of ethical sensitivity was constructed and empirically tested. Role conflict negatively and job satisfaction positively influenced tax practitioners' ethical sensitivity. Also, the covariates of the tax practitioner's professional risk level and type of employer were found to be significant. The significant factors are job specific. The tax firm may have the best opportunity to positively change a tax practitioner's ethical recognition abilities. Professional accounting organizations may need to evaluate if resources should be used to formulate, maintain, and publicize codes of conduct because of the lack of significance of professional commitment. (shrink)

We study the structure of algebraic -closed subsets of an algebraic lattice L, where is some Browerian binary relation on L, in the special case when the lattice of such subsets is an atomistic lattice. This gives an approach to investigate the atomistic lattices of congruence-Noetherian quasivarieties.

Cotton examines Plato 's ideas about education and learning, with a particular focus on the experiences a learner must go through in approaching philosophical understanding.

In this paper, I argue for a conditional parity thesis: if we are agents with respect to our intentions, we are agents with respect to our beliefs. In the final section, I motivate a categorical version of the parity thesis: we are agents with respect to belief and intention. My aim in this paper is to show that there is no unique challenge facing epistemic agency that is not also facing agency with respect to intention. My thesis is ambitious on (...) two fronts. First, the parity thesis is a substantive thesis about the nature of belief and intention. I argue that there is a structural parity of belief and intention; the status of whether they are agential stands and falls together. Second, the parity thesis illuminates the nature of agency. It constrains what counts as a satisfactory account of agency: either we must accept agency of both belief and intention, or we must reject both. In the final section, I argue that we have prima facie reason to accept agency of belief and intention. Finally, I diagnose why there has been such resistance to epistemic agency. Epistemic agency is problematic, but its problems are problems with agency, not problems with epistemic agency. (shrink)

A peculiar feature of our species is that we settle what to believe, value, and do by reasoning through narratives. A narrative is adiachronic, information-rich story that contains persons, objects, and at least one event. When we reason through narrative, we usenarrative to settle what to do, to make predictions, to guide normative expectations, and to ground which reactive attitudes we think areappropriate in a situation. Narratives explain, justify, and provide understanding. Narratives play a ubiquitous role in human reasoning. Andyet, (...) narratives do not seem up to the task. Narratives are often unmoored representations (either because they are do not purport to referto the actual world, or because they are grossly oversimplified, or because are known to be literally false). Against this, I argue thatnarratives guide our reasoning by shaping our grasp of modal structure: what is possible, probable, plausible, permissible, required,relevant, desirable and good. Narratives are good guides to reasoning when they guide us to accurate judgments about modal space. Icall this the modal model of narrative. In this paper, I develop an account of how narratives function in reasoning, as well as an account ofwhen reasoning through narrative counts as good reasoning. (shrink)

This research explores the relationships between business students’ academic misconduct and their attitudes toward professional ethics, specifically credential embellishment and business unethicality. Based on 135 survey responses from business students in a northwestern university, we tested hypothesized relationships using multiple regression analyses. We found that students’ attitudes toward academic misconduct, especially illicit collaboration and exam cheating, were positively correlated with their attitudes toward credential embellishment, unethical business operations, and unethical employee practices. In addition, gender yielded meaningful differences related to perceptions (...) of both dimensions of business unethicality. We emphasize the importance of ethics education, and suggest actionable remedies including placement of strict policies, promotions of shared norms and cultures, and curriculum redesign guidelines for business educators and administrators. (shrink)

The central focus of this paper is to motivate and explore the question, when is it permissible to endorse a psychologizing explanation of a sincere interlocutor? I am interested in the moral question of when (if ever) we may permissibly dismiss the sincere reasons given to us by others, and instead endorse an alternative explanation of their beliefs and actions. I argue that there is a significant risk of wronging the other person, and so we should only psychologize when we (...) are in a position to know that they are in bad faith. (shrink)