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)

Traditionally the domain of scientists, the history of science became an independent field of inquiry only in the twentieth century and mostly after the Second World War. This process of emancipation was accompanied by a historiographical departure from previous, 'scientistic' practices, a transformation often attributed to influences from sociology, philosophy and history. Similarly, the liberal humanists who controlled the Cambridge History of Science Committee after 1945 emphasized that their contribution lay in the special expertise they, as trained historians, brought to (...) the venture. However, the scientists who had founded the Committee in the 1930s had already advocated a sophisticated contextual approach: innovation in the history of science thus clearly came also from within the ranks of scientists who practised in the field. Moreover, unlike their scientist predecessors on the Cambridge Committee, the liberal humanists supported a positivistic protocol that has since been criticized for its failure to properly contextualize early modern science. Lastly, while celebrating the rise of modern science as an international achievement, the liberal humanists also emphasized the peculiar Englishness of the phenomenon. In this respect, too, their outlook had much in common with the practices from which they attempted to distance their project. (shrink)

Sometimes it is practically beneficial to believe what is epistemically unwarranted. Philosophers have taken these cases to raise the question are there practical reasons for belief? Evidentialists argue that there cannot be any such reasons. Putative practical reasons for belief are not reasons for belief, but reasons to manage our beliefs in a particular way. Pragmatists are not convinced. They accept that some reasons for belief are practical. The debate, it is widely thought, is at an impasse. But this debate (...) fails to address what is puzzling and interesting about the cases. By focusing on reasons for belief, the debate completely overlooks the role of action in relation to belief. We should be talking about the reasons for actions that shape our beliefs, which I will call belief management. I argue for three related theses: the interesting cases that motivate the debate are about belief management; Evidentialism is irrelevant to belief management; agents have practical reasons to manage their beliefs with the aim of forming true beliefs. These reasons are categorical in nature and result in the tension of conflict cases. (shrink)

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)

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.

Recent data indicate that under a specific posthypnotic suggestion to circumvent reading, highly suggestible subjects successfully eliminated the Stroop interference effect. The present study examined whether an optical explanation could account for this finding. Using cyclopentolate hydrochloride eye drops to pharmacologically prevent visual accommodation in all subjects, behavioral Stroop data were collected from six highly hypnotizables and six less suggestibles using an optical setup that guaranteed either sharply focused or blurred vision. The highly suggestibles performed the Stroop task when naturally (...) vigilant, under posthypnotic suggestion not to read, and while visually blurred; the less suggestibles ran naturally vigilant, while looking away, and while visually blurred. Although visual accommodation was precluded for all subjects, posthypnotic suggestion effectively eliminated Stroop interference and was comparable to looking away in controls. These data strengthen the view that Stroop interference is neither robust nor inevitable and support the hypothesis that posthypnotic suggestion may exert a top-down influence on neural processing. (shrink)

Constructivist approaches in epistemology and ethics offer a promising account of normativity. But constructivism faces a powerful Schmagency Objection, raised by David Enoch. While Enoch’s objection has been widely discussed in the context of practical norms, no one has yet explored how the Schmagency Objection might undermine epistemic constructivism. In this paper, I rectify that gap. First, I develop the objection against a prominent form of epistemic constructivism, Belief Constitutivism. Belief Constitutivism is susceptible to a Schmagency Objection, I argue, because (...) it locates the source of normativity in the belief rather than the agent. In the final section, I propose a version of epistemic constructivism that locates epistemic normativity as constitutive of agency. I argue that this version has the resources to respond to the Schmagency Objection. (shrink)

The meta-problem of consciousness (Chalmers, 2018) is the problem of explaining the behaviours and verbal reports that we associate with the so-called 'hard problem of consciousness'. These may include reports of puzzlement, of the attractiveness of dualism, of explanatory gaps, and the like. We present and defend a solution to the meta-problem. Our solution takes as its starting point the emerging picture of the brain as a hierarchical inference engine. We show why such a device, operating under familiar forms of (...) adaptive pressure, may come to represent some of its mid-level inferences as especially certain. These mid-level states confidently re-code raw sensory stimulation in ways that (they are able to realize) fall short of fully determining how properties and states of affairs are arranged in the distal world. This drives a wedge between experience and the world. Advanced agents then represent these mid-level inferences as irreducibly special, becoming increasingly puzzled as a result. (shrink)