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)

Research using mHealth apps has the potential to positively impact health care management and outcomes. However, choosing an appropriate mHealth app may be challenging for the health researcher. The author team used existing evaluation tools, checklists, and guidelines to assess selected mHealth apps to identify strengths, challenges, and potential gaps within existing evaluation tools. They identified specific evaluation tool components, questions, and items most effective in examining app content, usability, and features, including literacy demand and cultural appropriateness; technical information; practical (...) aspects of app functionality; and evolving capabilities of mobile medical apps. Challenges included the subjective nature of the results, time required to complete the evaluation, lack of emphasis on evidence‐based content, and inadequate tool flexibility. Health researchers considering the integration of mobile apps into research will benefit from evaluation tools that assess both evidence‐based content and the ability of the mobile app to securely integrate with other digital technologies involved in patient care. Next steps will include the involvement of health care providers and professionals, including nurses a wide range of expertise, to develop an mHealth evaluation tool that focuses on identifying quality, evidence‐based mobile apps into patient outcomes research. (shrink)

We present a one per cent measurement of the cosmic distance scale from the detections of the baryon acoustic oscillations in the clustering of galaxies from the Baryon Oscillation Spectroscopic Survey, which is part of the Sloan Digital Sky Survey III. Our results come from the Data Release 11 sample, containing nearly one million galaxies and covering approximately 8500 square degrees and the redshift range 0.2 < z < 0.7. We also compare these results with those from the publicly released (...) DR9 and DR10 samples. Assuming a concordance Λ cold dark matter cosmological model, the DR11 sample covers a volume of 13 Gpc3 and is the largest region of the Universe ever surveyed at this density. We measure the correlation function and power spectrum, including density-field reconstruction of the BAO feature. The acoustic features are detected at a significance of over 7σ in both the correlation function and power spectrum. Fitting for the position of the acoustic features measures the distance relative to the sound horizon at the drag epoch, rd, which has a value of rd,fid = 149.28 Mpc in our fiducial cosmology. We find DV = at z = 0.32 and DV = at z = 0.57. At 1.0 per cent, this latter measure is the most precise distance constraint ever obtained from a galaxy survey. Separating the clustering along and transverse to the line of sight yields measurements at z = 0.57 of DA = and H =. Our measurements of the distance scale are in good agreement with previous BAO measurements and with the predictions from cosmic microwave background data for a spatially flat CDM model with a cosmological constant. © 2014 The Author Published by Oxford University Press on behalf of the Royal Astronomical Society. (shrink)

Combining her expertise in legal theory and her judicial practice in criminal law in a Court of Appeal, Jeanne Gaakeer explores the intertwinement of legal theory and practice to develop a humanities-inspired methodology for both the academic interdisciplinary study of law and literature and for legal practice. This volume addresses judgment and interpretation as a central concern within the field of law, literature and humanities. It is not only a study of law as praxis that combines academic legal theory with (...) judicial practice, but proposes both as central to humanistic jurisprudence and as a training in the conduct of public life. Drawing extensively on philosophical and legal scholarship and through analysis of literary works, Gaakeer proposes a perspective on law as part of the humanities that will inspire legal professionals, scholars and advanced students of law alike.-Back cover. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

We maximally extend the quantum‐mechanical results of Muller and Saunders ( 2008 ) establishing the ‘weak discernibility’ of an arbitrary number of similar fermions in finite‐dimensional Hilbert spaces. This confutes the currently dominant view that ( A ) the quantum‐mechanical description of similar particles conflicts with Leibniz’s Principle of the Identity of Indiscernibles (PII); and that ( B ) the only way to save PII is by adopting some heavy metaphysical notion such as Scotusian haecceitas or Adamsian primitive thisness. We (...) take sides with Muller and Saunders ( 2008 ) against this currently dominant view, which has been expounded and defended by many. *Received July 2008; revised May 2009. †To contact the authors, please write to: F. A. Muller, Faculty of Philosophy, Erasmus University Rotterdam, Burg. Oudlaan 50, H5–16, 3062 PA Rotterdam, The Netherlands; e‐mail: [email protected] , and Institute for the History and Foundations of Science, Utrecht University, Budapestlaan 6, IGG–3.08, 3584 CD Utrecht, The Netherlands; e‐mail: [email protected] . M. P. Seevinck, Institute for the History and Foundations of Science, Utrecht University, Budapestlaan 6, IGG–3.08, 3584 CD Utrecht, The Netherlands; e‐mail: [email protected]. (shrink)

The dominant position in Philosophy of Science contends that downward causation is an illusion. Instead, we argue that downward causation doesn’t introduce vicious circles either in physics or in biology. We also question the metaphysical claim that “physical facts fix all the facts.” Downward causation does not imply any contradiction if we reject the assumption of the completeness and the causal closure of the physical world that this assertion contains. We provide an argument for rejecting this assumption. Furthermore, this allows (...) us to reconsider the concept of diachronic emergence. (shrink)

The growing prevalence of obesity and related conditions such as Type II diabetes is held by many to be a major public health problem in developed countries, and increasingly in developing countries as well. If we wish to tackle this problem, it will be a major task. Individuals will have to change their consumption and exercise patterns, companies will have to improve the products they make and how they market them, nutrition experts and communities will have to redefine what is (...) acceptable and desirable in food practices and governments will have to lead and promote such societal-level changes in many different fields, including food policy, urban design, educational policies, agricultural subsidies and tax breaks, etc. This is all very difficult to achieve. In many people’s view, government action aiming at social change will be especially controversial and meet some resistance. New York …. (shrink)

Background Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral. Method The authors conducted a cross-sectional survey of a random sample of 2000 US physicians from all specialties. The (...) primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral. Results Of 1895 eligible physicians, 1032 (55%) responded. 57% of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one's practice (multivariable ORs, 1.6–2.4). Conclusions Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide. (shrink)

This bibliographical study involved first the exploitation of four data-banks: Medline, CNRS, Bioethics and AIDS, with the following key words (in conjunction with AIDS): ethics, human rights, confidentiality, legislation, jurisprudence. A total of 412 references were listed between 1983 and the end of 1987. Examination of the quantitative increase of articles over these years shows that, while references to AIDS and/or HIV infection--referred to as 'AIDS' for brevity--increased by about one third per year, the number of papers treating ethical problems (...) linked to AIDS doubled each year. This increase makes it clear that these problems are important and pressing, that they are evolving rapidly and can be given no easy solution. After reading and analysis of accessible articles in readily comprehensible languages, the different themes can be classified in two categories: 1: Measures intended to protect society (starting with the most coercive); quarantine and isolation; discriminatory measures concerning specific groups; non-respect of the confidential nature of medical information; application of the penal code; screening; obligatory declaration and registration; testing of blood given by donors; vaccination and medical innovations, therapeutic assays; information, education. 2. Measures intended to protect the individual: fundamental rights of the patient: his/her right to confidentiality, to information and to treatment; civil rights: civil liberty, right to education, right to work, etc...; rights of the healthy individual: right of those in contact with the patients, safety of hospital staff, of those receiving blood-transfusions, etc... The legislation adopted in the various countries and the main opinions to be found in these articles are listed and analysed, and for each particular theme it is possible to refer to a list of the 232 most important articles. While the debate seems to concentrate on the conflict between the right of society to protect itself against the spread of infection and the 'civil' rights of the infected minorities, our conclusion tends to reduce this antagonism, showing that, particularly as far as the confidential nature of medical information is concerned, measures intended to protect the individual also protect society. (shrink)

Coastal ecosystems are increasingly dominated by humans. Consequently, the human dimensions of sustainability science have become an integral part of emerging coastal governance and management practices. But if we are to avoid the harsh lessons of land management, coastal decision makers must recognize that humans are one of the more coastally dependent species in the biosphere. Management responses must therefore confront both the temporal urgency and the very real compromises and sacrifices that will be necessary to achieve a sustainable coastal (...) ecosystem, one that is economically feasible, socially just, and ecologically sound. (shrink)

The purpose of this essay is to investigate and critically analyse some of the formative factors which led to the spiritual maturation of a leading Vīraśaiva saint, Basava. This inquiry focuses on a single event in the life of this great reformer of medieval times, i.e. his spiritual conflict leading to his rejection of the upanayana ceremony. The study will proceed through an investigation of the earliest and subsequent sources which veil the personality of Basava. The traditional view will be (...) challenged as one-sided. By critically comparing the sources, a more comprehensive and plausible account will be suggested. (shrink)

IntroductionTranscranial magnetic stimulation is a consolidated procedure for the treatment of depression, with several meta-analyses demonstrating its efficacy. Theta-burst stimulation is a modification of TMS with similar efficacy and shorter session duration. The geriatric population has many comorbidities and a high prevalence of depression, but few clinical trials are conducted specifically for this age group. TBS could be an option in this population, offering the advantages of few side effects and no pharmacological interactions. Therefore, our aim is to investigate the (...) efficacy of TBS in geriatric depression.Clinical trial registration[https://clinicaltrials.gov/ct2/], identifier [NCT04842929]. (shrink)

Background:Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy.Objective:To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy.Setting:Two long-term residential care facilities: a nursing home for people with dementia and a care facility for people with intellectual disabilities.Methods:Ethnographic field study.Ethical considerations:The boards (...) representing clients and relatives/proxies of the clients were informed of the study and gave their written consent. The clients’ assent was sought through a special information leaflet. At any time clients and/or proxy were given the option to withdraw from the study. The research protocol was also reviewed by a medical ethics committee.Findings:Our findings show a pattern of two themes: (1) coping with new spaces which entailed clients: wandering around, getting lost, being triggered, and retreating to new spaces and (2) resisting the surveillance technology measure because clients feel stigmatized, missed the company, and do not like being “watched.”Conclusion:Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices’ presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach. (shrink)

9 Eastern Christianity and Jesuit Scholarship on Arabic and Islam: Modern History and Contemporary Theological Reflections -- 10 Autonomy, Dignity, Human Rights: Correcting a Popular Error -- 11 Liberal and Authoritarian Approaches to Raising Good Citizens -- 12 Stewardship as Welcome and Respect for the Dignity of the Vulnerable: An Essay in Bioethics -- 13 Dialogue in a Pluralist Context: Theological Ethics and the New Interest in Happiness -- Index.

The four-year wrangle over the ownership of what was then thought to have been the largest known meteorite, recognized near Melbourne in 1860, provides a fine-grained example of the interaction between scientific internationalism, metropolitan appetite for specimens, and colonial civic pride.

This paper describes COMET, the first 'expert' computer system to incorporate a comprehensive set of the rules of law and medical ethics relating to consent to medical treatment.

The construct of the self is important in the domain of memory research. Recent work has shown that person memory is influenced by similarity of social targets to the self. The current experiments investigate self-similarity as defined by traits and political ideology to better understand how memory for social targets is organised. Across three experiments, participants formed positive or negative impressions based on each target’s picture, a trait-implying behavior (Experiments 1 & 2), and/or political ideology (conservative/liberal label in Experiment 2; (...) political-ideological belief statements in Experiment 3) followed by a memory test. Results showed a self-similarity effect dependent on valence in Experiment 1, but not in Experiments 2 or 3 when participants processed ideological information associated with targets. These results suggest that self-similarity has an effect on memory for social targets, but that ideological information disrupts self-focused processing of others, suggesting that ideological information also has a powerful influence on what people remember about others (i.e. social targets). (shrink)

Recent work has shown that memory for various types of information associated with social targets (impressions based on behaviours and political ideology) influences decisions to approach or avoid those same targets. The current study was intended to better understand the extent that memory for other types of details associated with targets (beliefs and behaviours) affects subsequent approach/avoidance decisions. In this investigation, participants formed impressions of social targets represented by a picture and a sentence (a belief in Experiment 1; either a (...) belief or behaviour in Experiment 2). Later, memory for the impressions and sentences associated with each target was tested. Finally, participants decided whether they would want to approach or avoid each target. Results demonstrated that accurate memory strongly influenced approach/avoidance decisions for targets associated with different types of information (beliefs; behaviours), although there was no difference in the effect of memory between beliefs and behaviours. Overall, results suggest an important role of memory in decisions to approach or avoid others. (shrink)

_The purpose _of the article is to introduce into scientific circulation works by Ukrainian scholar Taras Zakydalsky on the philosophy of Hryhorii Skovoroda. Taras Zakydalsky is a representative of the Ukrainian diaspora, philosopher, and member of Canadian NTSh (Shevchenko Scientific Society of Canada). _Theoretical basis._ We consider the uniqueness of H. Skovoroda’s philosophy, which stimulates not only intellectually but also spiritually enlightens the reader. The reasons for the complex perception and interpretation of Hryhorii Skovoroda’s philosophy are highlighted. We have verified (...) the main methods of its interpretation given in the works by Dmytro Chyzhevskyi. The influence of philosophical thought of thinkers of Antiquity and the Middle Ages: Aristotle, Epicurus, the Church Fathers, and Tertullian has been studied. We have comprehended H. Skovoroda’s interpretation of the Bible as a two-layer existence, the symbolic world that makes the foundation of his philosophy. The peculiarity of the thinker’s division of the heart into "internal" and "external" is analyzed. Hryhorii Skovoroda’s position on the Good and the evil is stated. The Good is identified with God, and the evil – with the real world, the man can choose between the two. Much attention is paid to the understanding of man as a microcosm – rational thinking, and thought is the fundamental cause of human activity, which generates all existence. Hryhorii Skovoroda’s philosophy of metaphysics as the existence of three worlds is highlighted: the first is the macrocosm (the whole surrounding world), the second is the microcosm (the man), and the third is the symbolic world (the Bible). "Monodualism" as a characteristic feature of H. Skovoroda’s work is analyzed. We have highlighted H. Skovoroda’s attitude to the transcendence of God, which is not separated from the world but is present in it directly. The understanding of faith as a forced act of self-love is analyzed because by loving ourselves we love God. The criteria for true and false faith have been clarified. The significance of H. Skovoroda’s aphorism that _what is necessary is useful, and not useful is unnecessary_ is considered. Examples of ethical principles in H. Skovoroda’s philosophy are considered. Peculiarities of the concept HAPPINESS are revealed. This concept is a universal means of existence of the Good, its source is gratitude to God. _Originality_ of the article is in the systematic presentation of the philosophy of the heart by Hryhorii Skovoroda and the analysis of the integrity of the "inner man", the true meaning of life as interpreted by Taras Zakydalsky. _Conclusions_ summarize the "anthropological pragmatism" of the philosopher, whose main idea is to apply practical skills for the benefit of society. (shrink)

In this paper we investigate a number of analytical solutions to the polynomial class of nonlinear Klein-Gordon equations in multidimensional spacetime. This is done in the context of classical φ4 and φ6 field theory, the former with and without the inclusion of an external force field conjugate to φ. Both massive (m≠0) and massless (m=0) cases are considered, as well as tachyonic solutions allowed (v>c). We first present a complete set of translationally invariant solutions for the φ4 model and demonstrate (...) the role of external force fields in altering the form of these solutions. Next, spherically symmetric solutions are discussed in both φ4 and φ6 cases since they provide the most realistic models of elementary particles. (shrink)

After a brief review of pragmatic arguments against emotivism, the author of this monograph proceeds to outline and criticize two conflicting concepts of the morally right in Dewey's writings. A third interpretation, involving an "interaction of the factual and the normative" is advanced as more conformable to the spirit of instrumentalism.--A. D. P. M.

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)

Integrated information theory (IIT) is a candidate theory of consciousness that highlights the role of complex interactions between parts of a system as the basis of consciousness – and, due to its general information-theoretic formulation, is capable of making statements about consciousness in neural and non-neural systems alike. Here, we argue that a system radically different to a human brain, host to complex physiological and functional structures capable of integrating information, can be found in the meristems and vascular system of (...) higher plants. Following a pragmatic and ontologically innocent approach, neither taking for granted that plants are conscious nor dismissing the possibility that they are, we argue that the time is ripe to apply analysis tools inspired by IIT to plants, taking advantage of recent developments in both plant imaging and information theory. We introduce and discuss the relevant literature, and pro information and integration in plant behaviour, assessing the plausibility of plant sentience. If successful, these experiments could position plants as the next frontier in consciousness science, and urge us to rethink our perspectives on consciousness, how to measure it, and its prevalence amongst living beings. (shrink)

In 2017, Italy passed a law that provides for a systematic discipline on informed consent, advance directives, and advance care planning. It ranges from decisions contextual to clinical necessity through the tool of consent/refusal to decisions anticipating future events through the tools of shared care planning and advance directives. Nothing is said in the law regarding the issue of physician assisted suicide. Following the DJ Fabo case, the Italian Constitutional Court declared the constitutional illegitimacy of article 580 of the criminal (...) code in the part in which it does not exclude the punishment of those who facilitate the suicide when the decision has been freely and autonomously made by a person kept alive by life-support treatments and suffering from an irreversible pathology, the source of physical or psychological suffering that he/she considers intolerable, but fully capable of making free and conscious decisions. Such conditions and methods of execution must be verified by a public structure of the national health service, after consulting the territorially competent ethics committee. This statement admits, within strict and regulated bounds, physician assisted suicide, so widening the range of end-of-life decisions for Italian patients. Future application and critical topics will be called into question by the Italian legislator. (shrink)

In a recent issue of this journal, P.E. Vermaas ([2005]) claims to have demonstrated that standard quantum mechanics is technologically inadequate in that it violates the 'technical functions condition'. We argue that this claim is false because based on a 'narrow' interpretation of this technical functions condition that Vermaas can only accept on pain of contradiction. We also argue that if, in order to avoid this contradiction, the technical functions condition is interpreted 'widely' rather than 'narrowly', then Vermaas, argument for (...) his claim collapses. The conclusion is that Vermaas' claim that standard quantum mechanics is technologically inadequate evaporates. (shrink)