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)

Is the societal-level of analysis sufficient today to understand the values of those in the global workforce? Or are individual-level analyses more appropriate for assessing the influence of values on ethical behaviors across country workforces? Using multi-level analyses for a 48-society sample, we test the utility of both the societal-level and individual-level dimensions of collectivism and individualism values for predicting ethical behaviors of business professionals. Our values-based behavioral analysis indicates that values at the individual-level make a more significant contribution to (...) explaining variance in ethical behaviors than do values at the societal-level. Implicitly, our findings question the soundness of using societal-level values measures. Implications for international business research are discussed. (shrink)

Using student self-reported cheating admissions and answers from a hypothetical cheating scenario, this paper analyzes the effects of individual and situational factors on potential cheating behavior. Results confirm several conclusions about student factors that are related to cheating. The probability of cheating is associated with younger students, lower GPAs, alcohol consumption, fraternity/sorority membership, and having cheated in high school. Student perceptions of the certainty and severity of punishment appear to have a negative and significant impact on the probability of cheating (...) on in-class assignments. Students who report a belief that cheating is never acceptable appear to be significantly less likely to cheat in any circumstance. This study illustrates the context-dependent nature of academic dishonesty, and the associated difficulty in understanding the relationships between measurable factors and cheating behavior. (shrink)

This collection focuses on the introduction of phenomenology to the United States by the community of scholars who taught and studied at the New School for Social Research from 1954 through 1973. During those years, Dorion Cairns, Alfred Schutz, and Aron Gurwitsch--all former students of Edmund Husserl--came together in the department of philosophy to establish the first locus of phenomenology scholarship in the country. This founding trio was soon joined by three other prominent scholars in the field: Werner Marx, Thomas (...) M. Seebohm, and J. N. Mohanty. The Husserlian phenomenology that they brought to the New School has subsequently spread through the Anglophone world as the tradition of Continental philosophy. The first part of this volume includes original works by each of these six influential teachers of phenomenology, introduced either by one of their students or, in the case of Seebohm and Mohanty, by the thinkers themselves. The second part comprises contributions from twelve leading scholars of phenomenology who trained at the New School during this period. The result is a powerful document tracing the lineage and development of phenomenology in the North American context, written by members of the first two generations of scholars who shaped the field. Contributors: Michael Barber, Lester Embree, Jorge García-Gómez, Fred Kersten, Thomas M. T. Luckmann, William McKenna, J. N. Mohanty, Giuseppina C. Moneta, Thomas Nenon, George Psathas, Osborne P. Wiggins, Matthew M. Seebohm, and Richard M. Zaner. (shrink)

John McDowell’s ethical writings interpret ethical experience as intentional, socially-conditioned, virtuous responsiveness to situations and develop a modest account of practical rationality. His work converges with investigations of ethical experience by recent Kant scholars (Sherman, Brewer, Herman) and Emmanuel Levinas. The Kantian interpreters and Levinas locate the categorical demands of ethical experience in rational agents’ demands for respect, while McDowell finds it in noble adherence to the demands of virtuous living. For McDowell, moral-practical rational efforts to justify ethics cannot transcend (...) one’s form of life and are motivated by desires to coerce others under a veneer of rationality or an unnecessary modern anxiety to protect community beliefs. He overlooks how such justifications can be motivated by a desire to give an account of one’s beliefs out of responsibility to others different from oneself, a responsibility elicited by others in ethical experience as depicted by the Kantian interpreters and Levinas. (shrink)

Disjunctivism about sensory experience is frequently put forward in defence of a particular conception of perception and perceptual experience known as naïve realism. In this paper, I present an argument against naïve realism that proceeds through a rejection of disjunctivism. If the naïve realist must also be a disjunctivist about the phenomenal nature of experience, then naïve realism should be abandoned.

The received theories of epistemology identify abductive inferences with the cognitive patterns of speculation (hypothesis formation) and insist that they cannot verify or confirm hypotheses. I criticize various descriptions of abduction, offer a structural analysis of abductive inference,, characterize abduction without alluding to its putative role in inquiry, and then demonstrate that some abductions do provide evidence and that not all scientific hypotheses derive from abductive inferences. This result challenges those notions of scientific k knowledge that dismiss some central scientific (...) ideas (for example, evolution) as ‘meta-physical research programs’ or ‘just theories’ when they are instead well substantiated by abductive evidence. (shrink)

In recent years, we have seen a new concern with ethics training for research and development professionals. Although ethics training has become more common, the effectiveness of the training being provided is open to question. In the present effort, a new ethics training course was developed that stresses the importance of the strategies people apply to make sense of ethical problems. The effectiveness of this training was assessed in a sample of 59 doctoral students working in the biological and social (...) sciences using a pre–post design with follow-up and a series of ethical decision-making measures serving as the outcome variable. Results showed not only that this training led to sizable gains in ethical decision making but also that these gains were maintained over time. The implications of these findings for ethics training in the sciences are discussed. (shrink)

How ought the historian to reconcile themselves philosophically with the fact of evental contingency and of its relationship to structural determination? Does the existence of contingent causation undermine the very concept of historical necessity, or do the two instead in dialectical entanglement? In this essay, I engage with the problem of historical contingency from a transcendental-materialist perspective informed by the work of Slavoj Žižek, tendering a philosophically serious response to the famous Pascalian conundrum of Cleopatra’s nose and its challenge to (...) structuralist accounts of historical causation. The position associated with Laplace – that is to say, that the course of history would be entirely predictable were one provided with a complete account of initial conditions – is firmly rejected. Instead, I revive Althusser’s attempt to craft a theory of ‘aleatory materialism’, in which the determinative power of structural forces nevertheless leave space for the radical and unpredictable transformation of a situation by the chance crystallisation of events and encounters. In this effort, I recruit conceptual architecture not only from the fields of historiography and philosophy, but also quantum physics, psychoanalysis, and mathematics. (shrink)

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict were (...) higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

Objective: The field of clinical ethics is relatively new and expanding. Best practices in clinical ethics against which one can benchmark performance have not been clearly articulated. The first step in developing benchmarks of clinical ethics services is to identify and understand current practices.Design and setting: Using a retrospective case study approach, the structure, activities, and resources of nine clinical ethics services in a large metropolitan centre are described, compared, and contrasted.Results: The data yielded a unique and detailed account of (...) the nature and scope of clinical ethics services across a spectrum of facilities. General themes emerged in four areas—variability, visibility, accountability, and complexity. There was a high degree of variability in the structures, activities, and resources across the clinical ethics services. Increasing visibility was identified as a significant challenge within organisations and externally. Although each service had a formal system for maintaining accountability and measuring performance, differences in the type, frequency, and content of reporting impacted service delivery. One of the most salient findings was the complexity inherent in the provision of clinical ethics services, which requires of clinical ethicists a broad and varied skill set and knowledge base. Benchmarks including the average number of consults/ethicist per year and the hospital beds/ethicist ratio are presented.Conclusion: The findings will be of interest to clinical ethicists locally, nationally, and internationally as they provide a preliminary framework from which further benchmarking measures and best practices in clinical ethics can be identified, developed, and evaluated. (shrink)

The following questions arising in connection with the géométrisation of modern physics are discussed: is the physical theory a bicomponent one or everything can be reduced to space? Whether the hypothesis of the macroscopic nature of space and time deals with the theoretical or empirical structure of physical theory? Is there géométrisation of quanta or quantisation of geometry?

LIFE offers various amusements, and anyone these days who can choose among them will come late to the study of hiatus in Greek prose. Germany in the 1880s, so it seems, was less fortunate, and few greater excitements were known to young or old than the hunt for hiatus; but now that we no longer strait-waistcoat our classical authors and the austerity of those times is discredited, few collectors of hiatus are to be found, and there are people even in (...) Germany who have never identified a single specimen. Yet there is nothing to be said for underrating an author' stylistic pretensions, still less for encouraging others to do the same; and the textual critic, whose path is slippery enough at the best of times, can ill afford to dispense with footholds. There has been no broad study of hiatus in Greek prose since 1841, when Benseler in a long and original book De hiatu in oratoribus et historicis Graecis went through the text of 27 authors and attempted to determine their practice. (shrink)

In a brief article under the present title, Adam Parry raised a simple but profound question: were there certain things that the inherited vocabulary of oral poets did not allow them to sayF; The mere raising of this question, whatever his answer, is enough to make the article one of the more important contributions to Homeric studies in the last fifty years. As it happens, his answer was affirmative, and it has not been contested. Contested it will now be.