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)

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)

(No abstract is available for this citation).

(No abstract is available for this citation).

Both the recent 'Warner' review of the UK research ethics committee (REC) system and the subsequent consultation document produced by the Central Office for Research Ethics Committees (COREC) emphasize the need to distinguish 'research' from what might be termed 'non-research'. This is to be determined through a process of filtering or 'triage', the intention being that RECs will avoid considering proposals with 'no material ethical issues'. In this paper we argue that trying to distinguish 'true' research from other projects is (...) counterproductive, misleading and potentially unethical. Our case is built around three assertions: (1) the distinction between research and non-research is imprecise; (2) both medical research and non-research can generate similar ethical issues; and (3) projects should be judged according to what they involve, not how they are labelled. (shrink)

Davey suggests that increased resistance to extinction of CRs conditioned to fear-relevant stimuli may be due to more persistent expectancies of the UCS following these stimuli. However, this viewpoint is contradicted by existing empirical evidence that fear-relevant CRs survive an extinction trials series producing extinction of expectancies whereas CRs conditioned to non-fear-relevant CSs do not.

There are wide individual differences in the ability to detect a stimulus contingency embedded in a complex paradigm. The present study used a cognitive masking paradigm to better understand individual differences related to contingency learning. Participants were assessed on measures of electrodermal arousal and on working memory capacity before engaging in the contingency learning task. Contingency awareness was assessed both by trial-by-trial verbal reports obtained during the task and by a short post-task recognition questionnaire. Participants who became aware had fewer (...) non-specific skin conductance responses and tended to score higher on a digit span assessment. Skin conductance level was not significantly lower in the aware group than in the unaware group. These findings are consistent with studies showing that lower arousal and greater cognitive processing capacity facilitate conscious perception of a greater breadth of information within a scene or a task. (shrink)

One enduring legacy of the twentieth century will be the slow, certain transformation of the world from insular civilizations to interactive societies enmeshed in global systems of electronic communication, economics, and politics. Financial news from Thailand or Brazil is often more important globally than political events in the old centers of power. Some bemoan the uncertainty and flux of all this. However, the mutual definition of the world’s societies presents an extraordinary opportunity to humanize a situation that all too quickly (...) could degenerate into a Weberian ‘iron cage’ of truly global proportions. What contribution can the world’s great philosophical traditions make toward humanity’s common task of civilizing the rise of globalization? Here the ancient concept of paideia walks upon the stage of the twenty-first century. (shrink)

One enduring legacy of the twentieth century will be the slow, certain transformation of the world from insular civilizations to interactive societies enmeshed in global systems of electronic communication, economics, and politics. Financial news from Thailand or Brazil is often more important globally than political events in the old centers of power. Some bemoan the uncertainty and flux of all this. However, the mutual definition of the world’s societies presents an extraordinary opportunity to humanize a situation that all too quickly (...) could degenerate into a Weberian ‘iron cage’ of truly global proportions. What contribution can the world’s great philosophical traditions make toward humanity’s common task of civilizing the rise of globalization? Here the ancient concept of paideia walks upon the stage of the twenty-first century. (shrink)

One enduring legacy of the twentieth century will be the slow, certain transformation of the world from insular civilizations to interactive societies enmeshed in global systems of electronic communication, economics, and politics. Financial news from Thailand or Brazil is often more important globally than political events in the old centers of power. Some bemoan the uncertainty and flux of all this. However, the mutual definition of the world’s societies presents an extraordinary opportunity to humanize a situation that all too quickly (...) could degenerate into a Weberian ‘iron cage’ of truly global proportions. What contribution can the world’s great philosophical traditions make toward humanity’s common task of civilizing the rise of globalization? Here the ancient concept of paideia walks upon the stage of the twenty-first century. (shrink)

Recent policy in relation to clinical research proposals in the UK has distinguished between two types of review: scientific and ethical. This distinction has been formally enshrined in the recent changes to research ethics committee structure and operating procedures, introduced as the UK response to the EU Directive on clinical trials. Recent reviews and recommendations have confirmed the place of the distinction and the separate review processes. However, serious reservations can be mounted about the science/ethics distinction and the policy of (...) separate review that has been built upon it. We argue here that, first, the science/ethics distinction is incoherent, and, second, that RECs should not only be permitted to consider a study’s science, but that they have anobligation do so. (shrink)

This research addresses the question of whether men and women in sales differ in their ethical attitudes and decision making. The study asked 209 subjects to respond to 20 ethical scenarios, half of which were "relational" and half "non-relational." The study concludes (1) that there are significant ethical differences between the sexes in situations that involve relational issues, but not in non-relational situations, and (2) that gender-based ethical differences change with age and years of experience. The implications of these finding (...) for sales organizations are discussed. (shrink)

Additional support is presented for the necessity of awareness of the CS-US relation in human autonomic conditioning. However, possible limitations and exceptions regarding this general rule are discussed. Limitations include the lack of relationship between conditioned response (CR) strength and degree of awareness, and an important exception may be the finding of conditioning with backwardly masked CSs of a biologically prepared nature.

We are printing in its entirety the discussion document which sets out a code of professional conduct for nurses published by the Royal College of Nursing in November 1976 together with commentaries by the Assistant Secretary of the British Medical Association, a professor of nursing studies, student nurses and a lawyer. The image of the nurse is still that of one of Florence Nightingale's young ladies or of a member of a religious order who is wholly dedicated to caring for (...) the sick. Today, as this document and the comments upon it show, 'dedication' is still part of the motive which leads a man or woman to become a nurse but in addition, and this is where the public may be ignorant or choose to be ignorant, nursing offers a career where intellectual achievement and the satisfaction of a demanding job bring their proper financial reward and place in the professional community. We are grateful to the Royal College of Nursing for permission to publish this document. (shrink)

This paper examines whether a classical model could be translated into a PDP network using a standard connectionist training technique called extra output learning. In Study 1, standard machine learning techniques were used to create a decision tree that could be used to classify 8124 different mushrooms as being edible or poisonous on the basis of 21 different Features (Schlimmer, 1987). In Study 2, extra output learning was used to insert this decision tree into a PDP network being trained on (...) the identical problem. An interpretation of the trained network revealed a perfect mapping from its internal structure to the decision tree, representing a precise translation of the classical theory to the connectionist model. In Study 3, a second network was trained on the mushroom problem without using extra output learning. An interpretation of this second network revealed a different algorithm for solving the mushroom problem, demonstrating that the Study 2 network was indeed a proper theory translation. (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)

Native women residing in the Subarctic and Arctic are currently struggling for the right to decide whether they will be hospitalized or have a midwife present for the birth of their children. The argument presented in this review paper outlines the cultural and clinical factors in favour of recognizing and legalizing traditional midwifery in the North and critically examines the statistical and safety concerns raised by those arguing against giving Northern Native women an alternative to evacuation from their home communities.

If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.