Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires (...) researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)

Public discourse is often caustic and conflict-filled. This trend seems to be particularly evident when the content of such discourse is around moral issues (broadly defined) and when the discourse occurs on social media. Several explanatory mechanisms for such conflict have been explored in recent psychological and social-science literatures. The present work sought to examine a potentially novel explanatory mechanism defined in philosophical literature: Moral Grandstanding. According to philosophical accounts, Moral Grandstanding is the use of moral talk to seek social (...) status. For the present work, we conducted six studies, using two undergraduate samples (Study 1, N = 361; Study 2, N = 356); a sample matched to U.S. norms for age, gender, race, income, Census region (Study 3, N = 1,063); a YouGov sample matched to U.S. demographic norms (Study 4, N = 2,000); and a brief, one-month longitudinal study of Mechanical Turk workers in the U.S. (Study 5, Baseline N = 499, follow-up n = 296), and a large, one-week YouGov sample matched to U.S. demographic norms (Baseline N = 2,519, follow-up n = 1,776). Across studies, we found initial support for the validity of Moral Grandstanding as a construct. Specifically, moral grandstanding motivation was associated with status-seeking personality traits, as well as greater political and moral conflict in daily life. (shrink)

The late Jacob Klein’s important book is, remarkably, a lucid presentation of esoteric argument. Dealing with the famed Platonic triad, Theaetetus, Sophist, and Statesman, Klein settles the dispute about the missing dialogue, "The Philosopher," by first denying that it is missing and second showing that it is unnecessary. He argues, in short, that the triad is a dyad. That argument is reinforced by the distinction Klein strongly implies between the Socratic Theaetetus and the Eleatic Sophist and Statesman. "We can now (...) understand why the conversations of the ‘trilogy’ occur in two, not three, days and why the Sophist, the Statesman, and the Philosopher are dealt with in two, not three, dialogues". (shrink)

Female coital orgasm may be an adaptation for preferentially retaining the sperm of males with “good genes.” One indicator of good genes may be physical attractiveness. Accordingly, R. Thornhill, S. W. Gangestad, and R. Comer (1995) found that women mated to more attractive men reported an orgasm during a greater proportion of copulations than did women mated to less attractive men. The current research replicates this finding, with several design variations. We collected self-report data from 388 women residing in the (...) United States or in Germany. Results support the hypothesis that women mated to more attractive men are more likely to report an orgasm at the most recent copulation than are women mated to less attractive men, after statistically controlling for several key variables. Discussion addresses (a) the inability of the present research to specify the causal link between female orgasm and male attractiveness and (b) the proactive nature of female sexuality documented in recent research guided by an evolutionary perspective. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:HUME'S IDEAS In the eighteenth century, there was widespread acceptance of a physiological basis for cognition. Some writers even argued for a rather detailed correlation between awareness and physiological changes, suggesting that (a) the former could be adequately explained in terms of the latter or, in some few instances, (b) that the former are the latter. David Hartley may come to mind as fitting one or the other of (...) these alternatives, but Robert Hooke had earlier argued for ideas as brain impressions, as of course did Descartes in his early scientific treatises. There was also one medical doctor in the eighteenth century, Dr. Astruc, who seems (on the basis of what Chambers reports) to have attempted a very specific correlation between specific forms of awareness and specific states and changes in physiology. There were also writers in this century who warned against the dangers of using physical-object vocabulary when talking about the mind and acts of awareness. Berkeley is one such writer,- Thomas Reid at the end of the century traced, to the use of this vocabulary, what he took to be the indirect realism of the way of ideas. Hume is writing in both these traditions: the tradition of using physical language for characterizing mental operations and the tradition of physiological explanations and correlations. The phrase used by Alexander Pope and Hume, 'the anatomy of the mind', seems to be a mixed metaphor, but it is a phrase which I take as an indication that Hume is doing what we would call 'cognitive psychology'. Another phrase used by Hume (this time in the Enquiry), 'mental geography', may capture his enterprise better: 'geography' still sounds physical, but it is modified by 'mental'. Hume is engaged in mental mapping. I want to take a look at the use of the term 'idea' in Hume's writing (mainly in the Treatise) in order to see 2. whether Hume's text enables us to say anything about the nature of his ideas, to discover what role they play in his mental geography. As far as I can determine, there are three possible candidates for the nature of ideas in Hume: images, brain impressions, and cognitive contents. The first of these is, I think, the standard reading of Hume's ideas. Professor Anderson has presented strong argument and evidence to support the second. I will be suggesting that the third is the best candidate, given the full range of the text of the Treatise. Of course, the correct answer 4 may be all three of these. The Treatise opens by dividing all perceptions of the human mind into two kinds. Impressions and ideas differ in the degree of force and liveliness with which they strike upon the mind. Even though the language of 'force' and 'liveliness' may be borrowed from physical talk, it is the mind, not the brain, on which perceptions strike. The examples of impressions are sensations, passions, and emotions. Ideas are said to be the faint images of these impressions in thinking and reasoning. The term 'image' throughout the eighteenth century never receives any clear explication. Its inheritance from optical treatises always hangs about it. We should look to the examples cited by Hume, in order to see whether we can construct a meaning for that term when used in these psychological contexts. Let us look first at his very first example of 'ideas': all the perceptions excited by the present discourse. (Tl) He explicitly excludes from these perceptions those which arise from the sight and touch, as well as the immediate pleasure or uneasiness his discourse may excite in us. The perceptions which are thus excluded are sensations and emotions, the impressions he has just distinguished. The only candidate left for ideas would seem to be what this discourse says, our thoughts about it, my understanding of what it says. The distinction is not one Hume thinks is difficult to follow: Every one of himself will readily perceive the difference betwixt feeling and thinking. (Tl-2) Last week I was sad, today I recall that feeling of sadness/ the difference between being sad and remembering that I was sad. Hume gives a different example: the perceptions formed when... (shrink)

Before daybreak on 23 November 57 B.C., about 11 weeks after his return from exile, Cicero wrote to Atticus and recorded for him, in diary form, events at Rome between 3 November and the date of writing. Clodius and his gangs were still causing trouble on the streets, interfering with the rebuilding of Cicero's house on the Palatine, and even molesting Cicero himself. Clodius was a candidate for the curule aedileship; if he were elected, he would succeed in evading (...) the accusation for vis which had been brought against him by Milo; he therefore made full use of his gangs to intimidate Rome and thus accelerate the elections. He was supported in this manœuvre by the consul Q. Caecilius Metellus Nepos, who planned to hold the comitia by surprise; this plan, however, was being thwarted by the tribune Milo, who was ready to use his power of obnuntiatio to prevent the elections being held. (shrink)

Before daybreak on 23 November 57 B.C., about 11 weeks after his return from exile, Cicero wrote to Atticus and recorded for him, in diary form, events at Rome between 3 November and the date of writing. Clodius and his gangs were still causing trouble on the streets, interfering with the rebuilding of Cicero's house on the Palatine , and even molesting Cicero himself . Clodius was a candidate for the curule aedileship; if he were elected, he would succeed (...) in evading the accusation for vis which had been brought against him by Milo; he therefore made full use of his gangs to intimidate Rome and thus accelerate the elections. He was supported in this manœuvre by the consul Q. Caecilius Metellus Nepos, who planned to hold the comitia by surprise; this plan, however, was being thwarted by the tribune Milo, who was ready to use his power of obnuntiatio to prevent the elections being held. (shrink)