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)

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)

The concept of normal is so familiar that it can be hard to imagine contemporary life without it. Yet the term entered everyday speech only in the mid-twentieth century. Before that, it was solely a scientific term used primarily in medicine to refer to a general state of health and the orderly function of organs. But beginning in the middle of the twentieth century, normal broke out of scientific usage, becoming less precise and coming to mean a balanced condition to (...) be maintained and an ideal to be achieved. In Normality, Peter Cryle and Elizabeth Stephens offer an intellectual and cultural history of what it means to be normal. They explore the history of how communities settle on any one definition of the norm, along the way analyzing a fascinating series of case studies in fields as remote as anatomy, statistics, criminal anthropology, sociology, and eugenics. Cryle and Stephens argue that since the idea of normality is so central to contemporary disability, gender, race, and sexuality studies, scholars in these fields must first have a better understanding of the context for normality. This pioneering book moves beyond binaries to explore for the first time what it does—and doesn’t—mean to be normal. (shrink)

P.M.S. Hacker 1. _The problems of Intentionality_ The problems of intentionality have exercised philosophers since the dawn of their subject. In the last century they were brought afresh into the limelight by Brentano. Famously he remarked that.

Davidson’s explanation of first‐person authority in utterance of sentences of the form ‘I V that p’ derives first‐person authority from the requirements of interpretation of speech. His account is committed to the view that utterance sentences are truth‐bearers, that believing that p is a matter of holding true an utterance sentence, and that a speaker’s knowledge of what he means gives him knowledge of what belief he expresses by his utterance. These claims are here faulted. His explanation of first‐person authority (...) by reference to the requirements of interpretability is committed to the view that all understanding involves interpretation. This is argued to be a misconception of understanding and of speaker’s meaning. Davidson’s account involves acceptance of the cognitive assumption that normally when a person Vs that p, he knows that he does. This assumption is challenged. Throughout, Davidson’s conception is compared and contrasted with Wittgenstein’s. (shrink)

This volume collects P. M. S. Hacker's papers on Wittgenstein and related themes written over the last decade. Hacker provides comparative studies of a range of topics--including Wittgenstein's philosophy of psychology, conception of grammar, and treatment of intentionality--and defends his own Wittgensteinian conception of philosophy.

1. The Tractatus doctrine of saying and showing In a letter to Russell dated 19.4.1919, written shortly after he had finished the Tractatus, Wittgenstein told Russell that the main contention of the book, to which all else, including the account of logic, is subsidiary, ‘is the theory of what can be expressed (gesagt) by prop[osition]s -- i.e. by language -- (and, which comes to the same, what can be thought) and what cannot be expressed by prop[osition]s, but only shown (gezeigt); (...) which I believe is the cardinal problem of philosophy’ (CL 68). This was emphasized in both preface and conclusion of the book. The preface observes that the whole sense of the book can be summed up in the following words: ‘what can be said at all can be said clearly, and what we cannot talk about we must pass over in silence’ (TLP p.3). The conclusion of the book (TLP 7) simply repeats this. The preceding three remarks, however, are noteworthy. They make three claims. First, ‘There are, indeed, things that cannot be put into words. They make themselves manifest. They are what is mystical’ (TLP 6.522). This reiterates the leitmotif of the book, namely that there are things that cannot, by the very nature of representation, be said. But though they cannot be said, they are shown by features of the relevant system of representation. Secondly, the correct method in philosophy would really be to say nothing except what can be said, i.e. empirical propositions that have nothing to do with philosophy, and then, when someone wanted to say something metaphysical, to demonstrate to him that he had failed to give meaning to certain signs in his propositions (TLP 6.53). This method, of course, is not the method that has been followed throughout the book, which consists almost exclusively of modal assertions concerning what must, can or cannot be thus and so in reality, in language and in the relation between language and reality.. (shrink)

The desire to see a sign phenomenon in different ways always has a reason to interpret it in an unbiased, panoramic way, and in some places - even allowing for contradictions in its understanding by different participants in the interpretative process. For modern humanities, this disposition is quite understandable, since it follows from its very postmodern nature, thereby defining the semantic semantic fields of the leading humanities. True, it is not so wide-spread, but instead, it is evident that Ukrainian religious (...) thinkers of the Middle Ages and Baroque have interpreted the iconic phenomena more deeply. In the story of Petro Mohyla "On the Wonderful Elder Grigory Mezhyhirsky" the metropolitan Mohyla clearly expresses the need to build before the thinking gaze of the reader his own, immanently religious-philosophical conception of the Divine, which every time would present him not just as an act of manifestation, otherwise he appears before the person, while remaining alone. The contemporary study of this issue in order to integrate its leading concepts in the religious-philosophical and general cultural discourse of the postmodern era has largely determined the relevance of the proposed article. The study of the phenomenon of "leaving" by itself in changing forms of the phenomenon of the Divine is also one of the key ones in the proposed studio, because it expresses the very meaning of the Divine as a religious, and therefore a cultural phenomenon. (shrink)

Throughout its long history metaphysics has been variously conceived. At its most sublime, it has been taken to be the study of the super‐sensible, in particular of the existence of a god, the nature of the soul, and the possibility of an afterlife. When the young Ludwig Wittgenstein entered the lists, it was entirely reasonable to conceive of metaphysics in this manner. Its subject matter was held to be the language‐independent and thought‐independent de re necessities of the world. The Tractatus (...) is dominated by three problems: first, the nature of logic and logical necessity; secondly, the essence of the proposition and hence the characterization of the general propositional form; and thirdly, the intentionality of the proposition. Logical propositions are combinations of elementary propositions by means of truth‐functional logical connectives. The metaphysics adumbrated in the Tractatus, Wittgenstein thought, was required for the possibility of representation and for the possibility of logic. (shrink)

This paper canvasses recent arguments in favor of commercial markets in human transplant kidneys, raising objections to those arguments on grounds of the role of injustice, exploitation, and coercion in compromising the autonomy of those most likely to sell a kidney, namely, the least well off members of society.

Davidson has attempted to integrate externalism into his account of meaning and understanding. He contends that what words mean is fixed in part by the circumstances in which they were learnt, in which the basic connection between words and things is established. This connection is allegedly established by causal interaction between people and the world. Words and sentences derive their meanings from the objects and circumstances in which they were learnt, which.

The author clarifies the existential philosophy that is implicit in Kurt Goldstein's philosophy of organism (Goldstein, 1963; 1995). Situated in response to the growing trend that psychological phenomena are reducible to the nervous system, the author argues for the reverse: that the significance of nervous system activity can only be understood by viewing it as background to foreground performances. Like the organization of perception into meaningful figure-- ground Gestalts, the existential modes of embodiment, sociality, temporality, spatiality, and attunement are organized (...) together to accomplish foreground performances. It is only within this context that the activity of the nervous system may be understood as significant or insignificant. Speech is given as an example. The article concludes with a commentary on how the trend of reducing psychological phenomena to neurological phenomena has impaired our understanding of brain disorders and psychological disorders. (shrink)

This chapter contains sections titled: Background The Tractatus The role of the Tractatus in the history of analytic philosophy The collapse of the Tractatus vision The Philosophical Investigations Philosophy of language Philosophy of mind The critique of metaphysics and nature of philosophy Wittgenstein's place in postwar analytic philosophy Notes Bibliography.

Sympathy, empathy, and compassion are strands in the network of love and essential corollaries of friendship. Together with love and friendship, they are the saving graces of mankind. This chapter aims to clarify the relationship between sympathy and empathy. It may be helpful first to list the relevant dispositions, tendencies, powers, and feelings. The most important contributions to the analysis of sympathy were Hume's A Treatise of Human Nature and Adam Smith's The Theory of Moral Sentiments. It was they who (...) provided the first extensive phenomenological description and philosophical anatomy of sympathy. It is noteworthy that Theodor Lipps had translated Hume's Treatise into German. His account of empathy had its roots in Hume's projectivism. With the demise of behaviourism in the 1970s, the notion of empathy became an object for reflections of experimental and practical psychologists and therapists. (shrink)

Von Wright argued that moral goodness is a derivative form of goodness. He proceeded to give an account of the moral goodness of an act, in terms of the good of man. Philosophical anthropology must render the phenomenon of morality intelligible. This chapter suggests that the roots of moral value lie in human sympathy, in maternal love, in intuitive recognition of the humanity of others, and in the nature of loving friendship. The sentiment of sympathy is virtually ubiquitous, but sympathetic (...) propensities vary from person to person, being partly a function of their imagination. Sympathy is an emotional tap‐root of moral reasons and a presupposition of moral reasoning. Kant's argument in support of a requirement of equal formal respect for human beings as moral agents is problematic. The explicit emergence of the idea of formal respect is one of the great advances in our evolving understanding of human nature and our conception of ourselves. (shrink)

This chapter is concerned with the mischaracterization of avowals of experience as descriptions of experience and the misconception of avowals and reports of experience as a matter of reading a description off the facts presented to one in introspection. One paradigm of description which Wittgenstein often employed as an object of comparison is giving a word‐picture of perceptible states of affairs, events or objects. To view avowals of pain as forms of pain‐behaviour akin to moans or cries of pain is (...) not to identify pain with pain‐behaviour. The affinity between spontaneous avowals and natural expressive behaviour must not mask the fact that the uses of first‐person psychological sentences are heterogeneous. Some approximate to primitive cries and gestures, and others are far removed from those paradigms. The spectrum of uses of first‐person psychological sentences to which Wittgenstein drew attention involves subtle gradations. (shrink)

This chapter contains section titled: Possibility Powers of the Inanimate Active and Passive Powers of the Inanimate Power and its Actualization Power and its Vehicle First‐and Second‐order Powers; Loss of Power Human Powers: Basic Distinctions Human Powers: Further Distinctions Dispositions.

The central limit theorem has been found to apply to random vectors in complex Hilbert space. This amounts to sufficient reason to study the complex–valued Gaussian, looking for relevance to quantum mechanics. Here we show that the Gaussian, with all terms fully complex, acting as a propagator, leads to Schrödinger’s non-relativistic equation including scalar and vector potentials, assuming only that the norm is conserved. No physical laws need to be postulated a priori. It thereby presents as a process of irregular (...) motion analogous to the real random walk but executed under the rules of the complex number system. There is a standard view that Schrödinger’s equation is deterministic, whereas wavefunction “collapse” is probabilistic —we have now a demonstrated linkage to the central limit theorem, indicating a stochastic picture at the foundation of Schrödinger’s equation itself. It may be an example of Wheeler’s “It from bit” with “No underlying law”. Reasons for the primary role of \ are open to discussion. The present derivation is compared with recent reconstructions of the quantum formalism, which have the aim of rationalizing its obscurities. (shrink)

Incorporating significant editorial changes from earlier editions, the fourth edition of Ludwig Wittgenstein's _Philosophical Investigations_ is the definitive _en face_ German-English version of the most important work of 20th-century philosophy The extensively revised English translation incorporates many hundreds of changes to Anscombe’s original translation Footnoted remarks in the earlier editions have now been relocated in the text What was previously referred to as ‘Part 2’ is now republished as _Philosophy of Psychology – A Fragment_, and all the remarks in it (...) are numbered for ease of reference New detailed editorial endnotes explain decisions of translators and identify references and allusions in Wittgenstein's original text Now features new essays on the history of the _Philosophical Investigations_, and the problems of translating Wittgenstein’s text. (shrink)