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)

Principled discussions of civil rights became inherently less likely as a direct result of the observation by Earl Warren, in Brown v. Board of Education, that, respecting freedmen, “Education of Negroes was almost non-existent, and practically all of the race were illiterate,” and in proportion as that observation increasingly became the foundation of common opinion on the subject. Warren's observation was not true in any meaningful or non-trivial sense. Nevertheless, it served to perpetuate the myth of a backward people needing (...) help to catch up instead of the truth of a people being held back. That is the perspective – the disadvantaged group perspective – that ultimately infected all discussion of civil rights, even after the designation of so-called “disadvantaged groups” had been extended beyond American blacks. To define civil rights, we may well begin with what all mankind would likely recognize. Thus the dictionary definition of “civil rights” stands: “the rights that belong to all individuals in a nation or community touching property, marriage, and the like.” In that definition the term “rights” may be further expanded to mean “legitimate claims,” following the definition of right as law – as “a claim or title or interest in anything whatever that is enforceable by law.” This definition applies with minimal distinction of regimes intruding and, therefore, without the host of recent complications in the United States that create the impression that civil rights have something to do with pluralism. Previously, the generic definition was thought to exhaust the meaning of the term in the United States. (shrink)

The Thebaid, with all its faults, deserves more attention than it generally receives in these days; it is something more than a desirable quarry for ‘unseens.’ Its exegesis is in a very backward state, quite unworthy of modern scholarship. It is almost a hundred years since the last explanatory edition was published, and the commentators on Statius have, as a rule, been more remarkable for their learning than for their discernment. Before the appearance of the Oxford edition and the latest (...) Teubner recension the materials for the establishment of the text were very defective; and in spite of the valuable labours of Messrs. Garrod and Klotz , the Thebaid still offers considerable scope for the textual critic. The MSS. present many puzzles; it must also be confessed that in not a few places the work of scholars in the last century has done more harm than good. The following notes on Book II., whatever their value, may perhaps help to call attention to the need for more labourers in a promising field. (shrink)

As I had rejected en bloc references to Bacchanalia as indications of date, it was a mere chance which led me, after the above had left my hands, to look up Cas. 980 ‘ nunc Bacchae nullae ludunt,’ quoted in Schanz, R. Lit.3, p. 78. As this affords an excellent opportunity of testing my conclusions, perhaps a word or two will not be out of place.

1. The use of the imperfect τικτε ‘was the mother of’, with τíκτουσα; νίκων, ο νικντες; διδος is well known, and no doubt correctly explained. Reference is frequently made to Virgil's quem dat Sidonia Dido, but δίδου seems not to be used, no doubt because it is so extensively used in the sense of ‘offered’. In T. 7. 56. 3 περιεγíγνοντο seems to be a substitute for νíκων, ‘were victorious’; cf. φερε in Find. O. 10 , 74 ‘was prizewinner’ —the (...) other winners all have an aorist. So too Pyth. 3. 44. (shrink)

One Morality or many? Liberal morality and Socialist morality; bourgeois morality and Georges Sorel's “morality of producers”; Protestant morality and Catholic; Greek morality and Christian; “aristocratic” morality and “slave” morality, “open” morality and “closed” morality—what, if any, is the relevance of such distinctions as these to moral philosophy?