David Hume's theory of justice: a defence of the establishment without recourse to the argument for the divine right of kings, or a workable guiding principle of legitimate and lasting government?

David Hume' political philosophy has a strongly paternalistic feel, leading to a misconception of Hume as a conservative thinker with little to contribute in the field of political philosophy beyond a defence of the status quo. This Thesis assesses the extent to which Hume's work can help us understand his world and our own. Chapter One dwells on the personality of David Hume, as a prerequisite to a fuller understanding of the intentions and significance of his work. Includes: Hume’s ambition; his concern for accuracy (and restraint from empty rhetoric); his caution; his objectivity (demonstrated by his greed for independence; his emotional side (including an introduction to the idea of Hume as agnostic rather than strictly an atheist as he is - still - often characterised); his attitude towards the truth. Chapter Two moves onto an examination of relevant parts of Hume's general philosophy, forming the beginning of Hume's theory of justice. Chapter Three concerns the impact of Hume's general philosophy on his politics. Hume’s theory of just government is rooted in his general thoughts on morality, which are characterised by a scepticism sometimes mistaken for cynicism. Hume dismisses the idea of an original and binding Contract of Government. In Hume's political philosophy man has the capacity for improvement and progress without being restrained by the past. Justice underscores civil society, which is about mutual protection - peace is justice. Justice is not necessarily about democracy, although Hume is not challenging the possibility of legitimate government authority. Key questions: What does Hume mean by stability in government? Is Hume right about Justice? What precisely does Hume mean by self-interest? Was Hume a democrat? Chapter Four Conclusion: concluding comments on Hume's philosophy of the state. Hume shares Hobbes' objective of non-ideological government. Hume was wary of change, especially if it was in accordance with some grand plan for society and / or mankind (which tended to mean revolution). Includes: the crucial role of property in Hume’s jurisprudence, empirical evidence from history to support this and other claims; more on the political culture in Hume's functional civil society, including a look at how Hume uses the Aristotelean distinction between man and citizen; the practical aspects of his theory of justice in government; conclusion that Hume’s theory of justice is a theory of property, and that this is because self-interest drives all men. Key questions: What is Hume's "common sense"? Has Hume identified the elusive, verifiable moral absolute? Can we derive a workable principle of civil society from Hume’s analysis? Did David Hume fulfil his lofty intellectual ambitions

Impact of infection preventionists on Centers for Medicare and Medicaid quality measures in Maryland nursing homes.

BackgroundHealth care-associated infections are the leading cause of morbidity and mortality in US nursing homes (NHs). The objective of the research is to assess the impact of Maryland NH infection preventionists (IPs) on NH quality measures.MethodsTwo hundred thirty-four NHs were queried through mailed survey. These survey data were then linked with 2008 quality data from Nursing Home Compare and the On-line Survey Certification of Automated Records.ResultsThree of the 8 quality measures examined-influenza vaccination for both short- and long-stay residents and pressure ulcer prevention in high-risk residents-were significantly associated with the number of IPs. None of the quality measures were shown to be significant with IPs who received specialized training on infection prevention and management compared with those who did not receive specialized training.ConclusionIPs play a critical role in preventing and managing health care-associated infections in nursing homes, especially in the areas of influenza vaccination and pressure ulcer prevention among high-risk nursing home residents. Quality measures that reflect the effects of IP training may not have been elucidated yet. Further research is needed to support the IP role in order for policy to advocate for increased IP funding

Leadership Styles of Nursing Home Administrators and Their Association With Staff Turnover

Purpose: The purpose of this study was to examine the associations between nursing home administrator (NHA) leadership style and staff turnover. Design and Methods: We analyzed primary data from a survey of 2,900 NHAs conducted in 2005. The Online Survey Certification and Reporting database and the Area Resource File were utilized to extract organizational and local economic characteristics of the facilities. A general linear model (GLM) was used to estimate the effects of NHA leadership style, organizational characteristics, and local economic characteristics on nursing home staff turnover for registered nurses (RNs), licensed practical nurses (LPNs), and nurse’s aides (NAs). Results:The complete model estimates indicate that NHAs who are consensus managers (leaders who solicit, and act upon, the most input from their staff) are associated with the lowest turnover levels, 7% for RNs, 3% for LPNs, and 44% for NAs. Shareholder managers (leaders who neither solicit input when making a decision nor provide their staffs with relevant information for making decisions on their own) are associated with the highest turnover levels, 32% for RNs, 56% for LPNs, and 168% for NAs. Implications: The findings indicate that NHA leadership style is associated with staff turnover, even when the effects of organizational and local economic conditions are held constant. Because leadership strategies are amenable to change, the findings of this study may be used to develop policies for lowering staff turnover

Voluntary and Involuntary Nursing Home Staff Turnover

The goal of this study was to identify nursing home characteristics that have differential associations to voluntary and involuntary turnover among formal caregivers (i.e., registered nurses, licensed practical nurses, and nurse aides). Primary data from 354 facilities from four states were merged with data from the 2004 Online Survey, Certification and Recording system. Multinomial logistic regression analyses were conducted to determine whether organizational characteristics were related to a greater probability of high or low levels of voluntary and involuntary turnover among formal caregivers. The analysis revealed that a higher ratio of nurses to beds, a smaller number of quality-of-care deficiencies, and a smaller proportion of residents using Medicaid were all associated with lower voluntary turnover but higher involuntary turnover. The findings indicate that controlling turnover is a complex process that may involve monitoring the organizational levels not only of voluntary separations but also of involuntary terminations

Finite element modeling of residual mechanical hearing function after cochlear implant surgery

Cochlear implant (CI) surgery is one of the most utilized treatments for severe hearing loss. Though CI surgery is proven to improve patients’ quality of life, results are variable as damage to very delicate inner ear tissues can be difficult to avoid. However, even the effects of optimal scala tympani insertions on the mechanics of hearing are not yet fully understood. This project presents two finite element models of the inner ear to study the interrelationship between the mechanical function of the cochlea and the insertion of a cochlear implant electrode, one derived from the chinchilla inner ear and one derived from the rhesus monkey inner ear. These subjects were chosen due to their wide usage in inner ear research as designs of the typical device tend to progress from chinchilla animal studies, to rhesus animal studies, and finally to human trials. Both FE models include a three-chambered cochlea and full vestibular system, rarely seen in prior studies. The procedure used to create these models is low-cost, rapid, and reproducible, and results in a highly detailed model using μMRI imaging as the data source. In the chinchilla model’s unimplanted state, data indicative of the tuning effect of the cochlea closely matched results obtained in In Vivo studies. In its implanted state, the chinchilla model found minimal loss of residual hearing or alteration of the cochlea’s tuning effect regardless of CI insertion angle. Its results suggest that an emphasis should be put on developing CI’s with maximal insertion angles and minimal trauma during insertion. The more detailed rhesus model is presented with its preliminary results and plans for its continued development. In the future, both models can be reused with minimal alteration to study a broad range of phenomena such as vestibulo-cochlear interaction, the results of vestibular implant surgery, and the effects of various pathologies on hearing function

Determinants of staff job satisfaction of caregivers in two nursing homes in Pennsylvania

BACKGROUND: Job satisfaction is important for nursing home staff and nursing home management, as it is associated with absenteeism, turnover, and quality of care. However, we know little about factors associated with job satisfaction and dissatisfaction for nursing home workers. METHODS: In this investigation, we use data from 251 caregivers (i.e., Registered Nurses, Licensed Practical Nurses, and Nurse Aides) to examine: job satisfaction scores of these caregivers and what characteristics of these caregivers are associated with job satisfaction. The data were collected from two nursing homes over a two and a half year period with five waves of data collection at six-month intervals. The Job Description Index was used to collect job satisfaction data. RESULTS: We find that, overall nursing home caregivers are satisfied with the work and coworkers, but are less satisfied with promotional opportunities, superiors, and compensation. From exploratory factor analysis three domains represented the data, pay, management, and work. Nurse aides appear particularly sensitive to the work domain. Of significance, we also find that caregivers who perceived the quality of care to be high have higher job satisfaction on all three domains than those who do not. CONCLUSION: These results may be important in guiding caregiver retention initiatives in nursing homes. The finding for quality may be especially important, and indicates that nursing homes that improve their quality may have a positive impact on job satisfaction of staff, and thereby reduce their turnover rates

Tracing social influence in responses to strategy change in an online community

Interest into the effects of social influence on members of online communities is growing but there is a lack of knowledge about the impact of influential members in online communities on responses to strategy change within the wider community. We explore social influence in responses to strategy change through content analysis of forum posts before and after a change in strategy. Acceptance or non-acceptance of strategy change and subsequent positive and negative behavioural responses online are dependent on individual factors. The details of these behavioural responses to a change in strategy are tabulated and included in a conceptual model to inform decision-makers. Strategy change precipitates a reduction in social influence effects. Non-acceptance of strategy change is associated with competitor advertisement, inflammatory behaviour, offensive behaviour and complaints. This negative behaviour has important ramifications for acceptance of strategy change within the wider community and impacts on the viability of setting up online forums

What airway and vascular access skills can be performed whilst wearing the NHS issued chemical, biological, radiation, and nuclear personal protective equipment?

The introduction of chemical, biological, radiation and nuclear personal protective equipment (CBRN-PPE) across the National Health Service (NHS), in 2007, represented an increase in the capacity to treat patients following a CBRN incident. However, little was known on what impact the NHS CBRN-PPE would have on skill performance. To date a number of studies have evaluated various skills performed whilst wearing a range of CBRN-PPE, none of which resembles the NHS CBRN-PPE. This gap in the evidence prompted a series of research studies addressing the following research question, ‘What airway and vascular access skills can be performed whilst wearing the NHS issued chemical, biological, radiation, and nuclear personal protective equipment? The resulting nine published peer-reviewed papers are presented with a critical commentary in three chapters: Chapter 3 (Papers 1 to 4) assesses what clinical skills can be performed using the NHS CBRN-PPE; Chapter 4 (Papers 5 & 6) explores clinicians’ views on the preferences and experiences of airway management whilst wearing CBRN-PPE; and Chapter 5 (Papers 7 to 9) evaluates the optimal strategies of airway management whilst wearing the NHS CBRN-PPE. Chapter 6 is a summary of the findings presented in this thesis and presents a number of new research questions to further expand our knowledge-base, regarding skill performance whilst wearing NHS CBRN-PPE, reflecting the developmental nature of this area of research. The research contained in this thesis utilises a combination of randomised controlled trials, interviews and questionnaires, to ascertain the impact of the NHS CBRN-PPE on skill completion. Papers 1 to 4 recruited a group of mixed clinicians allowing subgroup analysis observing for inter-professional differences regarding skill performance. Whereas, Papers 7 to 9 recruited student paramedics ensuring similar levels of airway management skills, thereby isolating prior expertise as a variable. The research presented in this thesis has been used during simulation training as part preparations for the 2012 Olympics, in the development of a CBRN training DVD and incorporated into a textbook. The results have also been shared with NHS England working party on CBRN-PPE and, are being incorporated into CBRN treatment protocols by an overseas ambulance service