Generics, modality, and morality

The issues in this dissertation reside at the intersections of, and relationships between, topics concerning the meaning of generic generalizations, natural language modality, the nature and role of moral principles, and the place of supererogation in the overall structure of the normative domain. In ’Generics and Weak Necessity’, I argue that generics—exception-granting generalizations such as ’Birds fly’ and ’Tigers are striped’—involve a covert weak necessity modal at logical form. I argue that this improves our understanding of the variability and diversity of generics. This chapter also argues that we can account for variability concerning normative generics within a modal approach to generics. In ’The Genericity of Moral Principles’, I provide evidence for the view that moral principles are generic generalizations, and, on the basis of this claim, argue that moral principles do not provide adequate support for reasoning about the moral statuses of particular cases. In ’Supererogation and the Structure of the Normative Domain’, I investigate the diversity of the central normative modal notions and argue that we should distinguish between two senses of supererogation based different ways deontic modals are sensitive to background information

Using Statistical Process Control to Monitor Anastomotic Leak

Background Surgery remains a cornerstone in the treatment of bowel diseases, such as those involving cancer or inflammation. In the majority of patients, a section of bowel is resected and the remaining bowel is re-joined surgically using sutures or staples (bowel anastomosis). However, in some cases this anastomosis can break down (Anastomotic Leak (AL)), causing significant complications for the patients including increased mortality, prolonged hospital stay and worse cancer outcomes. Despite the significance of this complication most hospitals do not prospectively measure their leak rate or engage in activities to reduce it. Another key postoperative outcome which can act as a surrogate marker of performance is Postoperative Length of Stay (PLoS) One way to address this is to promote the use quality improvement (QI) methodologies such as Statistical Process Control (SPC). This involves mapping the data points in time order and seeing if the process is stable between a set of upper and lower parameters (i.e. confidence intervals) and observing whether there has been a statistical change. Methods The aim of this study was to retrospectively map AL rates and PLoS using Statistical Process Control at Royal Devon and Exeter Foundation NHS Trust. This was to provide a baseline measurement as part of the first phase of a QI project as well as investigating the suitability for SPC chart analysis for monitoring postoperative outcomes. All patients undergoing colorectal resections with ileo-colonic, colo-colonic colorectal, colo-anal or ileo-anal anastomoses from 01//01/2010 to 30/04/2017 were included in this study. AL was defined as cases where there was subsequent return-to-theatre, radiological drainage or medical management of the AL. SPC charts were used to map AL rates to establish whether variation in the rate over time was due to “common-cause variation” or “special-cause variation.” The G-Chart, a type of SPC chart used to count the number of events between rare incidents was used to map AL. I-Charts were used to map median monthly Postoperative Length of Stay (PLoS). Results The AL rate is relatively low at this hospital with a return-to-theatre rate of 4.3% and an overall rate of 6.1% (once conservatively managed ALs and radiologically drained leaks were included). The overall median PLoS was 6 days. The SPC charts show that there is a reasonable chance of special cause variation for the Elective, Stapled and Right-sided AL charts, with some overlap with the former two categories. SPC charts for Sutured ALs and Left-sided ALs both only exhibited common cause variation. SPC charts for all six sub-groups monitoring PLoS indicated periods of special cause variation. Discussion In terms of the AL rate, 4.3% is a very acceptable return-to-theatre rate in line with other studies. The rate of 6.1% is difficult to interpret given that not all cases of medically managed ALs would have been identified. The overall median PLoS was also consistent with the literature. This is the first phase of a QI project to reduce rates of AL at Royal Devon and Exeter Foundation NHS Trust which can now take place prospectively and an intervention can be planned and implemented. Also, now that the methodology is in place, SPC charts can also be used to ensure patient safety over time, acting within a Quality Assurance context. Despite their ability to identify retrospective periods of SCV, the findings in SPC charts monitoring AL and PLoS will now need to be corroborated with the historial clinical context as SPC charts cannot identify which factors have caused the shift. In summary, this dissertation demonstrates that using SPC charts are a feasible methodology to retrospectively map AL and PLoS rates in a Colorectal Unit

Business Plan for Vending Machines installation in Indian Universities

Business Plan for installing Vending Machines in Universities and in Educational Sector

High functionality reversible arithmetic logic unit

Energy loss is a big challenge in digital logic design primarily due to impending end of Moore’s Law. Increase in power dissipation not only affects portability but also overall life span of a device. Many applications cannot afford this loss. Therefore, future computing will rely on reversible logic for implementation of power efficient and compact circuits. Arithmetic and logic unit (ALU) is a fundamental component of all processors and designing it with reversible logic is tedious. The various ALU designs using reversible logic gates exist in literature but operations performed by them are limited. The main aim of this paper is to propose a new design of reversible ALU and enhance number of operations in it. This paper critically analyzes proposed ALU with existing designs and demonstrates increase in functionality with 56% reduction in gates, 17 % reduction in garbage lines, 92 % reduction in ancillary lines and 53 % reduction in quantum cost. The proposed ALU design is coded in Verilog HDL, synthesized and simulated using EDA (Electronic Design Automation) tool-Xilinx ISE design suit 14.2. RCViewer+ tool has been used to validate quantum cost of proposed design

BIOLOGICAL EVALUATION, QSAR AND MOLECULAR MODELING STUDIES OF 2,4-DICHLOROBENZOIC ACID DERIVATIVES AS ANTIMICROBIAL AGENTS

Objective: The aim of this study was to evaluate 2,4-dichlorobenzoic acid derivatives as antimicrobial agents through in vitro, QSAR and molecular docking studies. Methods: The compounds were subjected to in vitro antimicrobial screening by test tube dilution method and the structural characteristics governing the antimicrobial potential were studied using QSAR methodology. These compounds were also screened for docking simulation to find out binding confirmation of reported compounds with PDB 1aj0 and 5fsa using AutoDock tools and discovery studio. Results: The antimicrobial evaluation data indicated that compounds 13 and 18 were found to be the most effective against all the bacterial strains and Aspergillus niger while compounds 1 and 14 exhibited more antifungal potential against Candida albicans. QSAR studies confirmed the role of molar refractivity and Balaban index (J) as controlling parameters for antimicrobial potential. Molecular modeling study revealed that compounds interact with the active site of PDB by hydrophobic, hydrogen bonding, and Van der Wall interactions. Conclusion: These test compounds were identified as potent candidates for the control of microbial strains tested, and structural relationship with activity may provide valuable information for further design and synthesis of compounds with antimicrobial potential

Digital monitoring for data-driven antimicrobial stewardship: a process perspective from resource-constrained contexts in India

Antimicrobial Resistance (AMR) is one of society’s most urgent global issues, requiring urgent multidisciplinary-based research and practice approaches to engage with these policies. Several global and national policy statements have been released in the last two decades, particularly emphasising the strengthening of the digital surveillance system. However, implementing these initiatives remains patchy, particularly in the context of public health systems in Low- and Middle-Income Countries. This paper argues that one of the significant reasons contributing to this sub-optimal uptake of these systems is that the top-down implementation models do not adequately cater to the needs, aspirations, and capacities of the health facility staff, who, ultimately, are the end users of the system. The paper highlights the importance of digital technology in healthcare facilities with resource constraints to promote the responsible use of antibiotics. It discusses the process of developing an evidence base for action in low- and middle-income countries (LMICs) through digitally mediated data-driven policy. This process is conceptualised as a three-phase process, which involves stabilising data entry, generating outcomes, and taking action at the local level. The paper argues the need for bottom-up implementation models, which emphasise the need to understand the practices users engage with in their everyday work and design the digital system to add value and not work to these everyday practices. The paper emphasises the importance of building local capacities to develop effective and sustainable antimicrobial stewardship (AMS) programs through enabling networking around digital solutions, creating value in networked partnerships, initiating conversations around data, and raising awareness of the digital to develop AMS programs

Routinizing practices and stabilizing institutional work: A case of digital monitoring of Antibiotic Resistance (ABR) in India

Antibiotic resistance (ABR) presents a widespread, complex threat to global health and achieving universal health coverage. A key global and national priority to address this challenge is by creating a digitally enabled evidence base to make visible this problem and strengthen policy and practice interventions. The invisibility of the ABR problem is particularly acute in low and middle-income settings, where digitization in this domain is in its infancy, and there is a high prevalence of infections and severe constraints of capacity and infrastructure. How can a digital ABR reporting system be introduced, routinized, and stabilized in such a context that the ABR challenge can be better managed, is the focus of this paper. The paper combines IS concepts from requirement analysis and implementation research together with concepts from institutional theory, to develop an analytical framework that makes the following contributions: i) how can new practices relating to a digital intervention be routinized into everyday work; ii) how can these routinized practices be translated into stabilized institutional work to ensure their sustainability over time; and iii) what is the work required to bridge the gaps between the formal institutions that accompany the new digital system and the informal constraints that are experienced in implementing them

Implementation and Analysis of Reversible logic Based Arithmetic Logic Unit

There is a tremendous growth in fabrication from small scale integration (SSI) to giant scale integration (GSI). It however raises a question of sustainability of Moore's law due to almost intolerable levels of power consumption. Researchers have invented a lot of methods to reduce power consumption and recent technologies are switching to reversible logic. Reversible logic has various applications in fields of computer graphics, optical information processing, quantum computing, DNA computing, ultra low power CMOS design and communication. Arithmetic Logic Unit (ALU) is considered to be the basic building block of a CPU in the computing environment and portability in computing system highly demands reversible logic based ALU. Modern processors usually have a word length of 32 or 64 bits. Divide and conquer approach principle cascades n number of 1 bit ALU to implement n bit ALU. Several researchers have proposed 1-bit ALU design using various reversible logic gates. This paper aims at categorizing various ways of implementation in VHDL using Xilinx ISE design suit 14.2 tool and comparative analysis of existing 1 bit ALU designs in terms of optimization metrics like power consumption, number of gates, number of constant inputs, number of garbage outputs and quantum cost. ALU realized using carry save adder block is found to be most optimum design in terms of gate count and quantum cost

Designing an Antibiotics Resistance (ABR) monitoring system to strengthen the evidence base for facilitating responsible antibiotics prescription by physicians: A case study from India

Antimicrobial resistance is described as a global health emergency, particularly affecting low and middle-income countries. A key strategy to engage with this challenge is effective monitoring to improve knowledge and support evidence-based interventions. However, LMICs lack the capacity, resources, infrastructure, and culture to implement digital interventions. To engage with this challenge, empirical work is carried out within the context of a public hospital in India to study the problem of antibiotics use followed by the design, implementation, and use of an AMR monitoring system and associated challenges in its digitization. An ADR approach is used to guide the design of the system to facilitate responsible antibiotic prescriptions by physicians. Three broad design principles are proposed which can help guide future implementation efforts for other contexts. This paper makes an important contribution to IS research of immense societal value, in informing how the potential of the digital can be effectively materialized

Generics and Weak Necessity

A prevailing thought is that generics have a covert modal operator at logical form. I claim that if this is right, the covert generic modality is a weak necessity modal. In this paper, I provide evidence for this claim and I sketch a theory. In particular, I will show that there are some important distributional parallels between generics and sentences with overt weak necessity modals: both sorts of sentences share behavior in nonmonotonic reasoning environments and also lack genuine epistemic readings. Acknowledging these parallels and the connection here is in the service of both our understanding of genericity and of weak necessity. Finally, I propose an understanding of generics as involving a covert weak necessity modal and argue that this is a promising path to pursue in relation to different issues related to the interpretation of generics.​PostprintPeer reviewe