A family of formulas with reversal of high avoidability index

We present an infinite family of formulas with reversal whose avoidability index is bounded between 4 and 5, and we show that several members of the family have avoidability index 5. This family is particularly interesting due to its size and the simple structure of its members. For each k ∈ {4,5}, there are several previously known avoidable formulas (without reversal) of avoidability index k, but they are small in number and they all have rather complex structure.http://dx.doi.org/10.1142/S021819671750024

Desert, Control, and Moral Responsibility

In this paper, I take it for granted both that there are two types of blameworthiness—accountability blameworthiness and attributability blameworthiness—and that avoidability is necessary only for the former. My task, then, is to explain why avoidability is necessary for accountability blameworthiness but not for attributability blameworthiness. I argue that what explains this is both the fact that these two types of blameworthiness make different sorts of reactive attitudes fitting and that only one of these two types of attitudes requires having been able to refrain from φ-ing in order for them to be fitting

Methodological analysis about the potential avoidability of motor vehicles colliding against pedestrians in urban areas

The main motivation of the authors of this article is to establish a rigorous definition of the potential capacity that a motor vehicle driver has to avoid a collision against a pedestrian. Henceforth we will call this capacity avoidability. To calculate the avoidability, it is necessary to analyze time, distance and itinerary, initial position of the pedestrian when exposed to the risk, initial speed; theoretical maximum speed developed by the vehicle and road limit speed; the driver’s reaction time and the influence of the environment; and the interrelation of the initial positions of vehicle and pedestrian with respect to the transversal axis of the road. The definition, categorized by variables, of a driver’s ability to avoid run over a pedestrian in an urban area has an evident usefulness: it allows knowing the influence of the initial speed of a vehicle as an isolated variable and the importance of the road limit speed in the ability to prevent an accident.Postprint (published version

Health Courts: An Alternative for Resolving Medical Liability Claims

Summarizes "'Health Courts' and Accountability for Patient Safety," a report describing a model for administrative compensation featuring health courts as an alternative to the tort system. Lists advantages, including broader eligibility and cost control

Inequality, avoidability, and healthcare

This review article of Shlomi Segall's Health, Luck, and Justice (Princeton University Press, 2010) addresses three issues: first, Segall’s claim that luck egalitarianism, properly construed, does not object to brute luck equality; second, Segall’s claim that brute luck is properly construed as the outcome of actions that it would have been unreasonable to expect the agent to avoid; and third, Segall’s account of healthcare and criticism of rival views. On the first two issues, a more conventional form of luck egalitarianism – that is, one which objects to brute luck even if it creates equality, and which construes brute luck as the inverse of agent responsibility – is defended. On the third issue, strengths and weaknesses in Segall’s criticism of Rawlsian, democratic egalitarian, and all-luck egalitarian approaches to healthcare, and in his own luck egalitarian approach, are identified

ADRIC: Adverse Drug Reactions In Children - a programme of research using mixed methods

Aims To comprehensively investigate the incidence, nature and risk factors of adverse drug reactions (ADRs) in a hospital-based population of children, with rigorous assessment of causality, severity and avoidability, and to assess the consequent impact on children and families. We aimed to improve the assessment of ADRs by development of new tools to assess causality and avoidability, and to minimise the impact on families by developing better strategies for communication. Review methods Two prospective observational studies, each over 1 year, were conducted to assess ADRs in children associated with admission to hospital, and those occurring in children who were in hospital for longer than 48 hours. We conducted a comprehensive systematic review of ADRs in children. We used the findings from these studies to develop and validate tools to assess causality and avoidability of ADRs, and conducted interviews with parents and children who had experienced ADRs, using these findings to develop a leaflet for parents to inform a communication strategy about ADRs. Results The estimated incidence of ADRs detected in children on admission to hospital was 2.9% [95% confidence interval (CI) 2.5% to 3.3%]. Of the reactions, 22.1% (95% CI 17% to 28%) were either definitely or possibly avoidable. Prescriptions originating in the community accounted for 44 out of 249 (17.7%) of ADRs, the remainder originating from hospital. A total of 120 out of 249 (48.2%) reactions resulted from treatment for malignancies. Off-label and/or unlicensed (OLUL) medicines were more likely to be implicated in an ADR than authorised medicines [relative risk (RR) 1.67, 95% CI 1.38 to 2.02; p  48 hours, the overall incidence of definite and probable ADRs based on all admissions was 15.9% (95% CI 15.0 to 16.8). Opiate analgesic drugs and drugs used in general anaesthesia (GA) accounted for > 50% of all drugs implicated in ADRs. The odds ratio of an OLUL drug being implicated in an ADR compared with an authorised drug was 2.25 (95% CI 1.95 to 2.59; p < 0.001). Risk factors identified were exposure to a GA, age, oncology treatment and number of medicines. The systematic review estimated that the incidence rates for ADRs causing hospital admission ranged from 0.4% to 10.3% of all children [pooled estimate of 2.9% (95% CI 2.6% to 3.1%)] and from 0.6% to 16.8% of all children exposed to a drug during hospital stay. New tools to assess causality and avoidability of ADRs have been developed and validated. Many parents described being dissatisfied with clinician communication about ADRs, whereas parents of children with cancer emphasised confidence in clinician management of ADRs and the way clinicians communicated about medicines. The accounts of children and young people largely reflected parents’ accounts. Clinicians described using all of the features of communication that parents wanted to see, but made active decisions about when and what to communicate to families about suspected ADRs, which meant that communication may not always match families’ needs and expectations. We developed a leaflet to assist clinicians in communicating ADRs to parents. Conclusion The Adverse Drug Reactions In Children (ADRIC) programme has provided the most comprehensive assessment, to date, of the size and nature of ADRs in children presenting to, and cared for in, hospital, and the outputs that have resulted will improve the management and understanding of ADRs in children and adults within the NHS. Recommendations for future research: assess the values that parents and children place on the use of different medicines and the risks that they will find acceptable within these contexts; focusing on high-risk drugs identified in ADRIC, determine the optimum drug dose for children through the development of a gold standard practice for the extrapolation of adult drug doses, alongside targeted pharmacokinetic/pharmacodynamic studies; assess the research and clinical applications of the Liverpool Causality Assessment Tool and the Liverpool Avoidability Assessment Tool; evaluate, in more detail, morbidities associated with anaesthesia and surgery in children, including follow-up in the community and in the home setting and an assessment of the most appropriate treatment regimens to prevent pain, vomiting and other postoperative complications; further evaluate strategies for communication with families, children and young people about ADRs; and quantify ADRs in other settings, for example critical care and neonatology

Administrative Compensation for Medical Injuries: Lessons From Three Foreign Systems

Examines "no-fault" systems in New Zealand, Sweden, and Denmark, in which patients injured by medical negligence can file for compensation through governmental or private adjudicating organizations. Considers lessons for U.S. medical malpractice reform