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To reduce both inappropriate testing for and diagnosis of healthcare-onset (HO) Clostridioides difficile infections (CDIs).
We performed a retrospective analysis of C. difficile testing from hospitalized children before (October 2017–October 2018) and after (November 2018–October 2020) implementing restrictive computerized provider order entry (CPOE).
Study sites included hospital A (a ∼250-bed freestanding children’s hospital) and hospital B (a ∼100-bed children’s hospital within a larger hospital) that are part of the same multicampus institution.
In October 2018, we implemented CPOE. No testing was allowed for infants aged ≤12 months, approval of the infectious disease team was required to test children aged 13–23 months, and pathology residents’ approval was required to test all patients aged ≥24 months with recent laxative, stool softener, or enema use. Interrupted time series analysis and Mann-Whitney U test were used for analysis.
An interrupted time series analysis revealed that from October 2017 to October 2020, the numbers of tests ordered and samples sent significantly decreased in all age groups (P < .05). The monthly median number of HO-CDI cases significantly decreased after implementation of the restrictive CPOE in children aged 13–23 months (P < .001) and all ages combined (P = .003).
Restrictive CPOE for CDI in pediatrics was successfully implemented and sustained. Diagnostic stewardship for CDI is likely cost-saving and could decrease misdiagnosis, unnecessary antibiotic therapy, and overestimation of HO-CDI rates.
There is a need for a paradigm shift across mental health in primary care to improve the lives of millions of Europeans. To contribute to this paradigm shift, the European Forum for Primary Care (EFPC-MH) working group for Mental Health, produced a Position Paper for Primary Care Mental Health outlining 14 themes that needed prioritizing. These themes were developed and discussed interactively during the EFPC conferences between 2012 and 2019. The Position Paper on Mental Health gives direction to the necessary improvements over the next ten years. The themes vary from preferable healthcare model to the social determinants highlighting issues such as inequalities. The Statement of Mental Health in Primary Care will be established in cooperation with fellow organizations.
Characterizing non-lethal damage within dry seeds may allow us to detect early signs of ageing and accurately predict longevity. We compared RNA degradation and viability loss in seeds exposed to stressful conditions to quantify relationships between degradation rates and stress intensity or duration. We subjected recently harvested (‘fresh’) ‘Williams 82’ soya bean seeds to moisture, temperature and oxidative stresses, and measured time to 50% viability (P50) and rate of RNA degradation, the former using standard germination assays and the latter using RNA Integrity Number (RIN). RIN values from fresh seeds were also compared with those from accessions of the same cultivar harvested in the 1980s and 1990s and stored in the refrigerator (5°C), freezer (−18°C) or in vapour above liquid nitrogen (−176°C). Rates of viability loss (P50−1) and RNA degradation (RIN⋅d−1) were highly correlated in soya bean seeds that were exposed to a broad range of temperatures [holding relative humidity (RH) constant at about 30%]. However, the correlation weakened when fresh seeds were maintained at high RH (holding temperature constant at 35°C) or exposed to oxidizing agents. Both P50−1 and RIN⋅d−1 parameters exhibited breaks in Arrhenius behaviour near 50°C, suggesting that constrained molecular mobility regulates degradation kinetics of dry systems. We conclude that the kinetics of ageing reactions at RH near 30% can be simulated by temperatures up to 50°C and that RNA degradation can indicate ageing prior to and independent of seed death.
Pediatric long-term care facilities were surveyed to assess infection control and antimicrobial stewardship practices. Policies mandated by the Centers of Medicare and Medicaid Services (CMS) were included. Only 40% of sites reported implementing >90% of surveyed CMS policies. The survey also identified several gaps in non–CMS-mandated policies.
In this brief report, computed tomography perfusion (CTP) thresholds predicting follow-up infarction in patients presenting <3 hours from stroke onset and achieving ultra-early reperfusion (<45 minutes from CTP) are reported. CTP thresholds that predict follow-up infarction vary based on time to reperfusion: Tmax >20 to 23 seconds and cerebral blood flow <5 to 7 ml/min−1/(100 g)−1 or relative cerebral blood flow <0.14 to 0.20 optimally predicted the final infarct. These thresholds are stricter than published thresholds.
It is a commonplace observation that Adam Ferguson's social and political thought seems troubled by many conflicts. It has even been suggested that his body of work lacks system. Certainly, his corpus is diverse and complex, replete with ambivalence, tension and even paradox. This essay seeks to build a picture of Ferguson's conception of the good polity and to explore the tensions that lie within it. Despite some puzzling exceptions, these tensions are, in fact, reconcilable once they are understood in relation to his social science, his historiography and his attempts to forge a new approach to politics that could be described as ‘liberal-Stoicism’. The discussion begins by canvassing some of the complications and underlying assumptions of Ferguson's political thought.
The Background to Ferguson's Political Thought
Ferguson makes for demanding reading partly because of his somewhat disorderly style of writing and partly because of his ambivalent attitude to many political issues. It is not so much that his thought lacks system as it is that the system that exists must be carefully culled by the reader. Yet, Ferguson leaves no doubt that politics is important, not only because it is highly consequential, but because humans are other-regarding creatures of action and conflict and politics is the ideal forum for the exercise of this special nature. Ferguson agrees with Aristotle that it is language that makes us both fit and destined for life in a polity. Since humankind alone is capable of speech it is the only species destined for political life.
Ferguson's turn of mind is, in many ways, moralistic and romantic, yet his politics seems to have been shaped and constrained by a strong desire to be practical and grounded. Normative moralizing has its place but one should not moralize simply to defend an abstract principle; after all, the point of all systems and institutions is to make people happy.
Simply put, compulsory voting exists where the state imposes a legal requirement to vote. The idea of being compelled to vote is anathema to many who live in Western democracies because it seems to run counter to both democratic and liberal values. But even though I agree that, in principle, voluntary political participation is preferable to obligatory participation, I argue in the following chapters that requiring people to vote can be reconciled with both liberal and democratic values.
In defending compulsory voting, I write as a normative political theorist, but I also approach the issue as a political scientist who is wary of normative arguments about elections and voting that do not engage with the empirical world. These kinds of arguments tend, either consciously or unconsciously, to embody assumptions about that world that, in turn, justify real-world laws and practice. Therefore, my argument is informed, where possible, by the empirical data and actual trends in electoral and political behavior. But, in the end, it is a normative argument written from a political-theory perspective.
Much has been written and said about compulsory voting, but quite a lot of it is controvertible. For this reason, the following set of arguments tends to be structured in response to criticism of compulsory voting and the high and socially even turnout it is able to deliver.
Before moving on to my general conclusion, I offer first a broad summary of the various steps and components of the rather dense argument I have given in the preceding chapters.
Compulsory voting is the only really reliable and decisive means by which to raise turnout.
Elections and the way they operate are important because voting is the agreed procedure for legitimizing governments.
High turnout is preferable to low turnout because low-turnout elections are less legitimate. Low-turnout elections are less legitimate because they are less procedurally legitimate: they only give a partial and biased picture of the priorities of the electorate. This makes the governments of low-turnout election less substantively legitimate because government attention is directed only to those sections of the population who vote. Because such people also happen to be better off than nonvoters, this exacerbates political inequality and results in unrepresentative government. Universal, socially even voting confers legitimacy on both the electoral process and the government that wins office.
There is no such thing as a right not to vote. The right to vote is fundamental: it is protective of all other rights, and its existence defines the very structure of representative democracy. It cannot, therefore, be legally waived, and any state’s refusal to allow citizens to waive it is justified.
Voting is not a privilege right: it is a claim-power-right. Further, it is not just a (claim-power) right: it is also a duty. Voting is a duty-right. Voting is a duty we owe to other voters so that (a) together we can constitute and perpetuate representative democracy so that (b) we can meet other classes of voters on equal terms for the purposes of self-protection and self-government.
Voting is not just any duty; it is a special duty because the existence and proper functioning of representative democracy depend on its performance. So too do our welfare and rights. When democracy functions well, rights are more secure.
Compulsory voting seems illiberal because it violates one conception of liberty: negative liberty. But, because it enhances other conceptions of liberty such as nondomination, autonomy, and positive liberty, it can be reconciled with liberal values.
The main argument against compulsory voting is the sheer weakness of the arguments for it. Over the past three chapters, we examined many attempts to justify compulsory voting. Some of these arguments were incoherent or self-contradictory. Others relied on questionable or discredited empirical speculations. Others relied on false or implausible normative premises. Even if we ignored these serious flaws, none of these arguments could then explain why a voting lottery would not be superior to compulsory voting. All the arguments were defective. The best of the arguments gave us little reason to support compulsory voting. Most of the arguments gave us no reason to support it at all.
At this point, we must conclude compulsory voting is unjust. Governments may not impose compulsory voting on their citizens, even if the overwhelming majority of citizens enthusiastically support compulsory voting. Australia, Belgium, and other countries must repeal their compulsory-voting laws immediately.
In this chapter, I stop refuting arguments for compulsory voting and instead produce an independent argument against it. In a sense, previous chapters argued that compulsory voting is bad because it is not good. This chapter argues compulsory voting is bad because it is bad. Remember, however, that the other side bears the burden of proof. Strictly speaking, to undermine compulsory voting, I do not need my argument in this chapter to succeed. The arguments of the other three chapters suffice.
In Chapter 2, I examined arguments that claimed compulsory voting is justified because it would produce good consequences. None of these arguments was sound. So far the case for compulsory voting isn’t just weak – it’s practically nonexistent.
In this chapter, I focus instead on deontological arguments for compulsory voting. Some of these arguments try to establish that, for one reason or another, citizens have a duty to vote. The arguments then try to show that this justifies government in making them vote. Others argue that compulsory voting would in some way make citizens more autonomous or more efficacious. I argue none of these arguments succeeds in justifying compulsory voting.
Not All Moral Duties Are Enforceable
For the sake of argument, suppose citizens have a moral duty to vote. (Some people prefer to say we have a civic duty to vote, but that doesn’t change anything. It just specifies what kind of moral duty the duty to vote is supposed to be.) Now spot the flaw in the following argument:
The Duty-to-Vote Argument
Citizens have a moral duty to vote.
If citizens have a moral duty to do something, then government may force them to do it.
Therefore, government may force citizens to vote (i.e., compulsory voting is justified).
Democracy is rule by the people. But what if the people refuse to rule? Many people worry if we do not have government by the people, then we will not have government for the people – at least not for all of them.
During presidential elections in the late nineteenth century, 70–80 percent of eligible Americans voted. For whatever reason, in the twentieth century, participation rates seem to have dropped to 50–60 percent. Midterm national, state, and local elections averaged a mere 40 percent.
A U.S. president has never been elected by a majority of eligible voters. In the 1964 election, 61.05 percent of voters cast their ballots for Lyndon Johnson – the largest majority any president has ever enjoyed. Yet, at the same time, because turnout was so low, Johnson was in fact elected by less than 38 percent of all voting-eligible Americans. We call Reagan’s 1984 victory a “landslide,” but less than a third of voting-age Americans actually voted for him. Less than a quarter of eligible Americans voted to reelect Bill Clinton in 1996. In all elections, a minority of the voting-eligible population imposes a president on the majority.