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An Epistemologica l and Didactic Study of a Specific Calculus Reasoning Rule: Educational Studies in Mathematics, Vol. 60, No. 2. (October 2005), pp. 149-172.It is widely attested that university students face considerable difficulties with reasoning in analysis, especially when dealing with statements involving two different quantifiers. We focus in this paper on a specific mistake which appears in proofs where one applies twice or more a statement of the kind ?for all X, there exists Y such that R(X, Y)?, and forgets that in that case, a priori, ?Y depends on X?. We analyse this mistake from both a logical and mathematical point of view, and study it through two inquiries, an historical one and a didactic one. We show that mathematics teachers emphasise the importance of the dependence rule in order to avoid this kind of mistake, while natural deduction in predicate calculus provides a logical framework to analyse and control the use of quantifiers. We show that the relevance of this dependence rule depends heavily on the context: nearly without interest in geometry, but fundamental in analysis or linear algebra. As a consequence, mathematical knowledge is a key to correct reasoning, so that there is a large distance between beginners' and experts' abilities regarding control of validity, that, to be shortened, probably requires more than a syntactic rule or informal advice. Les difficultés de manipulation, par les étudiants, des énoncés contenant deux quantificateur s différents, rencontrés dans de nombreux raisonnements en analyse, sont bien attestées. Nous nous intéressons plus spécialement dans cet article ŕ une erreur qui apparaît dans certaines preuves lorsque l'on applique deux fois ou plus un énoncé de la forme ?pour tout X, il existe Y tel que R(X,Y)? et que l'on oublie que dans un tel cas, a priori, ?Y dépend de X?. Nous analysons cette erreur d'un point de vue logique et d'un point de vue mathématique, puis nous l'étudions ŕ travers deux enquętes, l'une historique et l'autre didactique. Nous montrons que les professeurs de mathématiques soulignent l'importance de la rčgle de dépendance pour éviter ce type d'erreur, tandis que la déduction naturelle dans le calcul des prédicats fournit un cadre de référence logique pour analyser et contrôler l'usage des quantificateur s. Nous montrons que la pertinence de la rčgle de dépendance dépend fortement du contexte: pratiquement sans intéręt en géométrie, elle est tout ŕ fait fondamentale en analyse et en algčbre linéaire. De ce fait, les connaissances mathématiques sont la clé d'un raisonnement correct, si bien qu'il y a une grande distance entre le débutant et l'expert concernant le contrôle de la validité, que quelques rčgles syntaxiques ou quelques conseils informels ne permettent vraisemblablem ent pas de réduire.Vivian e Durand-Guerrie r, Gilbert Arsac

Source: Educational Studies in Mathematics, Vol. 60, No. 2. (October 2005), pp. 149-172.
Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention-- a randomised controlled trial.: Age Ageing, Vol. 34, No. 2. (March 2005), pp. 162-168.OBJECT IVES: To determine the effectiveness of multifactorial intervention to prevent falls in cognitively intact older persons with recurrent falls. DESIGN: Randomised controlled trial of multifactorial (medical, physiotherapy and occupational therapy) post-fall assessment and intervention compared with conventional care. SETTING: Accident & Emergency departments in a university teaching hospital and associated district general hospital. SUBJECTS: 313 cognitively intact men and women aged over 65 years presenting to Accident & Emergency with a fall or fall-related injury and at least one additional fall in the preceding year; 159 randomised to assessment and intervention and 154 to conventional care. Outcome measures: primary outcome was the number of falls and fallers in 1 year after recruitment. Secondary outcomes included injury rates, fall-related hospital admissions, mortality and fear of falling. RESULTS: There were 36% fewer falls in the intervention group (relative risk 0.64, 95% confidence interval 0.46-0.90). The proportion of subjects continuing to fall (65% (94/144) compared with 68% (102/149) relative risk 0.95, 95% confidence interval 0.81-1.12), and the number of fall-related attendances and hospital admissions was not different between groups. Duration of hospital admission was reduced (mean difference admission duration 3.6 days, 95% confidence interval 0.1-7.6) and falls efficacy was better in the intervention group (mean difference in Activities Specific Balance Confidence Score of 7.5, 95% confidence interval 0.72-14.2). CONCLUSION: Multifactorial intervention is effective at reducing the fall burden in cognitively intact older persons with recurrent falls attending Accident & Emergency, but does not reduce the proportion of subjects still falling.J Davison, J Bond, P Dawson, IN Steen, RA Kenny

Source: Age Ageing, Vol. 34, No. 2. (March 2005), pp. 162-168.
Artificial evil and the foundation of computer ethics: Ethics and Information Technology, Vol. 3, No. 1. (1 March 2001), pp. 55-66.Moral reasoning traditionally distinguishes two types of evil:moral (ME) and natural (NE). The standard view is that ME is theproduct of human agency and so includes phenomena such as war,torture and psychological cruelty; that NE is the product ofnonhuman agency, and so includes natural disasters such asearthquakes, floods, disease and famine; and finally, that morecomplex cases are appropriately analysed as a combination of MEand NE. Recently, as a result of developments in autonomousagen ts in cyberspace, a new class of interesting and importantexamp les of hybrid evil has come to light. In this paper, it iscalled artificial evil (AE) and a case is made for considering itto complement ME and NE to produce a more adequate taxonomy. Byisolating the features that have led to the appearance of AE,cyberspace is characterised as a self-contained environment thatforms the essential component in any foundation of the emergingfield of Computer Ethics (CE). It is argued that this goes someway towards providing a methodological explanation of whycyberspace is central to so many of CE's concerns; and it isshown how notions of good and evil can be formulated incyberspace. Of considerable interest is how the propensity for anagent's action to be morally good or evil can be determined evenin the absence of biologically sentient participants and thusallows artificial agents not only to perpetrate evil (and forthat matter good) but conversely to `receive' or `suffer from'it. The thesis defended is that the notion of entropy structure,whic h encapsulates human value judgement concerning cyberspace ina formal mathematical definition, is sufficient to achieve thispurpose and, moreover, that the concept of AE can be determinedform ally, by mathematical methods. A consequence of this approachis that the debate on whether CE should be considered unique, andhence developed as a Macroethics, may be viewed, constructively ,in an alternative manner. The case is made that whilst CE issuesare not uncontroversia lly unique, they are sufficiently novel torender inadequate the approach of standard Macroethics such asUtilitariani sm and Deontologism and hence to prompt the searchfor a robust ethical theory that can deal with them successfully.T he name Information Ethics (IE) is proposed for that theory. Itis argued that the uniqueness of IE is justified by its beingnon-biolo gically biased and patient-orient ed: IE is anEnvironmenta l Macroethics based on the concept of data entityrather than life. It follows that the novelty of CE issues suchas AE can be appreciated properly because IE provides a newperspective (though not vice versa). In light of the discussionprov ided in this paper, it is concluded that Computer Ethics isworthy of independent study because it requires its ownapplication -specific knowledge and is capable of supporting amethodologica l foundation, Information Ethics.Luciano Floridi, JW Sanders

Source: Ethics and Information Technology, Vol. 3, No. 1. (1 March 2001), pp. 55-66.
The psychological burden of injury: an 18 month prospective cohort study: Emerg Med J, Vol. 19, No. 5. (1 September 2002), pp. 400-404.Object ives: To determine the prevalence of post-trauma psychological problems among a cohort of male accident and emergency department patients admitted to hospital. To identify the changes in their psychological symptoms over an 18 month follow up period. Methods: A prospective cohort study of male accident and emergency department patients who were admitted for treatment of an injury. Baseline interview recorded demographic details and accident details. Standardised questionnaires measured baseline psychological state and personality type. Follow up at six weeks, six months, and 18 months after injury was by face to face interview or postal questionnaire and recorded progress since injury, and documented psychological status through the use of standardised questionnaires to detect psychiatric disorder and symptoms of post-traumatic stress disorder (PTSD). Results: 210 male patients were recruited into the study. Psychiatric disorder was identified in 47.6% of responders at six weeks, and 43.4% at six months after injury. This improved significantly at 18 months. PTSD symptoms were moderate in 25%-30% and severe in 5%-14% and did not change significantly over the study period. A significant relation was found between previous psychiatric history and psychological symptoms at 18 months after injury. No relation was identified between injury severity and psychological status after injury. Conclusion: This study finds a high prevalence of psychological distress in male accident and emergency department patients after injury. Although some symptoms resolve over the follow up period, a proportion remain and may be related to previous psychiatric history. There was no relation identified between severity of injury and psychological morbidity.S Mason, J Wardrope, G Turpin, A Rowlands

Source: Emerg Med J, Vol. 19, No. 5. (1 September 2002), pp. 400-404.
Accident and emergency attendances by children under the age of 1 year as a result of injury: Emerg Med J, Vol. 20, No. 1. (1 January 2003), pp. 21-24.Objectiv es: To examine all accident and emergency (A&E) department attendances by children under the age of 1 year over a period of 12 months. Also to try to identify the prevalence and severity of accident types in small children and to suggest ways to reduce such accidents. Methods: The A&E department of the Royal Aberdeen Children's Hospital (RACH) serves a population of over half a million. All children under 1 year of age attending this department in the year 2000 had their case notes reviewed by the author and the cause, type, and severity of the illness or injury noted. Results: During the 12 month audit period 1416 new cases under the age of 1 year presented to RACH, 790 of which presented directly to A&E. Six hundred and eighteen (78%) were self referred and 116 children attended A&E on more than one occasion during the year. Four hundred and thirty four (55%) of the A&E attendances were classed as "accidents", the remainder were mainly for medical conditions such as respiratory distress. Two hundred and sixty four (61%) were caused by falls and 38% were admitted for inpatient management. Two hundred and twenty nine (29%) required radiographs, which revealed 30 fractures. Thirty seven children sustained scalds/burns and there were 33 accidental ingestions. Six cases were judged to be non-accidental . Conclusions: There is a surprisingly high rate of "accidental" injury in this age group, bringing into question the effectiveness of current accident prevention strategies. Perhaps specific prevention advice should be targeted at parents and carers of young children. There should always be a high index of suspicion for non-accidental injury.DM Macgregor

Source: Emerg Med J, Vol. 20, No. 1. (1 January 2003), pp. 21-24.
Accident and emergency department access to the child protection register: a questionnaire survey: Emerg Med J, Vol. 19, No. 2. (1 March 2002), pp. 136-137.Object ives: To ascertain how UK accident and emergency (A&E) departments access the child protection register, their levels of satisfaction with that access and their criteria for checking the register. Methods: A postal questionnaire was sent to 254 "major" A&E departments listed in the 1996 British Association for Accident and Emergency Medicine directory. Results: 190 questionnaires were returned (response rate 75%). Ninety (48%) responding departments access the register through the duty social worker, 33 (17%) use a computerised copy, 32 (17%) a hard copy and 27 (14%) a combination. Twenty seven of 33 respondents (82%) using a computerised copy were satisfied with their mode of access. This compares with figures of 21 (66%) for hard copy, 45 (50%) for duty social worker and 14 (50%) for a combination. No departments using the duty social worker checked all patients routinely compared with 23 (72%) for hard copy, 22 (67%) for computer copy and 12 (44%) for departments using a combination of modes of access. Conclusion: There is no uniformity of the way in which UK A&E departments access the child protection register and there is also substantial variation in the criteria used to check the register. This survey suggests that the most common form of access (via the duty social worker) often fails to meet the needs of A&E departments, principally because it takes so long.G Quin, R Evans

Source: Emerg Med J, Vol. 19, No. 2. (1 March 2002), pp. 136-137.
Presentation to accident and emergency with crying or screaming and likelihood of child protection registration: Emerg Med J, Vol. 19, No. 1. (1 January 2002), pp. 17-18.Objectiv es: To determine whether children aged less than 2 years who present to accident and emergency (A&E) with crying or screaming as the only complaint, are more likely to be placed on the child protection register in later years than children who do not attend with crying or screaming alone. Methods: The Sheffield Children's Hospital A&E database was examined for five years from 1 January 1992. Children who presented at triage with crying or screaming as their sole complaint were identified. Controls were taken from children who presented with any other complaint. Matches were made for sex, postcode and date of birth. All names were checked against against files that contained dates of past or present child protection registration. In January 2000, the children's age ranged from 3 to 10 years. The mean follow up period was six years (SD one year seven months). Results: From 1 January 1992 until 31 December 1996, 450 children made 462 attendances to A&E with crying or screaming as their only complaint. Of these, 12 had been placed on the child protection register. Ten of the 450 control children had been registered. The odds ratio of subsequent child protection registration if a child presents in Sheffield with crying or screaming alone is 1.21 (95% confidence intervals 0.52 to 2.82) Conclusions: Presentation of young children who cry or scream for no clear reason is relatively common. Although child protection registration is not the same as abuse, it is the closest surrogate marker we have. This study shows there is no evidence of increased likelihood of child protection registration for children who present with crying or screaming alone and prejudices against parents of these children, if held, are inappropriate. AK Fletcher, DP Burke

Source: Emerg Med J, Vol. 19, No. 1. (1 January 2002), pp. 17-18.
Head injuries in infants: the risks of bouncy chairs and car seats: Arch Dis Child, Vol. 86, No. 3. (1 March 2002), pp. 168-169.Aims: To establish whether the incorrect use of bouncy chairs (BC) and car seats (CS) is a significant cause of injuries in babies. Methods: Prospective study over a 12 month period. All babies under the age of 1 year, presenting to the department with a head injury were eligible. Results: A total of 131 cases were recorded, 17 (13%) of which were associated with either BC or CS, the second largest aetiological group. All BC cases (11/11, 100%) were caused by a fall from a surface with the baby in the chair. In the CS group, 2/6 (33%) were caused by such a fall. The carer was aware in only one of the 13 cases involving a fall from a surface that there was any chance of injury from this mechanism. Conclusion: Falls from inappropriatel y placed bouncy chairs or car seats form a significant proportion of head injuries in infants, resulting in unnecessary and preventable morbidity.T Wickham, E Abrahamson

Source: Arch Dis Child, Vol. 86, No. 3. (1 March 2002), pp. 168-169.
National audit of emergency department child protection procedures: Emerg Med J, Vol. 20, No. 3. (1 May 2003), pp. 222-224.Object ive: To assess the compliance with national guidelines on child protection procedures and provision of paediatric services in major English emergency departments. Background: Victims of child abuse may present to emergency departments, and successful detection and management depends on adequate child protection procedures being in place. Two official documents published in 1999 provide recommendation s for child protection procedures and staffing arrangements in emergency departments, and these can be used as standards for audit. Methods: Structured telephone questionnaire survey of English emergency departments receiving at least 18 000 child attenders per year. Results: Many of the standards are being met. Areas for improvement include: better access to child protection registers with clearer indications for their use; improved communication with other professionals such as the school nurse; more formal training for medical and nursing staff in the identification of potential indicators of child abuse; and improved awareness of local named professionals with expertise in child protection. More consultants with training in paediatric emergency medicine and more registered children's nurses are needed. Conclusion: Many nationally agreed recommendation s are being met, but there is a need for improved training, increased numbers of specialised staff, and improved communication between professionals. There is considerable variation in practice between departments.W King, C Reid

Source: Emerg Med J, Vol. 20, No. 3. (1 May 2003), pp. 222-224.
Incidence and prevalence of domestic violence in a UK emergency department: Emerg Med J, Vol. 20, No. 5. (1 September 2003), pp. 438-442.Backgr ound: American and Australian studies indicate that domestic violence is common among patients attending for emergency care. It is not clear whether this applies to patients attending emergency departments in the UK. Methods: A single centre cross sectional study. Adult patients attending the emergency department of Addenbrooke's Hospital, Cambridge were interviewed in randomly allocated time blocks, using validated questions from a US study. Potential participants were excluded if they (1) were unwilling (2) had an altered mental status (3) had a companion who refused to leave (4) were too ill (5) were unable to speak English (6) personal contacts of the interviewer. Results and Conclusions: 256 completed interviews were returned out of a possible 307 (84.8%). The incidence of domestic violence was 1.2% (95% CI 0.2% to 3.4%). The lifetime prevalence of domestic violence was 22.4% (95% CI 15.6% to 30.4%) among men and 22.1% (95% CI 15.1% to 30.5%) among women. The incidence and prevalence rates of domestic violence were considerably lower than in the US study, but similar to prevalence rates recorded in British community surveys. A significant association was found between reported domestic violence and reported deliberate self harm in women (odds ratio 75.4 95% CI 13.1% to 433.7). There was no significant association between higher use of medical care and domestic violence. Interpretation : Domestic violence is common among patients attending for emergency care in the UK. There is a significant association between domestic violence and deliberate self harm in women, further work is required to see if this association is causal. Larger emergency department surveys are required to confirm these results.A Boyle, C Todd

Source: Emerg Med J, Vol. 20, No. 5. (1 September 2003), pp. 438-442.

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