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AI is revolutionising decision-making, but it can't replace human leaders
No full textAI is enhancing human decision-making, driving better outcomes and operational efficiency across the board. José Miguel Diez Valle and Nikita discuss the power of AI to improve business outcomes and its limitations for complex decision-making in which context and human insight are indispensable
Social care costs of depressive symptoms in the English older population: then role of housing quality improvements
No full textBackground and Objectives: Poor housing conditions pose a substantial threat to older people’s mental health and create inequalities in social care needs. However, their economic consequences for the social care sector have not been thoroughly investigated. This study projects the costs of social care for community-dwelling older people with depressive symptoms under different housing intervention scenarios in England. Research Design and Methods: Drawing on data collected from 10,601 individuals (33,461 observations across 4 waves) participating in the English Longitudinal Study of Ageing, we combined a Markov model with a Macrosimulation model to make projections of social care costs. Multinomial logistic regression and linear regression analyses were conducted to derive the parameters for the 2 simulation models. Results: We estimate that the costs of unpaid care for older people with depressive symptoms will rise from £33.6 billion in 2022 to £59.9 billion in 2042, and the costs of formal home care will rise from £4.2 billion in 2022 to £8.1 billion in 2042 in the base case scenario of no interventions to improve housing quality. In a scenario where the number of housing problems is reduced to zero, the costs of unpaid care and formal home care in 2042 are projected to rise to be £3.5 billion lower and £0.3 billion lower, respectively, than the no intervention scenario. Discussion and Implications: Housing improvements reduce social care demand in the older population by delaying and reversing the progression of depressive symptoms, which has the dual benefits of elevating personal well-being and generating long-term cost savings in the social care sector
Judge Dread: court severity, repossession risk and demand in mortgage and housing markets
No full textWe study the impact of borrower protection on mortgage and housing demand using variation in the likelihood that houses are repossessed coming from heterogeneity in preferences of local judges. We develop a framework that provides conditions to identify the impact of repossession risk on housing and credit demand, holding supply fixed. Empirically, we exploit exogenous variation in risk created by boundaries of court catchment areas. We find that a one-standard-deviation decrease in borrower protection decreases borrowing and house prices by 4.5%
The struggles of labour mobilisation in Lebanon and Iraq
No full textThis paper offers an analysis of contemporary Lebanese and Iraqi labour movements, aiming to explain their hitherto modest role as oppositional forces, and discuss their future potentials. Adopting a wide understanding of labour movements as encompassing both trade unions and professional syndicates, the paper traces the battle between ruling sectarian elites and opposition actors who seek to reduce elite dominance over organised labour. Instead, these movements promote class- or labour-based communities that transcend sect divisions. Drawing on data from interviews with Lebanese and Iraqi activists and members of the labour movement, as well as secondary sources, the paper uncovers differences in the strategies elites have used to thwart oppositional agency within these two types of organisations and across contexts. Moreover, it analyses how opposition groups in turn have sought to exploit narrow opportunities to exercise resistance. Finally, it reflects on the potential for strengthening these movements and explores the trade-offs between different opposition strategies
Fitting a square peg in a round hole? A mixed-methods study on research ethics and collaborative health and social care research involving ‘vulnerable’ groups
No full textBackground: Current research ethics frameworks that oversee health and social care research, in the United Kingdom and internationally, originated in biomedical research, having positivist underpinnings and an orientation towards experimental research. Limitations of these frameworks have been extensively documented including with regard to health and social care research that adopts collaborative approaches. This article contributes to debates about how the research ethics system deals with collaborative research with groups labelled or potentially perceived as vulnerable, and identifies practical recommendations to ensure a better fit between principles and practices of research ethics and those of collaborative research. Methods: We conducted a two-round online Delphi study with 35 academic researchers with experience of collaborative research involving vulnerable groups and of seeking research ethics approval in England (United Kingdom), followed by a focus group with eight members of the Delphi panel. The Delphi questionnaire, organised in 12 themes, comprised 66 statements about how researchers experience research ethics review and how the research ethics system could be improved. The focus group discussed the results of the Delphi study to generate practical recommendations. Results: By the end of the second Delphi round, only one statement relating to the experience of the current research ethics system reached consensus, signalling heterogeneous experiences among researchers working in this field. A total of 32 statements on potential improvements reached consensus. The focus group discussed the 14 Delphi statements with the highest levels of consensus and generated 12 practical recommendations that we grouped into three clusters (1. Endorsing the ‘collaborative’ dimension of collaborative research; 2. Allowing flexibility; and 3. Strengthening the relational and ongoing nature of ethical research practice). Conclusions: This work provides further empirical evidence of how the research ethics system deals with collaborative research involving ‘vulnerable’ groups. It also offers practical recommendations to ensure that the collaborative dimension of such research receives proper ethical scrutiny, to introduce a degree of flexibility in research ethics processes and supporting documents, and to replace formal, one-off research ethics approvals with ongoing, situated, relational ethical processes and practices
The moral ambiguity of the AI consciousness debate
No full textIn this paper, I review the recent debate on the prospect of AI consciousness and assess its ethical relevance. Intuitively, when a being is conscious, this is sufficient to ground its non-derivative moral status. However, the semantic content of consciousness is ambiguous, particularly when attributed to non-biotic entities. Standard ethical accounts concerning the moral status of sentient beings presuppose affective or valenced consciousness. Yet, recent speculations about artificial consciousness have largely been driven by considerations of cognitive architecture, often neglecting the affective aspect of subjective experience. Crucially, no persuasive narrative currently exists about how valenced states may emerge in artificial systems. This significantly reduces the ethical relevance of current AI consciousness claims. As ethicists, we are well-advised to treat such claims with care, demanding precision and rigor when consciousness is attributed to artificial systems. This involves developing logically coherent claims about the emergence of artificial valence
Adoption of clinical pharmacist roles in primary care: longitudinal evidence from English general practice
No full textBackground Over the past decade, the number of clinical pharmacists working within multidisciplinary teams in English general practices has expanded. Aim To examine changes in quality of prescribing after the adoption of clinical pharmacist roles in English general practices. Design and setting Longitudinal cohort study in English general practice. Method Two-way fixed-effects regression was used to compare differences in prescribing indicators in general practices with and without pharmacists between September 2015 and December 2019. Results Between September 2015 and December 2019, the proportion of practices employing a clinical pharmacist increased from 236/7623 (3.1%) to 1402/6836 (20.5%). Clinical pharmacist implementation resulted in statistically significant reductions in total costs of medicines per 1000 patients (−0.85%, 95% confidence interval [CI] = −1.50% to −0.21%), the total number of opioid prescriptions per 1000 patients (−1.06%, 95% CI = −1.82% to −0.29%), and the average daily quantity of anxiolytics per 1000 patients (−1.26%, 95% CI = −2.40% to −0.12%). Clinical pharmacist implementation also resulted in reductions in the total number of prescriptions per 1000 patients (−0.58%, 95% CI = −1.30% to 0.13%) and the total number of antibiotic prescriptions per 1000 patients (−0.51%, 95% CI = −1.30% to 0.27%) that trended towards statistical significance. There were no statistically significant differences in the share of broad-spectrum versus narrow-spectrum antibiotics (0.02%, 95% CI = −0.07% to 0.11%) and the oral morphine equivalence of high-dose opioids (>120 mg per 24 h) per 1000 patients (1.19%, 95% CI = −0.46% to 2.85%). Conclusion This analysis is limited by practice-level data but supports the hypothesis that clinical pharmacist implementation results in improvements in prescribing quality
Philosophical and practical dimensions of Gramsci's conjunctural analysis: a contribution to case study research
No full textPurpose This article employs interpretive conceptual analysis to provide a coherent research philosophy and practical insights for conjunctural analysis as a Marxist alternative to traditional case study methods. How can Gramsci’s writings inform our understanding of research philosophy? How does this philosophy shape his own method as applied to the case of the French Revolution? Design/methodology/approach Gramsci’s methodology is based on a dynamic and agentive understanding of what he calls “organized matter,” which is supplemented with a historicist epistemology. His philosophy brings to the fore the notion of “reciprocity” rather than mere causation and prioritizes the study of “regularities,” as opposed to fixed and universal laws. It incorporates both structural forces and human agency as valid sources of knowledge. Findings Using the French Revolution as a case study, Gramsci applies these principles to conjunctural analysis by examining socioeconomic convulsions as pivotal moments that elucidate the interaction between organic movements – indicative of profound, long-term structural changes such as the ascent of the bourgeoisie, the consolidation of their political power, industrialization, capitalist development and the emergence of the modern nation-state – and conjunctural periods, which are triggered by immediate, specific events precipitating these extensive structural transformations. Originality/value This article fills an important gap in the literature, considering that previous research has not systematically addressed Gramsci’s contributions to research philosophy and his study of the French Revolution using conjunctural analysis
