If dominating functions in ω ω are adjoined repeatedly over a model of GCH via a finite-support c.c.c. iteration, then in the resulting generic extension there are no long towers, every well-ordered unbounded family of increasing functions is a scale, and the splitting number s (and hence the distributivity number h) remains at ω 1.

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:166 HUME'S INTEREST IN NEWTON AND SCIENCE Many writers have been forced to examine — in their treatments of Hume's knowledge of and acquaintance with scientific theories of his day — the related questions of Hume's knowledge of and acquaintance with Isaac Newton and of the nature and extent of Newtonian influences upon Hume's thinking. Most have concluded that — in some sense — Hume was acquainted with and (...) influenced by Newton's thought in particular and scientific thought in general. The genesis of this paper is the recent point of view put forward by Peter Jones which challenges the many permutations of this almost ritualistic standard line by removing Hume entirely from the Newtonian and the scientific scenes of thought. Jones argues that Hume knew less about Newton and science, and needed to know less about Newton and 2 science, than he believes is required by the above interpretation. Indeed, Jones argues that Hume's fundamental assumptions, which, according to Jones, derive ultimately from a form of Ciceronian humanism, drive a "wedge" between Newton's thought and that of 3 Hume. Even Hume's introductory remarks in the Treatise about his universal "science of man" are, for Jones, a declaration of independence from the materialistic trend (as Jones sees it) of Newtonian 4 science and not, as so many commentators have maintained — however tenuously or strongly evidence for linkage of Hume's project with Newtonian or scientific thought. Jones baldly argues that Hume totally lacked interest in science in general and in Newton and Newtonian science in particular. Following J. H. Burton's observation that Hume's work is surprisingly free from the "opinions" of contemporary scientists, 167 Jones states there is no evidence that Hume ever studied science at the University of Edinburgh or that he "pursued" scientific studies of any formal sort. Regarding Newtonian scientific thought, he emphasizes the paucity of specifically Newtonian scientific textbooks in the early eighteenth century 7 which might have been available for Hume to study and argues that nowhere in Hume's writings is there evidence of precise and detailed knowledge of Newton's science beyond what is available in Q Chamber's Cyclopaedia. Jones acknowledges that, in the Introduction to the Treatise, Hume utilizes a "general version" of Newton's "Regulae Philosophandi" from the beginning of Book III of Newton's Principia. Nevertheless, in Jones' view, Hume's fundamentally humanistic orientation separates him completely from g any Newtonian influence. Finally, according to Jones, Hume does not betray the least bit of knowledge of Newton's mathematics and its role in Newton's experimental methodology. On this evidence Jones grounds his central claim of Hume's "total lack of interest in contemporary science." What references there are to Newton and to science in Hume's works Jones finds "traceable to essentially literary predecessors such as Fontenelle or Montesquieu, or to standard works of theologians ] 2 or free-thinkers." The absence of clearly direct references to what Jones feels are scientific works results both from Hume's "total lack of interest in science" and from his commitment to a form of Ciceronian humanism which is "inimical" to what Jones finds to be the obvious materialistic tendencies of 13 science in the early modern period. Jones' account of the Ciceronian and French contexts of Hume's thought is excellent. But his claim that Hume had no interest whatsoever in science 168 is simply too strong and finally forces us to view science in Hume's day as equivalent to science in our own time, a manifestly anachronistic point of view. Throughout this paper, my argument will be conditioned by my view that Hume's interest in science cannot be separated from his epistemology or his religious scepticism. Hume's interest in science was precisely that of a man of letters of the eighteenth century vitally engaged in determining the proper use of scientific methodology in establishing the limits of the secular science of man once it has 14 been freed from the fetters of theology. Hume's interest in theological and epistemological issues inevitably gave rise to a strong interest on his part in the science of his day and in Newton's contributions... (shrink)

The Alexandrian emphasis on smallness, elegance, and slightness at the expense of grand themes in major poetic genres was not preciosity for its own sake: although the poetry was written by and for scholars, it had much larger sources than the bibliothecal context in which it was composed. Since the time of the classical poets, much had changed. Earlier Greek poetry was an intimate part of the life of the city-state, written for its religious occasions and performed by its citizens. (...) But eh conquests of Alexander had altered the structure and the boundaries of the Greek world to an astonishing degree. Alexandria, the center of the poetic culture of the new age, was a city that had not even existed at the time of Euripides; it was in Egypt, not in Greece, and was a huge, polyglot community. As immigrants immersed in a new, impersonal, and bureaucratic society, the poets not unreasonably sought out what was small, intimate, and personal in their verses. The heroes of early Greek poetry are larger than life; those of Alexandrian poetry are life-size. They are human, like us; they have a childhood and an old age; they are afraid or in love or caught in a rainstorm. It was simply one way of reducing the world to more manageable dimensions. At the same time, the new world of Alexandria needed a new poetry. To continue writing epics about a mythology that seemed very far away was senseless; it was impossible to recapture either the style or the immediacy of Homer, lyric poetry, or Attic tragedy. The scholar-poets of Alexandria admired the literature of classical Greece; for them Homer was incomparable and inimitable, to be studied—but not to be copied. Far better, then, to find a new voice on a more manageable scale: instead of oral epic, erudite epyllion; instead of lyric, epigram; instead of tragedy, mime. The poets of an urban and unheroic world might long for but could never re-create the grandeur of the past. James E. G. Zetzel is associate professor of classics at Princeton University and editor of the Transactions of the American Philological Association. He is the author of Latin Textual Criticism in Antiquity and, with Anthony T. Grafton and Glenn W. Most, has translated Friedrich August Wolf’s Prolegomena ad Homerum. (shrink)

Moral distress is a major problem for nurses, other clinicians, and the health system itself. But if properly understood and responded to, it is also a promising guide for healthcare improvement. When individuals experience moral distress or burnout, their reports must be seen as crucial data requiring careful attention to the individuals and to the organization. Distress and burnout will often point to important opportunities for system improvements, which may in turn reduce the experience of distress. For this potential virtuous (...) cycle to happen, individuals must be able to articulate their concerns without fear of retribution, and organizational leaders must be able to listen in an undefensive, improvementoriented manner. (shrink)

Utilitarian ideas in nineteenth-centuryAmerica have been given short shrift inmodern historical and philosophicalscholarship. Collecting the relevant publishedwork together in one place is an essentialstarting point for any serious investigation of American utilitarians andtheir critics. James Crimmins and Mark Spencer have made an expertselection from scattered sources of around 60 important articles andessays. These include treatments of Bentham by his friend John Neal,editor of The Yankee, and commentaries on John Stuart Mill gatheredfrom rare American journals. There are also discussions of (...) utilitarianjurisprudence by the great American jurist Oliver Wendell Holmes, andpieces by many other writers. This collection, with its substantialeditorial introduction, will be vital reading for historians of ideas,scholars of philosophy and political thought, and any one elseinterested in the fate of utilitarianism in America. (shrink)

Let κ denote a regular uncountable cardinal and NS the normal ideal of nonstationary subsets of κ. Our results concern the well-known open question whether NS fails to be κ + -saturated, i.e., are there κ + stationary subsets of κ with pairwise intersections nonstationary? Our first observation is: Theorem. NS is κ + -saturated iff for every normal ideal J on κ there is a stationary set $A \subseteq \kappa$ such that $J = NS \mid A = \{X \subseteq (...) \kappa:X \cap A \in NS\}$ . Turning our attention to large cardinals, we extend the usual (weak) Mahlo hierarchy to define "greatly Mahlo" cardinals and obtain the following: Theorem. If κ is greatly Mahlo then NS is not κ + -saturated. Theorem. If κ is ordinal Π 1 1 -indescribable (e.g., weakly compact), ethereal (e.g., subtle), or carries a κ-saturated ideal, then κ is greatly Mahlo. Moreover, there is a stationary set of greatly Mahlo cardinals below any ordinal Π 1 1 -indescribable cardinal. These methods apply to other normal ideals as well; e.g., the subtle ideal on an ineffable cardinal κ is not κ + -saturated. (shrink)

Current conceptions of the integration of computers into society often depend on the view that the human mind, as well as the computer, is a computational system. This view is widely taken to have broad implications for educational policy. We present a critique of the premise and some of the conclusions of the above argument. It is here shown that the thesis that the human mind is a computational system is, in principle, not scientifically supportable. It is also shown that, (...) even if the computational theory of mind were held for non-scientific reasons, the educational implications often derived from it do not follow. (shrink)

While the prevalence of opioid use disorder among pregnant women has multiplied in the United States in the last decade, buprenorphine treatment for peripartum women with OUD has been administered to reduce risks of repeated cycles of craving and withdrawal. However, the maternal behavior and bonding in mothers with OUD may be altered as the underlying maternal behavior neurocircuit is opioid sensitive. In the regulation of rodent maternal behaviors such as licking and grooming, a series of opioid-sensitive brain regions are (...) functionally connected, including the ventral pallidum. In humans, these brain regions, interact with the supplementary motor area to regulate maternal behaviors and are functionally dysregulated by opioids. It is unclear how these brain regions respond to the emotions of their child for mothers receiving BT. In this functional magnetic resonance imaging pilot study in 22 mothers within the first postpartum year, including six mothers receiving BT and 16 non-OUD mothers as a comparison group, we devised a child face mirroring task in fMRI settings to assess maternal responses to pictures of facial expressions of own child and an unknown child in an empathic mirroring condition and a non-mirroring observation condition. In each condition, faces of neutral, ambiguous, distressed, and joyful expressions of each child were repeatedly displayed in a random order. The response of SMA during empathic mirroring vs. non-mirroring of own child was reduced among BT/OUD vs. CG. Within MBN, the left VP, critical for parental sensitivity, had a similar deficit. This study outlines potential mechanisms for investigating the risks of deficits in the neural responses to actual maternal sensitivity and parenting behavior in mothers with OUD, and potential targets for interventions that reduce stress and augment maternal behavior and child outcome. (shrink)

Although leaders in the field of ethics have for many years pointed to the crucial role that organizations play in shaping healthcare ethics, organizational ethics remains a relatively undeveloped area of ethics activity. Clinical ethics committees are an important source of potential expertise, but new skills will be required. Clinical ethics committees seeking to extend their purview to organizational issues will have to respond to three challenges—how to gain sanction and support for addressing controversial and sensitive issues, how to develop (...) an acceptable process, and how to make a difference on the ground. The article presents practical suggestions for how clinical ethics committees meet these challenges. (shrink)

In his new book, Constitutional Essentials, Frank Michelman provides a splendid elaboration and defense of ‘the constitutional theory of political liberalism’ implicit in John Rawls’s classic work, Political Liberalism. In this essay, we make some observations about what a difference 30 years makes, comparing the political and constitutional climate in which Rawls wrote and published Political Liberalism in 1993 with the climate in which Michelman wrote and published this exegesis of it. We focus on (1) changes in our circumstances of (...) pluralism, including the accentuation of polarization and unreasonable views, and (2) the simultaneous breakdown of trust in the Supreme Court authoritatively to resolve disputes concerning constitutional essentials. Throughout, we acknowledge and seek to reckon with the possibility that Michelman may have given Rawls’s liberal principle of legitimacy its fullest, most coherent account just at the moment when the possibility of realizing it seems to be passing. (shrink)

We study the I-ultrafilters on ω, where I is a collection of subsets of a set X, usually R or ω 1 . The I-ultrafilters usually contain the P-points, often as a small proper subset. We study relations between I-ultrafilters for various I, and closure of I-ultrafilters under ultrafilter sums. We consider, but do not settle, the question whether I-ultrafilters always exist.

The conventional interpretation of Adam Smith is that he is a prophet of commercialism. The liberal capitalist reading of Smith is consistent with the view that history culminates in commercial society. The first part of the article develops this optimistic interpretation of Smith's view of history. Smith implies that commercial society is the end of history because (1) it supplies the ends of nature that he identifies; (2) it is inevitable; and (3) it is permanent. The second part of the (...) article shows that Smith has some dark moments in his writings where he seems to reject completely such teleological notions. In this more civic humanist mood he confesses that commercial society does not supply the ends of nature, nor is it inevitable, nor is it permanent. Both views exist in Smith and the commentator is forced to choose between passages in Smith's work in order to support a particular interpretation of the former's view of history. (shrink)

This thesis argues for a reconsideration of the social theories of Max Horkheimer and C. Wright Mills in order to increase our understanding of the ideological forces at play in modern society. Despite clear similarities in their work in terms of both subject matter and perspective, the discipline of political science lacks a critical comparison of their writings. I demonstrate that a comprehensive and comparative reading of Horkheimer and Mills can offer a new way to address many issues that remain (...) at the heart of writings on ideology, the production of knowledge, and the culture industry. Instead of simply studying the concept of ideology as it appears in each theorist's writings, I propose to place their views in dialogue with one another. Taken together, Horkheimer and Mills provide an illuminating and dynamic perspective on the current, and often conflicting approaches to the theory of ideology. ;Much of the current literature on ideology reflects fixed positions with little room for compromise. The impasse in the study of ideology revolves around the conceptualization of ideology as either enabling or constraining critical consciousness. A combination of the writings of Horkheimer and Mills can guide social theorists beyond the present impasse towards a reflexive theory of ideology, one that considers its own social and ethical presuppositions and normative values. (shrink)

Cancer-related electronic support groups (ESGs) may be regarded as a complement to face-to-face groups when the latter are available, and as an alternative when they are not. Advantages over face-to-face groups include an absence of barriers imposed by geographic location, opportunities for anonymity that permit sensitive issues to be discussed, and opportunities to find peers online. ESGs can be especially valuable as navigation aids for those trying to find a way through the healthcare system and as a guide to the (...) cancer journey. Outcome indicators that could be used to evaluate the quality of ESGs as navigation aids need to be developed and tested. Conceptual models for the navigator role, such as the Facilitating Navigator Model, are appropriate for ESGs designed specifically for research purposes. A Shared or Tacit Model may be more appropriate for unmoderated ESGs. Both conceptual models raise issues in Internet research ethics that need to be address. (shrink)

Dick Popkin and James Force have attended a number of recent conferences where it was apparent that much new and important research was being done in the fields of interpreting Newton's and Spinoza's contributions as biblical scholars and of the relationship between their biblical scholarship and other aspects of their particular philosophies. This collection represents the best current research in this area. It stands alone as the only work to bring together the best current work on these topics. Its (...) primary audience is specialised scholars of the thought of Newton and Spinoza as well as historians of the philosophical ideas of the late seventeenth and early eighteenth centuries. (shrink)