Anselm: I agreed that Pegasus is a flying horse according to the stories people tell, the paintings painters paint and so on . That is, Pegasus is a flying horse in the understanding of storytellers, their readers and the artists who depict Pegasus. You asked whether flying is not an unmediated causal power . Well, it could be an unmediated causal power if you or I had it, but not if a being with only mediated powers had it. And so (...) poor Pegasus, a being whose powers are only those given him by storytellers and artists, has only the mediated power of flying that they have given him. He flies in the thoughts and depictions of beings with unmediated powers. Still, Pegasus has not only the mediated power to fly but also the mediated power to entertain us, and perhaps even inspire us. Fool: But people could tell stories about you, too, about how you sprouted wings and flew onto the roof of Canterbury Cathedral. Anselm: Alas, if it were only in stories that I could do that, then flying would not be an unmediated causal power of mine. I would still have unmediated causal powers all right, and so would be greater than Pegasus. But flying is not one of my unmediated causal powers. However, something than which nothing greater can be conceived would, and does, as I have proved in my Proslogion, have unmediated causal powers – indeed, much greater unmediated causal powers than any poor mortals like you and me.1 •↵1 For …. (shrink)

This chapter contains sections titled: The Tractatus and rules of logical syntax From logical syntax to philosophical grammar Rules and rule‐formulations Philosophy and grammar The scope of grammar Some morals.

This chapter contains sections titled: Setting the stage Leitmotifs External guidelines Necessary propositions and norms of representation Concerning the truth and falsehood of necessary propositions What necessary truths are about Illusions of correspondence: ideal objects, kinds of reality and ultra‐physics The psychology and epistemology of the a priori Propositions of logic and laws of thought Alternative forms of representation The arbitrariness of grammar A kinship to the non‐arbitrary Proof in mathematics Conventionalism.

The advances in treatment of HIV and the introduction of polymerase chain reaction assay for the virus now make it acceptable for HIV discordant couples where the male partner is seropositive to attempt to conceive through artificial insemination by husband or via in vitro fertilisation. With undetectable viral load and washed sperm, there is minimal risk of transmission of HIV to the female partner, children, other patients, or staff. We describe the development of a programme of AIH for HIV discordant (...) couples and the reasoning behind offering such a programme. (shrink)

THE TITLE W. used the title 'Philosophische Untersuchungen, Versuch einer Umar- beitung' as the heading of his 1936 revision of Br. B. in Vol. ...

Mitchell et al.'s claim, that their propositional theory is a single-process theory, is illusory because they relegate some learning to a secondary memory process. This renders the single-process theory untestable. The propositional account is not a process theory of learning, but rather, a heuristic that has led to interesting research.

This chapter contains sections titled: Is a language necessarily shared with a community of speakers? Innate knowledge of a language Robinson Crusoe sails again Solitary cavemen and monologuists Private languages and ‘private languages’ Overview.

This chapter contains sections titled: Initial compass bearings Accord and the harmony between language and reality Rules of inference and logical machinery Formulations and explanations of rules by examples Interpretations, fitting and grammar Further misunderstandings.

Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires (...) researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)

This chapter contains sections titled: The scaffolding of facts The role of our nature Forms of life Agreement: consensus of human beings and their actions.

This chapter contains sections titled: Following a rule Practices and techniques Doing the right thing and doing the same thing Privacy and the community view On not digging below bedrock.

The Second Edition of _Wittgenstein: Rules, Grammar and Necessity_ now includes extensively revised and supplemented coverage of the Wittgenstein's complex and controversial remarks on following rules. Includes thoroughly rewritten essays and the addition of one new essay on communitarian and individualist conceptions of rule-following Includes a greatly expanded essay on Wittgenstein’s conception of logical, mathematical and metaphysical necessity Features updates to the textual exegesis as the result of taking advantage of the search engine for the Bergen edition of the _Nachlass_ (...) Reflects the results of scholarly debates on rule-following that have raged over the past 20 years. (shrink)

Sexual reproduction is a composite, not a singular, phenomenon and as such can be subdivided into a number of componentsi.e. fusion, recombination, fission, and the male-female phenomenon. These components can evolve independently, though any evolutionary change in one component is likely to influence the future evolution of the other components. The ambiguity that surrounds the term ‘sex’ due to a failure to recognise the composite nature of sexual reproduction has led to considerable confusion in past discussions of the evolution of (...) the phenomenon. This paper considers the possible chronological interaction of the components of sexual reproduction both with each other and with the sequence of selective pressures that seem likely to have acted. This chronological approach is used to consider: the origin of sexual reproduction; the evolution of sexual reproduction in the common ancestor of the procaryotes and eucaryotes; the modification of the ancestral system in the procaryote line following the procaryote-eucaryote dichotomy; and the modification of the ancestral system in the eucaryote line up to the origin of the male-female phenomenon.It is suggested that the fusion and recombination of the first living organisms were chronological continuations of the fusion and recombination of complex organic molecules that led up to the origin of life. The evolution of the third major component of sexual reproductioni.e. fission , by definition coincided with the origin of life. Initial selection on the components of sexual reproduction are likely to have been related to the optimum manifestations of size, complexity, diversity, multiplication, and distribution. Resultant early evolutionary trends are likely to have been: selective fusion between more-similar organisms; increase in number of fissions per fusion; and less recombination.The procaryote-eucaryote dichotomy is argued to have evolved in response to the increasing cellular problems of packing and replicating an increasing amount of hereditary material. The evolution of a single circular hereditary organelle in the procaryote line is argued to have led to the loss of total fusion and the specialisation of individuals into either donors or recipients. The donor-recipient phenomenon of procaryotes is directly analogous to the male-female phenomenon of eucaryotes and leads to parallel evolution due to sexual selection in both groups. In the eucaryote line the ancestral mechanism of sexual reproduction is argued to have persisted through, but to have been greatly modified by, the evolution of complex machinery for the handling of multiple hereditary organelles at cell division and reduction division. The evolutionary modification of the ancestral system of sexual reproduction is suggested to have led in eucaryotes to the evolution of: the species phenomenon; allelic recombination; and the male-female phenomenon. (shrink)

Since its inception in 2010, the Network for Public Health Law has aligned with federal, state, tribal, and local public health practitioners to assess how law can promote and protect the public’s health. In 2013, Network authors illustrated major trends in public health laws and policies emanating from an internal assessment of thousands of requests for technical assistance nationally. More recently, the Robert Wood Johnson Foundation has invited the Network and other partners to consider new ideas and strategies toward building (...) a “culture of health.” Per Figure 1, RWJF’s conception of a culture of health emphasizes key action areas essential to the promotion of health across all sectors and diverse populations. (shrink)

> Wealthy nations must do much more, much faster. The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference 26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature (...) and protect health. Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal; a global increase of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2 3 Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions. Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory. The risks to health of increases above 1.5°C are now well established.2 Indeed, no temperature rise is ‘safe’. In the past 20 years, heat-related mortality among people aged over 65 has increased by more than 50%.4 Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.5 6 Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities and those with underlying health problems.2 4 Global heating is also contributing to the decline in …. (shrink)