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)

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)

This is a collection of the key articles written by renowned Wittgenstein scholar, G.P. Baker, on Wittgenstein’s later philosophy, published posthumously. Following Baker’s death in 2002, the volume has been edited by collaborator and partner, Katherine Morris. Contains articles previously only available in other languages, and one previously unpublished paper. Completely distinct from the widely-known work Baker did with P.M.S. Hacker in the Analytical Commentary on the Philosophical Investigations.

The twenty‐six‐year‐old patient requested a prophylactic bilateral mastectomy with reconstruction because of an extensive family history of cancer. She reported that she had developed melanoma at twenty‐five; that her mother, sister, aunts, and a cousin all had breast cancer; that a cousin had ovarian cancer at nineteen; and that a brother was treated for esophageal cancer at fifteen. The treating team was skeptical about this history, and they could find no documentation of the patient's reported melanoma. The surgeon wrote the (...) patient's primary care physician, explaining that he had seen the patient and planned to proceed with the bilateral mastectomy and reconstruction. The primary care physician responded that he was unable to substantiate several of the patient's claims; some of his colleagues believed the family history to be fabricated. Trying to make sense of the discrepancies, the genetic counselor called a counselor colleague who had met with this patient. The colleague suggested that the in‐house genetic counselor “google” the patient. The search revealed two Facebook pages linked to the patient. In one, apparently a personal profile, the patient stated that in addition to battling stage four melanoma, she had recently been diagnosed with breast cancer. She provided a link to a site where she solicited donations to attend a summit for young cancer patients. The other Facebook page featured numerous pictures of her with a bald head, as though she has been through chemotherapy. The genetic counselor showed the Facebook pages to the surgeon, who then decided not to operate. Should health care professionals “google” their patients? (shrink)

In ‘Wittgenstein on Language and Rules’, Professor N. Malcolm took us to task for misinterpreting Wittgenstein's arguments on the relationship between the concept of following a rule and the concept of community agreement on what counts as following a given rule. Not that we denied that there are any grammatical connections between these concepts. On the contrary, we emphasized that a rule and an act in accord with it make contact in language. Moreover we argued that agreement in judgments and (...) in definitions is indeed necessary for a shared language. But we denied that the concept of a language is so tightly interwoven with the concept of a community of speakers as to preclude its applicabilty to someone whose use of signs is not shared by others. Malcolm holds that ‘This is an unwitting reduction of Wittgenstein's originality. That human agreement is necessary for “shared” language is not so striking a thought as that it is essential for language simpliciter.’ Though less striking, we believe that it has the merit of being a true thought. We shall once more try to show both that it is correct, and that it is a correct account of Wittgenstein's arguments. (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.

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)

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: 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: 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: 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.

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.

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.

This chapter contains sections titled: The continuation of the Early Draft into philosophy of mathematics Hidden isomorphism A common methodology The flatness of philosophical grammar.

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.