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The main question of this Element is whether God has a personality. The authors show what the question means, why it matters, and that good sense can be made of an affirmative answer to it. A God with personality - complete with particular, sometimes peculiar, and even seemingly unexplainable druthers - is not at war with maximal perfection, nor is the idea irredeemably anthropomorphic. And the hypothesis of divine personality is fruitful, with substantive consequences that span philosophical theology. But problems arise here too, and new perspectives on inquiry itself. Our cosmos is blessed with weirdness aplenty. To come to know it is nothing less than to encounter a strange and untamed God.
Materialists about human persons say that we are, and must be, wholly material beings. Substance dualists say that we are, and must be, wholly immaterial. In this article, I take issue with the ‘and must be’ bits. Both materialists and substance dualists would do well to reject modal extensions of their views and instead opt for contingent doctrines, or doctrines that are silent about those modal extensions. Or so I argue.
Antimicrobial stewardship has special challenges in particular populations and facilities, including pediatrics. We sought to augment the information available to antimicrobial stewardship programs (ASPs) by created a cumulative statewide antibiogram for neonatal and pediatric populations.
Methods:
In the Antimicrobial Stewardship Collaborative of South Carolina (ASC-SC), we created statewide antibiograms, including a separate antibiogram accounting for the pediatric and neonatal intensive care unit (NICU) populations. We collated data from the 4 pediatric and 3 NICU facilities in the state to provide a cumulative statewide antibiogram.
Results:
Methicillin-susceptible Staphylococcus aureus was more prevalent than methicillin-resistant Staphylococcus aureus. Pseudomonas aeruginosa, Citrobacter koserii, and Acinetobacter baumannii were isolated in only 1 NICU.
Conclusions:
These antibiograms should improve empiric prescribing in both the inpatient and outpatient setting, providing data in some areas that historically do not have pediatric antibiogram to inform prescribing. The antibiogram alone is not sufficient independently to improve prescribing but is one important aspect of stewardship in the pediatric population of South Carolina.
To examine differences in surgical practices between salaried and fee-for-service (FFS) surgeons for two common degenerative spine conditions. Surgeons may offer different treatments for similar conditions on the basis of their compensation mechanism.
Methods:
The study assessed the practices of 63 spine surgeons across eight Canadian provinces (39 FFS surgeons and 24 salaried) who performed surgery for two lumbar conditions: stable spinal stenosis and degenerative spondylolisthesis. The study included a multicenter, ambispective review of consecutive spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network registry between October 2012 and July 2018. The primary outcome was the difference in type of procedures performed between the two groups. Secondary study variables included surgical characteristics, baseline patient factors, and patient-reported outcome.
Results:
For stable spinal stenosis (n = 2234), salaried surgeons performed statistically fewer uninstrumented fusion (p < 0.05) than FFS surgeons. For degenerative spondylolisthesis (n = 1292), salaried surgeons performed significantly more instrumentation plus interbody fusions (p < 0.05). There were no statistical differences in patient-reported outcomes between the two groups.
Conclusions:
Surgeon compensation was associated with different approaches to stable lumbar spinal stenosis and degenerative lumbar spondylolisthesis. Salaried surgeons chose a more conservative approach to spinal stenosis and a more aggressive approach to degenerative spondylolisthesis, which highlights that remuneration is likely a minor determinant in the differences in practice of spinal surgery in Canada. Further research is needed to further elucidate which variables, other than patient demographics and financial incentives, influence surgical decision-making.
The main question of this Element is how the existence, supremacy, and uniqueness of an almighty and immaterial God bear on our own nature. It aims to uncover lessons about what we are by thinking about what God might be. A dominant theme is that Abrahamic monotheism is a surprisingly hospitable framework within which to defend and develop the view that we are wholly material beings. But the resulting materialism cannot be of any standard variety. It demands revisions and twists on the usual views. We can indeed learn about ourselves by learning about God. One thing we learn is that, though we are indeed wholly material beings, we're not nearly as ordinary as we might seem.
Many say that ontological disputes are defective because they are unimportant or without substance. In this paper, we defend ontological disputes from the charge, with a special focus on disputes over the existence of composite objects. Disputes over the existence of composite objects, we argue, have a number of substantive implications across a variety of topics in metaphysics, science, philosophical theology, philosophy of mind, and ethics. Since the disputes over the existence of composite objects have these substantive implications, they are themselves substantive.
In its recent history, the philosophy of mind has come to resemble an entry into the genre of Hammer horror or pulpy science fiction. These days it is unusual to encounter a major philosophical work on the mind that is not populated with bats, homunculi, swamp-creatures, cruelly imprisoned genius scientists, aliens, cyborgs, other-worldly twins, self-aware Computer programs, Frankenstein-monster-like ‘Blockheads,’ or zombies. The purpose of this paper is to review the role in the philosophy of mind of one of these fantastic thought-experiments — the zombie — and to reassess the implications of zombie arguments, which I will suggest have been widely misinterpreted. I shall argue that zombies, far from being the enemy of materialism, are its friend; and furthermore that zombies militate against the computational model of consciousness and in favour of more biologically-rooted conceptions, and hence that zombie- considerations support a more reductive kind of physicalism about consciousness than has been in vogue in recent years.
Queues are part of everyday routine and experienced by most shoppers, yet little attention has been given to providing historical accounts of queuing as a consumer task or as a shopper experience. This paper examines grocery shop queues and the changing experience of shoppers in historical perspective, specifically focusing upon the shift from counter-service to self-service grocery formats in Britain from 1945 to 1975. The paper draws upon a wide range of material using evidence from oral histories and witness groups, which is supported by contemporary sources from the Mass Observation Archive, newspapers, shopper surveys, and trade publications and reports. The conceptual framework developed in the paper explores the public and private dimensions of queues to consider the experiences and perceptions of shoppers during a period of rapid change in the retail grocery system. More generally, the paper contributes to our understanding of how management innovations are connected to untraded public values.
Background: Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord impairment. In a public healthcare system, wait times to see spine specialists and eventually access surgical treatment for CSM can be substantial. The goals of this study were to determine consultation wait times (CWT) and surgical wait times (SWT), and identify predictors of wait time length. Methods: Consecutive patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) prospective and observational CSM study from March 2015 to July 2017 were included. A data-splitting technique was used to develop and internally validate multivariable models of potential predictors. Results: A CSORN query returned 264 CSM patients for CWT. The median was 46 days. There were 31% mild, 35% moderate, and 33% severe CSM. There was a statistically significant difference in median CWT between moderate and severe groups; 207 patients underwent surgical treatment. Median SWT was 42 days. There was a statistically significant difference in SWT between mild/moderate and severe groups. Short symptom duration, less pain, lower BMI, and lower physical component score of SF-12 were predictive of shorter CWT. Only baseline pain and medication duration were predictive of SWT. Both CWT and SWT were shorter compared to a concurrent cohort of lumbar stenosis patients (p <0.001). Conclusions: Patients with shorter duration (either symptoms or medication) and less neck pain waited less to see a spine specialist in Canada and to undergo surgical treatment. This study highlights some of the obstacles to overcome in expedited care for this patient population.
The role played by the Arabian Peninsula in hominin dispersals out of Africa has long been debated. The DISPERSE Project has focused on south-western Arabia as a possible centre of hominin settlement and a primary stepping-stone for such dispersals. This work has led to the recent discovery, at Wadi Dabsa, of an exceptional assemblage of over 1000 lithic artefacts, including the first known giant handaxe from the Arabian Peninsula. The site and its associated artefacts provide important new evidence for hominin dispersals out of Africa, and give further insight into the giant handaxe phenomenon present within the Acheulean stone tool industry.
The northeastern sector of the Rub' al-Khali desert in the eastern United Arab Emirates (UAE) is dominated by large NE–SW trending dune ridges orientated perpendicular to the currently prevailing northwesterly wind regime. In this study, extensive use has been made of artificially exposed sections through these major dune ridges that reveal internal sedimentary structures and allow an intensive, high-resolution sampling programme to be carried out. Here, we present the optical dating results for samples from 7 sections. The results indicate that dune activity and preservation occurred within the periods 7–3 ka, 16–10 ka and 22–20 ka with evidence of earlier preservation during marine oxygen isotope stages MIS 3 and 5, with net accumulation rates in the range 2.2–25 m.ka− 1. In several instances, hiatuses in the preserved record of dune accumulation coincide with stratigraphic bounding surfaces visible in the exposed section profiles with associated truncation of internal sedimentary structures. Caution must be exercised when interpreting such gaps in the recorded accumulation chronologies of these dunes since these may simply constitute phases of low preservation potential rather than phases of low aeolian activity. Other factors such as sediment supply and availability in relation to sea-level dynamics may be significant and are also considered.
In monetary policy, decision makers seek to influence the expectations of agents in ways that can avoid making abrupt, dramatic, and unexpected decisions. Yet in October 1979, Chairman Paul Volcker led the Federal Reserve's Federal Open Market Committee (FOMC) unanimously to shift its course in managing U.S. monetary policy, which in turn eventually brought the era of high inflation to an end. Although some analysts argue that “the presence and influence of one individual”—namely, Volcker—is sufficient to explain the policy shift, this overlooks an important feature of monetary policymaking. FOMC chairmen—however, omnipotent they may appear—do not act alone. They require the agreement of other committee members, and in the 1979 revolution, the decision was unanimous. How, then, did Chairman Volcker manage to bring a previously divided committee to a consensus in October 1979, and moreover, how did he retain the support of the committee throughout the following year in the face of mounting political and economic pressure against the Fed? We use automated content analysis to examine the discourse of the FOMC (with this discourse recorded in the verbatim transcripts of meetings). In applying this methodology, we assess the force of the arguments used by Chairman Volcker and find that deliberation in the FOMC did indeed “matter” both in 1979 and 1980. Specifically, Volcker led his colleagues in coming to understand and apply the idea of credible commitment in U.S. monetary policymaking.
Substance dualism is on the move. Though the view remains unfashionable, a growing and diverse group of philosophers endorse it on impressive empirical, religious, and purely metaphysical grounds. In this note, I develop and evaluate one conceptual argument for substance dualism. According to that argument, we may derive a conclusion about our nature from the mere fact that we have the concept of a spirit. The argument is intriguing and fruitful; but I shall contend that it is, nonetheless, unsound.
Arguments for substance dualism—the theory that we are at least partly nonmaterial beings—abound. Many such arguments begin with our capacity to engage in conscious thought and end with dualism. Such are familiar. But there is another route to dualism. It begins with our moral value and ends with dualism. In this article, we develop and assess the prospects for this new style of argument. We show that, though one version of the argument does not succeed, there may yet be a deep problem for standard physical accounts of our nature.
To aid in preparation of military medic trainers for a possible new curriculum in teaching junctional tourniquet use, the investigators studied the time to control hemorrhage and blood volume lost in order to provide evidence for ease of use.
Hypothesis
Models of junctional tourniquet could perform differentially by blood loss, time to hemostasis, and user preference.
Methods
In a laboratory experiment, 30 users controlled simulated hemorrhage from a manikin (Combat Ready Clamp [CRoC] Trainer) with three iterations each of three junctional tourniquets. There were 270 tests which included hemorrhage control (yes/no), time to hemostasis, and blood volume lost. Users also subjectively ranked tourniquet performance. Models included CRoC, Junctional Emergency Treatment Tool (JETT), and SAM Junctional Tourniquet (SJT). Time to hemostasis and total blood loss were log-transformed and analyzed using a mixed model analysis of variance (ANOVA) with the users represented as random effects and the tourniquet model used as the treatment effect. Preference scores were analyzed with ANOVA, and Tukey’s honest significant difference test was used for all post-hoc pairwise comparisons.
Results
All tourniquet uses were 100% effective for hemorrhage control. For blood loss, CRoC and SJT performed best with least blood loss and were significantly better than JETT; in pairwise comparison, CRoC-JETT (P < .0001) and SJT-JETT (P = .0085) were statistically significant in their mean difference, while CRoC-SJT (P = .35) was not. For time to hemostasis in pairwise comparison, the CRoC had a significantly shorter time compared to JETT and SJT (P < .0001, both comparisons); SJT-JETT was also significant (P = .0087). In responding to the directive, “Rank the performance of the models from best to worst,” users did not prefer junctional tourniquet models differently (P > .5, all models).
Conclusion
The CRoC and SJT performed best in having least blood loss, CRoC performed best in having least time to hemostasis, and users did not differ in preference of model. Models of junctional tourniquet performed differentially by blood loss and time to hemostasis.
KraghJFJr, LunatiMP, KharodCU, CunninghamCW, BaileyJA, StockingerZT, CapAP, ChenJ, AdenJK3d, CancioLC. Assessment of Groin Application of Junctional Tourniquets in a Manikin Model. Prehosp Disaster Med. 2016;31(4):358–363.
Some philosophers say that you do not think in the primary or nonderivative sense. Rather, they say some item distinct from you (perhaps one of your parts or something of which you are a part) does your thinking for you; you inherit your mental life from that item. In this paper, I argue that this is a mistake. We do not inherit our thoughts in this way.
Laura, Gary, Bridget, Chris and Theresa have been referred to social services. Laura is an 83-year-old White British lesbian. Her civil partner died last year and she now lives alone in their large multi-storey house in a rural area. She has several private pensions. Her eyesight is deteriorating and she can no longer drive. She is lonely and depressed. Gary is a single 70-year-old gay man of African Caribbean decent, living in an inner-city local authority flat and reliant on state pensions and other forms of welfare support. He is showing signs of memory loss and confusion. Bridget is a 65-year-old bi-identifying woman of White Irish Catholic origin. She lives in the suburbs with her partner, Chris, aged 69, a White British bisexual man who has multiple sclerosis, needing increasing care and support. Their daughter is supportive, but lives a long distance away. Theresa is a 61-year-old heterosexual trans woman with an Asian/White British heritage, who transitioned three years ago. She has a son, but they are estranged. She lives in a sheltered housing scheme for people with mental health issues. Theresa has complained that staff are discriminating against her.
What would good practice look like for each of these people?
Introduction
Lesbian, gay, bisexual and trans (LGBT) ageing occurs in wide-ranging socio-legal contexts. In countries where there is a lack of legal recognition and social protections, the health of LGBT people is impacted not only by the accumulated effects of discrimination but also by the fact that their older age care needs are served by health and social care systems that offer little or no recognition of their minority identities (AGE Platform Europe and ILGA-Europe, 2012). Even in more liberal countries offering some forms of legal rights, older LGBT people experience a range of health inequalities (Fish, 2007). These disadvantages (Fredriksen-Goldsen et al, 2013a, 2013b) can be clustered into four main areas:
• the cumulative physical and psychological effects of discrimination, stigma and marginalisation across the lifecourse;
• a relative lack of social capital, particularly informal social support, compared with heterosexual and cisgender older people;
• health and social care provision that is ill-equipped to recognise and meet the needs of older LGBT people (Fish, 2007; 2009);