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 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)

This article investigates the question why even the existence of “moral conscience” became regarded with serious doubts among radical eighteenth-century French philosophes La Mettrie, d’Holbach, Diderot, and Voltaire, from the vantage point of conceptual history. The philosophes’ stance of regarding moral conscience only as a name for certain acquired prejudices both fails to engage with the conception of moral conscience upheld by their theistic opponents and stands in a sharp contrast to the moral thought of Protestant reformation, which – less (...) than two centuries earlier – had elevated moral conscience to a position of an infallible moral authority. The article argues, however, that, in spite of the opposition between these two conceptions of conscience, they might be connected, and that the former might have even been a consequence of the latter. It will be shown that the pre-Reformation conception of moral conscience, crystallized in Aquinas, presents it being based on our natural attraction to “the human good”. However, as this conception was not created by medieval theologians, but was inherited from non-theistic ancient philosophy, in principle it would have been as compatible with the deistic and atheistic worldviews of the philosophes as the other ancient philosophical concepts, such as “the human good” and “human nature”, that the philosophes continued using in their original, teleological senses. Having presented a brief overview of the history of moral conscience, the article proceeds to show how the Protestant reformers removed the attraction to the human good from moral conscience while making its normative guidance infallible. The article will suggest that, due to the prevalence of this, exclusively theological, conception of moral conscience in the intellectual environment shaped by Protestantism, several British thinkers of the seventeenth century, including Hobbes, Locke, and Hume, who could not endorse the theological aspects of moral conscience, gradually reduced it into a mere acquired “sentiment”. As their philosophy was a major influence on the philosophes, the article concludes that the loss of a rational justification for moral conscience in the works of the British philosophers could have also been what motivated the philosophes to question moral conscience. (shrink)

Over fifteen years have passed since Cora Diamond and James Conant turned Wittgenstein scholarship upside down with the program of “resolute” reading, and ten years since this reading was crystallized in the major collection _The New Wittgenstein_. This approach remains at the center of the debate about Wittgenstein and his philosophy, and this book draws together the latest thinking of the world’s leading Tractatarian scholars and promising newcomers. Showcasing one piece alternately from each “camp”, _Beyond the Tractatus Wars_ pairs newly (...) commissioned pieces addressing differing views on how to understand early Wittgenstein, providing for the first time an arena in which the debate between “strong” resolutists, “mild” resolutists and “elucidatory” readers of the book can really take place. The collection includes famous “samizdat” essays by Warren Goldfarb and Roger White that are finally seeing the light of day. (shrink)

According to the canonical formulation of the modal account of luck [e.g. Pritchard (2005)], an event is lucky just when that event occurs in the actual world but not in a wide class of the nearest possible worlds where the relevant conditions for that event are the same as in the actual world. This paper argues, with reference to a novel variety of counterexample, that it is a mistake to focus, when assessing a given event for luckiness, on events (...) distributed over just the nearest possible worlds. More specifically, our objection to the canonical formulation of the modal account of luck reveals that whether an event is lucky depends crucially on events distributed over all possible worlds–viz., across the modal universe. It is shown that an amended modal account of luck which respects this point has the additional virtue of avoiding a notable kind of counterexample to modal accounts of luck proposed by Lackey (2008). (shrink)

When fcc single crystals with high-symmetry crystal orientations are deformed to moderate strains by rolling, tension or channel die compression, long dislocation boundaries inclined to the extension axis form. Similarly, long dislocation boundaries are often found in grains embedded in polycrystals deformed in the same manner. These extended planar boundaries are characteristically - 30-40° from the extension direction and contain the transverse specimen axis. The objective of the present article is to demonstrate that EPBs formed during plane strain deformation (...) are parallel to equivalent slip planes, a pair of hypothetical slip systems used for analyses of the strain and crystal rotation components in place of the larger number of physical slip systems. The coincidence of EPBs and equivalent slip plane inclinations is shown to account for persistent observations of EPBs in the angle range - 30-40° from the rolling direction, in rolled single crystals of various initial orientations. The tendency of EPBs towards tilt or twist boundary character can also be rationalized on the basis of the equivalent slip system concept and consideration of the dislocation types available to be incorporated into EPBs. (shrink)

The evolution of microstructure upon partial crystallization and its influence on the mechanical properties such as hardness, elastic modulus and viscosity in a La 55 Al 25 Cu 10 Ni 5 Co 5 bulk metallic glass alloy are studied. Specimens with various volume fractions of crystalline phases were obtained by annealing the as-cast amorphous alloy above its glass transition temperature and were characterized by transmission electron microscopy. Microscopic examination of the heat-treated samples shows short-range-ordered domains prior to nanocrystallization within the (...) amorphous matrix, followed by the growth and impingement of the crystallites. Whereas the hardness of the annealed samples increases linearly with increasing crystallinity, the elastic modulus and the viscosity both increase abruptly when the crystalline volume fraction is about 40 vol.%, with a only minor variation on either side of this range. The sudden rises in the modulus and viscosity are similar to those in the literature data on the fracture strength of partially crystallized bulk amorphous alloys that shows a steep drop in strength at 30-50 vol.% crystallinity. On the basis of the microscopic observations, it is suggested that the interaction and formation of rigid networks of crystalline phases upon the attainment of a critical second-phase volume fraction may be the possible reason for the sudden change in mechanical properties. Percolation theory is utilized in further substantiating this hypothesis. (shrink)