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Along with an increase in opioid deaths, there has been a desire to increase the accessibility of naloxone. However, in the absence of respiratory depression, naloxone is unlikely to be beneficial and may be deleterious if it precipitates withdrawal in individuals with central nervous system (CNS) depression due to non-opioid etiologies.
Objective:
The aim of this study was to evaluate how effective prehospital providers were in administering naloxone.
Methods:
This is a retrospective study of naloxone administration in two large urban Emergency Medical Service (EMS) systems. The proportion of patients who had a respiratory rate of at least 12 breaths per minute at the time of naloxone administration by prehospital providers was determined.
Results:
During the two-year study period, 2,580 patients who received naloxone by prehospital providers were identified. The median (interquartile range) respiratory rate prior to naloxone administration was 12 (6-16) breaths per minute. Using an a priori respiratory rate of under 12 breaths per minute to define respiratory depression, only 1,232 (47.8%; 95% CI, 50.3%-54.2%) subjects who received naloxone by prehospital providers had respiratory depression.
Conclusion:
This study showed that EMS providers in Los Angeles County, California (USA) frequently administered naloxone to individuals without respiratory depression.
Delivering high quality genomics-informed care to patients requires accurate test results whose clinical implications are understood. While other actors, including state agencies, professional organizations, and clinicians, are involved, this article focuses on the extent to which the federal agencies that play the most prominent roles — the Centers for Medicare and Medicaid Services enforcing CLIA and the FDA — effectively ensure that these elements are met and concludes by suggesting possible ways to improve their oversight of genomic testing.
Policy-critical, micro-level statistical data are often unavailable at the desired level of disaggregation. We present a Bayesian methodology for “downscaling” aggregated count data to the micro level, using an outside statistical sample. Our procedure combines numerical simulation with exact calculation of combinatorial probabilities. We motivate our approach with an application estimating the number of farms in a region, using count totals at higher levels of aggregation. In a simulation analysis over varying population sizes, we demonstrate both robustness to sampling variability and outperformance relative to maximum likelihood. Spatial considerations, implementation of “informative” priors, non-spatial classification problems, and best practices are discussed.
Traditional theistic proofs are often understood as evidence intended to compel belief in a divinity. John Clayton explores the surprisingly varied applications of such proofs in the work of philosophers and theologians from several periods and traditions, thinkers as varied as Ramanuja, al-Ghazali, Anselm, and Jefferson. He shows how the gradual disembedding of theistic proofs from their diverse and local religious contexts is concurrent with the development of natural theologies and atheism as social and intellectual options in early modern Europe and America. Clayton offers a fresh reading of the early modern history of philosophy and theology, arguing that awareness of such history, and the local uses of theistic argument, offer important ways of managing religious and cultural difference in the public sphere. He argues for the importance of historically grounded philosophy of religion to the field of religious studies and public debate on religious pluralism and cultural diversity.
Part II offers three exploratory demonstrations of how comparative philosophy of religion might proceed, if oriented by the study of theistic arguments as embedded in religious forms of life. In these chapters Clayton discusses the degrees and kinds of difference that become visible through such comparative historical projects. He also provides examples of pre-modern theistic argument in relation to which the distinctive character of modern uses of such argument might be measured. Chapter 5, ‘Ramanuja, Hume and “Comparative Philosophy”: Remarks on the Sribhasya and the Dialogues concerning Natural Religion’, develops a comparison of Hume and Ramanuja by analysing their theistic arguments with respect to the interpretative communities to which they belonged. Differentiation between the grounds, motives and ends of argument for Ramanuja and Hume provides the philosophical structure through which Clayton historicizes instances of rationality.
Chapter 6, ‘Piety and the Proofs’, continues Clayton's attention to the operations of theistic argument within specific religious traditions and communities, here described as forms of life. In this chapter we see an intensification of interest in the genres within which theistic proofs occur, and the audiences for such genres, topics which receive yet more explicit treatment in Chapter 7, ‘The Otherness of Anselm’, and in Part III. All of the essays in Part II (Chapters 6 and 7 most explicitly) approach the comparative philosophical study of theistic proofs by analysing them within contexts of composition and reception. On Clayton's view, without such contextual analysis one risks making mistaken philosophical claims.
Religious piety and proofs of God's existence have not in modern times invariably sat so happily beside one another as the attempted euphony of my title may at first appear to suggest.
In the seventeenth and eighteenth centuries, the existence and nature of God came to be conceived as a purely philosophical question that could be answered, if at all, without recourse to ‘narrowly religious’ considerations. Philosophers and sympathetic theologians agreed that a religiously independent philosophy is itself competent to demonstrate the Deity's existence and nature by means of formally valid and generally convincing rational proofs.
Motives varied. Some philosophers may have desired that a common rational religion would eventually displace the diverse ‘positive religions’, which – as the then recent religious wars in Europe and the invasion of the Turks from the South had shown – tend toward divisiveness, intolerance and bloodshed. Some Jewish thinkers may have hoped via a confessionally neutral ‘rational theology’ to win an equal place within Europe's intellectual mainstream. And a few Christian theologians may have joined in the ‘Enlightenment project’ – as it has been called – in the belief that ‘natural theology’ itself already contained the best that is in Christianity, whilst others may have been confident that the independent foundation would be sufficient to support a robustly Christian superstructure.
It has become commonplace in recent philosophical discussion in Europe and America to speak, be it approvingly or disapprovingly, of something called the Modern project or the project of Enlightenment or the Enlightenment project. Each of these phrases has its own local appeal and creates its own conceptual problems. Each can be given a certain tone, so that in one voice it can evoke all the aspirations of the human spirit made free from self-imposed chains; in another voice each phrase can evoke a sense of cultural fragmentation and loss of community. If we try, against all the odds, to encapsulate that project in a single paragraph, we could do worse, I think, than propose something like this:
‘The Enlightenment project in its most general form is an attempt to identify and to justify without recourse to outside authority or private passion but by the exercise of reason and the limits of experience alone what we can truly know, what we ought rightly to do and what we may reasonably hope. Public rationality requires us in all our deliberations to achieve neutrality by divesting ourselves of allegiance to any particular standpoint and to achieve universality by abstracting ourselves from all those communities of interest that may limit our perspective. By this means, the sovereign self sets out to lay sound foundations on which to build with reasoned confidence.’
The vigour with which radically conservative religious movements have gained ground around the world – East and West, North and South – caught the liberal intellectual establishment unprepared. Many consoled themselves at first by insisting that it was a temporary blip and predicted that the corrective forces of secularization would soon reassert themselves and set things back on course in and beyond the West. However, this has not happened. In the mean time, the liberal community has gone on the offensive, warning with uncharacteristic sensationalism against domestic culture wars or global clashes of civilizations if commonality is not maximized. Rawlsians may have soberly realized that citizens of modern democratic societies share less in common than they had once imagined, but they have not abandoned the strategy of seeking out and expanding the possible patches of overlapping consensus that may survive. This typifies the intuitive response of liberalism, both classical and contemporary, to diversity: privatize difference and cultivate common ground as a means of containing the potentially destructive social effects of cultural, especially religious, diversity.
Who indeed could doubt that staking out and tending common ground is the first thing required to overcome difference and to create a common good? Where there are differences of opinion between persons or states or religions, most of us instinctively look to strategies that maximize common ground. The image of common ground evokes public parks and village greens. It is an image full of warmth and reassurance, exuding a sense of community and well being.
The proximate point of origin for this volume is John Clayton's 1992 Stanton Lectures, delivered at the University of Cambridge. Clayton had planned to publish his Stanton Lectures soon thereafter with Cambridge University Press. However, that publication was delayed for a variety of reasons. In 1997 he retired from his position as Professor and Head of the Department of Religious Studies at the University of Lancaster to become Professor, Chair of Department, and Director of the Graduate Division of Religious and Theological Studies at Boston University. During the late 1990s Clayton focused primarily on the administrative side of his professional work. By 2000, he had returned in earnest to his Stanton Lectures, deciding that Religions, Reasons and Gods: Essays in CrossCultural Philosophy of Religion ought to come to publication as a nearly independent typescript rather than as a lightly revised version of the Stanton Lectures. The gods did not smile on Clayton's plans. In the autumn of 2001 he fell seriously ill with a condition requiring exhausting treatment. One year later, he was diagnosed with a second illness, an aggressive cancer that took his life in September 2003.
Clayton recognized that his ambitious plans for the completion of Religions, Reasons and Gods would not be realized in this context of illhealth and, accordingly, he revised arrangements for the publication of this volume. With the generous support of editors at Cambridge University Press, he specified a collection of essays (some previously published and some unpublished).
In an article on the current state of Indology, first published in Hochland in the late 1960s, Paul Hacker made a plea for a new kind of philosophizing, one grounded in an immediate knowledge of both Indian and European sources. This quotation was later used as the epithet for the muchrespected book India and Europe by Wilhelm Halbfass, whose work as a whole can be said to have exemplified just that kind of philosophizing.
However dubious one may be that it is ever possible to have immediate knowledge of any text, one cannot but agree that doing philosophy would be greatly enriched by immersion in the main texts of a variety of reflective traditions, including – of course – the reflective traditions of India. Ideally, one would want to be open to more than just the traditions of India and ‘the West’, intricately differentiated though each of them may be in itself. The ideal would be, from intimate knowledge of several traditions, to develop a reflective style that is global and not simply bi-cultural. The ideal, however, is just that – an ideal. It is for most of us hardly possible to master the varieties even of Western and Indian thought in tandem, to discern the points of real (not just apparent) difference and similarity, much less to add to that the full range of other indigenous styles of reflection it would be necessary to master in order to earn a right to philosophize in a global mode or a right to undertake what is now grandly called ‘world philosophy’.
The introductory chapter, ‘Claims, Contexts and Contestability’, ends by suggesting that studying the pre-modern history of theistic proofs may support investigation of the selective and collective instrumentality of argument. Clayton indicates a variety of ways in which theistic proofs may function within intra-traditional, as well as inter-traditional, contexts. This discussion reveals his particular interest in the ways in which intra-traditional uses of theistic proofs may enhance ‘group solidarity’. Moreover, examining this role of the proofs in pre-modern contexts may render it more easily visible at work in modern contexts.
Such remarks provide a crucial frame for the chapters that follow in Part I. Chapter 2, ‘Thomas Jefferson and the Study of Religion’, proceeds on several fronts. Against the view that ‘natural religion’ provides a universal discourse suited to the management of pluralism by virtue of its supra-traditional character, Clayton presents one account of its origins, emphasizing the Protestant Christian character of this ‘universal’ language of religion. He also notes the limited character of difference required to be managed by such language in Jefferson's day. Jeffersonian America's religious parochialism is juxtaposed with the greater religious pluralism of contemporary Britain and America. Here Clayton argues that the disciplinary language of philosophy of religion retains the parochial character of its origins in natural religion discourse and is thus limited in its capacity to communicate among diverse religious communities.
My thesis concerning theistic arguments in the modern period is fairly straightforward: disembedded from their traditional contexts, in which they had served mainly tradition-specific ends, they were asked more and more to serve tradition-neutral ends by carrying the full load of justifying the rationality of basic religious claims. This was a job for which they were ill equipped, and they eventually collapsed, surviving only when they did not serve the whims of this ‘disembedded foundationalism’. It is less surprising that they failed to do what they were not equipped to do than that they held up for as long as they did. How do we account for that?
FROM MEDIAEVAL TO MODERN: DAWNING OF THE ENLIGHTENMENT IN EUROPE
An unclear divide: the mediaeval mentalité and the marks of modernity
Some accounts of modernity apply equally to the thirteenth century and to post-Enlightenment Europe. It is not surprising that some intellectual historians now push the origins of modernity further and further back into what we once with no sense of unease called the ‘Middle Ages’. This unclear divide has led some to say that there is no unique modernity. It is true that we need thoroughly to reassess the intricate links between modern and mediaeval, as well as the similarity between the modern and what used to be called in our anthropological innocence ‘primitive’, but we should not allow ourselves to become blind to the fact that there remains a distinct difference.
Anselm's Proslogion is an obvious resource for anyone wishing to reflect on ‘the otherness of God’. The mediaeval monk's desire to be allowed to know and love and rejoice in the being of his God (§26) was in no way fed by a desire to deny God's otherness. His strategy was rather to confirm what we already believe about God's utter difference by making the divine ‘otherness’ intelligible to the human mind; that is, by making otherness thinkable.
God's way of being is one kind; ours, quite another. For instance, I know that my existence is contingent. I can easily think of myself as not existing. I can imagine a time in the past before I came into being, and I can also imagine a time in the future after I shall cease to be. If I put my mind to it, I can even imagine my never having existed at all.
But that is not the way God is, according to Anselm. Unlike ourselves, God can only be conceived as being without beginning and without end, as being ‘inoriginate’ and ‘imperishable’; that is, as being necessary in one mediaeval sense of that term. In chapter 22 of the Proslogion, Anselm hymns his God:
You are that being who exists truly and simply, because you neither were nor will be but always already are, nor can you be thought not to be at any time. And you are life and light, wisdom and blessedness, eternity and many other such good things, indeed you yourself are nothing other than the one and highest good, entirely sufficient to yourself, needing nothing, but he whom all things need for their being and well-being.
Philosophers have tended to discuss theistic proofs (and theistic disproofs) largely in abstraction from their specific roles within the religious traditions in which those proofs were cultivated and in which, until modern times, they flourished. As a result, the traditional theistic proofs of the West are generally presented in the philosophical literature as no more than (failed) attempts to demonstrate or within tolerable limits to establish the probability of the existence of at least one god. Whatever the history of philosophy may suggest, the history of religions shows that theistic proofs have been developed from a variety of motives and have been employed to a variety of ends, only one of which is to persuade someone not already so inclined to believe that god/s exist. Indeed, this latter purpose is fairly subsidiary in the history of religions. A survey of the place and roles of theistic proofs and disproofs within a range of religious traditions, Eastern as well as Western, suggests that in the main they were used to serve intra-traditional ends. Their principal function seems to have been more nearly explanatory than justificatory. Even when they aimed them outside the tradition and used them to apologetic ends, purveyors of the proofs tended to assume prior belief in god/s on the part of their intended audience.
I
The specifically religious significance of theistic proofs has been too little explored in recent philosophy of religion.