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John R. Schneider explores the problem that animal suffering, caused by the inherent nature of Darwinian evolution, poses to belief in theism. Examining the aesthetic aspects of this moral problem, Schneider focuses on the three prevailing approaches to it: that the Fall caused animal suffering in nature (Lapsarian Theodicy), that Darwinian evolution was the only way for God to create an acceptably good and valuable world (Only-Way Theodicy), and that evolution is the source of major, God-justifying beauty (Aesthetic Theodicy). He also uses canonical texts and doctrines from Judaism and Christianity - notably the book of Job, and the doctrines of the incarnation, atonement, and resurrection - to build on insights taken from the non-lapsarian alternative approaches. Schneider thus constructs an original, God-justifying account of God and the evolutionary suffering of animals. His book enables readers to see that the Darwinian configuration of animal suffering unveiled by scientists is not as implausible on Christian theism as commonly supposed.
Comparisons of antipsychotics with placebo can be biased by unblinding due to side effects. Therefore, this meta-analysis compared the efficacy of antipsychotics for acute schizophrenia in trials using barbiturates or benzodiazepines as active placebos.
Randomized controlled trials (RCTs) in acute schizophrenia with at least 3 weeks duration and comparing any antipsychotic with barbiturates or benzodiazepines were eligible. ClinicalTrials.gov, CENTRAL, EMBASE, MEDLINE, PsycINFO, PubMed, WHO-ICTRP as well as previous reviews were searched up to 9 January 2018. Two separate meta-analyses, one for barbiturates and one for benzodiazepines, were conducted using random-effects models. The primary outcome was response to treatment, and mean values of schizophrenia rating scales and dropouts were analyzed as secondary outcomes. This study is registered with PROSPERO (CRD42018086263).
Seven barbiturate-RCTs (number of participants n = 1736), and two benzodiazepine-RCTs (n = 76) were included in the analysis. The studies were published between 1960 and 1968 and involved mainly chronically ill patients. More patients on antipsychotics in comparison to barbiturates achieved a ‘good’ response (36.2% v. 16.8%; RR 2.15; 95% CI 1.36–3.41; I2 = 48.9) and ‘any’ response (57.4% v. 27.8%; RR 2.07; 95% CI 1.35–3.18; I2 = 68.2). In a single small trial (n = 60), there was no difference between antipsychotics and benzodiazepines on ‘any’ response (74.7% v. 65%; RR 1.15; 95% CI 0.82–1.62).
Antipsychotic drugs were more efficacious than barbiturates, based on a large sample size. Response ratios were similar to those observed in placebo-controlled trials. The results on benzodiazepines were inconclusive due to the small number of studies and participants.
In recent years, the discovery of massive quasars at
has provided a striking challenge to our understanding of the origin and growth of supermassive black holes in the early Universe. Mounting observational and theoretical evidence indicates the viability of massive seeds, formed by the collapse of supermassive stars, as a progenitor model for such early, massive accreting black holes. Although considerable progress has been made in our theoretical understanding, many questions remain regarding how (and how often) such objects may form, how they live and die, and how next generation observatories may yield new insight into the origin of these primordial titans. This review focusses on our present understanding of this remarkable formation scenario, based on the discussions held at the Monash Prato Centre from November 20 to 24, 2017, during the workshop ‘Titans of the Early Universe: The Origin of the First Supermassive Black Holes’.
We present two spanwise-localized travelling-wave solutions in the asymptotic suction boundary layer, obtained by continuation of solutions of plane Couette flow. One of the solutions has the vortical structures located close to the wall, similar to spanwise-localized edge states previously found for this system. The vortical structures of the second solution are located in the free stream far above the laminar boundary layer and are supported by a secondary shear gradient that is created by a large-scale low-speed streak. The dynamically relevant eigenmodes of this solution are concentrated in the free stream, and the departure into turbulence from this solution evolves in the free stream towards the walls. For invariant solutions in free-stream turbulence, this solution thus shows that the source of energy of the vortical structures can be a dynamical structure of the solution itself, instead of the laminar boundary layer.
The star has to go on radiating and radiating and contracting and contracting until, I suppose, it gets down to a few km. radius, when gravity becomes strong enough to hold in the radiation, and the star can at last find peace. Dr. Chandrasekhar had got this result before, but he has rubbed it in in his latest paper; and, when discussing it with him, I felt driven to the conclusion that this was almost a reductio ad absurdum of the relativistic degeneracy formula.
(A. S. Eddington )
The emphasis of this chapter is on four parts of relativistic astrophysics in which general relativity plays a fundamental role. After briefly reviewing the early history of the subject, we discuss
The structure and stability of relativistic stars
Observational evidence for black holes
General relativistic astrophysics encompasses a broader arena, and separate chapters or parts of chapters in this volume are devoted to cosmology, gravitational waves, the inspiral and merger of compact binaries, and black-hole stability.
Relativistic astrophysics began in 1916 on the Russian front, where Karl Schwarzschild wrote two papers, one reporting the solution to the Einstein equation for an incompressible spherical star, the other presenting the celebrated vacuum Schwarzschild spacetime. Schwarzschild was dead within the year, and for the next 47 years his solutions had a twilight existence. In no known stars did general relativity play a significant role, and only a handful of papers in astronomy or astrophysics mentioned the work.
Although sparsely distributed, the exceptions to this neglect were remarkable. In 1931, shortly before Chadwick's discovery of the neutron and shortly after the first paper by Chandrasekhar  (following approximate computations by Anderson  and Stoner  on an upper mass limit of white dwarfs, Landau  submitted a paper that independently argued that there was an upper limit on the mass of a collection of degenerate fermions and speculated on the existence of stars with cores of nuclear density.
The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective.
To critically evaluate how the NHS works with care homes.
A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose.
Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient.
Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population. Clinical commissioners seeking to improve the quality of care of care home residents need to consider how best to provide fair access to health care for older people living in a care home, and to establish a specification for service delivery to this vulnerable population.
Background: Despite ongoing policy debate, little is known about the growth in orthopedic surgery practices with onsite magnetic resonance imaging (MRI) capacity, or practice characteristics associated with the acquisition of in-office MRI equipment.
Methods: In July 2012, American Academy of Orthopaedic Surgeons (AAOS) member practices received a web-based survey requesting general information about their practice, such as number practice providers authorized to order MRIs, the type of onsite MRI capacity present (if any), and the date of acquisition for the MRI equipment. Survey responses were augmented with county-level measures of practice area characteristics as of the year of first onsite MRI acquisition (or 2012 for practices without an onsite MRI).
Results: The survey obtained usable responses from 740 orthopedic practices, which were geographically representative of AAOS member practices. Forty percent (298) reported onsite MRI capacity. Onsite MRI acquisition occurred at a steady pace over 2000–2012, with no dramatic increase occurring in any particular year over that period. Multivariate logistic regression indicated that practice size (number of providers) was the most important factor affecting the likelihood of onsite MRI acquisition. There was no association between onsite MRI acquisition and any of the county-level practice area characteristics included in the analysis.
Conclusions: Orthopedic practices acquiring onsite MRI equipment on average are much larger than practices without onsite MRI capacity. Larger practices may be more likely to attain the economies of scale necessary to absorb the fixed costs associated with onsite MRI acquisition.
The Enlightenment took enormous interest in a wide variety of religious topics: the existence of God, the problem of evil, the meaning of revelation, ecclesiastical authority, the status of scripture, religious tolerance, and immortality. This last issue is particularly important as one of the essential components, along with the existence of a moral God, of a “natural” theology that could be fully derived or endorsed by reason. Furthermore, reflection on immortality plays directly into the urgent discussions in the eighteenth century about autonomy, freedom, and progress; the way one envisions a hereafter profoundly reflects and legitimates the way one envisions life in the present. This fluidity between an understanding of the here and the hereafter is perfectly captured in Johann Joachim Spalding's extremely influential Bestimmung des Menschen (1748; The Vocation of Man), which envisions immortality as a process of ever increasing rational pleasure and self-perfection—goals not at all unfamiliar to the mortals of the Enlightenment.
Johann Gottfried Herder is a central and in some ways transitional voice in this public discussion of man's immortal Bestimmung. In the early 1769 letters to Mendelssohn he espoused a model of nonprogressive palingenesis, in which the soul is endlessly reborn within the same class of being without undergoing any overarching development. There is, in short, no personal, angelic afterlife. Compared to the essentially Christian afterlife of the rationalist Popularphilosophen of Herder's day, this position was quite austere.
“Classicism” and “secular humanism” seems an obvious combination: Goethe, the great pagan, substituted a generalized ethic of humanity (taken in its broadest possible religio-ethical and aesthetic sense) as the social glue that replaced the function of sectarian religion in post-Enlightenment secularized Europe. He offered a heightened version of Enlightenment culture and reason that obviated the need for religion. Through World War I his name alone evoked an entire system of ethics, aesthetics, and even epistemology among writers as disparate as Adalbert Stifter, Wilhelm Raabe, Theodor Fontane, Hugo von Hofmannsthal; and scholars such as the psychoanalytic generation, Hannah Arendt, Norbert Elias, Oswald Spengler; and philosophers such as Benedetto Croce and José Ortega y Gasset. My subtitle reveals the underlying schism— “sanctification” is a religious term; Die Zauberflöte (The Magic Flute), a hangover of the particularly secular and disrespectful Enlightenment associated with the French Revolution; and the “Novelle,” a charming, respectable, Biedermeier idyll. The Goethe cult that substituted German classicism for religion was, for better or worse, not interested in the Goethe of the 1820s, except for his conversations with Eckermann; “the late Goethe,” or, as I would have it, “the Biedermeier Goethe,” offers, however, a more mature, richer classicism, indeed a sanctified classicism.
Sed omnia praeclara tam diffidila, quam rara sunt.
[For all excellent things are as difficult as they are rare.]
The Revolutionary Rhizome
All eyes, it would seem, are on Spinoza at the moment. Much of the credit for this remarkable renaissance is due to Gilles Deleuze, who wrote two books on Spinoza, and then went even further in his best-selling manifesto What Is Philosophy?, anointing Spinoza both the “prince” and the “Christ” of philosophy. And Deleuze is hardly alone in his attentions. Spinoza now looms large in our understanding of the entire Age of Goethe. The controversy over Spinoza still figures as a minor flap in Lewis White Beck's classic history, Early German Philosophy; but it has become the defining intellectual controversy of the whole age since the publication of Frederick Beiser's influential study The Fate of Reason in 1987. Further, over the past decade, the intellectual historian Jonathan Israel has published three massive tomes asserting that, basically, every significant thinker of the Enlightenment was a closet Spinozist. Skepticism may be in order: on Wall Street, this latest development would be read as a “contrary indicator,” signaling a market top. But the centrality of the Spinozastreit (Spinoza controversy) clearly means that we have to understand both the extent and the import of Spinoza's influence on the Age of Goethe. And the centrality of Spinoza to contemporary discourse is beyond doubt; somehow, he figures in everyone's equations.
When it comes to religion, Goethe's reputation is anything but spotless. Heinrich Heine famously referred to Goethe as “der große Heide” (the great heathen). August Wilhelm Schlegel took this one step further when he called Goethe “einen zum Islam bekehrten Heiden” (a heathen who converted to Islam). Wolfgang Frühwald points out that in an altar painting by Konrad Eberhard for the St. Clara Hospital in Basel, Goethe is grouped with the heathens who cannot be converted by St. Paul. Similarly, Prince Metternich opposed the creation of a Goethe monument because of Goethe's spotty record on religion, declaring that we should not “dem Andenken eines Mannes zu große Ehre … erweisen, der ersichtlich seines religiösen Bekenntnisses nicht ohne Anstoß gewesen sei” (pay too much tribute to the memory of a man whose religious creed was not inoffensive). Finally, Romano Guardini, in a letter to Ernst Beutler, summed it up when he declared that Goethe had done more harm to Christianity than even Nietzsche (Perels 28).
Though these claims are surely inflated, they are not wholly unfounded. In the following, I will provide a brief overview over Goethe's stance on religion. I then contrast Goethe's views with those introduced in Kant's “Die Religion innerhalb der Grenzen der bloßen Vernunft” (1793; Religion within the Limits of Reason Alone). Here, I pay particular attention to the role both thinkers assign to the concepts of sensuality and the body.
Es ist ein armseliges kleinliches Ideal, für eine Nation zu schreiben.
[It is a pathetic, petty ideal to write for only one nation.]
—Schiller's letter to Körner of 13 October 1789
By 1788, Friedrich schiller (1759-1805) could look back on nearly a decade of blasphemous production regarding prophets, priests, and organized religion. In 1789, after several years of assaulting the negative social and political functions of Jesus Christ and Christianity, Schiller, then a professor of history, turned his attention to the Hebrew prophet Moses in the lecture “Die Sendung Moses” (The Mission of Moses or The Legation of Moses), delivered at the University of Jena in the summer of 1789 and published in Schiller's journal Thalia in 1790. In light of recent charges of blasphemy (and—in an insightless or disingenuous smear attempt—polytheism) inspired by his poem “Die Götter Griechenlandes” (The Gods of Ancient Greece) in 1788, Schiller's Moses essay comprises both a response to the charges and an articulation of his earlier criticisms of religion. In the Moses essay, Schiller moves beyond the concerns of the political misuses of and intellectual detours posed by Christianity in contemporary European states to an explanation of the original paradigmatic political purposes of religion and the initial civilizing effect of monotheism as a step toward a constitution based on reason for all humankind.
O meine Freunde, warum sollten wir scharfsinniger als Leibnitz … scheinen wollen…?
[O my friends, why should we try to appear more sharp-witted than Leibniz…?]
—Gotthold Ephraim Lessing, “Leibnitz von den ewigen Strafen”
[Leibniz] ein materieller Idealist von der subtileren Art… [a most subtle materialist Idealist…]
—Jacobi, Über die Lehre des Spinoza in Briefen
In chapter 10 of The Romantic Imperative, “Religion and Politics in Frühromantik,” Frederick Beiser argues for the significance of Herder in the crucial process of reinterpreting Spinoza at the end of the eighteenth century in Germany. Specifically, Herder's 1787 Gott: Einige Gespräche (God: Some Dialogues) introduced a “vitalistic” reading of Spinoza and “self-consciously fuse[d] him with his great metaphysical contemporary: Leibniz.” However, besides another brief mention of Herder's belief in “combining Spinoza's monism and naturalism with Leibniz's vitalism” (182), Leibniz falls out of Beiser's story. In Beiser's earlier Fate of Reason Leibniz suffers the same fate, disappearing in the excellent and gripping tale of the so-called Pantheism controversy around Spinoza. Given the weight of Beiser's account, this essay undertakes what many a novel has done with, say, Jane Austen or Gone with the Wind, namely, a shift in focus onto a minor or at least somewhat neglected character in order to let Leibniz emerge from the immense shadow cast by Spinoza.