California has focused on health equity in the state’s COVID-19 reopening plan. The Blueprint for a Safer Economy assigns each of California’s 58 counties into 1 of 4 tiers based on 2 metrics: test positivity rate and adjusted case rate. To advance to the next less-restrictive tier, counties must meet that tier’s test positivity and adjusted case rate thresholds. In addition, counties must have a plan for targeted investments within disadvantaged communities, and counties with more than 106 000 residents must (...) meet an equity metric. California's explicit incorporation of health equity into its reopening plan underscores the interrelated fate of its residents during the COVID-19 pandemic and creates incentives for action. This article evaluates the benefits and challenges of this novel health equity focus, and outlines recommendations for other US states to address disparities in their reopening plans. (shrink)

Mental health care providers increasingly confront challenges posed by the introduction of new neurotechnology into the clinic, but little is known about the impact of such capabilities on practice patterns and relationships with patients. To address this important gap, we sought providers’ perspectives on the potential clinical translation of functional neuroimaging for prediction and diagnosis of mental illness. We conducted 32 semi-structured telephone interviews with mental health care providers representing psychiatry, psychology, family medicine, and allied mental health. Our results suggest (...) that mental health providers have begun to re-conceptualize mental illness with a neuroscience gaze. They report an epistemic commitment to the value of a brain scan to provide a meaningful explanation of mental illness for their clients. If functional neuroimaging continues along its projected trajectory to translation, providers will ultimately have to negotiate its role in mental health. Their perspectives, therefore, enrich bioethical discourse surrounding neurotechnology and inform the translational pathway. (shrink)

Concussion is a form of traumatic brain injury that has been defined as a “trauma-induced alteration in mental status that may or may not involve loss of consciousness.” Terms such as getting a “ding” or getting your “bell rung” are sometimes used as colloquialisms for concussion, but inappropriately downplay the seriousness of the injury. It is estimated that between 1.6 and 3.8 million concussions occur annually in the United States as a result of participation in sports or recreational activities. To (...) date, there are no objective, biological markers for concussion; rather, the current diagnosis of concussion is dependent upon symptom reporting by the athlete. In the acute phase, concussions can result in a broad spectrum of symptoms that can be transient or last for days, weeks, or even months. Symptom prolongation is generally referred to as post-concussion syndrome. (shrink)

Las clases virtuales son una modalidad de estudio a distancia que ha sido aplicadas por más de 10 años. Son utilizadas principalmente en universidades para abarcar las necesidades de sus estudiantes que no pueden acceder al sistema presencial. Al encontrarnos en una emergencia sanitaria por el COVID-19, la aplicación de las clases virtuales alrededor del mundo se volvió una obligación para precautelar la vida de los estudiantes. Es por esto que la población universitaria tuvo que adaptarse a nuevas condiciones de (...) estudio como: las clases, trabajos y exámenes en línea con el fin de no detener su aprendizaje. Sin duda, esto desencadenó inconformidades e inquietudes al estudiar por primera vez bajo esta modalidad. En este trabajo se evaluó la satisfacción sobre clases virtuales tomadas el primer semestre del 2020 a estudiantes de la carrera de Ingeniería Industrial de la Universidad de las Américas con edades entre 18 a 20 años. Para ello se realizó una encuesta de 15 ítems los cuales evaluaron las distintas condiciones que se presentaron en las clases virtuales durante el periodo de pandemia, con datos validados por un alfa de Cronbach 0,92. En este trabajo se obtuvo como resultado que gran parte de las personas encuestadas aprobó el software aplicado para la realización de las clases virtuales debido a que es una herramienta de uso intuitivo y de fácil acceso, por otro lado, están en desacuerdo con la modalidad de evaluación del conocimiento adquirido. Palabras Clave: Clases virtuales, Satisfacción estudiantil, COVID-19, TIC’s. Referencias [1]K. Brandl, «Are you ready to Moodle?,» Language Learning & Technology, vol. 9, nº 2, pp. 16-23, 2005. [2]C. Belloch, «Entornos virtuales de aprendizaje,» Universidad de Valencia, vol. 1, nº 1, pp. 1-3, 2012. [3]J. Jarrín, «Informe Nacional: Ecuador,» Universa, Quito, 2016. [4]M. Reeves. y T. Barbour, «The reality of virtual schools: A review of the literature,» Computers & Education, vol. 52, nº 10, pp. 402-416, 2009. [5]C. Bonfill, «Clases virtuales a través de videoconferencias: factores críticos vivenciados por los tutores en un sistema de educación a distancia.,» Temas de Managment, vol. 5, nº 2, pp. 12-20, 2007. [6]A. García, M. Mediavilla y A. Casares, «Evaluación entre iguales en entornos de edcucación superior online mediante el taller Moodle,» A case study, vol. 13, nº 2, pp. 119-126, 2020. [7]R. Bendezu, A. Quijuano, H. Rebatta y G. Gutierrez, «Aprendizaje en tiempos de aislamiento social: cursos masivos abiertos en línea sobre la COVID-19,» vol. 37, nº 2, pp. 375-277, 2020. [8]M. Bautista y R. Torres, «El uso de material didáctico y las tecnologías de la información y comunicación para mejorar el alcance académico,» Ciencia y tecnología, nº 14, 2014. [9]G. Gutierrez, P. Krystell, C. Zarate, I. Juarez. y M. López, «Uso de tecnologías de la información en el rendimiento académico basado en una población de estudiantes de Medicina,» Educ Med Super, vol. 31, nº 2, pp. 23-34, 2017. [10]A. Rodrífuez, B. González y J. Fariñas, «Simulaciones virtuales como complemento de las clases y los laboratorios de Física. Ejemplos en la carrera de Ingeniería en Telecomunicaciones y Electrónica.,» Latin-American Journal of Physics Education, vol. 7, nº 4, pp. 16-20, 2013. (shrink)

This letter to the editor responds to commentaries in the September‐October 2021issue of the Hastings Center Report by Douglas B. White and Bernard Lo, by Govind Persad, and by Virginia A. Brown, which were themselves responding, in part, to the article “Life‐Years and Rationing in the Covid‐19 Pandemic: A Critical Analysis,” by MaryKatherine Gaurke, Bernard Prusak, Kyeong Yun Jeong, Emily Scire, and Daniel P. Sulmasy.

Gender representations reproduce and legitimate gender systems. To examine this aspect of the gendered social order, we analyze the representation of males and females in the titles and central characters of 5,618 children’s books published throughout the twentieth century in the United States. Compared to females, males are represented nearly twice as often in titles and 1.6 times as often as central characters. By no measure in any book series are females represented more frequently than males. We argue that these (...) disparities are evidence of symbolic annihilation and have implications for children’s understandings of gender. Nevertheless, important differences in the extent of the disparity are evident by type of character, book series, and time period. Specifically, representations of child central characters are the most equitable and animals the most inequitable; Little Golden Books contain the most unequal representations; and the 1930s-1960s—the period between waves of feminist activism—exhibits greater disparities than earlier and later periods. Examining multiple types of books across a long time period shows that change toward gender equality is uneven, nonlinear, and tied to patterns of feminist activism and backlash throughout the century. (shrink)

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...) describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. (shrink)

Research has demonstrated beneficial effects of acute exercise on memory for neutral materials, such as word lists of neutral valence/low arousal. However, the impacts of exercise on emotional memory is less understood. Across three laboratory experiments in college students, we tested if acute exercise could enhance both neutral and emotional memory performance, anticipating a greater effect for emotional memory. We examined effects of exercise at varying intensities (Experiment 1: high-intensity; Experiment 2: low- and high-intensity; Experiment 3: moderate-intensity), of diverse modalities (...) (Experiment 1: treadmill jogging; Experiment 2: cycling; Experiment 3: open-skill (racquetball) and closed-skill (treadmill jogging) exercise), and on emotional memory performance assessed at increasing levels of hippocampal dependency (Experiment 1: Y/N recognition task; Experiment 2: paired-associative recognition task; Experiment 3: cued-recall task). We found that, in all experiments, acute exercise did not significantly influence emotional or neutral memory performance relative to sedentary control conditions. However, we observed several noteworthy outcomes indicating that acute exercise may be linked to improvements in memory confidence and accuracy for central aspects of emotional memory stimuli, and that select exercise modalities (e.g. treadmill exercise) may also be associated with increased frequency of memory intrusions. (shrink)

Using Madison Powers and Ruth Faden's definition of ‘well‐being,’ the authors argue that Israel, the international community and public health practitioners have a justice‐based obligation to assist the Palestinian people in the Occupied Palestinian Territories. Focusing on Palestinians in Gaza, the authors first outline a normative framework of justice, as articulated by Powers and Faden. Following Powers and Faden's assumption that empirical assessments of justice can be made using the six dimensions of well‐being, the authors next present current data on (...) the living conditions in Gaza and describe how these conditions prevent residents from achieving sufficient levels of well‐being. Using these indicators to demonstrate that Palestinians living in Gaza suffer deficiencies in these dimensions of well‐being, the authors present a strong argument from justice to assist the residents of Gaza. The medical, public health, and bioethics community cannot sit idle while injustice continues. (shrink)

The purpose of this multi-study article was to investigate the roles of adaptability and social support in predicting a variety of psychological outcomes. Data were collected from Year 12 college students, university students, and non-studying members of the general public. Findings showed that, beyond variance attributable to social support, adaptability made a significant independent contribution to psychological wellbeing and psychological distress across all studies. Beyond the effects of adaptability, social support was found to make a significant independent contribution to most (...) wellbeing outcomes. In a multi-group analysis comparing predictors of psychological wellbeing in university students and non-studying adults, where the same outcome measures were used, it was found that adaptability played a stronger role for university students, whereas social support played a stronger role for non-studying adults. Finally, there was no evidence of an interaction between adaptability and social support predicting psychological outcomes—adaptability and social support operated as independent main effects. These findings demonstrate the importance of adaptability and social support in uniquely predicting psychological wellbeing in different sample groups. It is argued here that these two factors, should be given greater consideration in discussions of psychological wellbeing, and are relevant to psychological wellbeing at different major developmental life stages. (shrink)

BackgroundThe ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines are widely endorsed but compliance is limited. We sought to determine whether journal-requested completion of an ARRIVE checklist improves full compliance with the guidelines.MethodsIn a randomised controlled trial, manuscripts reporting in vivo animal research submitted to PLOS ONE (March–June 2015) were randomly allocated to either requested completion of an ARRIVE checklist or current standard practice. Authors, academic editors, and peer reviewers were blinded to group allocation. Trained reviewers performed outcome adjudication (...) in duplicate by assessing manuscripts against an operationalised version of the ARRIVE guidelines that consists 108 items. Our primary outcome was the between-group differences in the proportion of manuscripts meeting all ARRIVE guideline checklist subitems.ResultsWe randomised 1689 manuscripts (control: n = 844, intervention: n = 845), of which 1269 were sent for peer review and 762 (control: n = 340; intervention: n = 332) accepted for publication. No manuscript in either group achieved full compliance with the ARRIVE checklist. Details of animal husbandry (ARRIVE subitem 9b) was the only subitem to show improvements in reporting, with the proportion of compliant manuscripts rising from 52.1 to 74.1% (X2 = 34.0, df = 1, p = 2.1 × 10−7) in the control and intervention groups, respectively.ConclusionsThese results suggest that altering the editorial process to include requests for a completed ARRIVE checklist is not enough to improve compliance with the ARRIVE guidelines. Other approaches, such as more stringent editorial policies or a targeted approach on key quality items, may promote improvements in reporting. (shrink)

Cognitively engaging physical activity has been suggested to have superior effects on cognition compared to PA with low cognitive demands; however, there have been few studies directly comparing these different types of activities. The aim of this study is to compare the cognitive effects of a combined physically and cognitively engaging bout of PA to a physical or cognitive activity alone in children. Children were randomized in pairs to one of three 20-min conditions: a cognitive sedentary activity; a non-cognitively engaging (...) PA; and a cognitively engaging PA. Executive function was assessed using a modified Eriksen flanker task immediately before and 10–15 min following the experimental condition. Children ages 6–8 years were included in the study. A repeated measures ANOVA found no significant difference between groups with respect to scores on the flanker task. The results do not support the hypotheses that a cognitively engaging bout of PA enhances cognitive performance over non-cognitively engaging PA or sedentary activities. Possible explanations for our findings include overexertion during the acute bout of PA and depletion of positive affect prior to performing the post-intervention EF tasks. (shrink)

O século XVIII é considerado uma época em que o método de pesquisa newtoniano está bem estabelecido e o seu uso não é questionado, segundo autores como Kuhn. No entanto, como veremos, isso está longe da realidade, pois aqui propomos os seguintes dois objetivos: por um lado, observaremos como dentro dos próprios autores chamados newtonianos não há um uso uniforme do método newtoniano e que alguns deles até o modificam em suas obras onde expõem a doutrina de Newton. Por outro (...) lado, exporemos o método de Émilie du Châtelet, que, tendo lido Newton e esses pensadores, rejeita a metodologia que eles propõem e se prepara para elaborar o que pode ser considerado um precedente do método hipotético-dedutivo utilizado hoje. Em última análise, o objetivo deste estudo é lançar luz sobre a situação do newtonianismo no século XVIII e mostrar a obra de du Châtelet como uma ponte entre duas épocas em relação à metodologia. (shrink)

Daniel Sennert , a prominent physician and a prolific and influential writer, was both an atomist and an Aristotelian. He was influenced by a distinctive and now little known Aristotelian approach to matter and form, and this promoted his development over time of a hierarchical account of atoms, with elementary atoms and grades of molecules. The first section provides a study of Sennert's Aristotelian foundation. The final two sections consider, in turn, Sennert's development over time of an atomistic theory, and (...) the nature and significance for him of substantial forms. (shrink)

Wayfinding is defined as the ability to learn and remember a route through an environment. Previous researchers have shown that young children have difficulties remembering routes. However, very few researchers have considered how to improve young children's wayfinding abilities. Therefore, we investigated ways to help children increase their wayfinding skills. In two studies, a total of 72 5-year olds were shown a route in a six turn maze in a virtual environment and were then asked to retrace this route by (...) themselves. A unique landmark was positioned at each junction and each junction was made up of two paths: a correct path and an incorrect path. Two different strategies improved route learning performance. In Experiment 1, verbally labeling on-route junction landmarks during the first walk reduced the number of errors and the number of trials to reach a learning criterion when the children retraced the route. In Experiment 2, encouraging children to attend to on-route junction landmarks on the first walk reduced the number of errors when the route was retraced. This was the first study to show that very young children can be taught route learning skills. The implications of our results are discussed. (shrink)

Supporting children to successfully transition from primary to secondary school is of utmost importance for several reasons, including to prevent future emotional and behavioural problems. Level Up is a novel, UK-based intervention consisting of five online group sessions, straddling the summer holidays, and providing at-risk children and their parents/carers with skills to manage their behaviour, emotions, and relationships to support their transition to secondary school. A prior evaluation of Level Up reported a need to better describe the mechanisms of change. (...) This study therefore evaluated the experiences of children and their parents/carers regarding the facilitators and barriers to engagement and change, and the perceived impact. Fourteen children and 17 parents/carers were interviewed. Identified barriers and facilitators were: (1) Having a safe, supportive, and fun space, (2) Learning through connection, (3) A family approach, (4) Problematic group dynamics, and (5) Connecting through video calls. Perceived impact was described as: (1) Empowering children, (2) Supporting children socially, (3) Supporting parents and carers in their parenting role, and (4) Supporting a successful transition to secondary school. Another theme (5) describes some families’ experiences of limited impact. These findings can be used to better understand how to support children in their school transition. (shrink)

A one-of-a-kind reference to the international vocabulary of the humanities This is an encyclopedic dictionary of close to 400 important philosophical, literary, and political terms and concepts that defy easy—or any—translation from one language and culture to another. Drawn from more than a dozen languages, terms such as Dasein (German), pravda (Russian), saudade (Portuguese), and stato (Italian) are thoroughly examined in all their cross-linguistic and cross-cultural complexities. Spanning the classical, medieval, early modern, modern, and contemporary periods, these are terms that (...) influence thinking across the humanities. The entries, written by more than 150 distinguished scholars, describe the origins and meanings of each term, the history and context of its usage, its translations into other languages, and its use in notable texts. The dictionary also includes essays on the special characteristics of particular languages—English, French, German, Greek, Italian, Portuguese, Russian, and Spanish. Originally published in French, this one-of-a-kind reference work is now available in English for the first time, with new contributions from Judith Butler, Daniel Heller-Roazen, Ben Kafka, Kevin McLaughlin, Kenneth Reinhard, Stella Sandford, Gayatri Chakravorty Spivak, Jane Tylus, Anthony Vidler, Susan Wolfson, Robert J. C. Young, and many more.The result is an invaluable reference for students, scholars, and general readers interested in the multilingual lives of some of our most influential words and ideas. Covers close to 400 important philosophical, literary, and political terms that defy easy translation between languages and cultures Includes terms from more than a dozen languages Entries written by more than 150 distinguished thinkers Available in English for the first time, with new contributions by Judith Butler, Daniel Heller-Roazen, Ben Kafka, Kevin McLaughlin, Kenneth Reinhard, Stella Sandford, Gayatri Chakravorty Spivak, Jane Tylus, Anthony Vidler, Susan Wolfson, Robert J. C. Young, and many more Contains extensive cross-references and bibliographies An invaluable resource for students and scholars across the humanities. (shrink)

Personification has received little philosophical attention, but Daniel Nolan has recently argued that it has important ramifications for the relationship between fictional representation and possibility. Nolan argues that personification involves the representation of metaphysically impossible identities, which is problematic for anyone who denies that fictions can have impossible content. We develop an account of personification which illuminates how personification enhances engagement with fiction, without need of impossible content. Rather than representing an identity, personification is something that is done with representations—a (...) matter of use rather than content—and involves only a comparison of possibilities. We illustrate our account using the personification of death in the film Meet Joe Black, and show that there are no grounds for taking it to be fictionally true that there is a metaphysically impossible identity between Death and death. (shrink)

Michelle Maiese: Trauma, dissociation, and relational authenticity; Caroline Christoff: Performative trauma narratives: Imperfect memories and epistemic harms; Aisha Qadoos: Ambiguous loss: A loved one's trauma; Alberto Guerrero Velázquez: El trauma está en la respuesta. Hacia una visión post-causal en la definición de trauma psicológico; Clarita Bonamino, Sophie Boudrias, and Melanie Rosen: Dreams, trauma, and prediction errors; Gabriel Corda: Memoria episódica y trastorno de estrés postraumático en animales no humanos: una propuesta metodológica; María López Ríos, Christopher Jude McCarroll, and Paloma Muñoz (...) Gómez: Memory, mourning, and the Chilean constitution; Sergio Daniel Rojas-Sierra, and Tito Hernando Pérez Pérez: Subjetividades rememorantes, marcas narrativas y trauma cultural en la construcción de memoria de desmovilizados de las FARC-EP en el AETCR Pondores; Germán Bonanni: Y después de la guerra... ¿Qué? (shrink)

People in an emotional exchange form a temporal interpersonal emotion system (TIES), in which their emotions are interconnected over time (Butler, 2011). These systems can be in various states, defined by the pattern of emotional interconnections. We have defined coregulation as one such state involving coupled dampened oscillations between partners’ emotions that converge on a stable level. Coregulation could be distinguished from other states, such as stress buffering, by comparing statistical models that represent the theoretical distinctions between states. Optimal data (...) for such modeling includes assessments of both partners’ emotions over time and a contrast between securely attached partners, strangers, and being alone. Research of this sort is needed to uncover the mechanisms by which emotional interdependence promotes well-being. (shrink)

This groundbreaking interactive book contains the tools that you will need in order to clean your emotional house from top to bottom. It includes a journal as well as access to audio meditations for you to listen along to as you read. The meditations will help you dig deep into past trauma and discover when and how trauma took root, learn to get in touch with various parts of the physical and energy body, and how to use them to let (...) go of stored traumas. From this, you will learn to live from a new mindful and powerful space. (shrink)

The Covid-19 pandemic elevated global attention to the complex problem of allocating and disseminating newly approved vaccines. Following early calls for vaccine equity,1 global health leaders made progress but struggled to fully realize distribution goals.2 With respect to vaccination rates, low and middle income countries have not achieved full parity with high income countries.3 In this issue, Harmon, Kholina, and Graham follow longstanding critiques of market-based vaccine procurement to propose “legal and practical solutions for realizing a new access to vaccines (...) environment”4 that will, they suggest, further the goal of global health justice. (shrink)

During spring of 2020, environmental ethics students at a medium sized metropolitan university in the Southeastern United States were asked to read and comment on classic essays from Robert Heilbroner and Garrett Hardin, essays regarding our responsibilities towards future generations. In general, students seemed to hold more with Heilbroner’s stance, which left room for compassion, while condemning Hardin’s harshness. Students were then asked to provide written responses stating whether they would personally sacrifice their eventual retirement in order to stop COVID-19 (...) and the reasons for their views. Responses were analyzed and categorized to detect inconsistencies between students’ described views and their willingness to personally sacrifice for the sake of others. Almost 72% of respondents asserted that they would be willing to intervene to stop the novel coronavirus by sacrificing their retirement. A fair number of respondents that stated they would sacrifice said that they would do so because they would benefit personally from the avoidance of guilt and/or from the opportunity to feel good about themselves, suggesting that even seemingly selfless behaviors are sometimes driven by egoistic motivations. Forty percent of all respondents held inconsistent views. Most notably, a number of students condemned Hardin for his lack of compassion, yet were not willing to act compassionately themselves. (shrink)

Discourse on communities and aging traditionally has focused on the availability, accessibility, and quality of local services to support older adults in need of assistance. More recently, however, a growing worldwide “age‐friendly” movement has pushed the conceptualization of community supports for an aging society beyond service provision. The term “age friendly” is used in considering how various aspects of a community facilitate or impede the health and well‐being of individuals as they experience long lives.Frameworks on age friendliness include attention to (...) health and community services for older adults but also encompass other aspects of communities, such as the physical design of outdoor spaces and buildings, the diversity of mobility options for drivers and nondrivers alike, and the availability of safe, affordable, and various types of housing. Age‐friendly frameworks also highlight how the very social fabric of a community can influence older residents’ quality of life. Over the past decade, a growing number of cities and communities have launched age‐friendly initiatives as organized and comprehensive efforts to make localities better for residents as they age. This essay begins to explore how AFIs can address social inequalities in health and aging. It concludes by describing how embedding a spatial justice lens within age‐friendly efforts could help AFIs realize more fully the changes that they seek to create at the local, national, and global levels. (shrink)

Name der Zeitschrift: Archiv für Geschichte der Philosophie Jahrgang: 98 Heft: 8 Seiten: 1-20.

A decade after the ‘‘Sokal Hoax,’’ Alan Sokal and Paul Boghossian still claim that postmodern arguments are incoherent attacks on reason and truth. However, both also continue to mischaracterize ‘‘constructivist’’ epistemology, to engage in highly problematic logical gymnastics to defend their own views, and to ignore changes in philosophy of science and science studies since 1996. I offer a brief description of my own, rather different understanding of postmodern science criticism in order to contextualize my dissatisfaction with Sokal and Boghossian’s (...) arguments, and to highlight the value of cross-subfield anthropological collaboration based on the constructivist perspective articulated by Barbara Herrnstein Smith. Downloaded by [New York University] at 03:33 19 July 2011.. (shrink)

Public health agencies undertake a broad range of health promotion and injury and disease prevention activities in collaboration with an array of actors, such as the community, businesses, and non-profit organizations. These activities are “multisectoral” in nature and centered on public health agencies that oversee and engage with the other actors. Public health agencies can influence the hazardous activities in the private sector in a variety of ways, “ranging from prohibition and regulation to volunteerism, and from cooperation to cooption.” Hence, (...) a public health agency that possesses the necessary administrative resources and authority is vital to the effective implementation of health policies and regulations.In the developing world, however, many state health agencies lack these basic capacities in dealing with critical health threats, including their ability to avert epidemics of communicable diseases arising from poor sanitary conditions. A serious constraint is the shortage of public health funding for health agencies in the developing world for typical agency functions. This is often aggravated by the transaction-intensive demands entailed in enforcing regulations among an array of private and public sector actors including individuals, businesses, and local bodies responsible for providing civic services. (shrink)

Medical ethics assumes a clear boundary between clinical research and clinical medicine: one produces knowledge for the benefit of future patients, while the other provides optimal care to individuals right now. It also assumes that the two cannot be integrated without sacrificing the needs of the current patient to those of future patients. But integration could allow us to provide better care to everyone, now and in the future.

The rule of rescue describes the moral impulse to save identifiable lives in immediate danger at any expense. Think of the extremes taken to rescue a small child who has fallen down a well, a woman pinned beneath the rubble of an earthquake, or a submarine crew trapped on the ocean floor. No effort is deemed too great. Yet should this same moral instinct to rescue, regardless of cost, be applied in the emergency room, the hospital, or the community clinic? (...) -/- In health care, the desire to save lives at any cost must be reconciled with the reality of resource scarcity. As one example, the estimated cost for prophylactic Factor VIII to treat one patient with hemophilia for one year is $300,000. Costs of this magnitude have been accepted by public and private insurers in the developed world, even though, in principle, these sums could provide greater overall health benefit if allocated to pay for the unmet health care needs of many other patients. Looking forward, however, broad application of the rule of rescue will be increasingly untenable. But the moral instinct will remain: the desire to help those weakest among us, especially when their small numbers allow us to see them as unique individuals. What, then, is the ethical framework that can guide coverage and reimbursement decisions for orphan drugs into the future? (shrink)

At the time I wrote my original review (Schultz 2010) of the books by Sokal (2008), Boghossian (2006), and Smith (2006), I did not know that I would have the opportunity to reply to their responses to my review. Nevertheless, I value the occasion this offers to correct errors and respond to their commentary. Let me say, first of all, that Alan Sokal is quite correct in pointing out that the citation from Donna Haraway which I attribute to him is (...) incorrect. I realize now that I copied that version of the citation from an earlier working notes file for the review. I should have verified that the copied version was identical to the citation in the Beyond the Hoax text (Sokal 2008) before I sent off the review. That I did not do so is an error that I deeply regret, and for which I apologize. In line with this, I also apologize for, and retract, my observations in the review about the omitted passages in the citation, for which Sokal obviously was not responsible. So, does consideration of the full quotation by Donna Haraway in any way affect the rest of my critique? Not at all, as it happens, because the focus of the rest of my remarks is on the way Sokal treats this passage by Haraway. That is, he presents the excerpt to readers in isolation, and makes no effort to.. (shrink)

We argued last year in this journal that extensive integration of research and care is a worthy goal of health system design, and we second the call from Ruth Faden and colleagues to move toward learning health care systems. As they recognize, learning health care systems demand the coordination of research and medical ethics—two sets of normative commitments that have long been considered distinct. In offering a novel ethics framework for such systems, Faden et al. advance the scholarly debate about (...) how best to do this and challenge us to think more deeply about its practical implications. However, we believe that at least three issues they raise require additional attention. First, the research‐care distinction has more normative bite than they are willing to concede. Second, the role for independent oversight requires clarification. Finally, they neglect the concept of stewardship as a guiding obligation of learning health care systems. (shrink)