Cas9/guide RNA (gRNA)‐based gene drive systems are expected to play a transformative role in malaria elimination efforts., whether through population modification, in which the drive system contains parasite‐refractory genes, or population suppression, in which the drive system induces a severe fitness load resulting in population decline or extinction. DNA sequence polymorphisms representing alternate alleles at gRNA target sites may confer a drive‐resistant phenotype in individuals carrying them. Modeling predicts that, for observed levels of SGV at potential target sites and (...) observed rates of de novo DRA formation, population modification strategies are uniquely resilient to DRAs. We conclude that gene drives can succeed when fitness costs incurred by drive‐carrying mosquitoes are low enough to prevent strong positive selection for DRAs produced de novo or as part of the SGV and that population modification strategies are less prone to failure due to drive resistance. (shrink)

In this paper, a nonlinear dynamical system is proposed and qualitatively analyzed to study the dynamics and effects of HIV-malaria co-infection in the workplace. Basic reproduction numbers of sub-models are derived and are shown to have LAS disease-free equilibria when their respective basic reproduction numbers are less than unity. Conditions for existence of endemic equilibria of sub-models are also derived. Unlike the HIV-only model, the malaria-only model is shown to exhibit a backward bifurcation under certain conditions. Conditions for (...) optimal control of the co-infection are derived using the Pontryagin’s maximum principle. Numerical experimentation on the resulting optimality system is performed. Using the incremental cost-effectiveness ratio, it is observed that combining preventative measures for both diseases is the best strategy for optimal control of HIV-malaria co-infection at the workplace. (shrink)

Suicide is amongst the top ten causes of death for all age groups in most countries of the world. It is the second most important cause of death in the younger age group (15-19 yrs.) , second only to vehicular accidents. Attempted suicides are ten times the successful suicide figures, and 1-2% attempted suicides become successful suicides every year. Male sex, widowhood, single or divorced marital status, addiction to alcohol ordrugs, concomitant chronic physical or mental illness, past suicidal attempt, adverse (...) life events, staying in lodging homes or staying alone, or in areas with a changing population, all these conditions predispose people to suicides. The key factor probably is social isolation. An important WHO Study established that out of a total of 6003 suicides, 98% had a psychiatric disorder. Hence mental health professionals have an important role to play in the prevention and management of suicide. Moreover, social disintegration also increases suicides, as was witnessed in the Baltic States following collapse of the Soviet Union. Hence, reducing social isolation, preventing social disintegration and treating mental disorders is the three pronged attack that must be the crux of any public health programme to reduce/prevent suicide. This requires an integrated effort on the part of mental health professionals (including crisis intervention and medication/psychotherapy), governmental measures to tackle poverty and unemployment, and social attempts to reorient value systems and prevent sudden disintegration of norms and mores. Suicide prevention and control is thus a movement which involves the state, professionals, NGOs, volunteers and an enlightened public. Further, the Global Burden of Diseases Study has projected a rise of more than 50% in mental disorders by the year 2020 (from 9.7% in 1990to 15% in 2020). And one third of this rise will be due to Major Depression. One of the prominent causes of preventable mortality is suicidal attempts made by patients of Major Depression. Therefore facilities to tackle this condition need to be set up globally on a warfooting by governments, NGOs and health care delivery systems, if morbidity and mortality of the world population has to be seriously controlled . The need, first of all, is to identify suicide prevention as public health policy, just as we think in terms of Malaria or Polio eradication, or have achieved smallpox eradication. (shrink)

This is an appendix to the article "Wie effizient sollten Altruisten handeln?" ("How Efficient Should Altruists Act?") The appendix provides detailed moral efficiency calculations for two charitable projects: a children's home in Guatemala for neglected children versus malaria prevention by distributing mosquito nets in malaria areas in sub-Saharan Africa. The exact method of efficiency calculation is explained and applied. At least prima facie, the malaria prophylaxis project is clearly more efficient.

Why does the practice of the siesta vary across human cultures? One explanation is that it is a form of energy conservation in environments with high temperatures and/or agricultural labor. Disease palliation and prevention represents another area where the siesta might be beneficial. A preliminary study used the Human Relations Area Files (HRAF) to examine the characteristics associated with siesta occurrence. Siestas were not statistically associated with high temperatures or agricultural labor (p>.05). They were, however, statistically associated with the (...) occurrence of malaria (p<.05) and marginally associated with parasitic and chronic infectious disease. Preliminary results suggest that siestas could be adaptive in environments with chronic infectious disease. (shrink)

BackgroundHIV prevention research in resource-limited countries is associated with a variety of ethical dilemmas. Key amongst these is the question of what constitutes an appropriate standard of health care (SoC) for participants in HIV prevention trials. This paper describes a community-focused approach to develop a locally-appropriate SoC in the context of a phase III vaginal microbicide trial in Mwanza City, northwest Tanzania.MethodsA mobile community-based sexual and reproductive health service for women working as informal food vendors or in traditional (...) and modern bars, restaurants, hotels and guesthouses has been established in 10 city wards. Wards were divided into geographical clusters and community representatives elected at cluster and ward level. A city-level Community Advisory Committee (CAC) with representatives from each ward has been established. Workshops and community meetings at ward and city-level have explored project-related concerns using tools adapted from participatory learning and action techniques e.g. chapati diagrams, pair-wise ranking. Secondary stakeholders representing local public-sector and non-governmental health and social care providers have formed a trial Stakeholders' Advisory Group (SAG), which includes two CAC representatives.ResultsKey recommendations from participatory community workshops, CAC and SAG meetings conducted in the first year of the trial relate to the quality and range of clinic services provided at study clinics as well as broader standard of care issues. Recommendations have included streamlining clinic services to reduce waiting times, expanding services to include the children and spouses of participants and providing care for common local conditions such as malaria. Participants, community representatives and stakeholders felt there was an ethical obligation to ensure effective access to antiretroviral drugs and to provide supportive community-based care for women identified as HIV positive during the trial. This obligation includes ensuring sustainable, post-trial access to these services. Post-trial access to an effective vaginal microbicide was also felt to be a moral imperative.ConclusionParticipatory methodologies enabled effective partnerships between researchers, participant representatives and community stakeholders to be developed and facilitated local dialogue and consensus on what constitutes a locally-appropriate standard of care in the context of a vaginal microbicide trial in this setting.Trial registrationCurrent Controlled Trials ISRCTN64716212. (shrink)

The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits and minimising harms, mitigating unfair (...) disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, and their relative weight and application will vary by context. In addition, there are procedural principles such as transparency, engagement, and evidence-responsiveness. Prioritising instrumental value and minimising harms during the COVID-19 pandemic led to widespread agreement on priority tiers to include health-care workers, first responders, people living in congregate housing, and people with an increased risk of death, such as older adults and individuals with medical conditions. However, the pandemic also revealed problems with the implementation of these values and priority tiers, such as allocation on the basis of population rather than COVID-19 burden, and passive allocation that exacerbated disparities by requiring recipients to spend time booking and travelling to appointments. This ethical framework should be the starting point for the allocation of scarce medical resources in future pandemics and other public health conditions. For instance, allocation of the new malaria vaccine among sub-Saharan African countries should be based not on reciprocity to countries that participated in research, but on maximally reducing serious illness and deaths, especially among infants and children. (shrink)

New vaccines to prevent COVID-19 and malaria underscore the importance of scientific advances to promote public health globally. How is credit for such scientific discoveries attributed, and who benefits? The complex narrative of Amitav Ghosh’s _The Calcutta Chromosome_, both historical and speculative, demonstrates how medicine has come to value particular kinds of advances over others, prompting readers to question who controls access to resources and at what cost to global populations. In Ghosh’s imagined world, scientific discovery is evaluated and (...) rewarded—and ultimately deemed necessary—for its ability to serve communal, public health needs. (shrink)

In spite of advances in medicine and public health, malaria and other mosquito‐borne diseases are on the rise worldwide. Although vaccines, genetically modified mosquitoes and safer insecticides are under development, herein we examine a promising new approach to malaria control through better repellents. Current repellents, usually based on DEET, inhibit host finding by impeding insect olfaction, but have significant drawbacks. We discuss how comparative genomics, using data from the Anopheles genome project, allows the rapid identification of members of (...) three protein classes critical to insect olfaction: odorant‐binding proteins, G‐protein‐coupled receptors, and odorant‐degrading enzymes. A rational design approach similar to that used by the pharmaceutical industry for drug development can then be applied to the development of products that interfere with mosquito olfaction. Such products have the potential to provide more complete, safer and longer lasting protection than conventional repellents, preventing disease transmission by interrupting the parasite life cycle. BioEssays 25:1011–1020, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

Although the world has experienced remarkable progress in health care since the last half of the 20th century, global health inequalities still persist. In some poor countries life expectancy is between 37-40 years lower than in rich countries; furthermore, maternal and infant mortality is high and there is lack of access to basic preventive and life-saving medicines, as well a high prevalence of neglected diseases, HIV/AIDS, tuberculosis, and malaria. Moreover, globalization has made the world more connected than before such (...) that health challenges today are no longer limited within national or regional boundaries, making all persons equally vulnerable. Because of this, diseases in the most affluent countries are closely connected with diseases in the poorest countries. In this paper, we argue that, because of global health inequalities, in a situation of equal vulnerability, there is need for global solidarity not only as a means of reducing health inequalities, but also as a way of putting up a united force against global health challenges. We argue for an African approach to solidarity in which the humanity of a person is not determined by his/her being human or rational capacity, but by his/her capacity to live a virtuous life. According to this view of solidarity, because no one is self-sufficient, no individual can survive alone. If we are to collectively flourish in a world where no individual, nation or region has all the health resources or protection needed for survival, we must engage in solidarity where we remain compassionate and available to one another at all times. (shrink)

On March 8, 2005, the General Assembly adopted the United Nations Declaration on Human Cloning in which Member States are called upon toa) protect adequately human life in the application of life sciencesb) prohibit all forms of human cloning inasmuch as they are incompatible with human dignity and the protection of human lifec) prohibit the application of genetic engineering techniques that may be contrary to human dignityd) prevent the exploitation of women in the application of life sciencese) adopt and implement (...) national legislation to bring into effect paragraphs a to df) take into account the pressing global issues such as HIV/AIDS, tuberculosis, and malaria, which affect in particular the developing countries. a. (shrink)

Mosquito-borne diseases take a tremendous toll on human populations, especially in developing nations. In the last decade, scientists have developed mosquitoes that have been genetically modified to prevent transmission of mosquito-borne diseases, and field trials have been conducted. Some mosquitoes have been rendered infertile, some have been equipped with a vaccine they transmit to humans, and some have been designed to resist diseases. This article focuses on ethical issues raised by field trials of disease-resistant, genetically modified mosquitoes. Some of these (...) issues include: protecting the public and the environment from harm, balancing benefits and risks, collaborating with the local community, avoiding exploitation, and safeguarding the rights and welfare of research subjects. One of the most difficult problems involves protecting the welfare of community members who will be impacted by the release of mosquitoes but who are not enrolled in the study as research subjects. To address this concern, field trials should take place only when the targeted disease is a significant public health problem in an isolated area, the benefits of the trial for the community are likely to outweigh the risks, community leaders approve of the trial, and there are measures in place to protect the welfare of un-enrolled community members, such as informing the community about the study and offering free treatment to people who contract mosquito-borne diseases. Since the justification of any field trial depends on a careful examination of the scientific and ethical issues, proposed studies should be evaluated on a case-by-case basis. (shrink)

Tens of millions of adults and children die each year from illnesses that are treatable or preventable with existing medicines. Each year over 500 million people are infected with malaria, and the disease kills two million people annually. Hundreds of thousands more die annually from a myriad of lesser known diseases including diphtheria, measles, tetanus, and syphilis. Approximately 30 percent of the world’s population, over 1.7 billion people, has inadequate access or no access at all to essential medicines.Not surprisingly, (...) the vast majority of these illnesses are contracted in poor countries. Four million lives could be saved annually through prompt diagnosis and treatment of illnesses in Africa and Southeast Asia alone, and access to pharmaceutical drugs could likely save millions more. Many of the health problems facing the developing world do not arise from lack of understanding of complex diseases. Rather, the problem arises from a striking lack of availability of life-saving medicines for the consumers that need these medicines the most. (shrink)

À partir d’une approche anthropologique des prises en charge médicales de la tuberculose et du paludisme, ainsi que des conceptions et usages de la prévention dans des milieux urbains d’Afrique de l’Ouest , ce texte interroge la nature du métier de soignant. Après nous être penchés sur les spécificités de ce type d’étude anthropologique en milieu médical, nous nous attachons à décrypter les processus d’occultations des singularités du malade qui caractérisent les messages et discours de prévention. Dans les structures de (...) santé, sont étudiées les négociations des normes de diagnostic et de traitement à l’œuvre ; les attitudes des soignants qui oscillent entre sur- et sous-estimations des risques sanitaires ; et le hiatus entre la demande et les besoins réels de formations continues. Enfin, nous nous penchons sur la rencontre entre les soignants et les malades qui peut se trouver transformée par les spécificités de la maladie et de son traitement. On constate alors que les fondements de la professionnalisation tendent à disparaître au profit d’un mode de régulation du rapport au malade, au collègue et plus largement au savoir médical qui témoigne de l’émergence d’une culture soignante qui est, de fait, une culture organisationnelle. Elle se caractérise à la fois par la délégation des tâches à des non-professionnels, la production et la résolution des conflits mettant en évidence des réseaux clientélistes ainsi que par une routinisation des gestes.Drawing on an anthropological approach of tuberculosis and malaria care in West African cities , and on an analysis of prevention modes, this paper examines the characteristics of medical work. We first examined the conditions of an anthropological field study in health care centres. The concealment of both patients’ singularities and populations’ specificities targeted in the prevention messages were then studied. The negotiation of diagnosis and treatment standards, and the under- and over-estimations of nosocomial risks were also analysed. We also focused on the gap between demands and actual needs for training, and on the relationships between health care providers and patients, which can be modified by the specificities of the disease. We noticed a decay of professionalization, a kind of regulation of relationships between health care workers and patients, and among medical staff, which expresses an emerging medical culture, which is also an organizational culture. Its main features are the delegation of tasks to non-professionals workers, a strategy of conflict management based on clientelism, and the development of routine action. (shrink)

Despite global acknowledgement of HIV/AIDS reaching pandemic proportions with 37.8 million people (WHO/UNAIDS 2004) living with the infection, progress towards developing effective international responses to curb its spread has been slow. The focus of current debate tends to focus on the medical treatment and prevention of HIV/AIDS, leading to emphasis being placed on the rapid increase in HIV infection as well as opportunistic diseases such as tuberculosis and malaria. The traditional view of responding to these challenges has been (...) probing the high cost factors associated with antiretroviral treatment and burgeoning medical care needs. This article argues that these responses are limited in their effect as they have a narrow, medical focus. This article presents a broader perspective. It investigates the implications of HIV/AIDS to the goals of national sustainable development using theoretical standpoints provided by reflexive modernization, namely, the concepts of risk and reflexive judgement. Attention is given to those regions of the world—Africa and Asia—where HIV/AIDS are acute policy issues. (shrink)

Effective altruism is the project of using resources like time and money to help others as much as possible. Those who engage in this project—effective altruists—tend to focus on three ways of helping.First, effective altruists focus on helping people living in extreme poverty and typically support interventions that prevent diseases such as malaria, trachoma, and schistosomiasis. These interventions have been shown to be highly cost-effective. For example, it costs on average about $4,500 to prevent someone from dying of (...) class='Hi'>malaria.Second, effective altruists focus on reducing animal suffering. For example, tens of billions of animals are raised each year on factory farms. The conditions on these farms are so poor that the animals’ lives are probably not worth living. A host of charities aim to improve conditions on these farms or reduce the number of animals raised on them.Finally, effective altruists focus on improving the long-term future. This often takes the form of safeguarding the very existence of humanity's future by reducing risks of existential catastrophe posed by threats like nuclear weapons, pandemics, and artificial intelligence. It is frequently argued that, since there is vast value in avoiding such catastrophes, reducing the risk of any of them even fractionally has relatively high expected value.Each of these three ways of helping has been argued to be the most cost-effective way to help, that is, what makes the biggest positive difference, per dollar donated (or hour of time volunteered). There is disagreement among effective altruists over which of these areas, if any, should be the top priority.The effective altruism social movement has been around since about 2011 and now has thousands of supporters and is backed by billions of dollars in donations. At the same time, the project, underlying philosophy, and social movement of effective altruism have attracted substantial criticism, voiced in very visible venues. The present special issue of PAQ deals with a range of philosophical issues at the heart of this ongoing public debate. Below is a very brief overview of the articles in this issue.In “Why Not Effective Altruism?” Richard Yetter Chappell takes a careful look at criticisms that have been offered against effective altruism. He focuses on four ideas associated with effective altruism that have received particular attention, including moral prioritization, earning to give, billionaire philanthropy, and longtermism. Chappell argues that, in each case, the core moral claims of effective altruism cannot reasonably be rejected.In “Effective Altruists Need Not Be Pronatalist Longtermists,” Tina Rulli offers a sustained rebuttal to the argument for longtermism presented by William MacAskill in his recent book What We Owe the Future. In particular, she objects to pronatalist longtermism, which favors extensively populating the future, provided the future will be on balance good. Rulli argues that taking account of moral considerations most would recognize shows this position to be implausible. Her view is nonetheless compatible with versions of longtermism that focus on preventing harms to future people.In “How (Not) to Fear Death,” Susanne Burri provides a fresh perspective on the ancient question of whether we should fear death. She argues that, on a wide range of theories of well-being, it can be fitting to fear death. Burri argues that having a proper philosophical understanding of our reasons to fear death is in fact essential to reducing our death-related fears. This, she argues, provides an example of philosophical therapy, a neglected type of intervention effective altruists should consider. Given that the dissemination of valuable philosophical insight is so cheap, and could significantly benefit so many, it can and should be pursued alongside more resource-intensive interventions such as distributing malaria nets or reducing existential risks.In “Effective Altruism and Requiring Reasons to Help Others,” Thomas Sinclair provides a response to one of the main claims of my recent (2023) book The Rules of Rescue. I claim that each of us has a requiring reason (or pro tanto duty) to prevent harm to others, whenever we have the opportunity to do so. I argue that since these opportunities are ubiquitous, so, too, are requiring reasons. In response, Sinclair argues that we have requiring reasons to help others only when we engage with the plights of these others in a certain way. That engagement is not ubiquitous; it is present in cases of nearby emergency rescues, but it is not present simply whenever we can donate to effective charities.Philosophical debates surrounding effective altruism have developed rapidly over the past decade or so. As the articles in this special issue suggest, there is still much to be explored. (shrink)

In two experiments, subjects’ task was to decide whether a binocularly viewed target word was evaluatively good (e.g., fame, comedy, rescue) or bad (e.g., stress, detest, malaria) in meaning. Just prior to this target word, a priming word was presented to the nondominant eye, and masked by an immediately following presentation of a letter—fragment pattern to the dominant eye. (Masking effectiveness was demonstrated by subjects’ failure to discriminate the left vs. right position of a test series of words.) In (...) Experiment 1, which used evaluatively positive or negative words as priming stimuli, judgment latency for the evaluative decision task was facilitated by primes that agreed in evaluation with targets, and was retarded by primes that disagreed in evaluation with targets. This result demonstrated that the evaluative meaning of priming stimuli was processed under conditions that prevented subjects from detecting their presence. Primes in Experiment 2 were 2-word strings for which the evaluative meaning of individual words was orthogonal to the evaluative sentence meaning (e.g., the two evaluatively negative words, "enemy fails,“ make up an evaluatively positive sentence). Results of Experiment 2 indicated that masked priming effects were influenced by the evaluative meanings of individual words, but not by their sentence meanings. This result supported the conclusion that the processing of undetected, dichoptically masked words is limited to analyses that are not powerful enough to extract sentence meanings. (shrink)

Approximately two billion people lack access to medicines globally. People living with HIV, cancer patients, those suffering from tuberculosis or malaria, and other populations in desperate need of life-saving medicines are increasingly unable to access existing preventative, curative, and life-prolonging treatments. In many cases, treatment may be unavailable or inaccessible for even some of the most common and readily treatable health concerns, such as hypertension. In the developing world, many of the factors that contribute to making the world’s most (...) vulnerable and marginalized populations particularly susceptible to illness also operate to restrict their access to medicines. As a result of dramatic economic inequities and widespread poverty, it is not profitable for most originator pharmaceutical companies to develop new medicines for sale in developing markets or to lower the cost of existing drugs so that they are affordable for the majority of these populations. (shrink)

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify (...) ending their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons’ mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge. (shrink)

Between 1906 and 1909 the biologist Ronald Ross and the classicist W.H.S. Jones pioneered interdisciplinary research in biology and history in advancing the claim that malaria had been crucial in the decline of golden-age Greece. The idea had originated with Ross, winner of the Nobel Prize for demonstrating the importance of mosquitoes in the spread of the disease. Jones assembled what, today, we would call an interdisciplinary network of collaborators in the sciences and humanities. But early negative reviews of (...) Jones’s Malaria and Greek History by classicists and historians ended the project, despite a positive reception among malariologists. Today, the “Jones hypothesis” is often used to exemplify the naïvete of past scholarship, and few examine Jones’s evidence and reasoning. In this age of renewed interdisciplinarity, a review of what went wrong is timely. Jones and Ross knew they were opening new methodological territory and struggled with the challenges of multiple ways of knowing. Over 100 years later, malaria remains an important site of historical-biological research, yet integration is elusive. After reviewing the Jones-Ross relationship, Jones’s interdisciplinary campaign, and the reception of the hypothesis among classicists/ancient historians and in malariology, we conclude by highlighting some of the specific challenges faced by those exploring the interface of biology and history. (shrink)

The carbon emissions of global healthcare activities make up 4%–5% of total world emissions, with the majority coming from industrialised countries. The solution to healthcare carbon reduction in these countries, ostensibly, would be preventive healthcare, which is less resource intensive than corrective healthcare in itself and, as a double benefit, reduces carbon by preventing diseases which may require higher healthcare carbon to treat. This leads to a paradox: preventive healthcare is designed to give humans longer, healthier lives. But, by extending (...) life spans, the carbon emissions of a person increase both over a lifetime and in the medical industry overall. At the same time, the need for higher carbon end-of-life care does not disappear, particularly in resource intensive countries. This article will first identify sources of healthcare carbon, focusing on the industrialised world, and explain various efforts towards healthcare carbon reduction, which include preventive healthcare. Second, it will develop the ‘paradox of prevention’—that preventive healthcare may save healthcare carbon by proximally reducing the need for medical treatments, but also, paradoxically, result in more healthcare carbon both in an individual’s life and in the medical industry. The third section will offer ethical principles for approaching the paradox of prevention. The conclusion will emphasise the need for institutional approaches to healthcare carbon reduction in the industrialised world, which will relieve some of the tensions of healthcare industry decarbonisation and individual healthcare carbon use. (shrink)

Definitive diagnosis of malaria requires the demonstration through laboratory tests of the presence within the patient of malaria parasites or their components. Since malaria parasites can be present even in the absence of malaria manifestations, and since symptoms of malaria can be manifested even in the absence of malaria parasites, malaria diagnosis raises important issues for the adequate understanding of disease, etiology and diagnosis. One approach to the resolution of these issues adopts a (...) realist view, according to which the needed clarifications will be derived from a careful representation of the entities on the side of the patient which form the ultimate truthmakers for clinical statements. We here address a challenge to this realist approach relating to the diagnosis of malaria, and show how this challenge can be resolved by appeal to Basic Formal Ontology (BFO) and to the Ontology for General Medical Science (OGMS) constructed in its terms. (shrink)

In this paper, I present an emerging explanatory framework about ageing and care. In particular, I focus on how, in contrast to most classical accounts of ageing, biomedicine today construes the ageing process as a modifiable trajectory. This framing turns ageing from a stage of inexorable decline into the focus of preventive strategies, harnessing the functional plasticity of the ageing organism. I illustrate this shift by focusing on studies of the demographic dynamics in human population, observations of ageing as an (...) intraspecifically heterogenous phenotype, and the experimental manipulation of longevity, in both model organisms and humans. I suggest that such an explanatory framework about ageing creates the epistemological conditions for the rise of a peculiar form of prevention that does not aim to address a specific condition. Rather it seeks to stall the age-related accumulation of molecular damage and functional deficits, boosting individual resilience against age-related decline. I call this preventive paradigm “ground-state prevention.” While new, ground-state prevention bears conceptual resemblance to forms of medical wisdom prominent in classic Galenic medicine, as well as in the Renaissance period. (shrink)

In discussions of the ethics of human gene therapy, it has become standard to draw a distinction between the use of human gene transfer techniques to treat health problems and their use to enhance or improve normal human traits. Some dispute the normative force of this distinction by arguing that it is undercut by the legitimate medical use of human gene transfer techniques to prevent disease - such as genetic engineering to bolster immune function, improve the efficiency of DNA repair, (...) or add cellular receptors to capture and process cholesterol. If disease prevention is a proper goal of medicine, these critics argue, and the use of gene transfer techniques to enhance human health maintenance capacities will help achieve that goal, then the “treatment/enhancement‘ distinction cannot define the limits of legitimate gene therapy. In this paper, I argue that a line can be drawn between prevention and enhancement for gene therapy (and thus between properly medical and nonmedical uses of gene therapy), but only if one is willing to accept two rather old-fashioned claims: 1) Some health problems are best understood as if they were entities in their own right, reifiable as processes or parts in a biological system, with at least as much ontological objectivity and theoretical significance as the functions that they inhibit. 2) Legitimate preventive genetic health care should be limited to efforts to defend people from attack by these more robust pathological entities, rather than changing their bodies to evade social injustices. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research (...) evidence will be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

The aim of this Web-based survey of 15 German companies with an international profile was to identify which higher-level values serve as a basis for a company culture that promotes integrity and can thereby also be used to promote crime prevention. Results on about 2000 managers in German parent companies and almost 600 managers in Central and North European branch offices show that a major preventive role can be assigned to a company culture that promotes integrity. This requires a (...) ‘tone from the top’, ‘ethical leadership’ from the direct superior, and a general set of values that can be encouraged through training courses. Moreover, employees have to perceive these values as promoting their careers. The survey reveals that the companies in this study have basically succeeded in establishing their system of values in their Central and North European as well as their Asian branch offices. Moreover, it shows that the main values preventing crime on the management level are trustworthiness and consistency. Open communication is an important value on all levels of a company, and this is supplemented by transparency, compliance with the rules, and a rejection of behaving in one’s own interest. It is concluded that in spite of regional differences, major international companies can possibly make an important contribution to bringing about cultural change in regions with an affinity for corruption by implementing a culture that promotes integrity in both their company and their daily business. (shrink)

Neurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

IntroductionWith a definition that is evolving, a serious component of the contract cheating issue involves individuals paying a third-party to complete assessment items for them and then submitting this work as if it were their own. The issue of contract cheating poses a significant problem for tertiary institutions. The research literature conducted to date has addressed contract cheating, yet few papers discuss theory-based prevention strategies, and even fewer still evaluate the impact of theory-based prevention strategies.Case descriptionThis paper discusses (...) a case study of contract cheating that was identified in a business simulation operating in a capstone unit at a large Australian university. The problem is outlined, the theory-based intervention is explained, and the impact on the contract cheating problem is quantified.Discussion and evaluationBuilding on a platform provided by criminological theory and crime prevention practice, the Unit Coordinator systematically adjusted a large number of assessment elements to ensure contract cheating was less likely. Importantly, this intervention was effective but also did not disadvantage students who were not engaging in contract cheating.ConclusionsOverall, this paper connects criminological theory and crime/problem prevention practice with academic misconduct issues with the intent of demonstrating there is potential to minimise the opportunity for contract cheating by altering the opportunity structures for assessment items. Crucially, this can be done without impeding genuine student efforts and does not depend on apprehension and conviction. (shrink)

The near-miss has been considered an important factor of reinforcement in gambling behavior, and previous research has focused more on its industry-related causes and effects and less on the gaming phenomenon itself. The near-miss has usually been associated with the games of slots and scratch cards, due to the special characteristics of these games, which include the possibility of pre-manipulation of award symbols in order to increase the frequency of these “engineered” near-misses. In this paper, we argue that starting from (...) an elementary mathematical description of the classical (by pure chance) near-miss, generalizable to any game, and focusing equally on the epistemology of its constitutive concepts and their mathematical description, we can identify more precisely the fallacious elements of the near-miss cognitive effects and the inadequate perception and representation of the observational-intentional “I was that close.” This approach further suggests a strategy of using non-standard mathematical knowledge of an epistemological type in problem-gambling prevention and cognitive therapies. (shrink)

There is a death by suicide in the world every 40 seconds, and suicide is the second leading cause of death for 15–29-year-olds. Experts say that one of the best ways to prevent suicide is for those in distress to hear from people who care about them. Facebook is in a unique position—through its support for networks and friendships on the site—to help connect a person in these difficult situations with people who can support them. Connecting people with the resources (...) they need is part of Facebook’s ongoing efforts to help build a safe community inside and outside of Facebook. This article provides a brief overview of how Facebook’s work to develop suicide prevention tools started and evolved, and the ethical considerations which surfaced during the process in the form of concrete product decisions around the implementation of these tools. This article is structured into three sections. Section 1 reviews what has been done in this space and lists and briefly describes other suicide prevention apps and tools. Section 2 describes Facebook’s overall approach to suicide prevention. Here, we’ll delve first into how that approach originated and how it was influenced by the external community’s proactive interactions with Facebook, highlighting our unique position to help address the problem. Afterwards, we’ll explain how that approach evolved, describing its various stages and iterations: understanding, reactive reporting, queue prioritization, and proactive reporting. This section describes the tools and resources Facebook has developed for people who may be at risk. Particular attention is devoted to the use of ArtificiaI Intelligence and Machine Learning to detect posts or live videos where someone might be expressing thoughts of suicide. Section 3 will elaborate on the ethical questions addressed when developing our approach and when making concrete product decisions to implement our suicide prevention tools. In this last section, we’ll expound the competing values and interests that were at stake during the product development process, and how we reached ethical balances between them. (shrink)

While many experts and organizations have recognized infertility as a public health issue, most governments have not yet adopted a public health approach to infertility. This article argues in favor of such an approach by discussing the various implications of infertility for public health. We use a conceptual framework that focuses on the dual meaning of the term ‘public’ in this context: the health of the public, as opposed to that of individuals, and the public/collective nature of the required interventions. (...) This analysis highlights the need for a comprehensive public health approach toward infertility, points to some initiatives that are already in place and demonstrates that prevention is currently a neglected—yet much needed——element. We move on to discuss the sensitive nature of prevention initiatives as a probable explanation for their scarcity. We illustrate the complexity of prevention through an analysis of an infertility prevention campaign previously conducted in the United States, which provoked significant controversy. We use a public health communication ethics framework to expose the strengths and the shortcomings of this campaign, and conclude that prevention initiatives targeting infertility can indeed be conducted in a sensible way that promotes autonomy while improving public health. (shrink)

The past 20 years have seen dramatic rises in suicide rates in the United States and other countries around the world. These trends have been identified as a public health crisis in urgent need of new solutions and have spurred significant research efforts to improve our understanding of suicide and strategies to prevent it. Unfortunately, despite making significant contributions to the founding of suicidology – through Emile Durkheim’s classic Suicide (1897/1951) – sociology’s role has been less prominent in contemporary efforts (...) to address these tragic trends, though as we will show, sociological theories offer great promise for advancing our understanding of suicide and improving the efficacy of suicide prevention. Here, we review sociological theory and empirical research on suicide. We begin where all sociologists must: with Durkheim. However, we offer a more comprehensive understanding of Durkheim’s insights into suicide than the prior reviews provided by those in other disciplines. In so doing, we reveal the nuance and richness of Durkheim’s insights that have been largely lost in modern suicidology, despite being foundational to all sociological theories of suicide – even those that have moved beyond his model. We proceed to discuss broadly acknowledged limitations to Durkheim’s theory of suicide and review how more recent theoretical efforts have not only addressed those concerns, but have done so by bringing a larger swatch of sociology’s theoretical and empirical toolkit to bare on suicide. Specifically, we review how recent sociological theories of suicide have incorporated insights from social network theories, cultural sociology, sociology of emotions, and sociological social psychology to better theorize how the external social world matters to individual psychological pain and suffering. We conclude by making explicit bridges between sociological and psychological theories of suicide; by noting important limitations in knowledge about suicide – particularly regarding the roles of organizations, inequality, and intersectionality in suicide – that sociology is well situated to help address. (shrink)

Suicide is a leading cause of death in the United States and in many other parts of the world. As such, suicide is frequently framed as a medical and public health problem for which solutions are best recommended by medical and public health authorities. While, medicalized suicide prevention strategies often resonate with traditional Christian commitments to preserve life and to discourage suicide, there is little evidence to date that medical approaches to suicide risk-reduction decrease population rates of suicide. Further, (...) by treating suicide as a phenomenon that can be eliminated through technical managerial control, modern suicide prevention efforts construe suffering persons as carriers of risk best managed by standardized and often dehumanizing environments of care. This emphasis on the medical management of risk also erodes the clinician–patient relationship and inappropriately centers medical (e.g., systematic health screenings) rather than non-medical (e.g., access to housing) forms of response. Although, medicalized suicide prevention efforts should not be dismantled, those working to prevent suicide would do well to prioritize a positive commitment to human dignity and worth and to engage social and political systems beyond medicine and public health, while drawing on specific contributions that clinicians can offer. (shrink)

ObjectivesBuilding on what is known about the non-random nature of crime problems and the explanatory capacity of opportunity theories of crime, this study explores the utility of using existing university administrative data to detect unusual patterns of performance consistent with a student having engaged in contract cheating (paying a third-party to produce unsupervised work on their behalf).MethodsResults from an Australian university were analysed (N = 3798 results, N = 1459 students). Performances on unsupervised and supervised assessment items were converted to (...) percentages and percentage point differences analysed at the academic discipline-, unit-, and student-level, looking for non-random patterns of unusually large differences.ResultsNon-random, unusual patterns, consistent with contract cheating, were found at the academic discipline-, unit-, and student-level, with approximately 2.1% of students producing multiple unusual patterns.ConclusionsThese findings suggest it may be possible to use existing administrative data to identify assessment items that provide suitable opportunities for contract cheating. This approach could be used in conjunction with targeted problem-prevention strategies (based on situational crime prevention) to reduce the vulnerability of academic assessment items to contract cheating. This approach is worthy of additional research as it has the potential to help academic institutions around the world manage contract cheating; a problem that currently threatens the validity and integrity of tertiary qualifications. (shrink)

Zusammenfassung Um die Öffnung der Bundesliga gegenüber Investoren möglichst wettbewerbsneutral zu gestalten und den Einfluss von externen Geldgebern auf einen Profi-Fußballclub zu beschränken, wurde die sogenannte 50-plus-1-Regel in die Satzung des DFB aufgenommen. In diesem Beitrag wird umfassend analysiert, welche Konstellationen mit beherrschendem Einfluss nicht von dieser Regelung erfasst werden. Ziel dieser Analyse ist der anschließende Vorschlag eines alternativen Konzeptes, welches die vorgebrachten Zielsetzungen konsequent realisieren könnte. Zur Durchführung der Regulation werden außerdem konkrete Handlungsempfehlungen ausgesprochen. Die Vorteilhaftigkeit des vorgeschlagenen Konzeptes (...) wird aus sportökonomischer und rechtlicher Perspektive gewürdigt. (shrink)

Background People who are at elevated risk of suicide stand to benefit from internet-based interventions; however, research in this area is likely impacted by a range of ethical and practical challenges. The aim of this study was to examine the ethical issues and practical barriers associated with clinical studies of internet-based interventions for suicide prevention. Method This was a mixed-methods study involving two phases. First, a systematic search was conducted to identify studies evaluating internet-based interventions for people at risk (...) of suicide, and information pertaining to safety protocols and exclusion criteria was extracted. Second, investigators on the included studies were invited to complete an online survey comprising open-ended and forced-choice responses. Quantitative and qualitative methods were used to analyse the data. Results The literature search identified 18 eligible studies, of which three excluded participants based on severity of suicide risk. Half of the 15 suicide researchers who participated in the survey had experienced problems obtaining ethics approval, and none had encountered adverse events attributed to their intervention. Survey respondents noted the difficulty of managing risk in online environments and the limitations associated with implementing safety protocols, although some also reported increased confidence resulting from the ethical review process. Respondents recommended researchers pursue a collaborative relationship with their research ethics committees. Conclusion There is a balance to be achieved between the need to minimise the risk of adverse events whilst also ensuring interventions are being validated on populations who may be most likely to use and benefit from them. Further research is required to obtain the views of research ethics committees and research participants on these issues. Dialogue between researchers and ethics committees is necessary to address the need to ensure safety while also advancing the timely development of effective interventions in this critical area. (shrink)

Expanded universal carrier screening (EUCS) entails a population‐wide screening offer for multiple disease‐causing mutations simultaneously. Although there is much debate about the conditions under which EUCS can responsibly be introduced, there seems to be little discussion about its aim: providing carrier couples with options for autonomous reproductive choice. While this links in with current accounts of the aim of foetal anomaly screening, it is different from how the aim of ancestry‐based carrier screening has traditionally been understood: reducing the disease burden (...) in the population. The reasons why the aim of EUCS is presented in terms of ‘autonomy’ rather than ‘prevention’ have not been spelled out in the literature. This paper seeks to fill this gap by considering the morally relevant similarities and dissimilarities between foetal anomaly screening, ancestry‐based carrier screening and EUCS. When carrier screening is performed in the prenatal period, enhancing autonomy appears the most appropriate aim of EUCS, as the alternative of ‘prevention through selective abortion’ would urge women to terminate wanted pregnancies. However, when screening is conducted in the preconception period, carrier couples can avoid the birth of affected children by other means than selective abortion, for instance preimplantation genetic diagnosis. To the extent that this increased control over passing on a genetic disorder raises questions of parental responsibility, it seems necessary that the account of the aims of EUCS is wider than only in terms of enhancing reproductive autonomy. (shrink)

: This essay provides a critical analysis of rape prevention since the 1980s. I argue that we must challenge rape prevention's habitual reinforcement of the notion that fear is a woman's best line of defense. I suggest changes that must be made in the anti-rape movement if we are to move past fear. Ultimately, I raise the question of what, if not vague threats and scare tactics, constitutes prevention.

In this article, I challenge the risk assessment approach to the ethics of pre-exposure prophylaxis (PrEP) as HIV prevention among men who have sex with men (MSM). Traditional risk assessment focuses on the medical risks and benefits of using medical technologies, but this emphasizes certain risks and benefits over others. The medical risks of using PrEP are presently being overblown and its social and political risks are being overlooked. By recontextualizing risk within the history of HIV and considering the (...) lived experiences of MSM with sex, HIV, and HIV prevention, we can broaden the present risk assessment framework to include all of the relevant risks involved in using PrEP. We can also better situate risk as one of several moral concepts, including trust and solidarity, which move us towards a more nuanced analysis of the social and political effects of PrEP on the relationships and communities of MSM. (shrink)

The successful demonstration that antiretroviral (ARV) drugs can be used in diverse ways to reduce HIV acquisition or transmission risks – either taken as pre-exposure prophylaxis (PrEP) by those who are uninfected or as early treatment for prevention (T4P) by those living with HIV – expands the armamentarium of existing HIV prevention tools. These findings have implications for the design of future HIV prevention research trials. With the advent of multiple effective HIV prevention tools, discussions about (...) the ethics and the feasibility of future HIV prevention trial designs have intensified. This article outlines arguments concerning the inclusion of newly established ARV-based HIV prevention interventions as standard of prevention in HIV prevention trials from multiple perspectives. Ultimately, there is a clear need to incorporate stakeholders in a robust discussion to determine the appropriate trial design for each study population. (shrink)

In 2008, Representative John Read of Mississippi recently co-sponsored state legislation that would ban restaurants from serving obese customers. He later admitted that the bill was a publicity stunt,meant to “shed a little light on the number one problem in Mississippi.” Although controversial, Read’s bill exemplifies both the current perception of obesity as a national public health problem and the general sentiment underlying the types of interventions that are being considered to address this issue. The proposed legislation also demonstrates how (...) policymakers can use or, in this case misuse, information about obesity to generate significant discussion on an issue along with ill-conceived legal interventions.Information sharing and the methods used to share best practices are components of the fourth core element of public health legal preparedness. (shrink)

본 연구는 학교 폭력 예방 교육을 인성교육 및 사회⋅정서적 능력 함양 교육과 연계시킴으로써 학교 폭력을 조기에 감지하고 다양한 형태로 분화되어 나갈 수 있는 폭력의 유형에 장기적이고 효율적으로 대처할 수 있는 프로그램을 개발하고 효과성을 검증하는 데 목적이 있다. 아울러 인성교육과 도덕교육의 통합, 기타 교과 및 잠재적 교육과정, 가정, 지역사회와의 통합을 전제로 프로그램을 구성함으로써 어떠한 장소와 상황에서도 정서 및 폭력 예방교육을 진행할 수 있도록 하였다. 프로그램은 총 4개의 대주제와 10개의 소주제 아래에 모두 20회 차의 교안으로 구성되어 있어 프로그램의 완성도나 교육의 연속성 측면에서 (...) 완전성을 구현하고 있다. 기존의 여타 프로그램들이 단발성에 그치거나 10회 차를 넘지 않는 것과 비교해 볼 때, 장기적인 교육 프로그램으로서 기능과 상황에 맞는 선택적 교육에 효율적이다. 프로그램의 장점으로는 ① 연계성(連繫性), ② 통합성(統合性), ③ 현장성(現場性), ④ 실효성(實效性), ⑤ 용이성(容易性), ⑥ 완정성(完整性), ⑦ 목표성(目標性)을 들 수 있다. 물론 프로그램 시연 결과 본 연구에서 개발한 학교폭력 예방 프로그램은 보완해야 할 사항들도 제기되었지만, 충분한 시간이 제공된다면 초등학교 학생들에게서 일반적으로 나타나는 언어폭력과 따돌림 등의 학교폭력 발생을 억제하고 예방하는 데 도움이 되고, 공감이나 타인배려, 분노억제 등의 영역에서도 효과가 발생할 것이라는 예상을 해 볼 수 있었다. 따라서 본 프로그램의 적용이 확대되고 폭력 예방교육이 활성화되기 위해서는 다음과 같은 사항들이 고려되어야 한다. 첫째, 학생들의 발달 시기에 적합한 교육 프로그램이 필요할 뿐만 아니라 일반 학생과 고위험군 학생을 대상으로 하는 후속 프로그램이 연구 개발되어야 할 것이다. 둘째, 본 프로그램은 20차시로 이루어져 있어서 제대로 효과를 보기 위해서는 충분한 양의 교육시간이 보장되어야 한다. 셋째, 본 프로그램을 실시하기 전에 최소 한 차례 이상의 교사 연수 기회를 갖는 것이 프로그램의 효과를 극대화할 수 있는 방법이라 생각된다. 넷째, 프로그램 시작 시 학부모 설명회를 하거나 단원의 전개 시 학부모에게 편지를 보내 협력을 구할 필요가 있다. 다섯째, 사회 정서기술 관련 교육이 위기의 청소년이나 반사회적 행동을 반복하는 청소년들에게만 필요한 것이라는 인식은 지나치게 협소하다. 문제된 학생을 대상으로 한 선별적 상담지원이나 기술교육이 필요하지만 보다 효과적인 되려면 학교와 교실 환경의 개선과 지원이 요구된다. 여섯째, 지역공동체의 문화적 신념과 규범을 반영할 필요가 있다. 사회⋅문화적으로 적합하게 예방프로그램을 계획하는 일은 중요하다. 결국 예방교육의 효과성을 보장하기 위해서는 양질의 프로그램을 개발해야 할 뿐 아니라 프로그램을 지역사회의 요구에 맞게, 프로그램의 취지와 방법을 잘 아는 사람이, 청소년의 발달시기에 맞게 시행하고, 그 결과를 평가하여 프로그램을 개선하고 교육방법을 개선해 나가는데 달려 있다. (shrink)