This paper investigates the challenges of implementing antibiotic stewardship – reducing and optimizing the use of antibiotics – in agricultural settings of Low- and Middle-Income Countries (LMICs) as a strategic part of addressing the global problem of antimicrobial resistance (AMR). It does so through analysis of the rapidly transforming yet diverse Kenyan poultry sector, characterized by growing commercial operations alongside traditional smallholder farming. Our research involves interviews with farmers, processors, policymakers, and agro-veterinary stores in these settings. We blend Chandler’s (2019, (...) p. 8) notion of “antibiotics as infrastructure” with value chain frameworks to understand how the structural role of antibiotics in agriculture plays out through contrasting value chains, with different implications for stewardship. Weak regulation and intense market-based pressures are shown to drive widespread antibiotic use in poultry value chains involving small- and medium-sized farms supplying open markets. Antibiotic stewardship through adherence to agricultural and food safety standards is more evident, though unevenly observed, in value chains involving large commercial farms and processors supplying corporate buyers. Our findings reveal the complex structural roles of antibiotics in maintaining producer livelihoods in an intensely competitive and heterogeneous Kenyan poultry sector. This highlights challenges with applying global AMR policy to transforming food systems in LMICs without appropriate translation. We argue that attempts to reduce and optimize the use of antibiotics in agriculture must be informed by nuanced understandings of the roles of antibiotics in food systems in specific places including where very different scales and models of farming and value chain co-exist. (shrink)

In this book, the second in the Heart of Christian Faith series, Alister E. McGrath provides an exploration of how we can best understand God using analogies, illustrations, and stories. This short, accessible guide also provides a pastoral and spiritual consideration of the difference that our belief in God makes to the way in which we think about ourselves and our world. With future volumes to examine other core Christian principles, McGrath’s new series will define “mere Chrisitianity” to a (...) new generation for many years to come. (shrink)

Mr. Paul Mills suffered from cancer of the esophagus. Three major surgeries were unsuccessful in correcting the problem, and other treatment methods likewise failed. His condition deteriorated to the point where there was no longer any hope of recovery. Dr. Morrison, who was Mr. Mills's intensive care physician at the Queen Elizabeth II Health Sciences Centre in Halifax, and Mr. Mills's family agreed that active life support should be discontinued. Dr. Morrison then removed Mr. Mills's ventilator. To everyone's surprise, and (...) dismay, Mr. Mills did not die. He continued to breathe spontaneously and started to show signs of distress. Dr. Morrison increased the dosage of morphine, to no effect. She increased it again to the point where death could reasonably be expected to occur; signs of distress continued. Dr. Morrison at this point administered a dose of potassium chloride and Mr. Mills died. (shrink)

In Born to Wonder, Alister McGrath, a prolific Oxford scholar, scientist, and theologian, explores the deepest mystery at the heart of life itself. Life is a gift. We never asked to be born. Yet here we are, living in this strange world of space and time, trying to work out what it's all about before the darkness closes in and extinguishes us. We are adrift on a misty, grey sea of ignorance, seeking a sun-kissed island of certainty, on which (...) we might hope to find clear answers to our deepest and most poignant questions. What is the point of life? Why are we here? And what is it about us that makes us want to ask these questions? As far as we know, we're the only species on earth that asks these questions, and dares to hope that we might find an answer. It seems that we are born to wonder, not merely to exist. From time to time, all of us find ourselves overwhelmed by a sense of awe or mystery, often when confronted with the beauty of nature, whether it is a mountain stream or the vast expanse of ocean waters. That is when we see a flicker of a grander vision of reality, perhaps lying beyond the horizons of our experience. It is as if, for only a moment, a veil is removed, and we catch a half-glimpsed sight of a promised land, waiting to be mapped and explored. This sense of wonder fuels much of humanity's creativity and its search for understanding. (shrink)

En base al estudio empírico de los discursos de desarrollo presentes en actores clave del Gran Concepción, Chile, este artículo plantea algunos lineamientos teóricos a partir del mismo. Se distinguen dos temas centrales a la hora de hablar del par desarrollo-sustentabilidad: el poder de las representaciones sociales y la interrogante acerca del nivel de representatividad de las decisiones que se toman en relación a estos asuntos. Esto conecta las temáticas ambientales con una demanda de ciudadanía y con la pregunta acerca (...) de las prioridades sociales que como país aceptamos. (shrink)

"This book presents results from a four-year project addressing the central question: What factors, challenges, and contexts contribute to and constrain literacy achievement among at-risk adolescent learners with culturally diverse ...

Mental health acts allow for interference with the liberty of the individual. As such, they serve as test cases for theories of liberty, and thus the question of what Mill would think about them arises. My aim is to answer this question. I argue that Mill would embrace mental health acts to protect mentally disturbed individuals from themselves and others from them, and that they should have broad admission criteria, allow capable patients to refuse treatment, and have treatment decisions made (...) by patients or their families on the basis of substituted judgements rather than representatives of the state acting on best interest judgements. This interpretation will show that many writers who claim Mill's support cannot properly do so. It is also a combination of views that cannot be readily found in mental health acts themselves, but which, as Mill's reasons for it show, is a serious candidate for legislative adoption. (shrink)

This book is a vibrant investigation on a deeply human subconscious desire: the desire for omnipresence, or in a nutshell, the desire to be here, there, and everywhere at the same time. After all, why is it not enough just to be in the offline ordinariness of the here and now? To answer this question, Camila Mozzini-Alister does the crossing of two seemingly distant universes: mediation and meditation. Throughout a vigorous archaeology of the relationship between screen and mind allied (...) with an engaging first-person narrative, the author raises awareness of the risks of becoming addicted to social media and obsessed by meditation. This brings forth a vital question: what are the limits for the desire to be more than a body? (shrink)

Elective ventilation (EV) is ventilation applied, not in the interest of patients, but in order to secure transplantable organs. It carries with it a small risk that patients who would otherwise have died will survive in a persistent vegetative state. Is EV ever justifiable? We argue: (1) The only thing which can justify exposing patients to risk not taken for their benefit is their consent, and we cannot rely on implied consent or third party consent in the case of EV. (...) Thus, absent explicit consent of patients, EV is not justifiable. (2) It is not clear that explicit consent should be sought, or where it is offered honoured, given the potential EV has for deterring organ donors and causing stress to staff and families. (shrink)

Real Life in China at the Height of the Empire: Revealed by the Ghosts of Ji Xiaolan. Translated by DavId E. Pollard. Hong Kong: Chinese University Press, 2014. Pp. xl + 334. $45.

Among improvisers and composers today there is a resurgence of interest in experimental music (EM) practices that welcome contingency; engaging with unforeseen circumstances as an essential component of the music-making process, and a means to sonic discovery. I propose theExperimental Composition Improvisation Continua(ECIC) as a model with which to better understand these experimental musical works. The historical Experimental Music movement of the 1950s and 60s is briefly revisited, and the jazz tradition included as an essential protagonist; both being important historical (...) movements leading to the formulation of ideas around contingent musical practices. The ECIC model is outlined as providing a means to observe the interactions and continua between composition and improvisation on the one hand and more or less experimentally conceived music on the other. This model is applied as an investigative and comparative tool to three distinctive works in order to illuminate the presence or otherwise of various experimental interactions within them. The works are: “Spiral Staircase” – a composition by written by Satoko Fujii in late 2007, John Cage’s4′33″, and a performance of “My Favorite Things” by the John Coltrane Quartet. Further possible applications of the ECIC are suggested in the conclusion. (shrink)

El artículo recorre la obra de Rodolfo Kusch posicionando sus principales propuestas en la construcción de tres enfoques convergentes en su filosofía. El primer enfoque está relacionado con la fenomenología y la cultura. El segundo enfoque se refiere a la influencia de la antropología y el cuestionamiento por el símbolo. El tercer enfoque despliega una aproximación filosófico-política. Estos enfoques permiten introducir tres “horizontes de pregunta” principalmente relacionados con el método, con lo popular y con lo indígena, que son expuestos como (...) asuntos centrales en toda su obra. Estos “horizontes de pregunta” buscan comprender los alcances de la filosofía de Kusch y su contribución al pensamiento filosófico americano. This paper analyses the work of Rodolfo Kusch remarking his main philosophical proposals through three correlated perspectives. The first perspective refers to phenomenology and culture. The second focuses on the influence of anthropology and the problem of symbols. The third posits a political-philosophical approximation. These perspectives operate interdependently as the background for Kusch’s philosophy and allow us to introduce three “questioning horizons” related to the method, the popular and the indigenous as the central issues of his philosophical work. Thus, these “questioning horizons” build a platform to understand Kusch’s philosophy and his contribution to the Latin American philosophy. (shrink)

ABSTRACT Modern technology has made it uncertain as to when exactly death occurs, and this has put us in a quandary over when we can initiate behaviour traditionally deemed apt if and only if a patient is dead. In the light of this, there is general agreement that death should be redefined, but wide disagreement remains about how. I argue, against this, that it is a mistake to redefine death in any way: (1) redefining death will not help to settle (...) the question of when traditional death‐behaviour becomes appropriate, (2) any attempt to redefine death is attended with significant disutilities and no compensating utilities, and (3) the practical problems generated by the indeterminacy can be better handled in other ways. (shrink)

The recent history of the Canadian healthcare system has been increasingly one of shortages. There are delays for services that impose risk and hardship, disparities between the accessibility of healthcare for rural versus urban populations, and a lack of adequate coverage for or access to prescription drugs, diagnostic services, and homecare. Add to these problems shortages of healthcare providers—in particular, physicians and nurses—and state-of-the-art equipment, and we can understand the universal agreement that the Canadian healthcare system must change. The only (...) question is how. Some argue for modifications within the basic framework of a one-tier single-payer system; others for more radical reform that will allow for infusions of money by expedients such as user fees, extra billing, or a full-blooded second tier where one can buy any healthcare one wants. a. (shrink)

Residents in long-term care facilities and rehab hospitals sometimes ask healthcare professionals to help them do things that HCPs judge to be on balance harmful. A person with respiratory problems may ask for a cigarette, a diabetic for alcohol, a dysphagiac for food or fluids by mouth, a person at risk for falling for her walker, and so on. These requests raise two kinds of problems. The first pits residents against HCPs. Should HCPs ever help residents do what they consider (...) harmful? The second pits HCPs against HCPs. If HCPs disagree among themselves—some thinking that the resident should receive the assistance, others thinking not—what should be done? (shrink)

I argue that whether abortions are morally permissible depends on whether the fetus has a right to life, the only point of disagreement between the possible theories on this question--the Extreme Conservative, the Middle, and the Extreme Liberal--concerns the relevant temporal proximity to, or degree of probability of actualizing, some selected potential, there is in principle no non-arbitrary way of resolving this disagreement, and hence the problem of abortion is a pseudo-problem inasmuch as it is not theoretically capable of being (...) solved, and legislators should, in the light of this, act as if the Extreme Liberal Theory were true. (shrink)

The current main source of transplantable organs is from heart-beating donors. These are patients who have suffered a catastrophic brain injury, been ventilated, declared dead by neurological criteria, and had their vital functions maintained mechanically until the point of transplantation. But the demand for organs far outstrips the supply, and these patients are not the only potential donors. The idea behind non-heart-beating transplantation is to expand the donor pool by including in it patients who are in hopeless conditions but who (...) are not dying because of brain injury and hence will not suffer the neurological death necessary to become heart-beating donors. As long as we continue to hold the so-called dead donor rule, according to which dying donors cannot have their organs taken before they are dead, this requires that death be able to be declared by alternative criteria, specifically by cardiopulmonary criteria. The challenge is to find such criteria that will identify a state that the public will readily recognize as death and that will facilitate non-heart-beating transplantation. a. (shrink)

There are 12 different Mental Health Acts in Canada, all of which provide for the involuntary confinement of the mentally disordered to protect both them from themselves and others from them. The Acts differ in many ways, but three issues stand out above all: involuntary admission criteria, the right to refuse treatment, and who has the authority to authorize treatment. I first describe how the MHAs differ on these issues. I then take up the methodological question of how to select (...) or construct a MHA from the many, all of which have something to be said for them. Finally, I apply this test to the three main issues in dispute and identify which solutions would be in an ideal MHA. My aim in this last is not to settle the issues but to engage with them and so deepen our understanding of what is at stake. (shrink)

Landscapes are shaped over time by the changing imaginaries that result from new representations of nature and the value associated with it. This paper discusses the evolving discourses which have shaped the perception of the landscape in two socially and ecologically significant contexts in Chile. The first is the central-southern region of the country, a large portion of which is now devoted to commercial forestry plantations. The second is the Patagonia-Aysén region, where since the 1990s, colonisation of a land defined (...) by a tradition of livestock rearing has evolved into a process epitomised by the slogan “Aysén, Life Reserve”. The representation that was made of central-southern Chile in the 50 'and 60' as a deforested and degraded land was the justification for promoting a new form of land occupation: the monoculture forest, designed and executed by a specific law. Forty years on from the passing of this law, the plantations of central-southern Chile have undergone a process of naturalisation. In this case, the exaltation of nature has been permanent. The only thing that changes is the definition of nature, which ended up including forest plantations. In Patagonia-Aysén, by the other side, there has been a marked shift in the rhetoric surrounding land. This has been particularly noticeable in the case of government bodies and private ecotourism companies, which have constructed an imaginary in line with a new model of economic development for the area. In a break with tradition, both the public and private sectors are beginning to shift their investment away from agricultural and livestock exploitation and towards ecotourism and conservation projects. In both cases, we analyse the manner in which transformations in perceptions and representations of landscape bring about new forms of land use, and how new focuses of value and social interest, forged within wider environmental discourses, have brought with them unexpected social consequences, like depopulation, economic transformations, cultural changes, etc. Thus, the aim of this work is to expose and discuss the reality and scope of new green discourses and their influence on the perception of natural landscapes in the Chilean neoliberal context. (shrink)

I argue that (1) whether abortions are morally permissible depends on whether the fetus has a right to life, (2) the only point of disagreement between the possible theories on this question--the Extreme Conservative, the Middle, and the Extreme Liberal--concerns the relevant temporal proximity to, or degree of probability of actualizing, some selected potential, (3) there is in principle no non-arbitrary way of resolving this disagreement, and hence the problem of abortion is a pseudo-problem inasmuch as it is not theoretically (...) capable of being solved, and (4) legislators should, in the light of this, act as if the Extreme Liberal Theory were true. (shrink)

Advance directives enable individuals to project their healthcare preferences into a period of anticipated incapacity. With advance directives, individuals can designate whom they would like to have make healthcare decisions for them, or give their healthcare provider advice on what to do, or both. Canada has an unusually wide variety of legislative approaches to advance directives. In what follows we describe and evaluate these, with the aim of pointing the way toward the ideally best legislation and policies on such directives.

Canada is one of the few countries in the world—China is another—that has decriminalized abortion. In Canada, there are no legislative or judicial restrictions whatsoever on abortion: When, where, and under what circumstances abortions can be performed are all unregulated. In sharp contrast, abortion is generally illegal in South American and predominantly Catholic countries, as well as in African and Muslim countries. And the countries that do allow legal abortions, including most in Europe along with America, Australia, and Russia, typically (...) permit it only up to a certain time or make it subject to circumstances such as risk to the woman. In what follows we will first explain how Canada came to decriminalize abortion and then go on to assess that position from an ethical point of view. (shrink)

We have a philosopher friend who was quite ill and required surgery, but she was not ill enough to be admitted to hospital under the “life, limb, and organ preservation” guidelines that control surgical admissions. Her surgeon told her to go to emergency and gave her a list of symptoms to tell the physicians there. Those, he said, would get her a bed, and he would then come and perform the necessary surgery. And that is how our friend got her (...) surgery. (shrink)

It is a rare patient who always does everything healthcare providers advise. Sometimes no harm comes from this; sometimes good does. But occasionally, great harm comes from not listening, as when it results in patients returning time and again for costly and invasive treatments of, say, infections, valve replacements, pressure ulcers, and so forth. No class of patients arouses more anger and resentment in healthcare providers, who often put out a call to invoke some version of the three strikes rule (...) and refuse care. And if the patients are also unemployed substance abusers who live in a local park, impolite or dangerous to staff, disruptive to other patients, and have intimidating visitors, the call to say “No” is louder. Can care ever be refused? If so, when? These are the questions we take up in this article. The answers we provide were developed as part of a Paraplegics and Quadriplegics with Pressure Ulcers Project carried out at Vancouver Hospital and Health Sciences Centre. Following an established usage, we refer to patients who exhibit a cluster of the above characteristics, the dominant one of which is a reluctance to heed medical advice, as “noncompliant patients.” This term is offensive to some, but the politically correct lexicon does not provide any alternative which is as short and clear or substantially different. We use the term as a convenient way of referring to a familiar class of patients and without any imputation of blame. (shrink)

Baseball rules prohibit pitchers from intentionally throwing at batters. When a pitcher does so, however, it is common practice for a pitcher on the opposing team to retaliate by throwing at the first player of the offending team to bat the next inning, and for umpires to ignore the rule forbidding that. I argue that player retaliation in the form of one for one is a better response to the initial violation than any other that is available, one for one (...) can be justified as payback and for anticipated good consequences, and everyone who becomes a professional baseball player has consented to the practice. From these claims, I conclude that one for one is in the best interest of baseball, it is best if umpires follow common practice and wink at the rule forbidding it, and players cannot complain if they are told to throw at batters in certain circumstances, or are thrown at in just those circumstances. (shrink)

Current general restrictions on performance-enhancing drugs pose a collective action problem that cannot be solved and bring a variety of adverse consequences for sport. General prohibitions of PEDs are grounded in claims that they violate the integrity of sport. But there are decisive arguments against integrity of sport-based prohibitions of PEDs for elite sport. We defend a harm prevention approach to PED prohibition as an alternative. This position cannot support a general ban on PEDs, since it provides no basis for (...) prohibiting non-harmful PED use. We argue that a harm prevention approach to restricting PEDs is ethically justified, has better prospects of compliance, is consistent with respecting the integrity of sport, and holds at least a modest prospect of resolving the collective action problem around PED restriction. (shrink)

In 2015, the Supreme Court of Canada struck down the criminal law prohibiting physician assisted death in Canada. In 2016, Parliament passed legislation to allow what it called ‘medical assistance in dying.’ The authors first describe the arguments the Court used to strike down the law, and then argue that MAID as legalized in Bill C-14 is based on principles that are incompatible with a free and democratic society, prohibits assistance in dying that should be permitted, and makes access to (...) medically-assisted death unnecessarily difficult. They then propose a version of MAID legislation that gives proponents and opponents of MAID everything they can legitimately want, contend that it is the only way to legalize MAID that is compatible with a free and democratic society, and conclude that it is the way to legalize MAID in Canada and other similarly free and democratic societies. (shrink)

Two of the most poignant decisions in pediatrics concern disagreements between physicians and families over imperiled newborns. When can the family demand more life-sustaining treatment than physicians want to provide? When can it properly ask for less? The author looks at these questions from the point of view of decision theory, and first argues that insofar as the family acts in the child’s best interest, its choices cannot be constrained, and that the maximax and minimax strategies are equally in the (...) child’s best interest. He then proposes a guideline according to which the family can demand LST if it is physiologically possible to preserve a life the child can be expected to welcome, and refuse such treatment if it causes suffering that is “more than can be borne” even if an uncompromised life is expected to emerge. (shrink)

In any healthcare system in which demand exceeds supply—which means any typical public healthcare system—patients cannot always get the care they want or need when they want or need it. It is also unrealistic to suppose that it will ever be otherwise. There have been such advances in medicine and growth in the population that even if we forgot about all other goods such as education, roads, social services, and so forth and put the entire budget into healthcare, there would (...) still be a gap between supply and demand. Moreover, even if we could by that expedient make them match and had eyes only for health, we still should not. For it is now understood that healthcare is the least important determinant of health, lining up well behind poverty and social status. But if suboptimal care is to be our destiny, we must plan how it is to be delivered. (shrink)

This study was aimed at examining the impacts of the Sharing economy on the individual and community Quality of Life and wellbeing by looking at their associated influencing factors using Village Savings and Loans Associations as a model of sharing economy in Malawi. An online community-based cross-sectional study design was conducted from November 2020 through January 2021. In the survey, 402 Village Savings and Loans Associations members from the Mzuzu City area participated, recruited using snowball and respondent-driven sampling techniques. The (...) sample size was computed using a single population proportion using the Yamane formula. Descriptive statistics and ordinal logistic regression model techniques were also employed. Additionally, we used the Chi-Square test, two-way ANOVA, and Ordinal regression model to determine statistical associations between socioeconomic data and QOL and wellbeing variables with a 5% level of significance. On the aspect of community wellbeing, the findings of our study indicated that income provided members with options to live a better QOL and wellbeing within the community by either facilitating payment for better education, eating healthier foods, acquiring assets, etc. Further, the absence of discrimination provided a platform for voice, inclusion, and social trust, enhancing freedom of expression. We also found that education facilitated better earnings and knowledge of public health-related issues. As for the contribution to the sharing economy, our study has emphasized the role played by trust in enhancing sharing economy. We recommend and encourage people to join these VSLAs so as to improve their QOL and wellbeing. However, there is a need to replicate the study on a larger scale to validate our study findings for effective policy formulation and implementation geared to improving the overall quality of people’s lives. Based on these findings, we further recommend that authorities reinstate programs like National Strategy for Financial Inclusion 2016–2020 and Savings and Loan Groups Best Practice Guidelines 2016–2017 that could further enhance the future of VSLAs, which are vital for QOL and community wellbeing of the people in developing countries like Malawi. (shrink)

This paper offers a theologically‐orientated examination of some core themes of the works of the philosopher Mary Midgley (1919–2018), identifying areas of possible theological exploration and development. Particular attention is paid to her critique of the reductionist strategies of writers such as Richard Dawkins, her development of the ‘mapping’ metaphor for engaging complex issues, and her emphasis on the critical role of philosophy. Although the paper offers some brief examples of theological issues which are illuminated by Midgley’s philosophical approach (such (...) as soteriological mapping), the primary purpose of the paper is to highlight the theological hospitality that it offers. (shrink)

The Territories of Human Reason is the first major study to explore the emergence of multiple situated rationalities. It focuses on the relation of the natural sciences and Christian theology, but its approach can easily be extended to other disciplines. It provides a robust intellectual framework for discussion of transdisciplinarity, which has become a major theme in many parts of the academic world. McGrath offers a major reappraisal of what it means to be 'rational' which will have significant impact on (...) older discussions of this theme. He sets out to explore the consequences of the seemingly inexorable move away from the notion of a single universal rationality towards a plurality of cultural and domain-specific methodologies and rationalities. This groundbreaking volume will provoke intense discussion and debate. (shrink)