The advent of new antiretroviral medicines means that the effects of HIV can now be curbed, but only one in twenty infected people have so far benefited. For those living in developing countries, the new treatments are practically unattainable. Governments, UNAIDS and pharmaceutical companies recognise this only too well and have rethought established assumption in order to try and overcome the challenges posed by cost, inadequate health services and unreliable local supply of medicines.

The ethical question is whether university mask mandates should be relaxed. I argue that the use of face masks by healthy individuals has uncertain benefits, which potential harms may outweigh, and should therefore be voluntary. Systematic reviews by the World Health Organization (WHO) and Cochrane Acute Respiratory Infections concluded that the use of face masks by healthy individuals in the community lacks effectiveness in reducing viral transmission based on moderate-quality evidence. The only two randomized controlled trials of face masks (...) published during the pandemic found little to no benefit. Without high-quality evidence, it is difficult to justify a requirement rather than a recommendation. Notwithstanding, one might argue that the precautionary principle justifies mask mandates. If the precautionary principle can justify implementing mask mandates due to the risk of forgoing possible benefit, then it might also be able to justify not implementing mask mandates due to the risk of potential harm caused by the intervention. It is commonly thought that there is little to lose from the use of face masks, but this is not necessarily true. It is possible that masks have done more harm than good. (shrink)

Identifying what the differences are or ought to be between Catholic health care organizations and their non-Catholic counterparts is the subject of great debate. The author responds to the essays in this volume by Dennis Brodeur, Clarke E. Cochran and Christopher J. Kauffman, each of which represents a different perspective in the discussion of what is unique about Catholic health care.

Bulang He,1,2 Jeffrey M Hamdorf2 1Liver and Kidney Transplant Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia; 2School of Surgery, The University of Western Australia, Perth, WA, Australia Aims: The aim of this paper was to review the current status of laparoscopic/robotic kidney transplant and evaluate its feasibility and safety in comparison with conventional standard "open" kidney transplant. Methods: An electronic search of PubMed, Embase, and the Cochrane library database was performed to identify the papers between January 1980 and (...) June 2013 that reported on laparoscopic/robotic kidney transplantation. The terms "laparoscopic kidney/renal transplant" and "robotic kidney/renal transplant " were used. Cross-referencing was also used to find the further publications. Only English language reports were selected and accepted for descriptive analysis. Results: A total of 17 papers and abstracts were retrieved. There were two case-control studies of small volume. High-level evidence comparing the safety and efficacy of laparoscopic/robotic kidney transplant with conventional open kidney transplant was not available at the time of this review. Conclusion: The limited published data have suggested that laparoscopic/robotic kidney transplant may offer the advantages of less pain, better cosmesis, possible shorter hospital stay, and fewer wound complications, without compromising graft function. Accordingly, some immunosuppressive agents, such as sirolimus, might be able to be commenced earlier, after laparoscopic/robotic kidney transplant. The techniques are various at this early stage. A uniformed operative technique may be established in the near future. With refinement of laparoscopic devices, this technique may be widely employed. Further studies will be needed to demonstrate the advantages of laparoscopic/robotic kidney transplant over the conventional open kidney transplant. Keywords: laparoscopic surgery, robotic surgery. (shrink)

Bovine tuberculosis is an important and controversial animal health policy issue in England, which impacts humans, cattle and badgers. The government policy of badger culling has led to widespread opposition, in part due to the conclusions of a large field trial recommending against culling, and in part because badgers are a cherished wildlife species. Animal rights theorists argue that sentient nonhumans should be accorded fundamental rights against killing and suffering. In bovine TB policy, however, pro-culling actors claim that badgers must (...) be culled to avoid the slaughter of cattle. The first part of the paper compares AR theories of Regan, Francione, Cochrane, Garner and Donaldson and Kymlicka in the context of wildlife species. The second part of the paper applies these AR theories to bovine TB and badger control. AR theories are applied to badger control policy options of do nothing, badger culling, and badger vaccination. We conclude that AR theories are strongly opposed to badger culling. In general, culling is prohibited due to a badger’s right to life and its rights against suffering. The AR theories support a do-nothing, i.e. non-culling, non-vaccination approach to badger control. In the case of the AR theories of Regan and Francione, this is based on abolitionist positions with respect to farming. For Cochrane, Garner, and Donaldson and Kymlicka, the do-nothing policy option is preferred because badger vaccination causes a degree of suffering which generally is not for the individual’s benefit. (shrink)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: -/- The main aim of this review will be to assess the effects of changing practitioner empathy or patient expectations for all conditions. The main objective is to conduct a systematic review of randomised trials where the intervention involves manipulating either (a) practitioner empathy or (b) patient expectations, or (c) both.

Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires (...) researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)

BackgroundTitles and abstracts are the most read sections of biomedical papers. It is therefore important that abstracts transparently report both the beneficial and adverse effects of health care interventions and do not mislead the reader. Misleading reporting, interpretation, or extrapolation of study results is called “spin”. In this study, we will assess whether adverse effects of orthodontic interventions were reported or considered in the abstracts of both Cochrane and non-Cochrane reviews and whether spin was identified and what type (...) of spin.MethodsEligibility criteria were defined for the type of study designs, participants, interventions, outcomes, and settings. We will include systematic reviews of clinical orthodontic interventions published in the five leading orthodontic journals and in the Cochrane Database. Empty reviews will be excluded. We will manually search eligible reviews published between 1 August 2009 and 31 July 2019. Data collection forms were developed a priori. All study selection and data extraction procedures will be conducted by two reviewers independently. Our main outcomes will be the prevalence of reported or considered adverse effects of orthodontic interventions in the abstract of systematic reviews and the prevalence of “spin” related to these adverse effects. We will also record the prevalence of three subtypes of spin, i.e., misleading reporting, misleading interpretation, and misleading extrapolation-related spin. All statistics will be calculated for the following groups: (1) all journals individually, (2) all journals together, and (3) the five leading orthodontic journals and the Cochrane Database of Systematic Reviews separately. Generalized linear models will be developed to compare the various groups.DiscussionWe expect that our results will raise the awareness of the importance of reporting and considering of adverse effects and the presence of the phenomenon of spin related to these effects in abstracts of systematic reviews of orthodontic interventions. This is important, because an incomplete and inadequate reporting, interpretation, or extrapolation of findings on adverse effects in abstracts of systematic reviews can mislead readers and could lead to inadequate clinical practice. Our findings could result in policy implications for making judgments about the acceptance for publication of systematic reviews of orthodontic interventions. (shrink)

Reviews : T. Cutler, K. Williams and J. Williams, Keynes, Beveridge and Beyond ; J. Clarke, A. Cochrane and C. Smart, Ideologies of Welfare: From Dreams to Disillusion.

In this book, Tom Cochrane develops a new control theory of the emotions and related affective states. Grounded in the basic principle of negative feedback control, his original account outlines a new fundamental kind of mental content called 'valent representation'. Upon this foundation, Cochrane constructs new models for emotions, pains and pleasures, moods, expressive behaviours, evaluative reasoning, personality traits and long-term character commitments. These various states are presented as increasingly sophisticated layers of regulative control, which together underpin the (...) architecture of the mind as a whole. Clearly structured and containing numerous diagrams and examples to illustrate the discussion, this study draws on the latest research from fields including philosophy, psychology and neuroscience, and will appeal to readers interested in the philosophy and cognitive science of emotion. (shrink)

Alasdair Cochrane introduces an entirely new theory of animal rights grounded in their interests as sentient beings. He then applies this theory to different and underexplored policy areas, such as genetic engineering, pet-keeping, indigenous hunting, and religious slaughter. In contrast to other proponents of animal rights, Cochrane claims that because most sentient animals are not autonomous agents, they have no intrinsic interest in liberty. As such, he argues that our obligations to animals lie in ending practices that cause (...) their suffering and death and do not require the liberation of animals. Cochrane's "interest-based rights approach" weighs the interests of animals to determine which is sufficient to impose strict duties on humans. In so doing, Cochrane acknowledges that sentient animals have a clear and discernable right not to be made to suffer and not to be killed, but he argues that they do not have a prima facie right to liberty. Because most animals possess no interest in leading freely chosen lives, humans have no moral obligation to liberate them. Moving beyond theory to the practical aspects of applied ethics, this pragmatic volume provides much-needed perspective on the realities and responsibilities of the human-animal relationship. (shrink)

Introduction : animals and political theory -- Animals in the history of political thought -- Utilitarianism and animals -- Liberalism and animals -- Communitarianism and animals -- Marxism and animals -- Feminism and animals.

This paper identifies a tension between the commitment to forming rationally justified emotions and the happy life. To illustrate this tension I begin with a critical evaluation of the positive psychology technique known as ‘gratitude training’. I argue that gratitude training is at odds with the kind of critical monitoring that several philosophers have claimed is regulative of emotional rationality. More generally, critical monitoring undermines exuberance, an attitude that plays a central role in contemporary models of the happy life. Thus, (...) prominent notions of what it takes to maintain emotion rationality and what it takes to maintain happiness are in tension. To resolve this tension, I argue that some people have good reason to depreciate critical monitoring—even while maintaining the requirement of emotion rationality that we be sensitive to facts about how our concerns are faring. (shrink)

I argue for the possibility of an extremely intimate connection between the emotional content of the music and the emotional state of the person who produces that music. Under certain specified conditions, the music may not just influence, but also partially constitute the musician’s emotional state.

This paper examines the causal basis of our ability to attribute emotions to music, developing and synthesizing the existing arousal, resemblance and persona theories of musical expressivity to do so. The principal claim is that music hijacks the simulation mechanism of the brain, a mechanism which has evolved to detect one's own and other people's emotions.

The author proposes a dimensional model of our emotion concepts that is intended to be largely independent of one’s theory of emotions and applicable to the different ways in which emotions are measured. He outlines some conditions for selecting the dimensions based on these motivations and general conceptual grounds. Given these conditions he then advances an 8-dimensional model that is shown to effectively differentiate emotion labels both within and across cultures, as well as more obscure expressive language. The 8 dimensions (...) are: (1) attracted—repulsed, (2) powerful—weak, (3) free—constrained, (4) certain—uncertain, (5) generalized—focused, (6) future directed—past directed, (7) enduring—sudden, (8) socially connected—disconnected. (shrink)

All states must make decisions about how to regulate the treatment of animals. In this book, Alasdair Cochrane argues that this must go further. In order to ensure that their interests are taken seriously, it is imperative that we represent them throughout the political process - not only rights to protection, but also to democratic membership.

There is now widespread agreement that many non-human animals are sentient, and that this fact has important moral and political implications. This book is devoted to sketching what this 'sentientist politics' might look like.

It is an important feature of creatures like us that our various motivations compete for control over our behaviour, including mental behaviour such as imagining and attending. In large part, this competition is adjudicated by the stimulation of affect — the intrinsically pleasant or unpleasant aspects of experience. In this paper I argue that the motivation-affect system controls a sub-type of attention called 'alerting attention' to bring various goals and stimuli to consciousness and thereby prioritize those contents for action. This (...) view allows me to flesh out the global workspace theory of consciousness, as well as some of the phenomenal characteristics of conscious experience. (shrink)

If we were to connect two individuals’ brains together, how would this affect the individuals’ conscious experiences? In particular, it is possible for two people to share any of their conscious experiences; to simultaneously enjoy some token experiences while remaining distinct subjects? The case of the Hogan twins—craniopagus conjoined twins whose brains are connected at the thalamus—seems to show that this can happen. I argue that while practical empirical methods cannot tell us directly whether or not the twins share conscious (...) experiences, considerations about the locality of content processing in the brain entails that they most likely do so. (shrink)

This book defends Aestheticism- the claim that everything is aesthetically valuable and that a life lived in pursuit of aesthetic value can be a particularly good one. Furthermore, in distilling aesthetic qualities, artists have a special role to play in teaching us to recognize values; a critical component of virtue. I ground my account upon an analysis of aesthetic value as ‘objectified final value’, which is underwritten by an original psychological claim that all aesthetic values are distal versions of practical (...) values. This is followed by systematic accounts of beauty, sublimity, comedy, drama, and tragedy, as well as appendix entries on the cute, the cool, the kitsch, the uncanny, the horrific, the erotic, and the furious. (shrink)

In their inimitable history book, 1066 and All That (“A Memorable History of England, Comprising All the Parts You Can Remember”), first published in 1930, W. C. Sellar and R. J. Yeatman note that...

In this article we examine obsessive compulsive disorder (OCD). We examine and reject two existing models of this disorder: the Dysfunctional Belief Model and the Inference‐Based Approach. Instead, we propose that the main distinctive characteristic of OCD is a hyperactive sub‐personal signal of being in error, experienced by the individual as uncertainty about his or her intentional actions (including mental actions). This signalling interacts with the anxiety sensitivities of the individual to trigger conscious checking processes, including speculations about possible harms. (...) We examine the implications of this model for the individual's capacity to control his or her thoughts. (shrink)

We present here a hierarchical model for the evolution of compositional language. The model has the structure of a two-sender/one-receiver Lewis signaling game augmented with executive agents who m...

Recent studies indicate that mammalian chromosomes contain discretecis‐acting loci that control replication timing, mitotic condensation, and stability of entire chromosomes. Disruption of the large non‐coding RNA gene ASAR6 results in late replication, an under‐condensed appearance during mitosis, and structural instability of human chromosome 6. Similarly, disruption of the mouse Xist gene in adult somatic cells results in a late replication and instability phenotype on the X chromosome. ASAR6 shares many characteristics with Xist, including random mono‐allelic expression and asynchronous replication timing. (...) Additional “chromosome engineering” studies indicate that certain chromosome rearrangements affecting many different chromosomes display this abnormal replication and instability phenotype. These observations suggest that all mammalian chromosomes contain “inactivation/stability centers” that control proper replication, condensation, and stability of individual chromosomes. Therefore, mammalian chromosomes contain four types ofcis‐acting elements, origins, telomeres, centromeres, and “inactivation/stability centers”, all functioning to ensure proper replication, condensation, segregation, and stability of individual chromosomes. (shrink)

We consider how human subjects establish signaling conventions in the context of Lewis-Skyrms signaling games. These experiments involve games where there are precisely the right number of signal types to represent the states of nature, games where there are more signal types than states, and games where there are fewer signal types than states. The aim is to determine the conditions under which subjects are able to establish signaling conventions in such games and to identify a learning dynamics that approximates (...) how they succeed when they do. Our results suggest that human agents tend to use a win-stay/lose-shift with inertia dynamics to establish conventions in such games. We briefly consider the virtues and vices of this low-rationality dynamics. (shrink)

The literature on the venerable aesthetic category of the sublime often provides us with lists of sublime phenomena — mountains, storms, deserts, volcanoes, oceans, the starry sky, and so on. But it has long been recognized that what matters is the experience of such objects. We then find that one of the most consistent claims about this experience is that it involves an element of fear. Meanwhile, the recognition of the sublime as a category of aesthetic appreciation implies that attraction, (...) admiration or pleasure is also present.1However, there is also a sense of fear and attraction when we watch car chases or fights. Neither of these is an occasion for the sublime so much as a visceral sort of excitement.2 As .. (shrink)

Digital personal data is increasingly framed as the basis of contemporary economies, representing an important new asset class. Control over these data assets seems to explain the emergence and dominance of so-called “Big Tech” firms, consisting of Apple, Microsoft, Amazon, Google/alphabet, and Facebook. These US-based firms are some of the largest in the world by market capitalization, a position that they retain despite growing policy and public condemnation—or “techlash”—of their market power based on their monopolistic control of personal data. We (...) analyse the transformation of personal data into an asset in order to explore how personal data is accounted for, governed, and valued by Big Tech firms and other political-economic actors. However, our findings show that Big Tech firms turn “users” and “user engagement” into assets through the performative measurement, governance, and valuation of user metrics, rather than extending ownership and control rights over personal data per se. We conceptualize this strategy as a form of “techcraft” to center attention on the means and mechanisms that Big Tech firms deploy to make users and user data measurable and legible as future revenue streams. (shrink)