The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the protocol, summarize the protocol, and discuss the major ethical challenges (...) encountered, along with our answers to the challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments.We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the pandemic and similar public health emergencies. (shrink)

In Classical Quarterly N.S. ix , 80 ff. Professor Hugh Lloyd-Jones published an article on the closing scenes of Seven Against Thebes. In it he directed an assault on the orthodox belief that these scenes are, in whole or in part, not authentic. The movement in favour of authenticity seemed all the stronger when independently, and in the same year, Walter Potscher put forward arguments in Eranos in defence of some parts of the disputed passages.

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

Consumer concern for “ethical products”, or ethical aspects of the goods which they purchase, is a subject of increasing interest and research,which is here illustrated by an examination of the Fair Trade movement, with special reference to coffee as an indicative commodity. Kate Bird, is currently Lecturer in the Development Administration Group, School of Public Policy, Birmingham University, Birmingham B15 2TT, England, having previously worked abroad and written her MSc dissertation at Wye College on fair trade in coffee products. Dr (...) Hughest holds the Sainsbury Chair in Agribusiness and Food Marketing at Wye College, University of London, Wye, Ashford, Kent TN25 5AH, England (email: D.Hughes@wye.ac.uk), where he is also Director of the Food Industry Management Group. He has wide international experience of food management issues. (shrink)

Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

Consumer concern for “ethical products”, or ethical aspects of the goods which they purchase, is a subject of increasing interest and research,which is here illustrated by an examination of the Fair Trade movement, with special reference to coffee as an indicative commodity. Kate Bird, is currently Lecturer in the Development Administration Group, School of Public Policy, Birmingham University, Birmingham B15 2TT, England, having previously worked abroad and written her MSc dissertation at Wye College on fair trade in coffee products. Dr (...) Hughest holds the Sainsbury Chair in Agribusiness and Food Marketing at Wye College, University of London, Wye, Ashford, Kent TN25 5AH, England (email: D.Hughes@wye.ac.uk), where he is also Director of the Food Industry Management Group. He has wide international experience of food management issues. (shrink)

Quite rightly, philosophers of physics examine the theories of physics, theories like Quantum Mechanics, Quantum Field Theory, the Special and General Theories of Relativity, and Statistical Mechanics. Far fewer, however, examine how these theories are put to use; that is to say, little attention is paid to the practices of theoretical physicists. In the early 1950s David Bohm and David Pines published a sequence of four papers, collectively entitled, ‘A Collective Description of Electron Interaction.’ This essay uses that quartet as (...) a case study in theoretical practice. In Part One of the essay, each of the Bohm-Pines papers is summarized, and within each summary an overview is given, framing a more detailed account. In Part Two theoretical practice is broken into six elements: (a) the use of models, (b) the use of theory, (c) modes of description and narrative, (d) the use of approximations, (e) experiment and theory, (f) the varied steps employed in a deduction. The last element is the largest, drawing as it does from the earlier ones. Part Three enlarges on the concept of ‘theoretical practice,’ and briefly outlines the subsequent theoretical advances which rendered the practices of Bohm and Pines obsolete, if still respected. (shrink)

Uncoupling proteins (UCPs) regulate mitochondrial function, and thus cellular metabolism. Angiotensin‐converting enzyme (ACE) is the central component of endocrine and local tissue renin–angiotensin systems (RAS), which also regulate diverse aspects of whole‐body metabolism and mitochondrial function (partly through altering mitochondrial UCP expression). We show that ACE expression also appears to be regulated by mitochondrial UCPs. In genetic analysis of two unrelated populations (healthy young UK men and Scandinavian diabetic patients) serum ACE (sACE) activity was significantly higher amongst UCP3‐55C (rather than (...) T) and UCP2 I (rather than D) allele carriers. RNA interference against UCP2 in human umbilical vein endothelial cells reduced UCP2 mRNA sixfold (P < 0·01) whilst increasing ACE expression within a physiological range (<1·8‐fold at 48 h; P < 0·01). Our findings suggest novel hypotheses. Firstly, cellular feedback regulation may occur between UCPs and ACE. Secondly, cellular UCP regulation of sACE suggests a novel means of crosstalk between (and mutual regulation of) cellular and endocrine metabolism. This might partly explain the reduced risk of developing diabetes and metabolic syndrome with RAS antagonists and offer insight into the origins of cardiovascular disease in which UCPs and ACE both play a role. (shrink)

In this paper we investigate some families of decision problems associated with a restricted class of Post canonical forms, specifically, those defined over one-letter alphabets whose productions have single premises and contain only one variable. For brevity sake, we call any such form an RPCF (Restricted Post Canonical Form). Constructive proofs are given which show, for any prescribed nonrecursive r.e. many-one degree of unsolvability D, the existence of an RPCF whose word problem is of degree D and an RPCF with (...) axiom whose decision problem is also of degree D. Finally, we show that both of these results are best possible in that they do not hold for one-one degrees. (shrink)

Catalogue of the Hugh Nevill Collection of Sinhalese Manuscripts in the British Library. K. D. Somadasa. Pali Text Society and the British Library. Vol. 1, 1987. xi, 440 pp. £22.00. Vol. 2, 1989. vii, 316 pp. £24.95.

Initial responses to questionnaires used to assess participants' understanding of informed consent for malaria vaccine trials conducted in the United States and Mali were tallied. Total scores were analyzed by age, sex, literacy (if known), and location. Ninety-two percent (92%) of answers by United States participants and 85% of answers by Malian participants were correct. Questions more likely to be answered incorrectly in Mali related to risk, and to the type of vaccine. For adult participants, independent predictors of higher scores (...) were younger age and female sex in the United States, and male sex in Mali. Scores in the United States were higher than in Mali (P = 0.005). Despite this difference participants at both sites were well informed overall. Although interpretation must be qualified because questionnaires were not intended as research tools and were not standardized among sites, these results do not support concerns about systematic low understanding among research participants in developing versus developed countries. (shrink)

Sustainable farming, and waysto achieve it, are important issues foragricultural policy. New Zealand provides aninteresting case for examining sustainableagriculture options because gene technologieshave not been commercially released and thereis a small but rapidly expanding organicsector. There is no strong governmentsubsidization of agriculture, so while policiesseem to favor both options to some degree,neither has been directly supported. Resultsfrom a survey of 656 farmers are used to revealthe intentions, environmental values, andfarming practices for organic, conventional,and GE intending farmers. The results show thatorganic (...) and conventional farmers are relativelysimilar but contrast to GE intending farmers,especially with respect to perceivedconsequences of each technology. While 75%of farmers have not yet made a commitmentto either technology, one fifth were GEintending and one quarter may become organic.Organic farmers have different attitudes tonature, matched in part by conventionalfarmers. In terms of policy for sustainableagriculture, the results suggest that organicand conventional farmers are incrementallymoving towards agroecological sustainabilitywhile GE intending farmers are committed tointensive production methods of which GEproducts are potentially important. GEintending farmers reject incrementalism infavor of a revolutionary technological fix forsustainability concerns in agriculture.Overall, the results show that there areclearly two different paradigms ofsustainability among farmers. Policies that areseeking to achieve sustainable agriculture needto address the tensions that span the differentparadigms. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:R. D. Ackerman BELIEVING IN A FICTION: WALLACE STEVENS AT THE LIMITS OF PHENOMENOLOGY The "ring of men" of "Sunday Morning" will chant their "devotion to the sun, / Not as a god, but as a god might be, / Naked among them, like a savage source" (CP, pp. 69-70).' Solar nakedness is deferred even as it is named. The problem for belief is the question of appearance and (...) representation. Things appear as and like.... The phenomenological return to things is also a turn to fiction, as Husserl understood: "If anyone loves a paradox, he can really say... that the element which makes up the life of phenomenology... is fiction. ' " The sun is divine, and it is not; it is both naked and clothed, savage and civilized, source (or end) and means. But such paradox is ultimately unsatisfying, and as we will see with Stevens, the need for belief—for an image or idea of totality—forces the issue of fiction and reality. The Stevens we will have in view is not the Stevens—as if there were such a creature. Our Stevens is the one most persuaded by promises such as those of phenomenology, the one most concerned with decreation (reduction) and fresh beginnings, with discovery and recognition, with imagination, the body, and the earth. This is the Stevens for whom the barrier of language presages at last not absence and difference but fictive recovery of presence and identity, the one for whom poetry represents a way of belief beyond mysticism even as it bodes mythic proximity. Finally, this is the Stevens who predominates throughout the prose (as well as in much of the poetry), who tries mightily to secure a belief while disencumbering himself of metaphysics—but alas, I think, with small success. Although Stevens's association of the problem of belief with the idea of fiction occurs in early poems such as "A High-Toned Old Christian 79 80Philosophy and Literature Woman" and "To the One of Fictive Music," his most intensive involvement with fiction as belief dates from the early 1940s and spans the period of his major essays and his last four volumes of poems. He recounts, for instance, a 1942 conversation with a student: "I said that I thought that we had reached a point at which we could no longer really believe in anything unless we recognized that it was a fiction. The student said that that was an impossibility, that there was no such thing as believing in something that one knew was not true. It is obvious, however, that we are doing that all the time" (L, p. 430). What does it mean to believe in a fiction? That is my main subject here, as we seek out the limits of the phenomenological Stevens. His letters of this period are preoccupied with the problem of fictive belief: "If one no longer believes in God (as truth), it is not possible merely to disbelieve; it becomes necessary to believe in something else.... A good deal of my poetry recently has concerned an identity for that thing.... In one of the short poems that I have just sent to the harvard advocate, I say that one's final belief must be in a fiction. I think that the history of belief will show that it has always been in a fiction" (L, p. 370). The poem referred to, "Asides on the Oboe," begins: The prologues are over. It is a question now, Of final belief. So, say that final belief Must be in a fiction. It is time to choose. (CP, p. 250) Acknowledging that "in the long run, poetry would be the supreme fiction" (L, pp. 430-31), Stevens nonetheless singles out the nominative function of poetry as the essence of its claim to supremacy: "Poetry means not the language of poetry but the thing itself.... The subject matter is what comes to mind when one says of the month of August... 'Thou art not August, unless I make thee so'" (L, p. 377). The quoted line (also from "Asides") underscores the paradox that for Stevens the essence of fiction (the nontrue) is its capacity to nominate the true or the real. This... (shrink)

Hicks' edition of the De Anima contains valuable commentary from Hicks as well as useful summaries of the views of earlier commentators.