HOMEOPATHY IS UNSCIENTIFIC AND UNETHICAL

In opposition to the premises of Against Homeopathy – a Utilitarian Perspective, all four respondents base their objections on the central claims that homeopathy is in fact scientifically plausible and is supported by empirical evidence. Despite ethical aspects forming the main thrust of Against Homeopathy, the respondents’ focus on scientific aspects represents sound strategy, since the ethical case against homeopathy would be weakened concomitant with the extent to which any plausibility for homeopathy could be demonstrated. The trouble here is that the respondents are attempting to perpetuate a sterile debate. The notion that homeopathic preparations could have any biological effects represents a fringe viewpoint, one not entertained by serious scientists nor supported by reason and evidence. In the present article, I shall endeavour to explain why the respondents do not have a valid case. I will deal firstly with their general approach to scientific plausibility and evidence, and then consider some of the specific claims they have made. Finally, I will answer the philosophical arguments some of the respondents have raised.     

The positive value of moral distress

Moral distress in healthcare has been an increasingly prevalent topic of discussion. Most authors characterize it as a negative phenomenon, while few have considered its potentially positive value. In this essay, I argue that moral distress can reveal and affirm some of our most important concerns as moral agents. Indeed, the experience of it under some circumstances appears to be partly constitutive of an honorable character and can allow for crucial moral maturation. The potentially positive value, then, is twofold; moral distress carries both aretaic and instrumental value. Granted, this position is not without its caveats, but by making these clear, I provide a novel framework for policy recommendations regarding when, if ever, we should work to reduce moral distress.     

Molecular cloning of the rat integrin alpha 1-subunit: a receptor for laminin and collagen

Integrin heterodimers mediate a variety of adhesive interactions, including neuronal attachment to and process outgrowth on laminin. We report here the cloning and primary sequence of an M-200 kD integrin alpha subunit that associates with the integrin beta 1 subunit to form a receptor for both laminin and collagen. Similarities in ligand-binding specificity, relative molecular mass and NH2-terminal sequence make this a strong candidate for the rat homologue of the alpha subunit of the human integrin VLA-1. The full-length rat alpha 1 cDNAs encode a protein containing a purative signal sequence and a mature polypeptide of 1,152 amino acids, with extracellular, transmembrane and cytoplasmic domains. Several structural features are conserved with other integrin alpha chains, including (a) a sequence motif repeated seven times in the NH2-terminal half; (b) potential Ca2+/Mg2+ binding sites in repeats 5, 6, and 7, and (c) alignment of at least 14 of 23 cysteine residues. This rat alpha 1 sequence also contains a 206-amino acid I domain, inserted between repeats 2 and 3, that is homologous to I domains found in the same position in the alpha subunits of several integrins (VLA-2, Mac-1, LFA-1, p150). The rat alpha 1 and human VLA-2 apha subunits share greater than 50% sequence identity in the seven repeats and I domain, suggesting that these sequence identities may underlie some of their similar ligand-binding specificities. However, the rat integrin alpha 1 subunit has several unique features, including a 38-residue insert between two Ca2+/Mg2+ binding domains, and a divergent 15-residue cytoplasmic sequence, that may potentially account for unique functions of this integrin.     

Innovations in applications and prospects of non-isocyanate polyurethane bioplastics

Currently, conventional plastics are necessary for a variety of aspects of modern daily life, including applications in the fields of healthcare, technology, and construction. However, they could also contain potentially hazardous compounds like isocyanates, whose degradation has a negative impact on both the environment and human health. Therefore, researchers are exploring alternatives to plastic which is sustainable and environmentally friendly without compromising its mechanical and physical features. This review study highlights the production of highly eco-friendly bioplastic as an efficient alternative to non-biodegradable conventional plastic. Bioplastics are produced from various renewable biomass sources such as plant debris, fatty acids, and oils. Poly-addition of di-isocyanates and polyols is a technique employed over decades to produce polyurethanes (PUs) bioplastics from renewable biomass feedstock. The toxicity of isocyanates is a major concern with the above-mentioned approach. Novel green synthetic approaches for polyurethanes without using isocyanates have been attracting greater interest in recent years to overcome the toxicity of isocyanate-containing raw materials. The polyaddition of cyclic carbonates (CCs) and polyfunctional amines appears to be the most promising method to obtain non-isocyanate polyurethanes (NIPUs). This method results in the creation of polymeric materials with distinctive and adaptable features with the elimination of harmful compounds. Consequently, non-isocyanate polyurethanes represent a new class of green polymeric materials. In this review study, we have discussed the possibility of creating novel NIPUs from renewable feedstocks in the context of the growing demand for efficient and ecologically friendly plastic products.     

Are austerity measures really distressing? Evidence from Italy

Since 2007 financial recovery plans have been adopted by some Italian regions to contain the costs of the healthcare sector. It is legitimate to ask whether spending cuts associated with the austerity policy have had any effect on the health of the citizens. We examine the indirect impact of financial recovery plans on a broad set of health indicators, accounting for several dimensions of both physical and psychological diseases. We use an instrumental variable fixed-effects model to control for time-varying heterogeneity and to deal with the potential endogeneity of the enrolment in the austerity programme. We find that the Italian austerity policy Piano di Rientro resulted in unintended negative effects on several dimensions of health, hurting and potentially jeopardising the health of citizens.     

HOMEOPATHY AND EXTRAORDINARY CLAIMS – A RESPONSE TO SMITH'S UTILITARIAN ARGUMENT

Kevin Smith's utilitarian argument against homeopathy 1 is flawed because he did not review and refute the relevant basic science literature on ultra‐high dilutions. He also failed to appreciate that allopathic medicine is based on a deductive‐nomothetic method and that homeopathic medicine is based on an inductive‐idiographic method, and thus that the implications for clinical research are very different. His misunderstanding of provings and of the holism of homeopathic medicine also demonstrated his failure to understand the history, philosophy and method of homeopathy. Finally, I questioned the value of introducing ethical judgment into an ongoing scientific debate.     

Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study

BackgroundDuring the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dwelling individuals contributed to this decline in routine healthcare utilisation. Moreover, it is uncertain which specific symptoms were left unheeded by patients and which determinants predispose to healthcare avoidance in the general population. In this cross-sectional study, we assessed prevalence of healthcare avoidance during the pandemic from a patient perspective, including symptoms that were left unheeded, as well as determinants of healthcare avoidance.Methods and findingsOn April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19–specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population.ConclusionsIn this population-based cross-sectional study, 1 in 5 individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms. Healthcare avoidance was strongly associated with female sex, fragile self-appreciated health, and high levels of depression and anxiety. These results emphasise the need for targeted public education urging these vulnerable patients to timely seek medical care for their symptoms to mitigate major health consequences.

Marije J. Splinter and colleagues assess the prevalence of healthcare avoidance during the COIVD-19 pandemic and investigate related determinants     

From Exceptional to Liminal Subjects: Reconciling Tensions in the Politics of Tuberculosis and Migration

Controlling the movement of potentially infectious bodies has been central to Australian immigration law. Nowhere is this more evident than in relation to tuberculosis (TB), which is named as a ground for refusal of a visa in the Australian context. In this paper, I critically examine the “will to knowledge” that this gives rise to. Drawing on a critical analysis of texts, including interviews with migrants diagnosed with TB and healthcare professionals engaged in their care (n=19), I argue that this focus on border policing, rather than resettlement and the broader social determinants of health that drive current rates of TB, paradoxically renders migrants diagnosed with TB as liminal subjects in the post-arrival phase. This raises ethical issues about who “matters,” as well as dilemmas about what constitutes adequate care for the “Other,” both of which go to the heart of the political economy of migration.     

Antibody-catalyzed cleavage of the D-Ala-D-Lac depsipeptide: an immunological approach to the problem of vancomycin resistance

Vancomycin resistance is currently a major healthcare problem. The development of a catalytic monoclonal antibody (mAb) that hydrolyzes the D-Ala-D-Lac depsipeptide provides a potentially novel antibiotic strategy. A phosphonate hapten design was used to program antibody catalysis. The characteristics of the hapten were shown to be important for obtaining a viable immune response and several catalytic mAbs that cleave a peptidoglycan model substrate. The best mAb afforded a >500-fold rate enhancement over background.     

Machine Learning in Healthcare

Recent advancements in Artificial Intelligence (AI) and Machine Learning (ML) technology have brought on substantial strides in predicting and identifying health emergencies, disease populations, and disease state and immune response, amongst a few. Although, skepticism remains regarding the practical application and interpretation of results from ML-based approaches in healthcare settings, the inclusion of these approaches is increasing at a rapid pace. Here we provide a brief overview of machine learning-based approaches and learning algorithms including supervised, unsupervised, and reinforcement learning along with examples. Second, we discuss the application of ML in several healthcare fields, including radiology, genetics, electronic health records, and neuroimaging. We also briefly discuss the risks and challenges of ML application to healthcare such as system privacy and ethical concerns and provide suggestions for future applications.     

A methodology for developing clinical collaborative communication systems

As healthcare organizations are struggling to enhance healthcare qualities and efficiencies, they focus on secure and efficient sharing of clinical information among healthcare providers including doctors, nurses, medical laboratories, and informal caregivers, throughout the entire healthcare life cycle. Any failure or error during this clinical collaborative communication can have negative impact on the efficiencies of the whole healthcare delivery system. This paper suggests a methodological approach to address the needs in this area and proposes a methodology for developing clinical collaborative communication (C\(^{3})\) systems. Since C\(^{3}\) demands a variety of collaborative communications among multiple healthcare stakeholders, the proposed approach focuses on the effective system design and analysis with the objective to enhance collaboration and communication in healthcare organizations.     

Pretarsal structures in Leiodidae and Agyrtidae (Coleoptera,Staphylinoidea)

We analysed pretarsal characters of 87 species of Leiodidae (including 10 cholevines and representatives of all tribes and ca. 60% of the genera of non‐cholevines), five species of Agyrtidae, and nine representatives of outgroup taxa (Hydraenidae, Staphylinidae, Hydrophilidae, and Histeridae) using scanning electron microscopy. We focused our observations on the architecture of the empodium (including the sclerites and associated setae), the shape and composition of the medial projection of the distal margin of the terminal tarsomere, and the armature of the claws, which were considered a promising source of information for delimiting supraspecific taxa in our previous study. We identified several diagnostic features and recognize potential synapomorphies at the tribal, subtribal and generic levels. The internal systematic arrangement and/or even the monophyletic status of most of the subfamilies of Leiodidae (Camiarinae, Catopocerinae, Leiodinae, and Platypsyllinae) are challenged. We identified potential synapomorphies for Camiarinae (Camiarini and Agyrtodini) and Leiodinae. The non‐monophyly of Cholevinae is possible because part of the tribe (Anemadini, Eucatopini, and Oritocatopini) shares potentially apomorphic features with Leiodinae (e.g., a triangular medial projection with a diagonal row of conical spines), whereas another part (Leptodirini and Ptomaphagini) shares a potentially apomorphic feature with Coloninae and Platypsyllinae (a typical medial projection with two distinct triangular projections).     

Healing herbs and dangerous doctors: "fruit fever" and community conflicts with biomedical care in Northeast Thailand

In Northeast Thailand, khai mak mai (fruit fever) is a local, ethnomedical category of illness identified by community members as untreatable by biomedical health providers. The illness is believed to be incompatible with several substances that may induce death, including fruit as well as two forms of medication associated with biomedical care: injections and intravenous solution. Consequently, fevers suspected of being khai mak mai are treated by herbalists while biomedical health services are avoided and feared. In this article, I examine local perceptions and treatment of khai mak mai. I also explore the context and consequences of concerns about the inadequacy of biomedical care, as well as the social meanings associated with the illness and the political-economic context that shapes both the meanings of, and everyday responses to, fevers suspected of being khai mak mai.     

Patterns of genetic variation and covariation in ejaculate traits reveal potential evolutionary constraints in guppies

Ejaculates comprise multiple and potentially interacting traits that determine male fertility and sperm competitiveness. Consequently, selection on these traits is likely to be intense, but the efficacy of selection will depend critically on patterns of genetic variation and covariation underlying their expression. In this study, I provide a prospective quantitative genetic analysis of ejaculate traits in the guppy Poecilia reticulata, a highly promiscuous live-bearing fish. I used a standard paternal half-sibling breeding design to characterize patterns of genetic (co)variation in components of sperm length and in vitro sperm performance. All traits exhibited high levels of phenotypic and additive genetic variation, and in several cases, patterns of genetic variation was consistent with Y-linkage. There were also highly significant negative genetic correlations between the various measures of sperm length and sperm performance. In particular, the length of the sperm's midpiece was strongly, negatively and genetically correlated with sperm's swimming velocity-an important determinant of sperm competitiveness in this and other species. Other components of sperm length, including the flagellum and head, were independently and negatively genetically correlated with the proportion of live sperm in the ejaculate (sperm viability). Whether these relationships represent evolutionary trade-offs depends on the precise relationships between these traits and competitive fertilization rates, which have yet to be fully resolved in this (and indeed most) species. Nevertheless, these prospective analyses point to potential constraints on ejaculate evolution and may explain the high level of phenotypic variability in ejaculate traits in this species.     

Genetic regulation networks: circuits,regulons and attractors

We deal in this paper with the concept of genetic regulation network. The genes expression observed through the bio-array imaging allows the geneticist to obtain the intergenic interaction matrix W of the network. The interaction graph G associated to W presents in general interesting features like connected components, gardens of Eden, positive and negative circuits (or loops), and minimal components having 1 positive and 1 negative loop called regulons. Depending on parameters values like the connectivity coefficient K(W) and the mean inhibition weight I(W), the genetic regulation network can present several dynamical behaviours (fixed configuration, limit cycle of configurations) called attractors, when the observation time increases. We give some examples of such genetic regulation networks and analyse their dynamical properties and their biological consequences.     

Mapping out structural features in clinical care calling for ethical sensitivity: a theoretical approach to promote ethical competence in healthcare personnel and clinical ethical support services (CESS)

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the 'favourite' ethical issues of the day. In this paper we attempt to capture a comprehensive overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS.     

Inhospitable Healthcare Spaces: Why Diversity Training on LGBTQIA Issues Is Not Enough

In an effort to address healthcare disparities in lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations, many hospitals and clinics institute diversity training meant to increase providers’ awareness of and sensitivity to this patient population. Despite these efforts, many healthcare spaces remain inhospitable to LGBTQ patients and their loved ones. Even in the absence of overt forms of discrimination, LGBTQ patients report feeling anxious, unwelcome, ashamed, and distrustful in healthcare encounters. We argue that these negative experiences are produced by a variety of subtle, ostensibly insignificant features of healthcare spaces and interpersonal interactions called microaggressions. Healthcare spaces and providers often convey heteronormative microaggressions, which communicate to LGBTQ—and, we suggest, intersex and asexual (IA)—people that their identities, experiences, and relationships are abnormal, pathological, unexpected, unwelcome, or shameful. We identify heteronormative microaggressions common to healthcare settings and specify how they negatively impact LGBTQIA patients. We argue that standard diversity training cannot sufficiently address heteronormative microaggressions. Despite these challenges, healthcare institutions and providers must take responsibility for heteronormative microaggressions and take steps to reduce their frequency and mitigate their effects on LGBTQIA care. We conclude by offering strategies for problem-solving at the level of medical education, institutional culture and policy, and individual awareness.     

The Nature and Value of Bioethics Expertise

In this article, I address the extent to which experts in bioethics can contribute to healthcare delivery by way of aid in clinical decision‐making and policy‐formation. I argue that experts in bioethics are moral experts, in that their substantive moral views are more likely to be correct than those of non‐bioethicists, all else being equal, but that such expertise is of use in a relatively limited class of cases. In so doing, I respond to two recent arguments against the view that bioethicists are moral experts, one by Christopher Cowley and another by David Archard. I further argue that bioethics experts have significant additional contributions to make to healthcare delivery, and highlight a hitherto neglected aspect of that contribution: amelioration of moral misconception among clinicians. I describe in detail several aspects of moral misconception, and show how the bioethicist is in a prime position to resolve that sort of error.     

The hERG K(+) channel S4 domain L532P mutation: characterization at 37°C

hERG (human Ether-à-go-go Related Gene) is responsible for ion channels mediating rapid delayed rectifier potassium current, I(Kr), which is key to cardiac action potential repolarization. Gain-of-function hERG mutations give rise to the SQT1 variant of the Short QT Syndrome (SQTS). Reggae mutant zebrafish, with a S4 zERG mutation (Leucine499Proline; L499P), display arrhythmic features analogous to those seen in the SQTS. The affected S4 domain ERG residue is highly conserved. This study was executed to determine how the homologous hERG mutation (L532P) influences channel function at 37°C. Whole-cell measurements of current (I(hERG)) were made from HEK 293 cells expressing WT or L532P hERG. The half maximal activation voltage (V(0.5)) of L532P I(hERG) was positively shifted by ~+36mV compared to WT I(hERG); however at negative voltages a pronounced L532P I(hERG) was observed. Both activation and deactivation time-courses were accelerated for L532P I(hERG). The inactivation V(0.5) for L532P I(hERG) was shifted by ~+32mV. Under action potential (AP) voltage-clamp, L532P I(hERG) exhibited a dome-shaped current peaking at ~+16mV, compared to ~-31mV for WT-I(hERG). The L532P mutation produced an ~5-fold increase in the IC(50) for dronedarone inhibition of I(hERG). Homology modeling indicated that the L532 residue within the S4 helix lies closely apposed to the S5 region of an adjacent hERG subunit. Alterations to the S4 domain structure and, potentially, to interactions between adjacent hERG subunits are likely to account for the functional effects of this mutation.