Religious pluralism and the ethics of healthcare

Democratic societies that separate church and state face major challenges in accommodating religious convictions. This applies especially to determining healthcare policies. Building on our prior work on the demands and limits of religious accommodation in democratic societies, we propose a set of ethical standards that can guide societies in meeting this challenge. In applying and defending these standards, we explore three topics: vaccine resistance, abortion, and concerns about rights to healthcare. We clarify these and other issues of religious accommodation and propose ethical standards for approaching these and other problems.     

Accommodating religion and belief in healthcare: Political threats,agonistic democracy and established religion

This paper considers what concept of accommodation is necessary to identify and address discrimination, disadvantages and disparities in such a way that the plurality of religious people with their beliefs, values and practices may be justly accommodated in healthcare. It evaluates threats to the possibility of such accommodation pertaining by considering what beliefs and practices might increase the risk of unjust discrimination against and disadvantage for religious people, whether as individuals or as groups; and the risk of disparities between the care provided to religious people. The claim is that there is an important cluster of risks that are political in kind and emergent within philosophical bioethics. While not amounting (yet) to a trend, they are sufficiently threatening to a just civic life for patients and healthcare staff as to warrant scrutiny. After an Introductory Section 1, Section 2 evaluates a criticism of ‘accommodation’ and the apparently additional health-related requirements that those of religious faith demand, when compared with other people. It does so by comparing Lori Beaman's idea of agonism with that of a distinct and somewhat complementary approach in Jonathan Chaplin's political philosophy, before examining the role of established religion in setting the conditions for the accommodation of religion and belief in healthcare. Section 3 examines risks to such accommodation by engaging critically with three health-related instantiations of political philosophy that differ radically from both Beaman and Chaplin. A concluding Section 4 focusses on appropriate modes of communicating about religious and other beliefs in healthcare.     

Potential for industrial ecology to support healthcare sustainability: Scoping review of a fragmented literature and conceptual framework for future research

Healthcare is a critical service sector with a sizable environmental footprint from both direct activities and the indirect emissions of related products and infrastructure. As in all other sectors, the “inside‐out” environmental impacts of healthcare (e.g., from greenhouse gas emissions, smog‐forming emissions, and acidifying emissions) are harmful to public health. The environmental footprint of healthcare is subject to upward pressure from several factors, including the expansion of healthcare services in developing economies, global population growth, and aging demographics. These factors are compounded by the deployment of increasingly sophisticated medical procedures, equipment, and technologies that are energy‐ and resource‐intensive. From an “outside‐in” perspective, on the other hand, healthcare systems are increasingly susceptible to the effects of climate change, limited resource access, and other external influences. We conducted a comprehensive scoping review of the existing literature on environmental issues and other sustainability aspects in healthcare, based on a representative sample from over 1,700 articles published between 1987 and 2017. To guide our review of this fragmented literature, and to build a conceptual foundation for future research, we developed an industrial ecology framework for healthcare sustainability. Our framework conceptualizes the healthcare sector as comprising “foreground systems” of healthcare service delivery that are dependent on “background product systems.” By mapping the existing literature onto our framework, we highlight largely untapped opportunities for the industrial ecology community to use “top‐down” and “bottom‐up” approaches to build an evidence base for healthcare sustainability.     

Bound between care and control: Institutional contradictions and daily practices of healthcare for migrants in an irregular situation in Italy

On the books, the inclusiveness of the Italian framework regulating healthcare access for migrants is indisputable. However, we might wonder how access takes shape on the front-line of the healthcare system, particularly in times of increasingly hostile institutional and discursive environments. By focusing on Italian migration and healthcare policies and the practices of health workers during their encounters with migrants in an irregular situation, this contribution analyses how health workers deal with institutional tensions in the field and how these, in turn, shape their narratives and actions. It suggests that individual positioning plays a major role in favouring the adoption of discretional practices of care or control. Nonetheless, practices are also mediated by the wider institutional and discursive landscape, which has been exponentially characterized by a tension between a medical-humanitarian logic that legitimates providing healthcare to vulnerable migrants, and a control-oriented logic targeting immigration and health expenditure.     

Antibiotic resistance as a tragedy of the commons: An ethical argument for a tax on antibiotic use in humans

To the extent that antibiotic resistance (ABR) is accelerated by antibiotic consumption and that it represents a serious public health emergency, it is imperative to drastically reduce antibiotic consumption, particularly in high‐income countries. I present the problem of ABR as an instance of the collective action problem known as ‘tragedy of the commons’. I propose that there is a strong ethical justification for taxing certain uses of antibiotics, namely when antibiotics are required to treat minor and self‐limiting infections, such as respiratory tract infections, in otherwise healthy individuals. Taxation would allow a reduction in consumption (given certain behavioural economics assumptions) and/or ensure that individuals internalize or compensate for their contribution to the erosion of the common good of antibiotic effectiveness. I suggest that revenue from the tax could be used to fund conservation and innovation strategies. Taxation might be a coercive policy, especially for certain individuals, but the ethical case for coercive policies is very strong when the good to be preserved is important enough and when they force individuals to do something they have a moral obligation to do anyway. I argue that, in the case of mild and self‐limiting infections, individuals have a moral duty of easy rescue and a moral duty of fairness to make their contribution to the preservation of the common good of antibiotic effectiveness by foregoing antibiotics. I also suggest that taxing antibiotics in such cases is an all things considered ethically justified policy even if it would introduce inequalities in access to healthcare.     

Evolution,altruism and cognitive architecture: a critique of Sober and Wilson’s argument for psychological altruism

Sober and Wilson have propose a cluster of arguments for the conclusion that “natural selection is unlikely to have given us purely egoistic motives” and thus that psychological altruism is true. I maintain that none of these arguments is convincing. However, the most powerful of their arguments raises deep issues about what egoists and altruists are claiming and about the assumptions they make concerning the cognitive architecture underlying human motivation.     

The embodiment of sorcery: Supernatural aggression,belief and envy in a remote Aboriginal community

Anthropologists have long attempted to come to grips with Indigenous Australian sorcery beliefs and especially with the idea that acts with no understandable efficacy bring about illness and death. In this ethnographic interpretation of sorcery beliefs in the remote community of Numbulwar, I follow those few who have attempted to find a link between these apparently harmless acts and real physiological consequences, arguing that the fear of sorcery that pervades Numbulwar contributes directly to the stress of daily life and indirectly to the premature morbidity and mortality of too many lives. Belief is posited as the mechanism whereby the human stress response is activated to a harmful extent, a process in which the projection of envious feelings may often be critical.     

An updated phylogeny of Deprea (Solanaceae) with a new species from Colombia: interspecific relationships,conservation assessment,and a key for Colombian species

Deprea is a neotropical genus that comprises 51 species. Recent work based on molecular data has explored its monophyly and interspecific relationships, but the relationships amongst Deprea species were not entirely elucidated. The inclusion of more accessions and molecular markers in phylogenetic analysis is likely to produce more supported hypotheses. Therefore, the main objective of this study was to perform a combined phylogenetic analysis of Deprea including seven new samples representing six species and one more DNA plastid marker than in previous studies. In that process, a new species of Deprea from Colombia was discovered and is described and illustrated here. Deprea teresitae Deanna & A. Orejuela, sp. nov. is morphologically similar to D. dilloniana and phylogenetically closely related to D. hawkesii and D. harlingiana. This new species is distinguished by the combination of short calyx lobes, non-mucronate anthers, long staminal filaments and corolla lobes, and elongated appressed fruiting calyx around a subglobose green berry. The new phylogenetic results are presented, including discussion on phylogenetic interspecific relationships, taxonomy, geographic distribution, and conservation status from D. teresitae. The synonymy of Deprea sylvarum subsp. novogranatensis under D. glabra is also proposed and an identification key to the 10 Deprea species distributed in Colombia is included.     

Design of a polytopic construct of LACK,TSA and GP63 proteins for the diagnosis of cutaneous leishmaniasis: An in silico strategy

Cutaneous leishmaniasis (CL), which is caused by different species of the genus Leishmania, including L. major, is a significant parasitic disease worldwide. Commercial leishmaniasis diagnostic kits frequently target the entire parasite antigen, although this approach can reduce the specificity of the tests. The present study sought to increase the specificity of antigen detection tests by identifying the B-cell epitopes on the surface of the protozoa and developing an antigenic multiepitope construct to react with the system of B-cell epitopes unique to L. major. More specifically, the linear and conformational B-cell epitopes for three L. major proteins, namely, GP63, LACK, and TSA, were predicted using the ABCprd, IEDB, LBtope, CBTOPE, and DiscoTope servers. The three-dimensional structures of these proteins, as well as of the complete multiepitope, were predicted using the I-TASSER server. The multiepitope structure models were validated by means of Ramachandran plots and the Prosa and Verify3D servers. The multiepitope construct was evaluated using the ProtParam and SOLpro servers. The synthesized multiepitope was then successfully expressed into a pET28a plasmid. The expression was confirmed using SDS-PAGE and dot blot techniques. Moreover, the expressed protein was evaluated by means of Western blotting. A band of approximately 39 kDa was observed by SDS-PAGE. The rGLT-pET-28a showed a high response with the 1:1000 dilution of the anti-His-tag monoclonal antibody by Western blot. The results of this study indicated that the integrated GP63, LACK, and TSA multiepitope antigens of L. major represent a potential target for a novel diagnostic kit for CL.     

社会-经济-自然复合生态系统生态位评价模型——以四川省为例

在深入分析区域资源、环境、社会、经济综合系统基础上,建立了四川省2001—2010年社会-经济-自然复合生态系统生态位评价指标体系,复合生态系统综合生态位包括资源、环境、经济和社会4个子系统生态位。将耦合投影寻踪模型应用于复合生态系统生态位评价,其中,采用并行模拟退火算法对评价模型参数进行优化。研究结果表明:2001年—2010年四川省复合生态位呈现先降后升的趋势,复合生态位评价值从2001年3.1325下降到2005年的2.8499,从2005年开始,复合生态位逐渐增加,到2010年增加到3.3304。表明环境重视程度的提高,环保意识的加强,促进了复合生态位的提高,区域自然生态和环境得以改善。最佳投影方向各分量的大小反映了各评价指标对生态位评价等级的影响程度,值越大则对应的评价指标对生态位评价等级的影响程度越大。区域生态位评价等级指标的影响程度最大的10项中有4项是环境生态位子系统指标,表明环境生态位子系统对综合生态位影响最大。发展过程中经济生态位子系统和社会生态位子系统指标值相关系数为0.9957,表明两子系统基本上是保持同步发展。而经济生态位和环境生态位子系统指标值相关系数为-0.9346,呈现明显的负相关关系。资源子系统呈现上升趋势。模拟退火优化的投影寻踪耦合模型应用于复合生态位评价,具有实用性和可行性,为区域生态管理科学决策提供重要依据。     

An LC-MS/MS procedure for the quantification of naproxen in human plasma: development, validation, comparison with other methods, and application to a pharmacokinetic study

A sensitive, precise and accurate quantitative LC-MS/MS method for the measurement of naproxen in human plasma was developed and completely validated according to current FDA and EMA guidelines. The new method employs acetonitrile protein precipitation for sample preparation and uses ketoprofen as the internal standard. Suitability of the new assay was assessed in comparison with 36 reported bioanalytical assays and the pharmacokinetic results obtained by the new method were compared to 11 reported studies in humans. The principal advantage of this LC-MS/MS method is the simultaneous achievement of high absolute recovery (90.0±3.6%), acceptable sensitivity (lower limit of quantitation of 0.100 μg/mL), high inter-day precision (CV≤9.4%), high analytical recovery (between 94.4 and 103.1%), and excellent linearity over the concentration range 0.100-50.0 μg/mL (r(2)≥0.998) combined with a short run time of only 2 min.     

An application of different bioindicators for assessing water quality: a case study in the rivers Alfeios and Pineios (Peloponnisos, Greece)

A number of bioindicators and biotic indices and scores based on benthic macroinvertebrates, diatoms, fishes, aquatic and riparian vegetation in relation to physicochemical parameters have been applied in assessing the water quality of the rivers Alfeios and Pineios (Peloponnisos, Greece). According to the findings, the water quality in both rivers varied from very poor to very good. Among the bioindicators used, the benthic macroinvertebrates seem to be the most reliable. The BBI and IBE were the most applicable indexes while the applicability of the IBMWP and IASPT in the Greek region can be enforced with the inclusion of the Diptreran family Rhagionidae and the Coleopteran family Elminthidae.     

Isolation, immortalization, and initial characterization of uterine cell lines: An in vitro model system for the procine uterus

Summary The aim of this study was to develop immortalized cell lines from porcine uterus. Endometrial cells including luminal epithelium (LE), glandular epithelium (GE), stroma (ST), and myometrium (MYO) were enzymatically isolated from the uterus of a day 12 pregnant gilt. Primary cultures were immortalized by transduction with a retroviral vector containing the E6 and E7 open reading frames of human papillomavirus type 16 (LXSN-16E6E7) packaged by the amphotropic fibroblast line PA-317. Cells having integrated the vector were selected by resistance to the neomycin analog G418 (0.4–1.5 mg/ml). Surviving cells were maintained in complete culture medium containing G418 (0.1 mg/ml) and subcultured for 1 yr. Expression of the E7 protein was confirmed in all cell lines by Western blotting. Phase contrast microscopy revealed that LE and GE cells exhibited cobblestone morphology, whereas ST and MYO cells exhibited spindle-shaped morphology. The epithelial origin of LE and GE was confirmed by positive immunostaining for cytokeratin. Stromal and MYO cells were vimentin-positive, but cytokeratin-negative. The MYO cell lines were positive for smooth muscle α-actin staining, whereas LE, GE, and ST cell lines were negative for α-actin. Western blotting indicated that all cell lines expressed both estrogen and progesterone receptors, but only GE cells secreted uteroferrin (UF). Collectively, these porcine uterine cell lines provide an in vitro model for studying cell type-specific actions of hormones and cytokines, signal transduction pathways, cell-cell interactions, and gene expression.     

An exuberant, undescribed colour polymorphism in Theridion californicum (Araneae, Theridiidae): implications for a theridiid pattern ground plan and the convergent evolution of visible morphs

An opisthosomal (abdominal) colour polymorphism is described in the North American spider, Theridion californicum , comprising a plain Yellow morph and (at least) ten patterned morphs, which exhibit areas of red or black pigments superimposed on the yellow background, or no pigment (white). The polymorphism appears to be present throughout the species' range. The Yellow morph is the most frequent in populations, with patterned morphs all, individually, being rather rare. Progeny from known mothers were reared and indicate that the polymorphism is genetic and that Yellow is probably recessive to patterned morphs. Similar to other theridiids with well-studied colour polymorphisms, T. californicum occupies an under-leaf habitat and the variation in all these cases might be maintained by sight-hunting predators exerting negative frequency-dependent (apostatic) selection. In T. californicum , blocks of guanine underlying the pigmented hypodermis indicate a segmental patterning, which is not usually apparent in adult spiders. These segments, plus dorso-lateral divisions, permit the dorsal surface of the opisthosoma to be divided up into two mirror-image halves, each comprising 12 compartments. Each compartment can either lack pigment (thus appearing white as a result of underlying guanine) or be yellow, red, or black. All patterns in T. californicum can be derived from this ground plan, as can the morphs of other colour-polymorphic theridiids. It is suggested that selection for polymorphism, combined with constraints imposed by this theridiid ground plan, may have led to the convergent evolution of colour patterns across the family.  © 2009 The Linnean Society of London, Biological Journal of the Linnean Society , 2009, 96 , 23–34.     

Experiences of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State,India: An Analysis of Focus Group Discussions with Patients,Families, Community Members and Program Volunteers

Background

Globally 68 million people are infected with lymphatic filariasis (LF), 17 million of whom have lymphedema. This study explores the effects of a lymphedema management program in Odisha State, India on morbidity and psychosocial effects associated with lymphedema.

Methodology/Principal Findings

Focus groups were held with patients (eight groups, separated by gender), their family members (eight groups), community members (four groups) and program volunteers (four groups) who had participated in a lymphedema management program for the past three years. Significant social, physical, and economic difficulties were described by patients and family members, including marriageability, social stigma, and lost workdays. However, the positive impact of the lymphedema management program was also emphasized, and many family and community members indicated that community members were accepting of patients and had some improved understanding of the etiology of the disease. Program volunteers and community members stressed the role that the program had played in educating people, though interestingly, local explanations and treatments appear to coexist with knowledge of biomedical treatments and the mosquito vector.

Conclusions/Significance

Local and biomedical understandings of disease can co-exist and do not preclude individuals from participating in biomedical interventions, specifically lymphedema management for those with lymphatic filariasis. There is a continued need for gender-specific psychosocial support groups to address issues particular to men and women as well as a continued need for improved economic opportunities for LF-affected patients. There is an urgent need to scale up LF-related morbidity management programs to reduce the suffering of people affected by LF.     

An artificial osmotic cell: a model system for simulating osmotic processes and for studying phenomena of negative pressure in plants

Abstract An artificial osmotic cell has been constructed using reverse osmosis membranes. The cell consisted of a thin film of an osmotic solution (thickness: 100 to 200 μm) containing a non-permeating solute and was bounded between the membrane and the front plate of a pressure transducer which continuously recorded cell turgor. The membrane was supported by metal grids to withstand positive and negative pressures (P). At maximum, negative pressures of up to –0.7 MPa (absolute) could be created within the film on short-term and pressures of up to –0.3 MPa could be maintained without cavitation for several hours. As with living plant cells, the application of osmotic solutions of a non-permeating solute resulted in monophasic relaxations of turgor pressure from which the hydraulic conductivity of the membrane (Lp) and the elastic modulus of the cell (?) could be estimated. The application of solutions with permeating solutes resulted in biphasic pressure relaxation curves (as for living cells) from which the permeability (P_s) and reflection (σ_s) coefficients could be evaluated for the given membrane. Lp, P_s, and σ_s were independent of P and did not change upon transition from the positive to the negative range of pressure. It is concluded that the artificial cell could be used to simulate certain transport properties of living cells and to study phenomena of negative pressure as they occur in the xylem and, perhaps, also in living cells of higher plants.     

An unusual beta-ketoacyl:acyl carrier protein synthase and acyltransferase motifs in TaK, a putative protein required for biosynthesis of the antibiotic TA in Myxococcus xanthus

The antibiotic TA of Myxococcus xanthus is produced by a type-I polyketide synthase mechanism. Previous studies have indicated that TA genes are clustered within a 36-kb region. The chemical structure of TA indicates the need for several post-modification steps, which are introduced to form the final bioactive molecule. These include three C-methylations, an O-methylation and a specific hydroxylation. In this study, we describe the genetic analysis of taK, encoding a specific polyketide beta-ketoacyl:acyl carrier protein synthase, which contains an unusual beta-ketoacyl synthase and acyltransferase motifs and is likely to be involved in antibiotic TA post-modification. Functional analysis of this beta-ketoacyl:acyl carrier protein synthase by specific gene disruption suggests that it is essential for the production of an active TA molecule.     

Backbone Conformation in Nucleic Acids: An Analysis of Local Helicity through Heminucleotide Scheme and a Proposal for a Unified Conformational Plot

Abstract

A relationship has been established to express the local helicity of a polynucleotide backbone directly in terms of the virtual bonds spanning the conformationally equivalent heminucleotide repeats, with a view to provide a better understanding of the cumulative effects of all the chemical bond rotational variations on local helicity. Using this, an analysis made with a few oligodeoxynucleotide crystal structures clearly brings forth that it is the concerted movements manifested in the near neighbour correlations between the pair of chemical bonds C4′—C5′ and P—05′ and C4′-C3′ and P-03′ of the 5′ and 3′ heminucleotides respectively that are primarily responsible for the observed non-uniform helical twists both in A and B type helical backbones. That these need not be restricted to oligodeoxynucleotides but may be a feature of oligoribonucleotides backbone also is shown from an analysis of helical segments of yeast tRNA^Phe. A proposal of a unified or a grand two dimensional conformational plot which would help visualise succinctly the overall effect of the variations in all the repeating six chemical bonds of a polynucleotide backbone is made. Apart from considerable simplification, the plot affords identification on it regions characteristic of helical, and loop and bend conformations of nucleic acid backbone chain.