QALYs, age and fairness

... We can therefore conclude that either we should go for equality; and in that case QALYs are unfair because they haven't got enough of an ageist bias. Or we should accept consequentialism; and in that case QALYs have just the right sort of ageist bias. No plausible case can, however, be made for the claim that QALYs have an unfair bias against old people. Other things being equal we ought when distributing resources essential for survival favour the young. This ethical claim can be supported both by reference to equality (the life-time-view) and by reference to consequentialism (and the premises that resources generally will be more useful when given to young people).     

Do Muslim Women Really Need Saving? Anthropological Reflections on Cultural Relativism and Its Others

This article explores the ethics of the current "War on Terrorism, asking whether anthropology, the discipline devoted to understanding and dealing with cultural difference, can provide us with critical purchase on the justifications made for American intervention in Afghanistan in terms of liberating, or saving, Afghan women. I look first at the dangers of reifying culture, apparent in the tendencies to plaster neat cultural icons like the Muslim woman over messy historical and political dynamics. Then, calling attention to the resonances of contemporary discourses on equality, freedom, and rights with earlier colonial and missionary rhetoric on Muslim women, I argue that we need to develop, instead, a serious appreciation of differences among women in the world—as products of different histories, expressions of different circumstances, and manifestations of differently structured desires. Further, I argue that rather than seeking to "save" others (with the superiority it implies and the violences it would entail) we might better think in terms of (1) working with them in situations that we recognize as always subject to historical transformation and (2) considering our own larger responsibilities to address the forms of global injustice that are powerful shapers of the worlds in which they find themselves. I develop many of these arguments about the limits of "cultural relativism" through a consideration of the burqa and the many meanings of veiling in the Muslim world. [Keywords: cultural relativism, Muslim women, Afghanistan war, freedom, global injustice, colonialism]     

Small Sample Properties of the Likelihood Estimator in Proportional Hazard Regression Models with Omitted Variables

The paper deals with the effects of incorrectly omitted regressor variables in a parametric proportional hazard regression model. By studying conditions for equality between the estimators of correct and incorrect models it is demonstrated analytically that such cases are not to be expected in practise. A small sample Monte Carlo experiment indicates severe negative effects on the retained parameters both in terms of bias and mean square error.     

Women and political violence in contemporary Peru

Conclusions It follows from the discussion of the question of women and political violence in the contemporary Peru which I attempted to explore in its historical perspective in this essay, that the peculiarity of the division of labor in the Andean Sierra, based on the gender ideology which recognizes women's work as a complementary to men's work as relatively capable of resisting the extra-economic pressures of underdeveloped capitalism, has facilitated women's incorporation into an armed struggle led by the Sendero Luminoso. For Vicky Peláez, a leading Peruvian journalist, in the conditions of the Andean Sierra the movement could not survive and expand without the participation of women whose historical heritage of struggle has been multiplied by socio-economic and political crisis of the Peruvian state. On the other hand, the organizational framework of the PCP-SL, which recognizes and applies in practice the principle of equality between men and women, has stimulated female political activity. The inclusion of issues important to women in Sendero Luminoso's agenda has given additional impetus to the incorporation of women into class struggle not only as supporters or militants, but also as political and military leaders. Increasing participation of women in political and military actions creates additional conditions for the survival and expansion of collective action started by the PCP-SL years ago, using political violence as the main instrument of a new democratic revolution in Peru.

---

     

A Biocultural Investigation of Gender Differences in Tobacco Use in an Egalitarian Hunter-Gatherer Population

In the developing world, the dramatic male bias in tobacco use is usually ascribed to pronounced gender disparities in social, political, or economic power. This bias might also reflect under-reporting by woman and/or over-reporting by men. To test the role of gender inequality on gender differences in tobacco use we investigated tobacco use among the Aka, a Congo Basin foraging population noted for its exceptionally high degree of gender equality. We also tested a sexual selection hypothesis—that Aka men’s tobacco use is related to risk taking. Tobacco use, income, tobacco purchases, tobacco sharing, reasons for using tobacco, risk taking, and other variables were measured using structured surveys and peer reports. Tobacco use was verified by testing for salivary cotinine, a nicotine metabolite. Contrary to expectations, we found a very large male bias in tobacco use. Low levels of use among females appeared to be explained by aversions to tobacco, concerns over its negative effects on fetal health, and a desire to attract husbands, who prefer nonsmoking wives. High male use appeared to be related to a desire to enhance hunting abilities and attract and/or retain wives, who prefer husbands that smoke. We conclude that low levels of smoking by Aka women are better explained by the hypothesis that women evolved to avoid plant toxins to protect their fetuses and nursing infants. High male use might be better explained by sexual selection. We also highlight the important role that recreational drugs appear to play in hunter-gatherer sharing relationships.     

Valkyries: Was gender equality high in the Scandinavian periphery since Viking times? Evidence from enamel hypoplasia and height ratios

Scandinavian countries currently have very high values of female autonomy. Was this already the case in Viking Times? In this study, we trace the roots of gender equality in the Scandinavian periphery over the past two millennia. We evaluate and recommend a new measure of early gender equality: relative enamel hypoplasia values of males and females. This new indicator allows us to trace relative health and nutritional equality, using archaeological evidence. We find that Scandinavian women in the rural periphery already had relatively good health and nutritional values during the Viking era and the medieval period thereafter. The corresponding value is 0.8 equality advantage for Scandinavian women, whereas in the rest of Europe most values fall in a band around 1.2 ratio units. This suggests that the currently high gender equality had a precedence during the Middle Ages.     

Sexing pollen reveals female bias in a dioecious plant

* Information on angiosperm sex ratios has largely been restricted to surveys of flowering individuals. These often deviate from equality, with male bias more commonly reported. Female-biased sex ratios are concentrated in a few taxa and have been linked to the possession of heteromorphic sex chromosomes and bias introduced during the gametophytic stage of the life cycle. It has been proposed that differences in gamete quantity and quality could give rise to female bias, although there is no direct evidence with which to evaluate this possibility. * Here, we use flow cytometry to investigate microgametophytic 'sex ratios' in a flowering plant. We demonstrate that differences in DNA content between the sexes in Rumex nivalis, a species with heteromorphic sex chromosomes, make it possible to distinguish female- vs male-determining pollen nuclei. * We found a small but significant female bias in microgametophytes produced by males (mean 0.515) with significant variation among family means (range 0.463-0.586), and 18 of 22 families averaging > 0.50. * The observed female bias at the gametophytic stage of the life cycle is consistent with the direction of bias previously reported for seeds and vegetative and reproductive plants in wild populations of R. nivalis, but is insufficient to fully explain the degree of bias.     

Trends in breast cancer mortality in Sweden before and after implementation of mammography screening

Background

Incidence-based mortality modelling comparing the risk of breast cancer death in screened and unscreened women in nine Swedish counties has suggested a 39% risk reduction in women 40 to 69 years old after introduction of mammography screening in the 1980s and 1990s.

Objective

We evaluated changes in breast cancer mortality in the same nine Swedish counties using a model approach based on official Swedish breast cancer mortality statistics, robust to effects of over-diagnosis and treatment changes. Using mortality data from the NordCan database from 1974 until 2003, we estimated the change in breast cancer mortality before and after introduction of mammography screening in at least the 13 years that followed screening start.

Results

Breast mortality decreased by 16% (95% CI: 9 to 22%) in women 40 to 69, and by 11% (95% CI: 2 to 20%) in women 40 to 79 years of age.

Discussion

Without individual data it is impossible to completely separate the effects of improved treatment and health service organisation from that of screening, which would bias our results in favour of screening. There will also be some contamination of post-screening mortality from breast cancer diagnosed prior to screening, beyond our attempts to adjust for delayed benefit. This would bias against screening. However, our estimates from publicly available data suggest considerably lower benefits than estimates based on comparison of screened versus non-screened women.     

Magnetic resonance elastography in nonlinear viscoelastic materials under load

Characterisation of soft tissue mechanical properties is a topic of increasing interest in translational and clinical research. Magnetic resonance elastography (MRE) has been used in this context to assess the mechanical properties of tissues in vivo noninvasively. Typically, these analyses rely on linear viscoelastic wave equations to assess material properties from measured wave dynamics. However, deformations that occur in some tissues (e.g. liver during respiration, heart during the cardiac cycle, or external compression during a breast exam) can yield loading bias, complicating the interpretation of tissue stiffness from MRE measurements. In this paper, it is shown how combined knowledge of a material’s rheology and loading state can be used to eliminate loading bias and enable interpretation of intrinsic (unloaded) stiffness properties. Equations are derived utilising perturbation theory and Cauchy’s equations of motion to demonstrate the impact of loading state on periodic steady-state wave behaviour in nonlinear viscoelastic materials. These equations demonstrate how loading bias yields apparent material stiffening, softening and anisotropy. MRE sensitivity to deformation is demonstrated in an experimental phantom, showing a loading bias of up to twofold. From an unbiased stiffness of \(4910.4 \pm 635.8\) Pa in unloaded state, the biased stiffness increases to 9767.5 \(\pm \,\)1949.9 Pa under a load of \(\approx \) 34% uniaxial compression. Integrating knowledge of phantom loading and rheology into a novel MRE reconstruction, it is shown that it is possible to characterise intrinsic material characteristics, eliminating the loading bias from MRE data. The framework introduced and demonstrated in phantoms illustrates a pathway that can be translated and applied to MRE in complex deforming tissues. This would contribute to a better assessment of material properties in soft tissues employing elastography.

     

On the Improvement of Free-Energy Calculation from Steered Molecular Dynamics Simulations Using Adaptive Stochastic Perturbation Protocols

The potential of mean force (PMF) calculation in single molecule manipulation experiments performed via the steered molecular dynamics (SMD) technique is a computationally very demanding task because the analyzed system has to be perturbed very slowly to be kept close to equilibrium. Faster perturbations, far from equilibrium, increase dissipation and move the average work away from the underlying free energy profile, and thus introduce a bias into the PMF estimate. The Jarzynski equality offers a way to overcome the bias problem by being able to produce an exact estimate of the free energy difference, regardless of the perturbation regime. However, with a limited number of samples and high dissipation the Jarzynski equality also introduces a bias. In our previous work, based on the Brownian motion formalism, we introduced three stochastic perturbation protocols aimed at improving the PMF calculation with the Jarzynski equality in single molecule manipulation experiments and analogous computer simulations. This paper describes the PMF reconstruction results based on full-atom molecular dynamics simulations, obtained with those three protocols. We also want to show that the protocols are applicable with the second-order cumulant expansion formula. Our protocols offer a very noticeable improvement over the simple constant velocity pulling. They are able to produce an acceptable estimate of PMF with a significantly reduced bias, even with very fast perturbation regimes. Therefore, the protocols can be adopted as practical and efficient tools for the analysis of mechanical properties of biological molecules.     

On the power to detect differences between male and female mutation rates for Duchenne muscular dystrophy, using classical segregation analysis and restriction fragment length polymorphisms

The power to detect departures from the theoretical proportion of new mutants in X-linked lethal disorders has been analyzed for several types of segregation analysis, including methods based on completely linked restriction fragment length polymorphisms. It is shown that all methods require large sample sizes in order to detect even large differences between male and female mutation rates. Ascertainment bias is shown to have a great effect on the outcome of the segregation analysis. All reviewed studies concerning the proportion of new mutants in Duchenne muscular dystrophy, whether they claimed equality or inequality between the male and female mutation rates, give insufficient evidence because of ascertainment bias and a too low power. An ascertainment bias-free method is given, with the advantage that information from many studies can be combined. By doing so, in the long run, even moderate departures from equality in mutation rates (if present) can be detected.     

Interventions to Increase the Uptake of Mammography amongst Low Income Women: A Systematic Review and Meta-Analysis

Background

Two previous reviews found that access-enhancing interventions were effective in increasing mammography uptake amongst low-income women. The purpose of this study was to estimate the magnitude of the effect of interventions used to increase uptake of mammography amongst low-income women.

Methods

Searches were conducted in MEDLINE and EMBASE (2002–April 2012) using relevant MeSH terms and keywords. Randomised controlled trials which aimed to increase mammography use in an asymptomatic low-income population and which had as an outcome receipt of a mammogram, were eligible for inclusion. The primary outcome was the post-intervention difference in the proportion of women who had a mammogram in the intervention and control groups. The quality of the studies was assessed using the Cochrane risk of bias tool. We calculated summary estimates using random effects meta-analyses. Possible reasons for heterogeneity were investigated using sub-group analyses and meta-regression. Publication bias was assessed using Egger''s test.

Results

Twenty-one studies met the inclusion criteria, including 33 comparisons. Interventions increased the uptake of mammography in low income women by an additional 8.9% (95% CI 7.3 to 10.4%) compared to the control group. There was some evidence that interventions with multiple strategies were more effective than those with single strategies (p  = 0.03). There was some suggestion of publication bias. The quality of the included studies was often unclear. Omitting those with high risk of bias has little effect on the results.

Conclusions

Interventions can increase mammography uptake among low-income women, multiple interventions being the most effective strategy. Given the robustness of the results to sensitivity analyses, the results are likely to be reliable. The generalisability of the results beyond the US is unclear.     

Factors Affecting Women's Autonomous Decision Making In Research Participation Amongst Yoruba Women Of Western Nigeria

Research is a global enterprise requiring participation of both genders for generalizable knowledge; advancement of science and evidence based medical treatment. Participation of women in research is necessary to reduce the current bias that most empirical evidence is obtained from studies with men to inform health care and related policy interventions. Various factors are assumed to limit autonomy amongst the Yoruba women of western Nigeria. This paper seeks to explore the experience and understanding of autonomy by the Yoruba women in relation to research participation. Focus is on factors that affect women's autonomous decision making in research participation. An exploratory qualitative approach comprising four focus group discussions, 42 in‐depth interviews and 14 key informant interviews was used. The study permits a significant amount of triangulation, as opinions of husbands and religious leaders are also explored. Interviews and discussions were audiotaped and transcribed verbatim. Content analysis was employed for data analysis. Findings show that concepts of autonomy varied amongst the Yoruba women. Patriarchy, religion and culture are conceived to have negative impact on the autonomy of women in respect to research participation. Among the important findings are: 1) male dominance is strongly emphasized by religious leaders who should teach equality, 2) while men feel that by making decisions for women, they are protecting them, the women on the other hand see this protection as a way of limiting their autonomy. We recommend further studies to develop culturally appropriate and workable recruitment methods to increase women's participation in research.     

A response to Dodds and Jones

In response to "Surrogacy and Autonomy," by Susan Dodds and Karen Jones in this issue of Bioethics, the author concedes that only a surrogacy practice stringently regulated by good counseling, escape clauses for pregnant women, and the prohibition of profit-making agencies will save women from exploitation, but she objects to singling out women for paternalistic "protection against themselves," and to defending women's autonomy to the extent of their right to behave in ways known to harm a fetus. Dodds and Jones' concerns about attitudes toward women, genetic bias, the concept of children as property, and the harm principle generated by surrogacy contracts are answered with arguments for why surrogacy should not be illegal.     

The effect of emotion and personality on olfactory perception

It is well established that both the emotional tone of sensory stimuli and the personality characteristics of an individual can bias sensory perception. What has largely been unexplored is whether the current emotional state of an individual has a similar effect, and how it works together with other factors. Here we carry out a comprehensive study to examine how olfactory perception is affected by the emotional tone of the stimuli, and the personality and current emotional state of the individual. Subjects reported experiencing happiness, sadness, negativity/hostility and neutrality when exposed to corresponding emotionally themed video clips, and in each case, smelled a suprathreshold pleasant, an unpleasant and a neutral odorant. The time taken for the subject to detect each odorant and the olfactory intensity were recorded. We found that women detected the pleasant odorant faster than the neutral one. In addition, personality modulated reaction time and olfactory intensity, such that neurotic and anxious individuals were selectively biased toward affective rather than neutral odorants. Finally, current emotional state augmented intensity in men but not in women, and differentially influenced the response time. These findings provided new insights into the effects of emotion and personality on olfactory perception.     

Can respect be key to gender justice?

Equality and respect are, together with dignity, considered foundational values in international human rights discourse. While equality in particular has been established as a widely accepted goal in the women's rights movement, respect is, however, less commonly invoked. Based on long‐term ethnographic fieldwork conducted among the Arsi Oromo of Ethiopia, this article examines the notion of wayyuu, a tacit moral model of respect and sacredness that is central to institutions and norms that have secured women certain rights and power. These norms and institutions represent a challenge to the liberal feminist conceptualization of gender equality that dominates international women's rights discourse. Drawing on theories of respect and on feminist and anthropological discussions of equality, I argue that even though there are certain limitations inherent in wayyuu, the sacredness it entails and the implications this has had for women's status and power among the Arsi Oromo call for an exploration of respect not as an alternative to equality, but as a complementary notion which to a greater extent could be included in global discussions of gender justice.     

Survival Analysis of Faculty Retention and Promotion in the Social Sciences by Gender

Background

Recruitment and retention of talent is central to the research performance of universities. Existing research shows that, while men are more likely than women to be promoted at the different stages of the academic career, no such difference is found when it comes to faculty retention rates. Current research on faculty retention, however, focuses on careers in science, technology, engineering, and mathematics (STEM). We extend this line of inquiry to the social sciences.

Methods

We follow 2,218 tenure-track assistant professors hired since 1990 in seven social science disciplines at nineteen U.S. universities from time of hire to time of departure. We also track their time to promotion to associate and full professor. Using survival analysis, we examine gender differences in time to departure and time to promotion. Our methods account for censoring and unobserved heterogeneity, as well as effect heterogeneity across disciplines and cohorts.

Results

We find no statistically significant differences between genders in faculty retention. However, we do find that men are more likely to be granted tenure than women. When it comes to promotion to full professor, the results are less conclusive, as the effect of gender is sensitive to model specification.

Conclusions

The results corroborate previous findings about gender patterns in faculty retention and promotion. They suggest that advances have been made when it comes to gender equality in retention and promotion, but important differences still persist.     

China's Rural Public Health System Performance: A Cross-Sectional Study

Background

In the past three years, the Government of China initiated health reform with rural public health system construction to achieve equal access to public health services for rural residents. The study assessed trends of public health services accessibility in rural China from 2008 to 2010, as well as the current situation about the China''s rural public health system performance.

Methods

The data were collected from a cross-sectional survey conducted in 2011, which used a multistage stratified random sampling method to select 12 counties and 118 villages from China. Three sets of indicators were chosen to measure the trends in access to coverage, equality and effectiveness of rural public health services. Data were disaggregated by provinces and by participants: hypertension patients, children, elderly and women. We examined the changes in equality across and within region.

Results

China''s rural public health system did well in safe drinking water, children vaccinations and women hospital delivery. But more hypertension patients with low income could not receive regular healthcare from primary health institutions than those with middle and high income. In 2010, hypertension treatment rate of Qinghai in Western China was just 53.22% which was much lower than that of Zhejiang in Eastern China (97.27%). Meanwhile, low performance was showed in effectiveness of rural public health services. The rate of effective treatment for controlling their blood pressure within normal range was just 39.7%.

Conclusions

The implementation of health reform since 2009 has led the public health development towards the right direction. Physical access to public health services had increased from 2008 to 2010. But, inter- and intra-regional inequalities in public health system coverage still exist. Strategies to improve the quality and equality of public health services in rural China need to be considered.     

Telomeres and seed banks

We have found that a progressive loss of telomeric sequences occurs from high molecular weight DNA with an increasing appearance at low molecular weight as the periods of storage in the dry state were extended in time to provide seed germination loss from 98 to 0%. Telomere distribution would appear to follow the general pattern of DNA random fragmentation that occurs in the embryos of seeds stored in the dry state, but there are also indications of an overall telomere loss from DNA as a consequence of storage. There is a need for a convenient "equality marker" for the seeds that can be monitored over time. Reviewing the implications of our results very carefully we believe that there is considerable potential in the use of telomere sequences to mark embryo ageing of seeds held in Seed Banks.     

Chloe’s Law: A Powerful Legislative Movement Challenging a Core Ethical Norm of Genetic Testing

Since the early 1970s, the ethical norm governing counselors involved in testing and screening for genetic conditions related to reproduction has been strict neutrality. Counseling about reproductive genetics was to be patient centered but nondirective. Many advocates for people with Down syndrome believe that high abortion rates following a diagnosis of this condition show an unfounded bias against those with Down syndrome. These advocates have succeeded in enacting federal and state legislation that requires women who receive a prenatal diagnosis of Down syndrome to receive positive information about the condition, thereby ending the nominal goal of value-neutral counseling and setting the stage for further normative shifts in clinical reproductive genetics as counseling expands because of cell-free testing.

This Perspective is part of the “Where Next?” Series.