Ethics in practice : responding to an evolving problematic situation of nanotechnology in society

This thesis takes as its starting point the challenge of the novelty and uncertainty around the development of a new and emerging science and technology such as nanotechnology and attempts to respond to novelty and uncertainty, visible in the call for the ‘responsible development’ of nanotechnology. The aim of the thesis is to map the responses, particularly the ethical stances, of scientists and industrialists in relation to the challenge of the novelty and\ud uncertainty of nanotechnology and to evaluate their responses with regard to opportunities and possibilities which go beyond just adding to “organized irresponsibility”. The research questions are addressed through a sociological extension of the pragmatist ethics of American philosopher John Dewey, which couples Dewey’s notions of ‘problematic situation’ and ‘reflective inquiry’ with a multi‐level co‐evolutionary perspective of socio‐technical change in\ud society (Rip & Kemp, 1998; Geels, 2005).\ud The picture which emerges from the empirical analysis underlines the importance of existing roles, repertoires, mandates and institutional contexts in responses to the ‘problematic situation’ of novelty and uncertainty of nanotechnology and the pressure for responsible development in particular. While such ‘tried and tested’ responses may be sufficient as a first\ud and tentative move, they may not be adequate to respond to the problematic situation. Microlevel (individual) reflective inquiry is embedded in meso - level (institutions and sectors) and macro - level (division of moral labour) settings. Thus, if scientists are to pursue reflective inquiry at the\ud micro-level, the shaping effect of patterns and dynamics at meso- and macro-levels needs to be acknowledged.\ud To that end, a multi‐level co‐evolutionary perspective is deployed as a means of identifying building blocks for a more adequate and longer‐term response to problematic situations, which takes into account overall dynamics and the possibilities of modulating dynamics at different levels

The Ambivalence of Promising Technology

Issues of responsibility in the world of nanotechnology are becoming explicit with the emergence of a discourse on ‘responsible development’ of nanoscience and nanotechnologies. Much of this discourse centres on the ambivalences of nanotechnology and of promising technology in general. Actors must find means of dealing with these ambivalences. Actors’ actions and responses to ambivalence are shaped by their position and context, along with strategic games they are involved in, together with other actors. A number of interviews were conducted with industrial actors with the aim of uncovering their ethical stances towards responsible development of nanotechnology. The data shows that standard repertoires of justification of nanotechnological development were used. Thus, the industrial actors fell back on their position and associated responsibilities. Such responses reinforce a division of moral labour in which industrial actors and scientists can focus on the progress of science and technology, while other actors, such as NGOs, are expected to take care of broader considerations, such as ethical and social issues

Joint declaration on mainstreaming RRI across Horizon Europe

Leading RRI researchers and practitioners, together with policymakers and stakeholder organisations, discussed the state-of-the-art and future perspectives for RRI at the ‘Pathways to Transformation’ conference in June 2019, an event which was extended beyond Brussels, for instance by ca. 330 original tweets and ca. 840 retweets from ca. 160 unique accounts. In the conference, many participants expressed their concern about an uncertain future for RRI in the EC. As a result, numerous large-scale EU-funded RRI projects signed a Joint Declaration, urging the European Commission to make RRI a key objective of the upcoming framework programme, Horizon Europe – a plea to both mainstream the approach across the programme and provide specific resources for strengthening the RRI knowledge base. As the Horizon Europe programme is being forged, it is timely to present the Declaration for a broader audience

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Marginalisation, Ebola and Health for All: From Outbreak to Lessons Learned

The Ebola epidemic in West Africa between 2014 and 2015 was the deadliest since the discovery of the virus four decades ago. With the second-largest outbreak of Ebola virus disease currently raging in the Democratic Republic of the Congo, (DRC) it is clear that lessons from the past can be quickly forgotten—or be incomplete in the first instance. In this article, we seek to understand the health challenges facing marginalised people by elaborating on the multiple dimensions of marginalisation in the case of the West Africa Ebola epidemic. We trace and unpack modes of marginalisation, beginning with the “outbreak narrative” and its main components and go on to examine other framings, including the prioritisation of the present over the past, the positioning of ‘Us versus Them’; and the marginalisation—in responses to the outbreak—of traditional medicine, cultural practices and other practices around farming and hunting. Finally, we reflect on the ‘lessons learned’ framing, highlighting what is included and what is left out. In conclusion, we stress the need to acknowledge—and be responsive to—the ethical, normative framings of such marginalisation

Testing the Obligations of Presence in Academia in the COVID-19 Era

The COVID-19 crisis has given us a new, unprecedented impetus for thinking about the imperative of mobility in research. Travel and co-presence are widely accepted as being essential to career progression and promotion in academic life. Academics with fewer opportunities to travel find themselves at a significant disadvantage. COVID-19 and related public health measures have significantly limited the ability to be physically co-present in academia. Addressing obligations of co-presence in a less mobile world allows us to think concretely—and empathetically—about how to improve and extend virtual networking opportunities to those who have been marginalised with respect to research mobility. It also allows us to reflect on the role of reduced mobility and locality in how we think about and enact research. This article is informed and inspired by insights from research addressing academic mobility. I describe and discuss two prospects to productively work towards a new academic modus operandi characterised by limited opportunities for mobility. Furthermore, I highlight those issues and components that will require capacity building and a greater allocation of resources within the research system. In addition, I sketch out some pressing issues and questions for research mobility studies in a less mobile age going forward

Marginalisation, ebola and health for all: From outbreak to lessons learned

The Ebola epidemic in West Africa between 2014 and 2015 was the deadliest since the discovery of the virus four decades ago. With the second-largest outbreak of Ebola virus disease currently raging in the Democratic Republic of the Congo, (DRC) it is clear that lessons from the past can be quickly forgotten—or be incomplete in the first instance. In this article, we seek to understand the health challenges facing marginalised people by elaborating on the multiple dimensions of marginalisation in the case of the West Africa Ebola epidemic. We trace and unpack modes of marginalisation, beginning with the “outbreak narrative” and its main components and go on to examine other framings, including the prioritisation of the present over the past, the positioning of ‘Us versus Them’; and the marginalisation—in responses to the outbreak—of traditional medicine, cultural practices and other practices around farming and hunting. Finally, we reflect on the ‘lessons learned’ framing, highlighting what is included and what is left out. In conclusion, we stress the need to acknowledge—and be responsive to—the ethical, normative framings of such marginalisation