The Argument from Variation Against Using One’s Own Intuitions As Evidence

In philosophical methodology, intuitions are used as evidence to support philosophical theories. In this paper, I evaluate the skeptical argument that variation in intuitions is good evidence that our intuitions are unreliable, and so we should be skeptical about our theories. I argue that the skeptical argument is false. First, variation only shows that at least one disputant is wrong in the dispute, but each disputant lacks reason to determine who is wrong. Second, even though variation in intuitions shows that at least one disputant has the wrong intuition in the thought experiment, it is not evidence of unreliability of any disputant’s intuition regarding the philosophical theory being tested. So, variation in intuitions is not good evidence that one’s own intuitions are unreliable. One reply from the literature in peer disagreement is that we should conciliate if we cannot determine who is wrong. I argue that these disagreements are instead unconfirmed peer disagreements (i.e., no good reason to take or dismiss disputants as an epistemic peer, inferior or superior). I argue that if you have a strong intuition about a case, then it is rational for you to remain steadfast. Thus, variation in intuitions does not call for skepticism

Addressing two recent challenges to the factive account of knowledge

It is widely thought that knowledge is factive – only truths can be known. However, this view has been recently challenged. One challenge appeals to approximate truths. Wesley Buckwalter and John Turri argue that false-but-approximately-true propositions can be known. They provide experimental findings to show that their view enjoys intuitive support. In addition, they argue that we should reject the factive account of knowledge to avoid widespread skepticism. A second challenge, advanced by Nenad Popovic, appeals to multidimensional geometry to build a case where it seems intuitive that a person knows p even though p is false. In addition, Popovic argues that we should reject the factive account of knowledge because most of us would not become widespread skeptics if we discovered that ordinary objects in our world are actually four-dimensional. In this paper, we defend the factive account of knowledge against these arguments by challenging the intuitive appeal of the cases and arguing that there is no real threat of widespread skepticism for the factive account of knowledge

Minimally invasive versus transcatheter closure of secundum atrial septal defects:a systematic review and meta-analysis

BACKGROUND: Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to transcatheter (TC) closure of atrial septal defects (ASD). This systematic review and meta-analysis aims to compare post-operative outcomes of MIS versus TC repair in ASD closure. METHODS: PubMed, Medline and EMBASE were searched from inception until June 2018 for randomised and observational studies comparing post-operative outcomes for MIS and TC repair. The studies were reviewed for bias using the ROBINS-I Score and pooled in a meta-analysis using STATA (version 15). RESULTS: Six observational studies, involving 1524 patients assessing three primary and five secondary outcomes were included. Evidence suggests TC repair yielded shorter hospital stay (MD = 3.32, 95% CI 1.04–5.60) and lower rates of transient atrial fibrillation (AF) (RR = 0.48, 95% CI 0.20–1.15). TC repair patients also had fewer pericardial effusions (RR = 0.27, 95% CI 0.05–1.54, I(2) = 0.0%) and pneumothoraxes (RR = 0.18, 95% CI 0.04–0.80, I(2) = 0.0%). However, TC repair results in more minor residual shunts (RR = 6.04, 95% CI 1.69–21.63 in favour of MIS, I(2) = 39.0%). No differences were found for incidences of strokes (RR = 1.58, 95% CI 0.23–10.91, I(2) = 19.3%), unexpected bleeding (RR = 0.44, 95% CI 0.19–1.04, I(2) = 0.0%) and blood transfusion (RR = 0.39, 95% CI 0.09–1.59, I(2) = 0.0%). CONCLUSIONS: MIS closure for ASD has similar outcomes compared to TC repair. However, the lack of randomised literature related to MIS versus TC repair for ASD closure warrants further evidence in the form of RCTs to further support these findings

Contextual design choices and partnerships for scaling early child development programmes

Translating the Nurturing Care Framework and unprecedented global policy support for early child development (ECD) into action requires evidence-informed guidance about how to implement ECD programmes at national and regional scale. We completed a literature review and participatory mixed-method evaluation of projects in Saving Brains®, Grand Challenges Canada® funded ECD portfolio across 23 low- and middle-income countries (LMIC). Using an adapted programme cycle, findings from evaluation related to partnerships and leadership, situational analyses, and design for scaling ECD were considered. 39 projects (5 \u27Transition to Scale\u27 and 34 \u27Seed\u27) were evaluated. 63% were delivered through health and 84% focused on Responsive Caregiving and Early Learning (RCEL). Multilevel partnerships, leadership and targeted situational analysis were crucial to design and adaptation. A theory of change approach to consider pathways to impact was useful for design, but practical situational analysis tools and local data to guide these processes were lacking. Several RCEL programmes, implemented within government services, had positive impacts on ECD outcomes and created more enabling caregiving environments. Engagement of informal and private sectors provided an alternative approach for reaching children where government services were sparse. Cost-effectiveness was infrequently measured. At small-scale RCEL interventions can be successfully adapted and implemented across diverse settings through processes which are responsive to situational analysis within a partnership model. Accelerating progress will require longitudinal evaluation of ECD interventions at much larger scale, including programmes targeting children with disabilities and humanitarian settings with further exploration of cost-effectiveness, critical content and human resources

Molecular determinants of plaque size as an indicator of dengue virus attenuation

The development of live viral vaccines relies on empirically derived phenotypic criteria, especially small plaque sizes, to indicate attenuation. However, while some candidate vaccines successfully translated into licensed applications, others have failed safety trials, placing vaccine development on a hit-or-miss trajectory. We examined the determinants of small plaque phenotype in two dengue virus (DENV) vaccine candidates, DENV-3 PGMK30FRhL3, which produced acute febrile illness in vaccine recipients, and DENV-2 PDK53, which has a good clinical safety profile. The reasons behind the failure of PGMK30FRhL3 during phase 1 clinical trial, despite meeting the empirically derived criteria of attenuation, have never been systematically investigated. Using in vitro, in vivo and functional genomics approaches, we examined infections by the vaccine and wild-type DENVs, in order to ascertain the different determinants of plaque size. We show that PGMK30FRhL3 produces small plaques on BHK-21 cells due to its slow in vitro growth rate. In contrast, PDK53 replicates rapidly, but is unable to evade antiviral responses that constrain its spread hence also giving rise to small plaques. Therefore, at least two different molecular mechanisms govern the plaque phenotype; determining which mechanism operates to constrain plaque size may be more informative on the safety of live-attenuated vaccines

Smart Mobility Cities: Connecting Bristol and Kuala Lumpur project report

Financed by the British Council Institutional Links program this Smart Mobility Cities project has opened a fascinating window on a journey of discovery linking Bristol and Kuala Lumpur. This journey was in part directed towards the realisation of Smart Mobility solutions to the socio-economic and environmental challenges of global urbanisation. Beyond this, the journey was also concerned to strengthen research and innovation partnerships between the UK and the emerging knowledge economy of Malaysia, enabling UK social scientists to collaborate on challenging global issues with international researchers and vice versa. This Smart Mobility Cities project report presents innovative, creative and yet fully practical solutions for these societal challenges. Solutions that explore a range of opportunities, whichinclude those arising from new urban governance requirements, and which are in-line with visions for sustainable urban mobility.These Smart Mobility solutions have arisen from intensive co-design and co-creation engagement with a diversity of stakeholders. Research co-production has linked the principal university partners of the University of the West of England (UWE), Bristol, and Taylor’sUniversity, Kuala Lumpur, together with the Malaysia Institute of Transport (MITRANS), Universiti Teknologi Mara, and the University Sains Malaysia (USM) in intensive engagement with stakeholder interests in both UK and Malaysia over a two-year period

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London