Animals in Science: Ethical Justifications, Regulatory Frameworks, and Political Recommendations in the Canadian Context

Global estimates suggest that more than 100 million non-human animals are used for scientific purposes each year. The nature of the research, teaching, and testing conducted on these animals can be very invasive, painful, and fatal. Should we care? To discontinue these practices in some cases may result in human suffering. Should any human benefits of research, teaching, and testing outweigh the resultant animal suffering? This paper begins with an analysis of some of the most popular theories on the moral status of animals. From this analysis it is argued that mere species membership is not a morally relevant characteristic, and that non-human animals can have moral status and moral rights. A deontological approach to adjudicating moral claims across species is presented to overcome some of the challenges typical of utilitarian and rights-based approaches. This approach is used to sketch a general framework for evaluating which types of scientific animal use ought to be permitted. It is argued further that, while some forms of scientific animal use may be permitted at present, we ought to strive for the elimination of the practice. The focus will then shift to an analysis of Canada’s regulatory system for the scientific use of animals, identifying shortcomings of this system. The Canadian approach to regulation in this area will be compared against approaches that are taken in the UK and the Netherlands which are more closely aligned with the moral arguments made in the first section. There are opportunities for Canada to learn from these countries, and remarks will be made on how and why Canada should improve the regulation of animals in research, teaching, and testing. Such changes have the potential to improve the wellbeing not only of the animals used in science, but for humans as well. Finally, expected costs and benefits that would accompany the implementation of the recommendations are considered with comments on how costs can be alleviated and why they should be incurred

Improving quality of life in cancer patients through higher participation and health literacy: study protocol for evaluating the oncological social care project (OSCAR)

BACKGROUND: Cancer patients experience psychological and social distress due to their medical treatment and social issues. However, continuous and specialized social support is still lacking. In Germany, a group of company health insurance funds has developed an approach to support cancer patients with monthly structured interviews conducted by specially trained Social Care Nurses. The nurses will identify patient needs in order to provide help with medical, personal, and social matters. One aim of the scientific evaluation is to analyze the effect of the consultations on various patient-reported outcomes, especially quality of life. The evaluation concept will be described in this study protocol. METHODS/DESIGN: The evaluation is a non-randomized, controlled, multi-center intervention study with a mixed-method design. It consists of three research modules which include primary data from questionnaires, and claims data from the health insurance funds. In Module 1, cancer patients will be recruited to form an intervention group (OSCAR, n = 150) and a control group (n = 200) in four study centers for a period of 1 year. One baseline and three follow-up questionnaires will be conducted to survey the patient-reported outcomes. Relevant secondary outcomes are health literacy, participation, and physician-patient communication. In Module 2, claims data will be used to analyze cost effects and thereby assess effectivity and hospitalization. Module 3 will involve a qualitative analysis of project diaries kept by the Social Care Nurses. The diaries will record the nurses' practical experiences and the benefits of deploying OSCAR across the German healthcare system. DISCUSSION: OSCAR is an innovative way of providing cancer patients with continuous support to improve their quality of life. The evaluation concept aims to assess the effects of the monthly consultations by the Social Care Nurses on the patients, and will use a mixed-method design. The results are important for assessing the transferability of OSCAR to the healthcare system as a whole. TRIAL REGISTRATION: German Clinical Trials Register (DRKS-ID: DRKS00013640 ). Registered 29 December 2017

Weathering the storm: Generating intersectional urban design understandings for winter cities

Taking an intersectional approach, this research explicates the unique manner in which spatial injustice is experienced in a winter city when an individual possesses the multiple disadvantaged identities of disability, gender, age, and class. Employing case study methodology and go-along interview methods, this research answers the question: how can the lived experience of an older, formerly homeless woman with mobility and mental health disabilities inform intersectional design recommendations for winter cities? The findings identify three priority areas for intersectional design in winter cities to facilitate inclusion, wellness, and resilience among those disadvantaged by disability, gender, age, and class. These areas are: components of the built environment requiring intersectional understanding of accessibility (sidewalks, public transit-access routes, building entrances, and public transit pick-up zones); the urban context of senior and affordable housing; and public transportation. This paper contributes to the literature by demonstrating that intersectional understandings of urban winter environments are potent knowledge towards transforming cities from ones that disable and marginalize, to ones that enable and empower.En adoptant une approche intersectionnelle, cette recherche explique la manière unique dont l’oppression socio-spatiale est vécue dans une ville d’hiver lorsqu’un individu possède les multiples identités défavorisées du handicap, du sexe, de l’âge et de la classe. En utilisant une méthodologie d’étude de cas et des méthodes d’entrevues, cette recherche répond à la question: comment l’expérience vécue d’une femme âgée, anciennement sans-abri, à mobilité réduite et souffrant de troubles mentaux, peut-elle éclairer les recommandations de conception inclusive pour les villes d’hiver? Les résultats suggèrent trois domaines prioritaires pour une conception inclusive dans les villes d’hiver: les zones cibles de l’environnement bâti nécessitant une attention accrue sur l’accessibilité (trottoirs, voies d’accès aux transports en commun, entrées des bâtiments et zones de ramassage des transports en commun); l’emplacement urbain des logements pour personnes âgées et abordables; et les transports publics. Cet article contribue à la littérature en démontrant que la compréhension intersectionnelle des environnements hivernaux urbains est une connaissance puissante pour transformer les villes de celles qui désactivent et marginalisent, à celles qui permettent et autonomisent

Impact of COPD and anemia on motor and cognitive performance in the general older population: results from the English longitudinal study of ageing

Background: Cognitive and motor-performance decline with age and the process is accelerated by decline in general health. In this study, we aimed to estimate the effects of COPD and HB levels on cognitive and motor performance in the general older population and assess potential interaction. Methods: The English Longitudinal Study of Aging is a population-based cohort study including measurements of lung-function and HB levels together with cognitive and motor performance testing. Data were collected from 5709 participants including three measurement time over eight years. COPD was defined using lung-function-parameters and clinical symptoms. HB was assessed continuously and low HB was defined using clinical anemia cutoffs. Linear mixed-effects regression models were used to quantify the associations of COPD and HB with outcome measures, both individually and in combination. Results: Participants with both low HB and COPD demonstrated worse motor performance compared to individuals with only one exposure, resulting in up to 1 s (95%CI, 0.04–1.8) longer time needed to complete the five times sit to stand task than what would be expected based on purely additive effects. Additionally in individuals with COPD, the time to complete the motor-performance task per unit decrease in continuous HB levels was longer than in participants without COPD after full adjustment for confounding (up to 1.38 s/unit HB level, 95% CI: 0.65–2.11). Conclusion: In persons with COPD low HB levels may contribute to low motor-performance in a supra additive fashion. Further studies should re-evaluate whether earlier treatment of lower HB in these individuals might be beneficial

When Labor Enforcement and Immigration Enforcement Collide: Deterring Worker Complaints Worsens Workplace Safety

Regulatory agencies overseeing the labor market often rely on worker complaints to direct their enforcement. However, if workers face differential barriers to complain, this system could result in ineffective targeting and create disparities in working conditions. To investigate these implications, we examine how the onset of Secure Communities—a localized immigration enforcement program—affected occupational safety and health. Counties’ participation in Secure Communities substantially reduced complaints to government safety regulators, but increased injuries, at workplaces with Hispanic workers. We show that these effects are most consistent with employers reducing safety inputs in response to workers’ decreased willingness to complain

Community care coordination for stroke survivors: results of a complex intervention study

Background: Outpatient follow-up care for stroke survivors is often inadequate and mostly self-organized by the patients themselves. In the German health care system, there are no standard care programs for patients after they are discharged from the hospital to support them with their multifaceted and heterogeneous health care needs. The objective of this complex intervention study was to evaluate the effectiveness of a post-stroke care coordination program in comparison to standard care in the first year after a stroke. Methods: Patients aged 55 and older who had survived a stroke or a transient ischemic attack (TIA) within the last 6 months before enrollment were included. Participants received care coordination either by telephone or face-to-face for up to 1 year. Patients’ health insurance claims data were used to measure outcomes. The control group consisted of stroke survivors receiving standard care and was constructed by exact matching based on six criteria. Outcome measures were health services utilization, rate of recurrent events, readmissions and accompanying costs, and mortality. Outcomes were tested using different multiple models. Results: In total, N = 361 patients were included in the analyses. Intervention participants had seen an outpatient neurologist more often (OR = 4.75; 95% CI: 2.71–8.31) and were readmitted to a hospital less frequently (IRR = 0.42; 95% CI: 0.29–0.61), resulting in lower hospital costs (IQR = €0–1910 in the intervention group, IQR = €0–4375 in the control group). There were no substantial group differences in the rate of recurrent events and mortality. Conclusion: This study showed the beneficial potential of care coordination for a vulnerable patient population: the utilization rate of important health services was increased, and the rate of hospital readmissions decreased as a result. Future research should focus on the risk of recurrent strokes and the long-term effects of improved care. Trial registration: DRKS00017526 on DRKS – German Clinical Trials Register (retrospectively registered: 21 June 2019)

Bariatric surgery and brain health: A longitudinal observational study investigating the effect of surgery on cognitive function and gray matter volume

Dietary modifications leading to weight loss have been suggested as a means to improve brain health. In morbid obesity, bariatric surgery (BARS)—including different procedures, such as vertical sleeve gastrectomy (VSG), gastric banding (GB), or Roux-en-Y gastric bypass (RYGB) surgery—is performed to induce rapid weight loss. Combining reduced food intake and malabsorption of nutrients, RYGB might be most effective, but requires life-long follow-up treatment. Here, we tested 40 patients before and six months after surgery (BARS group) using a neuropsychological test battery and compared them with a waiting list control group. Subsamples of both groups underwent structural MRI and were examined for differences between surgical procedures. No substantial differences between BARS and control group emerged with regard to cognition. However, larger gray matter volume in fronto-temporal brain areas accompanied by smaller volume in the ventral striatum was seen in the BARS group compared to controls. RYGB patients compared to patients with restrictive treatment alone (VSG/GB) had higher weight loss, but did not benefit more in cognitive outcomes. In sum, the data of our study suggest that BARS might lead to brain structure reorganization at long-term follow-up, while the type of surgical procedure does not differentially modulate cognitive performance