Pragmatism and Effective Altruism: An Essay on Epistemology and Practical Ethics

This paper hopes to provide an American Pragmatist reading of the Effective Altruism philosophy and movement. The criticism levied against Effective Altruism here begins from one of its founding principles, and extends to practical aspects of the movement. The utilitarian leaders of Effective Altruism consider Sidgwick’s ‘point of view of the universe’ an objective starting point of determining ethics. Using Quality Adjusted Life Years (QALYs), a popular measure in contemporary welfare economics, they provide a “universal currency for misery” for evaluating decisions. Through this method, one can calculate exactly the value of each moral decision by identifying which one yields more QALYs, and, apparently, objectively come to a conclusion about the moral worth of seemingly unrelated situations, for example, whether it is more moral to donate money so as to help women suffering from painful childbirth-induced fistulas, or to donate to starving children in famine-ridden areas. What’s more, not making the choice that yields more QALYs is “unfair” to those one could have helped more, thus immoral. This paper provides, first a pragmatist conception of epistemology (or lack of it), in contrast to the Sidgwickian one held by the utilitarian effective altruists, and then explores how holding either epistemological position affects our ethical viewpoints and actions. It argues that the utilitarian conception is the wrong place, and way, from which to view all ethical action. It contends that Effective Altruism, in seeking to reorder society to meet its abstractly conceived teleological utilitarian moral ideal (as measured by QALYs- a measure settled upon by the movement’s leaders), is undemocratic, and ultimately misses much of the complexity and messiness provided by contingencies, personal and cultural, that is present in, and important to, human life. Altruism done this way is atomizing and thoughtless; and it depicts to a high degree what William James referred to as a “certain blindness in human beings” - the lack of recognition that different things matter to different people, and that it is impossible to aggregate these claims relative to a moral standard that exists outside their particular individual and societal experiences. The paper then provides a pragmatist reading of meliorism, as found in the works of John Dewey, William James, Richard Rorty and Jane Addams; a view of meliorism that hearkens towards solidarity and not objectivity; one that is not only democratic, cognizant of contingencies and focused on habit, but also, by its insistence on viewing ourselves as members of communities and societies, saves us from the moral atomization of Effective Altruism and its insistence on individual moral responsibility and action in line with “objective truths”, as opposed to collective and political action to address contingent issues

Precise Point Positioning Augmentation for Various Grades of Global Navigation Satellite System Hardware

The next generation of low-cost, dual-frequency, multi-constellation GNSS receivers, boards, chips and antennas are now quickly entering the market, offering to disrupt portions of the precise GNSS positioning industry with much lower cost hardware and promising to provide precise positioning to a wide range of consumers. The presented work provides a timely, novel and thorough investigation into the positioning performance promise. A systematic and rigorous set of experiments has been carried-out, collecting measurements from a wide array of low-cost, dual-frequency, multi-constellation GNSS boards, chips and antennas introduced in late 2018 and early 2019. These sensors range from dual-frequency, multi-constellation chips in smartphones to stand-alone chips and boards. In order to be comprehensive and realistic, these experiments were conducted in a number of static and kinematic benign, typical, suburban and urban environments. In terms of processing raw measurements from these sensors, the Precise Point Positioning (PPP) GNSS measurement processing mode was used. PPP has become the defacto GNSS positioning and navigation technique for scientific and engineering applications that require dm- to cm-level positioning in remote areas with few obstructions and provides for very efficient worldwide, wide-array augmentation corrections. To enhance solution accuracy, novel contributions were made through atmospheric constraints and the use of dual- and triple-frequency measurements to significantly reduce PPP convergence period. Applying PPP correction augmentations to smartphones and recently released low-cost equipment, novel analyses were made with significantly improved solution accuracy. Significant customization to the York-PPP GNSS measurement processing engine was necessary, especially in the quality control and residual analysis functions, in order to successfully process these datasets. Results for new smartphone sensors show positioning performance is typically at the few dm-level with a convergence period of approximately 40 minutes, which is 1 to 2 orders of magnitude better than standard point positioning. The GNSS chips and boards combined with higher-quality antennas produce positioning performance approaching geodetic quality. Under ideal conditions, carrier-phase ambiguities are resolvable. The results presented show a novel perspective and are very promising for the use of PPP (as well as RTK) in next-generation GNSS sensors for various application in smartphones, autonomous vehicles, Internet of things (IoT), etc

Multi-GNSS Precise Point Positioning Software Architecture and Analysis of GLONASS Pseudorange Biases

With expanding satellite-based navigation systems, multi-Global Navigation Satellite System (GNSS) Precise Point Positioning (PPP) presents an advantage over a single navigation system, which improves position accuracy and enhances availability of satellites and signals. The York GNSS PPP software was developed using C++ in the Microsoft.Net platform to utilize the existing multi-GNSS satellite constellations based on the software processor used by the Natural Resources Canada (NRCan) PPP online service. The software was built as a robust, scalable, modular tool that meets the highest of scientific standards compared to existing online PPP engines.There exists a correlation between receiver stations from heterogeneous networks, such as the IGS, in GNSS PPP processing and the increase in magnitude of the pseudorange and carrier-phase biases in both GPS + GLONASS and GLONASS-only PPP solutions. The correlation is due to mixed receiver and antenna hardware as well as firmware versions. Unlike GPS, GLONASS observations are affected by the Frequency Division Multiple Access (FDMA) satellite signal structure, which introduces inter-frequency channel biases and other system biases. The GLONASS pseudorange inter-channel frequency biases show a strong correlation with different receiver types, firmware versions and antenna types. This research estimated the GLONASS pseudorange inter-frequency channel biases using 350 IGS stations, based on 32 receiver types and 4 antenna types over a period of one week. An improvement of 19% was observed after calibrating for the pseudorange ICBs, in the horizontal components respectively, considering 20 minutes convergence period

Geographic Analysis of Alcohol-Related Crashes in Nine High-Need Louisiana Parishes

This report examines nine Louisiana communities and their alcohol availability concerns from a public health perspective. The nine communities are part of The Louisiana Partnership for Success II (LPFS ll), a 5-year Substance Abuse and Mental Health Services Administration (SAMHSA) grant. The LPFS ll grant is focused exclusively on addressing underage drinking behaviors, consequences, and risk factors among 9 to 20-year-olds in nine high-need, parish-level communities (HNCs) (Louisiana Department of Health [LDH], 2020a). Communities were selected through a data-driven, participatory process and supported to form a cross-sector coalition to implement interventions within those communities. The process for choosing the high-need communities included seven indicators from the Caring Communities Youth Survey (CCYS) (LDH, 2020b), alcohol-related crash reports, and student alcohol-related suspensions. Three additional indicators were taken from the 2018 County Health Rankings (University of Wisconsin Population Health Institute, 2018) and The Centers for Disease Control and Prevention (CDC) 1991-2017 High School Youth Risk Behavior Survey Data (CDC, 2018). In order to assist these communities with high rates of alcohol-related public health issues, this research project examined the interaction of alcohol outlets, alcohol-related motor vehicle crashes (MVC), and associated demographics and time variables using GIS mapping in order to help with planning the most appropriate and impactful interventions

Blood use in sub‐Saharan Africa: a systematic review of current data

Background: Data on the use of blood products in sub-Saharan Africa (SSA) are scarce. A systematic review of published data on blood utilization according to diagnosis in SSA was performed. Study design and methods: Studies published from January 2000 to June 2018 were searched in PubMed, Embase and African Index Medicus. Data were extracted and synthesized. The proportion of blood products used for different diagnostic categories is presented. Results: 37 studies representing 159,746 transfusions to 96,690 patients from 14 countries in SSA were included. Data from six of 37 studies were pooled to determine blood product use according to diagnosis. The primary diagnostic categories were pediatric malaria (20%), sickle cell anemia [SCA] (18%), obstetric hemorrhage (16%), and other causes of bleeding (16%). About 8%, 6% and 2% of products were used for other infections, cancer treatment, and surgery respectively. Overall, 58.5% of the products transfused were red blood cells, 31.7 % whole blood, 7.2% fresh frozen plasma, and 2.6% as platelets. Estimated blood product use per population in SSA was 5.3 transfusions per 1000 people, compared with 52 and 34 per thousand for Australia and United States respectively. Conclusion: This study provides a systematic attempt to quantify blood utilization for SSA. Blood products in SSA are used primarily for pediatric malaria, SCA, obstetric hemorrhage and other causes of bleeding. Studies such as this represent an important early step towards improving hemovigilance in SSA

Community perceptions of paediatric severe anaemia in Uganda

BACKGROUND: Severe anaemia remains a major cause of morbidity and mortality among children in sub-Saharan Africa. There is limited research on the beliefs and knowledge for paediatric severe anaemia in the region. The effect of these local beliefs and knowledge on the healthcare seeking of paediatric severe anaemia remains unknown. OBJECTIVE: To describe community perceptions of paediatric severe anaemia in Uganda. METHODS: Sixteen in-depth interviews of caregivers of children treated for severe anaemia and six focus group discussions of community members were conducted in three regions of Uganda between October and November 2017. RESULTS: There was no common local name used to describe paediatric severe anaemia, but the disease was understood in context as 'having no blood'. Severe anaemia was identified to be a serious disease and the majority felt blood transfusion was the ideal treatment, but concomitant use of traditional and home remedies was also widespread. Participants articulated signs of severe pediatric anemia, such as palmar, conjunctival, and tongue pallor. Other signs described included jaundice, splenomegaly, difficulty in breathing and poor appetite. Poor feeding, malaria, splenomegaly and evil spirits were perceived to be the common causes of severe anaemia. Other causes included: human immunodeficiency virus (HIV), haemoglobinuria, fever, witchcraft, mosquito bites, and sickle cell. Splenomegaly and jaundice were perceived to be both signs and causes of severe anaemia. Severe anaemia was interpreted to be caused by evil spirits if it was either recurrent, led to sudden death, or manifested with cold extremities. CONCLUSION: The community in Uganda perceived paediatric severe anaemia as a serious disease. Their understanding of the signs and perceived causes of severe anaemia to a large extent aligned with known clinical signs and biological causes. Belief in evil spirits persists and may be one obstacle to seeking timely medical care for paediatric severe anaemia

Caregivers and community perceptions of blood transfusion for children with severe anaemia in Uganda

Objective To describe local perceptions of blood transfusion for children with severe anaemia in Uganda. Background Blood transfusion is a common emergency treatment for children with severe anaemia and saves millions of lives of African children. However, the perceptions of transfusion recipients have not been well studied. A better understanding of the perceived risk may improve transfusion care. Methods A qualitative study based on 16 in‐depth interviews of caregivers of transfused children, and six focus group discussions with community members was conducted in three regions of Uganda between October and November 2017. Results Caregivers of children and community members held blood transfusion in high regard and valued it as life‐saving. However, there were widespread perceived transfusion risks, including: Human immunodeficiency virus (HIV) transmission, too rapid blood infusion and blood incompatibility. Other concerns were: fatality, changes in behaviour, donor blood being ‘too strong’ and use of animal blood. In contrast, recent transfusion, older age, knowledge of HIV screening of blood for transfusion, faith in God and having a critically ill child were associated with less fear about transfusion. Respondents also emphasised challenges to transfusion services access including distance to hospitals, scarcity of blood and health workers' attitudes. Conclusion Perceptions of the community and caregivers of transfused children in Uganda about blood transfusion were complex: transfusion is considered life‐saving but there were strong perceived transfusion risks of HIV transmission and blood incompatibility. Addressing community perceptions and facilitating access to blood transfusion represent important strategies to improve paediatric transfusion care

Trachoma in Western Equatoria State, Southern Sudan: Implications for National Control

Baseline data on trachoma prevalence is a prerequisite for intervention. Prior to the present study, all surveys in Southern Sudan reported trachoma prevalences that exceeded the threshold for large-scale intervention. This gave rise to the notion that the disease may be endemic throughout the country. The present study was conducted under the auspices of the National Program for Integrated Control of Neglected Tropical Diseases, to verify whether prevalences in two counties west of the Nile exceeded the WHO recommended intervention threshold for mass drug administration (MDA) of antibiotic treatment. The results show that trachoma prevalence at county level was below this threshold. However, prevalences in some communities within the county were above the threshold, meaning that they should be targeted with MDA of antibiotics, as well as with other interventions such as trichiasis surgery, health promotion and improved water and sanitation. This finding reminds us of the need for geographical targeting of resources, both for surveys and subsequent intervention. Current resources are insufficient to conduct population-based prevalence surveys for trachoma throughout Southern Sudan. Further surveys should thus be conducted in areas where collection of additional information will be most informative. We propose that a combination of risk-mapping and rapid assessments is used to identify such areas

Dense genotyping of immune-related susceptibility loci reveals new insights into the genetics of psoriatic arthritis

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis and, despite the larger estimated heritability for PsA, the majority of genetic susceptibility loci identified to date are shared with psoriasis. Here, we present results from a case-control association study on 1,962 PsA patients and 8,923 controls using the Immunochip genotyping array. We identify eight loci passing genome-wide significance, secondary independent effects at three loci and a distinct PsA-specific variant at the IL23R locus. We report two novel loci and evidence of a novel PsA-specific association at chromosome 5q31. Imputation of classical HLA alleles, amino acids and SNPs across the MHC region highlights three independent associations to class I genes. Finally, we find an enrichment of associated variants to markers of open chromatin in CD8(+) memory primary T cells. This study identifies key insights into the genetics of PsA that could begin to explain fundamental differences between psoriasis and PsA

Economic evaluation of postdischarge malaria chemoprevention in preschool children treated for severe anaemia in Malawi, Kenya, and Uganda: A cost-effectiveness analysis

Background Children hospitalised with severe anaemia in malaria-endemic areas are at a high risk of dying or being readmitted within six months of discharge. A trial in Kenya and Uganda showed that three months of postdischarge malaria chemoprevention (PDMC) with monthly dihydroartemisinin-piperaquine (DP) substantially reduced this risk. The World Health Organization recently included PDMC in its malaria chemoprevention guidelines. We conducted a cost-effectiveness analysis of community-based PDMC delivery (supplying all three PDMC-DP courses to caregivers at discharge to administer at home), facility-based PDMC delivery (monthly dispensing of PDMC-DP at the hospital), and the standard of care (no PDMC). Methods We combined data from two recently completed trials; one placebo-controlled trial in Kenya and Uganda collecting efficacy data (May 6, 2016 until November 15, 2018; n=1049), and one delivery mechanism trial from Malawi collecting adherence data (March 24, 2016 until October 3, 2018; n=375). Cost data were collected alongside both trials. Three Markov decision models, one each for Malawi, Kenya, and Uganda, were used to compute incremental cost-effectiveness ratios expressed as costs per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were performed to account for uncertainty. Findings Both PDMC strategies were cost-saving in each country, meaning less costly and more effective in increasing health-adjusted life expectancy than the standard of care. The estimated incremental cost savings for community-based PDMC compared to the standard of care were US$ 22·10 (Malawi), 38·52 (Kenya), and 26·23 (Uganda) per child treated. The incremental effectiveness gain using either PDMC strategy varied between 0·3 and 0·4 QALYs. Community-based PDMC was less costly and more effective than facility-based PDMC. These results remained robust in sensitivity analyses. Interpretation PDMC under implementation conditions is cost-saving. Caregivers receiving PDMC at discharge is a cost-effective delivery strategy for implementation in malaria-endemic southeastern African settings