How to allocate scarce health resources without discriminating against people with disabilities

One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the ’QALY trap’: we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination

Rising pitch, continuation, and the hierarchical structure of discourse

The meaningful contribution of terminal rising pitch has received a fair amount of scholarly attention, discussed for its ability to create questioning force on declarative syntax (Gunlogson, 2008), as part of listing intonation (Ladd, 2008), as well as indicating discourse relationships (Jasinskaja, 2010; Nilsenová, 2006; Pierrehumbert & Hirschberg, 1990). A common interpretation of the meaning of rising pitch is that it conveys incompleteness, more-to-come, continuation or is ‘forward-looking’ (Bolinger, 1989; Hirschberg, 2008; Pierrehumbert & Hirschberg, 1990). Recent experimental results contribute to this discussion, showing a rise can bias towards the coordinating interpretation of a coordination/subordination discourse ambiguity (Tyler, 2012). Because both interpretations of the ambiguity involve continuation, the rise is signaling not just that you continue but how you continue. In this paper, I will briefly present these results and then integrate them into a unified account of the contribution of rising pitch, which I see as a signal of incompleteness with respect to the current hierarchical level of the discourse

The Vast and Terrible Trauma: American Literary Naturalism, Ethics, and Levinas

In an 1896 essay, Frank Norris wrote that the reading world should abandon those “teacup tragedies” to which it had grown accustomed and embrace a new literature that would depict a “vast and terrible drama.” Realism, Norris claimed, could not be used to achieve an earnest portrait of the conditions that mark individual lives under capitalism. Instead, the world needed a romantic wrestling with the forces of existential inscrutability. Also, the perceived need for literature to depict a clear ethical system needed revising from the perspective of American literary naturalism, a school long denigrated for apparent moral vacuity. Through excruciating “drama,” naturalism therefore confronted the economic conditions that subject individual lives to the whims of a world wherein moral values seemed either the business of religious groups or of rationalist Enlightenment thinkers. The writings of Norris and Stephen Crane, as well as later naturalists like John Dos Passos and Nathanael West, refuse moral systematization and depict human beings in extraordinary predicaments that question reductive evaluations of human relationships. These traumatic encounters offered by naturalist fiction provide a route for us to think about the works of the French ethicist, Emmanuel Levinas. In Levinas, we find the ethical encounter traumatic, gut-wrenching, and overwhelming. No course of action is provided because every person demands of us a unique response that cannot be met. Levinas offers a means for us to expand our understanding of literary naturalism and think of its relevance in our own day, wherein value relativism makes moral response increasingly difficult. Such an approach allows us to find the similarities between such disparate authors as Norris and Crane, Dos Passos and West, all of whom find the ethical relationship troubling and painful. In naturalism\u27s scenes of trauma, inarticulacy, and paralysis, we find the origins of a radical ethical alternative, one that does not deny ethical possibility in its refusal to systematize, but, rather, finds it in the the breakdown of language and cognition – in other words, the complete dissembling of the self and the familiar structures that tend to give it precedent in the ethical relationship

Modernity, historical trauma, and the crisis of ethics reading Nathanael West\u27s Miss Lonelyhearts after Levinas

Nathanael West\u27s tragically brief creative career was intensely concerned with the anomie of modern society, especially in the landscape of twentieth-century America. For West, this landscape is one populated by the disintegration of traditional community and the interrogation of values once posited as unassailable. As such, conventional West criticism has read the author as an intractable nihilist. Within the last decade, however, West criticism has taken an entirely new approach. Critics like Jonathan Greenberg and Justus Nieland have attempted to erect an ethical West by placing him within the discourse of modernist antisentimentalism. It is within this critical reevaluation of West that I would like to place my argument.When we are first introduced to the title character of West\u27s Miss Lonelyhearts, we find the advice columnist incapable of offering another hackneyed response to his suffering readership, which is a refusal that places him on the road to what we might call a sincere ethical response that seeks an appropriate message of hope and healing. As we see, though, Miss Lonelyhearts\u27 ethical journey is fraught with peril: he must constantly battle with the rhetoric of the newspaper column\u27s sentimentalism, a morally bankrupt culture that degrades his desire for sincerity, and the dangers of egotistical pride. Indeed, he presumably dies unable to realize his ethical responsibility. Nonetheless, I locate within this ostensibly meaningless death and within the text the potential of a radical reassessment of ethics that anticipates the work of Emmanuel Levinas.For Levinas, ethical traumatism commands a supererogatory giving out of the subject, who has no available means of what constitutes an appropriate moral response. Using the ethical philosophy of Levinas, I perform a close reading of the novel that finds a West who presents ethical responsibility as a trauma that obligates the subject to a moral duty it can neither fulfill nor defer. We see, then, that the ethical moment in West comes not in normative ethical action, but instead, comes in the traumatic moments of Miss Lonelyhearts\u27 writer\u27s block, when language and cognition break down, and Miss Lonelyhearts has absolutely no idea how to respond or proceed

The Utilization of Morphological and Genetic Diagnostic Techniques for the Description of Trematode Species Collected from Waterbirds from Lake Winnibigoshish, Minnesota, USA

Historically, morphological techniques for species identification were the leading diagnostic methodology, however, the increased usage of genetic techniques has led to a decrease in reports of morphometrics. The decrease in morphological reports increases the chance of missing diagnostic morphometrics. The three studies described herein used morphological and genetic diagnostic methods to identify trematodes from five families in order to improve genetic and morphological information for trematode species identification. The first study identified ten species of trematodes from intestines of waterbirds previously collected from Lake Winnibigoshish, Minnesota. Nine of the species were sequenced for 28S ribosomal DNA (rDNA). Two species were also examined using ITS rDNA sequences. One species was sequenced for a portion of CO1 mitochondrial DNA as well. Morphology for all nine species was reported along with one additional species identified through morphology alone. The second study identified morphological and genetic variation of 28S rDNA of Neopsilotrema lisitsynae from North American waterfowl along with an analysis ofultrastructure using scanning electron microscopy. This was the first report of N. lisitsynae in North America, along with identification in four new hosts. Morphometrics of North American worms were found to vary highly in comparison to the original description from Ukraine-collected worms. Additionally, three features of Neopsilotrema were shown inaccurate in some cases: tegumental spines may be absent, egg number may be greater than 5, and the ovary may be located in a dextral, sinistral or medial position relative to the body. One variable nucleotide site was identified as well. The final study identified a new species Neopsilotrema itascae from lesser scaup using identical methods as the N. lisitsynae study. Psilotrema mediopora was also reclassified based upon morphology into Neopsilotrema.All three studies reported expansions of currently described morphometrics and diagnostic genetic sequences which may be used for future work involving species diagnosis

THE HISTORICAL DEVELOPMENT OF J. H. NEWMAN’S IDEA OF THE CONSCIENCE, VIEWED IN THE CONTEXT OF HIS DEFENCE OF RELIGIOUS BELIEF.

Since the Enlightenment, with its dependence on “Reason” alone, faith has been rejected by growing numbers as a basis of religious knowledge. It was now less and less an age of Faith and much more of “Reason”. If you wanted to be sure of something, you had to prove it with strict evidence open to the scrutiny of rational examination. By this test religion was deemed to have failed. John Henry Newman was born into this intellectual situation, one that was eroding the sense of ultimate religious certainty, most obviously among intellectuals. He was a man recognized for his prowess in logic, but was highly sceptical of the power of mere reasoning to take a person to the truth – and most especially to the truth of revealed religion. Many more things were required, he thought, although it was of course necessary to reason logically. There was the question of the inquirer’s basic starting points. What were they? There was the question of whether the idea of God was a fruit of mere formal reasoning, or whether it was also an implicit or tacit perception prior to formal ratiocination and creed. What was it to “reason” in this real-life context, anyway? Reasoning to certitude involved, he thought, the perception of probability. There was also the question of a necessary mental preparedness, a right ethos of mind, if a person was to reason to the being of God and to the truth of his revelation. Newman decided that the foundation and support of a real belief in God and in his Revelation was something accessible to all. It was the sense of moral obligation. Conscience, commonly regarded as the voice of God to the soul, was the foundation. But what did this mean and why did Newman think this? This thesis takes up Newman’s view that the conscience is the essential principle and sanction of belief in God and his revelation. The conscience of man prompts the thought of God at its beginning and enables a natural apprehension of him. With this inchoate yet developing knowledge of God as Lawgiver, Judge and Friend, and supported by numerous other helps, one may proceed to “divine faith” in revealed religion, and in the Church its authenticated witness and exponent. This process is, though, sustained by grace. This investigation does not purport to evaluate Newman’s position philosophically. There have been many such attempts. Its purpose is, rather, to track the course of his basic idea as it developed over his lifetime, as evidenced in his letters, diaries and publications

Assessment of Soil Properties and Vegetation in a Mounded Native Tallgrass Prairie with an Aquic and Udic Soil Moisture Regime in the Ozark Highlands Region of Northwest Arkansas

Native tallgrass prairies were once considered to be the dominant pre-settlement vegetation type in the eastern third of the Great Plains, but are now designated as America’s most endangered ecosystem due to conversion to agricultural land. Prairie mounds are unique soil features still present in remnant native tallgrass prairies across the United States. The main objective was to determine the effects of soil moisture regime (i.e., aquic and udic), mound position, (i.e., mound summit, backslope, toeslope, inter-mound), soil depth (i.e., 10-cm intervals from 0 to 90 cm), and their interactions on soil physical, chemical, and hydraulic properties in a mounded native tallgrass prairie in the Ozark Highlands region of northwest Arkansas. The secondary objective was to evaluate the effects of soil depth (i.e., 10, 20, 30, and 50 cm), mound position (i.e., mound summit and inter-mound), soil moisture regime (i.e., udic and aquic), and their interactions over time and to quantify the effects of soil moisture regime (i.e., udic and aquic), mound position (i.e., mound summit and inter-mound), sample date, and their interactions on prairie vegetation. Soil samples were collected in mid-April 2017, volumetric water content measurements were collected continuously from April 2017 – June 2018, and vegetation was sampled in June and August 2017 and in May and August 2018. Soil clay concentrations in the mound summits roughly doubled from 0-90 cm while the clay concentrations in the backslope, toeslope, and inter-mound increased by three to six times from 0-90 cm. The maximum soil volumetric water content for selected rainfall events was approximately 2.5 times greater at the 10-cm depth in the aquic inter-mound compared to the udic mound at 30 cm. Total aboveground dry matter was numerically largest (8489 kg ha-1) at the aquic summit in August 2018 and numerically smallest (1280 kg ha-1) at the aquic inter-mound in May 2018. The results of this study provide insight regarding soil nutrient contents and water dynamics of prairie mounds and inter-mound areas, which are important for plant growth. Results clearly demonstrate that prairie restoration/management activities need to account for mound topography and differing soil moisture regimes to be most successful

Phylogeny And Systematics Of The Superfamily Diplostomoidea Poirier, 1886 (Platyhelminthes: Trematoda)

The Diplostomoidea is a large superfamily of digeneans which possess a unique holdfast organ. Members of the superfamily are distributed worldwide and are known to parasitize a wide variety of animals, both invertebrates and vertebrates. In some cases, diplostomoideans have been associated with diseases such as ocular diplostomiasis and ‘black spot’ disease in fishes. The taxonomic and systematic history of diplostomoideans is complex and includes numerous revisions based on morphology and host associations. Prior to this study, the Diplostomoidea included 6 families and 16 subfamilies. Recent molecular phylogenetic analyses have revealed the Diplostomidae and the Strigeidae to be non-monophyletic and demonstrated a need for re-evaluation of the group. In the present study, diplostomoideans were collected from a diversity of intermediate and definitive hosts from around the world which resulted in the most comprehensive sample set to date. Digenean specimens were studied using morphological and molecular tools (primarily molecular phylogenies of the 28S rRNA and cytochrome c oxidase mtDNA genes) to study the interrelationships of diplostomoidean taxa, host-parasite relationships and diversity of taxa. Our results clearly demonstrate the non-monophyly of the Cyathocotylidae, Diplostomidae and Strigeidae and support the monophyletic status of the Proterodiplostomidae. Based on re-evaluation of morphological characters and results of phylogenetic analysis of partial 28S sequence, the Brauninidae is considered a junior synonym of the Cyathocotylidae. Further, molecular phylogenies were used to re-evaluate the system of the Proterodiplostomidae. Among other findings, the current subfamily system of the Proterodiplostomidae was rejected. The results of morphological and molecular study clearly demonstrates that the diversity of diplostomoidean taxa has been underestimated, including species likely associated with ‘black spot’ disease in fish. In total, we described 1 new subfamily, 3 new genera and 5 new species of diplostomoideans with descriptions of many additional new taxa pending. Molecular phylogenetic analyses demonstrated numerous host-switching events during the evolutionary history of the Diplostomoidea along with evidence of multiple dispersal events between biogeographic realms