Morality, modality, and humans with deep cognitive impairments

Philosophers struggle to explain why human beings with deep cognitive impairments have a higher moral status than certain non-human animals. Modal personism promises to solve this problem. It claims that humans who lack the capacities of “personhood” and the potential to develop them nonetheless could have been persons. I argue that modal personism has poor prospects because it's hard to see how we could offer a plausible account of modal personhood. I search for an adequate understanding of modal personhood by considering existing accounts and sketching new ones. But each account fails, either because it objectionably excludes some deeply cognitively impaired humans from the class of modal persons or because it makes modal personhood doubtfully relevant to moral status. And the modal personist cannot solve this problem by appealing to the misfortune suffered by modal persons

The CCP4 suite : integrative software for macromolecular crystallography

The Collaborative Computational Project No. 4 (CCP4) is a UK-led international collective with a mission to develop, test, distribute and promote software for macromolecular crystallography. The CCP4 suite is a multiplatform collection of programs brought together by familiar execution routines, a set of common libraries and graphical interfaces. The CCP4 suite has experienced several considerable changes since its last reference article, involving new infrastructure, original programs and graphical interfaces. This article, which is intended as a general literature citation for the use of the CCP4 software suite in structure determination, will guide the reader through such transformations, offering a general overview of the new features and outlining future developments. As such, it aims to highlight the individual programs that comprise the suite and to provide the latest references to them for perusal by crystallographers around the world

A prospective evaluation of the fourth national Be Clear on Cancer ‘Blood in Pee’ campaign in England

OBJECTIVE: To assess the impact of the fourth Be Clear on Cancer (BCoC) ‘Blood in Pee’ (BiP) campaign (July to September 2018) on bladder and kidney cancer symptom awareness and outcomes in England. METHODS: In this uncontrolled before and after study, symptom awareness and reported barriers to GP attendance were assessed using panel and one‐to‐one interviews. The Health Improvement Network (THIN), National Cancer Registration and Analysis Service (NCRAS) and NHS Cancer Waiting Times (CWT) data were analysed to assess the impact on GP attendances, urgent cancer referrals, cancer diagnoses and 1‐year survival. Analyses used Poisson, negative binomial and Cox regression. RESULTS: Symptom awareness and intention to consult a GP after one episode of haematuria increased following the campaign. GP attendance with haematuria (rate ratio (RR) 1.17, 95% confidence interval (CI): 1.07–1.28) and urgent cancer referrals (RR 1.18 95% CI: 1.08–1.28) increased following the campaign. Early‐stage diagnoses increased for bladder cancer (difference in percentage 2.8%, 95% CI: −0.2%–5.8%), but not for kidney cancer (difference −0.6%, 95% CI: −3.2%–2.1%). CONCLUSIONS: The fourth BCoC BiP campaign appears to have been effective in increasing bladder cancer symptom awareness and GP attendances, although long‐term impacts are unclear

Associations between general practice characteristics with use of urgent referrals for suspected cancer, and endoscopies: A cross-sectional ecological study

Background: Large variation in measures of diagnostic activity have been described previously between English general practices, but related predictors remain understudied. Objective: To examine associations between general practice population and characteristics, with the use of urgent referrals for suspected cancer, and use of endoscopy. Methods: Cross-sectional observational study of English general practices. We examined practice-level use (/1000 patients/year) of urgent referrals for suspected cancer, gastroscopy, flexible sigmoidoscopy and colonoscopy. We used mixed-effects Poisson regression to examine associations with the socio-demographic profile of practice populations and other practice attributes, including the average age, sex and country of qualification of practice doctors. Results: The socio-demographic characteristics of registered patients explained much of the between-practice variance in use of urgent referrals (32%) and endoscopic investigations (18%-27%), all being higher in practices with older and more socioeconomically deprived patients. Practice-level attributes explained a substantial amount of between-practice variance in urgent referral (19%) but little of the variance in endoscopy (3%-4%). Adjusted urgent referral rates were higher in training practices and those with younger GPs. Practices with mean doctor ages of 41 and 57 years (at the 10th/90th centiles of the national distribution) would have urgent referral rates of 24.1 and 19.1 / 1000 registered patients, p<0.001. Conclusion: Most between-practice variation in use of urgent referrals and endoscopies seems to reflect health need. Some practice characteristics, such as the mean age of GPs, are associated with appreciable variation in use of urgent referrals, though these associations do not seem strong enough to justify targeted interventions.Cancer Research UK / National Awareness and Early Diagnosis Initiative Project Grant No. C18081/A17854; Cancer Research UK Advanced Clinician Scientist Fellowship No. C18081/A1818