Extending life for people with a terminal illness: a moral right and an expensive death? Exploring societal perspectives

BACKGROUND: Many publicly-funded health systems apply cost-benefit frameworks in response to the moral dilemma of how best to allocate scarce healthcare resources. However, implementation of recommendations based on costs and benefit calculations and subsequent challenges have led to ‘special cases’ with certain types of health benefits considered more valuable than others. Recent debate and research has focused on the relative value of life extensions for people with terminal illnesses. This research investigates societal perspectives in relation to this issue, in the UK. METHODS: Q methodology was used to elicit societal perspectives from a purposively selected sample of data-rich respondents. Participants ranked 49 statements of opinion (developed for this study), onto a grid, according to level of agreement. These ‘Q sorts’ were followed by brief interviews. Factor analysis was used to identify shared points of view (patterns of similarity between individuals’ Q sorts). RESULTS: Analysis produced a three factor solution. These rich, shared accounts can be broadly summarised as: i) ‘A population perspective – value for money, no special cases’, ii) ‘Life is precious – valuing life-extension and patient choice’, iii) ‘Valuing wider benefits and opportunity cost - the quality of life and death’. From the factor descriptions it is clear that the main philosophical positions that have long dominated debates on the just allocation of resources have a basis in public opinion. CONCLUSIONS: The existence of certain moral positions in the views of society does not ethically imply, and pragmatically cannot mean, that all are translated into policy. Our findings highlight normative tensions and the importance of critically engaging with these normative issues (in addition to the current focus on a procedural justice approach to health policy). Future research should focus on i) the extent to which these perspectives are supported in society, ii) how respondents' perspectives relate to specific resource allocation questions, and iii) the characteristics of respondents associated with each perspective

Education recoded: policy mobilities in the international 'learning to code' agenda

Education policy increasingly takes place across borders and sectors, involving a variety of both human and nonhuman actors. This comparative policy paper traces the 'policy mobilities,' 'fast policy' processes and distributed 'policy assemblages' that have led to the introduction of new computer programming practices into schools and curricula in England, Sweden and Australia. Across the three contexts, government advisors and ministers, venture capital firms, think tanks and philanthropic foundations, non-profit organizations and commercial companies alike have promoted computer programming in schools according to a variety of purposes, aspirations, and commitments. This paper maps and traces the evolution of the organizational networks in each country in order to provide a comparative analysis of computing in schools as an exemplar of accelerated, transnationalizing policy mobility. The analysis demonstrates how computing in schools policy has been assembled through considerable effort to create alignments between diverse actors, the production and circulation of material objects, significant cross-border movement of ideas, people and devices, and the creation of strategic partnerships between government centres and commercial vendors. Computing in schools exemplifies how modern education policy and governance is accomplished through sprawling assemblages of actors, events, materials, money and technologies that move across social, governmental and geographical boundaries

Effects of neutral gas release on current collection during the CHARGE-2 rocket experiment

Observations of current collection enhancements due to cold nitrogen gas control jet emissions from a highly charged rocket payload in the ionosphere are reported. These observations were made during the second cooperative high altitude rocket gun experiment (CHARGE-2) which was an electrically tethered mother/daughter payload system. The current collection enhancement was observed at the daughter payload located 100 to 400 m away from the mother which was firing an energetic electron beam. The authors interpret these results in terms of an electrical discharge forming in close proximity to the daughter during the short periods of gas emission. The results indicate that it is possible to enhance the electron current collection capability of positively charged vehicles by means of deliberate neutral gas releases into an otherwise undisturbed space plasma. These results can also be compared with recent laboratory observations of hollow cathode plasma contactors operating in the ignited mode. Experimental observations of current collection enhancements due to cold nitrogen gas control jet emissions from a highly charged, isolated daughter payload in the nighttime ionosphere were made. These observations were derived from the second cooperative high altitude rocket gun experiment (CHARGE-2) which was an electrically tethered mother-daughter payload system. The rocket flew from White Sands Missile Range (WSMR) in December, 1985. The rocket achieved an altitude of 261 km and carried a 1 keV electron beam emitting up to 48 mA of current (Myers, et al., 1989a). The mother payload, carried the electron beam source, while the daughter acted as a remote current collection and observation platform and reached a distance of 426 m away from the main payload. Gas emissions at the daughter were due to periodic thruster jet firings to maintain separation velocity between the two payloads

Will the Global Financial Crisis Change the Development Paradigm?

The depth and breadth of the current crisis has led many to suggest it will fundamentally change development thinking and practice. We review four ways in which the crisis may affect the ‘development paradigm’: changes to global economic governance; new thinking on development policy; opportunities to institutionalise social protection; the implementation of a Green New Deal. The global financial crisis may change the development paradigm through its impact on the attitudes of developing country policymakers towards the prevailing policy prescriptions, rather than through major structural changes in global economic governance. Although the geopolitical and attitudinal changes will be significant, it is likely that the development paradigm after the crisis will be similar to that before. A greater tendency for developing countries to explore new development models and to rely on their own analysis and knowledge to fashion solutions to their problems, could be a positive outcome of this crisis

The PhoBR two-component system regulates antibiotic biosynthesis in Serratia in response to phosphate

<p>Abstract</p> <p>Background</p> <p>Secondary metabolism in <it>Serratia </it>sp. ATCC 39006 (<it>Serratia </it>39006) is controlled via a complex network of regulators, including a LuxIR-type (SmaIR) quorum sensing (QS) system. Here we investigate the molecular mechanism by which phosphate limitation controls biosynthesis of two antibiotic secondary metabolites, prodigiosin and carbapenem, in <it>Serratia </it>39006.</p> <p>Results</p> <p>We demonstrate that a mutation in the high affinity phosphate transporter <it>pstSCAB-phoU</it>, believed to mimic low phosphate conditions, causes upregulation of secondary metabolism and QS in <it>Serratia </it>39006, via the PhoBR two-component system. Phosphate limitation also activated secondary metabolism and QS in <it>Serratia </it>39006. In addition, a <it>pstS </it>mutation resulted in upregulation of <it>rap</it>. Rap, a putative SlyA/MarR-family transcriptional regulator, shares similarity with the global regulator RovA (regulator of virulence) from <it>Yersina </it>spp. and is an activator of secondary metabolism in <it>Serratia </it>39006. We demonstrate that expression of <it>rap</it>, <it>pigA-O </it>(encoding the prodigiosin biosynthetic operon) and <it>smaI </it>are controlled via PhoBR in <it>Serratia </it>39006.</p> <p>Conclusion</p> <p>Phosphate limitation regulates secondary metabolism in <it>Serratia </it>39006 via multiple inter-linked pathways, incorporating transcriptional control mediated by three important global regulators, PhoB, SmaR and Rap.</p

Prescribing hand strengthening exercise for patients with rheumatoid arthritis; clinical cues influencing occupational therapists' and physiotherapists' judgements

Objective To explore the clinical judgements of therapists in prescribing the intensity of hand strengthening exercise in rheumatoid arthritis (RA). Methods Phase I: Eleven therapists knowledgeable in treating patients with RA subjectively identified seven clinical cues. These were incorporated into 54 hypothetical patient case scenarios. Phase II: Therapists with ≥2 years post-registration experience and current or recent experience in treating patients with RA were asked to assess 69 case scenarios in total (54 + 15 repeats) and judge what intensity of hand strengthening exercise they would prescribe using the OMNI-Resistance Exercise Scale of perceived exertion. Using responses to the repeated cases, the Cochran-Weiss-Shanteau index of expertise was used to identify therapists who prescribed more consistently. Multiple regression was used to determine which clinical cues were most strongly associated with the intensity of exercise prescribed. A sub-group analysis explored differences between consistent and inconsistent prescribers. Results Fifty-three therapists took part. Thirty completed all 69 case scenarios. Across all therapists, the three most important clinical cues associated with lower intensity of exercise prescribed were (1) Patient's reported pain intensity whilst practising the exercise (β = −1.150, p < 0.001), (2) Disease activity (β = −0.425, p < 0.001) and (3) average hand pain over the last week (β = −0.353 p < 0.001). Twelve therapists were categorised as consistent prescribers. This group relied on fewer clinical cues (three vs. seven) when judging what intensity of exercise to prescribe. Conclusion This study provides insights into how therapists prescribe hand exercises. Intensity of hand strengthening exercise was influenced by three key clinical cues, including pain intensity and disease activity

Substrate flexibility of the flavin-dependent dihydropyrrole oxidases PigB and HapB involved in antibiotic prodigiosin biosynthesis

In the biosynthesis of the tripyrrolic pigment prodigiosin, PigB is a predicted flavin-dependent oxidase responsible for formation of 2-methyl-3-amylpyrrole (MAP) from a dihydropyrrole. To prove which dihydropyrrole is the true intermediate, both possibilities, 5a (resulting from transamination of the aldehyde of 3-acetyloctanal) and 6 (resulting from transamination of the ketone), were synthesised. Only 5a restored pigment production in a strain of Serratia sp. ATCC 39006 blocked earlier in MAP biosynthesis. PigB is membrane-associated and inactive when its transmembrane domain was deleted, but HapB, its homologue in Hahella chejuensis, lacks the transmembrane domain and is active in solution. Two colorimetric assays for PigB and HapB were developed, and the HapB-catalysed reaction was kinetically characterised. Ten analogues of 5a were synthesised, varying in the C2 and C3 side-chains, and tested as substrates of HapB in vitro and for restoration of pigment production in Serratia ΔpigD in vivo. All lengths of side-chain tested at C3 were accepted but only short side-chains at C2 were accepted. The knowledge that 5a is an intermediate in prodigiosin biosynthesis and the ease of synthesis of analogues of 5a makes a range of prodigiosin analogues readily available by mutasynthesis.We acknowledge the Frances and Augustus Newman foundation, the Cambridge Commonwealth Trust, Emmanuel College, Cambridge, and the B.B.S.R.C. (award codesBB/N008081/1 and BB/K001833/1) for funding this research