Transableism, Disability and Paternalism in Public Health Ethics: Taxonomies, identity Disorders and Persistent Unexplained Physical Symptoms

Transableism is a term which refers to moving between states of being able and disabled by choice rather than by happenstance. Insofar as this may imply a choice to become dependent, claims upon the healthcare system are likely to result. In this piece we aim to explore some ethical and legal implications of such claims. In order to do so, we draw upon current debates over the place of autonomy, beneficence and paternalism in public health ethics, the taxonomy of disability and the status of persistent unexplained physical symptoms (henceforth, PUPS). We suggest that transableism represents a useful construct which may contribute towards resolution of ongoing difficulties within public health ethics and theories of disability. In addition, we believe that it holds promise for the understanding of a significant proportion of patients presenting PUPS. We focus upon identity disorders, particularly in relation to what is currently termed Body Integrity Identity Disorder (henceforth, BIID), where sufferers report a subjective conviction that one or more of their limbs are superfluous, requesting medical assistance to remove the offending limb[s], repair the results of attempts at their self-removal or to provide prostheses and other assistance after removal. We have considered BIID elsewhere in relation to consent, capacity and the doctor/patient relationship (Mackenzie and Cox, 2005). One of us has also explored how the definition of addiction as a chronic relapsing disease within public health governance enables cycles of transitions between the rigours of rational liberal citizenship and the shriven status of the sick (Mackenzie, 2006). Since a central aim in this piece is evaluate the place of transableism within public health ethics, we will begin by considering the latter as a discursive context for the arguments which follow

Modelling the environmental impacts of pig farming systems and the potential of nutritional solutions to mitigate them

PhD ThesisThe overall aim of this thesis was to model the environmental impacts of pig farming systems in Canada using Life Cycle Assessment (LCA), and to quantify the potential of nutritional solutions to reduce these. To achieve this, methodological challenges regarding co-product allocation, modelling uncertainty in agricultural LCA and how to formulate pig diets for environmental impact objectives needed to be resolved. The options for co-product allocation in LCA studies of agricultural systems were evaluated and it was concluded that economic allocation was the methodology that could be adopted most consistently throughout the feed supply chain in livestock LCA models. A LCA model which quantified the environmental impact of Canadian pig farming systems, for multiple impact categories, was developed for the first time. A new approach to uncertainty analysis for the LCA of livestock systems using parallel Monte-Carlo simulations was also developed. The potential of including specific by-products from the human food and bio-ethanol supply chains in pig diets to reduce environmental impacts was investigated. Wheat shorts and bakery meal were found to reduce the environmental impact of the system in the scenarios tested. Further integration of diet formulation techniques with the LCA model allowed pig diets to be optimised explicitly to minimise environmental impact, while accounting for the effect of diets on nutrient excretion and the effect of energy density on feed intake in order to determine the optimum energy density of pig diets for different objectives. The potential effect of three environmental taxes, a carbon tax, and taxes on spreading N and P in manure respectively, on formulating pig diets and their implications for environmental impact were also modelled. The carbon tax was the only tax which consistently caused significant reductions in any of the impact categories tested in the LCA. Overall, novel methodologies for modelling uncertainty in livestock LCA and formulating pig diets to minimise environmental impacts were developed. Using the latter, pig diets were formulated to reduce the environmental impacts of the production system for multiple impact categories simultaneously for the first time. These methods allowed the potential of dietary alterations to reduce the environmental impact of pig farming systems to be investigated systematically, and have wider applications for LCA modelling in livestock systems.funded in part by Trouw Nutritio

Recruiting for the Future: A Realistic Road to a Points-Tested Visa Program in the United States

For over 40 years, lawmakers and academics have been debating whether the United States should adopt a merit-or skills-based approach to labor immigration and a points-based program for selecting foreign workers. Despite having bipartisan support, efforts to adopt such a program thus far have been unsuccessful. This idea is now back at the center of public debate, having been given new life by President Trump. He has called for “merit-based” immigration reforms that would make the United States more effective at attracting the world’s “best and brightest” and make it more competitive in the global marketplace for highly skilled foreign workers. The President’s public embrace of this goal has not been accompanied, however, by any detailed policy proposal or administration-backed bill introduced in Congress. This report capitalizes on this atmosphere of renewed interest by harnessing the current administration’s enthusiasm, providing evidence-based policy guidance, and mapping out a path forward that avoids the policy gridlock and political pitfalls that have beset past efforts to implement a points-based immigration program in the United States. This path forward is presented in the form of a legislative program. The authors recommend that the U.S. create a small pilot program that would allocate 50,000 green cards each year to candidates selected through a novel points-based selection program. Alongside this small pilot, the authors recommend creating a number of administrative supports meant to ensure that this program is effective, flexible, and transparent. Included are guidelines and financial support for U.S. Citizenship and Immigration Services (USCIS) or another executive agency to gather linked long-term data on the employment outcomes of admitted foreign workers; provisions requiring periodic review of the program by relevant congressional committees; and the establishment of a standing advisory board consisting of immigration experts and stakeholders. In designing these proposals, the authors sought to incorporate lessons from both the successes enjoyed by those countries that have already implemented points programs and the failures endured by those involved in past efforts toward comprehensive immigration reform here in the United States. Lessons from the former led the authors to embrace a two-stage selection process and criteria designed to balance both the short-and long-term needs of the U.S. economy. Lessons from the latter led the authors to adopt a more targeted and incremental approach to immigration reform, resulting in a policy proposal that is modest in its size, scope, strategy, and structure. The points-tested visa program laid out in this proposal would be temporary by design, initially authorized for just ten years, and would increase the number of green cards issued each year by only 4%. This program is designed to supplement, not displace, existing employment-related and family-based immigration categories. As such, this proposal does not call for any changes to existing immigration categories. Finally, the proposal embraces a piecemeal and incremental approach to legislative strategy, recommending that the pilot program be introduced in Congress as a standalone bill rather than as part of a comprehensive immigration reform package. For all these reasons, the authors believe that the policy recommendations presented in this report are legislatively achievable and would be programmatically successful

Genetic management strategies for controlling infectious diseases in livestock populations

This paper considers the use of disease resistance genes to control the transmission of infection through an animal population. Transmission is summarised by R0, the basic reproductive ratio of a pathogen. If R0 > 1.0 a major epidemic can occur, thus a disease control strategy should aim to reduce R0 below 1.0, e.g. by mixing resistant with susceptible wild-type animals. Suppose there is a resistance allele, such that transmission of infection through a population homozygous for this allele will be R02 < R01, where R01 describes transmission in the wildtype population. For an otherwise homogeneous population comprising animals of these two groups, R0 is the weighted average of the two sub-populations: R0 = R01ρ + R02 (1 - ρ), where ρ is the proportion of wildtype animals. If R01 > 1 and R02 < 1, the proportions of the two genotypes should be such that R0 ≤ 1, i.e. ρ ≤ (R0 - R02)/(R01 - R02). If R02 = 0, the proportion of resistant animals must be at least 1 - 1/R01. For an n genotype model the requirement is still to have R0 ≤ 1.0. Probabilities of epidemics in genetically mixed populations conditional upon the presence of a single infected animal were derived. The probability of no epidemic is always 1/(R0 + 1). When R0 ≤ 1 the probability of a minor epidemic, which dies out without intervention, is R0/(R0 + 1). When R0 > 1 the probability of a minor and major epidemics are 1/(R0 + 1) and (R0 - 1)/(R0 + 1). Wherever possible a combination of genotypes should be used to minimise the invasion possibilities of pathogens that have mutated to overcome the effects of specific resistance alleles

Recruiting for the Future: A Realistic Road to a Points-Tested Visa Program in the United States

For over 40 years, lawmakers and academics have been debating whether the United States should adopt a merit-or skills-based approach to labor immigration and a points-based program for selecting foreign workers. Despite having bipartisan support, efforts to adopt such a program thus far have been unsuccessful. This idea is now back at the center of public debate, having been given new life by President Trump. He has called for “merit-based” immigration reforms that would make the United States more effective at attracting the world’s “best and brightest” and make it more competitive in the global marketplace for highly skilled foreign workers. The President’s public embrace of this goal has not been accompanied, however, by any detailed policy proposal or administration-backed bill introduced in Congress. This report capitalizes on this atmosphere of renewed interest by harnessing the current administration’s enthusiasm, providing evidence-based policy guidance, and mapping out a path forward that avoids the policy gridlock and political pitfalls that have beset past efforts to implement a points-based immigration program in the United States. This path forward is presented in the form of a legislative program. The authors recommend that the U.S. create a small pilot program that would allocate 50,000 green cards each year to candidates selected through a novel points-based selection program. Alongside this small pilot, the authors recommend creating a number of administrative supports meant to ensure that this program is effective, flexible, and transparent. Included are guidelines and financial support for U.S. Citizenship and Immigration Services (USCIS) or another executive agency to gather linked long-term data on the employment outcomes of admitted foreign workers; provisions requiring periodic review of the program by relevant congressional committees; and the establishment of a standing advisory board consisting of immigration experts and stakeholders. In designing these proposals, the authors sought to incorporate lessons from both the successes enjoyed by those countries that have already implemented points programs and the failures endured by those involved in past efforts toward comprehensive immigration reform here in the United States. Lessons from the former led the authors to embrace a two-stage selection process and criteria designed to balance both the short-and long-term needs of the U.S. economy. Lessons from the latter led the authors to adopt a more targeted and incremental approach to immigration reform, resulting in a policy proposal that is modest in its size, scope, strategy, and structure. The points-tested visa program laid out in this proposal would be temporary by design, initially authorized for just ten years, and would increase the number of green cards issued each year by only 4%. This program is designed to supplement, not displace, existing employment-related and family-based immigration categories. As such, this proposal does not call for any changes to existing immigration categories. Finally, the proposal embraces a piecemeal and incremental approach to legislative strategy, recommending that the pilot program be introduced in Congress as a standalone bill rather than as part of a comprehensive immigration reform package. For all these reasons, the authors believe that the policy recommendations presented in this report are legislatively achievable and would be programmatically successful

Sporopollenin, the least known yet toughest natural biopolymer

© 2015 Mackenzie, Boa, Diego-Taboada, Atkin and Sathyapalan. Sporopollenin is highly cross-linked polymer composed of carbon, hydrogen, and oxygen that is extraordinarily stable and has been found chemically intact in sedimentary rocks some 500 million years old. It makes up the outer shell (exine) of plant spores and pollen and when extracted it is in the form of an empty exine or microcapsule. The exines resemble the spores and pollen from which they are extracted, in size and morphology. Also, from any one plant such characteristics are incredible uniform. The exines can be used as microcapsules or simply as micron-sized particles due to the variety of functional groups on their surfaces. The loading of a material into the chamber of the exine microcapsule is via multi-directional nano-diameter sized channels. The exines can be filled with a variety of polar and non-polar materials. Enzymes can be encapsulated within the shells and still remain active. In vivo studies in humans have shown that an encapsulated active substance can have a substantially increased bioavailability than if it is taken alone. The sporopollenin exine surface possesses phenolic, alkane, alkene, ketone, lactone, and carboxylic acid groups. Therefore, it can be derivatized in a number of ways, which has given rise to applications in areas, such as solid supported for peptide synthesis, catalysis, and ion-exchange chromatography. Also, the presence of the phenolic groups on sporopollenin endows it with antioxidant activity

Piezoelectric-based apparatus for strain tuning

We report the design and construction of piezoelectric-based apparatus for applying continuously tuneable compressive and tensile strains to test samples. It can be used across a wide temperature range, including cryogenic temperatures. The achievable strain is large, so far up to 0.23% at cryogenic temperatures. The apparatus is compact and compatible with a wide variety of experimental probes. In addition, we present a method for mounting high-aspect-ratio samples in order to achieve high strain homogeneity.Comment: 8 pages, 8 figure

Health human resources planning and the production of health: Development of an extended analytical framework for needs-based health human resources planning.

Traditional approaches to health human resources planning emphasize the role of demographic change on the needs for health human resources. Conceptual frameworks have been presented that recognize the limited role of demographic change and the broader determinants of health human resource requirements. Nevertheless, practical applications of health human resources planning continue to base plans on the size and demographic mix of the population applied to simple population-provider or population-utilization ratios. In this paper an analytical framework is developed based on the production of health care services and the multiple determinants of health human resource requirements. In this framework attention is focused on estimating the ‘flow’ of services required to meet the needs of the population that is then translated into the required ‘stock’ of providers to deliver this ‘flow’ of services. The requirements for human resources in the future is shown to depend on four elements: the size and demographic mix of the population (demography), the levels of risks to health and morbidity in the population (epidemiology), the services deemed appropriate to address the levels of risks to health and morbidity (standards of care), and the rate of service delivery by providers (productivity). Application of the framework is illustrated using hypothetical scenarios.health human resources planning, demography, epidemiology, standards of care, productivity

The use of biochar and pyrolysed materials to improve water quality through microcystin sorption separation

Unidad de excelencia María de Maeztu CEX2019-000940-MHarmful algal blooms have increased globally with warming of aquatic environments and increased eutrophication. Proliferation of cyanobacteria (blue-green algae) and the subsequent flux of toxic extracellular microcystins present threats to public and ecosystem health and challenges for remediation and management. Although methods exist, there is currently a need for more environmentally friendly and economically and technologically feasible sorbents. Biochar has been proposed in this regard because of its high porosity, chemical stability, and notable sorption efficiency for removing of cyanotoxins. In light of worsening cyanobacterial blooms and recent research advances, this review provides a timely assessment of microcystin removal strategies focusing on the most pertinent chemical and physical sorbent properties responsible for effective removal of various pollutants from wastewater, liquid wastes, and aqueous solutions. The pyrolysis process is then evaluated for the first time as a method for sorbent production for microcystin removal, considering the suitability and sorption efficiencies of pyrolysed materials and biochar. Inefficiencies and high costs of conventional methods can be avoided through the use of pyrolysis. The significant potential of biochar for microcystin removal is determined by feedstock type, pyrolysis conditions, and the physiochemical properties produced. This review informs future research and development of pyrolysed materials for the treatment of microcystin contaminated aquatic environments

Peptide immunotherapy for childhood allergy - addressing translational challenges

Allergic sensitisation usually begins early in life. The number of allergens a patient is sensitised to can increase over time and the development of additional allergic conditions is increasingly recognised. Targeting allergic disease in childhood is thus likely to be the most efficacious means of reducing the overall burden of allergic disease. Specific immunotherapy involves administering protein allergen to tolerise allergen reactive CD4+ T cells, thought key in driving allergic responses. Yet specific immunotherapy risks allergic reactions including anaphylaxis as a consequence of preformed allergen-specific IgE antibodies binding to the protein, subsequent cross-linking and mast cell degranulation. CD4+ T cells direct their responses to short "immunodominant" peptides within the allergen. Such peptides can be given therapeutically to induce T cell tolerance without facilitating IgE cross-linking. Peptide immunotherapy (PIT) offers attractive treatment potential for allergic disease. However, PIT has not yet been shown to be effective in children. This review discusses the immunological mechanisms implicated in PIT and briefly covers outcomes from adult PIT trials. This provides a context for discussion of the challenges for the application of PIT, both generally and more specifically in relation to children