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Antislavery writers experimented with the idea that slaves and masters might address each other through direct and formalized literary dialogues. To do so, these activists used pamphlets, a genre that had already enabled differing religious, political, and intellectual points of view to engage each other in eighteenth-century North America. In the deliberately double meaning of “salvation,” both political and religious, for both this world and the next, David Walker’s Appeal brings to bold fruition an idea only incipient in the dialogic experiments of Benjamin Banneker and Daniel Coker, that recognizing and following Black, not white, moral and spiritual leadership was the only hope for a slavery-corrupted America.
Glacier surges are periodic episodes of mass redistribution characterized by dramatic increases in ice flow velocity and, sometimes, terminus advance. We use optical satellite imagery to document five previously unexamined surge events of Sít’ Kusá (Turner Glacier) in the St. Elias Mountains of Alaska from 1983 to 2013. Surge events had an average recurrence interval of ~5 years, making it the shortest known regular recurrence interval in the world. Surge events appear to initiate in the winter, with speeds reaching up to ~25 m d−1. The surges propagate down-glacier over ~2 years, resulting in maximum thinning of ~100 m in the reservoir zone and comparable thickening at the terminus. Collectively, the rapid recurrence interval, winter initiation and down-glacier propagation suggest Sít’ Kusá's surges are driven by periodic changes in subglacial hydrology and glacier sliding. Elevation change observations from the northern tributary show a kinematic disconnect above and below an icefall located 23 km from the terminus. We suggest the kinematic disconnect inhibits drawdown from the accumulation zone above the icefall, which leads to a steady flux of ice into the reservoir zone, and contributes to the glacier's exceptionally short recurrence interval.
In this study we report a new record of a cryptogenic polychaete from southern Africa. The species was found inhabiting sand tubes in intertidal sand flats in the Knysna Estuary on the southern coast of South Africa. Morphological comparisons using light and scanning electron microscopy showed extensive taxonomic similarities with Dipolydora socialis described from other localities and from museum vouchers. In addition, 18S rRNA and COI barcodes were generated for the species. Genetic analysis of the assembled polydorid dataset corroborated the morphological data in delineating the species as a taxonomic unit with >99% genetic similarity to available sequences of D. socialis in the GenBank database. Dipolydora socialis has been reported as having a widespread distribution, and since it can reside within tubes associated with fouling communities or as a shell borer, several vectors may have been responsible for its global spread and introduction to southern Africa. Finally, considering the many cryptic complexes that are currently being uncovered within polychaetes, including spionids, future taxonomic studies should incorporate additional genetic data from other regions of the world to determine whether D. socialis may also be part of a larger species complex.
Coronavirus disease (COVID-19) has been identified as an acute respiratory illness leading to severe acute respiratory distress syndrome. As the disease spread, demands on health care systems increased, specifically the need to expand hospital capacity. Alternative care hospitals (ACHs) have been used to mitigate these issues; however, establishing an ACH has many challenges. The goal of this session was to perform systems testing, using a simulation-based evaluation to identify areas in need of improvement.
Four simulation cases were designed to depict common and high acuity situations encountered in the ACH, using a high technology simulator and standardized patient. A multidisciplinary observer group was given debriefing forms listing the objectives, critical actions, and specific areas to focus their attention. These forms were compiled for data collection.
Logistical, operational, and patient safety issues were identified during the simulation and compiled into a simulation event report. Proposed solutions and protocol changes were made in response to the identified issues.
Simulation was successfully used for systems testing, supporting efforts to maximize patient care and provider safety in a rapidly developed ACH. The simulation event report identified operational deficiencies and safety concerns directly resulting in equipment modifications and protocol changes.
HIV-associated neurocognitive disorders (HANDs) are prevalent in older people living with HIV (PLWH) worldwide. HAND prevalence and incidence studies of the newly emergent population of combination antiretroviral therapy (cART)-treated older PLWH in sub-Saharan Africa are currently lacking. We aimed to estimate HAND prevalence and incidence using robust measures in stable, cART-treated older adults under long-term follow-up in Tanzania and report cognitive comorbidities.
A systematic sample of consenting HIV-positive adults aged ≥50 years attending routine clinical care at an HIV Care and Treatment Centre during March–May 2016 and followed up March–May 2017.
HAND by consensus panel Frascati criteria based on detailed locally normed low-literacy neuropsychological battery, structured neuropsychiatric clinical assessment, and collateral history. Demographic and etiological factors by self-report and clinical records.
In this cohort (n = 253, 72.3% female, median age 57), HAND prevalence was 47.0% (95% CI 40.9–53.2, n = 119) despite well-managed HIV disease (Mn CD4 516 (98-1719), 95.5% on cART). Of these, 64 (25.3%) were asymptomatic neurocognitive impairment, 46 (18.2%) mild neurocognitive disorder, and 9 (3.6%) HIV-associated dementia. One-year incidence was high (37.2%, 95% CI 25.9 to 51.8), but some reversibility (17.6%, 95% CI 10.0–28.6 n = 16) was observed.
HAND appear highly prevalent in older PLWH in this setting, where demographic profile differs markedly to high-income cohorts, and comorbidities are frequent. Incidence and reversibility also appear high. Future studies should focus on etiologies and potentially reversible factors in this setting.
On October 10, 2020, the Memorial Sloan Kettering Cancer Center Supportive Care Service hosted their first-ever United States (US) World Hospice and Palliative Care Day (WHPCD) Celebration. The purpose of this article is to describe the US inaugural event in alignment with the broader goals of WHPCD and provide lessons learned in anticipation of the second annual conference to be held on October 5–6, 2021.
Description of the inaugural event in the context of COVID-19 and WHPCD, co-planning conference team reflection, and attendee survey responses.
The Worldwide Hospice Palliative Care Alliance initially launched WHPCD in 2005 as an annual unified day of action to celebrate and support hospice and palliative care around the world. The US-based innovative virtual conference featured 23 interprofessional hospice and palliative care specialists and patient and family caregiver speakers across nine diverse sessions addressing priorities at the intersection of COVID-19, social injustice, and the global burden of serious health-related suffering. Two primary aims guided the event: community building and wisdom sharing. Nearly 270 registrants from at least 16 countries and one dozen states across the US joined the free program focused on both personal and professional development.
Significance of results
Unlike many other academic conferences and professional gatherings that were relegated to online forums due to pandemic-related restrictions, the US WHPCD Celebration was intentionally established to create a virtual coming together for collective reflection on the barriers and facilitators of palliative care delivery amid vast societal change. The goal to ensure a globally relevant and culturally inclusive agenda will continue to draw increased participation at an international level during future annual events. Finally, the transparent and respectful sharing of palliative care team experiences in the year preceding the conference established a safe environment for both individual expression and scholarly discussion.
Unexplained infertility refers to the inability to conceive within 12 months of unprotected intercourse, not attributable to any known causes of infertility such as ovulatory dysfunction, reduced sperm quality, tubal pathology or other causes. Treatment for unexplained infertility can be done predominantly through intrauterine insemination with or without hyperstimulation or in vitro fertilisation. Given that these treatments are utilised to improve likelihood of conception in relation to the couple’s chances of spontaneous pregnancy, rather than targeting any specific pathology, a comparison should be drawn between these treatments and their natural conception prognosis. Utilisation of prognostic models can allow differentiation between those likely to benefit from immediate treatment from such individuals who have reasonable natural conception prognosis and thereby can delay treatment for 6 months in hopes of spontaneous pregnancy. This comparison is valuable given the aforementioned treatments have implications for both the woman and her future child, and the cost of such procedures also compromises care accessibility.
During the Randomized Assessment of Rapid Endovascular Treatment (EVT) of Ischemic Stroke (ESCAPE) trial, patient-level micro-costing data were collected. We report a cost-effectiveness analysis of EVT, using ESCAPE trial data and Markov simulation, from a universal, single-payer system using a societal perspective over a patient’s lifetime.
Primary data collection alongside the ESCAPE trial provided a 3-month trial-specific, non-model, based cost per quality-adjusted life year (QALY). A Markov model utilizing ongoing lifetime costs and life expectancy from the literature was built to simulate the cost per QALY adopting a lifetime horizon. Health states were defined using the modified Rankin Scale (mRS) scores. Uncertainty was explored using scenario analysis and probabilistic sensitivity analysis.
The 3-month trial-based analysis resulted in a cost per QALY of $201,243 of EVT compared to the best standard of care. In the model-based analysis, using a societal perspective and a lifetime horizon, EVT dominated the standard of care; EVT was both more effective and less costly than the standard of care (−$91). When the time horizon was shortened to 1 year, EVT remains cost savings compared to standard of care (∼$15,376 per QALY gained with EVT). However, if the estimate of clinical effectiveness is 4% less than that demonstrated in ESCAPE, EVT is no longer cost savings compared to standard of care.
Results support the adoption of EVT as a treatment option for acute ischemic stroke, as the increase in costs associated with caring for EVT patients was recouped within the first year of stroke, and continued to provide cost savings over a patient’s lifetime.
In recent years, a variety of efforts have been made in political science to enable, encourage, or require scholars to be more open and explicit about the bases of their empirical claims and, in turn, make those claims more readily evaluable by others. While qualitative scholars have long taken an interest in making their research open, reflexive, and systematic, the recent push for overarching transparency norms and requirements has provoked serious concern within qualitative research communities and raised fundamental questions about the meaning, value, costs, and intellectual relevance of transparency for qualitative inquiry. In this Perspectives Reflection, we crystallize the central findings of a three-year deliberative process—the Qualitative Transparency Deliberations (QTD)—involving hundreds of political scientists in a broad discussion of these issues. Following an overview of the process and the key insights that emerged, we present summaries of the QTD Working Groups’ final reports. Drawing on a series of public, online conversations that unfolded at www.qualtd.net, the reports unpack transparency’s promise, practicalities, risks, and limitations in relation to different qualitative methodologies, forms of evidence, and research contexts. Taken as a whole, these reports—the full versions of which can be found in the Supplementary Materials—offer practical guidance to scholars designing and implementing qualitative research, and to editors, reviewers, and funders seeking to develop criteria of evaluation that are appropriate—as understood by relevant research communities—to the forms of inquiry being assessed. We dedicate this Reflection to the memory of our coauthor and QTD working group leader Kendra Koivu.1
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Neo-Kantian philosophers see accountability as a key property of autonomy, or of social freedom more broadly. Autonomy, among those theorists, is, I contend, implicitly co-conceived with responsibility, producing a quasi-juridical conception of autonomy and a limiting notion of freedom. This article criticizes the connecting of freedom with accountability on a number of grounds. First, various conceptions of autonomy not only operate without a notion of accountability, but, in fact, would be impaired by an accountability requirement. Second, the neo-Kantians are unable to defend the freedom enhancing properties that are supposedly brought about by the giving of reasons for one’s beliefs and actions. Third, the project of accountability is indifferent to personal outlooks, not because it takes a holistic perspective, but because of its interest in social convergence.
Must we ascribe hope for better times to those who (take themselves to) act morally? Kant and later theorists in the Frankfurt School tradition thought we must. In this article, I disclose that it is possible – and ethical – to refrain from ascribing hope in all such cases. I draw on two key examples of acting irrespective of hope: one from a recent political context and one from the life of Jean Améry. I also suggest that, once we see that it is possible to make sense of (what I call) ‘merely expressive acts’, we can also see that the early Frankfurt School was not guilty of a performative contradiction in seeking to enlighten Enlightenment about its (self-)destructive tendencies, while rejecting the (providential) idea of progress.
Jürgen Habermas’ discourse theory of morality should be understood, in metaethical terms, as a constructivist theory. All constructivist theories face a Euthyphro-like dilemma arising from how they classify the constraints on their metaethical construction procedures: are they moral or non-moral? Many varieties of Kantian constructivism, such as Christine Korsgaard’s, classify the constraints as moral, albeit constitutive of human reason and agency in general. However, this constitutivist strategy is vulnerable to David Enoch’s ‘shmagency’ objection. The discourse theory of morality, by classifying the constraints on the metaethical construction procedure (principles (D) and (U)) as non-moral, can avoid this problem.
Theodor W. Adorno often made reference to Immanuel Kant’s famous essay on enlightenment. Although he denied that immaturity is self-incurred, the first section of this article will show that he adopted many of Kant’s ideas about maturity in his philosophically informed critique of monopoly conditions under late capitalism. The second section will explore Adorno’s claim that the educational system could foster maturity by encouraging critical reflection on the social conditions that have made us what we are. Finally, this article will demonstrate that Adorno links enlightenment to Kant’s idea of a realm of ends.
Many recent commentators have noticed how Adorno, in his late works, borrows Kant’s definition of enlightenment to define key areas of his own critical practice. These discussions, however, have failed to notice how these late borrowings present an image of Kant’s enlightenment which is diametrically opposed to his previous discussions. By tracing the development of Adorno’s engagement with Kant’s essay, I discover Adorno deliberately sublating Kant’s definition as to enable its incorporation into his own works. Further, the article will examine some problems which appear to arise for Adorno when borrowing Kant’s definition of enlightenment in his late works, which coalesce around the topics of negativism and the prospects for societal change.
In this article I press four different objections on Forst’s theory of the ‘Right to Justification’. These are (i) that the principle of justification is not well-formulated; (ii) that ‘reasonableness and reciprocity’, as these notions are used by Rawls, are not apt to support a Kantian conception of morality; (iii) that the principle of justification, as Forst understands it, gives an inadequate account of what makes actions wrong; and (iv) that, in spite of his protestations to the contrary, Forst’s account veers towards a version of moral realism that is prima facie incompatible with Kantian constructivism. I then evaluate Forst’s theory in the light of a distinction made by Sharon Street between restricted and unrestricted constructivism. I show that Forst has reason to deny that it is either the one or the other, but he is not able to show that it is both or neither. I conclude that the arguments Forst advances in support of his constructivist theory of the right to justification entail that it is a metaphysical and comprehensive conception in the relevant, Rawlsian sense. Forst’s theory of the right to justification therefore fails to fulfil one of the main stated aims.
In a lecture that Habermas gave on his 90th birthday he ironically, but with serious intent, called a good Kant a sufficiently Marxist educated Kant. This dialectical Kant is the only one of the many Kants who maintains the idea of an unconditioned moral autonomy but completely within evolution, history and in the middle of societal class and other struggles. The article tries to show what Kant could have learned from his later critics to enable him to become a member of the Frankfurt School’s neo-Marxist theory of society.
Habermas dialogically recasts the Kantian conception of moral autonomy. In a legal-political context, his dialogical approach has the potential to redress certain troubling features of liberal and communitarian approaches to democratic politics. Liberal approaches attach greater normative weight to negatively construed individual freedoms, which they seek to protect against the interventions of political authority. Communitarian approaches prioritize the positively construed freedoms of communal political participation, viewing legal-political institutions as a means for collective ethical self-realization. Habermas’ discourse theory of law and democracy seeks to overcome this competition between the negative and positive liberties. Doing so entails reconciling private and public autonomy at a fundamental conceptual level. This is his co-originality thesis, which seeks to show that private and public autonomy are internally connected and evenly balanced. I support his aim but argue that he fails to achieve it due to an unsatisfactory account of private autonomy. I suggest an alternative dialogical conception of autonomy as ethically self-determining agency that would enable him to establish his thesis.