Alasdair MacIntyre marks liberalism as a key opponent standing in opposition to an Aristotelian virtue ethics framework, and of the ability of communities to base a way of life around virtues centered upon man’s telos and what makes a good human life. This paper will argue that this does not need to be the case by citing how classical liberal political aims of decentralization of power and federalism can promote the efforts of communities attempting to build a culture with a focus on inculcating virtue through the lens of an Aristotelian sense of telos. MacIntyre himself acknowledges the vast differences in definitions of the virtues across cultures throughout history, and how there is unlikely to be any moral consensus. This paper will look at examples from the United States of America’s early history, as well as the modern example of the European Union, to illustrate samples of societies inculcating and guarding a traditional worldview within a decentralized political environment. The liberal political aim of decentralization of power provides more autonomy to local communities, including allowing those communities to build their own culture with a focus on forming a society interested in answering the question of what a good human life consists of. This paper will argue that it is precisely the liberal individualism that MacIntyre decries as a foe to Aristotelian teleology that provides an avenue for those interested in restoring Aristotelian virtue ethics to thrive.
Background & Aims There is controversy regarding the benefits of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection for patients with a history of hepatocellular carcinoma (HCC). We performed a multicenter cohort study to compare overall survival between patients with HCV infection treated with DAAs and patients who did not receive DAA treatment for their HCV infection after complete response to prior HCC therapy. Methods We conducted a retrospective cohort study of patients with HCV-related HCC who achieved a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy, from January 2013 through December 2017 at 31 health care systems throughout the United States and Canada. We used Cox proportional hazards regression to determine the association between receipt of DAA therapy, modeled as a time-varying covariate, and all-cause mortality, accounting for informative censoring and confounding using inverse probability weighting. Results Of 797 patients with HCV-related HCC, 383 (48.1%) received DAA therapy and 414 (51.9%) did not receive treatment for their HCV infection after complete response to prior HCC therapy. Among DAA-treated patients, 43 deaths occurred during 941 person-years of follow-up, compared with 103 deaths during 526.6 person-years of follow-up among patients who did not receive DAA therapy (crude rate ratio, 0.23; 95% confidence interval [CI], 0.16–0.33). In inverse probability-weighted analyses, DAA therapy was associated with a significant reduction in risk of death (hazard ratio, 0.54; 95% CI, 0.33–0.90). This association differed by sustained virologic response to DAA therapy; risk of death was reduced in patients with sustained virologic response to DAA therapy (hazard ratio, 0.29; 95% CI, 0.18–0.47), but not in patients without a sustained virologic response (hazard ratio, 1.13; 95% CI, 0.55–2.33). Conclusions In an analysis of nearly 800 patients with complete response to HCC treatment, DAA therapy was associated with a significant reduction in risk of death.
Chinese medicine is growing rapidly in the United States both as a field of research and in the daily treatment of illnesses. The popularity of Chinese medicine, particularly acupuncture, as a healing mechanism demonstrates American people’s positive experience with Chinese medicine and their embracing it as an alternative to the mainstream Western biomedicine. Chinese medicine is an important part of the Alternative and Complementary Medicine or Integrated Medicine in the United States health system. It is increasingly used and covered by health insurance. Although Chinese medicine has been in the United States since colonial times, it was discriminated against by local authorities. However, things began to change in the 1970s when individual states gradually passed laws to legalize the practice of acupuncture as a healing mechanism. American public interest in Chinese medicine, particularly acupuncture, was aroused by the media’s report of the “magic” power of acupuncture during President Nixon’s visit to China. Non-Asians studied acupuncture in the following decades, which contributed to the establishment of acupuncture as a profession in the American health system. The history of Chinese medicine in the United States illustrates that Chinese and Asian immigrants promoted Chinese medicine in the communities, while Chinese American medical scientists who were trained in biomedicine played an important role in shaping the biomedical method of acupuncture research. This article investigates the changes of Chinese medicine in the United States, with a focus on acupuncture. Situating the discussion in a larger context of social and cultural changes, this study examines the contributions of Chinese immigrants and the popularity of acupuncture in the United States. It analyzes the development of acupuncture practice and research, the professional training in Chinese medicine, and American people’s interest in using Chinese medicine as a reliable healing mechanism to many health problems, including chronic pain, cancer, and drug addictions.
Thais C. De Oliveira, Thais C. De Oliveira, Rodrigo Secolin
et al.
Genomics can reveal essential features about the demographic evolution of a population that may not be apparent from historical elements. In recent years, there has been a significant increase in the number of studies applying genomic epidemiological approaches to understand the genetic structure and diversity of human populations in the context of demographic history and for implementing precision medicine. These efforts have traditionally been applied predominantly to populations of European origin. More recently, initiatives in the United States and Africa are including more diverse populations, establishing new horizons for research in human populations with African and/or Native ancestries. Still, even in the most recent projects, the under-representation of genomic data from Latin America and the Caribbean (LAC) is remarkable. In addition, because the region presents the most recent global miscegenation, genomics data from LAC may add relevant information to understand population admixture better. Admixture in LAC started during the colonial period, in the 15th century, with intense miscegenation between European settlers, mainly from Portugal and Spain, with local indigenous and sub-Saharan Africans brought through the slave trade. Since, there are descendants of formerly enslaved and Native American populations in the LAC territory; they are considered vulnerable populations because of their history and current living conditions. In this context, studying LAC Native American and African descendant populations is important for several reasons. First, studying human populations from different origins makes it possible to understand the diversity of the human genome better. Second, it also has an immediate application to these populations, such as empowering communities with the knowledge of their ancestral origins. Furthermore, because knowledge of the population genomic structure is an essential requirement for implementing genomic medicine and precision health practices, population genomics studies may ensure that these communities have access to genomic information for risk assessment, prevention, and the delivery of optimized treatment; thus, helping to reduce inequalities in the Western Hemisphere. Hoping to set the stage for future studies, we review different aspects related to genetic and genomic research in vulnerable populations from LAC countries.
Proposed in the United States of America in the 1970s, the term “public history” is now used in various parts of the world. The internationalization of the field of public history raises various questions about its definition, its practices, and its theories. Based on sometimes long-established practices, public history reflects new approaches to audiences, collaboration and authority in history production. The article distinguishes and analyses the different phases of internationalization in the 1970s, 1990s, and 2010s and argues for a new international public history. Instead of a spread of public history, the new internationalization lies upon multicultural approaches and understandings of the field. Symbolized by the rise of public history in Italy, the glocal process of defining and practicing public history – where the local practices and theories relate and influence global definitions – provides more nuanced and richer understandings of the field. The new internationalization has concrete consequences on the public history structures, resources, languages, and projects.
Dear Editor,
Sugammadex is a modified gamma-cyclodextrin which reverses the neuromuscular blockade of aminosteroid agents (rocuronium and vecuronium) by binding and encapsulating the amionosteroid molecule. The rocuronium/sugammadex combination has found increasing popularity in rapid sequence induction, in place of suxamethonium. Sugammadex has also been used to treat rocuronium-induced anaphylaxis [1]. The application of sugammadex for the reversal of muscle relaxants is widespread in Japan. The anaphylaxis from sugammadex in Japan is 0.02% or 1:5000 administrations [2]. This exceeds the quoted ranges for succinylcholine (1:9006) and teicoplanin (1:6101), both widely felt in the United Kingdom (UK) to be the highest risk drugs in the cupboard for perioperative anaphylaxis [3].
This letter is about a 78-year-old man, who was attended for a video-assisted thoracoscopy, drainage and insertion of PleurX catheter for mesothelioma. Previously, he had undergone open reduction and internal fixation of right radius fracture and left ankle fracture fixation, under general anaesthesia, which were uneventful. He was not a smoker, and he had no other medical history. Specifically, he had no history of asthma, but only mild atopy. He had a history of nausea and vomiting following morphine administration. An arterial line was placed prior to induction of anaesthesia, which was achieved with midazolam, fentanyl and propofol followed by 100 mg rocuronium to facilitate tracheal intubation with a left sided double lumen tube (39Fr Shiley Endobronchial, Covidien, Ireland). One-lung ventilation was well tolerated, and anaesthesia was maintained with sevoflurane. Additional analgesia, antibiotics and antiemetics were administered throughout the procedure as per usual practice. The surgical site was prepared with alcohol in chlorhexidine. The procedure lasted 45 minutes, during which time there was no physiological derangement. At completion of surgery, there was significant residual neuromuscular blockade (one twitch on train-of-four testing). This was reversed with 200 mg sugammadex (slightly more than 2 mg/kg). Within 30 seconds of sugammadex administration, the patient started to cough and became flushed. The arterial line trace was observed to reduce over the course of less than one minute from 140/88 mmHg to a lowest reading of 35 mmHg systolic. The bed was inverted, a Senior Consultant support was called, and the patient was administered a fluid bolus of Gelofusin and repeated boluses of dilute metaraminol to a total of 3 mg. End-tidal sevoflurane at this point was around 0.3.
The patient’s blood pressure improved over the course of the next five minutes, following administration of 50 mg intravenous frusemide (due to the suspicion of pulmonary oedema), 100 mg intravenous hydrocortisone and 10 mg intravenous chlorpheniramine. During this time the patient developed new atrial fibrillation with fast ventricular response. He did not receive adrenaline boluses or an adrenaline infusion at any point and, aside from the coughing, was not difficult to ventilate or oxygenate. He was woken and extubated as soon as the blood pressure had stabilised. Subsequently his atrial fibrillation was cardioverted with intravenous amiodarone. Mast cell tryptase measurements were performed at one hour after the event which showed a rise to 9.0 ng/mL with a subsequent fall to 4.8 ng/mL (both values within normal range).
The patient had no recollection of the event when he was debriefed after recovery from anaesthesia. In accordance with hospital protocols for suspected perioperative anaphylaxis, he was given an information letter detailing the event and suspected culprit drugs, a letter was sent to his General Physician, notes were made in his clinical file, and a referral was made to the local perioperative allergy service.
On subsequent skin prick testing at the perioperative allergy clinic, the patient showed a strongly positive reaction to sugammadex. Intradermal testing was not performed due to the strongly positive skin prick test. Intradermal testing was performed to dexamethasone (negative) and chlorhexidine (due to the possibility of delayed skin absorption) and was also found to be positive. The patient has been counselled to avoid both sugammadex and chlorhexidine although the history and skin prick reaction make sugammadex the most likely culprit in this instance. Due to historical and licensing factors, the use of sugammadex has been less widespread in UK anaesthetic practice compared to countries such as Japan, Australia, and the United States. Thus, UK reports of anaphylaxis to sugammadex are rare. The first UK case report of sugammadex allergy was published in 2017 [4]. However, in countries where its use is more widespread, studies have demonstrated a relatively high rate of hypersensitivity reactions to the drug [5,6]. A retrospective, single centre study in Japan published in 2018 showed a probable anaphylaxis rate to sugammadex of 0.039%, or 1:2500 administrations (in this centre, sugammadex is the only reversal agent for neuromuscular blockade available as neostigmine was not stocked, and anaphylaxis was defined clinically, not on testing). This was close to the rates quoted for rocuronium or succinylcholine in a study published in 2018 [5]. The same group conducted a retrospective study comparing the incidence of anaphylaxis to sugammadex with that of neostigmine over five years in four hospitals in Japan, this time utilising immunological testing to confirm anaphylaxis. In this paper the authors demonstrated an incidence of anaphylaxis to sugammadex of 1:5000, or a rate of 0.02% [2]. There were no cases of anaphylaxis to neostigmine. It remains unclear whether this high rate is unique to Japan, where sugammadex use is widespread and up to 10% of the population have been exposed to the drug and thereby potentially sensitised to the antigen [5]. Therefore, whether we will see increasing frequency of reactions in countries where its use is currently more restricted, but may increase in the future.
To illustrate, currently 90% of reversed cases in Japan use sugammadex, compared with 9.1% in the UK [2]. When sugammadex comes off patent in 2023 its use in the UK is likely to increase substantially, leading to more adverse events simply as a statistical fact [6]. Whether or not the markedly elevated Japanese
rates of anaphylaxis are as a result of population sensitisation is
unclear, particularly when mechanistic studies have failed to
show an IgE or even a mast cell degranulation component or to
demonstrate increased incidence on subsequent exposures [2,7].
However, concerns around this have led to an editorial suggesting
that sugammadex/rocuronium combinations should be reserved
for situations where other drugs are contraindicated (e.g.,malignant
hyperthermia for succinylcholine) or where they have been shown to
have superior clinical outcomes [6].
The established treatment of anaphylaxis is adrenaline, fluids,
steroids, and antihistamines. In this case, there was a rapid
recovery of the patient in the absence of treatment with adrenaline,
which is unusual. This was partially due to slight delay in recognising
the problem to arrive at the diagnosis of the clinical situation and
an occupation of mental bandwidth with treating the sudden
hypotension with fluids and pressor agents that were immediately
to hand, coupled with other diagnostic possibilities being raised
such as pulmonary oedema. By the time the diagnosis of likely
anaphylaxis was made, the patient had recovered sufficiently not to
need adrenaline (which we were reluctant to use as the patient had
developed fast atrial fibrillation by this stage). Notably, anaphylactic
reactions have been reported to sugammadex, rocuronium and the
sugammadex/rocuronium complex [8], raising the possibility that
the patient had exhibited anaphylaxis only briefly to sugammadex
before the drug formed complexes with the remaining rocuronium
in his circulation, thereby essentially removing the antigen from his
circulation before the full anaphylaxis cascade reaction had been
triggered. In effect, this could represent the opposite of the effect
observed when rocuronium anaphylaxis is treated with sugammadex
to remove the antigen from the circulation. This theory is conjecture
only but potentially worthy of further investigation.
Previous studies have demonstrated that sugammadex hypersensitivity
reactions are dose dependent, occurring more frequently at higher doses [7,9]. Thus, a reduction in the exposed dose might conceivably
mitigate a full-blown anaphylactic reaction. This same study also
concluded that the mechanism of hypersensitivity to sugammadex
was not necessarily IgE mediated or even a result of direct mast cell
degranulation. A second similar study agreed that the mechanism
was likely to be non IgE mediated but found no association with dose
[10]. None of the subjects in these trials (which studied hypersensitivity
reactions to sugammadex administration in awake, healthy individuals)
demonstrated rise in their mast cell tryptase levels, despite two of
them having confirmed anaphylaxis on skin testing.
It seems clear that the mechanism of sugammadex hypersensitivity
and anaphylaxis is poorly understood and that further investigation
may be required as the use of sugammadex and therefore, frequency
of reactions increases worldwide.
In this paper, we present our experience designing and implementing a hybrid citizen science protocol combining local data collection reported digitally with the return of physical samples by mail. Our project, Fossil Atmospheres, housed within the Paleobiology Department of the Smithsonian Institution’s National Museum of Natural History, sought to complete a broad geographic collection of 'Ginkgo biloba' L. leaves to better understand climate change over time. We also wished to leverage and test the affordances of using an established online platform as a technological tool for research-quality data collection. Participants were asked to find a local ginkgo tree and, using a hybrid protocol, collect leaf samples and record site data, including photos, GPS coordinates, and tree characteristics, using the iNaturalist online platform. Participants then returned their leaf samples by mail. Fossil Atmospheres received 562 leaf samples from 352 participants. These samples, representing 36 states, met our target geographic transects and reflected the known habitat range of living ginkgo in the United States. We were able to successfully pair a large majority of received samples to their corresponding digital data records, allowing us to include 88% of the samples received within the Fossil Atmospheres data set. These results greatly exceeded our project goals. The hybrid protocol model we present, based on our experiences, indicates that using tools like iNaturalist provides multiple benefits that meet or exceed more traditional data collection models, including increases in the scale of data that can be collected, data accuracy, and data completeness, uniformity, usability, and accessibility.
The attack of the Yugoslav People's Army (JNA) and other Serb forces on Podrinje in the spring of 1992 was followed with mass detention, persecution, and mass killings of Bosniaks in towns and villages in the Drina River Valley. The beginning of the war in Bosnia and Herzegovina found the Islamic Community in new circumstances and faced with new issues. Mosques and other facilities of the Islamic Community were the target of destruction by Serb forces. The imams were purposely sought by the perpetrators in order to be killed. In addition to the biological threat itself, the Islamic Community and imams were faced with other issues arising in the midst of the war - burial of victims of mass crimes, moral support for victims and their families, and religious activities including religious instruction and support for defenders. The Srebrenica Islamic Community Committee's May 1995 report states that there are 51 imams in their area, most of whom have been involved in the work of the Islamic Community. This paper deals with elitocide on the example of the murders of imams in Srebrenica and its surroundings from 1992 to 1995. Elitocide is one of the key segments of the genocide against Bosniaks in Podrinje, which has not been the subject of significant research so far. This paper specifically deals with the murder of imams as an important aspect of elitocide in the context of Podrinje and Bosnia and Herzegovina. The work is based on information gathered from war reports, as well as the testimonies of surviving imams and witnesses to their killings or disappearances. The aim of this paper is to present a rather unexplored segment of our recent history based on case studies of Srebrenica - the United Nations enclave. One of the most brutal executions of the imam took place at the very beginning of the genocide, in May 1992 in the Bratunac camp when Mustafa-ef. Mujkanovic was publicly tortured and killed. The aim of this harassment and public murder was to send a message to the Bosniak population in Bratunac - that this awaits them as well. In the Bosnian context, especially in traditional Bosniak communities such as eastern Bosnia, imams have represented and continue to represent not only religious authorities but also socially active actors in their micro-communities. Given the specifics of the communist organization of the Islamic Community of Yugoslavia, and the specifics of their status in the then socio-political paradigm, imams cannot be considered elites in the narrow sense, which mainly means influence, power and wider influence and education. Their status is far from any wider and more important influence, but in Bosnian cultural circles, especially in micro-regions, the role and importance of imams is very important despite their unenviable socio-economic status. During the genocide in Srebrenica in July 1995, 26 imams were killed, or half as many as there were in the enclave. This destroyed not only families and settlements, but also complete spiritual communities, which existed for decades on these sites. The planned killing of imams as religious authorities in local communities was aimed at leaving the Bosniak population of the region completely without important local authorities. The genocide of Bosniaks in Podrinje, perpetrated by Serb forces - the Yugoslav People's Army (JNA), the Republika Srpska Army and Police and other special units and paramilitary formations from the Republic of Serbia - began in 1992 and ended in July 1995 - left local Bosniak communities almost completely destroyed and survivors with little chance of complete recovery.
Social history and conditions. Social problems. Social reform
Shannon L. White, Michael S. Eackles, Tyler Wagner
et al.
Abstract Objective Flathead catfish are rapidly expanding into nonnative waterways throughout the United States. Once established, flathead catfish may cause disruptions to the local ecosystem through consumption and competition with native fishes, including species of conservation concern. Flathead catfish often become a popular sport fish in their introduced range, and so management strategies must frequently balance the need to protect native and naturalized fauna while meeting the desire to maintain or enhance fisheries. However, there are currently few tools available to inform management of invasive flathead catfish (Pylodictis olivaris). We describe a suite of microsatellite loci that can be used to characterize population structure, predict invasion history, and assess potential mitigation strategies for flathead catfish. Results Our panel of 13 microsatellite loci were polymorphic and appear to be informative for population genetic studies of flathead catfish. We found moderate levels of diversity in four nonnative collections of flathead catfish in the Pennsylvania and Maryland sections of the Susquehanna River and the Schuylkill River, Pennsylvania. Analyses suggested patterns of genetic differentiation within- and among-rivers, highlighting the utility of this marker panel for understanding the structure and assessing the degree of connectivity among flathead catfish populations.
We challenge the widely held view that classic American voluntary groups were tiny, local, and disconnected from government. Using newly collected data to develop a theoretically framed account, we show that membership associations emerged early in U.S. history and converged toward the institutional form of the representatively governed federation. This form enabled leaders and members to spread interconnected groups across an expanding nation. At the height of local proliferation, most voluntary groups were part of regional or national federations that mirrored the structure of U.S. government. Institutionalist theories suggest reasons for this parallelism, which belies the rigid dichotomy between state and civil society that informs much current discussion of civic engagement in the United States and elsewhere.
The history of American education is a history of local control. Symbolized by the image of the one-room “little red schoolhouse”, from our nation’s beginnings, schools have been under the direction of local communities. Teachers were hired by local school boards, who paid their salaries and often provided housing and food as well. Curriculum was also set locally, although often through the choice of textbooks, or primers, that were the published work of various education “experts” from other places. Importantly, teachers were also fired locally. As a result, American education has long been quite sensitively calibrated to local outlooks, concerns and politics.
Jaime Martinez-Urtaza, Ronny van Aerle, Michel Abanto
et al.
ABSTRACT Vibrio parahaemolyticus is the leading cause of seafood-related infections with illnesses undergoing a geographic expansion. In this process of expansion, the most fundamental change has been the transition from infections caused by local strains to the surge of pandemic clonal types. Pandemic clone sequence type 3 (ST3) was the only example of transcontinental spreading until 2012, when ST36 was detected outside the region where it is endemic in the U.S. Pacific Northwest causing infections along the U.S. northeast coast and Spain. Here, we used genome-wide analyses to reconstruct the evolutionary history of the V. parahaemolyticus ST36 clone over the course of its geographic expansion during the previous 25 years. The origin of this lineage was estimated to be in ~1985. By 1995, a new variant emerged in the region and quickly replaced the old clone, which has not been detected since 2000. The new Pacific Northwest (PNW) lineage was responsible for the first cases associated with this clone outside the Pacific Northwest region. After several introductions into the northeast coast, the new PNW clone differentiated into a highly dynamic group that continues to cause illness on the northeast coast of the United States. Surprisingly, the strains detected in Europe in 2012 diverged from this ancestral group around 2000 and have conserved genetic features present only in the old PNW lineage. Recombination was identified as the major driver of diversification, with some preliminary observations suggesting a trend toward a more specialized lifestyle, which may represent a critical element in the expansion of epidemics under scenarios of coastal warming. IMPORTANCE Vibrio parahaemolyticus and Vibrio cholerae represent the only two instances of pandemic expansions of human pathogens originating in the marine environment. However, while the current pandemic of V. cholerae emerged more than 50 years ago, the global expansion of V. parahaemolyticus is a recent phenomenon. These modern expansions provide an exceptional opportunity to study the evolutionary process of these pathogens at first hand and gain an understanding of the mechanisms shaping the epidemic dynamics of these diseases, in particular, the emergence, dispersal, and successful introduction in new regions facilitating global spreading of infections. In this study, we used genomic analysis to examine the evolutionary divergence that has occurred over the course of the most recent transcontinental expansion of a pathogenic Vibrio, the spreading of the V. parahaemolyticus sequence type 36 clone from the region where it is endemic on the Pacific coast of North America to the east coast of the United States and finally to the west coast of Europe.