“Doomsday prepping” is a phenomenon which involves preparing for feared societal collapse by stockpiling resources and readying for self-sufficiency. While doomsday prepping has traditionally been reported in the context of extremists, during the COVID-19 pandemic, excessive stockpiling leading to supply shortages has been reported globally. It is unclear what psychological or demographic factors are associated with this stockpiling. This study investigated doomsday prepping beliefs and behaviors in relation to COVID-19 proximity, demographics, coping strategies, psychopathology, intolerance of uncertainty (IU), and personality (...) in 384 participants (249 female) in an online study. Participants completed a number of questionnaires including the Post-Apocalyptic and Doomsday Prepping Beliefs Scale and a scale designed for the current study to measure prepping in the context of COVID-19. These were analyzed using ANOVAs, correlational, and mediation analyses to examine relationships between psychometric variables and stockpiling. Prepping beliefs and behaviors were higher in males than females and positively associated with anxiety, obsessive-compulsive symptoms, IU, and traditional masculinity traits. Older age, male gender, obsessive-compulsive symptoms, and traditional masculinity predicted unique variance in prepping. The relationship between gender and stockpiling was mediated by social learning (witnessing other people panic buying) and the perceived threat of COVID-19 (doomsday interpretations) while proximity and personal vulnerability to COVID-19 were non-significant. Results indicate that panic buying was influenced more by witnessing others stockpiling, personality, and catastrophic thinking rather than by proximity to danger. Education could target these factors in ongoing waves of the pandemic or future catastrophes. (shrink)

The paper identifies common barriers and challenges to Pre-Exposure Prophylaxis (PrEP) uptake and offers considerations for state and local public health departments to address barriers and retool infrastructure to increase access to PrEP to new users. Authors identify synergistic opportunities with federal agencies and funders to advance PrEP-related HIV prevention efforts, that prioritize strategies and investments to provide PrEP to people who could benefit from the intervention but are unaware of PrEP or struggle to access (...) it. Barriers discussed and examined include financing strategies to reduce financial burden of PrEP medication, expanding PrEP access and outreach beyond clinical settings, and increasing the network and reach of the provider community to serve people we oppress through policy choices and discourses of racial and socioeconomic inferiority. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Prepping for the Day You Hope Never Arrives:Facing RecurrenceTerra TrevorMy 14–year–old son was eight years past diagnosis of a brain tumor. Gone were the pristine sick days when his white hooded sweatshirt stayed spotlessly clean for weeks at a time. Each time he left a muddy footprint on the kitchen floor I rejoiced; it felt so good to have a healthy kid again. However, my son was a survivor (...) of an anaplastic ependymoma, grade IV, brain tumor, and although I wanted to be out of the woods, I knew we were not. I’d climbed out of the space where medical problems were fi led in my mind, yet I kept the door open because statics showed that the type of brain tumor he had, frequently recurred.Still, I was determined to keep our lives as ordinary as possible. But for a brain tumor family this meant staying connected to sources of support. Parent programs, patient and sibling support groups [End Page 27] and camps, and we remained connected to hospital resources. Most of all we needed to have fun as a family, and we attended the cancer survivor picnics and parties our hospital hosted, where the doctors served as volunteers, grilling hamburgers and dishing up ice cream for the guest of honor patients.My husband and I felt confident that as long as we worked as a team with our doctors and stayed connected to resources offered, we would find a way to meet any challenges that might surface.In the end ultimately what saved us was this mosaic of support provided to us over the years from a multitude of good people and organizations offering help when we needed it most. And I had the opportunity to learn to accept help, which it turns out, is far harder than offering to help.Shortly after my son Jay celebrated his 8th year as a brain tumor survivor, I watched him open the medicine cabinet and reach for the bottle of Advil, for the second time in a row that day. “Do you have a headache again?” I asked. He shrugged his shoulders, then hiccupped hard, and ducked his head in the toilet and threw up. Tears welled in his eyes. I sank into the deep, silent panic that made me calm.Our primary care physician called in an authorization for an MRI. Jay hid his fear behind a mask of quiet strength. It was ten days before his fifteenth birthday.While we waited for the MRI appointment, that week Jay was elected student of the month, and he got a lead part in the school play. My idyll of family hood continued until the MRI confirmed my worst fear—the tumor was back, and this time its fingers spread into the brainstem.We had to decide on a plan of treatment. Surgery was scheduled. When Jay was admitted to the hospital and I requested that he be placed in the pediatric ward, an environment he was familiar with, they agreed. Although Jay was a teenager, the recurrence caused him to revert emotionally back to a younger age. It was as if he was seven–years–old again, reliving his first brain tumor experience, and he kept his childhood security item—a small teddy bear with him, tucked under the hospital covers, like he had with the first diagnosis.Luck held. With surgery most of the tumor was resected and symptoms disappeared. Three days later, on Thanksgiving, he was feeling well enough to be excited about the Thanksgiving dinner our hospital provided us. A table and chairs were brought in, along with a feast of good food. The nurses gave Jay lavish attention, they laughed at the corny jokes he told, and made us feel like special company.Within a week Jay was out of the hospital, recovering well. But what to do about the remaining brain tumor slivers that were inoperable? He had already received his lifetime dose of whole brain radiation, and chemotherapy available offered little hope of curing a recurrent tumor. But there was a small chance that stereotactic radiation might stall tumor growth. We set up a consultation.We had... (shrink)

Inequities in HIV pre-exposure prophylaxis (PrEP) use persist in the United States. Although scientific advancement in delivery options and social acceptance of PrEP has occurred in the past decade, gaps remain in ensuring that this sexual health program is available to all. Components of what a national PrEP program for all would look like are discussed.

The ethics of safe sex in the gay community has, for many years, been focused on debates surrounding the responsibility regarding the use of condoms to prevent HIV transmission, once the only tool available. With the development of Truvada as a pre-exposure prophylaxis for HIV, for the first time in the history of the HIV/AIDS epidemic there is the potential to significantly reduce the risk of HIV transmission during sex without the use of condoms. The introduction of PrEP necessitates (...) a renewed discussion about the politics and ethics of safe sex for men who have sex with men. We present the arguments of authors who hold radically opposite positions with regard to the ethics of condom use by gay men, but who currently both criticize the use of PrEP. We offer a critique of their arguments and advance the position that the use of PrEP, even without condoms, can be acceptable and part of a safe sex ethics framework for MSM. (shrink)

The proposed national PrEP program would serve people who are uninsured as well as those enrolled in Medicaid. In this article, the authors propose a set of recommendations for the proposed program’s implementers as well as state Medicaid agencies and Medicaid managed care organizations to ensure PrEP access for people enrolled in Medicaid, addressing gaps without undermining the important role of the Medicaid program in covering and promoting PrEP.

In order to demedicalize the ethics of pre-exposure prophylaxis as HIV prevention, I consider the social effects on men who have sex with men. The Centers for Disease Control and Prevention considers MSM to be the highest risk group for contracting HIV in the USA. The ethics of using PrEP as HIV prevention among MSM, however, has both a medical dimension and a social dimension. While the medical dimension of the ethics of PrEP includes concerns about side effects, (...) drug resistance and distribution, the social dimension of the ethics of PrEP includes concerns about stigmatization, sexual and romantic relationships and sexual freedom. The medical concerns of the ethics of PrEP may take precedence over the social concerns, but there is a growing body of literature that already addresses the medical concerns. Much less attention has been given to the social concerns of the ethics of PrEP, and in this article, I aim to fill this gap in the literature. Therefore, I focus on the often-overlooked social dimension of the ethics of PrEP to help understand the connection between the risks, relationships and communities of MSM using PrEP as HIV prevention. (shrink)

In 2004, the first ever multi‐sited clinical trials studied the prospect of HIV biomedical prevention (referred to as pre‐exposure prophylaxis—‘PrEP’). The trials were implemented at several international sites, but many officially closed down before they completed. At most sites, both scientists and community AIDS advocates raised concerns over the ethics and scientific rationales of the trial. Focusing on the Nigerian trial site, we detail the controversy that emerged among mostly Nigerian research scientists who scrutinized the research design and protocol. (...) While some of the disputes, especially those pertaining to community engagement mechanisms, were ultimately resolved in international fora and implemented in later PrEP trials, concerns over science rationales and assumptions were never addressed. We argue that scientific rationales should be treated as ethical concerns and suggest that such concerns should be deliberated at host sites before the trial protocol is finalized. (shrink)

This special edition ofJLMEcenters on a novel proposal for a national PrEP access program with the potential to break through a failed status quo.

The introduction of pre-exposure prophylaxis (PrEP) for HIV has triggered critical analysis within the social sciences. For example, some have signalled how PrEP may lead to a renewed medicalisation of gay and other homosexually-active men’s sexuality. This chapter challenges some of those accounts. Adopting a public health ethics perspective, it argues that gay men should be understood as agentic in their use of PrEP, as opposed to being the passive victims of medicalisation, and that greater attention should (...) be paid to questions of pleasure in PrEP use. Applying a reproductive justice framework, the chapter argues that the worldwide inaccessibility of PrEP constitutes a more serious ethical issue than the potential problem of the medicalisation of gay men’s sexuality. (shrink)

The implementation of pre-exposure prophylaxis (PrEP) as a new tool for prevention against HIV raised particular ethical concerns regarding the individuals’ and the collective's best interests in France. It was questioned whether the beneficence of taking or prescribing PrEP regarding its high efficacy to protect people from HIV is always more important than the maleficence represented by the risks involved, such as healthy people taking a pill with side effects, the growth of sexually transmitted infections or the potential (...) generalization of risk-taking sexual behaviour. The main objective of this study was to explore patients’ and health professionals’ ethical questioning on PrEP. Sixty-nine qualitative interviews were conducted with 45 users and 24 healthcare professionals. Overall, this study shows that those primarily concerned by PrEP tend to dismiss ethical questions regarding PrEP itself in the name of its efficacy and the empowerment it allows, but they would rather stress the impact PrEP can have on individuals’ sexual behaviour and how it can affect their autonomy if it is prescribed blindly without taking into consideration the specific living context and life history of each PrEP user. (shrink)

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at-risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother-to-child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary (...) with other preventive measures. In this sense, it represents a new bio-technology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries’ struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource-poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections. (shrink)

Published data show that new HIV prevention strategies including treatment-as-prevention and pre-exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV-based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the (...) provision of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment-as-prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment-as-prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment-as-prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV-based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

The successful demonstration that antiretroviral (ARV) drugs can be used in diverse ways to reduce HIV acquisition or transmission risks – either taken as pre-exposure prophylaxis (PrEP) by those who are uninfected or as early treatment for prevention (T4P) by those living with HIV – expands the armamentarium of existing HIV prevention tools. These findings have implications for the design of future HIV prevention research trials. With the advent of multiple effective HIV prevention tools, discussions about the ethics and (...) the feasibility of future HIV prevention trial designs have intensified. This article outlines arguments concerning the inclusion of newly established ARV-based HIV prevention interventions as standard of prevention in HIV prevention trials from multiple perspectives. Ultimately, there is a clear need to incorporate stakeholders in a robust discussion to determine the appropriate trial design for each study population. (shrink)

In this paper, I consider how trust affects the decisions of men who have sex with men (MSM) around using pre-exposure prophylaxis (PrEP) as HIV prevention in their sexual and romantic relationships, and how the use of PrEP affects their relationships with healthcare providers. MSM have to trust their sexual and romantic partners as well as their healthcare providers for PrEP to be successful as a relatively new HIV prevention strategy. This trust includes both interpersonal trust and (...) institutional trust and it is complicated by different kinds of relationship dynamics and the history of prejudice against MSM in healthcare institutions. (shrink)

Stellen Kondome einen potenten Schutz sowohl vor HIV als auch von anderen sexuell übertragbaren Infektionen (STIs) dar, und besteht außerdem ein barrierefreier Zugang zur HIV-Postexpositionsprophylaxe (PEP) (z. B. nach Kondom-Fatigue), muss präzise sondiert werden, wann die sich zunehmend etablierende HIV-Präexpositionsprophylaxe (PrEP) die bessere Wahl darstellt. Vor dem Hintergrund einer generalisierten everyone at risk-Annahme über MSM wird die PrEP zunehmend zu einem standard of care. Zwar kann kein Zweifel daran bestehen, dass dies für bestimmte MSM mit einem bestimmten Risikoprofil (...) wünschenswert ist. Es ist aber von Variabilitäten (z. B. casual condomless sex versus random condomless sex) auszugehen, die zur Vermeidung einer unverhältnismäßigen Medikalisierung berücksichtigt werden müssen. Im Spannungsfeld von hochpotenter HIV-Prävention und Medikalisierung insbesondere von Männern, die Sex mit Männern praktizieren, soll im Sinn einer Güterabwägung gefragt werden, wann genau eine PrEP (dauerhaft oder on demand) mehr Vorteile und weniger Nachteile bietet als der Gebrauch von Kondom oder PEP. Dazu gehört ein Fokus auf den aktuellen Stand der klinischen Forschung und ein Fokus auf die medizinethische Debatte. Die Medizingeschichte der Prävention und der HIV-Erkrankung erweist sich dabei als relevanter Erörterungszusammenhang für die weitgehend noch ausstehende ethische Untersuchung der PrEP. Methodisch basiert diese Arbeit auf einer Auswertung der interdisziplinären Fachliteratur über die HIV-Präexpositionsprophylaxe im Besonderen und über HIV-Prävention im Allgemeinen. Basierend auf den PRISMA (Prefered Reporting Items for Systematic Reviews and Meta-Analyses) Guidelines wurden aus der Datenbank PubMed/MEDLINE solche Studien ausgewählt, die die aktuelle klinische Praxis der PrEP oder eine medizinethische Diskussion der PrEP zum Gegenstand haben. Auf der Basis dieser Literatur erfolgt eine diskursive Erörterung und Abwägung der verfügbaren Pros und Cons zur PrEP. Präventionsmaßnahmen treten regelmäßig als ambivalente Instrumente der Gesundheitsförderung zwischen Liberalisierung und Restringierung des Individuums hervor. Insgesamt bietet daher die PrEP on demand gegenüber der kontinuierlichen PrEP im Sinne der Personalisierung die Option einer individuellen Anpassung an konkretes Risikoverhalten. Auch im Sinne einer Güterabwägung hat die PrEP gewichtige Vorteile gegenüber der kontinuierlichen PrEP und gegenüber einer PEP, wenn kein dauerhaft gleichhohes Risiko vorliegt. In dieser medizinethischen Untersuchung wird darauf hingewiesen, dass es sich bei MSM um eine heterogene Gruppe handelt, deren individuelles Sexualverhalten eine ebenfalls individualisierte HIV-Präventions-Strategie benötigt. Diese Studie argumentiert daher für ein stark personalisiertes decision making bei möglicher Indikation für eine PrEP bei MSM. Damit soll ein wesentlicher Faktor zur Vermeidung einer Medikalisierung von MSM dargestellt werden. (shrink)

Published data show that new HIV prevention strategies including treatment‐as‐prevention and pre‐exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV‐based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the (...) provision of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment‐as‐prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment‐as‐prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment‐as‐prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV‐based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

In this article, I challenge the risk assessment approach to the ethics of pre-exposure prophylaxis (PrEP) as HIV prevention among men who have sex with men (MSM). Traditional risk assessment focuses on the medical risks and benefits of using medical technologies, but this emphasizes certain risks and benefits over others. The medical risks of using PrEP are presently being overblown and its social and political risks are being overlooked. By recontextualizing risk within the history of HIV and considering (...) the lived experiences of MSM with sex, HIV, and HIV prevention, we can broaden the present risk assessment framework to include all of the relevant risks involved in using PrEP. We can also better situate risk as one of several moral concepts, including trust and solidarity, which move us towards a more nuanced analysis of the social and political effects of PrEP on the relationships and communities of MSM. (shrink)

This article examines the relationship between bioethics and the therapeutic standards in HIV prevention research in the developing world, focusing on the closure of the pre-exposure prophylaxis (PrEP) trials in the early 2000s. I situate the PrEP trials in the historical context of the vertical transmission debates of the 1990s, where there was protracted debate over the use of placebos despite the existence of a proven intervention. I then discuss the dramatic improvement in the clinical management of HIV (...) and the treatment access movement, and consider how these contexts have influenced research practice. I argue that as HIV prevention trials oblige researchers to observe the rate at which vulnerable people under their care acquire HIV, there is an obligation to provide antiretroviral treatment to seroconverters and other health care benefits that fall within the scope of researchers' entrustment, both to avoid exploitation and to enact reciprocal justice. I argue against propositions that the obligations to provide specific benefits are vague, fall only upon researchers and sponsors, and create injustices by privileging the few over the many. Finally, I contend that the realisation of a broader standard of care in HIV prevention research broadens the role of research from being a simple tool to produce knowledge to a complex intervention that can play a part in the reduction of health disparities. (shrink)

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV‐based pre‐exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at‐risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother‐to‐child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary (...) with other preventive measures. In this sense, it represents a new bio‐technology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries’ struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource‐poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections. (shrink)

In July 2012, based on evidence from two major trials, the United States Food and Drug Administration approved the use of combined oral tenofovir/emtricitabine as pre-exposure prophylaxis for people at high risk of HIV acquisition. PrEP effectiveness is marred by poor adherence, however, even in trial populations, thus it is not a magic bullet for HIV prevention. It is, however, the most effective biomedical HIV prevention intervention available for people at high risk of HIV, particularly those who have receptive (...) sex and lack the power to negotiate condom use. Accordingly, there are compelling reasons to compare future experimental HIV prevention interventions against PrEP. The interests both of trial participants and of science are served by using PrEP as comparator: Not only would HIV incidence be reduced, but also the question of whether new interventions were superior to best proven interventions, in a given setting, would be answered comprehensively. (shrink)

Provides comprehensive coverage of recent developments in the biomedical prevention of HIV -/- Raises critical questions about present and future directions in HIV prevention and care -/- Highlights the importance of continued community ownership of the HIV response -/- .

Antiretroviral pre-exposure prophylaxis (PrEP) is protective against HIV. Low utilization rates amongst HIV vulnerable populations are due in part to the high cost of PrEP. Generic PrEP offers the potential to improve health at significantly reduced costs. In this study, we examine early utilization patterns and prices for generic PrEP. We discuss the opportunities and challenges for generic PrEP to improve health among HIV vulnerable populations.

The last few years have seen dramatic progress in the development of HIV pre-exposure prophylaxis (PrEP). These developments have been met by ethical concerns. HIV interventions are often thought to be ethically difficult. In a context which includes disagreements over human rights, controversies over testing policies, and questions about sexual morality and individual responsibility, PrEP has been seen as an ethically complex intervention. We argue that this is mistaken, and that in fact, PrEP does not raise new (...) ethical concerns. Some of the questions posed by PrEP are not specific to HIV prophylaxis, but simply standard public health considerations about resource allocation and striking a balance between individual benefit and public good. We consider sexual disinhibition in the context of private prescriptions, and conclude that only unjustified AIDS-exceptionalism or inappropriate moralism about sex supports thinking that PrEP raises new ethical problems. This negative conclusion is significant in a context where supposed ethical concerns about PrEP have been raised, and in the context of HIV exceptionalism. (shrink)

Intracellular bacteria were recently shown to employ eukaryotic prenylation system for modifying activity and ensuring proper intracellular localization of their own proteins. Following the same logic, the proteins of viruses may also serve as prenylation substrates. Using extensively validated high-confidence prenylation predictions by PrePS with a cut-off for experimentally confirmed farnesylation of hepatitis delta virus antigen, we compiled in silico evidence for several new prenylation candidates, including IRL9 and few other proteins encoded by Herpesviridae, Nef, E1A, NS5A, PB2, HN, L83L, (...) MC155R, other Poxviridae proteins, and some bacteriophages of human associated bacteria. If confirmed experimentally, these findings may aid in dissection of molecular functions of uncharacterized viral proteins and provide a novel rationale for statin and FT/GGT1-based inhibition of viral infections. Prenylation of bacteriophage proteins may aid in moderation of microbial infections. Many human viruses, including HCV, HIV1, ASFV, and a number of Adeno-, Pox-, and herpesviruses, including CMV, encode the substrates for mammalian prenylation enzymes. Prenylation is advantageous for viral infection; its suppression by FT/GGT and FPPS inhibitors has antiviral effects. In bacteriophages, prenylation may aid in moderation of microbial infections. (shrink)

Intracellular bacteria were recently shown to employ eukaryotic prenylation system for modifying activity and ensuring proper intracellular localization of their own proteins. Following the same logic, the proteins of viruses may also serve as prenylation substrates. Using extensively validated high-confidence prenylation predictions by PrePS with a cut-off for experimentally confirmed farnesylation of hepatitis delta virus antigen, we compiled in silico evidence for several new prenylation candidates, including IRL9 and few other proteins encoded by Herpesviridae, Nef, E1A, NS5A, PB2, HN, L83L, (...) MC155R, other Poxviridae proteins, and some bacteriophages of human associated bacteria. If confirmed experimentally, these findings may aid in dissection of molecular functions of uncharacterized viral proteins and provide a novel rationale for statin and FT/GGT1-based inhibition of viral infections. Prenylation of bacteriophage proteins may aid in moderation of microbial infections. Many human viruses, including HCV, HIV1, ASFV, and a number of Adeno-, Pox-, and herpesviruses, including CMV, encode the substrates for mammalian prenylation enzymes. Prenylation is advantageous for viral infection; its suppression by FT/GGT and FPPS inhibitors has antiviral effects. In bacteriophages, prenylation may aid in moderation of microbial infections. (shrink)

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Recent advances in mobile electroencephalogram (EEG) systems, featuring non-prep dry electrodes and wireless telemetry, have urged the needs of mobile brain-computer interfaces (BCIs) for applications in our daily life. Since the brain may behave differently while people are actively situated in ecologically-valid environments versus highly-controlled laboratory environments, it remains unclear how well the current laboratory-oriented BCI demonstrations can be translated into operational BCIs for users with naturalistic movements. Understanding inherent links between natural human behaviors and brain activities is the (...) key to ensuring the applicability and stability of mobile BCIs. This study aims to assess the quality of steady-state visual-evoked potentials (SSVEPs), which is one of promising channels for functioning BCI systems, recorded using a mobile EEG system under challenging recording conditions, e.g., walking. To systemati-cally explore the effects of walking locomotion on the SSVEPs, this study instructed subjects to stand or walk on a treadmill running at speeds of 1, 2, and 3 mile (s) per hour (MPH) while con-currently perceiving visual flickers (11 and 12 Hz). Empirical results of this study showed that the SSVEP amplitude tended to deteriorate when subjects switched from standing to walking. Such SSVEP suppression could be attributed to the walking locomotion, leading to distinctly deteriorated SSVEP detectability from standing (84.87±13.55%) to walking (1 MPH: 83.03±13.24%, 2 MPH: 79.47±13.53%, and 3 MPH: 75.26±17.89%). These findings not only demonstrated the applicability and limitations of SSVEPs recorded from freely behaving humans in realistic environments, but also provide useful methods and techniques for boosting the translation of the BCI technology from laboratory demonstrations to practical applications. (shrink)

This paper proposes an architecture for the mapping between syntax and phonology — in particular, that aspect of phonology that determines ordering. In Fox and Pesetsky (in prep.), we will argue that this architecture, when combined with a general theory of syntactic domains ("phases"), provides a new understanding of a variety of phenomena that have received diverse accounts in the literature. This shorter paper focuses on two processes, both drawn from Scandinavian: the familiar process of Object Shift and the (...) less well-known process of Quantifier Movement. We will argue that constraints on these operations can be seen as instances of the same property of grammar that explains the fact that movement is local and successive cyclic. We begin by sketching a model in which locality and successive cyclicity are consequences of the architecture that we propose, rather than specific facts about movement itself. We next present our proposal in somewhat greater detail, and show how it can account for a wide range of apparent limitations on movement — in particular, superficially contradictory restrictions on Object Shift and Quantifier Movement. The restrictions on Object Shift include those grouped under the rubric of Holmberg's Generalization, which Quantifier Movement does not seem to obey. We will argue that Quantifier Movement instead obeys a near mirror-image of Holmberg's Generalization (an "Inverse Holmberg Effect"), but that both Holmberg's Generalization and its mirror image are expected if our proposed architecture is correct. (shrink)

Over the past decade AIDS research has turned toward the use of pharmacology in HIV prevention, including pre-exposure prophylaxis (PrEP): the use of HIV medication as a means of preventing HIV acquisition in those who do not have it. This paper explores the contradictory reasons offered in support of PrEP—to empower women, to provide another risk-reduction option for gay men—as the context for understanding the social meaning of the experimental trials that appear to show that PrEP works (...) in gay men and heterosexual couples but not single women. The PrEP debates reveal the different ideas about “demedicalization” in the earlier gay health and women’s health movements and highlight the relationship between health activism and critique of research ethics in the context of a global pharmaceutical market. (shrink)

How do social norms influence our choices? And does the presence of biased norms affect what we owe to each other? Looking at empirical research relating to PrEP rollout in HIV prevention policy, a...

In lieu of an abstract, here is a brief excerpt of the content:Fulfilling Mitzvot through the Practice of Lovingkindness and WisdomDavid J. GilnerSince it has been more than forty years since I last wrote a paper in comparative religion, I have chosen not to attempt a scholarly paper. Rather, after a biographical sketch, I will discuss examples of Jewish texts that underpin my choice to pursue a path that includes practices drawn from the teachings of Tibetan Buddhism, and explain how (...) I plan to teach these practices within traditional Jewish settings.I grew up in Brooklyn, New York, in a Jewish family that identified with the Conservative movement. When I turned five, I was sent to a modern Orthodox yeshiva. For three and a half hours each morning, first five, then six days a week, I studied a comprehensive Jewish curriculum—taught in modern Hebrew—which included Bible, commentaries, Talmud, history, grammar, and the laws and customs of Ashkenazic Jewry. At fourteen, I left the yeshiva to attend a nondenominational Christian prep school. This seemingly radical change in schools and religious traditions occasioned no significant intellectual conflicts or spiritual anxieties. By fourteen, I sensed that religion was something people were born into; it was one of the cards life dealt you at birth.My sophomore year at Emory University saw the beginning of my interest in Buddhism. I began to practice Sōtō Zen sitting (zazen), and, in my readings, stumbled upon the koan Mu, which occupied my attention in and out of meditation for several years. I became a religion major and was particularly interested in modern Japanese religions. However, my advisor discouraged me from pursuing this interest in graduate school and suggested I build further on my strong traditional Jewish education, which is how I came to Hebrew Union College in 1972 to pursue a PhD in biblical and ancient Near Eastern studies.It was at that time that I began to practice Transcendental Meditation, and, subsequently, the TM Sidhis program, a practice that took, on average, three hours per day, and four and a half hours on days when I did group practice. Not finding a job teaching Bible led me to library school, after which I returned to Hebrew Union College in 1977 to work as a librarian. I became involved in interfaith community outreach, and lectured, led Bible study groups, and conducted Passover seders at local [End Page 27] churches, toward the goal of enhancing interfaith dialogue and understanding in the community. At this time I was fortunate to become friends with Paul Knitter, then a professor at Xavier University.In 1997, after twenty-five years of dedicated twice-daily practice, it became clear to me that I was "attached" to my TM meditation program and that this attachment was hindering my growth. I put my TM Sidhis practice aside and went back to zazen. Soon, I became associated with the Dzogchen organization led by Lama Surya Das, and trekchö became my basic practice. As a member of the online "three-year mandala program," I received a cassette-based education in various Tibetan meditation practices, which included my first experiences with visualization, as part of Tara and Machigma practices.In 2001, I learned of many unfilled requests sent to Hebrew Union College by small congregations asking for students to lead High Holidays services, so I volunteered. For the past ten years, I have served as the High Holidays rabbi at Congregation Tikkun Olam in Woodstock, Illinois. The phrase tikkun olam, often translated as "repairing the world," has become popularized in Jewish culture over the past two decades.In 2003, a friend sent me a teaching tape by Lama John Makransky on loving-kindness practice. My immediate gut reaction was that everything else I had done for thirty-five years was preparation for this teaching. I attended several courses in which Lama Makransky taught practices to cultivate innate lovingkindness and wisdom, and in 2007 I was privileged to attend the week-long course in which he taught his then forthcoming book Awakening through Love: Unveiling Your Deepest Goodness. Since then, I have attended other courses taught by Makransky under the aegis of the Foundation for Active Compassion. Within the realm of Ati Yoga, I think it... (shrink)

A fundamental problem in game theory is the possibility of reaching equilibrium outcomes with undesirable properties, e.g., inefficiency. The economics literature abounds with models that attempt to modify games in order to avoid such undesirable properties, for example through the use of subsidies and taxation, or by allowing players to undergo a bargaining phase before their decision. In this paper, we consider the effect of such transformations in Boolean games with costs, where players control propositional variables that they can set (...) to true or false, and are primarily motivated to seek the satisfaction of some goal formula, while secondarily motivated to minimise the costs of their actions. We adopt preparation sets as our basic solution concept. A preparation set is a set of outcomes that contains for every player at least one best response to every outcome in the set. Prep sets are well-suited to the analysis of Boolean games, because we can naturally represent prep sets as propositional formulas, which in turn allows us to refer to prep formulas. The preference structure of Boolean games with costs makes it possible to distinguish between hard and soft prep sets. The hard prep sets of a game are sets of valuations that would be prep sets in that game no matter what the cost function of the game was. The properties defined by hard prep sets typically relate to goal-seeking behaviour, and as such these properties cannot be eliminated from games by, for example, taxation or subsidies. In contrast, soft prep sets can be eliminated by an appropriate system of incentives. Besides considering what can happen in a game by unrestricted manipulation of players’ cost function, we also investigate several mechanisms that allow groups of players to form coalitions and eliminate undesirable outcomes from the game, even when taxes or subsidies are not a possibility. (shrink)

En este trabajo analizo el surgimiento de las nuevas tecnologías de subjetivación farmacopornográficas como productos de un cambio en los esquemas de organización y resistencia inmunológica experimentados en los cuerpos sociales desde mediados del siglo XX, y que supone la neutralización técnica de la otredad inmunológicamente efectiva paralelo al desmoronamiento de la estructura y la semántica social dada la conformación de las espumas individualistas. Para ello, analizo los efectos somatopolíticos de un corpus representativo de dichas tecnologías de subjetivación: la Píldora (...) Anticonceptiva, el Viagra y PReP. (shrink)

The present study analyzes the English diaries written by a young Chinese English as a foreign language learner over a 1-year period in an attempt to determine the developmental process of Chinese EFL young learners’ written language in terms of syntactic complexity. This study aimed to use a wide range of metrics to explore densely collected data based on Dynamic Systems Theory. The longitudinal study data were analyzed through eight large-grained measures related to sentential, clausal, and phrasal features by using (...) L2 Syntactic Complexity Analyzer, as well as fine-grained measures related to seven modifiers, an adjective placed before a noun, ordinal numerals are indicated, cardinal numeral, predicative adjective, adverbial adjective, adverbs, prepositional phrases, subordinate, and relative clause, through manual annotations. The results show that, first, the developmental process was not linear but spiral in terms of large-grained measures. The sentential level varied, and the development process of the young learner is different from Chinese English learners studying in colleges. Second, the dynamic features of fine-grained measures are also prominent in the seven indicators. ADJA, PREP, and REL showed a steady increase, ADJP showed an obvious decline, while ADV and SUB first increased and then declined. Third, the correlation analysis revealed a competitive interaction within fine-grained measures and between large-grained and fine-grained measures. (shrink)

This paper reports of a case where a physician conscientiously objected to prescribing PrEP to a bisexual patient so as not to “enable immoral sexual behavior.” The case represents an instance of conscience creep, a phenomenon whereby clinicians invoke conscientious objection in sometimes objectionable ways that extend beyond the traditional contexts of abortion, sterilization, or physician aid in dying. This essay uses a reasonability view of conscientious objection to argue that the above case represents a discriminatory instance of conscience (...) creep that should not be permitted. (shrink)

Leveling the Playing Field examines the admissions policies of contemporary American colleges and universities in light of the assumption that enhancing the educational opportunities of lower-income and minority students would make American society more just. The book evaluates controversies about such issues as the nature of merit, the missions of universities, affirmative action, the role of standardized tests, legacy preference, early decision, financial aid, the test-prep industry, and athletics.

The family of a patient who is unconscious and respirator-dependent has made a decision to discontinue medical treatment. The patient had signed a donor card. The family wants to respect this decision, and agrees to non-heart-beating organ donation. Consequently, as the patient is weaned from the ventilator, he is prepped for organ explantation. Two minutes after the patient goes into cardiac arrest, he is declared dead and the transplant team arrives to begin organ procurement. At the time retrieval begins, it (...) is not certain that the patient's brain is dead or that cardiac function cannot be restored. Procurement follows uneventfully, and two transplantable kidneys are retrieved. (shrink)

Simple Mandarin Chinese texts translated into Update with Centering. Notes toward a directly compositional fragment of Mandarin Chinese, combining Categorial Grammar with Update with Centering, to appear in Bittner (in prep.) "Temporality: Universals and Variation".

The family of a patient who is unconscious and respirator-dependent has made a decision to discontinue medical treatment. The patient had signed a donor card. The family wants to respect this decision, and agrees to non-heart-beating organ donation. Consequently, as the patient is weaned from the ventilator, he is prepped for organ explantation. Two minutes after the patient goes into cardiac arrest, he is declared dead and the transplant team arrives to begin organ procurement. At the time retrieval begins, it (...) is not certain that the patient's brain is dead or that cardiac function cannot be restored. Procurement follows uneventfully, and two transplantable kidneys are retrieved.Many people now consider such cases of non-heart-beating organ donation to be ethically permissible. However, widespread disagreement persists as to how such practices are to be justified and whether such practices are compatible with the Uniform Declaration of Death Act. In this paper, I argue that non-heart-beating organ donation can be ethically justified, that in the justified cases the patients are in fact dead, and that the early declarations of death required for such donation do comply with the UDDA. (shrink)

The effectiveness of antiretroviral regimes (ARVs) to reduce risk of HIV transmission from mother to child and as post-exposure prophylaxis has been known for almost two decades. Recent research indicates ARVs can also reduce the risk of HIV transmission via sexual intercourse in two other ways. With pre-exposure prophylaxis (PrEP), ARVs are used to reduce risk of HIV acquisition among persons who are HIV negative and significantly exposed to the virus. With treatment as prevention (TasP), ARVs are used to (...) reduce risk of HIV transmission from persons who are already HIV positive. The development of these new prevention strategies raises a rationing problem: given the chronic shortage of ARVs for HIV-infected persons in need of treatment, is it ethically justified to allocate ARVs for PrEP and/or TasP? This article examines the intuitively appealing view that allocation of ARVs for treatment should be the highest priority, the use of ARVs for TasP should be a secondary priority, and that utilizing ARVs for PrEP would be unethical. I will argue that selective, evidence-based allocation of ARVs for prevention in certain cases could be ethically justified even when there is insufficient anti-retroviral access for all those needing it for treatment. (shrink)

“Almost every time somebody gives me a present, it ends up making me sad.”J. D. Salinger’s tale of juvenile weltschmerz, The Catcher in the Rye,1 portrays a personal psychology of youthful disillusion. Holden Caulfield, the novel’s narrator and antihero, embarks on an existential odyssey in New York City after being drummed out of his fourth private prep school for failing grades.Smart and resourceful enough when the occasion requires, Holden is disgusted with virtually everything and everyone around him. By maintaining (...) a negative attitude, he excuses himself in his own mind from doing anything potentially disappointing—it is all futile and pointless anyway. Holden thereby cultivates an attitude that prevents him.. (shrink)

This issue of the Kennedy Institute of Ethics Journal offers essays about risk, social values, and how to act in the face of risk, especially when our risk assessments are socially freighted. It is made up of two clusters of related papers.The first cluster consists of two papers that explore the ways in which our risk assessments are shaped by moral panic around HIV, and its accompanying legacy of fear, homophobia, and stigma. These papers take up ethical and social dimensions (...) of PrEP and of blood donation in the face of social and medical policies based on risk distortions.The second cluster of papers is a back-and forth exchange in response to... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:To Cut or Not to Cut?That is the QuestionTracy WilsonWhat is circumcision? In simple terms, it is the removal or excision of the foreskin of the penis. Seems so simple, right? In some families, it is that simple. In other families, it is a religious exercise. I am a doctorally-prepared Family Nurse Practitioner and started my nursing career in the NICU. I have seen my fair share of circumcisions. (...) As a nurse, our role was to prep the room with whichever instrument the OB/GYNS preferred and then soothe the baby. Some OB/GYNS prescribed Sucrose, which is ultimately sugar water, for the babies to have while undergoing circumcision, while others wouldn't prescribe anything. What I learned in the NICU and by watching circumcisions being performed was that the doctor's preference determined the pain management protocol. Some doctors cared more about pain control, some cared [End Page 85] about presentation and ensuring the foreskin was cut properly, and some were just old school and had their preferences. I wanted to comfort the baby and make his world as comfortable as possible.Watching circumcisions being performed, I never formed an opinion about them. I really looked at circumcision like any other procedure. However, I did see some parents really toil over the decisions, especially fathers who did not want to "see their son tortured or mutilated like that" as one told me once. I didn't quite understand the comparison to mutilation, but I understood why he did not want his son to go through the procedure. It wasn't until years later that I understood the gravity of the decision when I became pregnant with our son and knew immediately it was a boy. Call it a mother's intuition, but I just knew. To circumcise my son was never a decision I had to deliberate very long because it was something I was accustomed to in my family. It wasn't until one of my relatives got married and had her first son that I became aware that this would ever be a weighty decision for someone in my family.I took it for granted all those years before working in the NICU because circumcision was superficial to me. I realized that it's not just a piece of foreskin to many people. For some circumcision is done for religious reasons, for others making the choice to circumcise is about sameness, or hygiene. For my extended family member, it happened to be about sameness. She didn't want her sons to look different from their dad. Since potty training was mostly going to be taught by their father, they wanted their sons to look like him. Many NICU parents told me they wanted their sons to look like their fathers, so this notion was familiar to me. After my extended family member explained why sameness mattered, I understood the reasons why some parents felt this way.There are other stories like this which we pondered upon when we got pregnant with our son, and I really began to reflect on whether we should circumcise or not. Then two additional frames of thoughts arose; one, I ensured that my husband and I jointly made the decision together, but I really leaned on him for his opinion because he was a male and most of the male teaching would come from him. Second, we considered if the decision to circumcise should come from him once he became an adult. His father and I discussed whether he should have a choice regarding being circumcised. He may have chosen a different decision than us and we didn't want to take away his right to choose. However, waiting to have a circumcision as an adult comes with its own sets of challenges, including the possibility of infection, increased pain, missed work, edema, etc. So, ultimately, we made the decision to go ahead with the circumcision.In our case, our pediatrician performed the circumcision. I asked him explicitly which instrument he used because I had my preference, and I was not going to allow my son to be circumcised by a healthcare professional that did not use my... (shrink)

With the world grappling with continued spread of monkeypox internationally, vaccines play a crucial role in mitigating the harms from infection and preventing spread. However, countries with the greatest need - particularly historically endemic countries with the highest monkeypox case-fatality rates - are not able to acquire scarce vaccines. This is unjust, and requires rectification through equitable allocation of vaccines globally. We propose applying the Fair Priority Model for such allocation, which emphasizes three key principles: 1) preventing harm; 2) prioritizing (...) the disadvantaged; and 3) treating people with equal moral concern. Post-exposure prophylaxis (PEPV) has the most potential to mitigate harm, and so ensuring countries have sufficient supply for PEPV should be the first priority. And historically endemic countries, which face disadvantages that compound potential harms from monkeypox, should be the first recipients of such vaccines. Once sufficient supply is allocated for countries to apply PEPV, global allocation could move on to pre-exposure prophylaxis (PrEP), again prioritizing historically endemic countries first before distribution to the rest of the global community, based on projected number of cases and vulnerability to harm. (shrink)

What is it to be a better ape? This is the question Victor Kumar and Richmond Campbell ask in their book on the evolution of the moral mind, an ambitious story that starts with the common ancestor of the modern apes—humans, chimpanzees, bonobos, gorillas, and orangutans. Of all of us, it’s the humans who remain in the running for being a better ape, because we’re the ones who have all the necessary ingredients: the binding emotions of sympathy and loyalty which (...) we share with our nonhuman cousins, but also the collaborative emotions of trust and respect and the reactive emotions of guilt and resentment. Importantly, only humans are thought to have norms, and to be biologically prepared to learn norms. For Kumar and Campbell, the co-evolution of emotions and norms is what set humans on this path so we can become a better ape. -/- The story they tell is artfully woven from major theories in psychology and anthropology, and those of us who have pre-existing opinions about these theories have points where we can quibble regarding the nature of the emotions–whether only humans imitate, what norms of fairness amount to, or whether any other species are generalists who can survive in a wide range of habitats. Rather than focusing on these, I want to turn to an exciting hypothesis Kumar and Campbell propose about the evolution and function of norms. While it is most common to think that norms helped our ancestors solve the collective action problems that emerged when larger groups of individuals started living together, Kumar and Campbell suggest a different, though complementary, function for norms. They propose that norms provide a more precise and flexible means for coordinating behavior in quickly changing societies. On their view, it isn’t the size of community that is the most significant variable, but rather the speed at which culture evolves. -/- That norms are a human universal is indubitable. Our contemporary human societies are rife with rules constraining our behaviors, governing aspects of our lives from birth to death, prescribing practices about what to wear, how to work, what to eat, when and how to sleep as well as rules about rare practices that are proscribed. However, Kumar and Campbell also presume that norms are human unique. Here I have more than a quibble, given the burgeoning empirical and theoretical literature on the question of animal normativity (Andrews 2020; Danón 2019; Fitzpatrick 2020; de Waal 2014; von Rohr et al. 2011; Rohr et al. 2015; Whiten et al. 2005; Westra et al., in prep)... (shrink)

This dossier article contains four short and varied contributions from activists and other service and healthcare providers who have been agitating and working on the frontlines of HIV/AIDS in Ireland since the early 1980s. The dossier contains: (1) a history, by Bill Foley, of the early collective efforts of a group of gay men to provoke government action and healthcare under the umbrella of Gay Health Action (GHA) (2) a speech delivered by Dr. Erin Nugent to government officials on the (...) re-branding of HIV Ireland in 2015; (3) a brief history, recounted by Noel Donnellan, of ACT UP Dublin since it was revitalized in 2016 by a small cohort of dedicated activists from a dormant group into a vibrant collective that has achieved great legislative change with regards to pre-exposure prophylaxis (PrEP); and (4) a polemic, written by Thomas Strong, on living with HIV as a queer man in Ireland that demonstrates the ways in which HIV stigma not only thrives in but molds and shapes twenty-first-century gay men’s communities, both in real life and online. (shrink)