Occasionally, doctors and health providers have to choose whom they save from death and this is an extremely hard decision to take. Here, I work on what I deem to be a crucial caveat: scarcity of resources should never be used as an alibi for bad, and sometimes wicked, public policies. In other words, if scarcity is somewhat produced or at least induced, it should never serve as a pretext to put the blame or the responsibility on (...) medical doctors, nurses and other people who are at the front of the war against COVID-19. During the COVID-19 pandemic, an ethical question was often raised: if resources are scarce (and they often have been), whom should you prioritize? Should we protect first of all those who are young and can then have a long life before them? Or should we rather prioritize those who have rendered important services to health, or broadly to mankind, and could, therefore, bring other good results to society? This discussion is of course important, but it leaves aside something more fundamental: the fact that resources are not simply scarce, they have been made scarce in the last years by a series of public policies nourished by an economic view that sacrificed social welfare on behalf of neoliberal beliefs. (shrink)

This paper addresses two ways in which scarcity in health care turns up and three ways in which this dual condition of scarcity can be approached. The first approach is the economic approach, which focuses on the causes of cost-increase in health care and on developing various mechanisms of rationing and priority-setting in health care. The second approach is the justice approach, which interprets scarcity as one of the Humean ‹Circumstances of Justice.’ Whereas these approaches interpret (...) class='Hi'>scarcity as a given fact, the third approach casts doubt on this interpretation. Rather, it interprets scarcity as a social, anthropological, and technologically induced construction of Modernity. This paper supports the theories of Hans Achterhuis, Ivan Illich, and Nicholas Xenos but also further elaborates their views with regard to health care by offering an approach to scarcity that interprets it as an economic translation of finitude. I argue that this approach, which entails a contemporary revaluation of the ancient Socratic attitude on human life and finitude, will be better able to deal with the pressing contemporary issues of setting limits on health care because it mitigates contemporary health care’s tendency toward infinity in meeting – and creating – health care needs. (shrink)

Poverty is associated with a wide range of counterproductive economic behaviors. Scarcity theory proposes that poverty itself induces a scarcity mindset, which subsequently forces the poor into suboptimal decisions and behaviors. The purpose of our work is to provide an integrated, up-to-date, critical review of this theory. To this end, we reviewed the empirical evidence for three fundamental propositions: Poverty leads to attentional focus and neglect causing overborrowing, poverty induces trade-off thinking resulting in more consistent consumption decisions, and (...) poverty reduces mental bandwidth and subsequently increases time discounting and risk aversion. Our findings indicate that the current literature predominantly confirms the first and second proposition, although methodological issues prevent a firm conclusion. Evidence for the third proposition was not conclusive. Additionally, we evaluated the overall status of scarcity theory. Although the theory provides an original, coherent, and parsimonious explanation for the relationship between financial scarcity and economic decision making, the theory does not fully accord with the data and lacks some precision. We conclude that both theoretical and empirical work are needed to build a stronger theory. (shrink)

continent. 1.1 (2011): 22-25. The Author gratefully acknowledges the financial support of CAPES (Coordenação de Aperfeiçoamento do Ensino Superior), Brazil. From the multifarious subdivisions of semiotics, be they naturalistic or culturalistic, the realm of semiotics of value is a ?eld that is getting more and more attention these days. Our entire political and economic systems are based upon structures of symbolic representation that many times seem not only to embody monetary value but also to determine it. The connection between monetary (...) and linguistic exchanges is self-evident: the former requires the latter and develops in direct relation to it. Creative experimentation and design of digital systems of value exchange are blossoming on the web. Dr. Gilson Schwartz, an economist turned media theorist and professor at the University of São Paulo, adopted the concept of Iconomics, originally created by Michael Kaplan, an author concerned with the linguistics of economic value. Empowering local communities and unlocking new levels of value creation and representation via digital technologies are the main goals of Dr. Schwartz’s projects, aiming at the re-designing of our relationship to the economic value of imagination and the social control of property. Schwartz is Assistant Professor at the School of Communication and Arts of the University of São Paulo, a former Chief Economist at BankBoston, Brazil and Advisor to the President of the National Social and Economic Development Bank (BNDES). FURTHER READING: Kaplan, Michael. “Iconomics: The Rhetoric of Speculation.” Public Culture . 15.3 (2003): 477-493. Renata Lemos-Morais: You have recently produced and directed a short documentary about Creative Currencies in Latin America. Could you tell us a bit about its process and its findings? Gilson Schwartz: The “Creative Currencies” project is a work-in-progress platform which unfolds as an action research agenda connected both to the production of audiovisual content and the development of social currency software. The initiative dates back to 2003 when I led an experimental project supported by the Presidency of Brazil. At that time, we issued paper currency in a small, touristic village in the Northeast Region which stimulated local cultural projects. But it was only in 2009 that the Central Bank of Brazil acknowledged “social currencies” as a legitimate economic agenda, calling for more debate at the I Financial Inclusion Forum. This year, the monetary authorities organized a second forum that also opened the room to discussions on mobile payment systems and new perspectives on poverty alleviation via State subsidies. The Ministry of Culture funded the “Creative Currencies” project in 2009-2010 and our next stage in this discovery process is to be supported by the National Social and Economic Development Bank (BNDES). In short, there is genuine interest among public officials in different areas and public funding for social currencies is on the rise in Brazil. However, after all these years we are still at a very early stage of research and practice. Some of the most successful initiatives (such as Banco Palmas) actually evolved out of local monetary creation to become correspondent banking operations for commercial banks and other financial groups. After eight years of price stability and social inclusion, Brazil stands out as a major opportunity for social experimentation, even the Grameen Bank is now entering the Brazilian market and many NGOs are geared towards different forms of entrepreneurialism in the base of the pyramid, riding solidarity economic models, microfinance and microcredit for local development. It is yet to be seen, however, whether these developments are just one more stage of “bankarization”, that is to say, an extension of regular banking services or actually a new form of social and symbolic self-determination at the local level. So far, the Central Bank of Brazil is open to new forms of credit and local finance as long as they are strictly territorial and very close to barter among the poor. In other words, whether the process of monetary creation could be made to fit an open source paradigm is yet to be seen. Community banking and social currencies might as well end up as just another channel for access to and use of banking services. The “Creative Currencies” project aims at promoting the discussion of more fundamental issues, such as the limits of central banking, the prospects for local financial development and the possibility of creating and managing financial icons as cultural assets. The purpose of this project is to produce short documentaries that will bear testimony to this evolving regulatory framework while inducing more discussion about the fundamental iconomic issues concealed in the process of money and wealth creation. RLM: What new potential is there in applying digital technologies to currency creation? GS: Globalization is a result of the virtualization of money, that is, the overcoming of illusions such as the “gold standard”. Money is an icon created by institutions, not on supposedly natural or material foundations but out of political and financial interests. The “dollar standard” is an outstanding evidence of this phenomenon and Kaplan´s paper, the first to use the expression “iconomics”, insists on the rhetoric and semiotic effects associated to a supposedly scientific model of money creation and management. This is a fundamental change that was perceived and discussed much before the digitalization of the world by unorthodox economists such as John Maynard Keynes since the early 20th century. The digitalization of global financial flows accelerated this immateriality and the creation of the Euro was yet another evidence of the political foundations of currencies. The banking establishment, however, is keen on the idea that scientific formulae hold the key to sound money creation. Keynesianism has been repeatedly associated to “inflationism” while the supposedly sound monetary policies of the Orthodoxy serve well the political and financial interests of a technocratic elite. Corporate media also serve this fictitious depiction of the monetary process despite the cyclical bust of monetary rules and financial regulations. The internet, however, has created numerous opportunities for the disintermediation in industries such as film, music and commodities. There is no reason to doubt that the financial industry can also be transformed by Peer-to-Peer (P2P) infrastructures. Money is media as well. Credit is but confidence. Once people realize that the distributed computing power of networks can also be the platform to weave new monetary and credit operations, there is room for grassroots emancipation out of the established owners of monetary institutions. So far, however, there has been a privatization of monetary management and there is not a clear path or model for the emergent (P2P) property democratization that is inherent to the internet. Digital assets, however, clearly have an inherent potential to escape central control and proprietary regulatory frameworks. RLM: How are social networks transforming the ways in which we exchange value? Do you believe that online influence and reputation might be translated into a new kind of currency? GS: The foundation for social currencies as envisaged by solidarity economics is the territory. Authorities are willing to concede local monetary creation as long as it is restricted to poor neighborhoods, as a proxy to barter. In this relevant but limited context, reputation, personal knowledge and informal ties form the matrix of local or “proximity” finance which are expected to keep credit and leverage to a sustainable level. Anything beyond that should and would lead to an integration of local finance into the established banking system. However, inasmuch as the internet promotes virtual territories and reputation is now subject to all sorts of digital manipulation and stardom becomes an everyday cultural process among teenagers and elders alike, the territorial “foundation” is substituted for more complex patterns of solidarity, cooperation and exchange that reach beyond the physical territory and even the “human.” Digital assets embody knowledge, technology, cultural and educational values that are exchanged at a global scale beyond the control of democratic States (Chinese-like intervention is the exception, not the rule). Hacktivism is unstoppable and so is monetary hacktivism. Especially in the Third World, mobile communications fast became conveyors of money transfers and other appropriation strategies. Banking and telecom sectors already battle for the control of these emerging markets and, as a matter of fact, have so far contributed to the containment of these processes. Governments serve these moguls and have usually adopted a wait-and-see attitude. If open source hardware and grassroots social movements combine to challenge these proprietary battles, then social networks may evolve into new forms of social capital and thus form the ground on which to design and implement social currencies. The global financial crisis, as well as the dollar demise, are an event of such a proportion that social networks may open the path for emancipator subjects to seize the opportunity. RLM: What are some of the social experiments that you think are revolutionizing the way in which value is exchanged? GS: There is a broad evolution of economic systems towards the valuation of intangible assets such as knowledge, reputation and sustainability. There are many examples of local as well as global events that call the traditional systems of exchange into question, from carbon credits to educational bonuses, digital barter frameworks and locally based solidarity and fair trade networks. These emerging examples, no matter how different in nature or scale, represent a challenge to the traditional value creation schemes and theories which are based on use and exchange value, supply and demand. This is not to say that utility and labour or scarcity are to be totally dismissed, but there is now an emerging perception that value is also a function of behavioral codes, symbolic patterns and the energy of institutional frameworks. The plasticity of digital platforms is relevant insofar as intellectual property becomes the central source of value creation. But when you discuss the property rights of public goods such as the environment or basic social rights (of minorities or localities), then a new paradigm seems to emerge. RLM: Are gaming and online storytelling digital practices that might have an impact on the way new currencies are created and developed? GS: “Play money” has been one of the early and most intriguing phenomena associated to the diffusion of virtual worlds. These virtual currencies have also been prone to “boom and bust” dynamics, speculation and pure theft (Second Life scams were common and led to “intervention” by the owners of the game). Storytelling is a major source of value, that is, the value of attention and the markets for audience. There are plenty of private monies created and managed by corporate entertainment groups, telecom operators (via mobile virtual network operators) and marketing frameworks. The casino economy, as already depicted by Keynes and other unorthodox economists, is always storytelling about future states of the world, confidence building and leverage of animal spirits. The novelty of current events is not the fictitious nature of any form of capital, but the potential for digital democratization of controls over the imaginary nature of value creation. But this is just a potential, a possibility, a figment that more often than not is appropriated by centralized and opaque private powers. The game industry is a testbed for new connections between storytelling and money creation. RLM: Monetary value was originally connected to the scarcity of precious metals, such as gold. Our entire monetary system seems therefore to function according to a logic of scarcity. Do you believe it is possible to reverse this logic into a logic of abundance? GS: The gold standard was a fiction itself, the “scarcity” is always produced by institutions that regulate confidence and access to credit. The key issue is not to fabricate abundance, but to question the institutions which produce scarcity out of any standard, gold or whatever. Central banks are at the service of private banks in the creation and management of scarcity. RLM: The promise that nanotechnology holds for our future is one of radical abundance (or so say transhumanists). The possibility of creating any kind of material substance through nanoengineering seems each day more feasible. What would this possibility entail in terms of systems of value exchange? GS: Nanotechnology, environmental concerns and grassroots appropriation of distributed knowledge are the frontiers of a new horizon of energy creation and management. Social groups in charge of managing scarcity for the sake of wealth and power concentration must be held accountable for the destruction of our future. Once this key political conundrum is accounted for, new systems of value exchange and even a non-mercantile society will come into existence. Revolutionary theorists such as Marx envisaged transformation via the extreme clash of contradictions between capital and labour. This approach has never led to a change in the systemic logic of scarcity for the sake of social control. We are once again facing the threshold of large scale societal change, but the outcome of the current crisis should come from our imagination, not from yet another paradox of abundance and scarcity. As long as we remain attached to the materiality of value, the illusion of freedom will but reinforce the massive manipulation of necessity. RLM: What do you think is the role of crowdfunding in this context? GS: Crowdsourcing as well as crowdfunding are examples of the peer to peer opportunities that come along with distributed computer power. However, the power structure behind wealth and scarcity creation may or may not be changed by crowd management. But it should not be taken at face value, so to speak. The stock market of course is an early form of crowdfunding without calling into question the proprietary framework of the companies offering their investment projects to the market. Any market is a form of crowdsourcing, that is to say, of distributed forms of supply and demand matchmaking. The wealth of networks, however, depends on the contractual ecosystem, the institutional framework, the channeling of social imagination, not on the purely quantitative distribution of bids and offers. I see economics as supply, demand and code. Once you have access to the code, once openness becomes part of the game, then there is a chance of crowd behavior becoming collective intelligence and sustainable imagination. RLM: Is the development of digital currencies headed towards a pluralistic ecology in which many micro currency systems co-exist, or is it penetrating the mainstream monetary system? If it is affecting the mainstream financial system, what would be its effect in the long-term? GS: The same issue is at stake both at local and global levels. The global system is, as a matter of fact, an unstable ecosystem of “micro currencies” whereas the dollar has so far exerted an overwhelming influence. Local currencies and private monies coexist with national currencies only to the extent that the Central Bank admits, for instance, that grassroots monetary emissions remain territorial and strictly connected to poverty. However, the question of how new developments in digital technologies and nanotechnologies might alter not only our current monetary systems but also our understanding of value in itself, is still an open question. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

G.A. Cohen criticizes Rawls’s account of justice because his difference principle permits inequalities that reflect the relative scarcity of different skills and natural abilities. Instead of viewing the ‘basic structure’ as the primary subject of justice, Cohen argues that individual citizens should cultivate an egalitarian ethos, which would enable a just society to dispense with the use of incentive payments to induce individuals to use their talents in socially ideal ways. This study examines Cohen’s critique, including his rejection of (...) ‘incentives,’ and vindicates Rawls’s approach. Ultimately, Cohen’s argument fails to grapple with the moral pluralism that characterizes modern, democratic societies, whereas Rawls’s theory is constructed to accommodate such pluralism. (shrink)

Economists since the First Industrial Revolution have been interested in the links between economic growth and resources, often pointing to resource scarcities as a hindrance to growth. Offering a counter perspective, this volume highlights the positive role that scarcities can play in inducing technical progress and economic growth. It outlines a structural framework for the political economy of scarcity and rents, and offers a novel way of organizing the evidence concerning the role of resources in industrial growth. This book (...) proposes a major shift in the treatment of scarcity issues by focusing on bottlenecks and opportunities arising within the production system, and will appeal to economists and policy makers interested in the role of resources as triggers of structural change. (shrink)

Using computer simulations I studied the simultaneous effect of variable environments, mutation rates, ploidy, number of loci subject to evolution and random and assortative mating on various reproductive systems. The simulations showed that mutants for sex and recombination are evolutionarily stable, displacing alleles for monosexuality in diploid populations mating assortatively under variable selection pressure. Assortative mating reduced excessive allelic variance induced by recombination and sex, especially among diploids. Results suggest a novel adaptive value for sex and recombination. They show (...) that the adaptive value of diploidy and that of the segregation of sexes is different to that of sex and recombination. The results suggest that the emergence of sex had to be preceded by the emergence of diploid monosexual organisms and provide an explanation for the emergence and maintenance of sex among diploids and for the scarcity of sex among haploid organisms. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS I. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[i] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[ii] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. II. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[iii] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[iv] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[v] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[vi] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[vii] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[viii] In democratic societies, one must take into consideration community morals and values.[ix] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[x] III. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[xi] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[xii] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[xiii] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[xiv] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. IV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[xv] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[xvi] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[xvii] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[xviii] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[xix] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[xx] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[xxi] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. VI. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[xxii] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[xxiii] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[xxiv] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. VII. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [i] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [ii] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [iii] Moss, p. 1295-1298. [iv] Moss, p. 1296. [v] Moss, p. 1295-1298. [vi] Moss, p. 1295-1298. [vii] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [viii] Cohen, p. 1299-1301. [ix] Moss, p. 1297. [x] Cohen, p. 1300. [xi] Cappelen, p. 478-480. [xii] Cappalen, p. 478-480. [xiii] Cappelen, p.479. [xiv] Cappelen, p. 479. [xv] Cappelen, p. 479 [xvi] Cohen, p. 1301. [xvii] Cappelen, p. 478. [xviii] Cohen, p. 1299-1301. [xix] Cohen, p. 1301. [xx] Cappelen, p. 476-480. [xxi] Cappelen, p. 476-480. [xxii] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [xxiii] Kawachi, p. 18-33. [xxiv] Kawachi, p. 18-33. (shrink)

Survivors of the Black Death confronted a world changed very much for the worse, or so we often say when ignoring nuance. There is no denying that many chroniclers wrote from a situation of real anxiety about an uncertain future. Many locales felt the effects of severe wage inflation and dramatic price fluctuations, some work regimes intensified, social mobility increased, and the utility of traditional safety nets failed to provide against localized food scarcity. Nevertheless, we should view with caution (...) descriptions of plague-induced economic and social dislocation leading to anarchy and decadence, which can become colorful exaggerations, especially when buboes and piled bodies get added to the narrative mix. In recent years many researchers have begun to confront the overload of stereotypes about postplague living to which a human inclination to prurience and some vast historical lacunae have led us. Edwin Hunt, James Murray, and others have found men and women in late-medieval Europe seizing latent economic opportunities in the midst of their difficult circumstances, stimulating producer innovations and encouraging a consumption boom. The medical practitioners studied by Jon Arrizabalaga and John Henderson did not surrender to the defeatism often ascribed to them. And despite the evidence that social stress made room for extremism—flagellant self-abuse, attacks upon Jewish communities, urban riots and rebellions—in government and the world of custom pragmatic flexibility insulated foundational institutions against radical upheaval. Important continuities bridged the pre- and postplague eras. Plague epidemiology has also grown more complex in response to a keener understanding of the morphology of disease agents and the historical shaping of disease categories. (shrink)

Because of the impact of close partner's touch on psychological and physical well-being by alleviating stress, it is important to explore the influence factors that underlie the stress-alleviating effect of close partner's touch. Previous studies suggested that the stress-alleviating effect was different when individuals were touched by different persons. Specifically, the stress was reduced significantly when the individual was touched by the close partner compared with the acquaintance and the stranger. However, whether the stress-alleviating effect of touch was modulated by (...) the close relationship quality is unknown. To examine this question, the participants performed a 3 × 2 within-subjects experiment. The results revealed that the stress of the participants alleviated significantly while close partners present with touch compared with without touch during facing a threat. We also found that the relationship quality of couple-members modulated touch-induced stress alleviation. Participants perceiving the low quality of alternatives and the high partners' commitment level showed stronger touch-induced stress-alleviating effect than participants perceiving the high quality of alternatives and the low partners' commitment level. The explained variance was around 16.8% jointly for actor and partner effects. These findings provide evidence for explaining the reasons for touch-induced alleviating stress and have important implications for predicting the future effect of interactive behaviors. (shrink)

BackgroundIt has been well investigated that nature exposure intervention can restore directed attention and improve subsequent cognitive performance. The impairment of decision-making skills in mentally fatigued soccer players was attributed to the inability of attention allocation. However, nature exposure as the potential intervention to counter mental fatigue and improve the subsequent decision-making skill in soccer players has never been investigated.ObjectsThis study aimed to evaluate the effects of nature exposure intervention on decision-making skills among mentally fatigued university soccer players. Moreover, different (...) durations of nature exposure were also evaluated.MethodsA random control between-subject design was adopted. Players were randomly assigned into six groups with three different durations of the experimental group compared with the corresponding control group. All players were first mentally fatigued by performing a 45-min Stroop task; then, they viewed virtual photos of natural or urban scenes; and finally, they performed a soccer decision-making task.ResultsThe subjective ratings of mental fatigue were significantly higher following the Stroop task. Only Exp 3 significantly improved decision-making reaction time compared with Con 3. Moreover, the accuracy slightly increased in Exp 3 after the intervention.ConclusionIn line with attention restoration theory, nature exposure significantly improved decision-making skills in mentally fatigue university players. However, the duration must be 12.50 min for each stimulus to stay longer to attract involuntary attention. (shrink)

BackgroundThe measures taken to contain the coronavirus disease 2019 pandemic, such as the lockdown in Italy, do impact psychological health; yet, less is known about their effect on cognitive functioning. The transactional theory of stress predicts reciprocal influences between perceived stress and cognitive performance. However, the effects of a period of stress due to social isolation on spatial cognition and exploration have been little examined. The aim of the present study was to investigate the possible effects and impact of the (...) COVID-19 pandemic on spatial cognition tasks, particularly those concerning spatial exploration, and the physiological leftward bias known as pseudoneglect. A right-hemisphere asymmetry for spatial attention processes crucially contributes to pseudoneglect. Other evidence indicates a predominantly right-hemisphere activity in stressful situations. We also analyzed the effects of lockdown on coping strategies, which typically show an opposite pattern of hemispheric asymmetry, favoring the left hemisphere. If so, then pseudoneglect should increase during the lockdown and be negatively correlated with the efficacy of coping strategies.MethodsOne week before the start of the lockdown due to COVID-19 in Italy, we had collected data from a battery of behavioral tests including tasks of peri-personal spatial cognition. During the quarantine period, from late April to early May 2020, we repeated the testing sessions with a subgroup of the same participants. At both testing sessions, participants performed digitized neuropsychological tests, including a Cancellation task, Radial Arm Maze task, and Raven’s Advanced Progressive Matrices. Participants also completed a newly developed COVID-19 Student Stress Scale, based on transactional models of stress, and the Coping Orientation to Problems Experienced—New Italian Version to assess coping orientation.ResultsThe tendency to start cancelation from a left-sided item, to explore first a left-sided arm of the maze, and to choose erroneous response items on the left side of the page on Raven’s matrices increased from T1 to T2. The degree of pseudoneglect increment positively correlated with perceived stress and negatively correlated with Positive Attitude and Problem-Solving COPE-NIV subscales.ConclusionLockdown-related stress may have contributed to increase leftward bias during quarantine through a greater activation of the right hemisphere. On the other hand, pseudoneglect was decreased for better coping participants, perhaps as a consequence of a more balanced hemispheric activity in these individuals. (shrink)

BackgroundThere are limited sensitive evaluation methods to distinguish people’s symptoms of peripheral fatigue and central fatigue simultaneously. The purpose of this study is to identify and evaluate them after acute exercise with a simple and practical scale.MethodsThe initial scale was built through a literature review, experts and athlete population survey, and a small sample pre-survey. Randomly selected 1,506 students were evaluated with the initial scale after exercise. Subjective fatigue self-assessments were completed at the same time.ResultsThe Acute Exercise-Induced Fatigue Scale (...) was determined after performing a factor analysis. In the exploratory factor analysis, the cumulative variance contribution rate was 65.464%. The factor loadings of the total 8 questions were 0.661–0.816. In the confirmatory factor analysis, χ2/df = 2.529, GFI = 0.985, AGFI = 0.967, NFI = 0.982, IFI = 0.989, CFI = 0.989, and RMSEA = 0.048. The Cronbach’s alpha coefficient for the scale was 0.872, and it was 0.833 for peripheral fatigue and 0.818 for central fatigue. The intra-class correlation coefficient for the scale was 0.536, and the intra-class correlation coefficients for peripheral fatigue and central fatigue were 0.421 and 0.548, respectively. The correlation coefficient between the total score of the AEIFS and the SFSA score was 0.592.ConclusionOur results demonstrate that the AEIFS can distinguish peripheral fatigue and central fatigue and can also reflect their correlation. This scale can be a useful evaluation tool not only for measuring fatigue after acute exercise but also for guiding reasonable exercise, choosing objective testing indicators, and preventing sports injuries resulting from acute exercise-induced fatigue. (shrink)

While many publications have reported brain hemodynamic responses to decision-making under various conditions of risk, no inventory management scenarios, such as the newsvendor problem, have been investigated in conjunction with neuroimaging. In this study, we hypothesized that NP stimulates the dorsolateral prefrontal cortex and the orbitofrontal cortex joined with frontal polar area significantly in the human brain, and that local brain network properties are increased when a person transits from rest to the NP decision-making phase. A 77-channel functional near infrared (...) spectroscopy system with wide field-of-view was employed to measure frontal cerebral hemodynamics in response to NP in 27 healthy human subjects. NP-induced changes in oxy-hemoglobin concentration, Δ[HbO], were investigated using a general linear model and graph theory analysis. Significant activation induced by NP was shown in both DLPFC and OFC+FPA across all subjects. Specifically, higher risk NP with low-profit margins activated left-DLPFC but deactivated right-DLPFC in 14 subjects, while lower risk NP with high-profit margins stimulated both DLPFC and OFC+FPA in 13 subjects. The local efficiency, clustering coefficient, and path length of the network metrics were significantly enhanced under NP decision making. In summary, multi-channel fNIRS enabled us to identify DLPFC and OFC+FPA as key cortical regions of brain activations when subjects were making inventory-management risk decisions. We demonstrated that challenging NP resulted in the deactivation within right-DLPFC due to higher levels of stress. Also, local brain network properties were increased when a person transitioned from the rest phase to the NP decision-making phase. (shrink)

Transport of DNA across bacterial membranes involves complex DNA uptake systems. In Gram‐positive bacteria, the DNA uptake machinery shares fundamental similarities with type IV pili and type II secretion systems. Although dedicated pilus structures, such as type IV pili in Gram‐negative bacteria, are necessary for efficient DNA uptake, the role of similar structures in Gram‐positive bacteria is just beginning to emerge. Recently two essentially very different pilus structures composed of the same major pilin protein ComGC were proposed to be involved (...) in transformation of the Gram‐positive bacterium Streptococcus pneumoniae – one is a long, thin, type IV pilus‐like fiber with DNA binding capacity and the other one is a pilus structure that was thicker, much shorter and not able to bind DNA. Here we discuss how competence induced pili, either by pilus retraction or by a transient pilus‐related opening in the cell wall, may mediate DNA uptake in S. pneumoniae. (shrink)

Post-stroke depression is a serious complication of stroke that significantly restricts rehabilitation. The use of immersive virtual reality for stroke survivors is promising. Herein, we investigated the effects of a novel immersive virtual reality training system on PSD and explored induced effective connectivity alterations in emotional networks using multivariate Granger causality analysis. Forty-four patients with PSD were equally allocated into an immersive-virtual reality group and a control group. In addition to their usual rehabilitation treatments, the participants in the immersive-virtual (...) reality group participated in an immersive-virtual reality rehabilitation program, while the patients in the control group received 2D virtual reality rehabilitation training. The Hamilton Depression Rating Scale, modified Barthel Index, and resting-state functional magnetic resonance imaging data were collected before and after a 4-week intervention. rsfMRI data were analyzed using multivariate GCA. We found that the immersive virtual reality training was more effective in improving depression in patients with PSD but had no statistically significant improvement in MBI scores compared to the control group. The GCA showed that the following causal connectivities were strengthened after immersive virtual reality training: from the amygdala, insula, middle temporal gyrus, and caudate nucleus to the dorsolateral prefrontal cortex; from the insula to the medial prefrontal cortex; and from the thalamus to the posterior superior temporal sulcus. These causal connectivities were weakened after treatment in the control group. Our results indicated the neurotherapeutic use of immersive virtual reality rehabilitation as an effective non-pharmacological intervention for PSD; the alteration of causal connectivity in emotional networks might constitute the neural mechanisms underlying immersive-virtual reality rehabilitation in PSD. (shrink)

This article explores how both corporate governance and corporate social responsibility can be improved by using insights from complexity theory. Complexity theory reveals that decentralized governance architecture is required for firms to absorb competently the increased intricacies, variety of variables, and objectives introduced by CSR. The current predominant form of centralized governance based on command-and-control hierarchies copes with complexities by reducing data inputs. This approach results in firms reducing their objectives, concerns, and insights about CSR. Firms with a decentralized “network” (...) form of governance architecture are used to illustrate how the data inputs of each manager can be reduced through the decomposition of decision-making labor to improve the capability of the firm to intelligently absorb and manage complexity. Network governance also introduces a division of powers with stakeholders to facilitate information flow and strengthen incentives to manage the enterprise to enhance both shareholder value and CSR. (shrink)

It is often argued, most recently by Samuel Scheffler, that we should reconcile with our mortality as constitutive of our existence: as essential to its temporal structure, to the nature of deliberation, and to our basic motivations and values. Against this reconciliatory strategy, I argue that there is a kind of immortal existence that is coherently conceivable and potentially desirable. First, I argue against the claim that our existence has a temporal structure with a trajectory that necessarily culminates in an (...) ending. This claim is based on two false assumptions: that a life as a whole calls for narrative structure, and that narratives necessarily require closure as temporal endings. Second, I reject the proposal that temporal finitude is constitutive of the basic elements of diachronic agency, including the nature of deliberation and of our values. I argue that only finitude as scarcity of opportunities is constitutive of these elements. Additionally, scarcity might be present in an endless existence. Therefore, it is not incoherent to conceive of a recognizable and potentially desirable immortality that grounds the core features of diachronic agency. Thus, against the reconciliatory strategy, I conclude that we might never fully reconcile with mortality. Although we might embrace our inescapable mortality as essential to a fuller range of features of our existence, we can still justifiably regret our missing on an immortal existence. (shrink)

This paper discusses contemporary advancements in the affective sciences that can inform the music-emotion literature. Key concepts in these theories are outlined, highlighting their points of agreement and disagreement. This summary shows the importance of appraisal within the emotion process, provides a greater emphasis upon goal-directed accounts of behavior, and a need to move away from discrete emotion “folk” concepts and toward the study of an emotional episode and its components. Consequently, three contemporary music emotion theories are examined through a (...) skeptical lens. This critique highlights the over-reliance upon categorization and a lack of acknowledgment of appraisal processes, specifically goal-directed appraisal, in examining how individual experiences of music emerge in different contexts. Based on this critique of current music-emotion models, we present our skeptically informed CODA model - Constructivistly-Organised Dimensional-Appraisal model. This model addresses skeptical limitations of existing theories, reinstates the role of goal-directed appraisal as central to what makes music relevant and meaningful to an individual in different contexts and brings together different theoretical frameworks into a single model. From the development of the CODA model, several hypotheses are proposed and applied to musical contexts. These hypotheses address theoretical issues such as acknowledging individual and contextual differences in emotional intensity and valence, as well as differentiating between induced and perceived emotions, and utilitarian and aesthetic emotions. We conclude with a sections of recommendations for future research. Altogether, this theoretical critique and proposed model points toward a positive future direction for music-emotion science. One where researchers can take forward testable predictions about what makes music relevant and meaningful to an individual. (shrink)

In photoreceptors of a dark adapted eye, the inward flux of sodium and calcium ions in the outer segment is balanced by the outward flux of potassium ions. But in the presence of light the creation of cyclic guanosine monophosphate in the outer segment decreases. Due to low concentration of cG the channels in the outer segment open relatively less and thus the influx of calcium ion decreases, leading finally to hyperpolarization of the photoreceptors. We have analyzed theoretically the effect (...) of oxidizing iron ions on the photoreceptors. In order to explain the effects of iron-induced oxidative stress, the different molecules and ions involved in phototransduction are quantified leading to a differential equation for calculating the electroretinogram a-wave voltage. The theoretical results are compared with published experimental data. In the presence of light, the iron ions could push outward the similarly charged calcium ions resulting in a small increase in the amount of inward calcium flux. Again, the presence of iron ions generates Reactive Oxygen Species, and ROS could attract the calcium ions which also increases the calcium flux. This will result in a reduction in the amplitude and slope of the a-wave voltage in the electroretinogram. These results are parametrized in terms of calcium ion concentrations. As the amplitude of the a-wave shows how much electrical signal is produced, its reduction indicates reduction in the visual signal. Thus, the increase in iron ions could explain the reduction in the electrical signal due to iron-induced oxidative stress. (shrink)

Previously published studies have reported that 150 min of short-term monocular deprivation temporarily changes perceptual eye dominance. However, the possible mechanisms underlying monocular deprivation-induced perceptual eye dominance plasticity remain unclear. Using a binocular phase and contrast co-measurement task and a multi-pathway contrast-gain control model, we studied the effect of 150 min of monocular pattern deprivation in normal adult subjects. The perceived phase and contrast varied significantly with the interocular contrast ratio, and after MPD, the patched eye became dominant. Most (...) importantly, we focused on the potential mechanisms of the deprivation effect. The data of an averaged subject was best fitted by a model, which assumed a monocular signal enhancement of the PE after the MPD. The present findings might have important implications for investigations of binocular vision in both normal and amblyopic populations. (shrink)

Pain has not only sensory, but also emotional and cognitive, components. Some studies have explored the effect of pain on time perception, but the results remain controversial. Whether individual pain-related emotional and cognitive factors play roles in this process should also be explored. In this study, we investigated the effect of electrical stimulation–induced pain on interval timing using a temporal bisection task. During each task session, subjects received one of five types of stimulation randomly: no stimulus and 100 and (...) 300 ms of non-painful and painful stimulation. Pain-related emotional and cognitive factors were measured using a series of questionnaires. The proportion of “long” judgments of a 1,200-ms visual stimulus duration was significantly smaller with 300 ms painful stimulation than with no stimulus and 100 ms and 300 ms non-painful stimulation. The point of subjective equality did not differ among sessions, but the average Weber fraction was higher for painful sessions than for no-stimulus session. The pain fear score correlated positively with the PSE under 100 ms non-painful and painful and 300 ms painful stimulation. Pain catastrophizing and pain anxiety scores correlated significantly with the WF under no stimulus and 100 ms non-painful stimulation, respectively. These results suggest that electrical stimulation–induced pain affects temporal sensitivity, and that pain-related emotional and cognitive factors are associated with the processing of time perception. (shrink)

In this paper, we give an algebraic completeness theorem for constructive logic with strong negation in terms of finite rough set-based Nelson algebras determined by quasiorders. We show how for a quasiorder R, its rough set-based Nelson algebra can be obtained by applying Sendlewski’s well-known construction. We prove that if the set of all R-closed elements, which may be viewed as the set of completely defined objects, is cofinal, then the rough set-based Nelson algebra determined by the quasiorder R forms (...) an effective lattice, that is, an algebraic model of the logic E 0, which is characterised by a modal operator grasping the notion of “to be classically valid”. We present a necessary and sufficient condition under which a Nelson algebra is isomorphic to a rough set-based effective lattice determined by a quasiorder. (shrink)