Does environmental science crowd out non-epistemic values?

While no one denies that science depends on epistemic values, many philosophers of science have wrestled with the appropriate role of non-epistemic values, such as social, ethical, and political values. Recently, philosophers of science have overwhelmingly accepted that non-epistemic values should play a legitimate role in science. The recent philosophical debate has shifted from the value-free ideal in science to questions about how science should incorporate non-epistemic values. This article engages with such questions through an exploration of the environmental sciences. These sciences are a mosaic of diverse fields characterized by interdisciplinarity, problem-orientation, policy-directedness, and ubiquitous non-epistemic values. This article addresses a frequently voiced concern about many environmental science practices: that they 'crowd out' or displace significant non-epistemic values by either (1) entailing some non-epistemic values, rather than others, or by (2) obscuring discussion of non-epistemic values altogether. With three detailed case studies - monetizing nature, nature-society dualism, and ecosystem health - we show that the alleged problem of crowding out emerges from active debates within the environmental sciences. In each case, critics charge that the scientific practice in question displaces non-epistemic values in at least one of the two senses distinguished above. We show that crowding out is neither necessary nor always harmful when it occurs. However, we do see these putative objections to the application of environmental science as teaching valuable lessons about what matters for successful environmental science, all things considered. Given the significant role that many environmental scientists see for non-epistemic values in their fields, we argue that these cases motivate lessons about the importance of value-flexibility (that practices can accommodate a plurality of non-epistemic values), transparency about value-based decisions that inform practice, and environmental pragmatism.

Reliability of a new measure to assess modern screen time in adults.

BACKGROUND: Screen time among adults represents a continuing and growing problem in relation to health behaviors and health outcomes. However, no instrument currently exists in the literature that quantifies the use of modern screen-based devices. The primary purpose of this study was to develop and assess the reliability of a new screen time questionnaire, an instrument designed to quantify use of multiple popular screen-based devices among the US population. METHODS: An 18-item screen-time questionnaire was created to quantify use of commonly used screen devices (e.g. television, smartphone, tablet) across different time points during the week (e.g. weekday, weeknight, weekend). Test-retest reliability was assessed through intra-class correlation coefficients (ICCs) and standard error of measurement (SEM). The questionnaire was delivered online using Qualtrics and administered through Amazon Mechanical Turk (MTurk). RESULTS: Eighty MTurk workers completed full study participation and were included in the final analyses. All items in the screen time questionnaire showed fair to excellent relative reliability (ICCs = 0.50-0.90; all < 0.000), except for the item inquiring about the use of smartphone during an average weekend day (ICC = 0.16, p = 0.069). The SEM values were large for all screen types across the different periods under study. CONCLUSIONS: Results from this study suggest this self-administered questionnaire may be used to successfully classify individuals into different categories of screen time use (e.g. high vs. low); however, it is likely that objective measures are needed to increase precision of screen time assessment.

Interference of the most frequent haemoglobin variants on quantification of HbA1c: comparison between the LC-MS (IFCC reference method) and three routinely used methods.

AIM: Assaying HbA1c in patients with haemoglobin variants has long been a technical challenge, despite methodological advances that have progressively limited the problem. The purpose of this study was to evaluate the impact of the most frequent haemoglobin variants on three routine separation methods compared with the IFCC reference method. PATIENTS: Blood samples from heterozygous patients (AS, AC, AD, AE) were analyzed using the IFCC reference method (LC-MS), and the results compared with those obtained by capillary electrophoresis (CAPILLARYS 2 Flex Piercing, Sebia) and two HPLC methods using cation-exchange (Variant II, Bio-Rad) and affinity chromatography (Ultra(2), Primus). RESULTS: HbA1c values obtained by the IFCC reference method were comparable to those obtained by the three tested methods whatever the haemoglobin variant. Mean relative biases did not exceed the threshold of 7% (above which differences are generally considered clinically significant), although some individual values were above this limit with Variant II in samples with HbS and for all three methods in samples with HbE. CONCLUSION: This comparative study of the LC-MS reference method and three field methods has demonstrated that these assays are not clinically influenced by the presence of the most common haemoglobin variants. The present results also confirm that the interpretation of HbA1c values in patients with Hb variants remains complex and depends on the assays used and should, in some cases, take into account parameters other than analytical ones (such as differences in glycation rates and half-lives of haemoglobin variants).

Increase of Fas-induced apoptosis by inhibition of extracellular phosphorylation of Fas receptor in Jurkat cell line.

Apoptosis signalling through the Fas pathway requires several steps of aggregation of the Fas receptor in the membrane, including aggregation that may occur in the absence of Fas ligand. Association of Fas domains is determinant to signal transmission following Fas ligand binding to a specific domain. The domains involved in Fas aggregation are located in its extracellular region and contain three potential protein kinase C-binding motifs. We therefore studied the possibility that phosphorylation of the extracellular region of Fas might be implicated in the regulation of Fas-mediated apoptosis. Inhibition experiments of extracellular phosphorylation were performed in human Jurkat T leukemia cells with K252b, an impermeant protein-kinase inhibitor. Extracellular phosphorylation of Fas receptor was related to ecto-kinase, as assessed by the [gamma-(32)P] ATP labelling of Fas-116 kDa aggregates, suppressed by K252b inhibitor which significantly increased the sensitivity to Fas-mediated apoptosis. Ecto-PKC involvement was demonstrated by bisindolylmaleimide VIII, a selective inhibitor of protein kinase C which significantly increased both Fas aggregation in the membrane and Fas-mediated apoptosis and by the addition of the PKC pseudo-substrate 19-36 which inhibited the phosphorylation of 116 kDa Fas aggregates. These data support a role for Fas phosphorylation in the decreased sensitivity to apoptosis in the Jurkat T leukemia cell line.

Sedimentation field flow fractionation purification of immature neural cells from a human tumor neuroblastoma cell line.

The use of stem cells for therapeutic applications is now an important objective for the future. Stem cell preparation is difficult and time-consuming depending on the origin of cells. Sedimentation field flow fractionation (SdFFF) is an effective tool for cell separation, respecting integrity and viability. We used the human neuroblastic SH-SY5Y clone of the SK-N-SH cell line as a source of immature neural cells. Our results demonstrated that by using SdFFF cell sorter under strictly defined conditions, and immunological cell characterization, we are now able to provide, in less than 15 min, a sterile, viable, usable and purified immature neural cell fraction without inducting cell differentiation.

Expression of a functional Fas death receptor by human foetal motoneurons.

The expression of the apoptosis inducer Fas (CD95/APO-1) surface receptor by human foetal neurons was investigated in vitro and ex vivo. Immunofluorescence studies of brain and spinal cord cells in primary cultures and of cryosections obtained from 9- and 10-week-old human foetuses, respectively, showed that all Fas-expressing cells were motoneurons (5.3 and 4.2% of the neurons in brain or spinal cord cultures, respectively) on the basis of morphology, reactivity with the monoclonal antibody SMI-32, a mostly motoneuronal marker and acetylcholine esterase expression. Fas was undetectable on the other cell types in culture. The ability of Fas to induce apoptosis of cultured cells from both tissues was determined by using the terminal transferase (TdT)-mediated dUTP nick-end labelling (TUNEL) method combined with the same double-staining procedure. Under basal culture conditions, about 9% of cells, all glial fibrillary acidic protein-expressing astrocytes, were apoptotic. After a 48-h incubation with Fas ligand, mean 28.5% of brain motoneurons and 29.4% of spinal motoneurons underwent apoptosis, with an inhibition by Z-IETD-FMK, a caspase-8 inhibitor. Hence, Fas appears to be functional through a caspase-8-dependent pathway in a subpopulation of human foetal motoneurons.

Physicians' views on quality of care: a five-country comparison.

Interest is resurging in the problems relating to the quality of patient care. This paper provides a comparative perspective on this issue from a five-country physician survey conducted in Australia, Canada, New Zealand, the United Kingdom, and the United States in 2000. Physicians in all five countries reported a recent decline in quality of care and concerns with how hospitals address medical errors. Physicians in four countries expressed serious concerns about shortages of medical specialists and inadequate facilities. U.S. physicians reported problems caused by patients' inability to pay for prescription drugs and medical care. Asked about efforts to improve quality of care in the future, physicians indicated support for electronic medical records, electronic prescribing, and initiatives to reduce medical errors.

Expression of interleukin 13 receptor in glioma and renal cell carcinoma: IL13Ralpha2 as a decoy receptor for IL13.

Glioma and renal cell carcinoma (RCC) cells express high affinity interleukin 13 (IL13) binding sites, but only RCC cell proliferation was inhibited by IL13. Both of these two cell types are IL2-receptor (gamma)c chain-negative. We thus used these cell models to investigate the patterns of expression of IL13Ralpha1, IL13Ralpha2, and IL4Ralpha chains and the role of IL13Ralpha2 in the response to IL13. Using new specific antibodies and flow cytometry, we observed a similar surface expression of IL4Ralpha and IL13Ralpha1 chains in most RCC and glioma cells, whereas IL13Ralpha2 was only present on five of six glioma cell lines. In all glioma cell lines, the amount of IL13Ralpha2 expression was 10 to 30 times higher than that of the two other chains. Although there was no surface or intracellular expression of IL13Ralpha2, its mRNA was detected in three of seven RCC cell lines. The expression on RCC cells of IL13Ralpha2 mRNA and/or that of high-affinity IL13 binding sites is not sufficient to predict IL13Ralpha2 protein expression. Blocking experiments showed that IL4 and IL13 strongly inhibited RCC cell proliferation through a unique receptor composed of IL4Ralpha and IL13Ralpha1 chains. Using RCC cells stably transfected with IL13Ralpha2 cDNA, we showed that the overexpression of IL13Ralpha2 decreased the response to IL13 but not that to IL4. Our results demonstrate that IL13Ralpha2 acts as a decoy receptor for IL13 and that it may exert a tight regulation of IL13 activity without impairing the IL4 response of the same cell target.

Caregiving: challenges and implications for women's health.

Informal and unpaid care is an integral feature of the U.S. health care system for the nation's sick, disabled, frail, and terminally ill. Much of what we know about caregiving is based on interviews with caregivers and, in some cases, care recipients. Prior studies have either not been based on a nationally representative sample or have collected very little information about non-caregivers. This study, using the Commonwealth Fund 1998 Survey of Women's Health, uses a nationally representative sample of caregivers and non-caregivers to examine the health impact of providing informal and unpaid care, focusing primarily on women. Our findings indicate that caregivers experience double jeopardy. They are significantly more likely to be in poor health and to have experienced problems getting needed care. These findings suggest that it is time to explore alternative or complements to informal caregiving. They underscore the need to find more equitable ways to share caregiving costs and risk, and provide support to assist those who currently provide care.

Americans' views on the use and regulation of dietary supplements.

This article presents the views of Americans on what the government's future role should be in regulating or overseeing the growing sales of dietary supplements for health purposes. Based on results of multiple national opinion surveys, including the views of both users and nonusers of supplements, we found that a substantial percentage of Americans surveyed reported that they regularly take dietary supplements as a part of their routine health regimen. However, they reported that they do not discuss the use of dietary supplements with their physicians because they believe that the physicians know little or nothing about these products and may be biased against them. Many users felt so strongly about the potential health benefits of some of these products that they reported that they would continue to take them even if they were shown to be ineffective in scientifically conducted clinical studies. However, there also was broad public support for increased government regulation of these products. We found that a majority of Americans surveyed supported the following: to require that the Food and Drug Administration review the safety of new dietary supplements prior to their sale; to provide increased authority to remove from sale those products shown to be unsafe; and to increase government regulation to ensure that advertising claims about the health benefits of dietary supplements are true.

Americans' health priorities: curing cancer and controlling costs.

In this paper we provide a comprehensive examination of Americans' priorities within both health and health care. We find that Americans do have a clear set of priorities in each of these areas. Americans rated cancer, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), and heart disease, and medical research to address these conditions, as top priorities among eighty health problems. However, they did not rank many leading causes of death very high as serious problems. On the issue of health care, problems of costs, prescription drugs, and the uninsured top the list. Americans are very concerned about emerging international infectious diseases that they believe threaten their health.

In vitro induction of neuronal apoptosis by anti-Fas antibody-containing sera from amyotrophic lateral sclerosis patients.

Sera from 26% of patients with sporadic amyotrophic lateral sclerosis (ALS) induced in vitro apoptosis of a human neuroblastoma cell line, as detected by two methods, and most contained anti-Fas autoantibodies. In contrast, Alzheimer sera (studied as controls) very rarely induced apoptosis and did not contain detectable anti-Fas antibodies. Soluble Fas-ligand levels in ALS sera were not different from those in normal sera, except for slightly higher levels in a single case. In mixed cultures of rat embryonic brain and spinal cord cells, ALS sera (and agonistic anti-Fas monoclonal antibodies and soluble Fas-ligand) induced the apoptosis of a subpopulation of neurons. These neurons were motoneurons on the basis of staining with the monoclonal antibody SMI 32 and Fas expression was restricted to these SMI 32-positive neurons. These data are compatible with the hypothesis of the participation of an autoimmune mechanism possibly related to anti-Fas autoantibodies in certain ALS patients.

Kinetics of carbamylated haemoglobin in acute renal failure.

BACKGROUND: Carbamylation of proteins by isocyanic acid, the reactive form of cyanate derived from urea, is increased in uraemia and may contribute to uraemic toxicity. Kinetics of carbamylation that may reflect uraemic toxicity is not clearly defined in acute renal failure (ARF). METHODS: Twenty-eight patients with ARF and 13 with chronic renal failure (CRF) were included in the study in order to determine changes in carbamylated haemoglobin concentration (CarHb) in ARF. The usefulness of this parameter for differentiating ARF from CRF was also investigated. CarHb was measured by high-performance liquid chromatography after acid hydrolysis. RESULTS: Mean CarHb level (expressed as microg carbamyl valine per gram (CV/g) Hb) was significantly higher in ARF (54.3+/-5.2) than in normal subjects (31.6+/-1.3). On admission, CarHb level was correlated with duration of ARF prior to hospitalization in the intensive care unit (r(2)=0.723, P<0.001). CarHb was significantly higher at recovery in the subgroup of patients requiring haemodialysis than in the subgroup not requiring haemodialysis (82. 4+/-11.3 vs 46.7+/-5.2, P<0.01). Similarly dialysis patients lost more weight (8.6+/-1.4 vs 2.7+/-0.5 kg, P<0.005) and had higher averaged blood urea levels in the 20 days prior to recovery (17. 6+/-1.9 vs 11.3+/-1.8 mol/l, P<0.05). After recovery, CarHb level decreased at a rate of 0.219 microg CV/g Hb per day in patients with reversible renal insufficiency. CarHb concentration was higher in patients with CRF. A cut-off CarHb value of 100 microg CV/g Hb had a sensitivity of 94% and a positive predictive value of 94% for differentiating ARF from CRF. CONCLUSIONS: Kinetics of CarHb showed a near normal red blood cell life span in ARF. Changes in CarHb enabled, with a good sensitivity, the distinction to be made between patients who recovered from ARF and those with sustained renal impairment, whether due to prior CRF or resulting from parenchymal sequelae. Measurement of CarHb is valuable at clinical presentation of ARF in patients with an unknown medical history of renal disease.

Uninsured and unstably insured: the importance of continuous insurance coverage.

OBJECTIVE: To examine the importance of continuous health insurance for access to care by comparing the access and cost experiences of insured adults with a recent time uninsured to the experiences of currently uninsured adults and experiences of adults with no time uninsured within a reference time period (continuously insured). DATA SOURCES: Adults ages 18-64. Data draw from three different survey databases: the Robert Wood Johnson Foundation 1996-1997 Community Tracking Survey, the Kaiser/Commonwealth 1997 National Survey of Health Insurance, and the 1995-1997 Kaiser/Commonwealth State Low Income Surveys. STUDY DESIGN: The study groups individuals into three insurance categories based on respondents' reports of insurance coverage within a reference time period: continuously insured; insured when surveyed but with recent time uninsured; and currently uninsured. In the two Kaiser/Commonwealth surveys the recently uninsured group included any insured respondent with a time uninsured in the past two years. In the Community Tracking Survey, the recently uninsured group included any insured respondent with a time uninsured in the past year. Measures of access include foregoing health care when needed, usual source of care, use of health care services, difficulties paying for medical care, and satisfaction with care. DATA COLLECTION: All three surveys were conducted primarily by telephone. The Community Tracking Survey drew from 60 community sites, with an additional random national sample. The Kaiser/Commonwealth National Survey was a random national sample; the Kaiser/Commonwealth State Low Income Surveys included adults ages 18-64 with incomes at or below 250 percent of poverty in seven states: Minnesota, Oregon, Tennessee, Florida, Texas, New York, and California. PRINCIPAL FINDINGS: Compared to the continuously insured, those insured but with a recent time uninsured were at high risk of going without needed care and of having problems paying medical bills. This group was two to three times as likely as those with continuous coverage to report access problems. Rates of access and cost problems reported by insured adults with a recent time uninsured neared levels reported by those who were uninsured at the time of the survey. These two groups also rated care received more negatively than did adults with continuous insurance coverage. In general, the access gap between persons insured and uninsured widened as a result of distinguishing insured adults with a recent time uninsured from insured adults with no time uninsured. CONCLUSION: Studies that focus on current insurance status alone will underestimate the extent to which having a time uninsured during the year contributes to access difficulties and undermines quality of care, and will underestimate the proportion of the population at risk because they are uninsured. Policy reforms are needed to maintain continuous insurance coverage and avoid spells uninsured. Currently uninsured and unstably insured adults are both at high risk.

Health insurance markets and income inequality: findings from an international health policy survey.

OBJECTIVE: To assess disparities in access to health care, financial burden of medical bills and perceived quality of care between those with above average incomes and those with below average incomes in five nations and to examine the relationship inequities in care experiences to health insurance coverage. DESIGN: Cross-sectional analysis of a random survey of adults in 1998. SUBJECTS: 5059 adults ages 18 and over in five English-speaking countries: Australia, Britain, Canada, New Zealand and the United States (approximately 1000 per country). MAIN OUTCOME MEASURES: Failure to receive needed care, difficulty getting care, waiting for elective surgery, problems paying medical bills, failure to fill prescriptions due to cost, perceived quality of medical care received and of most recent doctor visit. RESULTS: There were two to three-fold differences between those with above and below average incomes on measures of access to care in the US, Australia and New Zealand. In Britain and Canada indicators of access of to care were similar for the two income groups. Problems paying medical bills were most prevalent in the US, yet significant differences by income also existed in Australia, Canada and New Zealand. Those with below average incomes were more likely to have not filled a prescription due to cost in Australia, Canada, New Zealand and the US, with gaps by income most severe in the US. Ratings of quality of doctor visit were significantly different for the two income groups in the US, but not other countries. CONCLUSIONS: The analysis finds striking differences among countries in the relative equity of health care experiences. In general, care experiences are more unequal in three countries such as the US, Australia and New Zealand where systems have relatively greater reliance on private health insurance and markets. Greater inequality in care experiences is also associated with more divided public opinion regarding the need for system reform and the direction of recent policy changes. In Canada and Britain where care experiences are more equal of the health system are similar across income groups. Reliance on private insurance and patient user fees appears to lead to more divided views of the overall health system as well as inequity in access to care.

Inadequate health insurance: costs and consequences.

CONTEXT: Changes in the healthcare marketplace have begun to test the nature and adequacy of health insurance. The complex nature of insurance is driving us away from the notion that there are 2 distinct groups - the insured and the uninsured - toward an idea that insurance is best represented along a continuum, from the very well insured to the chronically uninsured, with a wide range of quality of coverage in between. OBJECTIVE: The objective of this study was to examine the experiences of insured adults as they try to get needed healthcare and balance the payment for these services against other basic needs. DESIGN: Using data from the Commonwealth Fund 1999 Survey of Workers' Health Insurance, the study analyzes the cost and access problems of insured adults by a number of different variables including income, plan satisfaction, health status, and insurance stability. RESULTS: Bivariate results indicate that insured adults with low incomes and those reporting fair or poor health are more likely to experience problems getting and paying for healthcare. These groups are also more likely to have problems paying for basic living expenses. CONCLUSIONS: The most essential notion of insurance is that it will provide protection against financial risk and assurance that we can get healthcare services when we are sick. Yet, we find substantial proportions of low- and modest-income, insured adults who struggle to afford insurance premiums; we also find that their insurance plans do not provide them with either access to care when needed or financial protection from the cost of that care.