Best to possibly not be: A prudential argument for antinatalism.

This article starts by examining the present state of death ethics by attending to the euthanasia debate. Given that voluntary active euthanasia has seen strong support in the academic community, insights on the choiceworthiness of continued existence may be derived. Having derived cases of choiceworthy nonexistence (which I refer to as choiceworthy nonexistence [CNE] cases), I extend these intuitions to lives not worth starting, or choiceworthy nonexistence for potential people (which I refer to as foetal-CNE, or fCNE cases). Although I depart from Benatarian antinatalism by rejecting Benatar's claim that all existence is necessarily a harm, I posit a weaker argument that all existence is likely a harm since we cannot know until later in life if an existence is a harm. If I am right, then we have prudential reasons not to bear children, since they are more likely to suffer in lives not worth living than not.

Why the irremediability requirement is not sufficient to deny psychiatric euthanasia for patients with treatment-resistant depression.

Treatment-resistant depression (TRD) holds centrality in many debates regarding psychiatric euthanasia. Among the strongest reasons cited by opponents of psychiatric euthanasia is the uncertainty behind the irremediability of psychiatric illnesses. According to this argument, conditions that cannot be considered irremediable imply that there are possible remedies that remain for the condition. If there are possible remedies that remain for the condition, then patients with that condition cannot be considered for access to euthanasia. I call this the irremediability requirement (IR). I argue that patients with TRD can, indeed, meet the operationalisation of irremediability in the IR. This is because the irremediability it asks for is not some global or absolute irremediability, but rather a present irremediability based on the current state of medical science. I show this by considering irremediability relating to (1) possible future treatments and (2) not trying presently available alternative treatments. I extend Schuklenk nd van de Vathorst's argument from parity to terminal malignancies, to show that (1) is an unreasonable expectation for all cases of euthanasia. Taking (2) as a more serious opponent to psychiatric euthanasia, I show how the IR, based on how it is presently operationalised, can be realistically applied to cases of TRD. I do this by further developing Tully's argument on broad-sense treatment resistance with the robust empirical data from the STAR*D trials. If my argument from Tully's is valid, then we have reasons to, again, seek parity between the operationalisations of irremediability in terminal malignancies and TRD.

Exploring the Socio-Demographic and Psychosocial Factors That Enhance Resilience in the COVID-19 Crisis.

The Coronavirus disease 2019 (COVID-19) has greatly affected mental health worldwide. This study aimed to identify sociodemographic and psychosocial factors that influence the level of resilience among Singaporeans amidst the pandemic. An online questionnaire was administered to Singaporeans and permanent residents aged 21 and above. The online questionnaire collected information on sociodemographics, infection, and contact with COVID-19. Psychosocial variables-specifically optimism, self-efficacy, hope, and resilience-were also assessed through validated questionnaires. A total of 404 responses were collected in this study. Men were reported to have higher resilience compared to women (28.13 vs. 25.54, p-value < 0.001). Married individuals were observed to have higher resilience compared to their single counterparts (27.92 vs. 25.77, p-value < 0.001). Interestingly, participants who knew of family members/friends who had contracted COVID-19 were reported to be more resilient than those who did not (28.09 vs. 26.19, p-value = 0.013). Optimism, self-efficacy, and hope were also found to be associated with higher resilience (p-value < 0.001). In conclusion, one's sex, marital status, contact with COVID-19, level of optimism, self-efficacy, and hope were shown to significantly affect resilience. Given the long-drawn nature of the COVID-19 pandemic, interventions should aim to improve optimism, self-efficacy, and hopefulness in the community.

Cost-effectiveness of two technology-assisted manual medication picking systems versus traditional manual picking in a hospital outpatient pharmacy.

OBJECTIVE: To evaluate the cost-effectiveness of two technology assisted manual medication picking systems vs traditional manual picking. METHODS: This was a retrospective observational study comparing three outpatient pharmacies of a tertiary referral hospital in Singapore, where a light-emitting diode (LED-guided) manual picking system, an LED-guided manual picking plus lockable drawer (LED-LD) system, and traditional manual picking were implemented, respectively. The primary outcome measure was the incidence of medication near-misses over the observation period. The incremental cost-effectiveness ratio (ICER) per near-miss avoided was also determined. Data on medications picked and near-misses reported between September 2017 and June 2018 were retrieved from electronic databases. The incidence of medication near-misses from the LED-guided and LED-LD systems, relative to traditional picking, was compared using logistic regression. We compared annual operating costs between manual medication picking systems, and reported ICERs per near-miss avoided, to evaluate the cost-effectiveness of each picking system. RESULTS: A total of 358 144, 397 343 and 254 162 medications were picked by traditional manual picking, LED-guided and LED-LD systems, respectively. The corresponding near-miss rates were 8.32, 4.08 and 0.69 per 10 000 medications picked, respectively. Medication near-miss rates were significantly lower for the LED-guided (OR 0.49, 95% CI 0.40 to 0.59, p<0.001) and LED-LD systems (OR 0.08, 95% CI 0.05 to 0.13, p<0.001) compared with traditional picking. The annual operating costs of traditional picking, LED-guided and LED-LD systems were S$60 912, S$129 832 and S$152 894, respectively. The LED-guided and LED-LD systems yielded ICERs of S$189 and S$140 per near-miss avoided, respectively, compared with traditional manual picking. CONCLUSION: The LED-LD system is more cost-effective than both the LED-guided and manual medication picking systems in reducing medication picking near-misses.

Management of hepatitis C.

Hepatitis C virus (HCV) infection is a common cause of chronic liver disease and hepatocellular carcinoma. It is estimated that 15-20% of those infected will develop cirrhosis after 20 years of infection. It is transmitted parenterally, and HCV antibody and HCV RNA tests diagnose infection with a high degree of accuracy. Currently, a combination of peginterferon and ribavirin is the most efficacious treatment, with sustained viral response rates of 45% for genotype 1 and 80% for genotypes 2 and 3. There is some evidence that treatment with interferon-based regimens can improve the natural history of this infection. The side effects of treatment are well recognized and include leucopenia, thrombocytopenia, haemolytic anaemia and depression. Patients with HCV-related decompensated cirrhosis and/or hepatocellular carcinoma should be considered for liver transplantation. The management of special groups, including those with acute HCV infection, co-infected with hepatitis B (HBV) or human immunodeficiency virus (HIV), continues to be defined.

Small bowel bacterial overgrowth is a common cause of chronic diarrhea.

BACKGROUND AND AIMS: Often a cause for chronic non-specific diarrhea (> or =3 stools per day for more than 4 weeks) is not identified. Small bowel bacterial overgrowth (SBO) can occur without morphological damage and remains difficult to diagnose. Often diarrhea is treated empirically with antibiotics with a good response. The aims of the present study were first to investigate the prevalence of SBO in a consecutive series of patients with chronic diarrhea and second to compare the utility of duodenal fluid culture and (14)C-d-xylose breath/lactulose test in diagnosing SBO. METHODS: In the first study, the cause of chronic diarrhea was prospectively diagnosed in 87 subjects. In the second study, tests of SBO were compared in 18 subjects with chronic diarrhea and 15 subjects with reflux oesophagitis used as control subjects. Duodenal fluid was aspirated at endoscopy and cultured and later a (14)C-d-xylose breath/lactulose test was performed. RESULTS: In the first study, SBO was present in 48% of those with chronic diarrhea. In the second study, the diarrhea group had an average (range) stool frequency of 5.5 (3-10) per day and had normal duodenal biopsies. A total of 33%, 50%, 67% of subjects had SBO by duodenal culture alone, by a (14)C-d-xylose breath/lactulose test alone and by a combination of both tests, respectively. In the control group, 0%, 13% and 13% had SBO by duodenal culture alone, by (14)C-d-xylose breath/lactulose test alone and by combination of tests, respectively. CONCLUSION: Small bowel bacterial overgrowth is a common (33-67%) cause of chronic diarrhea.