Search

Background Three months after the first reported cases, COVID-19 had spread to nearly 90% of World Health Organization (WHO) member states and only 24 countries had not reported cases as of 30 March 2020. This analysis aimed to 1) assess characteristics, capability to detect and monitor COVID-19, and disease control measures in these 24 countries, 2) understand potential factors for the reported delayed COVID-19 introduction, and 3) identify gaps and opportunities for outbreak preparedness, particularly in low and middle-income countries (LMICs). We collected and analyzed publicly available information on country characteristics, COVID-19 testing, influenza surveillance, border measures, and preparedness activities in these countries. We also assessed the association between the temporal spread of COVID-19 in all countries with reported cases with globalization indicator and geographic location. Results Temporal spreading of COVID-19 was strongly associated with countries’ globalization indicator and geographic location. Most of the 24 countries with delayed COVID-19 introduction were LMICs; 88% were small island or landlocked developing countries. As of 30 March 2020, only 38% of these countries reported in-country COVID-19 testing capability, and 71% reported conducting influenza surveillance during the past year. All had implemented two or more border measures, (e.g., travel restrictions and border closures) and multiple preparedness activities (e.g., national preparedness plans and school closing). Conclusions Limited testing capacity suggests that most of the 24 delayed countries may have lacked the capability to detect and identify cases early through sentinel and case-based surveillance. Low global connectedness, geographic isolation, and border measures were common among these countries and may have contributed to the delayed introduction of COVID-19 into these countries. This paper contributes to identifying opportunities for pandemic preparedness, such as increasing disease detection, surveillance, and international collaborations. As the global situation continues to evolve, it is essential for countries to improve and prioritize their capacities to rapidly prevent, detect, and respond, not only for COVID-19, but also for future outbreaks.

In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) were authorized for emergency use in the United States for the prevention of coronavirus disease 2019 (COVID-19).* Because of limited initial vaccine supply, the Advisory Committee on Immunization Practices (ACIP) prioritized vaccination of health care personnel† and residents and staff members of long-term care facilities (LTCF) during the first phase of the U.S. COVID-19 vaccination program (1). Both vaccines require 2 doses to complete the series. Data on vaccines administered during December 14, 2020-January 14, 2021, and reported to CDC by January 26, 2021, were analyzed to describe demographic characteristics, including sex, age, and race/ethnicity, of persons who received ≥1 dose of COVID-19 vaccine (i.e., initiated vaccination). During this period, 12,928,749 persons in the United States in 64 jurisdictions and five federal entities§ initiated COVID-19 vaccination. Data on sex were reported for 97.0%, age for 99.9%, and race/ethnicity for 51.9% of vaccine recipients. Among persons who received the first vaccine dose and had reported demographic data, 63.0% were women, 55.0% were aged ≥50 years, and 60.4% were non-Hispanic White (White). More complete reporting of race and ethnicity data at the provider and jurisdictional levels is critical to ensure rapid detection of and response to potential disparities in COVID-19 vaccination. As the U.S. COVID-19 vaccination program expands, public health officials should ensure that vaccine is administered efficiently and equitably within each successive vaccination priority category, especially among those at highest risk for infection and severe adverse health outcomes, many of whom are non-Hispanic Black (Black), non-Hispanic American Indian/Alaska Native (AI/AN), and Hispanic persons (2,3).

As cases and deaths from coronavirus disease 2019 (COVID-19) in Europe rose sharply in late March, most European countries implemented strict mitigation policies, including closure of nonessential businesses and mandatory stay-at-home orders. These policies were largely successful at curbing transmission of SARS-CoV-2, the virus that causes COVID-19 (1), but they came with social and economic costs, including increases in unemployment, interrupted education, social isolation, and related psychosocial outcomes (2,3). A better understanding of when and how these policies were effective is needed. Using data from 37 European countries, the impact of the timing of these mitigation policies on mortality from COVID-19 was evaluated. Linear regression was used to assess the association between policy stringency at an early time point and cumulative mortality per 100,000 persons on June 30. Implementation of policies earlier in the course of the outbreak was associated with lower COVID-19-associated mortality during the subsequent months. An increase by one standard deviation in policy stringency at an early timepoint was associated with 12.5 cumulative fewer deaths per 100,000 on June 30. Countries that implemented stringent policies earlier might have saved several thousand lives relative to those countries that implemented similar policies, but later. Earlier implementation of mitigation policies, even by just a few weeks, might be an important strategy to reduce the number of deaths from COVID-19.

In this paper we discuss three different kinds of disagreement that have been, or could reasonably be, characterized as deep disagreements. Principle level disagreements are disagreements over the truth of epistemic principles. Sub-principle level deep disagreements are disagreements over how to assign content to schematic norms. Finally, framework-level disagreements are holistic disagreements over meaning not truth, that is over how to understand networks of epistemic concepts and the beliefs those concepts compose. Within the context of each of these kinds of disagreement it is not possible for the parties to the dispute to rationally persuade one another through only offering epistemic reasons for their conflicting points of view. However, in spite of the inability to rationally persuade, we explore how it may nevertheless be possible to rationally navigate each of these varieties of deep disagreement.

Pourquoi la pollution de l’information se repand elle si aisement dans le media sociaux ? et pourquoi est-il si vain de recourir aux preuves et aux donnees pour la combattre ? Ma reponse repose sur une nouvelle hypothese au sujet de la fonction de certains de nos actes de communication dans les media sociaux. Elle vise a comprendre le phenomene des fake news, mais aussi la communication en general.

Perfectionism is a complex, multidimensional personality construct that has been linked to both adaptive and maladaptive behavioral and mental health outcomes, particularly for college students. Based on the premise that personality reflects patterns of affect, cognition, and behavior, we deconstructed perfectionism into these constituent parts, with the goal of examining how they contribute to disparate expressions of the trait. We hypothesized that distinct profiles of perfectionism would be identified, and that these profiles would be differently associated with indices of mental health and well-being. Participants (N = 410; M = 18.9 years of age) were recruited from a voluntary online pool of undergraduate students. Data was collected through administration of several self-report measures. Six underlying factors of perfectionism were identified by submitting measures of behavioral, emotional, and cognitive correlates to a principal components analysis. These factor scores were submitted to cluster analysis, which identified four distinct profiles: constructive, motivated, obsessive, and non-perfectionist. The data indicated that these profiles were associated with differences in well-being. Among college students, constructive and motivated expressions of perfectionism may allow individuals to pursue high standards without suffering the mental health consequences that can result from inevitable challenges and setbacks experienced in a demanding environment.

The answers to the questions in the title depend on the kind of pluralism one is talking about. We will focus here on our own views. The purpose of this article is to trace out some possible connections between these kinds of pluralism. We show how each of them might bear on the other, depending on how certain open questions are resolved.

This chapter explores two contributing factors to cognitive polarization. The first is what is known as epistemic disagreement—or disagreement over what is known, who knows it, or how we know. Crucially, even the perception that such disagreement is widespread—whether or not it actually is—can be dangerous. The second factor is intellectual arrogance. This is arrogance about what we know or think we know; it is the kind of arrogance that tells whites they have nothing to learn about racism from people of color and that reassures those who believe they know more about infectious diseases than those who spend their lives studying them. The chapter also attempts to argue that these two factors can be mutually reinforcing. This makes them doubly dangerous, because by increasing cognitive polarization, they in turn undermine the democratic value of the pursuit of truth.

In this chapter, Hanna Gunn and Michael Patrick Lynch examine the connection between epistemic agency and the internet. They identify two conditions that are true of responsible epistemic agency: first, responsible epistemic agents aim to develop epistemic virtues, merit, and capacities that help them to responsibly change their epistemic environment, as well as the capacities that enable them to recognize and respect these epistemic traits in others. Second, responsible epistemic agents treat other epistemic agents with a form of respect that demonstrates a willingness to learn from them. Gunn and Lynch then show that the ways in which the internet makes information more widely available can also undermine our ability to be responsible epistemic agents. For instance, the personalization of online spaces can unwittingly lead users into echo chambers and filter-bubbles and away from a diverse range of perspectives, and fake news and information pollution can make for a hostile online epistemic environment.

This chapter concerns the interrelationship between deepening political disagreements and a tribal or group-indexed form of intellectual arrogance. I argue that first, this kind of intellectual arrogance is bound up with, and worsens the effects of, affective or attitude polarization. And second, certain kinds of disagreements can, in turn, feed that attitude, or at the very least our perception of who is displaying it.

Polarisation, intransigence and dogmatism in political and moral debate have in recent years threatened to overwhelm many Western-style democracies, where for centuries reasoned argument has been a hallmark feature of tackling disagreement. For many people, this marks a worrying deterioration in the moral and political climate, threatening to create a divisive environment of "us" versus "them". In this superb collection a team of international contributors examine these pressing issues from a philosophical perspective. Topics explored include: the problem of "deep disagreements"; martial conceptions of argumentation and the motivation to argue to win; epistemic egocentrism; intellectual trust; bullshit and dogmatism, intellectual humility and the internet; epistemic and "tribal" arrogance and authoritarianism; empathy and polarisation; and epistemic rights violations. Polarisation, Arrogance, and Dogmatism: Philosophical Perspectives will be of great interest to researchers in political philosophy, applied and social epistemology, ethics and feminist philosophy, as well as those working in politics, and sociology.

Foodborne diseases represent a substantial public health concern in the United States. CDC's Foodborne Diseases Active Surveillance Network (FoodNet) monitors cases reported from 10 U.S. sites* of laboratory-diagnosed infections caused by nine enteric pathogens commonly transmitted through food. This report describes preliminary surveillance data for 2016 on the nine pathogens and changes in incidences compared with 2013-2015. In 2016, FoodNet identified 24,029 infections, 5,512 hospitalizations, and 98 deaths caused by these pathogens. The use of culture-independent diagnostic tests (CIDTs) by clinical laboratories to detect enteric pathogens has been steadily increasing since FoodNet began surveying clinical laboratories in 2010 (1). CIDTs complicate the interpretation of FoodNet surveillance data because pathogen detection could be affected by changes in health care provider behaviors or laboratory testing practices (2). Health care providers might be more likely to order CIDTs because these tests are quicker and easier to use than traditional culture methods, a circumstance that could increase pathogen detection (3). Similarly, pathogen detection could also be increasing as clinical laboratories adopt DNA-based syndromic panels, which include pathogens not often included in routine stool culture (4,5). In addition, CIDTs do not yield isolates, which public health officials rely on to distinguish pathogen subtypes, determine antimicrobial resistance, monitor trends, and detect outbreaks. To obtain isolates for infections identified by CIDTs, laboratories must perform reflex culture†; if clinical laboratories do not, the burden of culturing falls to state public health laboratories, which might not be able to absorb that burden as the adoption of these tests increases (2). Strategies are needed to preserve access to bacterial isolates for further characterization and to determine the effect of changing trends in testing practices on surveillance.

Background Failure of endovascular aneurysm repair may require explant of the stent graft in a subset of patients. We sought to assess outcomes in a cohort of patients undergoing explant of endovascular aneurysm repair in both emergency and elective settings. Methods Patients undergoing explant of endovascular aneurysm repair were identified from a prospectively maintained database, with additional information obtained through retrospective analysis of medical records. Results Over a 21-year period, 1997–2018 (May), there were 597 endovascular aneurysm repair procedures performed in our institution for abdominal aortic aneurysm. There were 19 endovascular aneurysm repair explants; five of these were referrals from other vascular centres. The median age was 73 years (range 46–81). The median length of time from insertion to explant was 39.2 months (range 0–153). Indications for elective explant were type Ia endoleak (n = 4), type 1b endoleak (n = 1), type II endoleak with increasing sac size (n = 1), type I/III endoleak (n = 1), type IV endoleak (n = 1), and increasing sac size without evident endoleak (type V, n = 2). The remaining nine cases were emergency procedures, with four patients presenting with rupture post endovascular aneurysm repair, four patients presenting with acute stent thrombosis, of which one also had a type 1a endoleak and one aorto-enteric fistula. There were no mortalities in the elective group and three mortalities in the emergency group (0 vs 33.3%, p = 0.087). Overall 30-day mortality was 15.8% Conclusion Explant of aortic stent grafts can be associated with high mortality and morbidity rates, especially in the emergent setting. Patient and device selection and post-operative surveillance remain vitally important to optimise outcomes post endovascular aneurysm repair.

Background:Retirement ages are rising in many countries due to population ageing and increasing life expectancy. However, poor health, comorbidity and workplace factors are major reasons for work absence and it is unclear if people in later working-age life (age ≥50) are able to work for longer. Osteoarthritis (OA), the most common joint condition in adults, is the fastest increasing major health condition globally and is a leading cause of disability (especially in adults age ≥50).Objectives:We aimed to estimate healthy working life expectancy (HWLE; defined as the average number of years that adults from age 50 can expect to be healthy and in paid work) for adults with and without osteoarthritis and investigate the role of mental health problems as a comorbidity and the role of workplace factors through examining whether there is a sense of having any control over what happens at work.Methods:Longitudinal survey data of adults aged ≥50 years were used from six waves (2002-2013) of the English Longitudinal Study of Ageing with linked mortality data from the National Health Service Central Register. HWLE was defined using two self-report variables; health was defined as no long-standing illness or no activity limitation if long-standing illness was present, and work was defined being in employment or self-employment. OA status was identified by self-report of ever receiving a diagnosis from a doctor. Mental health and control of work were measured by self-report. Continuous-time multistate models with three states (healthy and working [state 1], other alive [2], dead [3]) were fitted in R (version 3.6.1) to investigate factors driving transitions out of the healthy and working state. Models included age and combinations of sex, OA, control at work, and mental health problems. Age-adjusted hazards of transitions between states were estimated using the ‘msm’ R package. HWLE for adults with different factors (OA, control of work, mental health) was estimated with the ‘elect’ R package using models fitted with ‘msm’. Missing data was handled using multiple imputation by predictive mean matching.Results:There were 11,540 adults with at least two observations (including survey and mortality data) for the study period (5251 males, 6289 females). Life expectancy at age 50 was 29.7 years for men and 33.4 years for women with HWLE being 9.9 years (men) and 8.3 years (women). HWLE at age 50 for adults with osteoarthritis was 7.3 years (men: 8.2, women: 6.8), and for adults without osteoarthritis was higher at 9.9 years (men: 10.6, women: 9.1). After adjusting for age, the instantaneous risk of ceasing to be both healthy and in work (not due to death) for people with OA was 1.5 times that of people without OA (hazard rate ratio 1.5 with 95% CI [1.3, 1.6]). For adults without OA, HWLE at age 50 was 13.2 years if they felt they had control at work and 4.1 years without control at work, whilst for adults with OA, HWLE was 10.4 years if they felt they had control at work and 3.1 years without. The effect of mental health problems as a comorbidity on HWLE was smaller; for adults without OA, HWLE at age 50 was 11.0 years for those without mental health problems and 8.3 years for those with, whilst for adults with OA, HWLE was 8.6 years for those without mental health problems and 6.2 years with.Conclusion:While the average HWLE for men and women in England is lower than State Pension age, HWLE at age 50 is even lower (by approximately 25%) in adults with OA compared to adults without OA. Poor mental health further reduces HWLE. However, good quality work environments significantly lessen the impact of osteoarthritis (there is a 7.3 year difference in HWLE for those with OA who do and do not experience control at work). These results suggest that interventions and policies that create appropriate job opportunities and supportive workplaces for older workers with health conditions are key to the feasibility and success of extended working life policies.Disclosure of Interests:None declared

A simulating leaching (migration) study was performed on a model container-closure system relevant to parenteral and ophthalmic drug products. This container-closure system consisted of a linear low-density polyethylene bottle (primary container), a polypropylene cap and an elastomeric cap liner (closure), an adhesive label (labeling), and a foil overpouch (secondary container). The bottles were filled with simulating solvents (aqueous salt/acid mixture at pH 2.5, aqueous buffer at pH 9.5, and 1/1 v/v isopropanol/water), a label was affixed to the filled and capped bottles, the filled bottles were placed into the foil overpouch, and the filled and pouched units were stored either upright or inverted for up to 6 months at 40 °C. After storage, the leaching solutions were tested for leached substances using multiple complementary analytical techniques to address volatile, semi-volatile, and non-volatile organic and inorganic extractables as potential leachables.The leaching data generated supported several conclusions, including that (1) the extractables (leachables) profile revealed by a simulating leaching study can qualitatively be correlated with compositional information for materials of construction, (2) the chemical nature of both the extracting medium and the individual extractables (leachables) can markedly affect the resulting profile, and (3) while direct contact between a drug product and a system's material of construction may exacerbate the leaching of substances from that material by the drug product, direct contact is not a prerequisite for migration and leaching to occur.LAY ABSTRACT: The migration of container-related extractables from a model pharmaceutical container-closure system and into simulated drug product solutions was studied, focusing on circumstances relevant to parenteral and ophthalmic drug products. The model system was constructed specifically to address the migration of extractables from labels applied to the outside of the primary container. The study demonstrated that (1) the extractables that do migrate can be correlated to the composition of the materials used to construct the container-closure systems, (2) the extent of migration is affected by the chemical nature of the simulating solutions and the extractables themselves, and (3) even though labels may not be in direct contact with a contained solution, label-related extractables can accumulate as leachables in those solutions.

Reasons, Wittgenstein warned, come to an end; we hit bedrock; the spade is turned. Long philosophical tradition, not to mention common sense, agrees. You can’t justify everything. In this paper, I examine a case where it is not only especially compelling that reasons run out—it is especially troubling. The case is when there is disagreement over explicitly epistemic first principles. Epistemic first principles are principles that announce that basic methods for acquiring beliefs are reliable. Where we disagree over such principles, we face the alarming prospect of being unable to defend them without relying on the very methods whose reliability is in question. I then explore, however briefly, what options remain in such situations for still engaging in what we might call rational persuasion. I suggest our prospects depend on whether we can make sense of giving objective practical reasons for our epistemic first principles.

Epistemic Authority: A Theory of Trust, Authority, and Autonomy in Belief. By Linda Trinkaus Zagzebski. New York: Oxford University Press, 2012. Pp. xiii +279. isbn 978–0–19–993647–2.

Although Alston believed epistemically circular arguments were able to justify their conclusions, he was also disquieted by them. We will argue that Alston was right to be disquieted. We explain Alston’s view of epistemic circularity, the considerations that led him to accept it, and the purposes he thought epistemically circular arguments could serve. We then build on some of Alston’s remarks and introduce further limits to the usefulness of such arguments and introduce a new problem that stems from those limits. The upshot is that adopting Alston’s view that epistemically circular arguments can be used to justify their conclusions is more costly than even he thought.

This chapter argues that academic freedom is justified because it is an inherently epistemic practice that serves the ideals of democracy. With Dewey, it is argued that “The one thing that is inherent and essential [to the idea of a university] is the ideal of truth.” But far from being apolitical, the value of pursuing truth and knowledge—the value that justifies academic freedom, both within and without the public mind—is a fundamental democratic value, and for three reasons: the practices of academic inquiry exemplify rational inquiry of the kind needed for democratic deliberation; those practices serve to train students to pursue that kind of inquiry; and those practices are important engines of democratic dissent.

Monism about truth is the view that there is precisely one way of being true. Nihilism about truth is the view that there is no such thing as being true. Pluralism about truth is the view that there are several ways of being true. For the pluralist, truth is Many; in particular, different ways of being true apply to different domains of discourse. The way in which propositions about physics may be true could differ from the way in which the propositions of morality may be true. This chapter provides an introduction to truth pluralism and offers a brief survey of different incarnations of the view. It discusses whether different kinds of pluralist have the resources adequately to address the various challenges and objections, and ends with a brief discussion of what connections, if any, pluralism about truth might bear to other kinds of pluralism.

Simon Blackburn has recently alleged that truth pluralism “double-counts”: it distinguishes not only between different kinds of propositions; it (unnecessarily) distinguishes between different kinds of truth. In this chapter, I respond to this objection, arguing that, given certain explanatory goals that quasi-realists such as Blackburn or Price share with the pluralist, either distinction brings a functionally similar one in its wake.