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The expansion in the wealth of the extremely wealthy has received much attention in recent public and academic debate. In political theory, the phenomenon has only recently begun to be scrutinized. This article builds on these preliminary steps, exploring the normative reasons we have to worry about extreme wealth. Looking at the issues, first, through a distributive lens, we reveal that the excess wealth of the extremely wealthy compounds the injustice of inequality and insufficiency, making the situation distinctly unjust. Through a relational lens, we see that extreme wealth may create societal segregation, which poses distinct threats to solidarity. Finally, when the two previous perspectives interact, the particular ways in which the wealthy can influence society, change rules and norms and bend existing regulation to their advantage open up the possibility of vicious societal feedback loops. [ABSTRACT FROM AUTHOR]

Many consider play a natural part of childhood, and although there is disagreement in the literature on what essentially defines "play" in childhood, philosophical theories of play tend to support this initial consideration. But is childhood play also something we owe each other within a framework of educational justice? This is a question yet to be addressed. In this paper, I answer this question affirmatively. I take off from a generic account of educational justice and argue that childhood play should be considered a central entitlement of this account. I then argue in line with the capability approach that if we ought to protect childhood play, it should be children's capability for play rather than the functioning of play that needs protection. I end by offering an account of the capability for childhood play.

BackgroundTelemedicine may have the possibility to provide better access to healthcare delivery for the citizens. Telemedicine in arctic remote areas must be tailored according to the needs of the local population. Therefore, we need more knowledge about their needs and their view of telemedicine.ObjectiveThe aim of this study has been to explore how citizens living in the Greenlandic settlements experience the possibilities and challenges of telemedicine when receiving healthcare delivery in everyday life.Materials and methodsCase study design was chosen as the overall research design. Qualitative interviews (n = 14) were performed and participant observations (n = 80 h) carried out in the local healthcare center in the settlements and towns. A logbook was kept and updated each day during the field research in Greenland. Observations were made of activities in the settlements.FindingsData collected on citizens' views about the possibilities of using telemedicine in Greenland revealed the following findings: Greenlandic citizens are positive toward telemedicine, and telemedicine can help facilitate improved access to healthcare for residents in these Greenlandic settlements. Regarding challenges in using telemedicine in Greenland, the geographical and cultural context hinders accessibility to the Greenlandic healthcare system, and telemedicine equipment is not sufficiently mobile.ConclusionGreenlandic citizens are positive toward telemedicine and regard telemedicine as a facilitator for improved access for healthcare in the Greenlandic settlements. We have identified challenges, such as geographical and cultural context, that hinder accessibility to the Greenlandic healthcare system.

In many Western countries, it has become standard to demand immigrants that earn their right to citizenship by coming to meet a set of citizenship requirements. Moreover, many European governments justify the citizenship requirements on the grounds of fairness, because they are not discriminatory and because the demands of the requirements are to immigrants' individual efforts. This trend invites exploration of whether this practice is justified. We argue that citizenship requirements are justified from a liberal viewpoint only if differentiated to adjust for factors that are unmoved by the individual exercise of responsibility but have a strong impact on the chances of fulfilling citizenship requirements – such as age, prior education, economic cycles, and ethnic discrimination. Upon this, we develop a differentiated model for fair citizenship requirements inspired by the typological work of John Roemer. The model allows for different degrees of demandingness but preserves respect for fairness in so far as it differentiates requirements on the background of age, education, economic cycles, and ethnicity. [ABSTRACT FROM AUTHOR]

Cerebral fat embolism is a rare cause of stroke and therefore an overlooked diagnosis. Often it is seen as a consequence of major bone fractures or after arthroplasty, and can lead to respiratory or circulatory collapse. We present a case of a patient with a history of paraplegia after a thoracic spinal cord injury that developed cerebral fat embolism following a bilateral femur fracture. Since the patient was paraplegic and with an altered mental state upon admission, femoral bone fractures were not initially suspected. The case shows the difficulties in diagnosing this condition. [ABSTRACT FROM AUTHOR]

Relational egalitarianism is a theory of justice according to which people must relate as equals. In this article, we develop relational sufficientarianism – a view of justice according to which people must relate as sufficients. We distinguish between three versions of this ideal, one that is incompatible with relational egalitarianism and two that are not. Building on this, we argue that relational theorists have good reason to support a pluralist view that is both egalitarian and sufficientarian. [ABSTRACT FROM AUTHOR]

Ageism is the view that it is of greater moral value to allocate health care resources to younger people than to older people. In medical ethics, it is well-known that standard interpretations of distributive principles such as utilitarianism and egalitarianism imply some form of ageism. At times, ethicists argue as if practical complications are the only or main reason for not abiding to ageism. In this article, we argue that inferences to ageism from such distributive principles tend to commit what we call the anticipation-blindness fallacy: A much too narrow focus on life quality benefits of health care treatments inclines us to overlook the importance of life quality benefits of health care safety , that is the mere trust in and expectation of being treated and cared for as one grows old. This is a key omission because health safety has value for a much larger population and for much longer time. Taking health safety into account therefore has important implications as for how ageist we ought to be. [ABSTRACT FROM AUTHOR]

It is generally accepted that morally justified healthcare rationing must be non-discriminatory and cost-effective. However, given conventional concepts of cost-effectiveness, resources spent on disabled people are spent less cost-effectively, ceteris paribus, than resources spent on non-disabled people. Thus, it is reasonable to assume that standard cost-effectiveness discriminates against the disabled. Call this the disability discrimination problem. Part of the disability discrimination involved in cost-effectiveness stems from the way in which health-related quality of life is accounted for and measured. This paper offers and defends a patient-sensitive account of health-related quality of life, which can effectively make cost-effectiveness less discriminatory against the disabled and thus more morally justified. [ABSTRACT FROM AUTHOR]

Forests emit large quantities of volatile organic compounds (VOCs) to the atmosphere. Their condensable oxidation products can form secondary organic aerosol, a significant and ubiquitous component of atmospheric aerosol (1,2), which is known to affect the Earth's radiation balance by scattering solar radiation and by acting as cloud condensation nuclei (3). The quantitative assessment of such climate effects remains hampered by a number of factors, including an incomplete understanding of how biogenic VOCs contribute to the formation of atmospheric secondary organic aerosol. The growth of newly formed particles from sizes of less than three nanometres up to the sizes of cloud condensation nuclei (about one hundred nanometres) in many continental ecosystems requires abundant, essentially nonvolatile organic vapours (4-6), but the sources and compositions of such vapours remain unknown. Here we investigate the oxidation of VOCs, in particular the terpene α-pinene, under atmospherically relevant conditions in chamber experiments. We find that a direct pathway leads from several biogenic VOCs, such as monoterpenes, to the formation of large amounts of extremely low-volatility vapours. These vapours form at significant mass yield in the gas phase and condense irreversibly onto aerosol surfaces to produce secondary organic aerosol, helping to explain the discrepancy between the observed atmospheric burden of secondary organic aerosol and that reported by many model studies (2). We further demonstrate how these low-volatility vapours can enhance, or even dominate, the formation and growth of aerosol particles over forested regions, providing a missing link between biogenic VOCs and their conversion to aerosol particles. Our findings could help to improve assessments of biosphere-aerosol-climate feedback mechanisms (6-8), and the air quality and climate effects of biogenic emissions generally., We studied the oxidation of several monoterpenes and other VOCs under atmospherically relevant conditions in the highly instrumented Julich Plant Atmosphere Chamber, JPAC (9), a continuously stirred tank reactor (see [...]

This paper argues in defence of sufficientarianism that there is a general flaw in the most common critiques against it. The paper lays out sufficientarianism and presents the problems of indifference, of outweighing priority, and of discontinuity. Behind these problems is a more general objection to the abruptness of the sufficiency threshold relying upon an assumption regarding arithmeticism about value. The paper argues that sufficientarians need not accept arithmeticism about value and that the commonly held critiques of sufficientarianism are in fact instances of the numbers fallacy pertaining to the construction of numerical counterexamples that gain intuitive traction from ‘empty numbers’ – numbers without meaningful content in reference to the view under investigation. The paper concludes that we should remain sceptical about such use of numerical counterexamples, and while this does not by itself prove sufficientarianism correct, it is an important and novel contribution to its justification. [ABSTRACT FROM AUTHOR]

Aim: To compare the efficacy and safety of once‐weekly (OW) semaglutide versus thrice‐daily (TID) insulin aspart (IAsp) in participants with inadequately controlled type 2 diabetes (T2D) treated with insulin glargine (IGlar) and metformin. Materials and Methods: SUSTAIN 11 (NCT03689374) was a randomized (1:1), parallel, open‐label, multinational, phase 3b trial. After a 12‐week run‐in to optimize once‐daily IGlar U100, 1748 adults with T2D (HbA1c >7.5% to ≤10.0%) were randomized to OW semaglutide or TID IAsp as add‐on to optimized IGlar and metformin for 52 weeks. The primary outcome was change in HbA1c from randomization to week 52. Confirmatory secondary endpoints included the occurrence of severe hypoglycaemic episodes and change in body weight (BW). Safety was assessed. Results: HbA1c (randomization: 8.6% [70.0 mmol/mol]) decreased by 1.5% points (16.6 mmol/mol) and 1.2% points (13.4 mmol/mol) with semaglutide (n = 874) and IAsp (n = 874), respectively (estimated treatment difference [ETD] −0.29% points [95% confidence interval {CI} −0.38; −0.20]; P <.0001 for non‐inferiority). Few severe hypoglycaemic episodes were recorded in either group, with no statistically significant difference between the groups. Change in BW from randomization (87.9 kg) to week 52 was in favour of semaglutide (−4.1 kg) versus IAsp (+2.8 kg) (ETD −6.99 kg [95% CI −7.41; −6.57]). A higher proportion of participants experienced adverse events with semaglutide (58.5%) versus IAsp (52.1%); most were mild to moderate. Conclusions: In this basal insulin‐treated population, OW semaglutide improved glycaemic control to a greater extent than TID IAsp and provided numerically greater weight loss. [ABSTRACT FROM AUTHOR]

The Contents of This Issue In their article "Exceptionalism in the Time of COVID-19: Where Nationalism Meets Irrationality", Lisa Bortolotti and Kathleen Murphy Hollis investigate the role of nationalist exceptionalist rhetoric in shaping inadequate responses to the early stages of the COVID-19 pandemic in the United States and Great Britain. So-called classical nationalism (ethno-nationalism) sees nations as defined by a common, "national", culture extending beyond the confines of political projects. "Nationalism" may mean several things within modern political philosophy.[1] Here, we will focus on nationalism in a normative prescriptive sense and set aside nationalism as a psychological attitude. In principle, one may be a nationalist concerning one nation only, but typically nationalists are universalist nationalists and apply their prescriptions to all nations. [Extracted from the article]

Much research has studied the importance of play for children's development. However, questions of its political importance and our public institutions' duties to protect it have been largely neglected. This article argues that childhood play is politically important due to having both intrinsic and instrumental value, and it suggests that the duty to protect the capability for play in childhood falls especially on the public health system. If this argument succeeds, it follows that we have stronger duties toward our children than we currently believe. [ABSTRACT FROM AUTHOR]

Torbjörn Tännsjö has written a clear and thought-provoking book on healthcare priority setting. He argues that different branches of ethical theory--utilitarianism, egalitarianism, and prioritarianism--are in general agreement on real-world healthcare priorities, and that it is human irrationality that stands in the way of complying with their recommendations. While I am generally sympathetic to the overall project and line of argumentation taken by the book, this paper raises two concerns with Tännsjö's argument. First, that he is wrong to set aside deontic constraints as irrelevant or as pointing in the same direction as consequentialism. Secondly, that his argument against prioritarianism in favor of utilitarianism is insufficient and under-developed. Given these problems, I conclude that we should welcome Tännsjö's contribution but with these qualifications in mind. [ABSTRACT FROM AUTHOR]

Age rationing is a central issue in the health care priority‐setting literature, but it has become ever more salient in the light of the Covid‐19 outbreak, where health authorities in several countries have given higher priority to younger over older patients. But how is age rationing different under outbreak circumstances than under normal circumstances, and what does this difference imply for ethical theories? This is the topic of this paper. The paper argues that outbreaks such as that of Covid‐19 involve special circumstances that change how age should influence our prioritization decisions, and that while this shift in circumstances poses a problem for consequentialist views such as utilitarianism and age‐weighted consequentialism, contractualism is better equipped to cope with it. The paper then offers a contractualist prudential account of age rationing under outbreak circumstances. [ABSTRACT FROM AUTHOR]

Discussions within political theory on naturalisation tend to focus on whether or not it is reasonable and fair to make naturalisation conditional on meeting integration requirements. Those who emphasise the right of long-term immigrants to be included as equal citizens argue that automatic naturalisation is preferable, while those who put emphasis on the state's legitimate interest in promoting the conditions for a reasonably just society tend to argue that conditional naturalisation is normatively preferable. However, most participating in this debate seem to agree that naturalisation rules must balance these different concerns. In this paper, we argue that the conflicting views on each side of the automatic-conditional divide can be reconciled by introducing the model of discounting-conditional naturalisation. We suggest that a practice in which integration requirements are gradually relaxed over time can in fact sufficiently accommodate those normative considerations that are in conflict under the current practices. [ABSTRACT FROM AUTHOR]

Legislative gridlock is a failure of one of the key functions of government: to pass legislation. Can voters counter such political dysfunction? This paper examines whether and how voters hold politicians accountable for gridlock. We focus on the passage of the government budget, the central task of any legislature, and define a legislature to experience budgetary gridlock if it fails to pass the budget on time. We argue, based on evidence from twenty years of budget enactment data, that voters hold state legislators accountable for budget gridlock in US state governments, with gridlocked incumbents losing their seat more often than incumbents passing budgets on time. Based on established theories of party organization in American politics, we develop three competing theoretical hypotheses to guide our understanding of the observed patterns of retrospective voting. We find strong support for collective electoral accountability with voters punishing incumbent members of state legislature majority parties. [ABSTRACT FROM AUTHOR]

Joseph Butler stated that identity can be seen in two ways: a loose and popular one, and a strict and philosophical one. In this paper I will argue that every identity must be seen in the former since it is impossible to have identity in a strict and philosophical sense. I aim to show this by looking at the persistence question arguing that since it is designed to establish identity without accepting change, it fails to give us a useful account of personal identity. I therefore hope to establish what I believe to be a much more useful question, namely that of existence, not persistence. [ABSTRACT FROM AUTHOR]

Dinoflagellates can serve as predators or parasites of tintinnid ciliates. Known predators feed on the ciliate from outside the tintinnid lorica, while parasites either grow in the host cytoplasm or feed inside in the lorica while attached to the outside of the host cell. Here we report mixotrophic species of Scrippsiella that enter the lorica to consume the ciliate zooid of Helicostomella subulata from Denmark and multiple tintinnid species from Korea. We contrast morphology and life-history stages of these mixotrophic predators with dinokaryote parasites of tintinnids and address phylogenetic relationships based on rDNA sequences. Mixotrophic Scrippsiella species sometimes attack tintinnids that are simultaneously infected by syndinean dinoflagellates, complicating study of life histories and potentially leading to confusion about trophic status and taxonomy. [ABSTRACT FROM AUTHOR]