Dominant models of prioritising resources in intensive care unit (ICU) settings under conditions of severe resource scarcity, such as a pandemic, are likely to replicate and potentially exacerbate existing health inequities. One proposal is to advance equity by reserving a proportion of ICU resources, such as beds, for members of specific groups. This qualitative study explored the ethical acceptability of a reserve bed system (RBS) for healthcare workers and for indigenous Māori in the Aotearoa New Zealand context. Participants included Māori (...) and non-Māori clinicians working in ICU settings, and non-clinical staff with expertise in ICU management and policy. Although there was a consensus on the urgency of addressing health inequities in New Zealand, especially for indigenous Māori, participants identified critical ethical challenges in implementing an RBS in the ICU setting. These findings contribute to the broader literature on the ethics of reserve systems for priority-setting. (shrink)

Primary progressive multiple sclerosis (PPMS) shows a highly variable disease progression with poor prognosis and a characteristic accumulation of disabilities in patients. These hallmarks of PPMS make it difficult to diagnose and currently impossible to efficiently treat. This study aimed to identify plasma metabolite profiles that allow diagnosis of PPMS and its differentiation from the relapsing-remitting subtype (RRMS), primary neurodegenerative disease (Parkinson’s disease, PD), and healthy controls (HCs) and that significantly change during the disease course and could serve as surrogate (...) markers of multiple sclerosis (MS)-associated neurodegeneration over time. We applied untargeted high-resolution metabolomics to plasma samples to identify PPMS-specific signatures, validated our findings in independent sex- and age-matched PPMS and HC cohorts and built discriminatory models by partial least square discriminant analysis (PLS-DA). This signature was compared to sex- and age-matched RRMS patients, to patients with PD and HC. Finally, we investigated these metabolites in a longitudinal cohort of PPMS patients over a 24-month period. PLS-DA yielded predictive models for classification along with a set of 20 PPMS-specific informative metabolite markers. These metabolites suggest disease-specific alterations in glycerophospholipid and linoleic acid pathways. Notably, the glycerophospholipid LysoPC(20:0) significantly decreased during the observation period. These findings show potential for diagnosis and disease course monitoring, and might serve as biomarkers to assess treatment efficacy in future clinical trials for neuroprotective MS therapies. (shrink)

In ‘Semantic Foundations for the Logic of Preference’ (Rescher, ed.,The Logic of Decision and Action, University Press, Pittsburgh, 1967), Nicholas Rescher claims that, on the semantics developed in that paper, a certain principle - call it ‘Q’ turns out to be ‘unacceptable’. I argue, however, that, given certain assumptions that Rescher invokes in that same paper,Q can in fact be shown to be a ‘preference-tautology’, and henceQ should be classified as ‘acceptable’ on Rescher's theory.

Graphical AbstractIdentifying the properties and molecules of the intestinal microbiome may help our understanding of various diseases and therefore facilitate their treatment; from excluding pathogens to manipulation of the immune system and regulation of non-intestinal sites.