The COVID-19 (Coronavirus disease of 2019) pandemic has led to intense conversations about ventilator allocation and reallocation during a crisis standard of care. Multiple voices in the media and multiple state guidelines mention reallocation as a possibility. Drawing upon a range of neuroscientific, phenomenological, ethical, and sociopolitical considerations, the authors argue that taking away someone’s personal ventilator is a direct assault on their bodily and social integrity. They conclude that personal ventilators should not be part of reallocation pools and (...) that triage protocols should be immediately clarified to explicitly state that personal ventilators will be protected in all cases. (shrink)

A ventilator is a device that provides cool air by moving the air in or out of the lungs, inhaling a patient who is not fit to smell, or breathing properly. In this paper, a resistive chest belt sensorbased mechanical ventilator is designed to provide the COVID-19 patient with the volume of air you need to deliver with the expansion of the patient's chest in need of more air. The resistive band sensor senses the expansion of the patient's chest and (...) controls the solenoid valve attached to the oxygen compressor. The function of the respirator is tested with the MATLAB / Simulink tool with the help of a Proportional Integral Derivative (PID) Controller and a promising result obtained. (shrink)

In response to the COVID‐19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an (...) important higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre‐existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID‐19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives. (shrink)

In the first wave of the COVID-19 pandemic, healthcare workers in some countries were forced to make distressing triaging decisions about which individual patients should receive potentially life-saving treatment. Much of the ethical discussion prompted by the pandemic has concerned which moral principles should ground our response to these individual triage questions. In this paper we aim to broaden the scope of this discussion by considering the ethics of broader structural allocation decisions raised by the COVID-19 pandemic. More specifically, we (...) consider how nations ought to distribute a scarce life-saving resource across healthcare regions in a public health emergency, particularly in view of regional differences in projected need and existing capacity. We call this the regional triage question. Using the case study of ventilators in the COVID-19 pandemic, we show how the moral frameworks that we might adopt in response to individual triage decisions do not translate straightforwardly to this regional-level triage question. Having outlined what we take to be a plausible egalitarian approach to the regional triage question, we go on to propose a novel way of operationalising the ‘save the most lives’ principle in this context. We claim that the latter principle ought to take some precedence in the regional triage question, but also note important limitations to the extent of the influence that it should have in regional allocation decisions. (shrink)

In this paper, the design of a low cost portable ventilator with performance analysis have been done to solve the scarcity of respiratory ventilators for COVID-19 patients. The materials used to build the system are: DC motor, rotating disc and pneumatic piston. The system input is the patient heart beat and the output is volume of air to the patient lung with adjusted breathing rate. This ventilator adjusts the breathing rate to the patient depending on his heart beat rate. (...) The performance analysis of this system have been done using Proportional Integral Derivative (PID) and Full State Feedback H2 controllers. Comparison of the system with the proposed controllers have been done using a step change and a random change of the patient heart beat and a promising result have been analyzed successfully. (shrink)

In this paper, the design of a low cost portable ventilator with performance analysis have been done to solve the scarcity of respiratory ventilators for COVID-19 patients. The materials used to build the system are: DC motor, rotating disc and pneumatic piston. The system input is the patient heart beat and the output is volume of air to the patient lung with adjusted breathing rate. This ventilator adjusts the breathing rate to the patient depending on his heart beat rate. (...) The performance analysis of this system have been done using Proportional Integral Derivative (PID) and Full State Feedback H2 controllers. Comparison of the system with the proposed controllers have been done using a step change and a random change of the patient heart beat and a promising result have been analyzed successfully. (shrink)

This paper develops a philosophical account of moral disruption. According to Robert Baker (2013), moral disruption is a process in which technological innovations undermine established moral norms without clearly leading to a new set of norms. Here I analyze this process in terms of moral uncertainty, formulating a philosophical account with two variants. On the Harm Account, such uncertainty is always harmful because it blocks our knowledge of our own and others’ moral obligations. On the Qualified Harm Account, there is (...) no harm in cases where moral uncertainty is related to innovation that is “for the best” in historical perspective, or where uncertainty is the expression of a deliberative virtue. The two accounts are compared by applying them to Baker’s historical case of the introduction of mechanical ventilation and organ transplantation technologies, as well as the present-day case of mass data practices in the health domain. (shrink)

This article presents information about facades, their thermal insulating role in buildings in Albania. The façade in construction is one of the necessary factors to ensure a longer life of the buildings and indoor thermal comfort. Façade systems are composed of different materials, which provide a protective effect during the life of the building. The article will focus on the characteristic materials used in Albania for the construction of facades and the main materials used from the year 2000 up to (...) today. The article will be informative, statistical, and comparative in order to draw conclusions. Nowadays building facades are again becoming one of the main subjects of discussion, undoubtedly due to the increasing importance of the building envelope in relation to energy consumption. In the 90s, minimal attention was paid to the efficiency and quality of facades; everything was done strictly in relation to residency requirements. But, during this last decade, Albania experienced a construction boom, with a series of good new buildings, which are accompanied by progress in the architectural style and in the techniques of building materials usage. However, the advantages of façade systems in construction are not only to make the building long-lasting. The function of facades always undergoes changes and advances over time, in terms of their impact on the temperature fluctuations inside the building or energy storage. (shrink)

This paper develops a philosophical account of moral disruption. According to Robert Baker, moral disruption is a process in which technological innovations undermine established moral norms without clearly leading to a new set of norms. Here I analyze this process in terms of moral uncertainty, formulating a philosophical account with two variants. On the harm account, such uncertainty is always harmful because it blocks our knowledge of our own and others’ moral obligations. On the qualified harm account, there is no (...) harm in cases where moral uncertainty is related to innovation that is “for the best” in historical perspective or where uncertainty is the expression of a deliberative virtue. The two accounts are compared by applying them to Baker’s historical case of the introduction of mechanical ventilation and organ transplantation technologies, as well as the present-day case of mass data practices in the health domain. (shrink)

During the coronavirus pandemic, communities have faced shortages of important healthcare resources such as COVID-19 vaccines, medical staff, ICU beds and ventilators. Public health officials in the U.S. have had to make decisions about two major issues: which infected patients should be treated first (triage), and which people who are at risk of infection should be inoculated first (vaccine distribution). Following Beauchamp and Childress’s principlism, adopted guidelines have tended to value both whole lives (survival to discharge) and life-years (survival (...) for years past discharge). This process of collective moral reasoning has revealed our common commitment to both Kantian and utilitarian principles. For Kant, respecting people’s rights entails that we ought to value whole lives equally. Therefore we ought to allocate resources so as to maximise the number of patients who survive to discharge. By contrast, the principle of utility has us maximise life-years so that people can satisfy more of their considered preferences. Although people are treated impartially in the utilitarian calculus, it does not recognise their equal worth. Subjecting Kantian ethics and utilitarianism to the process of reflective equilibrium lends support to the idea that we need a pluralistic approach that would accommodate our moral intuitions regarding both the equal value of whole lives and the additive value of life-years. (shrink)

The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), and equal access (...) may compete with one another. We propose the use of a “categorized priority system” (also known as a “reserve system”) as an improvement over existing allocation methods, particularly because it may be able to achieve disparity mitigation better than other methods. (shrink)

Current COVID-19 pandemic and previous SARS/MERS outbreaks have caused a series of major crises to global public health. We must integrate the large and exponentially growing amount of heterogeneous coronavirus data to better understand coronaviruses and associated disease mechanisms, in the interest of developing effective and safe vaccines and drugs. Ontologies have emerged to play an important role in standard knowledge and data representation, integration, sharing, and analysis. We have initiated the development of the community-based Coronavirus Infectious Disease Ontology (CIDO). (...) As an Open Biomedical Ontology (OBO) library ontology, CIDO is an open source and interoperable with other existing OBO ontologies. In this article, the general architecture and the design patterns of the CIDO are introduced, CIDO representation of coronaviruses, phenotypes, anti-coronavirus drugs and medical devices (e.g. ventilators) are illustrated, and an application of CIDO implemented to identify repurposable drug candidates for effective and safe COVID-19 treatment is presented. (shrink)

In their important article, Haward et al. (2020) discuss whether guidelines for treating extremely premature babies should be altered to free up ventilators during crises such as COVID-19 pandemic. The authors’ claim is that premature babies do not deserve special consideration for ventilator treatment but merely equal consideration. In this brief commentary, I continue their discussion by considering additional factors that may help us determine whom we should save in a crisis: babies or the elderly.

Although policymakers and investigators still struggle to quantify and compare the effects of various Covid-related interventions, we are steadily amassing data that could help inform choices. The pandemic’s medical, social, and economic harms have been immense, and they warrant a continuous policy response. All decision makers use some type of mental model to weigh the pros and cons of various policy options. Rigorous economic evaluation formalizes this process. Value judgments will still be required, but economic evaluation can make the decision-making (...) process more systematic, comprehensive, and transparent. (shrink)

In this bioethical poem, the narrator reflects on the experience of their father's degenerative illness, and decisions that must be made about whether to continue life support technologies such as ventilation and nutrition/hydration. What is it that is owed to family and patient at the end of life? What must no one who loves anyone ever do to the one they love?

Albania is part of the emerging economies of the Western Balkan region. Polis University is one of the pioneering institutions in the field of architecture, built environment, and city sciences that represents innovative methodologies and concepts for educational and scientific purposes. Nowadays, many constructions in Albania involve a wide range of different materials. The building envelope is one of the main elements that provide protection from the outside environment but also the required thermal comfort for the inhabitants. The necessary balance (...) must be archived between energy efficiency and the durability of buildings. This paper will focus on the thermal performance and materials composition of two different types of masonry walls, a constituent part of Polis University's main building. The study will be based on an experiment using specific instruments to diagnose these typologies of wall composition. The results are further analyzed and compared. Specific instruments such as the thermal camera (Testo 882), U-value(Testo 435-2), and “Silverline Digital Moisture Meter” (from POLIS Energy lab) are engaged. The collected data are further interpreted through graphs, tables, and diagrams for both cases. It is observed that ventilated facades perform much better than standard facades, therefore their usage is strongly recommended. (shrink)

Objective: This study aimed to investigate and compare the effects of tubular gastroesophageal anastomosis and traditional gastroesophageal supra-arch anastomosis on the postoperative lung function of patients with esophageal carcinoma. -/- Methods: A total of 90 patients with middle-lower segmental esophageal cancer admitted in our hospital from August 2014 to August 2016 were recruited to our study. They were randomly divided into two groups. The observation group underwent tubular gastroesophageal anastomosis, whereas the control group underwent traditional gastroesophageal supra-arch anastomosis. Changes in (...) the postoperative pulmonary function were compared between the two groups. -/- Results: The numbers of CD4 cells (27.45 ± 5.48), CD8 cells (35.97 ± 7.16), and natural killer cells (20.79 ± 2.49), as well as the CH4/CD8 ratio (0.69 ± 0.18), of the patients in the observation group were significantly higher than the (38.45 ± 5.98), (20.45 ± 6.41), (39.44 ± 3.49), and (1.31 ± 0.48), respectively, of the patients in the control group. The differences between the two groups were statistically significant (P<0.05). By contrast, the preoperative forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and maximum voluntary ventilation (MVV) did not significantly differ between the two groups (P>0.05). The FEV1 (1.76 ± 0.41 L), FVC (2.33 ± 0.32 L), and MVV (33.7 ± 5.2 L/min) of the observation group were significantly higher than those of the control group (P<0.05). Meanwhile, the complication rate of the observation group was 42.2%, which was significantly lower than that of the control group (75.6%) (P<0.05). -/- Conclusion: Tubular gastroesophageal anastomosis can benefit patients with esophageal cancer by significantly reducing the adverse effects on their postoperative pulmonary function and control the occurrence of postoperative complications. (shrink)

The focus of the paper is the comparison between the two composite aluminum panels, respectively Alpolic and Durabond. The paper is going to explore their reaction when interacting with Tirana`s climatological factors and their tension strength through an experiment, in order to find out which panel displays the best performance. The construction urge is constantly evolving, especially in Tirana mostly because it is the main industrial and economical district of Albania. It is distinguished that innovative technology is being used in (...) facades of the new buildings. One of the features that finds massive use in façade coating in the city is the application of ventilated facades equipped with external aluminum composite panels. This paper is going to deal with two buildings with different typologies of external coating, including the different types of aluminum panels. The analysis will focus on identifying each panel property such as tension strength; their respond to various external factors; their thermal conductivity; and their manufacturing companies which have been selected and produced. Within this paper graphics displays of the records will be included, offering concentrated information and a high level of reliability for both aluminum composite panels. (shrink)

Since 1968, the irreversible loss of functioning of the whole brain, called brain death, is assimilated to individual’s death. The almost universal acceptance of this neurological criterion of death had decisive consequences for the contemporary medicine, such as the withdrawal of mechanical ventilation in these patients and organ retrieval for transplantation. The new criterion was successfully accepted in part because the assimilation of brain death state to death was presented by medicine --and acritically assumed by most of societies-- as a (...) scientific and objective fact. Nevertheless, many people do not think that the patients suffering brain death are actually dead. We show here that those people are not necessarily wrong. It can be argued that, in fact, the justification of the neurological criterion is not scientific but moral. We outline the thesis that the problem surrounding the vital status of brain dead patients is due to a confusion between factual and normative questions. Furthermore, we claim that the donation of organs and the withdrawal of life-support could be ethically acceptable even if the patients suffering brain death are considered as alive. As an alternative to the dead donor rule, we propose a justification for organ donation of brain-dead patients based on the (moral) concepts of harm and consent : what truly justifies the procurement of organs on those patients is not that they are dead, but that they wish to donate their organs and that, since they have irreversibly lost their brain, they cannot be harmed. (shrink)

Background: Critically ill patients often require complex clinical care by highly trained staff within a specialized intensive care unit (ICU) with advanced equipment. There are currently limited data on the costs of critical care in low-and middle-income countries (LMICs). This study aims to investigate the direct-medical costs of key infectious disease (tetanus, sepsis, and dengue) patients admitted to ICU in a hospital in Ho Chi Minh City (HCMC), Vietnam, and explores how the costs and cost drivers can vary between the (...) different diseases. -/- Methods: We calculated the direct medical costs for patients requiring critical care for tetanus, dengue and sepsis. Costing data (stratified into different cost categories) were extracted from the bills of patients hospitalized to the adult ICU with a dengue, sepsis and tetanus diagnosis that were enrolled in three studies conducted at the Hospital for Tropical Diseases in HCMC from January 2017 to December 2019. The costs were considered from the health sector perspective. The total sample size in this study was 342 patients. -/- Results: ICU care was associated with significant direct medical costs. For patients that did not require mechanical ventilation, the median total ICU cost per patient varied between US$64.40 and US$675 for the different diseases. The costs were higher for patients that required mechanical ventilation, with the median total ICU cost per patient for the different diseases varying between US$2,590 and US$4,250. The main cost drivers varied according to disease and associated severity. -/- Conclusion: This study demonstrates the notable cost of ICU care in Vietnam and in similar LMIC settings. Future studies are needed to further evaluate the costs and economic burden incurred by ICU patients. The data also highlight the importance of evaluating novel critical care interventions that could reduce the costs of ICU care. (shrink)

I agree with about 95% of what Paul Moser has written in his book The Elusive God. However, I have three main points of disagreement with Moser, two of which I ventilate in this paper. The third I discuss in my paper "What's Love Got to Do with It?" also on this website.

The incorporation of thermal insulation materials into building walls is a novel strategy for reducing heating and cooling energy consumption. Nowadays, the issues of energy production, consumption, and energy storage have become global problems. Furthermore, the thermal insulation of buildings increases the thermal comfort of residential premises in order to save energy. The use of several kinds of thermal insulation materials is required in the construction sector. This paper compares the thermal and moisture performance of two different types of walls. (...) The buildings taken under consideration are located in two different Tirana neighborhoods, close to each other sharing similar climate parameters. Depending on the presence of thermal insulation, two types of walls were taken into consideration. A wall in which thermal insulation is not present and a wall with a ventilated façade system, are considered. Thermal insulation in the second case is made with rock mineral cotton. In order to obtain the most accurate results, pertinent temperature and humidity, measurements were made at several spots along the walls. The comparative analysis was performed using special measuring instruments. The temperature and moisture level in the internal walls and the temperatures of the external walls, at various spots on the walls, were taken into consideration, along with the layers of the relevant walls in both cases. The aim of this paper is to experimentally study the thermal performance of walls with various types of thermal insulation, including the ventilated façade system, as well as walls without thermal insulation. The purpose of the study is also to show how the technical and architectural methods utilized during construction affect the moisture and temperature fluctuations of the perimeter walls. (shrink)

Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of first-come, (...) first-served allocation; (iv) the relevance of post-episode survival; (v) the difference between age and other factors that affect life-expectancy; and (vi) the need to avoid quality-of-life judgments. In the second part, we lay out some positions on which reasonable people can and do differ. These include (i) conflicts between maximizing benefits and priority to the worst off; (ii) role-based priority; and (iii) whether patients’ existing lifesaving resources should be subject to redistribution. (shrink)

This paper is guided by, and begins to make plausible, the idea that there can be a naturalistic metaphilosophy, i.e., an inquiry that takes philosophy as an object of study in something like the way that contemporary (naturalistic) philosophy of science takes science as an object of study. The paper’s more specific goal is to ventilate certain provocative speculations concerning the character of philosophy’s cognitive achievement, especially over time. But this more specific goal will be approached indirectly, through addressing in (...) a preliminary way the question what the proper relationship is between philosophy and the study of philosophy’s history. (shrink)

John Herbinius (1633–1679) was a well-known Lutheran theologian and writer. Living for a long time on the territory of the Polish-Lithuanian Commonwealth, he wrote a description of the religious caves of Kyiv, which was published in 1675 in Jena. Plenty of popular cults of Ruthenian spiritual life of the first half of the seventeenth century are reflected in the book. It is important to underline that Herbinius did not criticize the glorification and imitation of saints. He briefly mentioned their post-mortem (...) waiting role in the place of salvation and omitted the Orthodox prayers to them. The great Orthodox mistake for Herbinius was glorifying human and not Christ’s merits as a cause of sanctity and miracle. This very important theological difference was, however, the only one distinction that Herbinius saw between the Orthodox and Protestant traditions of the veneration of saints. The veneration of relics was not criticized by John Herbinius either. On the contrary, relics of Christ’s followers can and must be worshiped, through them God performs miracles, the Protestant author believed. However, Herbinius did not share the Orthodox idea of miraculous unperishability of the saints’ remains in the Cave Monastery. Those remains, as he wrote, are particularly damaged and particularly preserved because of the existing ventilation system in the caves; the saints’ heads are oozing the oil as a result of absorbing of the special air as well. Trying to provide these arguments, Herbinius aimed to deny the core of the Orthodox belief that Kyiv relics preserved undamageed because of great merits and dignities possessed by the Cave fathers in the eyes of God. Obviously, the very idea of merits, earned by the monks due to their ascetic efforts, could have not been accepted by the Protestant author. It strongly contradicted with his confessional views and was unambiguously treated by him as idolatry. (shrink)

Objective: Otitis media is one of the most common ear disorders occurring in childhood, which causes alterations in communication between parents and children, thereby having a significant effect on the health-related quality of life. Otitis Media-6 questionnaire (OM-6) is a Likert-type scale used to assess the health-related quality of life in children with otitis media. In this study, our aim was to create a consistent, reliable, and valid Turkish version of the OM-6. Methods: Children with otitis media presenting with effusion (...) and healthy children were enrolled in this study between February 2019 and September 2019. The OM-6 test was administered to three different groups, including preoperative, postoperative, and control, among the children who had undergone ventilation tube insertion operation and among the healthy children. Results: The overall scores of children with otitis media presenting with effusion exhibited a changing pattern, indicating a statistical significance in the evaluation of the health-related quality of life. The Turkish version of OM-6 includes the scores of construct validity (Spearman values between 0, 58-0, 89), internal consistency (Cronbach’s alpha values between 0, 88-0, 96), and reliability (Pearson correlation value between 0, 67-0, 91). These scores exhibited a statistical significance. Conclusion: The Turkish version of OM-6 is a stable, valid questionnaire with internal consistency. (shrink)

The article aims to investigate and analyze the social impact of industrialization on Badli. Badli is one of the largest industrial zones in Delhi which also bears large slums neighboring to the industries. The literature available on the area is also limited to news articles and government reports, thus further research on Badli is required. The social implications were examined through naturalistic observational research and unstructured interviews of 10 individuals from Badli. Using thematic analysis and secondary data analysis the data (...) was interpreted into common themes and key ideas. The analysis showed most Industries in Badli are unauthorized and have issues such as unemployment, child labor, hazardous working conditions, nominal wages, producing illegal substances and lack of healthcare management. People living in the neighboring slum areas suffer from issues such as poor health care facilities, below par educational infrastructure, high crime rates, harmful drainage and ventilation services, congested housing structures, economic disparity, and toxic family environment. Thus Industrialization has deeper implications on the society of Badli which can be attributed to the influx of migrants, industries and poor governance by the administrative authorities to control and manage the industrial process in Badli. It can be concluded that there is a huge correlation between social change and industrialization. Further studies are required to create socio-economic policies catering to the situation in Badli for a long-lasting sustainable effect on the area. (shrink)

Hospital acquired infections (HAIs), especially ventilator associated respiratory infection (VARI) cause significant morbidity and mortality, and disproportionally so in low and middle-income countries (LMICs), including Vietnam, where infection control in hospitals is often neglected. The management of HAIs in these settings is challenging because of the high proportions of antimicrobial drug resistance and limitations of laboratory diagnostics, financial and human resources in terms of knowledge and skills for antimicrobial stewardship and infection prevention and control.