Ethical Criteria for Health-Promoting Nudges: A Case-by-Case Analysis.

Health-promoting nudges have been put into practice by different agents, in different contexts and with different aims. This article formulates a set of criteria that enables a thorough ethical evaluation of such nudges. As such, it bridges the gap between the abstract, theoretical debates among academics and the actual behavioral interventions being implemented in practice. The criteria are derived from arguments against nudges, which allegedly disrespect nudgees, as these would impose values on nudgees and/or violate their rationality and autonomy. Instead of interpreting these objections as knock-down arguments, I take them as expressing legitimate worries that can often be addressed. I analyze six prototypical nudge cases, such as Google's rearrangement of fridges and the use of defaults in organ donation registration. I show how the ethical criteria listed are satisfied by most-but not all-nudges in most-but not all-circumstances.

Effective Vote Markets and the Tyranny of Wealth.

What limits should there be on the areas of life that are governed by market forces? For many years, no one seriously defended the buying and selling votes for political elections. In recent years, however, this situation has changed, with a number of authors defending the permissibility of vote markets (e.g. Freiman 2014). One popular objection to such markets is that they would lead to a tyranny of wealth, where the poor are politically dominated by the rich. In a recent paper, Taylor (Res Publica 23(3):313-328, 2017. doi:10.1007/s11158-016-9327-0) has argued that this objection can be avoided if certain restrictions are placed on vote markets. In this paper we will argue that this attempt to rebut an argument against vote markets is unsuccessful. Either vote markets secure their purported benefits but then they inevitably lead to a tyranny of wealth, or they are restricted so heavily that they lack the features that have been claimed to make vote markets attractive in the first place. Using Taylor's proposal as a test case, we make the more general claim that vote markets cannot avoid the tyranny of wealth objection and bring about their supposed benefits at the same time.

Cartilage island on stapes: autologous PORP in the hypoventilated middle ear.

The most common technique in sound restoration of the middle ear is prosthetic surgery. Hypoventilation of the middle ear may cause adhesive otitis or atelectasis resulting in a higher risk of prosthetic extrusion rate and recurrence of the underlying cholesteatoma. We report long-term results using an island of tragal cartilage as an autologous PORP in selected patients with poor middle ear ventilation. Retrospective chart reviews were performed for procedures involving 52 patients between year 2000 and 2009. All patients that underwent surgery using tragal cartilage interposed between the suprastructure of the stapes and the tympanic membrane were included in this study. Audiological parameters using four frequencies, 0.5, 1, 2 and 3 kHz, according to AAO-HNS guidelines, were assessed pre-and postoperatively. The hearing results on different PTA frequencies were also investigated. We report long-term follow-up of patients with hypoventilated middle ear with a success rate of 71% (ABG <20%). With regards to the ABG, the low frequency component (5 and 1 kHz) showed a significantly (p < 0.05) larger improvement of mean values after surgery as compared to the high-frequency component (2 and 3 kHz). Cartilage island PORP on stapes is a stable and efficient method for selected patients with chronic middle ear disease.

The sexual ethics of HPV vaccination for boys.

Human papillomavirus (HPV) is one of the most common sexually transmitted infections. It is a leading cause of cervical cancer in women but the virus is increasingly being linked to several other cancers in men and women alike. Since the introduction of safe and effective but also expensive vaccines, many developed countries have implemented selective vaccination programs for girls. Some however argue that these programs should be expanded to include boys, since (1) HPV constitutes non-negligible health risks for boys as well and (2) protected boys will indirectly also protect girls. In this paper we approach this discussion from an ethical perspective. First, on which moral grounds can one justify not reimbursing vaccination for the male sex? We develop an ethical framework to evaluate selective vaccination programs and conclude that, in the case of HPV, efficiency needs to be balanced against non-stigmatization, non-discrimination and justice. Second, if vaccination programs were to be expanded to boys as well, do the latter then also have a moral duty to become immunized? Two arguments in favor of such a moral duty are well known in vaccination ethics: the duty not to harm others and to contribute to the public good of public health. However, we argue that these are not particularly convincing in the context of HPV. In contrast, we believe a third, more powerful but also more controversial argument is possible. In our view, the sexual mode of transmission of HPV constitutes an additional reason to believe that boys in fact may have a moral obligation to accept vaccination.

Forecasting global aluminium flows to demonstrate the need for improved sorting and recycling methods.

The probable emergence of a global aluminium scrap surplus in the coming decade is one of the main incentives for the aluminium recycling industry to invest in new methods and technologies to collect, sort and recycle aluminium scrap. However, due to the considerable uncertainty in the evolution of the global scrap surplus, it is difficult for policymakers and the recycling industry to accurately estimate the economic and environmental advantages of implementing enhanced sorting and recycling methods. The International Aluminium Institute (IAI) has developed a model to track and forecast the global flows of aluminium, but this model is not extensive enough to estimate the scrap surplus evolution. Therefore, this paper introduces an alloy series resolution to the supply and demand of aluminium in the IAI's global flow model and estimates the composition of the recovered scrap flows to improve the estimate of the technical potential of secondary alloy production. The estimated scrap surplus evolution is subjected to a sensitivity analysis, considering the most critical parameters, including the speed of electrification in the automotive sector, the recovered scrap's composition and the lifetime of aluminium products. In addition, the estimated composition of the recovered aluminium scrap in the model is compared to composition measurements of alumimium scrap collected at a Belgian recycling facility as a means of validation. This study allows to estimate that the global aluminium scrap surplus will emerge soon and reach a size of 5.4 million tonnes by 2030 and 8.7 million tonnes by 2040, if currently adopted aluminium sorting and recycling methods are not improved.

More important and surprising actions of a moral exemplar trigger stronger admiration and inspiration.

Admiring a moral role model has been found to inspire people to become better persons themselves. But what are the antecedents that trigger admiration and thus make inspiration more likely? In three studies, we tested the effect of perceived importance and perceived surprisingness of the moral action on resulting admiration and inspiration. Study 1 finds that perceived importance, and to a lesser extent, the perceived surprisingness of a moral action, are related to stronger admiration. Manipulating the perceived importance of the same moral action by only providing a little more detail about the moral action, could increase the admiration and inspiration the role models elicit (Studies 2 and 3). Our findings help the understanding of how moral exemplars trigger inspiration and provide valuable insights into further investigation toward the causes of admiration.

In vitro cholesteatoma growth and secretion of cytokines.

CONCLUSION: Our results show a significant difference between skin and cholesteatoma biology in vitro. OBJECTIVES: Cholesteatoma disease is a process of destruction characterized by uncontrolled growth of squamous epithelial cells in the middle ear or temporal bone. The pathophysiology behind the cholesteatoma development is controversial, and the mechanisms driving the cholesteatoma growth, migration and destructive properties is still unclear. We aimed to provide a method to study the effect of various compounds on cholesteatoma and skin tissue growth, as well as to further investigate the biological differences between normal skin and cholesteatoma tissue. METHODS: We have established a method to study cholesteatoma biopsy tissue in vitro. Cholesteatoma tissues from patients undergoing surgery for chronic otitis were grown in culture medium and compared to growth patterns and behaviour of normal retroauricular skin. Conditioned medium was analysed for various secreted cytokines. RESULTS: We found a radial outgrowth of keratinocyte epithelium from the circular biopsies. After 5 days of culture we found a significant growth of both cholesteatoma and skin-derived cells. Cholesteatoma samples showed higher growth rate as compared with skin control cultures from the same patient. Moreover, the cholesteatoma cells showed higher production of monocyte chemoattractant protein-1 (MCP-1) and interleukin (IL)-6 as compared with normal skin.