Jewish Ethics Regarding Refugees: Ideology and Realization

This article addresses the Jewish ethical approach to refugees. According to Jewish ethics, help must be offered to refugees of a foreign people, and sometimes, for the sake of peace, even to those of an enemy state. Reviewing the Jewish sources, I conclude that from an ethical point of view, preference should be given to refugees who are near the border over those from farther away. Priority must be given to those in acute distress who lack the basic items of sustenance. Sometimes there is a special value in finding a way to assist even one's enemies in the hope that such help will break down the barriers of hatred. Similarly, it is ethically preferable to offer help to blameless children over adults, whose intentions might be suspect.

Time for Universal Public Distribution System: Food Mountains and Pandemic Hunger in India

The latest National Family Health Survey (NFHS 5) indicates that child stunting in India was severe and has been deteriorating since 2015. This trend could have worsened since the pandemic and the stringent lockdowns meant to contain it. There has been an acute increase in impoverishment as governmental food policies have further exacerbated rather than mitigated inequalities. Families eligible under the National Food Security Act (NFSA), 2013, have been provided with double food grain rations during two waves of the pandemic. However, nearly 45% of India’s population without these ration cards have been largely excluded from additional food relief from the central government. Simultaneously, India’s food grain stocks in government granaries have accumulated to their all-time peak with 2 years of bumper harvests. Therefore, in light of the acute distress faced by marginalised communities due to the pandemic, this article analyses the availability of adequate food grain stocks and contends that the time is opportune for the universal expansion of the public distribution system.

Universal Public Distribution System: Food Mountains and Pandemic Hunger in India

The latest National Family Health Survey (NFHS 5), indicates that even before the pandemic, child stunting in India was severe and has been deteriorating since 2015. But after the stringent lockdown, there has been an acute increase in impoverishment as governmental food policies have further exacerbated rather than mitigated inequalities. Families eligible under the National Food Security Act (NFSA, 2013) have been provided with double food grain rations during two waves of the pandemic. But nearly 45 percent of India’s population without these ration cards have been excluded from any additional food relief from the central government. Simultaneously, India’s food grain stocks in government granaries have accumulated manifold with two years of bumper harvests. Therefore, in light of the acute distress faced by marginalised communities due to the pandemic and unprecedented economic recession, this paper analyses the availability of adequate foodgrain stocks and contends that the time is ripe for the universal expansion of the public distribution system.

Both, and: Transmedicalism and resistance in non-binary narratives of gender-affirming care

While gender dysphoria is a real and acute distress for many transgender people, it is not universal, and it is experienced and oriented to in a myriad of ways. However, its status as a prerequisite for gender-affirming care can lead trans people to feel compelled to amplify its salience in their pursuits for medical support. Through a critical discourse analysis of non-binary healthcare narratives, I trace the relationship between linguistic practices in these care interactions and the gender and sexual logics of the transmedicalist model of transgender care. With a focus on excerpts that center on individuals’ descriptions of dysphoria in the consultation room, I contend that these experiences are not straightforward accounts of assimilation to transmedicalist expectations. Rather, when read from a trans linguistic perspective, these strategies are examples of non-binary patients enacting their own interventions on a process over which (it may seem) they have minimal control and present a critical thirding (Tuck 2009) of a dichotomous view of either transnormativity or resistance.

Increased heart rate functions as a signal of acute distress in non-communicating persons with intellectual disability

Intellectual disability (ID) affects approximately 1% of the population. Some patients with severe or profound ID are essentially non-communicating and therefore risk experiencing pain and distress without being able to notify their caregivers, which is a major health issue. This real-world proof of concept study aimed to see if heart rate (HR) monitoring could reveal whether non-communicating persons with ID experience acute pain or distress in their daily lives. We monitored HR in 14 non-communicating participants with ID in their daily environment to see if specific situations were associated with increased HR. We defined increased HR as being > 1 standard deviation above the daily mean and lasting > 5 s. In 11 out of 14 participants, increased HR indicated pain or distress in situations that were not previously suspected to be stressful, e.g. passive stretching of spastic limbs or being transported in patient lifts. Increased HR suggesting joy was detected in three participants (during car rides, movies). In some situations that were previously suspected to be stressful, absence of HR increase suggested absence of pain or distress. We conclude that HR monitoring may identify acute pain and distress in non-communicating persons with ID, allowing for improved health care for this patient group.

Suicide Exposure in Crisis Workers

Background: Crisis workers provide services to individuals who are in acute distress. There is no research examining personal and occupational exposure to suicide in these workers. Aims: We aimed to examine the prevalence of personal, occupational, and colleague suicide exposure among crisis workers, the mental health outcomes associated with suicide exposures, and perceived professional preparedness for client suicide. Method: Crisis workers ( n = 115) completed an online survey assessing suicide exposure, depression, anxiety, and posttraumatic stress disorder. Results: Over a third of participants (33.9%, n = 37) reported that they had lost at least one client to suicide, with an average of 2.30 clients ( SD = 4.47) lost to suicide. Over three quarters (77.1%, n = 81) of study participants reported they had experienced at least one personal loss to suicide. Those who perceived their relationship to the personal suicide as close or very close had significantly greater PTSD symptoms ( M = 3.29, SD = 2.23) than those who perceived their relationship as not at all close, not close, or somewhat close ( M = 1.38, SD = 1.69), t(20) = −2.10, p = .049. Limitations: Snowball sampling is the study's main limitation. Conclusion: The current study demonstrates that a substantial percentage of crisis workers are exposed to suicide and additional research is needed to determine how exposures impact practice and personal symptoms in this population.

Early Crowdfunding Response to the COVID-19 Pandemic: Cross-sectional Study

Background As the number of COVID-19 cases increased precipitously in the United States, policy makers and health officials marshalled their pandemic responses. As the economic impacts multiplied, anecdotal reports noted the increased use of web-based crowdfunding to defray these costs. Objective We examined the web-based crowdfunding response in the early stage of the COVID-19 pandemic in the United States to understand the incidence of initiation of COVID-19–related campaigns and compare them to non–COVID-19–related campaigns. Methods On May 16, 2020, we extracted all available data available on US campaigns that contained narratives and were created between January 1 and May 10, 2020, on GoFundMe. We identified the subset of COVID-19–related campaigns using keywords relevant to the COVID-19 pandemic. We explored the incidence of COVID-19–related campaigns by geography, by category, and over time, and we compared the characteristics of the campaigns to those of non–COVID-19–related campaigns after March 11, when the pandemic was declared. We then used a natural language processing algorithm to cluster campaigns by narrative content using overlapping keywords. Results We found that there was a substantial increase in overall GoFundMe web-based crowdfunding campaigns in March, largely attributable to COVID-19–related campaigns. However, as the COVID-19 pandemic persisted and progressed, the number of campaigns per COVID-19 case declined more than tenfold across all states. The states with the earliest disease burden had the fewest campaigns per case, indicating a lack of a case-dependent response. COVID-19–related campaigns raised more money, had a longer narrative description, and were more likely to be shared on Facebook than other campaigns in the study period. Conclusions Web-based crowdfunding appears to be a stopgap for only a minority of campaigners. The novelty of an emergency likely impacts both campaign initiation and crowdfunding success, as it reflects the affective response of a community. Crowdfunding activity likely serves as an early signal for emerging needs and societal sentiment for communities in acute distress that could be used by governments and aid organizations to guide disaster relief and policy.

Coagulative Disorders in Critically Ill COVID-19 Patients with Acute Distress Respiratory Syndrome: A Critical Review

In critically ill patients with acute respiratory distress syndrome (ARDS) coronavirus disease 2019 (COVID-19), a high incidence of thromboembolic and hemorrhagic events is reported. COVID-19 may lead to impairment of the coagulation cascade, with an imbalance in platelet function and the regulatory mechanisms of coagulation and fibrinolysis. Clinical manifestations vary from a rise in laboratory markers and subclinical microthrombi to thromboembolic events, bleeding, and disseminated intravascular coagulation. After an inflammatory trigger, the mechanism for activation of the coagulation cascade in COVID-19 is the tissue factor pathway, which causes endotoxin and tumor necrosis factor-mediated production of interleukins and platelet activation. The consequent massive infiltration of activated platelets may be responsible for inflammatory infiltrates in the endothelial space, as well as thrombocytopenia. The variety of clinical presentations of the coagulopathy confronts the clinician with the difficult questions of whether and how to provide optimal supportive care. In addition to coagulation tests, advanced laboratory tests such as protein C, protein S, antithrombin, tissue factor pathway inhibitors, D-dimers, activated factor Xa, and quantification of specific coagulation factors can be useful, as can thromboelastography or thromboelastometry. Treatment should be tailored, focusing on the estimated risk of bleeding and thrombosis. The aim of this review is to explore the pathophysiology and clinical evidence of coagulation disorders in severe ARDS-related COVID-19 patients.