No abstract

Twenty-four congenitally blind children between 3 and 9 years of age were studied for the prevalence of "autistic-like" features, as assessed by teacher reports and by systematic observations of the children's behaviour. A comparison between the 15 blind children who had IQs over 70 and 10 sighted children group-matched for age and verbal ability revealed that a number of autistic-like features were more common in the blind. When the nine blind children who had IQs less than 70 were compared with nine group-matched autistic children, the picture that emerged was of substantial overlap in clinical presentation, despite subtle differences on clinical impression. Similar results were obtained when blind subgroups were reconstituted according to the children's nonautistic or autistic-like clinical presentation, rather than IQ. These findings are discussed in relation to competing theories concerning the development of autism and "theory of mind".

There is much debate about the use of immunity passports in the response to the COVID-19 pandemic. Some have argued that immunity passports are unethical and impractical, pointing to uncertainties relating to COVID-19 immunity, issues with testing, perverse incentives, doubtful economic benefits, privacy concerns, and the risk of discriminatory effects. We first review the scientific feasibility of immunity passports. Considerable hurdles remain, but increasing understanding of the neutralising antibody response to COVID-19 might make identifying members of the community at low risk of contracting and transmitting COVID-19 possible. We respond to the ethical arguments against immunity passports and give the positive ethical arguments. First, a strong presumption should be in favour of preserving people's free movement if at all feasible. Second, failing to recognise the reduced infection threat immune individuals pose risks punishing people for low-risk behaviour. Finally, further individual and social benefits are likely to accrue from allowing people to engage in free movement. Challenges relating to the implementation of immunity passports ought to be met with targeted solutions so as to maximise their benefit. Context of the debateAt this point in the COVID-19 pandemic, how or when our lives might return to normality is unclear. One strategy proposed to help this resumption is the identification and documentation of immunity: so-called immunity passports. These passports are a potential tool for recording and sharing the immune status of an individual. The introduction of immunity passports is being considered by several countries, including the UK, Estonia, Italy, and Chile; although as yet, there is no information on the effects of their use. [1][2][3] Health certification for public health purposes is already used in other contextseg, in the management of yellow fever. 4 Passports could take different forms, such as a wristband, smartphone application, or certificate, and be used to confirm to others that a particular individual is at a low risk of acquiring or transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During periods of lockdown, immunity passports could allow immune individuals to follow less stringent requirements around physical distancing and travel, perhaps permitting them to return to work, care for those at risk, visit friends and relatives, or undertake other activities that expose them to the virus. Whether this strategy should be pursued depends on both scientific evidence and ethical reasoning.

In an online study conducted separately in the UK and the US, participants rated the acceptability and fairness of four interventions: two types of financial incentives (rewards and penalties) and two types of medical interventions (pills and injections). These were stated to be equally effective in improving outcomes in five contexts: (a) weight loss and (b) smoking cessation programmes, and adherence in treatment programmes for (c) drug addiction, (d) serious mental illness and (e) physiotherapy after surgery. Financial incentives (weekly rewards and penalties) were judged less acceptable and to be less fair than medical interventions (weekly pill or injection) across all five contexts. Context moderated the relative preference between rewards and penalties: participants from both countries favoured rewards over penalties in weight loss and treatment for serious mental illness. Only among US participants was this relative preference moderated by perceived responsibility of the target group. Overall, participants supported funding more strongly for interventions when they judged members of the target group to be less responsible for their condition, and vice versa. These results reveal a striking similarity in negative attitudes towards the use of financial incentives, rewards as well as penalties, in improving outcomes across a range of contexts, in the UK and the USA. The basis for such negative attitudes awaits further study.

The COVID-19 pandemic has led a number of countries to introduce restrictive ‘lockdown’ policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of immunity passports raises a number of practical and ethical challenges. In this paper, we seek to review the challenges relating to various practical considerations, fairness issues, the risk to social cooperation and the impact on people’s civil liberties. We make tentative recommendations for the ethical introduction of immunity passports.

Background Policies to use financial incentives to encourage healthy behaviour are controversial. Much of this controversy is played out in the mass media, both reflecting and shaping public opinion.

Analysis 1.1. Comparison 1 Aripiprazole versus placebo, Outcome 1 Mean change in YMRS from baseline at three weeks. Analysis 1.2. Comparison 1 Aripiprazole versus placebo, Outcome 2 Mean change in YMRS from baseline at day four. Analysis 1.3. Comparison 1 Aripiprazole versus placebo, Outcome 3 Mean change in YMRS from baseline week four. Analysis 1.4. Comparison 1 Aripiprazole versus placebo, Outcome 4 Mean change in YMRS from baseline at week six. Analysis 1.5. Comparison 1 Aripiprazole versus placebo, Outcome 5 Mean change in YMRS from baseline to week 12.

Analysis 1.1. Comparison 1 Aripiprazole versus placebo, Outcome 1 Mean change in YMRS from baseline at three weeks. Analysis 1.2. Comparison 1 Aripiprazole versus placebo, Outcome 2 Mean change in YMRS from baseline at day four. Analysis 1.3. Comparison 1 Aripiprazole versus placebo, Outcome 3 Mean change in YMRS from baseline week four. Analysis 1.4. Comparison 1 Aripiprazole versus placebo, Outcome 4 Mean change in YMRS from baseline at week six. Analysis 1.5. Comparison 1 Aripiprazole versus placebo, Outcome 5 Mean change in YMRS from baseline to week 12.