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SAMJ: South African Medical Journal
On-line version ISSN 2078-5135
Print version ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.99 n.2 Pretoria Feb. 2009
Surgeons and HIV: South African attitudes
C P SzaboI; A DhaiII; M VellerIII; A KleinsmidtIV
IMB BCh, FCPsych (SA), MMed Psych, PhD, MSc Med (Bioethics & Health Law). Division of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand
IIMB BCh, FCOG (SA), LLM, PGDip Int Res Ethics. Steve Biko Centre for Bioethics, Faculty of Health Sciences, University of the Witwa tersrand
IIIMB BCh, FCS (SA), MMed (Surg). Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand
IVBA, LL B, LL M. Attorney of the High Court of South Africa
OBJECTIVES: The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons.
DESIGN: A cross-sectional survey of surgeons who were members of the Association of Surgeons of South Africa, regarding their attitudes to the preceding issues.
RESULTS: The salient findings included the view that a patientcentred approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients, and that HIV-positive surgeons should determine their own scope of practice.
CONCLUSION: Patient-centred approaches and restrictive policies, related to this issue, do not accord with clinician sentiment. In the absence of comparable local or international data, this study provides clinicians' views with implications for the development of locally relevant policies and guidelines.
The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) have had a considerable impact on society.1 South Africa has an estimated 5.7 million adults and children living with HIV, and an estimated 350 000 AIDS-related deaths in 2007.2
The initial focus of risk in the medical setting was on health care workers (HCWs) (and surgeons in particular),3 but the emergence of HIV-positive HCWs resulted in concerns that also included patient safety. The perceived risk to patients appeared to have been overstated, especially in view of the advent of antiretrovirals that reduce viral load and infectivity.4
Following initial reports of HCW-to-patient HIV transmission, the Centers for Disease Control and Prevention (CDC) issued guidelines in 1991 for HIV-positive HCWs. These guidelines, specific to the prevention of transmission of HIV and hepatitis B virus,5 were criticised for numerous reasons, not least of which was that they seemed to discriminate against practitioners while not necessarily conferring benefit on patients.4
The Health Professions Council of South Africa (HPCSA) guidelines for the management of patients with HIV infection or AIDS (http://www.hpcsa.co.za/hpcsa/userfiles/file/ProfessionalGuidelines.doc) make specific recommendations for infected practitioners relating to both practice (continuation thereof) and disclosure (no obligation) as well as the need to seek counselling. Along similar lines, South African Medical Association publications suggest that practitioners who are HIV-positive could be regarded as impaired on the basis that they should consider modifying their practice so as not to place patients at risk. However, there is no obligation for disclosure to either employers or co-workers, and any restrictions imposed on such practitioners should only be those that are 'scientifically justifiable', which accords with the HPCSA guidelines.6,7
Local policies and those from developed countries may not address the clinical realities or sentiments in South Africa and may not accord with clinicians' views. We surveyed the views of practising South African surgeons regarding aspects of HIV and its impact on surgeons.
Materials and methods
The study employed a cross-sectional postal survey of practising surgeons in South Africa, using a questionnaire. There are approximately 500 registered general surgeons in South Africa, including plastic and vascular surgeons. The questionnaires were sent to surgeons on the database of the Association of Surgeons of South Africa, with a letter detailing the purpose of the research and inviting participation. The questionnaire comprised two components; the first addressed age, gender, surgical discipline and years of surgical practice, and the second consisted of questions based on existing issues highlighted by the relevant literature. Permission to conduct the study was granted by the Human Research Ethics Committee (Medical) of the Faculty of Health Sciences, University of the Witwatersrand.
Data analysis
As the study was primarily descriptive, frequency distributions based on responses to the questionnaire were used. Means and standard deviations were calculated for continuous variables, e.g. age and years in practice.
From the database of 574 surgeons, 529 questionnaires were sent in November 2006. Responses ceased to come in by the end of March 2007. There were 266 (53%) responses, including those who felt unable to contribute and a respondent who refused to participate, from a total of 506 possible responders (23 questionnaires were not delivered (returned to sender)).
The mean age of the respondents (N=257) was 53.05 years (SD 12.30; range 28 - 85). Of the respondents (N=255), 94.7% (N=232) were male and 5.3% (N=13) were female. The mean age of male respondents was 52.99 (SD 12.08) and that of female respondents was 43.84 (SD 10.70).
(The variable N in the preceding paragraph is inconsistent with the total in the paragraph before as these are the actual number of responses for the specific data, and may therefore differ from the total number of respondents and between specific items of data - both here and elsewhere in the text.)
Years in surgical practice
The mean number of years in surgical practice for all respondents (N=241) was 20.73 (SD 11.65) - range 1 - 52 years. For male respondents (N=228), the mean number of years in surgical practice was 20.52 (SD 11.59; range 1 - 52 years); for females (N=13), the mean was 15.38 (SD 9.8; range 2 - 33 years).
Surgical discipline
Respondents described themselves as general surgeons (78.1%; N=200), paediatric surgeons (4.3%; N=11), trauma surgeons (3.9%; N=10), vascular surgeons (5.5%; N=14), gastroenterologists (2%; N=5), and as working in other areas of surgical practice, e.g. transplantation, ENT.
Disclosure of status
Colleagues: 78.4% (N=182) did not believe that HIV-positive surgeons should disclose their status to colleagues; 21.6% (N=50) believed they should.
Patients: 76% (N=174) did not believe that HIV-positive colleagues should disclose their status to patients; 24% (N=55) believed they should.
Hospital advisory board: 51.1% (N=120) did not believe that HIV-positive colleagues should disclose their status to a hospital advisory board, bound by confidentiality; 49% (N=115) believed they should.
Unsure: 8.5% (N=22) were unsure about disclosure to anyone.
Exposure-prone procedures
Forty-three per cent (N=112) believed that HIV-positive surgeons should refrain from undertaking exposure-prone procedures, 47% (N=122) believed that they should not refrain, and 10% (N=25) were unsure.
Scope of practice
Seventy-four per cent (N=192) believed that HIV-positive surgeons should determine their own scope of practice; 20% (N=53) believed that they should not; 5% (N=14) were unsure.
Exposure to blood products
Only 17% (N=42) of patients had been exposed to their surgeons' blood products; 83% of patients (N=207) had no exposure to their surgeons' blood products. However, 92% (N=254) of surgeons had been exposed to patients' blood products, with only 8% (N=21) reporting no exposure.
Mandatory testing
Sixty-one per cent (N=159) disagreed with mandatory HIV testing for surgeons, while 34% (N=88) felt that there should be mandatory testing, and 5% (N=12) were unsure.
HIV status
Ninety-one per cent (N=235) were aware of their HIV status, while 9% (N=24) were not.
HIV testing
Nine per cent (N=24) had never been tested for HIV, 12% (N=31) had been tested once, and 79% (N=203) had been tested more than once.
Frequency of HIV testing
Sixty per cent (N=141) were tested less frequently than annually, 35% (N=82) annually, 3.8% (N=9) quarterly, with 1.3% (N=3) more than quarterly.
Awareness of policy
Ninety-five per cent (N=244) were not aware of any policy giving clear guidelines regarding the practice of HIV-positive surgeons, whereas 5% (N=13) were aware of such a policy.
Respondents were predominantly male, older and with decades of surgical experience, largely as general surgeons but with several surgical sub-specialties represented. Most were against informing patients or colleagues of HIV status but were more divided concerning hospital advisory boards bound by confidentiality. Few were unsure. Such attitudes appear to be contrary to a patient-centred approach whereby such information could be deemed in the best interests of the patient for informed consent. Within the context of s 6.1(c) of the National Health Act 61 of 2003, such information (surgeon HIV status) could represent a risk, cost or consequence associated with a treatment option, i.e. a surgical procedure, requiring disclosure. However, if there is no risk, then surely there is no cost or consequence. Hence, bearing in mind the HPCSA guidelines on informed consent and in relation to general ethical duties (http://www.hpcsa.co.za/hpcsa/userfiles/file/ProfessionalGuidelines.doc), would such information be in the best interests of the patient to know?
Patient knowledge of surgeon status may serve no purpose, but it could deter the patient from undergoing a procedure by a surgeon who could be uniquely skilled. Any policy requiring disclosure could result in a loss of professionals to the discipline. Moreover, since patients are not bound by confidentiality rulings and ethical codes of conduct as are health practitioners, such information could be disseminated, with further negative consequences for the surgeon. Therefore, it seems that such information should not be shared, and to do so would probably do more harm than good.
There is an incongruity between full, informed consent on the patient's part, and antidiscrimination regarding the HCW.8 Based on the risk of surgeon-to-patient transmission of HIV, knowledge of the surgeon's HIV status does not appear to be required for informed consent, which accords with the American College of Surgeons' (ACS) standpoint that a surgeon's HIV status is 'personal health information and does not need to be disclosed to anyone'.9
While most respondents in this study were against HIVpositive surgeons having a limited scope of practice, opinion was more divided as to whether HIV-positive surgeons should perform exposure-prone procedures. A Nigerian study of specialist surgeon trainees established that 91% did not think that HIV-positive surgeons should be barred from practice, but 53% thought they should be barred from performing invasive procedures.10
A substantial majority were against mandatory HIV testing, compared with those in favour. The reasons for advocating mandatory HIV testing encompassed general and specific aspects and motivating their position based on everyone needing to know their status for the purpose of destigmatising and promoting safer practices, within the context of responsible behaviour. Those against mandatory testing were motivated primarily by surgeon-related concerns, specifically as it was perceived as discriminatory and undermining surgeon autonomy.
Despite the fact that most surgeons were against mandatory testing, attitudes appear to be shifting towards HIV testing generally, with calls and arguments for compulsory11 and routine testing (on an opt-out basis).12 Regarding surgeons and HIV screening, a study assessing the impact of such screening determined that it would be costly, with costs extending beyond testing and counselling, which would potentially reduce the risk of HIV transmission from surgeons to patients but would not eliminate it.13 In our study, 91% were aware of their HIV status, suggesting that mandatory testing is not needed as it is done as a matter of course. To impose such testing upon surgeons would unquestionably constitute discrimination. The ACS statement on surgeons and HIV infection specifically recommends that surgeons should know their HIV status, with no mention of such knowledge arising from mandatory testing.9
While most surgeons had been exposed to patient blood products, a minority of patients had been exposed to surgeon blood products (as far as could be ascertained by the surgeon). Therefore it was not surprising that over 90% of respondents knew their HIV status. The majority had been tested more than once, but most respondents had been tested less than annually. The relative risk of seroconversion for surgeons working in tropical Africa is estimated as 15 times higher than in Western countries.14 While our study did not survey 'universal precautions', several respondents cited this as a standard practice that would preclude a requirement for mandatory testing or limiting the scope of practice of HIV-positive surgeons. This consideration echoes earlier pronouncements about HIV-positive HCWs supporting adherence to universal precautions rather than mandatory HIV testing or disclosure of HIV status as the best protection for patients.15 A similar sentiment was expressed as to whether surgeons testing positive for hepatitis C should be barred from undertaking exposure-prone procedures, i.e. efforts should be directed at ensuring simple preventive measures are employed rather than limiting the practice of infected surgeons.16
Over 95% of respondents were unaware of any policy that specifically gave guidance as to how HIV-positive surgeons should practise, in spite of the existence of various policies that have provided best-practice approaches under such circumstances. This finding raises a critical issue - the role of practising clinicians in formulating policy that governs their practice. In this study, the major concerns were discrimination against doctors and that doctors were increasingly susceptible to escalating outside regulations, apparently based on a growing perception that the medical profession can no longer be trusted to regulate itself regarding the best interests of patients.17 Consequently, attempts have been made from within the discipline to explore, redefine and address medical professionalism.18
Almost a decade ago, the ramifications of HIV in relation to surgeons were understood to be a controversial issue, and required an approach based on 'objective information'.19 Such an approach is desirable and critical because policy development must take cognisance of evidence generally, but more specifically as there are calls for policies that affect patient care to be transparent, i.e. available to patients; this promotes patient autonomy and informed consent20 and access to new knowledge that should be available not only for medical professionals.21 Based on a legitimate call for transparency and availability of policies, the provisions of those related to controversial issues such as the HIV-positive surgeon behove careful consideration.
Regarding HIV-positive surgeons, an understandable yet apparently unjustified concern is surgeon-to-patient transmission of HIV. Science should inform policy and guide ethics in this dilemma whereby 'the fear of harm ought to be proportional not merely to the gravity of harm, but also the probability of harm'.22
A clear, unequivocal policy that safeguards the rights of doctors and the wellbeing of patients is required - and is certainly possible. It should articulate the problem and the risk, and state best practice, while outlining the responsibilities and obligations of all parties, taking into account current knowledge, prevailing concerns related to trust in medicine, and awareness of the attitudes and concerns of those whose practice will be influenced by such a policy. South African surgeons should create - or endorse - practice guidelines akin to those of the ACS,9 incorporating all that is known on the subject, and rationally advance the position.
1. Lieberman JD, Derse AR. HIV-positive health care workers and the obligation to disclose. Do patients have a right to know? J Leg Med 1992; 13: 333-356. [ Links ]
2. UNAIDS. HIV and AIDS Estimates and Data, 2007 and 2001. 2008 Report on the Global AIDS Epidemic. Geneva: UNAIDS, 2008. [ Links ]
3. Wright JG, McGeer A. Human immunodeficiency virus transmission between surgeons and patients in orthopaedic surgery. Clin Orthop Relat Res 1993; 297: 272-281. [ Links ]
4. Szabo CP, Dhai A, Veller M. HIV-positive status amongst surgeons - an ethical dilemma. S Afr Med J 2006; 96(10): 1072-1075. [ Links ]
5. Centers for Disease Control. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. Mor Mortal Wkly Rep 1991; 40 (RR08):1-9. [ Links ]
6. South African Medical Association. Basic rights and ethical duties. In: Human Rights and Ethical Guidelines on HIV and AIDS. A Manual for Medical Practitioners. Pretoria: SAMA, 2006: 5. [ Links ]
7. South African Medical Association. HIV/AIDS and employment. In: Human Rights and Ethical Guidelines on HIV and AIDS. A Manual for Medical Practitioners. Pretoria: SAMA, 2006: 21. [ Links ]
8. Bayer R. Discrimination, informed consent, and the HIV infected clinician. BMJ 1997; 314: 915. [ Links ]
9. American College of Surgeons [ST 13]. Statement on the surgeon and HIV infection. Revised May 2004. http://www.facs.org/fellows_info/statements/st-13.html (accessed 30 December 2008). [ Links ]
10. Adebamowo CA, Ezeome ER, Ajuwon A, Ogundiran TO. Survey of the knowledge, attitudes and practice of Nigerian surgery trainees to HIV-infected persons and AIDS patients. BMC Surgery 2002, 2: 7. http://www.biomedcentral.com/1471-2482/2/7 (accessed 30 December 2008). [ Links ]
11. Falk-Kessler J, Barnowski C, Salvant S. Mandatory HIV testing and occupational therapists. Am J Occup Ther 1994; 48(1): 27-37. [ Links ]
12. McQuoid-Mason D. Routine testing for HIV - ethical and legal implications. S Afr Med J 2007; 97(6): 416-420. [ Links ]
13. Schulman KA, McDonald RC, Lynn LA, Frank I, Christakis NA, Schwartz JS. Screening surgeons for HIV infection: assessment of a potential public health program. Infect Control Hosp Epidemiol 1994; 15(3): 147-155. [ Links ]
14. Consten EC, van Lanscot JJ, Henny PC, Tinnemans JG, van der Meer JT. A prospective study on the risk of exposure to HIV during surgery in Zambia. AIDS 1995; 9(6): 585-588. [ Links ]
15. DiMaggio SL. State regulations and the HIV-positive health care professional: a response to a problem that does not exist. Am J Law Med 1993; 19(4): 497-522. [ Links ]
16. Cockcroft A. Surgeons who test positive for hepatitis C should not be transferred to low risk duties. Rev Med Virol 2000; 10(2): 79-82. [ Links ]
17. Clark CC. Trust in Medicine. J Med Philos 2002; 27(1): 11-29. [ Links ]
18. Medical Professionalism Project. ABIM Foundation. Medical Professionalism in the New Millennium: A Physician Charter. Ann Intern Med 2002; 136(3): 243-246. [ Links ]
19. Flum DR, Wallack MK. The surgeon's database for AIDS: a collective review. J Am Coll Surg 1997; 184(4): 403-412. [ Links ]
20. Williamson C. Withholding policies from patients restricts their autonomy. BMJ 2005; 331: 1078-1080. [ Links ]
21. Richter M. SAMA's inward-looking approach to AIDS and ethics. S Afr Med J 2007; 97(7): 474. [ Links ]
22. Gupta M. Occupational risk: the outrageous reaction to HIV positive public safety and health care employees in the workplace. J Law Health 2004-2005; 19(1): 39-73. [ Links ]
Accepted 23 September 2008.
Corresponding author: C P Szabo (email@example.com)


text:
Microsoft on Thursday promised that it would provide at least one public beta to Office 2010, saying that its assertion to the contrary Wednesday was "the wrong impression."
"Although we are not disclosing a date for the public beta, there definitely will be one," a company spokesman said Thursday morning. "This development cycle for Office is no different than years past; technical preview is usually invite-only, but still goes out to hundreds of thousands of people, and there is a public beta cycle where millions can download and try Office."
[ Earlier, Microsoft said the Office 2010 beta would not be available to the public. Meanwhile, the Office 2007 SP2 release is set for April 28. | Keep up with app dev issues and trends with InfoWorld's Fatal Exception and Strategic Developer blogs. ]
On Wednesday, a different company spokesperson said that Microsoft had no plans to distribute a beta to the general public -- as it had done with Office 2007 -- but said that a closed test involving "thousands" would begin during the third quarter of 2009.
The spokesman on Thursday declined to outline a timetable for Office 2010's public beta, to specify the number of betas Microsoft will produce and to say what it will be called. "We have not locked on that yet," he said, referring to the last of the three questions.
Microsoft delivered two public betas for Office 2007, the first in March 2006 and the second in September, dubbing the latter "Beta 2 Technical Refresh." In between the two dates, it let users try out the suite from within their browsers and charged $1.50 to download the preview. The latter move, Microsoft said in July 2006, was because "the beta 2 downloads have exceeded our goals," prompting it to "implement a cost-recovery measure."
The spokesman Thursday said Microsoft had not decided whether it would mimic that for-a-fee scheme with Office 2010. "We are still working out the delivery options and will share additional details later this year," he said in a follow-up e-mail.
Microsoft first seeded a group of invitation-only testers with Office 2007 Beta 1 in November 2005.
If the company runs Office 2010 through testing at the same pace as it did Office 2007, it wouldn't release the new suite to manufacturing until the third quarter of 2010, with the first public beta in the November 2009-January 2010 time frame.
However, since Microsoft has pegged a final release of Office 2010 in the first half of 2010, assuming the same kind of schedule as three years ago and a ship date at the end of the six-month window, it could issue a beta as early as November 2009 and as late as April 2010.
This story, "Microsoft backtracks, says Office 2010 beta will be public" was originally published by Computerworld.

subset: commoncrawl


text:
In Policy Reversal, U.S. Seeks Participation in U.N. Human Rights Council
The United States will seek to join the U.N. Human Rights Council, reversing its policy of shunning the group and prompting concern among some Jewish organizations.
On Tuesday, the Obama administration announced it would participate in May elections for a seat on the 47-member council, "with the goal of working to make it a more effective body to promote and protect human rights." The Bush administration had withheld U.S. membership from the Geneva-based council for its failure to confront human rights abusers and its singling out of Israel for condemnation.
"The United States helped to found the United Nations and retains a vital stake in advancing that organization's genuine commitment to the human rights values that we share with other member nations," U.S. Secretary of State Hillary Clinton said in a statement announcing the decision.
JTAS has learned that top State Department officials briefed Jewish organizational leaders about the decision in a conference call late Tuesday evening.
Since its creation in 2006 to replace the widely discredited U.N. Commission on Human Rights, the council has passed 32 resolutions; 26 have been critical of Israel, according to UN Watch. More than half of the council's members fall short of basic democracy standards, according to Freedom House, a democracy watchdog group. And in the past two years the council has moved to eliminate its country-specific special experts investigating human rights abuses in Darfur, Congo, Cuba, Belarus and Liberia.
"Those who suffer from abuse and oppression around the world, as well as those who dedicate their lives to advancing human rights, need the Council to be balanced and credible," the U.S. ambassador to the United Nations, Susan Rice, said. "The U.S. is seeking election to the Council because we believe that working from within, we can make the council a more effective forum to promote and protect human rights. We hope to work in partnership with many countries to achieve a more effective Council."
The Anti-Defamation League expressed concern about the Obama administration's decision.
"There is no question that the U.S. can play a decisive role in making U.N. institutions more effective, but the Human Rights Council has deep systemic flaws," said ADL National Director Abraham Foxman. "We remain concerned that the U.S. decision to join the Council before meaningful reforms are put into motion may not achieve this desired goal."
Rep. Howard Berman (D-Calif.), the most senior Jewish lawmaker in the U.S. House of Representatives in his capacity as chairman of the Foreign Relations Committee, supported the decision.
"The time is ripe to take a more positive and active role in challenging the Council and in speaking out about genuine human rights atrocities," Berman said in a statement. "In two years, the Human Rights Council faces a mandated five-year review. By participating in the process as a member of the Council, the Obama Administration can begin working to bring about a much-needed overhaul."
The World Jewish Congress wondered whether the time was ripe for joining the council. "There are so many players on the Human Rights Council that do not have our interests at heart that I think it will mobilize against the things that the United States is going to fight for," said Betty Ehrenberg, a spokeswoman for the WJC. "I'm not sure at this moment that the Human Rights Council is free enough of its past and present difficulties and complications to make this effort fruitful at this moment."
The executive director of UN Watch, Hillel Neuer, said he welcomes the U.S. decision, "but only if it's to vigorously push back against the world's worst abusers." He added, "The council is worse than ever before, pathologically obsessed with scapegoating Israel, while turning a blind eye to millions of human rights victims around the world."


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Architects: BETILLON / DORVAL‐BORY
- Area: 20 m²
- Year: 2013
Text description provided by the architects. Spectral apartment is a renovation project of a small Parisian studio, in which the lack of natural light led the client to ask us to intervene particularly on the issue of artificial light.
To do this, we chose to adopt a radical and binary approach by studying the spectral qualities of two different sources of artificial light.
Although often overlooked, since hardly noticeable in everyday use, the color rendering index, abbreviated CRI is one of the fundamental criteria for evaluating light. It depends more precisely on the spectral power distribution of light (SPD) and was identified in 1948 by the Scientific JP Bouma, then qualified by the International Commission on Illumination (CIE). The CRI of a light describes its ability to reflect accurate color of a surface. Bouma noticed that daylight was much better to estimate the colors and the work of the CIE established its value to 100 to determine the scale of CRI. Thus, a light with high CRI, close to 100, can render the colors properly (homogeneity in the spectral power distribution), while a low CRI is synonymous with loss of color range, so a disappearance of colors.
So in the manner of architect Philippe Rahm, the idea is to explore from an objective and scientific point of view the spectral qualities of these various light sources, and then to create an architecture that considers and even uses their special qualities.
The case of low-pressure sodium lamps (LPS) is in this particular. This system is extremely popular because of its particularly high efficiency (amount of light compared to consumed electricity) and it is used for the illumination of cities along the streets, roads and highways. Its characteristic color temperature gives this particular orangey shade to our nocturnal urban environment. However, these lamps have the lowest CRI, close to 0. This means that the light is monochromatic, in a wavelength of 589.3 nm, and cannot render any other color.
At night, along a road, we believe we can discern red from blue, but it is physically impossible with LPS light. A photo taken with such a light is monochromatic and necessarily, so to say, in black and white. Furthermore, for humans this wavelength is particularly suited to night vision, since the wavelengths around the blue (totally absent from LPS) induces a contraction of the pupil, limiting the amount of light perceived by the eye. After a few seconds of retina adaptation, the human brain rebalances the perceived color to produce a virtual spectrum, giving an impression of the scene as close as possible to objective reality. Now with LPS lighting, the brain has no other color to produce the virtual spectrum, so it literally produces a grayscale image.
So what does a space illuminated only in black and white become? What is the most appropriate architecture, the one that operates at best this particular artificial light. It is known that LPS lighting makes police work more difficult on the road at night, as distinguishing the color of a car is impossible. But one could imagine very intensely lit places where it would not be useful to perceive colors, and where this feature of artificial lighting would be known and controlled. Similarly, certain types of fluorescent lighting tubes with high CRI should be used for places that have been developed taking into account the abundance of some spectral peaks.
In our project, the first phase consisted of a division of program elements according on their spectral needs: which uses need a good color rendering, which spaces can be content with a very low color rendering? This first classification generates a hierarchy of space: on one side the kitchen, the living room, where distinguishing colors is required, on the other hand the bed and the shower where monochromatic light suffices.
This bipolarity between high and low CRI becomes the crucial element of space composition. Holding two separate light sources, a simple 2m high wall divides the studio and generates this composition. On one side an over 90 CRI lighting (940 fluorescent tubes) with a neutral color temperature (4000K), on the other side a warm light from low-pressure sodium lamps with zero CRI. Each of the two light sources produces about 16,000 lumens. The accurate analysis of the distribution of light in space then indicates the positioning of uses. Since there is no other source of artificial light in the studio those spaces are arranged in a form of free plan. As both sources can be switched independently, different lightning patterns appear, giving rise to unforeseen uses in particular areas of the apartment.
The apartment is designed in a simple and neutral expression, without color or particular detail, annihilating any architectural expressiveness or narrative to leave only the logic of composition generated by light.


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Cancel the philosophy courses, people. Oh, and we're going to be shuttering the political science, religion and pre-law departments too. We'll keep some of the English and history folks on for a while longer, but they should probably keep their resumes handy.
Because, you see, they are of no use anymore. We have the answers to the big questions, so why keep pretending there's anything left to discuss?
At least that's where Erin Ching, a student at Swarthmore College, seems to be coming down. Her school invited a famous left-wing Princeton professor, Cornel West, and a famous right-wing Princeton professor, Robert George, to have a debate. The two men are friends, and by all accounts they had an utterly civil exchange of ideas. But that only made the whole thing even more outrageous.
"What really bothered me is, the whole idea is that at a liberal arts college, we need to be hearing a diversity of opinion," Ching told the Daily Gazette, the school's newspaper. "I don't think we should be tolerating [George's] conservative views because that dominant culture embeds these deep inequalities in our society."
Swarthmore must be so proud.
Over at Harvard, another young lady has similar views. Harvard Crimson editorial writer Sandra Y.L. Korn recently called for getting rid of academic freedom in favor of something called "academic justice."
"If our university community opposes racism, sexism and heterosexism, why should we put up with research that counters our goals simply in the name of 'academic freedom'?" Korn asks.
Helpfully, she answers her own question: "When an academic community observes research promoting or justifying oppression, it should ensure that this research does not continue."
One could easily dismiss these students as part of that long and glorious American tradition of smart young people saying stupid things. As Oscar Wilde remarked, "In America the young are always ready to give to those who are older than themselves the full benefits of their inexperience."
But we all know that this nonsense didn't spring ex nihilo from their imaginations. As Allan Bloom showed a quarter century ago in "The Closing of the American Mind," these ideas are taught.
Indeed, we are now up to our knees in this Orwellian bilge. Diversity means conformity.
Let me invoke personal privilege by citing a slightly dated example. When the Los Angeles Times picked me up as a columnist in 2005, Barbra Streisand publicly canceled her subscription in protest (I'm proud to say). You see, Streisand's friend, iconic left-wing columnist Robert Scheer, had been let go. And I was one of the new columnists brought on board. This was an outrage.
"The greater Southern California community is one that not only proudly embraces its diversity, but demands it," Streisand wrote to the Times in a syntactically impaired rant that read a bit like one of those letters I occasionally get from prison inmates who've memorized words from a thesaurus without fully understanding what they mean. "Your publisher's decision to fire Robert Scheer is a great disservice to the spirit of our community. ... So although the number of contributors to your op-ed pages may have increased, in firing Robert Sheer [sic] and putting Jonah Goldberg in his place, the gamut of voices has undeniably been diluted. ..."
Nearly a decade later, I still don't know what it means to dilute a gamut of voices. But I do know what she meant by "diversity." It means: "people who agree with me." It's lazy and insipid shorthand for "left wing." After all, by the normal metrics of identity politics -- race, religion, gender -- Scheer and I are largely interchangeable. Where we differ is ideology. And ideological diversity is the only kind of diversity the left finds offensive.
Which brings us back to the sages of Swarthmore and Harvard. They at least understand that ideological diversity is actually, like, you know, a thing. They just think it's a bad thing.
More pernicious, however, is that they believe the question of justice is a settled matter. We know what justice is, so why let serious people debate it anymore? The millennia-old dialogue between Aristotle, Plato, St. Augustine, Aquinas, Machiavelli, Rawls, Rorty, Hayek et al.? Shut it down, people. Or at least if the conversation heads in a direction where the Korns, Chings and Streisands smell "oppression" -- as defined solely by the left -- then it must not be "put up with." Diversity demands that diversity of opinion not be tolerated anymore.