Aishik Hossain

Placebo-controlled trials are controversial when individuals might be denied existing beneficial medical interventions. In the case of malaria, most patients die in rural villages without healthcare facilities. An artesunate suppository that can be given by minimally skilled persons might be of value when patients suddenly become too ill for oral treatment but are several hours from a facility that can give injectable treatment for severe disease. In such situations, by default, no treatment is (or can be) given until the patient reaches a facility, making the placebo control design clinically relevant; alternative bioequivalence designs at the facility would misrepresent reality and risk incorrect conclusions. We describe the ethical issues underpinning a placebo-controlled trial in severe malaria. To protect patients and minimise risk, all patients were referred immediately to hospital so that each had a higher chance of prompt treatment through participation. There was no difference between artesunate and placebo in patients who reached clinic rapidly; among those who could not, a single artesunate suppository significantly reduced death or permanent disability, a finding of direct and indirect benefit to patients in participating villages and elsewhere

This thesis addresses fundamental issues in sustainability thinking, especially in relation to its epistemological and methodological bases. The sustainability crisis has invoked multiple schools of thought cross-cutting wide range of human activities/ scholarships. The resultant diversity of perspectives has imparted a high degree of ambiguity, and an intellectual ‘looseness’, potentially obfuscating many sustainability issues, which in consequence deepened social confusion and political inaction. Despite this, sustainability has taken on a certain moral tone as a normative goal of society, which is based upon implicit assumptions about the constituent forms of knowledge and the methods by which this knowledge is legitimated. It is out of these normative bases of sustainability that ‘sustainability science’ has emerged as an overt attempt aiming to champion pluralistic and integrated forms of knowledge and research in addressing the sustainability crisis. Chapter 1 analyzes the intellectual standing of sustainability. This reveals the necessity for an intellectual perspective to replace the normative essence associated with the notion, and a necessary pluralistic orientation and avenue of knowledge. This intellectual perspective—formed in Chapter 2—stipulates that sustainability scholarship needs to operate both across and within disciplines, albeit cognizant of a more integrated reality. The reductionist mode of enquiry is unable to do this. Thus, the sustainability crisis requires a new mode of enquiry, which can enable the production of ‘bricks of knowledge while looking at the whole building’, in contrary to the production of ‘specialized bricks of knowledge at the expense of not seeing the whole building’ as characteristic of the reductionist mode. This new mode of enquiry necessitates a fundamental intellectual process, capable of enabling the pluralistic orientation and avenue of knowledge. Accordingly, based on fundamental research the thesis aims to analyze the sustainability science discourse and, through both deductive and inductive methods, develop a fundamental intellectual process to inform on the dimensions and structure of a pluralistic knowledge avenue, leading to the laying of an intellectual foundation for the scholarship of sustainability. This is corresponded to three key research questions : KRQ-1: How can an intellectual process fundamentally be framed in order to study the pluralistic knowledge and research structures regarding sustainability? KRQ-2: What are the basic structures of the discourse of sustainability science and how are they structured? KRQ-3: How might a pluralistic knowledge avenue and the layout of an intellectual foundation for the scholarship of sustainability be elicited based on the rationale, framing and application of the fundamental intellectual process? The thesis takes the first decade’s ‘body of work’ of sustainability science as a dataset for analysis in answering these questions through heuristic fundamental research. Chapters 1-3 reflect fundamental research, while Chapters 4-6 and Chapter 7 present the results of heuristic deductive analysis and inductive analysis, respectively. The rationale for the KRQs is formed in Chapters 1-2, besides forming the intellectual perspective of sustainability. KRQ-1 is addressed in Chapter 3 in empirically framing a fundamental intellectual process. The analysis of the first decade’s ‘body of work’ of sustainability science is presented in Chapters 4-6, elucidating the discursive, integrative and contextual structures of its discourse, thus, addressing KRQ-2. These together form a continuous thread of inquiry on the intellectual treatment of sustainability, leading to addressing KRQ-3 in Chapter 7. In framing the fundamental intellectual process the Chapter 3 produces a fundamental literature organization process resulting in a structure of five cross-connected layers of organizations within the literature archive, while a discourse analysis mechanism produces an analytical process based on a system of five stages of discourse analysis. These together construct a fundamental scheme for analyzing the basic structures of pluralistic knowledge/ research. There are four key findings arising from Chapters 4-6. KF-1 reveals an overall lack of precision in characterizing the concept of ‘human-environment system’ in sustainability science along with an extremely open-ended representation. KF-2, revealing the overall contribution of sustainability science as consistent across its three different basic structures demonstrates mere structural contributions while lacking in intellectual capacities to provide the functional aspects to the intellectual treatment of sustainability. Based on conceptualization and extensive exemplification of a theoretical framework on the language of conversation in sustainability research KF-3 produces a new intellectual lens for approaching effective trans-disciplinary sustainability research through facilitating knowledge co-production. KF-4 reveals a strong correlation between the dominant ‘original nature’ and the characters of ‘literature survey’ and ‘literature archive analysis’ of sustainability science research, together with a dominance of these characters across the other empirical classes. This reveals the significance of fundamental literature organization and analysis process in brokering common language and understanding for the enabling of sustainability scholarship, besides breaking the impasse of the conventional incompatibility between original research and literature analysis processes. In Chapter 7, the KF 1-4 are analyzed in terms of different dimensions of the pluralistic knowledge avenue. The chapter also produces the structure of this avenue through inductively projecting on the characteristics of an integration expertise in light of the new mode of enquiry. Besides, Chapter 7 also extracts nine latent elements/ characters of an intellectual foundation of the scholarship of sustainability from the rationale, framing and application of the fundamental intellectual process as well as the inductive framing of the pluralistic knowledge avenue. These together produce the basis for an integrated theory on the intellectual foundation of sustainability. In summary, new knowledge components are pertinent to KF 1-4 and the inductive framing of the pluralistic knowledge avenue. Through fundamentally analyzing the prevailing scholastic reality of sustainability that is based on normative assumption-based works, the thesis produces a structure of sustainability scholarship based on fundamental intellectual justification. Its implications for sustainability science include: the possibility of overcoming reductionist methods—constraining the contribution of the practice—through active intellectual orientation of the new mode of enquiry, prospects for innovation in the practice stem from the integrative structure of its discourse and in developing functional-intellectual capabilities, and a fundamental intellectual process is a means to overcome its normative impulse.