This article draws on an empirical investigation of how Australia’s cervical screening program came to be the way it is. The study was carried out using grounded theory methodology and primarily uses interviews with experts involved in establishing, updating or administering the program. We found strong differences in experts’ normative evaluations of the program and beliefs about optimal ways of achieving the same basic outcome: a reduction in morbidity and mortality caused by invasive cervical cancer. Our analysis demonstrates how variations (...) in values and preferences associated with key concepts underpinning public health such as benefit, harm and burden led to different perspectives on the purpose of an organized cervical screening program. These variations were largely driven by different bases of professional experience. Differently conceived purposes in turn led to conflict over how the program should be operationalized. Following Frith’s model of empirical bioethics, the results of the study both draw on and inform the existing public health and screening ethics literature. (shrink)

Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly fund (...) access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long-term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations. (shrink)

There are increasing concerns that research regulatory requirements exceed those required to manage risks, particularly for low- and negligible-risk research projects. In particular, inconsistent documentation requirements across research sites can delay the conduct of multi-site projects. For a one-year, negligible-risk project examining biobank operations conducted at three separate Australian institutions, we found that the researcher time required to meet regulatory requirements was eight times greater than that required for the approved research activity. In total, 76 business days were required to (...) obtain the necessary approvals, and site-specific processes required twice as long as primary Human Research Ethics Committee and Research Governance Office processes. We describe the impact of this administrative load on the conduct of a one-year, externally-... (shrink)

BackgroundCervical cancer disproportionately burdens disadvantaged women. Organised cervical screening aims to make cancer prevention available to all women in a population, yet screening uptake and cancer incidence and mortality are strongly correlated with socioeconomic status. Reaching underscreened populations is a stated priority in many screening programs, usually with an emphasis on something like ‘equity’. Equity is a poorly defined and understood concept. We aimed to explain experts’ perspectives on how cervical screening programs might justifiably respond to ‘the underscreened’.MethodsThis paper reports (...) on a grounded theory study of cervical screening experts involved in program organisation. Participants were 23 experts from several countries and a range of backgrounds: gynecology; epidemiology; public health; pathology; general practice; policy making. Data were gathered via semi-structured interview and concepts developed through transcript coding and memo writing.ResultsMost experts expressed an intuitive commitment to reducing systematic differences in screening participation or cancer outcomes. They took three different implicit positions, however, on what made organised programs justifiable with respect to underscreened populations. These were: 1) accepting that population screening is likely to miss certain disenfranchised groups for practical and cultural reasons, and focusing on maximising mainstream reach; 2) identifying and removing barriers to screening; and 3) providing parallel tailored screening services that attended to different cultural needs. Positions tended to fall along country of practice lines.ConclusionsExperts emphasised the provision of opportunity for underscreened populations to take up screening. A focus on opportunity appeared to rely on tacit premises not supported by evidence: that provision of meaningful opportunity leads to increased uptake, and that increased uptake of an initial screening test by disadvantaged populations would decrease cervical cancer incidence and mortality. There was little attention to anything other than the point of testing, or the difficulties disadvantaged women can have in accessing follow up care. The different approaches to ‘improving equity’ taken by participants are differently justified, and differently justifiable, but none attend directly to the broader conditions of disadvantage. (shrink)

This article reports initial findings from a research project that focused on the impact of the reaccreditation process and its outcomes on teacher educators in four institutions in England where Qualified Teacher Status accreditation was removed, despite leading successful programmes as detailed in Ofsted inspections and National Student Survey data. Whilst the outcomes of the reaccreditation process were mentioned in the mainstream press, the impact of this policy on teacher educators had only been reported anecdotally. This research fills a research (...) gap to document impact on teacher educator identity and provides an evidence base to inform teacher education policy debates. Data were gathered through focus groups using a triad collaborative enquiry approach, based on the lesson study model, where researchers took on different roles: clarifier, observer, and questioner. This method formed part of a constructed focus group and built on a process of semi-structured and unstructured creative tasks. Initial findings identified the shifting context university educators perceived in relation to policy constraints, including a greater top-down, centralisation that negated the opportunity for teacher educators to provide a contextualised, evidence informed approach to teacher preparation. This contributed to the impact of the reaccreditation process on teacher educators’ professional identity, self-efficacy and agency. (shrink)

Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities in (...) New South Wales, Australia to elicit the views of well-informed community members on the acceptability and legitimacy of: making pathogen WGS and linked administrative data available for public health researchusing this information in concert with data linkage and machine learning to enhance communicable disease surveillance systems Fifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts. Results Almost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective systems. Conclusions Participants across all four events strongly supported the introduction of data linkage and pathogenomics to public health research under current research governance structures. Combining pathogen WGS with event-based data surveillance systems, however, is likely to be controversial because of a lack of public trust, even when the potential public health benefits are clear. Any suggestion of private sector involvement or commercialisation of WGS or surveillance data was unanimously rejected. (shrink)

Women in Rock, Women in Romanticism is the first book-length work to explore the interrelationships between contemporary female musicians and eighteenth- and nineteenth-century art, music, and literature by women and men. The music and videos of contemporary musicians including Erykah Badu, Beyoncé, The Carters, Hélène Cixous, Missy Elliot, the Indigo Girls, Janet Jackson, Janis Joplin (and Big Brother and the Holding Company), Natalie Merchant, Joni Mitchell, Janelle Monáe, Alanis Morrisette, Siouxsie Sioux, Patti Smith, St. Vincent (Annie Clark), and Alice Walker (...) are explored through the lenses of pastoral and Afropresentism, Gothic, female Gothic, and the literature of William Blake, Beethoven, Arthur Schopenhauer, Samuel Taylor Coleridge, Charlotte Dacre, Ralph Waldo Emerson, E.T.A. Hoffmann, Ann Radcliffe, William Shakespeare, Mary Shelley, her husband Percy Shelley, Henry David Thoreau, Horace Walpole, Jane Williams, Mary Wollstonecraft, and William Wordsworth to explore how each sheds light on the other, and how women have appropriated, responded to, and been inspired by the work of authors from previous centuries. (shrink)

Abstract In this paper I undertake an in-depth examination of an oft mentioned but rarely expounded upon state: suspended judgment. While traditional epistemology is sometimes characterized as presenting a “yes or no” picture of its central attitudes, in fact many of these epistemologists want to say that there is a third option: subjects can also suspend judgment. Discussions of suspension are mostly brief and have been less than clear on a number of issues, in particular whether this third option should (...) be thought of as an attitude or not. In this paper I argue that suspended judgment is (or at least involves) a genuine attitude. Content Type Journal Article Pages 1-17 DOI 10.1007/s11098-011-9753-y Authors Jane Friedman, St Catherine’s College, University of Oxford, Oxford, OX1 3UJ UK Journal Philosophical Studies Online ISSN 1573-0883 Print ISSN 0031-8116. (shrink)

This book is the result of a three-year study undertaken by a multidisciplinary working party of the Institute of Medical Ethic (UK). The group was chaired by a moral theologian, and its members included biological and ethological scientists, toxicologists, physicians, veterinary surgeons, an expert in alternatives to animal use, officers of animal welfare organizations, a Home Office Inspector, philosophers, and a lawyer. Coming from these different backgrounds, and holding a diversity of moral views, the members produced the agreed report as (...) a result of detailed and rigorous discussions. The book sets out facts about animal experiments and about animal abilities to experience pain, distress and anxiety. There is a detailed examination of the moral claims related to the benefits likely to accrue from animal research, and of strategies for weighing these benefits against the harm caused to animals, in order to decide whether particular research projects ought or ought not to proceed. This leads to consideration of the statutory and non-statutory controls which safeguard standards in such research. The final section explores a variety of philosophical arguments about the use of animals in research, and offers a philosophical justification for the Working Party's more practical conclusions. Written in clear, nontechnical language, this book is accessible to lay people as well as to scientists. It is the first such document to emerge from a meeting of people with such widely differing views on this highly controversial subject, and represents a major contribution towards informing and raising the quality of contemporary debate. The book is unique in drawing together material and ideas never before found in one volume. It will interest a broad spectrum of readers, from ethicists and animal rights advocates to scientific researchers and laboratory administrators, along with general readers concerned about this compelling issue. (shrink)

“In When Your Life Is On Fire Erik Kolbell listens, provokes, and most of all, shares with us the enduring lessons and insights of life and faith as realized by a diverse population of thoughtful people. It’s a town hall of the soul.” -- Tom Brokaw If your life was on fire, what would be the one thing you save? Psychotherapist and former pastor Erik Kolbell asks that question of 13 remarkable and unique individuals, and the answers may surprise you. (...) Provided by celebrities such as Jane Pauley and Alan Alda, artists such as Regina Carter and Tao Porchon Lynch, and ordinary people put into extraordinary situations like Don Lange and Brenda Berkman, these reflections will help all of us consider what it is that we value most in life. His goal, Kolbell says, is not to examine the worth of each of these things. “What matters is that for all of the sham and artifice that can make cynics of us all, there are things, solid things, that compel us onward.”. (shrink)

(2009). Mellow Monday and furious Friday: The approach-related link between anger and time representation. Cognition & Emotion: Vol. 23, No. 6, pp. 1166-1180.

It has been suggested that Marr took the three levels he famously identifies to be independent. In this paper, we argue that Marr's view is more nuanced. Specifically, we show that the view explicitly articulated in his work attempts to integrate the levels, and in doing so results in Marr attacking both reductionism and vagueness. The result is a perspective in which both high-level information-processing constraints and low-level implementational constraints play mutually reinforcing and constraining roles. We discuss our recent work (...) on Spaun—currently the world's largest functional brain model—that demonstrates the positive impact of this kind of unifying integration of Marr's levels. We argue that this kind of integration avoids his concerns with both reductionism and vagueness. In short, we suggest that the methods behind Spaun can be used to satisfy Marr's explicit interest in combining high-level functional and detailed mechanistic explanations. (shrink)

Evidence-Based Medicine (EBM) has now been part of the dominant medical paradigm for 15 years, and has been frequently debated and progressively modified. One question about EBM that has not yet been considered systematically, and is now particularly timely, is the question of the novelty, or otherwise, of the principles and practices of EBM. We argue that answering this question, and the related question of whether EBM-type principles and practices are unique to medicine, sheds new light on EBM and has (...) practical implications for those involved in all EBM. This is because one's answer to the question (whether explicit or implicit) affects the amount and type of funding and attention received by EBM, the extent to which EBM, and the generation, judgment and use of evidence more generally, can be appropriated by certain groups and questioned by others, and the extent to which truly unique socio-political developments in evidence, and in medicine more generally, are recognized and harnessed. (shrink)

This article examines the contribution that poetry written over the last fifty years might make to the established and burgeoning field of Medical Humanities. It takes poems by women about cancer and depression as a case study of how they can offer insight into the impact of these conditions on the sufferer. Collectively, the poems document and effect shifts in knowledge about, and the associated stigmas concerning, illnesses that carry secrecy and shame, specifically cancer and depression. Additionally, drawing on Virginia (...) Woolf’s remarkable essay “On Being Ill”, we see how the non-verbal features of poems, particularly metaphors and symbols, mark the space of what a patient cannot fully articulate. Accordingly, the poems discussed illuminate how literature can express human interiority but at the same time remind the reader – or health professional – that interiority can never be fully presented. Thus, poetry both contributes to and also checks the ways in which literature is appropriated by the biomedical sciences. The poets included are Eavan Boland, Julia Darling, U.A. Fanthorpe, Jackie Kay, Gwyneth Lewis, Carol Satyamurti and Jo Shapcott. Some poems specify a female subjectivity, some express agency as autonomous individuals, while others presume to speak of common human experience. (shrink)

ASHÉ: Ritual Poetics in African Diasporic is a collection of interdisciplinary essays contributed by international scholars and practitioners. Having distinguished themselves across such disciplines as Anthropology, Art, Music, Literature, Dance, Philosophy, Religion, and Theology and conjoined to construct a defining approach to the study of Aesthetics throughout the African Diaspora with the Humanities at the core, this collection of essays will break new ground in the study of Black Aesthetics. This book will be of great interest to scholars, practitioners, and (...) students interested in tracing African heritage identities throughout the African Diaspora through close examination of a variety of discourses directly connected to expressive elements of cultural production and religious rituals. (shrink)

Throughout her life Diane Hirabayashi Carter has seen a flow, or interconnection, that has led to self-awareness. It is the awareness of the intertwining of families and life experience that can offer peace of mind and purpose.

In Australia, debates over the appropriate length of undergraduate nursing programs have a long history. Submissions from both universities and industry to key government reports have consistently argued that the current minimum entry level of practice, a three‐year program, is too short to enable students to gain the knowledge and skills necessary for the contemporary nursing role. Despite these submissions, the established entry level for nursing practice in Australia remains a three‐year undergraduate bachelor degree. However, there is a small group (...) of high‐achieving students who will begin practice at the end of a four‐year program. Little is known about these programs, or the students who are currently enrolled in them. Designed as a collaborative endeavour, based on co‐operative inquiry, the study discussed in this article aimed to provide an insight into aspects of a four‐year undergraduate nursing program. Potentially, the broader theoretical and clinical preparation that is possible in a four‐year program provides students with enhanced learning opportunities that will enable them to graduate with more confidence and greater ability. In this study a four‐year program provided an opportunity for a regional university to prepare students for the demanding realities of a complex area of practice, rural nursing. (shrink)

: Green consciousness is a holistic worldview based in many ancient and still-current principles and wisdoms, holistic worldview, and one that offers alternative conceptions of human and non-human subjectivity, of humans' relationships with each other and with non-human nature. Its principles are elaborated not only in environmentalist philosophies but also in some forms of popular culture. Shrek retells ancient earth-based myth, specifically around its imagination of greenness as an emblem of the life force, its respect for the feminine principle, its (...) refusal of hierarchy and split consciousness, its endorsement of the happy body and communal ecstasy, and its ringing celebration of diversity. (shrink)

Through postcolonial studies, indigenous perspectives are finally being heard, challenging various Western views of the world. However, these challenges are often made in the same moralizing voice as the original conlonizations were justified. In keeping with the moralizing-resistant perspectives of Foucault, Benjamin and Derrida The Politics of Moralizing issues a warning about the risks of speaking, writing and thinking in a manner too confident about you own judgments. Can a clear line be drawn between dogmatism and simple certainty and indignation? (...) This collection starts by questioning what has become a popular, even pervasive, cultural narrative told by both the left and the right-the story of the West's moral decline, degeneration or confusion. Beyond declaiming the perils of this approach, each essay goes on to experiment with strategies for warding off moralistic tendencies and effects within our own texts and actions. Contributors even explore the dynamics and dilemmas of moralizing by advocates of liberal causes, including patriotism, environmental protection and women's rights. The Politics of Moralizing argues that taking the so-called moral high ground gives free license to self-aggrandizement, cruelty, vengeance and punitiveness and a generalized resistance to or abjection of diversity. (shrink)

This paper presents a computational account of nonderived environment blocking (NDEB) that indicates the challenges it has posed for phonological theory do not stem from any inherent complexity of the patterns themselves. Specifically, it makes use of input strictly local (ISL) functions, which are among the most restrictive (i.e., lowest computational complexity) classes of functions in the subregular hierarchy (Heinz 2018) and shows that NDEB is ISL provided the derived and nonderived environments correspond to unique substrings in the input structure. (...) Using three classic examples of NDEB from Finnish, Polish, and Turkish, it is shown that the distinction between derived and nonderived sequences is fully determined by the input structure and can be achieved without serial derivation or intermediate representations. This result reveals that such cases of NDEB are computationally unexceptional and lends support to proposals in rule- and constraint-based theories that make use of its input-oriented nature. (shrink)