BackgroundHIV prevention research in resource-limited countries is associated with a variety of ethical dilemmas. Key amongst these is the question of what constitutes an appropriate standard of health care (SoC) for participants in HIV prevention trials. This paper describes a community-focused approach to develop a locally-appropriate SoC in the context of a phase III vaginal microbicide trial in Mwanza City, northwest Tanzania.MethodsA mobile community-based sexual and reproductive health service for women working as informal food vendors or in traditional and modern (...) bars, restaurants, hotels and guesthouses has been established in 10 city wards. Wards were divided into geographical clusters and community representatives elected at cluster and ward level. A city-level Community Advisory Committee (CAC) with representatives from each ward has been established. Workshops and community meetings at ward and city-level have explored project-related concerns using tools adapted from participatory learning and action techniques e.g. chapati diagrams, pair-wise ranking. Secondary stakeholders representing local public-sector and non-governmental health and social care providers have formed a trial Stakeholders' Advisory Group (SAG), which includes two CAC representatives.ResultsKey recommendations from participatory community workshops, CAC and SAG meetings conducted in the first year of the trial relate to the quality and range of clinic services provided at study clinics as well as broader standard of care issues. Recommendations have included streamlining clinic services to reduce waiting times, expanding services to include the children and spouses of participants and providing care for common local conditions such as malaria. Participants, community representatives and stakeholders felt there was an ethical obligation to ensure effective access to antiretroviral drugs and to provide supportive community-based care for women identified as HIV positive during the trial. This obligation includes ensuring sustainable, post-trial access to these services. Post-trial access to an effective vaginal microbicide was also felt to be a moral imperative.ConclusionParticipatory methodologies enabled effective partnerships between researchers, participant representatives and community stakeholders to be developed and facilitated local dialogue and consensus on what constitutes a locally-appropriate standard of care in the context of a vaginal microbicide trial in this setting.Trial registrationCurrent Controlled Trials ISRCTN64716212. (shrink)

The successful demonstration that antiretroviral (ARV) drugs can be used in diverse ways to reduce HIV acquisition or transmission risks – either taken as pre-exposure prophylaxis (PrEP) by those who are uninfected or as early treatment for prevention (T4P) by those living with HIV – expands the armamentarium of existing HIV prevention tools. These findings have implications for the design of future HIV prevention research trials. With the advent of multiple effective HIV prevention tools, discussions about the ethics and the (...) feasibility of future HIV prevention trial designs have intensified. This article outlines arguments concerning the inclusion of newly established ARV-based HIV prevention interventions as standard of prevention in HIV prevention trials from multiple perspectives. Ultimately, there is a clear need to incorporate stakeholders in a robust discussion to determine the appropriate trial design for each study population. (shrink)

Background HIV prevention trials conducted among disadvantaged vulnerable at-risk populations in developing countries present unique ethical dilemmas. A key concern in bioethics is the validity of informed consent for trial participation obtained from research subjects in such settings. The purpose of this study was to investigate the effectiveness of a continuous informed consent process adopted during the MDP301 phase III vaginal microbicide trial in Mwanza, Tanzania. Methods A total of 1146 women at increased risk of HIV acquisition working as alcohol (...) and food vendors or in bars, restaurants, hotels and guesthouses have been recruited into the MDP301 phase III efficacy and safety trial in Mwanza. During preparations for the trial, participatory community research methods were used to develop a locally-appropriate pictorial flipchart in order to convey key messages about the trial to potential participants. Pre-recorded audio tapes were also developed to facilitate understanding and compliance with gel-use instructions. A comprehension checklist is administered by clinical staff to all participants at screening, enrolment, 12, 24, 40 and 50 week follow-up visits during the trial. To investigate women's perceptions and experiences of the trial, including how well participants internalize and retain key messages provided through a continuous informed consent process, a random sub-sample of 102 women were invited to participate in in-depth interviews conducted immediately after their 4, 24 and 52 week follow-up visits. Results 99 women completed interviews at 4-weeks, 83 at 24-weeks, and 74 at 52 weeks. In all interviews there was evidence of good comprehension and retention of key trial messages including that the gel is not currently know to be effective against HIV; that this is the key reason for conducting the trial; and that women should stop using gel in the event of pregnancy. Conclusions Providing information to trial participants in a focussed, locally-appropriate manner, using methods developed in consultation with the community, and within a continuous informed-consent framework resulted in high levels of comprehension and message retention in this setting. This approach may represent a model for researchers conducting HIV prevention trials among other vulnerable populations in resource-poor settings. Trial registration Current Controlled Trials ISRCTN64716212. (shrink)

The call of the wild -- A stranger in strange lands -- Song of myself -- Senses and sensibilities -- I, robot -- Lord of the things -- And then there were none.

Using two contemporary cases of the global #MeToo movement and UK-based collective Sisters Uncut, this paper argues that a more in-depth and critical concern with gendered difference is necessary for understanding radical democratic ethics, one that advances and develops current understandings of business ethics. It draws on practices of social activism and dissent through the context of Irigaray’s later writing on democratic politics and Ziarek’s analysis of dissensus and democracy that proceeds from an emphasis on alterity as the capacity to (...) transform nonappropriative self-other relations. Therefore, the aims of the paper are: to develop a deeper understanding of a culture of difference and to consider sexual difference as central to the development of a practical democratic ethics and politics of organizations; to explore two key cases of contemporary feminist social movements that demonstrate connected yet contrasting examples of how feminist politics develops through an appreciation of embodied, intercorporeal differences; and to extend insights from Irigaray and Ziarek to examine ways in which a practical democratic politics proceeding from an embodied ethics of difference forms an important advancement to theorising the connection between ethics, dissent and democracy. (shrink)

Three experiments examined whether children and adults would use temporal information as a cue to the causal structure of a three-variable system, and also whether their judgements about the effects of interventions on the system would be affected by the temporal properties of the event sequence. Participants were shown a system in which two events B and C occurred either simultaneously (synchronous condition) or in a temporal sequence (sequential condition) following an initial event A. The causal judgements of adults and (...) 6-7-year-olds differed between the conditions, but this was not the case for 4-year-olds' judgements. However, unlike those of adults, 6-7-year-olds' intervention judgements were not affected by condition, and causal and intervention judgements were not reliably consistent in this age group. The findings support the claim that temporal information provides an important cue to causal structure, at least in older children. However, they raise important issues about the relationship between causal and intervention judgements. (shrink)

This paper takes as its starting point the fact that Bourdieu’s views on sociology as a science have not been sufficiently and adequately understood and discussed. It traces the links between his conception and that of the French tradition of historical epistemology which is critical of positivism. How Bourdieu extends their views, and those of Bachelard especially, beyond the realm of the natural sciences, to the social sciences and sociology in particular, is discussed. In the process he introduces new concepts (...) and methods, such as that of participant objectivation. His perspective reveals a convergence between the natural sciences and the social sciences as human endeavours striving for universal truths. This is reinforced and widened to include the humanities as well as demonstrated by his analysis of the literary field. The paper concludes with the observation that Bourdieu’s post-positivist science is a salutary alternative to the postmodern critique of science. (shrink)

This article draws on a study of infant participation in research, and work in philosophical-empirical inquiry, to illuminate some of the inexhaustible entanglements constituting the collec...

Generalisation, universal knowledge claims, and recommendations within disaster studies are problematic because they lead to miscommunication and the misapplication of actionable knowledge. The consequences and impacts thereof are not often considered by experts; forgone as irrelevant to the academic division of labour. There is a disconnect between expert assertions for disaster risk reduction (DRR) and their practical suitability for laypersons. Experts currently assert independently of the context within which protective action measures (PAMs) are to be used, measures unconnected to the (...) people for whom they are developed. This has knock-on effects for DRR: much expert-generated science and policy remains unused, unimplemented, and sometimes misapplied. I use philosophical accounts of assertion and epistemic blame to highlight the epistemic relationship between experts and laypersons. This relationship includes responsibilities and agreements between epistemic agents. Since multilevel DRR knowledge still transfers top-down from experts to laypersons, if experts impair the epistemic relationship, they can be held epistemically blameworthy. To address the pervasiveness of top-down systems, I analyse the epistemic framings and narratives currently shaping DRR, and more specifically PAMs and campaigns. I deconstruct universal perspectives that dominate the epistemic processes of generating, disseminating, and implementing DRR knowledge and specifically for co-seismic landslide PAMs for Nepal. I argue for more inclusive, contextual, and epistemically responsible DRR. Co-production of knowledge should begin from the standpoints of marginalised persons who may have an epistemic advantage due to their socio-politically marginalised positions. Often these epistemic contributions are left out of DRR efforts because marginalised persons are rarely afforded equal, if any, epistemic agency, which results in epistemic gaps and a large pool of relevant knowledge remaining unincorporated and unused in DRR research and policy. (shrink)

How biological form is generated remains one of the most fascinating but elusive challenges for science. Moreover, it is widely documented in contemporary literature that development is tightly coordinated. The idea that such development is governed by a coordinating field of force, the morphogenetic field, and its position in embryology research paradigms, is traced in this article. Empirical evidences for field phenomena are described, ranging from bioelectromagnetic effects, morphology, transplantation, regeneration, and other data. Applications of medical potential including treatment of (...) cancer, birth defects, and wound healing are highlighted. The article hypothesizes that distinct morphological forms may have distinct field parameters. Experimentally tractable field parameters may thus provide an exciting research program for probing morphogenesis and phylogenetic diversity. (shrink)

This article reviews some recent research on the development of temporal cognition, with reference to Weist's (1989) account of the development of temporal understanding. Weist's distinction between two levels of temporal decentering is discussed, and empirical studies that may be interpreted as measuring temporal decentering are described. We argue that if temporal decentering is defined simply in terms of the coordination of the temporal locations of three events, it may fail to fully capture the properties of mature temporal understanding. Characterizing (...) the development of mature temporal cognition may require, in addition, distinguishing between event-dependent and event-independent thought about time. Experimental evidence relevant to such a distinction is described; these findings suggest that there may be important changes between 3 and 5 years in children's ability to think about points in time independently of the events that occur at those times. (shrink)

This paper problematises the ways women’s leadership has been understood in relation to male leadership rather than on its own terms. Focusing specifically on ethical leadership, we challenge and politicise the symbolic status of women in leadership by considering the practice of New Zealand Prime Minister Jacinda Ardern. In so doing, we demonstrate how leadership ethics based on feminised ideals such as care and empathy are problematic in their typecasting of women as being simply the other to men. We apply (...) different strategies of mimesis for developing feminist leadership ethics that does not derive from the masculine. This offers a radical vision for leadership that liberates the feminine and women’s subjectivities from the masculine order. It also offers a practical project for changing women’s working lives through relationality, intercorporeality, collective agency and ethical openness with the desire for fundamental political transformation in the ways in which women can lead. (shrink)

Four studies are reported that employed an object location task to assess temporal–causal reasoning. In Experiments 1–3, successfully locating the object required a retrospective consideration of the order in which two events had occurred. In Experiment 1, 5- but not 4-year-olds were successful; 4-year-olds also failed to perform at above-chance levels in modified versions of the task in Experiments 2 and 3. However, in Experiment 4, 3-year-olds were successful when they were able to see the object being placed first in (...) one location and then in the other, rather than having to consider retrospectively the sequence in which two events had happened. The results suggest that reasoning about the causal significance of the temporal order of events may not be fully developed before 5 years. (shrink)

The idea that infant participation in research is achievable by researchers ‘voicing’ infants’ experiences and ‘perspectives’ is a central feature of current moves towards participatory research. In this article we offer an alternative. Specifically, we suggest a different point of reference than infants’ own experiences and ‘perspectives’; namely, the encounter between researcher and infant as it unfolds in practice. Drawing from a large-scale study of infants in family day care, and Merleau-Ponty’s notions of écart and reversibility, we articulate the possibility (...) that infants’ participation in research encounters may be felt by researchers in the ways that infants evoke embodied responses. Drawing on Dillon’s ethics of particularity, which builds upon écart and reversibility, we discuss the idea that researchers’ embodied responses to infants provoke possibilities for ethical reflection, which can afford new ways of ‘going on’. We propose that space may be created for infants to influence ECEC practice when researchers attend to their own embodied responses to infants during the research encounter; and to the factors that may diminish infants’ capacities to affect such responses. (shrink)

Theft, grievances and absenteeism show the need to examine mutual loyalty and establish a‘win‐win’policy.

[Un]disciplined Gestures and [Un]common sense: The Sensual, Acoustic Logic[s] of Paradox and Art Photography and the Representation of Modernist Architectural Space: From the Melancholy Fragment to the Colour of Utopia.

Volume 19, Issue 6, June 2019, Page 76-78.

PARLOUR R and MCCORMACK B. Nursing Inquiry 2012; 19: 308–321 Blending critical realist and emancipatory practice development methodologies: making critical realism work in nursing researchThis paper examines the efficacy of facilitation as a practice development intervention in changing practice within an Older Person setting and in implementing evidence into practice. It outlines the influences exerted by the critical realist paradigm in guiding emancipatory practice development activities and, in particular, how the former may be employed within an emancipatory practice development (...) study to elucidate and increase understanding pertinent to causation and outcomes. The methodology is based upon an emancipatory practice development approach set within a realistic evaluation framework. This allows for systematic analysis of the social and contextual elements that influence the explication of outcomes associated with facilitation. The study is concentrated upon five practice development cycles, within which a sequence of iterative processes is integrated. The authors assert that combining critical realist and emancipatory processes offers a robust and practical method for translating evidence and implementing changes in practice, as the former affirms or falsifies the influence that emancipatory processes exert on attaining culture shift, and enabling transformation towards effective clinical practice. A new framework for practice development is proposed that establishes methodological coherency between emancipatory practice development and realistic evaluation. This augments the existing theoretical bases for both these approaches by contributing new theoretical and methodological understandings of causation. (shrink)

Investigates the roles of temporal concepts and self-consciousness in the development of episodic memory. According to some theorists, types of long-term memory differ primarily in the degree to which they involve or are associated with self-consciousness (although there may be no substantial differences in the kind of event information that they deliver). However, a known difficulty with this view is that it is not obvious what motivates introducing self-consciousness as the decisive factor in distinguishing between types of memory and what (...) role it is supposed to play in remembering. The authors argue that distinctions between different kinds of memory should be made initially on the basis of the ways in which they represent events. In particular, it is proposed that the way in which remembered events are located in time provides an important criterion for distinguishing between different types of memory. According to this view, if there is a link between memory development and self-consciousness, it is because some temporal concepts emerge developmentally only once certain self-conscious abilities are in place. (shrink)

To provide rigour when preparing a research design, the researcher needs to carefully consider not only the methodology but also the philosophical intent of the study. This, however, is often absent from reported research and provides the reader with little evidence by which to judge the merits of the chosen methodology and its influence on the study. The purpose of this paper is to set out the case for critical realism as a framework to guide appropriate action in practice development (...) and realistic evaluation for understanding the consequences of those actions.It is evident that critical realism and critical social science share common ground. Emancipatory practice development (ePD) is based on the philosophy of critical social science and therefore by virtue is linked to the tenets of critical realism. Until now, the evaluation of ePD programme has been well served by 4th-generation evaluation. However, this paper outlines the need for a different approach to evaluation, one that is based on critical realism, that is concerned with emancipation, and that can be used in the ever-changing environment of clinical practice. Realistic evaluation not only links strongly to ePD programmes, but also serves as the basis for effective research questions that will test the outcomes of the research and inform the transferability of ePD mechanisms into differing contexts. (shrink)

Sometime around their first birthday most infants begin to engage in relatively sustained bouts of attending together with their caretakers to objects in their environment. By the age of 18 months, on most accounts, they are engaging in full-blown episodes of joint attention. As developmental psychologists (usually) use the term, for such joint attention to be in play, it is not sufficient that the infant and the adult are in fact attending to the same object, nor that the one’s attention (...) cause the other’s. The latter can and does happen much earlier, whenever the adult follows the baby’s gaze and homes in on the same object as the baby is attending to; or, from the age of six months, when babies begin to follow the gaze of an adult. We have the relevant sense of joint attention in play only when the fact that both child and adult are attending to the same object is, to use Sperber and Wilson’s (1986) phrase, ‘mutually manifest’. Psychologists sometimes speak of such jointness as a case of attention being ‘shared’ by infant and adult, or of a ‘meeting of minds’ between infant and adult, all phrases intended to capture the idea that when joint attention occurs everything about the fact that both subjects are attending to the same object is out in the open, manifest to both participants. (shrink)

Modern medicine consumes vast amounts of resources, ranging from human to technological and financial. In a well-functioning and well-equipped health system, resource allocation considerations rarely impact clinical decision-making as all patients that need care will (eventually) receive it. In light of this, health care providers (HCPs) are often taught to focus on the patient in front of them, driven by a type of patient-centred ethics (of care) that prioritizes the individual person’s well-being above the aggregate. Informed by the principle of (...) autonomy and respect for individual self-determination, patients in well-resourced health systems often have the autonomy to make decisions that require high resource utilization with little concern directed to how these choices may impact the care provided to other patients or groups of patients. In fact, it is generally accepted that if resources are sufficient, patients and their providers should be able to make medical decisions unencumbered by considerations related to broader resource allocation (with some caveats related to personal or national health insurance schemes). This means that the average HCP in the best case and in their daily routine spends little time considering how their clinical choices might impact the care available to others—concerns related to how resources are allocated, and who receives care are far removed from clinical interaction and related medical decision-making. (shrink)

The National Socialist Physicians League, was a professional medical organization founded upon the same ideologies that shaped the broader National Socialist agenda. Despite the vast historical and ethical literature focused on physician involvement in Nazi atrocities during the Holocaust, little attention has been paid to the NSDÄB. However, the establishment of this group is important to understanding the forces shaping physician participation in the Nazi party. Physicians often look to professional medical organizations as a source of moral guidance; thus, ideologies (...) of racism and the active harassment of ethnic or racial minority groups by this professional organization may have contributed to the establishment of this behavior as not only permissive but normal. This article will explore how this organization contributed to normalizing, desensitizing and legitimizing behavior that could not be justified by any normative theory of professional medical ethics. (shrink)

This book focuses on resource allocation in military and humanitarian medicine during times of scarcity and austerity. It is in these times that health systems bend, break, and even collapse and where resource allocation becomes a paramount concern and directly impacts clinical decision-making. Such times are challenging and this book covers this very important, yet, scarcely researched topic within the field of bioethics. This work brings together experts and practitioners in the fields of military health care, philosophy, ethics, and other (...) disciplines to provide analysis on a variety of related topics ranging from case studies and first-hand experiences to policy and philosophical analysis. It is of great interest to to academics, practitioners, policy makers and students who are looking for analyses and guidance regarding the fair provision of medical care and the use of medical rules of eligibility under adverse conditions. (shrink)

I propose an account of desire that reconciles two apparently conflicting intuitions about practical agency. I do so by exploring a certain intuitive datum. The intuitive datum is that often when an agent desires P she will seem to immediately and conclusively know that there is a reason to bring P about. Desire-based theories of reasons seem uniquely placed to explain this intuitive datum. On this view, desires are the source of an agent’s practical reasons. A desire for P grounds (...) conclusive knowledge of a reason to bring P about because that desire makes it true that there is a reason to do so. However, this implies that a basic desire for P can never be in error about there being at least some reason to bring P about. We have the conflicting intuition that basic desires sometimes rationally count for nothing. The guise of the good explains this intuition about the fallibility of desires. On this view, a desire for P represents P as good in some respect. Desires and reasons are independent, so a desire might misrepresent one’s reasons. But this independence is usually taken to rule out that desires ever provide conclusive knowledge of reasons. Capturing the intuition about conclusive knowledge rules out capturing the intuition about fallibility, and vice versa. I propose an epistemological disjunctivist version of the guise of the good that reconciles fallibility with the possibility of conclusive knowledge. (shrink)

This book provides a comprehensive insight into the ways in which psychoanalysts think and work. Mary Brownescombe Heller and Sheena Pollet bring together internationally known contributors trained at the Institute of Psychoanalysis to explore the broad range of clinical work, thinking, and teaching undertaken with children, families, adults and staff by psychoanalysts in the UK public health sector. Divided into four sections, _The Work of Psychoanalysts in the Public Health Sector_ covers: clinical work with parents and young children clinical (...) work with adults and their families analytic thinking in health service practice analytic support for health service staff. Experienced psychoanalysts discuss work with various client groups including parents with babies, children, adolescents who self harm, and adults with serious mental health conditions and psychosis. The book also explores how psychoanalytically-informed work can be used alongside other treatment methods, and how health service staff can best be trained and supported. _The Work of Psychoanalysts in the Public Health Sector_ offers the reader a broad perspective and a clear understanding of the various analytical concepts used in clinical practice. It will be invaluable reading for anyone interested in, or already using psychoanalytic ideas and techniques in the health sector, as well as students in training. (shrink)

An account of the development of temporal understanding is proposed which links such understanding with the development of episodic memory. We distinguish between different ways of representing time in terms of the kinds of temporal frameworks they involve. Distinctions are made between frameworks that are perspectival or nonperspectival and those that represent recurrent sequences or particular times. Even primitive temporal understanding integrates both perspectival and nonperspectival components. However, since early frameworks are event-based and localized, they are not yet sufficient for (...) episodic memory in that they do not enable the child to think of events as having occurred at particular points in time. We describe the emergence of new kinds of frameworks in terms of the development of temporal decentering. Two levels of temporal decentering are distinguished, with the higher level involving an appreciation of how event representations depend on one's temporal perspective. (shrink)

In temporal binding, the temporal interval between one event and another, occurring some time later, is subjectively compressed. We discuss two ways in which temporal binding has been conceptualized. In studies showing temporal binding between a voluntary action and its causal consequences, such binding is typically interpreted as providing a measure of an implicit or pre-reflective “sense of agency”. However, temporal binding has also been observed in contexts not involving voluntary action, but only the passive observation of a cause-effect sequence. (...) In those contexts, it has been interpreted as a top-down effect on perception reflecting a belief in causality. These two views need not be in conflict with one another, if one thinks of them as concerning two separate mechanisms through which temporal binding can occur. In this paper, we explore an alternative possibility: that there is a unitary way of explaining temporal binding both within and outside the context of voluntary action as a top-down effect on perception reflecting a belief in causality. Any such explanation needs to account for ways in which agency, and factors connected with agency, have been shown to affect the strength of temporal binding. We show that principles of causal inference and causal selection already familiar from the literature on causal learning have the potential to explain why the strength of people’s causal beliefs can be affected by the extent to which they are themselves actively involved in bringing about events, thus in turn affecting binding. (shrink)

It is well established that the temporal proximity of two events is a fundamental cue to causality. Recent research with adults has shown that this relation is bidirectional: events that are believed to be causally related are perceived as occurring closer together in time—the so‐called temporal binding effect. Here, we examined the developmental origins of temporal binding. Participants predicted when an event that was either caused by a button press, or preceded by a non‐causal signal, would occur. We demonstrate for (...) the first time that children as young as 4 years are susceptible to temporal binding. Binding occurred both when the button press was executed via intentional action, and when a machine caused it. These results suggest binding is a fundamental, early developing property of perception and grounded in causal knowledge. (shrink)

This chapter considers in what sense, if any, planning and future thinking is involved both in the sort of behaviour examined by McCarty et al. (1999) and in the sort of behaviour measured by researchers creating versions of Tulving's spoon test. It argues that mature human planning and future thinking involves a particular type of temporal cognition, and that there are reasons to be doubtful as to whether either of those two approaches actually assesses this type of cognition. To anticipate, (...) it argues that there is a commonsense notion of planning according to which planning involves event-independent thought about time. It also argues that thinking about the future involves the ability to think about the potential temporal locations of events within a linear temporal framework in which temporal locations are unique rather than repeated. (shrink)