Using the British mental health services as a case study, this book critically reviews the various social, political and intellectual developments which have shaped psychiatric practice and the delivery of mental health services.
This paper offers a semantically-based solution to the problem of predicting whether a verb will display the subjective conjugation or the objective conjugation in Hungarian. This alternation correlates with the definiteness of the object, but definiteness is not a completely reliable indicator of the subjective/objective alternation, nor is specificity. A prominent view is that the subjective/objective alternation is conditioned by the syntactic category of the object, but this view has also been shown to be untenable. This paper offers a semantic (...) solution: If the referential argument of a phrase is lexically specified as familiar/new, then the phrase bears the feature [+DEF]/[−DEF], and this feature governs the conjugations. The notions of novelty and familiarity are made precise using a compositional version of DRT in the context of a suitably large fragment of Hungarian, including local and non-local personal pronouns, demonstratives, definite and indefinite articles, quantifiers, wh-words, numerals, and possessives. (shrink)
Next SectionThis paper provides a lexical entry schema for exclusives covering the adverbs only, just, exclusively, merely, purely, solely, simply, and the adjectives only, sole, pure, exclusive and alone. We argue, on the basis of inter-paraphrasability relations among these exclusives and entailments involving at least and at most, that all of these items make an at-issue contribution of an upper bound on the viable answers to the current question under discussion (expressible with at most), and signal that a lower bound (...) on those answers (expressible with at least) is taken for granted. The lexical entry schema accommodates two main points of variation, which makes it possible to capture the differences in meaning among these terms: (i) semantic type (restricted to the class of modifiers), and (ii) constraints on the current question under discussion or the strength ranking over its alternative possible answers. We propose 22 different specific instantiations of the schema for exclusives in English. (shrink)
Philosophy should and can contribute to bioethics Content Type Journal Article DOI 10.1007/s11016-010-9476-2 Authors Vicki Langendyk, School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW 1797, Australia Journal Metascience Online ISSN 1467-9981 Print ISSN 0815-0796.
Dr. Fouts began his lecture with the story of how he and his wife Deborah became involved with Washoe—the first non-human to acquire the signs of American Sign Language (ASL). Project Washoe began in 1966 with Drs. Allen and Beatrix Gardner in Reno, Nevada. There had been other experiments that attempted to get chimpanzees to speak. These experiments were not successful due to anatomical and neurological differences between humans and chimpanzees. (Fouts showed some video of the chimpanzee Vicki trying (...) to say the four words she had learned—mama, papa, up, cup.) Part of the issue is the construction of the chimpanzee’s vocal box while another part of the issue is that chimpanzee vocalizations are tied to their .. (shrink)
In Telling Flesh: the Substance 0f the C0rporeul, Vicki Kirby suggests, among other things, that it is not in the interests of feminism to propound what she describes as an ‘inessentialist’ position in regards to embodiment. While she objects to undifferentiating biological givens that might, for example, attempt to construe women as confined to a nurturing role, she also does not want to simplistically insist that embodiment has nothing to do with subjectivity. To pose the problem in terms more (...) closely aligned with her own, Kirby is wary of the tendency to simply reverse binary oppositions, to swap nature for culture, reality for representation, and originary cause for interpretive effect. According to her, themes like ‘textuality’, and linguistic ideality have all but replaced the notion of ‘reality’. As arguably the pre-eminent ‘continental’ philosopher of our generation, the work of Derrida is invariably associated with this reversal of binary oppositions that seem to prohibit recourse to questions concerning embodiment. Several critics have even suggested that deconstruction is nothing but semiological reductionism in disguise. However, Kirby’s thesis, via an extended meditation upon Derrida’s claim that "there is nothing outside of the text," constitutes an important attempt to redeem him from such criticism. Rather than eschewing any and every reference to the body, she wants to insist that deconstruction cannot be contained within such a framework, and that it makes sense, within the logic of Of Grummutology (and she also pays cursory attention to Derrida’s ""Eating Well," or the Calculation of the Subject"), to conceive of embodiment in deconstructive terms. Examining the coherence of this claim will be the main focus of this paper, though in order to facilitate this task, this paper will also compare the notion of embodiment that Kirby espouses, to a curiously similar conception of the body that Merleau-Ponty theorizes in his unfinished text The Wsible und the Invisible.. (shrink)
This article explores Derrida's suggestion in Of Grammatology that deconstruction might be considered a positive science. The implication here is that ‘no outside of text’ does not evoke an enclosure whose limits can't be breached, an enclosure that discovers human exceptionalism in linguistic and technological capacities. Instead, this sense of a system and its involvements (différance) is already entangled in any ‘atom’ of its expression, whereby ‘no outside of text’ can be read as ‘no outside of Nature’. The logic that (...) informs and justifies the conventional separations between nature and culture, ideation and matter, and human and non-human, are thereby confounded; the dimensions of efficacy, as well as the vexed question of intention appear as non-local (systemic); and the very notion of language – what it is and how it works – is distributed in ways that give rise to the same quandaries that surround the quantum problematic. Indeed, at the end of this meditation the difference between the humanities and the sciences, especially in its current configuration as the impasse of ‘the two cultures’, can no longer be sustained. (shrink)
This article engages with the philosophical reflections of the French historian of science Hélène Metzger (1886–1944) in order to develop a vocabulary for understanding the rise of non-reductive Continental naturalism in the contemporary humanities. The bibliography of current naturalist approaches in the arts and the human sciences is still in the making, but it is altogether clear that the trend is not scientist or historicist or relativist. This epistemological diagnosis refers us to Metzger, who found herself surrounded with the logical (...) positivism of the Wiener Kreis, on the one hand, and the historicism of her French colleagues, on the other, as well as with the infiltration of the history of science by a chronological empiricism. In this article I will take the most recent book of Vicki Kirby – Quantum Anthropologies: Life at Large from 2011 – as an exemplary case of non-reductive Continental naturalist scholarship in the humanities today and by reading it through the concepts of Metzger, I will demonstrate how this type of research leads to refreshing insights in what constitutes positive humanities knowledge and what is the role of the a priori in the field. (shrink)
Background: There is general consensus internationally that unfair distribution of the benefits of research is exploitative and should be avoided or reduced. However, what constitutes fair benefits, and the exact nature of the benefits and their mode of provision can be strongly contested. Empirical studies have the potential to contribute viewpoints and experiences to debates and guidelines, but few have been conducted. We conducted a study to support the development of guidelines on benefits and payments for studies conducted by the (...) KEMRI-Wellcome Trust programme in Kilifi, Kenya. Methods: Following an initial broad based survey of cash, health services and other items being offered during research by all programme studies (n = 38 studies), interviews were held with research managers (n = 9), and with research staff involved in 8 purposively selected case studies (n = 30 interviewees). Interviews explored how these ‘benefits’ were selected and communicated, experiences with their administration, and recommendations for future guidelines. Data fed into a consultative workshop attended by 48 research staff and health managers, which was facilitated by an external ethicist.FindingsThe most commonly provided benefits were medical care (for example free care, and strengthened quality of care), and lunch or snacks. Most cash given to participants was reimbursement of transport costs (for example to meet appointments or facilitate use of services when unexpectedly sick), but these payments were often described by research participants as benefits. Challenges included: tensions within households and communities resulting from lack of clarity and agreement on who is eligible for benefits; suspicion regarding motivation for their provision; and confusion caused by differences between studies in types and levels of benefits. Conclusions: Research staff differed in their views on how benefits should be approached. Echoing elements of international benefit sharing and ancillary care debates, some research staff saw research as based on goodwill and partnership, and aimed to avoid costs to participants and a commercial relationship; while others sought to maximise participant benefits given the relative wealth of the institution and the multiple community needs. An emerging middle position was to strengthen collateral or indirect medical benefits to communities through collaborations with the Ministry of Health to support sustainability. (shrink)
We amplify possible complications to the tidy division between early vision and later categorisation which arise when we consider the perception of human faces. Although a primitive face-detecting system, used for social attention, may indeed be integral to “early vision,” the relationship between this and diverse other uses made of information from faces is far from clear.
There is wide agreement that community engagement is important for many research types and settings, often including interaction with ‘representatives’ of communities. There is relatively little published experience of community engagement in international research settings, with available information focusing on Community Advisory Boards or Groups (CAB/CAGs), or variants of these, where CAB/G members often advise researchers on behalf of the communities they represent. In this paper we describe a network of community members (‘KEMRI Community Representatives’, or ‘KCRs’) linked to a (...) large multi-disciplinary research programme on the Kenyan Coast. Unlike many CAB/Gs, the intention with the KCR network has evolved to be for members to represent the geographical areas in which a diverse range of health studies are conducted through being typical of those communities. We draw on routine reports, self-administered questionnaires and interviews to: 1) document how typical KCR members are of the local communities in terms of basic characteristics, and 2) explore KCR's perceptions of their roles, and of the benefits and challenges of undertaking these roles. We conclude that this evolving network is a potentially valuable way of strengthening interactions between a research institution and a local geographic community, through contributing to meeting intrinsic ethical values such as showing respect, and instrumental values such as improving consent processes. However, there are numerous challenges involved. Other ways of interacting with members of local communities, including community leaders, and the most vulnerable groups least likely to be vocal in representative groups, have always been, and remain, essential. (shrink)
Feminism could be described as a discourse that negotiates corporeality, what a body is and what a body can do. Nevertheless, the specter of essentialism means that the biological or anatomical body, the body that is commonly understood to be the "real" body, is often excluded from this investigation. The increasingly sterile debate between essentialism and antiessentialism has inadvertently encouraged this somatophobia. I argue that these opposing positions are actually inseparable, sharing a complicitous relationship that produces material effects.
BackgroundThere is general consensus internationally that unfair distribution of the benefits of research is exploitative and should be avoided or reduced. However, what constitutes fair benefits, and the exact nature of the benefits and their mode of provision can be strongly contested. Empirical studies have the potential to contribute viewpoints and experiences to debates and guidelines, but few have been conducted. We conducted a study to support the development of guidelines on benefits and payments for studies conducted by the KEMRI-Wellcome (...) Trust programme in Kilifi, Kenya.MethodsFollowing an initial broad based survey of cash, health services and other items being offered during research by all programme studies (n = 38 studies), interviews were held with research managers (n = 9), and with research staff involved in 8 purposively selected case studies (n = 30 interviewees). Interviews explored how these ‘benefits’ were selected and communicated, experiences with their administration, and recommendations for future guidelines. Data fed into a consultative workshop attended by 48 research staff and health managers, which was facilitated by an external ethicist.FindingsThe most commonly provided benefits were medical care (for example free care, and strengthened quality of care), and lunch or snacks. Most cash given to participants was reimbursement of transport costs (for example to meet appointments or facilitate use of services when unexpectedly sick), but these payments were often described by research participants as benefits. Challenges included: tensions within households and communities resulting from lack of clarity and agreement on who is eligible for benefits; suspicion regarding motivation for their provision; and confusion caused by differences between studies in types and levels of benefits.ConclusionsResearch staff differed in their views on how benefits should be approached. Echoing elements of international benefit sharing and ancillary care debates, some research staff saw research as based on goodwill and partnership, and aimed to avoid costs to participants and a commercial relationship; while others sought to maximise participant benefits given the relative wealth of the institution and the multiple community needs. An emerging middle position was to strengthen collateral or indirect medical benefits to communities through collaborations with the Ministry of Health to support sustainability. (shrink)
Americans read more than 10 magazines per month. Despite the profound effect this exposure has on individuals and society, little research has been done into ethical standards of magazines. Results of this pilot study of 100 consumer magazines indicate a considerable lack of standard practices and few ethical guidelines.
Community engagement is increasingly emphasized in biomedical research, as a right in itself, and to strengthen ethical practice. We draw on interviews and observations to consider the practical and ethical implications of involving Community Health Workers (CHWs) as part of a community engagement strategy for a vaccine trial on the Kenyan Coast. CHWs were initially engaged as an important network to be informed about the trial. However over time, and in response to community advice, they became involved in trial information (...) sharing and identifying potential participants; thereby taking on roles that overlapped with those of employed fieldworkers (FWs). While CHWs involvement was generally perceived as positive and appreciated, there were challenges in their relations with FWs and other community members, partly related to levels and forms of remuneration. Specifically, payment of CHWs was not as high as for FWs and was based on ‘performance’. This extrinsic motivation had the potential to crowd out CHWs intrinsic motivation to perform their pre-existing community roles. CHWs remuneration potentially also contributed to CHWs distorting trial information to encourage community members to participate; and to researchers encouraging CHWs to utilize their social connections and status to increase the numbers of people who attended information giving sessions. Individual consent processes were protected in this trial through final information sharing and consent being conducted by trained clinical staff who were not embedded in study communities. However, our experiences suggest that roles and remuneration of all front line staff and volunteers involved in trials need careful consideration from the outset, and monitoring and discussion over time. (shrink)
Internationally, calls for feedback of findings to be made an ‘ethical imperative’ or mandatory have been met with both strong support and opposition. Challenges include differences in issues by type of study and context, disentangling between aggregate and individual study results, and inadequate empirical evidence on which to draw. In this paper we present data from observations and interviews with key stakeholders involved in feeding back aggregate study findings for two Phase II malaria vaccine trials among children under the age (...) of 5 years old on the Kenyan Coast. In our setting, feeding back of aggregate findings was an appreciated set of activities. The inclusion of individual results was important from the point of view of both participants and researchers, to reassure participants of trial safety, and to ensure that positive results were not over-interpreted and that individual level issues around blinding and control were clarified. Feedback sessions also offered an opportunity to re-evaluate and re-negotiate trial relationships and benefits, with potentially important implications for perceptions of and involvement in follow-up work for the trials and in future research. We found that feedback of findings is a complex but key step in a continuing set of social interactions between community members and research staff (particularly field staff who work at the interface with communities), and among community members themselves; a step which needs careful planning from the outset. We agree with others that individual and aggregate results need to be considered separately, and that for individual results, both the nature and value of the information, and the context, including social relationships, need to be taken into account. (shrink)
International health research in malaria-endemic settings may include screening for sickle cell disease, given the relationship between this important genetic condition and resistance to malaria, generating questions about whether and how findings should be disclosed. The literature on disclosing genetic findings in the context of research highlights the role of community consultation in understanding and balancing ethically important issues from participants’ perspectives, including social forms of benefit and harm, and the influence of access to care. To inform research practice locally, (...) and contribute to policy more widely, this study aimed to explore the views of local residents in Kilifi County in coastal Kenya on how researchers should manage study-generated information on sickle cell disease and carrier status. (shrink)
(2013). The “Difficult Patient” Conundrum in Sickle Cell Disease in Kenya: Complex Sociopolitical Problems Need Wide Multidimensional Solutions. The American Journal of Bioethics: Vol. 13, No. 4, pp. 20-22. doi: 10.1080/15265161.2013.767960.
Research ethics is predominantly taught and practiced in Anglophone countries, particularly those in North America and Western Europe. Initiatives to build research ethics capacity in developing countries must attempt to avoid imposing foreign frameworks and engage with ethical issues in research that are locally relevant. This article describes the process and outcomes of a capacity-building workshop that took place in Kinshasa, Democratic Republic of Congo in the summer of 2011. Although the workshop focused on a specific ethical theme – the (...) responsibilities of researchers to provide health-related care to their research participants – we argue that the structure of the workshop offers a useful method for engaging with research ethics in general, and the theme of ancillary care encourages a broad perspective on research ethics that is highly pertinent in low-income countries. The workshop follows an interactive, locally driven model that could be fruitfully replicated in similar settings. (shrink)
This paper studies welfare tradeoffs in two-sided, one-to-one matching markets. We begin by providing theoretical upper bounds on a utilitarian price of stability, and show that these bounds vary with the composition of participants’ ordinal preference lists. We then turn to simulation experiments to describe how changes in basic characteristics of agents’ preferences can increase or decrease the average price of stability as measured by both utilitarian and Rawlsian welfare criteria. Our results indicate that markets featuring moderate degrees of correlation (...) and positive intercorrelation in the preferences of participants exhibit the steepest tradeoffs between stability and utilitarian welfare and between stability and Rawlsian welfare. (shrink)
Anorexia nervosa remains an enigma among Western cultures. Various causal explanations have been offered, encompassing biological, psychological, and sociocultural models. These explanations, however, focus on the immediate or proximal mechanisms of causation. A more thorough understanding of anorexia nervosa can be achieved by understanding the relationship between these factors and ultimate causation, the level of explanation which deals with individual reproductive fitness. This paper reviews the biological, psychological, sociocultural, and evolutionary models and indicates a necessary synthesis between proximate and ultimate (...) levels of causation in examining the anorexia nervosa puzzle. (shrink)