Aims and background: Little is known about how participants perceive prevention trials, particularly trials designed to prevent mental illness. This study examined participants’ motives for participating in a trial and their views of randomisation and the ability to withdraw from a randomised controlled trial for prevention of depression. Methods: Participants were older adults reporting elevated depression symptoms living in urban and regional locations in Australia who had consented to participate in an RCT of interventions to prevent depression. Participants rated their (...) agreement with various statements describing motivations for enrolment in the trial and opinions regarding randomisation and withdrawal. Results: The majority of participants expressed a triad of altruistic motivation for participation, relative lack of concern about randomisation and commitment to the trial. Certain subgroups of participants, such as women and those with higher depression scores, reported higher levels of concern about specific issues. Conclusions: The findings suggest that participants enrolled in prevention trials for mental illness are likely to hold positive attitudes towards research trials. The identification of relationships between key person factors and trial-related attitudes enabled profiling of participant groups, which can inform recruitment strategies and interactions of participants and research projects in future prevention trials. (shrink)

Virgil, in his description of the establishment of a new city by Aeneas for those Trojans who wished to remain in Sicily, is thinking of the Roman practice of colonial foundation: ‘Meanwhile Aeneas marked out the city with the plough and allocated the houses ’. We may note the personal role of the founder, the ploughing of the ritual first furrow, the organized grants to the settlers and the equality of treatment implied in the use of lot . Virgil was (...) writing at the end of the first century B.C. at a time of great activity in land distribution, but the Romans had been founding colonies from the mid fourth century. Each colony involved the creation of an urban area and the settlement of people on the surrounding agricultural land, and so perpetuated the city state, which was central to ancient life and culture. Indeed a colony was a smaller image of Rome itself. In the early Republic, colonies, either of Latins or of Roman citizens, were established on the periphery of Roman territory, largely for military and strategic reasons. Between 200 and 173 B.C. more than 40,000 may have received plots of land, amounting to about 1,000 square miles of territory. Later, the motives for colonial foundations became more complex, being closely connected with increasing economic and political problems. There can have been few more important aspects in the development of colonies than the need to find land for discharged troops. These in the main were rank and file soldiers who would expect equal shares in land allocations. (shrink)

Virgil, in his description of the establishment of a new city by Aeneas for those Trojans who wished to remain in Sicily, is thinking of the Roman practice of colonial foundation: ‘Meanwhile Aeneas marked out the city with the plough and allocated the houses ’. We may note the personal role of the founder, the ploughing of the ritual first furrow, the organized grants to the settlers and the equality of treatment implied in the use of lot. Virgil was writing (...) at the end of the first century B.C. at a time of great activity in land distribution, but the Romans had been founding colonies from the mid fourth century. Each colony involved the creation of an urban area and the settlement of people on the surrounding agricultural land, and so perpetuated the city state, which was central to ancient life and culture. Indeed a colony was a smaller image of Rome itself. In the early Republic, colonies, either of Latins or of Roman citizens, were established on the periphery of Roman territory, largely for military and strategic reasons. Between 200 and 173 B.C. more than 40,000 may have received plots of land, amounting to about 1,000 square miles of territory. Later, the motives for colonial foundations became more complex, being closely connected with increasing economic and political problems. There can have been few more important aspects in the development of colonies than the need to find land for discharged troops. These in the main were rank and file soldiers who would expect equal shares in land allocations. (shrink)

‘Now that all parts and members of the mortal creature had been fashioned into one, seeing that it must be the creature's lot for reasons of necessity to spend its life in the domain of fire and air and that it was like to waste away being continually melted and emptied by their onslaught, the gods contrived reinforcement for it. Blending a being kindred to man's being but with different shapes and senses, they brought it into life, a second kind (...) of living creature. Trees, plants, and seeds are these, and those among them which are cultivated types to-day have arrived at their mild benevolence to man only because they have been civilized by his husbandry; formerly only the wild kinds existed, for these are older than the cultivated. Now everything that is alive, whatever it be, may perfectly correctly and of right be termed ‘a living creature’. The creature now in question has at any rate the third kind of soul which our discourse told us is situated between the midriff and the navel. This kind of soul has nothing of opining or of reasoning mind, but it has sensation of pleasant and painful with attendant desires. For continually it is subject to every impression. Its manner of birth has not granted it the power to revolve by itself in itself upon itself rejecting outside motion and asserting its own and thus by beholding all things by native endowment of soull to reason out aught of its own concerns. So it has life and is not some second being other than a living creature, but it stays fixed, rooted, motionless, for it has never been granted movement of its own initiation.’. (shrink)

This is an interview with author Lester Grinspoon, M.D., whose work on psychoactive substances over the last thirty‐five years has been highly influential. His book, Marihuana: The Forbidden Medicine (written with James B. Bakalar), is a classic source on the medical marijuana controversy. His books Psychedelic Drugs Reconsidered and Cocaine: A Drug and Its Social Evolution are standards in the field. Dr. Grinspoon received his M.D. from Harvard Medical School and currently is associate professor emeritus at Harvard Medical School. His (...) academic work has also reached a general audience through publications ranging from the New York Times Book Review to Playboy. Describing him as the "complete medical scholar," his citation for the Lindesmith Award for Achievement in the Field of Scholarship also notes, "Lester Grinspoon represents all those scholars who report the results of their research truthfully, despite the political consequences of this unwelcomed honesty.". (shrink)

Throughout his life, John Tyler Bonner contributed to major transformations in the fields of developmental and evolutionary biology. He pondered the evolution of complexity and the significance of randomness in evolution, and was instrumental in the formation of evolutionary developmental biology. His contributions were vast, ranging from highly technical scientific articles to numerous books written for a broad audience. This historical vignette gathers reflections by several prominent researchers on the greatness of John Bonner and the implications of his work.

For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a re-clarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to review outcome measures for (...) use in routine care settings. Central features include the user-centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence-based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care. (shrink)

In its most basic form, Simple Reliabilism states that: a belief is justified iff it is formed as the result of a reliable belief-forming process. But so-called New Evil Demon cases have been given as counterexamples. A common response has been to complicate reliabilism from its simplest form to accommodate the basic reliabilist position, while at the same time granting the force of NED intuitions. But what if despite initial appearances, Simple Reliabilism, without qualification, is compatible with the NED intuition? (...) What we can call the Dispositionalist Response to the New Evil Demon problem is fascinating because it contends just that: Simple Reliabilism is fully compatible with the NED intuition. It is claimed that all we need to do to recognize their compatibility is appreciate that reliability is a dispositional property. In this paper I shall critically evaluate the Dispositionalist proposal. (shrink)

The topic of consent in paediatrics is made more difficult, and at the same time more interesting, by the complexity of the issues involved and the consequent diversity of viewpoints. In a teaching session for senior medical students on consent in paediatrics it proved necessary to reinstate previous learning from a range of disciplines. Philosophical medical ethics, developmental psychology, communication skills and the appropriate legal definitions all contributed to a proper understanding of the cases presented. The two most important additional (...) components appeared to be a) a basic knowledge of cognitive development and how to apply it, and b) an awareness of the need to balance an individual child's rights or best interests, with those of the family unit, as well as the wider society. (shrink)

Seen in its historical context, Mazur & Booth's (M&B's) target article may come to be viewed as a turning point in the study of the biological basis of human behavior in general, and dominance in particular. To facilitate further research, suggestions are offered for making the definition of dominance more precise. From an evolutionary point of view, the testosterone-dominance link may be as important in women as it is in men.

The ELSI Program: Closing the Loop was an interpretive policy study undertaken to identify how the research and the researchers funded through the program to study the ethical, legal, and social implications of mapping the human genome contributed to the construction of a public policy agenda. The stated goals of this federal grant program, known as ELSI and administered through the National Center for Human Genome Research within the National Institutes of Health, was to maximize the benefits and minimize (...) the harms of the genetic information developed as a result of the government supported genomic research. The purpose of the research project was to generate meaning and understanding regarding the social constructions of this community of researchers. Specifically, identifying themes in the process and outcomes of the research activity was intended to inform future public policy actions, thereby, closing the loop on the reflexive activity generated by the ELSI Program. The activities of the sixty-four researchers granted awards between 1990 and 1993 comprised the core sample for the study. The research process was embedded in a constructivist philosophy and the design included participant observation and an analysis of textual materials generated by the grantees. Data included periodical articles, authored and edited books, videos, popular print and visual media materials, conference papers and presentations, forum reports, interviews, and materials generated by the researcher in the process of the research--notes and analytic memos. Data analysis was an interpretive synthesis of a content analysis, contextual analysis, grounded theory coding categories, and the reflexive process of the researcher. ;The phenomena under investigation were the interactional activities of the ELSI group of researchers through which meaning was shaped on the ethical, legal, and social implications of genomic mapping. A theoretical model of the constructions of the researchers as developed included two core categories: "Framing Academic Constructions" and "Institutionalizing the Myth". The ELSI researchers used a variety of strategies, including rhetorical questioning, professional blocking and impersonalizing, plying a trade, and academic time in generating constructions. The research and researchers contributed to institutionalizing a myth of a genome through strategies that included being the expert, narrowing the focus, and marveling. The consequence of these social interactions was a process of "Making Points Not Meaning", participation in symbolic activities that generated few issues for the public policy agenda. The constructions of the policy study were then situated in the context of the discipline of public administration and policy studies. Significant to the impact of the research findings was understanding how the cooptation of these researchers might effect an health care delivery system dominated by commercial interests such as biotechnology and managed care organizations. The study concluded with a discussion of how situated knowledge constructions, social epistemology, interdisciplinarity, and interpretive research methods might contribute to enhanced credibility in public policy actions. (shrink)

To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of (...) the guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guidelines were less strict in categorically excluding patients groups (32% vs 64%) and in particular incompetent patients (10% vs 29%). Healthcare institutions should accurately state the boundaries of the law, also when they prefer to set stricter boundaries for their own institution. Only then can guidelines provide adequate support for physicians and nurses in the difficult EAS decision-making process. (shrink)

The Doris Duke Charitable Foundation's competitive career development award selects awardees annually. This paper describes changes DDCF made to its grants making process to improve gender representation in its applicant and awardee pools.

This study investigates the reactions of graduate students to perceived gender bias in their classes, using survey data from 254 social science graduate students in seven Ph.D.-granting departments in three universities. In addition to summarizing reported rates of gender-biased behavior in classrooms, we test hypotheses connecting perceptions of sexist behavior with students' emotional reactions, levels of distraction, and subsequent performance. Results are mixed, depending on students' perceptions of professors as either sensitive or insensitive to gender issues. Second, we use a (...) model of social influence to test for negative effects of reported sexist behavior on students' perceptions of professors' expertness, attractiveness, and trustworthiness. Strong support is demonstrated for these hypotheses. (shrink)

These two texts come from a store of papyrus fragments which are at present being examined and worked over at Oxford. They are the property of the Egypt Exploration Society and will be republished in vol. xxxi of the Oxyrhynchus Papyri as Nos. 2544 and 2534; permission for their separate publication here has been granted by the Society in view of the relevance of the former of them to the article by Mr. W. S. Barrett which appears on pp. 58–71 (...) below. We are much indebted to Mr. Barrett and Professor Hugh Lloyd-Jones for many valuable suggestions and criticisms. The nature of both texts was recognized by R. A. Coles, of Magdalen College, Oxford, one of the collaborators in this article. (shrink)

Deep brain stimulation — a novel surgical procedure — is emerging as a treatment of last resort for people diagnosed with neuropsychiatric disorders such as severe obsessive-compulsive disorder. The US Food and Drug Administration granted a so-called humanitarian device exemption to allow patients to access this intervention, thereby removing the requirement for a clinical trial of the appropriate size and statistical power. Bypassing the rigors of such trials puts patients at risk, limits opportunities for scientific discovery, and gives device manufacturers (...) unique marketing opportunities. We argue that Congress and federal regulators should revisit the humanitarian device exemption to ensure that it is not used to sidestep careful research that can offer valuable data with appropriate patient safeguards. (shrink)

Injury to the central or peripheral nervous system is often associated with persistent pain. After ischemic injury to the spinal cord, rats develop severe mechanical allodynia-like symptoms, expressed as a pain-like response to innocuous stimuli. In its short-lasting phase the allodynia can be relieved with the [gamma]-aminobutyric acid (GABA)-B receptor agonist baclofen, which also reverses the hyperexcitability of dorsal horn interneurons to mechanical stimuli. Furthermore, there is a reduction in GABA immunoreactivity in the dorsal horn of allodynic rats. Clinical neuropathic (...) pain of peripheral and central origin often cannot be relieved by opiates at doses that do not cause side effects. The loss of sensitivity to opiates may be associated with the up-regulation of endogenous antiopioid substances, such as the neuropeptide cholecystokinin (CCK). CCK and its receptor (CCK-R) protein is normally not detectable in rat dorsal root ganglion cells. After peripheral nerve section, both CCK and CCK-R are up-regulated in the dorsal root ganglia. Furthermore, CI 988, an antagonist of the CCK-B receptor, chronically coadministered with morphine, reduces autotomy, a behavior that may be a sign of neuropathic pain following peripheral nerve section. Thus, opiate insensitivity may be due to the release of CCK from injured primary afferents. Similarly, in the chronic phase of the spinal ischemic model of central pain, the allodynia-like symptom is not relieved by systemic morphine, but is significantly reversed by the CCK-B antagonist. Consequently, up-regulation of CCK and CCK-R in the CNS may also underlie opiate drug insensitivity following CNS injury. Thus, dysfunction of central inhibition involving GABA and endogenous opioids may be a factor underlying the development of sensory abnormalities and/or pain following injury to neural tissue. (shrink)

Background: Black, Asian and minority ethnic groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks. Objective: To identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent. Methods: Three-phase programme comprising community-based research (...) involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; hospital-based research examining staff practices and influences on family consent through ethics discussion groups with staff, a study on intensive care units and interviews with bereaved ethnic minority families; and development and evaluation of a training package to enhance cultural competence among ICU staff. Setting: Community focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts. Participants: Community studies: 228 focus group participants; hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and evaluation: 66 health professionals. Data sources: Focus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation. Review methods: Systematic review and narrative synthesis. Results: Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. Evaluation: professional development package – a digital versatile disk-based training package was developed to promote confidence and skills in cross-cultural communication. Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation. Limitations: Participants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families. Conclusions: The research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS. Future work: Greater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families. Funding: The National Institute for Health Research Programme Grants for Applied Research programme. (shrink)

In 1943 Dr J.C.B. Grant, of the University of Toronto, published the first anatomical atlas ever fully produced in North America, An Atlas of Anatomy. Within the history of biomedical teaching, the publication of this textbook is remarkable for at least two reasons, both connected to the themes of animation and automation. The visual narrative of the anatomical body found in Grant’s Atlas encapsulated a paradigmatic shift in gross anatomy from a systemic approach (dividing the body into its (...) systems) to a regional anatomy (dividing the body into areas containing interlocking systems). The contextually contingent reasons for this shift in medical training are represented in the production of this textbook. What is crucial is that anatomy is thus conceived as directly applicable to surgical practice, which intervenes on the bodies of the living, rather than the dead. The second important dimension of Grant’s Atlas was his rigorous, yet invisible, incorporation of photography into the practice of medical illustration. Grant’s Atlas systematically deployed hand-drawn tracings of photographic images in the production of his bestselling textbook to affirm an indexical connection to a ‘real body’. At the same time, this use of photography is erased within the visuals, which rely instead on hand-drawn illustrations (line-drawings and carbon-dusting) to produce this particular pedagogy of the anatomical body. The production of ‘textbook anatomy’ is thus articulated to changes in technical modes of representation (photography) and to the new techniques in print-technologies from the late 19th until the mid 20th century. (shrink)

Law plays a critical role in all stages of a public health emergency, providing an infrastructure for planning, response, and recovery efforts. A growing body of research has underscored the potential for certain types of state laws, such as those granting liability protections to responders, to influence the public health workforce's participation in emergency responses. It is therefore especially important to focus on particular state-level laws that may be associated with individuals' increased or decreased willingness to respond. We conducted a (...) systematic identification and analysis of specific state emergency preparedness laws that may affect individuals' willingness to respond and offer recommendations for policymakers seeking to promote more effective responses to public health emergencies. (shrink)

Law plays a critical role in all stages of a public health emergency, including planning, response, and recovery. Public health emergencies introduce health concerns at the population level through, for example, the emergence of a novel infectious disease. In the United States, at the federal, state, and local levels, laws provide an infrastructure for public health emergency preparedness and response efforts: they grant the government the ability to officially declare an emergency, authorize responders to act, and facilitate interjurisdictional coordination. (...) Law is perhaps most visible during an emergency when the president or a state's governor issues a disaster declaration establishing the temporal and geographic parameters for the response and making financial and other resources available. This legal authority has increasingly been used during the last decade. (shrink)

As in other fields, scholarly publication in sociology is not only the key to career success but also the route by which feminist analyses and perspectives become known to others in the discipline. A growing literature has analyzed women's and men's rates of publication, but the gender politics of the prepublication production of research and gender differences in reputation building after publication remain underexplored. This report reviews the current state of knowledge about sociological publishing at three phases: prepublication, the publication-seeking (...) phase, and postpublication. It concludes with critical questions to be addressed in developing a comprehensive model of gender effects on sociological publishing. (shrink)

We discuss some recent work by Tim Maudlin concerning Black Hole Information Loss. We argue, contra Maudlin, that there is a paradox, in the straightforward sense that there are propositions that appear true, but which are incompatible with one another. We discuss the significance of the paradox and Maudlin's response to it.

We show a sense in which the spacetime property of effective completeness—a type of “local hole-freeness” or “local inextendibility”—is not stable.

Little is in print on the development in Britain of university disciplines including the academic study of education. This paper provides a historical narrative of the study of adolescence from the 1870 Education Act to the contemporary day. Adolescence textbooks are examined in the context of changes in the education system, such as the demand for secondary education and the expansion of teacher education. Changing emphases in adolescence research are traced through various publications to illustrate curriculum developments. The important contributions (...) of Dame Olive Wheeler, Professor W. D. Wall and other leading writers on adolescence are evaluated. It is clear that in over a century of national educational provision British teachers have never faced a great choice of adolescence texts and the paper concludes with some reflections on this observation. (shrink)

Introduction.--Dualism and the new problem.--Truth and experience.--Plan and stages of the argument.--The interpretation of sense-experience: and of perceptual experience.--Understanding and the world of noumena and phenomena.--Self-conscious experience.--The sphere of reason, scientific experience.--The sphere of finite spirit, moral experience.--The sphere of absolute spirit, religious experience, contemplation.