The everyday expressions of nursing practices are driven by their entanglement in complex flows of social, cultural, political and economic interests. Early expressions of trained nursing practice in the United States and Europe reflect claims of moral, spiritual and clinical exceptionalism. They were both imposed upon—and internalized by—nursing pioneers. These claims were associated with an endogenous narrative of discipline and its physical manifestation in early nursing schools and hospitals, which functioned as “total institutions.” By contrast, the external forces—diffuse yet pervasive—impacting (...) upon contemporary nursing more closely align with the power dynamics explored in Gilles Deleuze's concept of the Society of Control. The example of sensor technology and telemetric monitoring of nurses’ locations in the clinical setting exemplifies the intense presence of surveillance, performance metrics and the “rationalization” of nursing practice. It falls upon nurses to recognize, accept or challenge these dynamics in order to shape the future of nursing practice into a discipline which embodies our values and priorities. (shrink)

Race and religion are integral parts of bioethics. Harm and oppression, with the aim of social and political control, have been wrought in the name of religion against Blacks and people of color as embodied in the Ten Commandments, the Inquisition, and in the history of the Holy Crusades. Missionaries came armed with Judeo/Christian beliefs went to nations of people of color who had their own belief systems and forced change and caused untold harms because the indigenous belief systems were (...) incompatible with their own. The indigenous people were denounced as ungodly, pagan, uncivilized, and savage. Hence, laws were enacted because of their perceived need to structure a sense of morality and to create and build a culture for these indigenous people of color. To date bioethics continues to be informed by a Western worldview that is Judeo/Christian in belief and orientation. However, missing from bioethical discourse in America is the historical influence of the Black Church as a cultural repository, which continues to influence the culture of Africans and Blacks. Cultural aspects of peoples of color are still largely ignored today. In attempting to deal with issues of race while steering clear of the religious and cultural impact of the Black Church, bioethics finds itself in the middle of a distressing situation: it simply cannot figure out what to do with race. (shrink)

A new diagnostic modeling system for automatically synthesizing a deep‐structure model of a student's misconceptions or bugs in his basic mathematical skills provides a mechanism for explaining why a student is making a mistake as opposed to simply identifying the mistake. This report is divided into four sections: The first provides examples of the problems that must be handled by a diagnostic model. It then introduces procedural networks as a general framework for representing the knowledge underlying a skill. The challenge (...) in designing this representation is to find one that facilitates the discovery of misconceptions or bugs existing in a particular student's encoding of this knowledge. The second section discusses some of the pedagogical issues that have emerged from the use of diagnostic models within an instructional system. This discussion is framed in the context of a computer‐based tutoring/gaming system developed to teach students and student teachers how to diagnose bugs strategically as well as how to provide a better understanding of the underlying structure of arithmetic skills. The third section describes our uses of an executable network as a tool for automatically diagnosing student behavior, for automatically generating “diagnostic” tests, and for judging the diagnostic quality of a given exam. Included in this section is a discussion of the success of this system in diagnosing 1300 school students from a data base of 20.000 test items. The last section discusses future research directions. (shrink)

Background Offering financial incentives to achieve medication adherence in patients with severe mental illness is controversial. Aims To explore the views of different stakeholders on the ethical acceptability of the practice. Method Focus group study consisting of 25 groups with different stakeholders. Results Eleven themes dominated the discussions and fell into four categories: (1) ‘wider concerns’, including the value of medication, source of funding, how patients would use the money, and a presumed government agenda behind the idea; (2) ‘problems requiring (...) clear policies’, comprising of practicalities and assurance that incentives are only one part of a tool kit; (3) ‘challenges for research and experience’, including effectiveness, the possibility of perverse incentives, and impact on the therapeutic relationship; (4) ‘inherent dilemmas’ around fairness and potential coercion. Conclusions The use of financial incentives is likely to raise similar concerns in most stakeholders, only some of which can be addressed by empirical research and clear policies. (shrink)

Alterations to cognitive function are often reported with depression and anxiety symptoms, yet few studies have examined the same associations with mental well-being. This study examined the association between mental well-being, depression and anxiety symptoms and cognitive function in 1502 healthy adult monozygotic and dizygotic twins, and the shared/unique contribution of genetic and environmental variance. Using linear mixed models, mental well-being was positively associated with sustained attention, inhibition, cognitive flexibility, motor coordination and working memory, whereas depression and anxiety symptoms were (...) associated with poorer sustained attention, inhibition, cognitive flexibility and executive function. Bivariate twin modelling showed well-being shared a small environmental correlation with motor coordination and a small genetic correlation with working memory. Trivariate twin modelling showed well-being shared a small genetic correlation with inhibition, whereas depression and anxiety symptoms shared a small environmental correlation with inhibition. The remaining variance was mostly driven by unique G and/or E variance. Overall, well-being and depression and anxiety symptoms show both independent and shared relationships with cognitive functions but this is largely attributable to unique G or E variance and small shared G/E variance between pairs of variables. (shrink)

Airway mucin secretion is important pathophysiologically and as a model of polarized epithelial regulated exocytosis. We find the trafficking protein, SNAP23, selectively expressed in secretory cells compared with ciliated and basal cells of airway epithelium by immunohistochemistry and FACS, suggesting that SNAP23 functions in regulated but not constitutive epithelial secretion. Heterozygous SNAP23 deletant mutant mice show spontaneous accumulation of intracellular mucin, indicating a defect in baseline secretion. However mucins are released from perfused tracheas of mutant and wild-type mice at the (...) same rate, suggesting that increased intracellular stores balance reduced release efficiency to yield a fully compensated baseline steady state. In contrast, acute stimulated release of intracellular mucin from mutant mice is impaired whether measured by a static imaging assay 5 min after exposure to the secretagogue ATP or by kinetic analysis of mucins released from perfused tracheas during the first 10 min of ATP exposure. Together, these data indicate that increased intracellular stores cannot fully compensate for the defect in release efficiency during intense stimulation. The lungs of mutant mice develop normally and clear bacteria and instilled polystyrene beads comparable to WT mice, consistent with these functions depending on baseline secretion that is fully compensated. (shrink)

It is well established that retrieval of names is harder than the retrieval of other identity specific information. This paper offers a review of the more influential accounts put forward as explanations of why names are so difficult to retrieve. A series of five experiments tests a number of these accounts.Experiments One to Three examine the claims that names are hard to recall because they are typically meaningless, or unique. Participants are shown photographs of unfamiliar people or familiar people and (...) given three pieces of information about each: a name, a unique piece of information, and a shared piece of information. Learning follows an incidental procedure, and participants are given a surprise recall test. In each experiment shared information is recalled most often, followed by unique information, followed by name. Experiment Four tests both the `uniqueness' account and an account based on the specificity of the naming response. Participants are presented with famous faces and asked to categorise them by semantic group. Results indicate that less time is needed to perform this task when the group is a subset of a larger semantic category. A final experiment examines the claim that names might take longer to access because they are less often retrieved than other classes of information. Latencies show that participants remain more efficient when categorising faces by their occupation than by their name even when they have received extra practice of naming the faces.We conclude that the explanation best able to account for the data is that names are stored separately from other semantic information and can only be accessed after other identity specific information has been retrieved. However, we also argue that the demands we make of these explanations make it likely that no single theory will be able to account for all existing data. (shrink)

Because no single person or group holds knowledge about all aspects of research, mechanisms are needed to support knowledge exchange and engagement. Expertise in the research setting necessarily includes scientific and methodological expertise, but also expertise gained through the experience of participating in research and/or being a recipient of research outcomes. Engagement is, by its nature, reciprocal and relational: the process of engaging research participants, patients, citizens and others brings them closer to the research but also brings the research closer (...) to them. When translating research into practice, engaging the public and other stakeholders is explicitly intended to make the outcomes of translation relevant to its constituency of users. In practice, engagement faces numerous challenges and is often time-consuming, expensive and ‘thorny’ work. We explore the epistemic and ontological considerations and implications of four common critiques of engagement methodologies that contest: representativeness, communication and articulation, impacts and outcome, and democracy. The ECOUTER methodology addresses problems of representation and epistemic foundationalism using a methodology that asks, “How could it be otherwise?” ECOUTER affords the possibility of engagement where spatial and temporal constraints are present, relying on saturation as a method of ‘keeping open’ the possible considerations that might emerge and including reflexive use of qualitative analytic methods. This paper describes the ECOUTER process, focusing on one worked example and detailing lessons learned from four other pilots. ECOUTER uses mind-mapping techniques to ‘open up’ engagement, iteratively and organically. ECOUTER aims to balance the breadth, accessibility and user-determination of the scope of engagement. An ECOUTER exercise comprises four stages: engagement and knowledge exchange; analysis of mindmap contributions; development of a conceptual schema ; and feedback, refinement and development of recommendations. ECOUTER refuses fixed truths but also refuses a fixed nature. Its promise lies in its flexibility, adaptability and openness. ECOUTER will be formed and re-formed by the needs and creativity of those who use it. (shrink)

The rapid rise of international collaborative science has enabled access to genomic data. In this article, it is argued that to move beyond mapping genomic variation to understanding its role in complex disease aetiology and treatment will require extending data sharing for the purposes of clinical research translation and implementation.

Randomized controlled clinical trials play an important role in the development of new medical therapies. There is, however, an ethical issue surrounding the use of randomized treatment allocation when the patient is suffering from a life threatening condition and requires immediate treatment. Such patients can only benefit from the treatment they actually receive and not from the alternative therapy, even if it ultimately proves to be superior. We discuss a novel new way to analyse data from such clinical trials based (...) on the use of the recently developed theory of imprecise probabilities. This work draws an explicit distinction between the related but nevertheless distinct questions of inference and decision in clinical trials. The traditional question of scientific interest asks 'Which treatment offers the greater chance of success?' and is the primary reason for conducting the clinical trial. The question of decision concerns the welfare of the patients in the clinical trial, asking whether the accumulated evidence favours one treatment over the other to such an extent that the next patient should decline randomization and instead express a preference for one treatment. Consideration of the decision question within the framework of imprecise probabilities leads to a mathematical definition of equipoise and a method for governing the randomization protocol of a clinical trial. This paper describes in detail the protocol for the conduct of clinical trials based on this new method of analysis, which is illustrated in a retrospective analysis of data from a clinical trial comparing the anti-emetic drugs ondansetron and droperidol in the treatment of postoperative nausea and vomiting. The proposed methodology is compared quantitatively using computer simulation studies with conventional clinical trial designs and is shown to maintain high statistical power with reduced sample sizes, at the expense of a high type I error rate that we argue is irrelevant in some specific circumstances. Particular emphasis is placed on describing the type of medical conditions and treatment comparisons where the new methodology is expected to provide the greatest benefit. (shrink)

Gutenbergs tryckteknik ledde till en medierevolution som förändrades Europa. I 1500-talets början spreds litteratur, grafik och vetenskap, men också nyhetsblad om katastrofer, pamfletter om invaderande turkar och religiösa stridsskrifter. Medan mycket ännu vägde blommade renässanshumanismen genom Erasmus av Rotterdam. Han stod bakom en femtedel av Europas böcker, och skulle ge framtiden ett viktigt arv. Nina Burton skriver om Erasmus och hans tid så att man känner sig vara med när han träffar konstnärerna och de intellektuella? Albrecht Dürer, Holbein d.y., (...) Paracelsus, Thomas More och Luther? lika väl som påvar, kejsare, pedagoger och rebeller. Genom honom möter man en hel epok. Vilken var Erasmus hemlighet? I sina brev klottrade han självporträtt med dubbla ansikten, och hans förmåga att se två sidor födde ett samtal bortom all fanatism? en dröm om ett gränslöst Europa, där kultur och vetenskap knöt nya samband. Men då religiösa strider började skaka världen fick han mäktiga fiender. Erasmus visade vilken roll litteraturen kan spela i en dramatisk tid som har många likheter med vår egen. (shrink)

This case note considers the availability in the United Kingdom of the provocation defence in cases of intimate homicide in the context of the recent House of Lords decision in Rv. Smith [2000] 3 W.L.R. 654. The note argues that the expansion of the objective component of the defence to encompass the mental infirmities of individual defendants is dangerous for women. Although it has the potential to help some abused women who kill to use the defence, it has, at the (...) same time, exposed women who are abused by sexually possessive, violent men to even greater danger. It is thus argued that the defence should be restricted in the way envisaged by the minority judgement of Lord Millett so that abused women will still be able to use the defence, but by anon-medical route. Alternatively, the defence should be abolished and defences which pose no risk of encompassing violent men should be developed to accommodate abused women. (shrink)

The concepts and theories surrounding the aesthetic category of the grotesque are explored in this book by pursuing their deployment in the films of American auteurs Tim Burton, Terry Gilliam, the Coen Brothers and David Lynch"--Provided by publisher.

Sentencing practices in cases of domestic homicide have been the object of critical scrutiny on previous occasions across a number of jurisdictions. It has been suggested by some that these practices reveal judges to be taking a more lenient approach to women who kill their violent male partners than to men who kill allegedly unfaithful female partners. This note evaluates claims of gender bias in sentencing practices in UK cases of domestic homicide following the Court of Appeal sentencing decision in (...) R. v. Suratan, R. v.Humes and R.v. Wilkinson [2002]E.W.C.A. 2982 concerning three men who killed their female partners. It will argue that in the wake of this decision current proposals to review both the substantive law of provocation and sentencing practices are to be welcomed. (shrink)