There is a need for empirically based research on social and ethical challenges related to informed consent processes, particularly in studies focusing on adolescent sexual and reproductive health. In a pilot study of a school-based pregnancy prevention intervention in rural Zambia, the majority of the guardians who were asked to consent to their daughters’ participation, refused. In this paper we explore the reasons behind the low participation in the pilot with particular attention to challenges related to the community engagement and (...) informed consent process. The pilot was implemented in two schools and examined the acceptability of a package of interventions including economic support to families to keep their girls in school, pocket money for girls, youth club meetings on reproductive health, and community meetings to sensitize the community. Focus group discussions were conducted with girls who participated in the pilot, boys in their class and with parents. Individual semi-structured interviews were conducted with teachers, peer educators and community health workers involved in the coordination of the intervention as well as with religious and traditional leaders. Data were analyzed through thematic analysis. The findings indicate that inadequate use of recognized community communication channels during the community engagement process and dissemination of information about the pilot resulted in limited understanding of the pilot concept by the community. This surfaced through uncertainty and fear that the intervention may result in loss of control over daughters, worries about why money was provided unconditionally to girls, and suspicion of links to satanism. The sense of insecurity appeared to be exacerbated by low literacy levels, poverty, fear of loss of bride wealth, perceived disregard for local perceptions of social status, and scanty trust in the actors implementing the pilot. Inadequate use of locally appropriate channels in the dissemination of information created room for interpretation and facilitated development of mistrust, undermining the conditions for community engagement and actual informed consent. A key lesson learnt is the importance of taking seriously the complexity of local values and structures that may impact people’s capability to consent or not consent to a study in an informed manner. (shrink)

In Tudor and Stuart Britain, women writers took active roles in negotiating cultural ideas and systems to gain power by participating in politics through writing, shaping the aesthetics of genre, and fashioning feminine gender, despite constraints on women. Through the lens of cultural studies, the authors explore the ways in which women of this era worked to actually create culture. Articles cover five areas: women, writing, and material culture; women as objects and agents in reproducing culture; women's role in producing (...) gender; popular culture and women's pamphlets; and women's bodies as inscriptions of culture. (shrink)

The purpose of this action research project was to examine the lived experience of university and community participants in ethical decision making in the setting of an interprofessional university-community partnership. The participatory framework for applied ethics presented by Prilleltensky, Rossiter, and Walsh-Bowers informed the research design. University and community participants in the 4-year-old partnership were interviewed about the ethical dilemmas faced in the partnership and ways of dealing with these dilemmas that often took place in the nexus of meeting the (...) community's and students' needs. An important aspect of making sound ethical decisions was the availability of multiple opportunities for discourse in an environment open to learning. (shrink)

Schools are ideal settings for implementing multi-component programs to prevent and control childhood obesity. Thoughtful improvements to proven strategies, coupled with careful evaluation, can contribute to accumulation of evidence needed to design and implement the next generation of optimal interventions.

The obesity epidemic among children and adolescents in the United States continues to worsen. The most recent analysis of data from the National Health and Nutrition Examination Survey showed that the prevalence of overweight among children and adolescents – defined as a Body Mass Index at or above the 95th percentile on gender-specific BMI-for-age growth charts developed by the Centers for Disease Control and Prevention – increased significantly between 1999-2000 and 2003-2004. Over this period, the prevalence of overweight among children (...) and adolescents aged 2-19 increased 23% – from 13.9% to 17.1%. In 2003-2004, 18.8% of children aged 6-11 and 17.4% of adolescents aged 12-19 were overweight. Roughly comparable proportions of each age group were considered to be at risk of becoming overweight. (shrink)

This paper describes the significance of key empirical findings from the recent and landmark study Caring and Aging with Pride: The National Health, Aging and Sexuality Study (with Karen I. Fredriksen‐Goldsen as the principal investigator), on lesbian, gay, bisexual, and transgender aging and health disparities. We will illustrate these findings with select quotations from study participants and show how nonconscious bias (i.e., activation of negative stereotypes outside conscious awareness) in the clinical encounter and health care setting can threaten shared (...) decision‐making and perpetuate health disparities among LGBT older adults. We recognize that clinical ethicists are not immune from nonconscious bias but maintain that they are well situated to recognize bias and resulting injustice by virtue of their training. Further, we discuss how clinical ethicists can influence the organization's ethical culture and environment to improve the quality and acceptability of health care for LGBT older adults. (shrink)

BackgroundInformation processing speed is a marker for cognitive function. It is associated with neural maturation and increases during development. Traditionally, IPS is measured using paper and pencil tasks requiring fine motor skills. Such skills are often impaired in patients with neurological conditions. Therefore, an alternative that does not need motor dexterity is desirable. One option is the computerized symbol digit modalities test, which requires the patient to verbally associate numbers with symbols.MethodsEighty-six participants were examined, 38 healthy and 48 hospitalized for (...) a non-neurological disease. All participants performed the written SDMT, c-SDMT, and the Test of Non-verbal Intelligence Fourth Edition. Statistical analyses included a multivariate analysis of covariance for the effects of intelligence and hospitalization on the performance of the SDMT and c-SDMT. A repeated measures analysis of variance was used to compare performance across c-SDMT trials between inpatients and outpatients.ResultsThe MANCOVA showed that hospitalization had a significant effect on IPS when measured with the SDMT but not with the c-SDMT, while IQ had no effect on IPS. Age was the best predictor of performance of both tests. The repeated measures ANOVA revealed no significant difference in within-test performance between outpatient and inpatient participants in the c-SDMT.ConclusionPerformance of the c-SDMT is not confounded by hospitalization and gives within-test information. As a valid and reliable measure of IPS for children and adolescents, it is suitable for use in both inpatient and outpatient populations. (shrink)

(2006). Not 'Getting Some Guns and Doing Some Damage': Listening to Teens and Learning From a Ragtime Festival. Educational Studies: Vol. 39, No. 2, pp. 102-123.

Jay Asher’s novel Thirteen Reasons Why and its Netflix adaptation have enjoyed widespread popularity. While they draw needed attention to issues like bullying and teen estrangement, they may have an unintended effect: they mislead about the etiology of suicide and even glamorize it to a degree. The medical literature has shown that suicide is almost always the result of psychiatric disorder, not provocative stress, in much the same way an asthmatic crisis is primarily the result of an underlying medical condition, (...) not an allergic stimulus. Both the novel and Netflix series ignore this premise and even belittle the idea. Thus, while the story has artistic merits, it also has the potential to be destructive if accessed by young readers and viewers seeking guidance. Approximately ten percent of teens suffer from depression, and suicide recently surpassed homicide as the second-leading cause of death among persons ages ten to twenty-four in the United States. A more balanced view addressing these misconceptions is provided for teens, parents, and mental health professionals. (shrink)

Over several years, genetic studies in the model system, Drosophila melanogastor, have uncovered genes that when mutated, lead to a block in myoblast fusion. Analyses of these gene products have suggested that Arp2/3‐mediated regulation of the actin cytoskeleton is crucial to myoblast fusion in the fly. Recent advances in imaging in Drosophila embryos, both in fixed and live preparations, have led to a new appreciation of both the three‐dimensional organization of the somatic mesoderm and the cell biology underlying myoblast fusion. (...) BioEssays 30:423–431, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

This study investigated acute effects of real and imagined endurance exercise on sustained attention performance in healthy young adults in order to shed light on the action mechanisms underlying changes in cognitive functioning. The neural similarities between both imagined and physically performed movements reveal that imagery induces transient hypofrontality, whereas real exercise reflects both transient hypofrontality effects and the global release of signaling factors due to muscle contraction and the accompanying sensory feedback. We hypothesized improved cognitive functioning after both interventions (...) with greater improvements for real exercise because it targets both mechanisms. Fifty-three sport science students completed two 25-min sessions of moderate endurance exercise in either a motor imagery modality or an executed bodily activity within the framework of an order-balanced crossover study. Assessments for sustained attention performance were performed before and after each endurance exercise condition. Statistical results showed improvements for both groups over time, which can mostly be explained by retest effects. However, we observed a significant interaction effect between group and time, F = 3.64, p = 0.04, η2 = 0.07, with higher increases in the first session in case physical endurance exercise was performed compared to motor imagery exercise, t = −2.71, p = 0.09, d = 0.75. This might suggest that the release of signaling factors due to muscle contractions with sensory feedback processing is an additional mediating mechanism alongside motor-related transient hypofrontality that improves cognitive performance. (shrink)

Since the 1980s, there has been an increasing acknowledgement of the importance of recognising the ethical dimension of clinical decision-making. Medical professional regulatory authorities in some countries now include ethical knowledge and practice in their required competencies for undergraduate and post graduate medical training. Educational interventions and clinical ethics support services have been developed to support and improve ethical decision making in clinical practice, but research evaluating the effectiveness of these interventions has been limited. We undertook a systematic review of (...) the published literature on measures or models of evaluation used to assess the impact of interventions to improve ethical decision making in clinical care. We identified a range of measures to evaluate educational interventions, and one tool used to evaluate a clinical ethics support intervention. Most measures did not evaluate the key impact of interest, that is the quality of ethical decision making in real-world clinical practice. We describe the results of our review and reflect on the challenges of assessing ethical decision making in clinical practice that face both developers of educational and support interventions and the regulatory organisations that set and assess competency standards. (shrink)

ObjectiveMost young adults diagnosed with breast or gynecologic cancers experience adverse reproductive or sexual health outcomes due to cancer and its treatment. However, evidence-based interventions that specifically address the RSH concerns of young adult and/or LGBTQ+ survivor couples are lacking. Our goal is to develop a feasible and acceptable couple-based intervention to reduce reproductive and sexual distress experience by young adult breast and gynecologic cancer survivor couples with diverse backgrounds.MethodsWe systematically adapted an empirically supported, theoretically grounded couple-based intervention to address (...) the RSH concerns of young couples coping with breast or gynecologic cancer through integration of stakeholder perspectives. We interviewed 11 couples with a history of breast or gynecologic cancer to review and pretest intervention materials. Three of these couples were invited to review and comment on intervention modifications. Content experts in RSH and dyadic coping, clinicians, and community advisors participated throughout the adaptation process.ResultsFindings confirmed the need for an online, couple-based intervention to support young couples experiencing RSH concerns after breast or gynecologic cancer. Qualitative themes suggested intervention preferences for: A highly flexible intervention that can be tailored to couples’ specific RSH concerns; Active steps to help members of a dyad “get on the same page” in their relationship and family building plans; A specific focus on raising partners’ awareness about how cancer can affect body image and physical intimacy; and Accessible, evidence-based information about RSH for both partners. These results, along with feedback from stakeholders, informed adaptation and finalization of the intervention content and format. The resulting virtual intervention, Opening the Conversation, includes five weekly sessions offering training to couples in communication and dyadic coping skills for addressing RSH concerns.ConclusionThe systematic adaptation process yielded a theory-informed intervention for young adult couples facing breast and gynecological cancers, which will be evaluated in a randomized controlled trial. The long-term goal is to implement and disseminate Opening the Conversation broadly to reach young adult couples with diverse backgrounds who are experiencing RSH concerns in cancer survivorship. (shrink)

This paper summarizes (in German) recent tendencies in the philosophy of the life sciences.

This book brings together scholars from a variety of epistemological perspectives to explore the multiple ways in which sexuality does indeed matter in the arena of public education.

Having a serious illness like breast cancer is a calamity for individuals and families. Along with the pain, discomfort, and dislocation comes the issue of how to pay the medical expenses for the care and treatment of the disease. If the seriously ill person has inadequate or no insurance, these problems are aggravated.Stories abound about seriously ill people losing private health insurance following diagnosis with a catastrophic disease, remaining in jobs just to maintain health insurance, or facing financial hardship because (...) of gaps in coverage. Yet surprisingly little research has focused on the problems that people with serious illness face with health coverage and, in particular, how concerns about access to health insurance coverage shape their lives.Further, despite profoundly moving anecdotes of cancer victims and other seriously ill people about their problems with health insurance and despite recent federal and state efforts to reform the private health insurance market in ways discussed below, neither the federal government, states, nor the private sector has crafted comprehensive strategies to enhance health coverage for the seriously ill. (shrink)

Having a serious illness like breast cancer is a calamity for individuals and families. Along with the pain, discomfort, and dislocation comes the issue of how to pay the medical expenses for the care and treatment of the disease. If the seriously ill person has inadequate or no insurance, these problems are aggravated.Stories abound about seriously ill people losing private health insurance following diagnosis with a catastrophic disease, remaining in jobs just to maintain health insurance, or facing financial hardship because (...) of gaps in coverage. Yet surprisingly little research has focused on the problems that people with serious illness face with health coverage and, in particular, how concerns about access to health insurance coverage shape their lives.Further, despite profoundly moving anecdotes of cancer victims and other seriously ill people about their problems with health insurance and despite recent federal and state efforts to reform the private health insurance market in ways discussed below, neither the federal government, states, nor the private sector has crafted comprehensive strategies to enhance health coverage for the seriously ill. (shrink)

This is a unique, groundbreaking study in the history of philosophy, combining leading men and women philosophers across 2600 years of Western philosophy, covering key foundational topics, including epistemology, metaphysics, and ethics. Introductory essays, primary source readings, and commentaries comprise each chapter to offer a rich and accessible introduction to and evaluation of these vital philosophical contributions. A helpful appendix canvasses an extraordinary number of women philosophers throughout history for further discovery and study.

Whatever may be said about contemporary feminists’ evaluation of Descartes’ role in the history of feminism, Mary Astell herself believed that Descartes’ philosophy held tremendous promise for women. His urging all people to eschew the tyranny of custom and authority in order to uncover the knowledge that could be found in each one of our unsexed souls potentially offered women a great deal of intellectual and personal freedom and power. Certainly Astell often read Descartes in this way, and Astell herself (...) has been interpreted as a feminist – indeed, as the first English feminist. But a close look at Astell’s and Descartes’ theories of reason, and the role of authority in knowledge formation as well as in their philosophies of education, show that there are subtle yet crucial divergences in their thought – divergences which force us to temper our evaluation of Astell as a feminist. -/- My first task is to evaluate Astell’s views on custom and authority in knowledge formation and education by comparing her ideas with those of Descartes. While it is true that Astell seems to share Descartes’ wariness of custom and authority, a careful reading of her work shows that the wariness extends only as far as the tyranny of custom over individual intellectual development. It does not extend to a wariness about social and institutional customs and authority (including, perhaps most crucially, the institution of marriage as we see in her Reflection on Marriage). The reason for this is that Astell’s driving goal is to help women to come to know God’s plan for women – both in their roles as human and in their roles as women. According to Astell, while it is true that, as individuals, women must develop their rational capacities to the fullest in order to honor God and his plan for women as human, as members of social institutions, including the institution of marriage, women must subordinate themselves to men, including their husbands, in this case so as to honor God and his plan for women as women. Once we understand the theological underpinnings of her equivocal reaction to authority and custom, we can see that Astell may be considered a feminist in a very tempered way. -/- My second task is to use these initial conclusions to re-read her proposal for single-sexed education that we find in A Serious Proposal to the Ladies. It is true that Astell encourages women to join single-sexed educational institutions for the unique and empowering friendships that women can develop in such institutions. Still, my argument continues, the development of such friendships is not entirely an end in itself. Rather, Astell encourages women to develop such friendships such that they can re-enter the broader world armed with the tools that will help them endure burdensome features of the lives that await them in the world, including their lives as subordinated wives –burdens that Astell does not, in principle, challenge. (shrink)

ObjectiveThe objective of this study was to validate the computerized Symbol Digit Modalities Test in a Swiss pediatric cohort, in comparing the Swiss sample to the Canadian norms. Secondly, we evaluated sex effects, age-effects, and test–retest reliability of the c-SDMT in comparison to values obtained for the paper and pencil version of the Symbol Digit Modalities Test.MethodsThis longitudinal observational study was conducted in a single-center setting at the University Children’s Hospital of Bern. Our cohort consisted of 86 children aged from (...) 8 to 16 years. The cohort included both healthy participants and patients hospitalized for a non-neurological disease. Forty eight participants were assessed during two testing sessions with the SDMT and the c-SDMT.ResultsTest–retest reliability was high in both tests. A reliable change index was calculated for the SDMT and the c-SDMT corrected for practice effects. While a significant age effect on information processing speed was observed, no such effect was found for sex. When data on the c-SDMT performance of the Swiss cohort was compared with that from a Canadian cohort, no significant difference was found for the mean time per trial in any age group. Norm values for age groups between 8 and 16 years in the Swiss cohort were established.ConclusionNorms for the c-SDMT between the Swiss and the Canadian cohort were comparable. The c-SDMT is a valid alternative to the SDMT. It is a feasible and easy to administer bedside tool due to high reliability and the lack of motor demands. (shrink)

In this paper, I consider Mary Astell's contributions to the history of feminism, noting her grounding in and departure from Cartesianism and its relation to women.

This article examines popular discourses of women's sexuality in 1920s England and argues that sex manuals like Marie Stopes's Married Life and sex novels like E.M. Hull's The Sheik, despite their adherence to status quo values, were liberating for women through their affirmation of women's sexual subjectivity. Stopes's enormously popular book contributed strongly to a new understanding of women's sexual drives as natural and autonomous. The changing attitudes were reflected in the numbers of postwar women who actively participated in (...) the creation and consumption of popular sex-novels and films, exercising both economic and sexual freedoms at once. This article focusses on the film version of The Sheik, which experienced great success as part of this growing leisure market catering specifically to women's desire, and in particular on the figure of Rudolph Valentino as a “woman-made” man. The film's “crossed” representations of sexuality (the emancipated “flapper” and the effeminate yet virile “sheik”) challenged traditional notions of femininity and masculinity, and in doing so, were liberating for women consumers at the same time that they threatened the sexual identities of men. (shrink)

The way in which medical professionals engage in bioethical issues ultimately reflects the type of care such patients are likely to receive. It is therefore critical for doctors and other health care professionals to have a broad understanding of disability. Our purpose in this paper is to explore ways of teaching bioethical issues to first year medical students by integrating alternative approaches. Such approaches include (a) the use of the narrative format, (b) the inclusion of a disability perspective, and (c) (...) the presentation and facilitation of classes by people with disabilities. We consider how these new kinds of presentations are evaluated by students, faculty, people with disabilities and professional ethicists. We hope new knowledge may provide health care professionals with a greater understanding of the perspectives of patients with disabilities, who are confronted by conflicting ethical values and frameworks for decision-making in their interaction with such professionals. (shrink)

This chapter shows how Mary Astell and Margaret Cavendish can reasonably be understood as early feminists in three senses of the term. First, they are committed to the natural equality of men and women, and related, they are committed to equal opportunity of education for men and women. Second, they are committed to social structures that help women develop authentic selves and thus autonomy understood in one sense of the word. Third, they acknowledge the power of production relationships, especially friendships (...) among women, in cultivating fulfilling lives for women. All three forms of feminism promote greater liberty for women. Moreover, the chapter establishes that many of these conclusions are especially forceful given Cavendish’s use of the genre of literature, and given the method that literature allows, namely that of presenting alternate points of view. (shrink)

Although Catharine Macaulay was a contract theorist and early feminist her philosophy is not based on a concept of liberty like that of Hobbes, but on a notion of individual liberty as self government close to that accepted by Mary Astell. This raises the question of whether criticisms of liberal feminism which assume that it is rooted in Hobbes's suspect notion of freedom and consent may miss there mark.

Despite the fact that the High-Church Tory, Mary Astell, held political views diametrically opposed to the Whiggish Catharine Trotter Cockburn and Catharine Macaulay, it is here argued that their metaethical views were surprisingly similar. All were influenced by a blend of Christian universalism and Aristotelian eudaimonism, which accepted the existence of a law of nature, that we strive for happiness, and that happiness results from living in accord with our God-given nature. They differed with regard to epistemological issues; the means (...) by which we can know the law of nature, and with regard to the characterization of that nature; our telos. Traces of the ethical theories developed by these women can also be seen in the works of the philosophically informed novelists, Sarah Fielding, Jane Collier, Sarah Scott, and Hannah More. (shrink)

During the eighteenth century, elite women participated in the philosophical, scientific, and political controversies that resulted in the overthrow of monarchy, the reconceptualisation of marriage, and the emergence of modern, democratic institutions. In this comprehensive study, Karen Green outlines and discusses the ideas and arguments of these women, exploring the development of their distinctive and contrasting political positions, and their engagement with the works of political thinkers such as Hobbes, Locke, Mandeville and Rousseau. Her exploration ranges across Europe from (...) England through France, Italy, Germany and Russia, and discusses thinkers including Mary Astell, Emilie Du Châtelet, Luise Kulmus-Gottsched and Elisabetta Caminer Turra. This study demonstrates the depth of women's contributions to eighteenth-century political debates, recovering their historical significance and deepening our understanding of this period in intellectual history. It will provide an essential resource for readers in political philosophy, political theory, intellectual history, and women's studies. (shrink)

Argues that like more conservative feminist writers, Gabrielle Suchon and Mary Astell, writing earlier in the Eighteenth Century, Macaulay's concept of liberty is closely tied to virtue and involves free self government according to reason. Unlike these earlier writers from this concept of liberty she deduces the rationality of democratic republican government. Thus the grounds on which she builds her republicanism involve a very different concept of rational self interest to that usually assumed to ground social contract theory. For virtue (...) and the genuine self interest of rational beings are taken to coincide. (shrink)