For decades, aged care facility residents at risk of pressure ulcers have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week. Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent of residents identified as (...) being at risk of PUs and repositioned two-hourly 24/7, 34 per cent died with one or more PUs. Behaviours of concern were noted in 72 per cent of residents of whom 38 per cent were restrained. Dementia was diagnosed in 70 per cent of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia. The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress. (shrink)

Background: Fear of cancer recurrence or progression is a common challenge experienced by people living with and beyond cancer and is frequently endorsed as the highest unmet psychosocial need amongst survivors. This has prompted many cancer organizations to develop self-help resources for survivors to better manage these fears through psychoeducation, but little is known about whether they help reduce FCR/P.Method: We recruited 62 women with ovarian cancer. Women reported on their medical history and demographic characteristics and completed the Fear of (...) Progression Questionnaire-Short Form. They then read a booklet on FCR specifically created for Ovarian Cancer Australia by two of the authors. One week after reading the booklet, 50/62 women completed the FoP-Q-SF and answered questions about their satisfaction with the booklet.Results: More than half of the women scored in the clinical range for FCR/P at baseline. Of the completers, 93% said that they would recommend the booklet to other women. Satisfaction with the booklet was relatively high and more than two-thirds of women rated it as moderately helpful or better. However, FCR/P did not change significantly over the week following reading the booklet [t = 1.71, p = 0.09]. There was also no difference in change in FCR/P between women in the clinical vs. non-clinical range on the FoP-Q. Women high in FCR/P rated the booklet as less helpful in managing FCR/P, but overall satisfaction with the booklet was not associated with degree of FCR/P.Conclusions: These results suggest that a simple online FCR booklet is acceptable to women with ovarian cancer and they are satisfied with the booklet, but, it was insufficient to change in FCR/P levels. These results suggest that such resources are valued by women with ovarian cancer, but more potent interventions are necessary to reduce FCR in this population. (shrink)

IntroductionResearch indicates that body image disturbance is associated with poorer psychosocial outcomes for individuals with physical health conditions, with poorest body image reported for individuals with visible bodily changes. Using White’s theoretical model of body image the present paper aimed to examine the nature of these relationships in two distinct groups: individuals with an amputation and individuals with diabetes. It was hypothesized that body image disturbance would be associated with psychosocial outcomes and would mediate the relationships between self-ideal discrepancy and (...) personal investment in psychosocial outcomes.MethodsIndividuals with diabetes and individuals with an amputation provided details regarding their medical condition, and completed measures assessing body image, investment, self-ideal discrepancy, depression, anxiety, and quality of life. Structural equation and invariance modeling were used to test the model paths and the invariance of the model.ResultsAs hypothesized, body image disturbance was found to mediate the relationships between personal investment and psychosocial outcome, and between self-ideal discrepancy and psychosocial outcome. The predicted paths were invariant across groups, although the model accounted for more variance in people with an amputation than people with diabetes.ConclusionBody image disturbance, personal investment, and self-ideal discrepancy are important factors contributing to psychosocial outcome for individuals with diabetes and individuals with an amputation. These findings not only confirm the validity of the model in these two groups, but they emphasize the importance of targeting body image in future psychological interventions for individuals with a health condition. (shrink)

For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) (...) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress. (shrink)

BackgroundFear of cancer recurrence is common amongst cancer survivors. There is rapidly growing research interest in FCR but a need to prioritize research to address the most pressing clinical issues and reduce duplication and fragmentation of effort. This study aimed to establish international consensus among clinical and academic FCR experts regarding priorities for FCR research.MethodsMembers of the International Psycho-oncology Society Fear of Cancer Recurrence Special Interest Group were invited to participate in an online Delphi study. Research domains identified in Round (...) 1 were presented and discussed at a focus group to consolidate the domains and items prior to presentation in further survey rounds aimed at gaining consensus on research priorities of international significance.ResultsThirty four research items were identified in Round 1 and 33 of the items were consolidated into six overarching themes through a focus group discussion with FCR experts. The 33 research items were presented in subsequent rounds of the delphi technique. Twenty one participants contributed to delphi round 1, 16 in round 2, and 25 and 29 participants for subsequent delphi rounds. Consensus was reached for 27 items in round 3.1. A further four research items were identified by panelists and included in round 3.2. After round 3.2, 35 individual research items were ratified by the panelists. Given the high levels of consensus and stability between rounds, no further rounds were conducted. Overall intervention research was considered the most important focus for FCR research. Panelists identified models of care that facilitate greater access to FCR treatment and evaluation of the effectiveness of FCR interventions in real world settings as the two research items of highest priority. Defining the mechanisms of action and active components across FCR/P interventions was the third highest priority identified.ConclusionThe findings of this study outline a research agenda for international FCR research. Intervention research to identify models of care that increase access to treatment are based on a flexible approach based on symptom severity and can be delivered within routine clinical care were identified as research areas to prioritize. Greater understanding of the active components and mechanisms of action of existing FCR interventions will facilitate increased tailoring of interventions to meet patient need. (shrink)

While cancer survivors commonly experience fear and anxiety, a substantial minority experience an enduring and debilitating fear that their cancer will return; a condition commonly referred to as fear of cancer recurrence. Despite recent advances in this area, little is known about FCR among people from Indigenous or other ethnic and racial minority populations. Given the high prevalence and poor outcomes of cancer among people from these populations, a robust understanding of FCR among people from these groups is critical. The (...) current review identified and aggregated existing literature on FCR amongst adult cancer survivors from Indigenous and minority populations. The protocol of this review was registered with PROSPERO in July 2020. A systematic search of bibliographic databases was conducted for relevant articles published from 1997 to November 2019. Data from eligible articles were extracted and appraised for quality by two independent reviewers. Nineteen articles from four countries met the inclusion criteria, including 14 quantitative, 4 qualitative and 1 mixed-methods study. Only one article reported on an Indigenous population. Few studies reported on FCR prevalence or severity. While the variation in tools used to measure FCR hindered a robust estimate of severity, results suggested some differences in FCR severity between minority and dominant populations, although these may have been due to study metholodological differences. Few factors were reported as being associated with FCR in minorities across multiple studies. The qualitative synthesis found five themes associated with the lived experience of FCR: variations in the lived experience of FCR; spirituality and worldview impacting on FCR; the importance of staying positive; complexities around support; and increasing cancer knowledge. The findings of this review highlight differences in FCR across cultures and contexts, which reinforces the need for culturally-specific approaches to this condition. The dearth of research in this area is of concern given the significant burden of cancer in these populations. A deeper understanding of this condition among Indigenous and minority populations is critical to developing and delivering appropriate and effective psychosocial care for cancer survivors from these groups. Systematic Review Registration: identifier [CRD42020161655]. (shrink)

The paper builds upon a growing body of critical research on the proliferating use of bibliometrics as a means to evaluate academic research, but brings to it a specifically Foucauldian, genealogical approach. The paper has three parts. Part 1 situates bibliometrics as a new technology of neoliberal, biopolitical governmentality, alongside the host of other ‘metrics’ that have emerged in the last two decades. Part 2 analyses bibliometrics’ antecedents in prior notational practices in the Western heritage, highlighting how forms of noting (...) have almost always had political valences tied to projects of control or subversion. Part 3 then delineates the specific features of bibliometrics as a new form of notation, highlighting the latest forms of academic subjectivity bibliometrics suppose and increasingly are summoning into being. (shrink)

"Understanding Psychoanalysis" presents a broad introduction to the key concepts and developments in psychoanalysis and its impact on modern thought. Charting pivotal moments in the theorization and reception of psychoanalysis, the book provides a comprehensive account of the concerns and development of Freud's work, as well as his most prominent successors, Melanie Klein and Jacques Lacan.The work of these leading psychoanalytic theorists has greatly influenced thinking across other disciplines, notably feminism, film studies, poststructuralism, social and cultural theory, the philosophy of (...) science and the emerging discipline of neuropsychoanalysis. Analysing this engagement with other disciplines and their key theorists, "Understanding Psychoanalysis" argues for a reconsideration of psychoanalysis as a resource for philosophy, science, and cultural studies. (shrink)

Much of the sustained attention on pandemic preparedness has focused on the ethical justification for plans for the “crisis” phase of a surge when, despite augmentation efforts, the demand for life...

Albert Camus repeatedly denied the label “existentialist,” and pointed to his formative experiences of natural beauty and his early introduction to classical Greek thought and culture as determinative of his philosophy. Pierre Hadot, famous for his post-1970 work on philosophy as a way of life in classical antiquity, continued throughout his life to work on the history of Western conceptions of nature. In Le voile d’Isis, Hadot excavated a second strain of Western attitudes towards nature, alongside the instrumental or “Promethean” (...) approach dominant in modernity: this is that of the contemplative Orphic perspective, closely tied in antiquity to philosophical regimens of spiritual exercises to transform philosophers’ ways of seeing. This paper will argue that Camus and Hadot should be read as two twentieth century “Orphic” figures in this sense, in a way that at once singles them out against almost all other European contemporaries, as well as speaking to our ecological concerns today. Yet the only comparative piece on the two thinkers to date, by Matthew Lamb, misses this shared contemplative, Orphic core to their positions. This paper aims to redress this shortcoming in the reception of the two figures. (shrink)

The ethical ideologies of psychologists and physicians were compared using the Ethics Position Questionnaire. The findings reveal that psychologists tend to be less relativistic than physicians. Further, we explored the degree to which physicians and psychologists report being influenced by a variety of factors in their ethical decision making. Psychologists were more influenced by their code of ethics and less influenced by family views, religious background, and peer attitudes than were physicians. We argue that these differences reflect the varied professional (...) cultures in which practitioners are trained and socialized. (shrink)

This essay is a critique of Derrida's ethical works, using Camus's last novella The Fall as a critical sounding board. It argues that a danger pertains to any such highly self-reflexive position as Derrida's: a danger that Camus identified in The Fall, and staged in his character, Jean-Baptiste Clamence. Clamence is a successful Parisian lawyer, on top of his personal and professional life, whose equanimity is troubled after he is the unwitting passer-by as a young woman suicides one night on (...) the Seine. After this time, he comes to consider all his former virtues as concealed vices. He also becomes acutely aware of what he terms the 'duplicity' of human beings as such. In Part I, I consider how Clamence's fall from innocence can be read 'with' Derrida's deconstructive registration of a 'double bind' pertaining to our standing vis-á-vis what he terms 'logocentrism'. I argue that Derrida's is a post-lapsarian philosophy, which challenges all attempts to construct closed conceptual systems that would confer an epistemic and/or moral certitude upon their expositors. In Part II, I then enter into a more detailed exposition of Derrida's 'later' works broaching friendship, the invitation, the gift, and other 'matters moral'. I read these texts in the light of an examination of what is involved, for Camus, in being a 'judge-penitent' (what Clamence in The Fall calls his profession). I suggest that Derrida runs the risk of a certain 'puritanism of difference' in his moral reflections, which defend the aporetic formulation: 'tout autre est tout autre' [every other is every bit other] (The Gift of Death). The problem is that, while Derrida's position allows one (everywhere) to say what one is against, it problematizes any affirmative moral stance. Like Clamence, who assumes the right to judge everyone else because he has subjected himself to a severe penitence, I suggest that we have a right to wonder whether Derrida's deconstructive critique of metaphysics can validate only endless repetitions of itself. Key Words: Camus • Derrida • ethics • The Fall • innocence • 'puritanism of difference. (shrink)

Music students at the University of Chichester Conservatoire completed questionnaires about their experience of the forced use of remote teaching and learning due to Lockdown, as imposed in the United Kingdom from March to June 2020, and how this impacted their self-beliefs, decision making processes, and methods of preparation for their performance assessments. Students had the choice to either have musical performance assessed in line with originally published deadlines via self-recorded video or defer the assessment until the following academic year. (...) Student’s choice to defer or submit the assessment during Lockdown was influenced by a range of forced factors, such as adaptions required by online teaching, limitations of rehearsal in their home environment, and the challenges in facilitating and recording their own assessments. Students completed online questionnaires about their self-efficacy, resilience, wellbeing, and provided free text responses explaining the reasoning for their decision to record their performance or to defer the assessment were coded to reveal patterns impacting their decision and preparation processes. Those choosing to submit their assessments demonstrated more strategies in their preparation and reported higher perceived self-efficacy scores. The specific conditions for this assessment, as a result of Lockdown, revealed correlations between resilience and both self-efficacy and wellbeing. The impact on teaching and the student experience is discussed and suggestions to support students in future settings of blended delivery are presented. Theoretical and practical implications are discussed. (shrink)

Animalism is the view that human persons are human animals – biological organisms that belong to the species Homo sapiens. This paper concerns a family of modal objections to animalism based on the essentiality of personhood (persons and animals differ in their persistence conditions; psychological considerations are relevant for the persistence of persons, but not animals; persons, but not animals, are essentially psychological beings). Such arguments are typically used to support constitutionalism, animalism’s main neo-Lockean rival. The problem with such arguments (...) is that they wrongly assume that animalism is incompatible with our essentially being psychological beings. In this paper, I discuss a formulation of animalism, what I call psychologically-serious animalism, according to which human persons are essentially human animals and essentially persons. I show how the availability of this neglected formulation of animalism undermines objections based on the essentiality of personhood. (shrink)

This book explores a fundamental tension in Aristotle's metaphysics: how can an entity such as a living organisma composite generated through the imposition of form on preexisting matterhave the conceptual unity that Aristotle demands of primary substances? Mary Louise Gill bases her treatment of the problem of unity, and of Aristotle's solution, on a fresh interpretation of the relation between matter and form. Challenging the traditional understanding of Aristotelian matter, she argues that material substances are subverted by matter and (...) maintained by form that controls the matter to serve a positive end. The unity of material substances thus involves a dynamic relation between resistant materials and directive ends. Aristotle on Substance offers both a general account of matter, form, and substantial unity and a specific assessment of particular Aristotelian arguments. At every point, Gill engages Aristotle on his own philosophical ground through the detailed analysis of central, and often controversial, texts from the Metaphysics, Physics, On Generation and Corruption, De Anima, De Caelo, and the biological works. The result is a coherent, firmly grounded rethinking of Aristotle's central metaphysical concepts and of his struggle toward a fully consistent theory of material substances. (shrink)

This study aimed to capture how the coronavirus disease 2019 crisis disrupted and affected individuals’ goal pursuits and self-efficacy beliefs early during the lockdown phase of COVID-19. Participants impacted by lockdown regulations accessed an online questionnaire during a 10-day window from the end of March to early April 2020 and reported a significant personal goal toward which they had been working, and then completed quantitative and qualitative survey items tapping self-efficacy beliefs for goal achievement, subjective caring about the goal during (...) disrupted world events, and current pursuit or abandonment of the goal. The findings from both quantitative and qualitative measures demonstrated a significant drop in self-efficacy beliefs from before to during the pandemic with a large effect based on whether people thought they could still achieve their goal under current conditions. Over two-thirds of the sample was unsure or did not believe they could still carry out their goal, and over a quarter either abandoned or were uncertain they could pursue the goal. Despite this, people continued to care about their goals. Reasons for abandonment and strategies for coping with goals within the lockdown and beyond are discussed. (shrink)

Following up on a 1989 paper on the subject, this essay revisits the question of ethical expertise in the court room. Informed by recent developments in the use of ethics experts, the authors argue 1) that the adversarial nature of court proceedings challenges the integrity of the ethicist's pedagogical role; 2) that the use of ethics experts as normative authorities remains dubious; 3) that clarification of the State's interest in “protecting the ethical integrity of the medical profession” is urgently required; (...) and 4) that the expertise of the ethicist may be more appropriately used in advising the legislature than in influencing the court. (shrink)

'Most of us are still groping for answers about what makes life worth living, or what confers meaning on individual lives', writes Charles Taylor in Sources of the Self. 'This is an essentially modern predicament.' Charles Taylor's latest book sets out to define the modern identity by tracing its genesis, analysing the writings of such thinkers as Augustine, Descartes, Montaigne, Luther, and many others. This then serves as a starting point for a renewed understanding of modernity. Taylor argues that modern (...) subjectivity has its roots in ideas of human good, and is in fact the result of our long efforts to define and attain the good. The modern turn inwards is far from being a disastrous rejection of rationality, as its critics contend, but has at its heart what Taylor calls the affirmation of ordinary life. He concludes that the modern identity, and its attendant rejection of an objective order of reason, is far richer in moral sources that its detractors allow. Sources of the Self provides a decisive defence of the modern order and a sharp rebuff to its critics. (shrink)

Compatibilists respond to the problem of causal exclusion for nonreductive physicalism by rejecting the exclusionist’s ban on overdetermination. By the compatibilist’s lights there are two forms of overdetermination, one that’s problematic and another that is entirely benign. Furthermore, multiple causation by “tightly related” causes requires only the benign form of overdetermination. Call this the tight relation strategy for avoiding problematic forms of overdetermination. To justify the tight relation strategy, modal compatibilists appeal to a widely accepted counterfactual test. The argument of (...) this paper is that the counterfactual test fails to legitimize the tight relation strategy as it fails to adequately distinguish between problematic and benign overdetermination. Contrary to modal compatibilists, modal dependence does not suffice for benignity. I conclude by arguing that adequately addressing overdetermination worries requires a much heavier metaphysical burden than modal compatibilists have typically recognized. (shrink)

This book offers a critical feminist perspective on the widely debated topic of transitional justice and forgiveness. Louise Du Toit examines the phenomenon of rape with a feminist philosophical discourse concerning women’s or ‘feminine’ subjectivity and selfhood. She demonstrates how the hierarchical dichotomy of male active versus female passive sexuality – which obscures the true nature of rape – is embedded in the dominant western symbolic frame. Through a Hegelian and phenomenological reading of first-person accounts by rape victims, she (...) excavates an understanding of rape that also starts to open up a way out of the denial and destruction of female sexual subjectivity. (shrink)

This paper challenges a view of the Gender Recognition Act 2004 as involving an unequivocal shift from the concept of sex to the concept of gender in law’s understanding of the distinction between male and female. While the Act does move in the direction of gender, and ostensibly in an obvious way through abandoning surgical preconditions for legal recognition, it will be argued that the Act retains and deploys the concept of sex. Moreover, it will be argued that the concept (...) of sex retained is not merely an anatomical understanding, but sex in a biological sense. In this respect the Gender Recognition Act can be viewed as embodying a tension between gender and sex. Further, it is contended that this tension is explicable in terms of irresolution of contrary legal desires to reproduce the gender order and to insulate marriage and heterosexuality from homosexuality in the moment of reform. (shrink)

The anthropic principle, that the universe exists in some sense for life, has persisted in recent religious and scientific thought because it derives from cosmological fact. It has been unsuccessful in furthering our understanding of the world because its advocates tend to impose final metaphysical solutions onto what is a physical problem. We begin by outlining the weak and strong versions of the anthropic principle and reviewing the discoveries that have led to their formulation. We present the reasons some have (...) given for ignoring the anthropic implications of these discoveries and find these reasons wanting—a real phenomenon demands real investigation. Theological and scientific solutions of the problem are then considered and criticized; these solutions provide dead ends for explanation. Finally, we pursue the path that explanation must follow and look at the physical details of the problem. It seems clear that the anthropic principle has been poorly framed. Removing the ambiguities surrounding the meaning of “life” may lead to more profitable investigations. (shrink)

What follows is a work of critical reconstruction of Camus' thought. It aims to answer to the wish Camus expressed in his later notebooks, that he at least be read closely. Specifically, I hope to do three things. In Part I, we will show how Camus' famous philosophy of the absurd represents a systematic scepticism whose closest philosophical predecessor is Descartes' method of doubt, and whose consequence, as in Descartes, is the discovery of a single, orienting certainty, on the basis (...) of which Camus would proceed to pass beyond the 'nihilism' that conservative critics continued to level against him (MS 34). Part II will unfold the central tenets of Camus' mature thought of rebellion, and show how Camus' central political claims follow from his para-Cartesian claim to have found an irreducible or 'invincible' basis for a post-metaphysical ethics, consistent with the most thoroughgoing epistemic scepticism. Part III then undertakes to show that the neoclassical rhetoric and positioning Camus claimed for his postwar thought—as a thought of moderation or mesure, and a renewed Greek or Mediterranean naturalism—is more than a stylistic pretension. It represents, so I argue, a singular amalgam of modern and philosophical classical motifs which makes Camus' voice nearly unique in twentieth century ideas, and all the more worth reconsidering today. So let us proceed. (shrink)

As in science, so in bioethics: if prohibiting conflicts of interest is not feasible, rigorous requirements for disclosure can at least manage them.

We examine the phenomenon of emergence, referring particularly to Arthur Peacocke’s ideas on emergence, the self, and spirituality. He believes that the whole of an emergent structure influences the way its parts cohere and that emergent structures (including minds and persons) and their effects are very important. He thereby hopes to remove the reductionist challenge that seeks to understand a whole fully in terms of its parts. We argue that emergent phenomena are not influential in the above sense. The holistic (...) completeness of these structures at their own theoretical level does not substitute for the causal independence Peacocke suggests by the idea of influence. Some computer simulations that generate emergent complexity follow simple and self-contained sets of rules. Peacocke also adheres to a hierarchical account of reality as a series of levels into which matter is organized, running from atoms through molecules to cells and eventually to whole ecosystems. But influential behavior does not respect this ordering. Further, Peacocke’s opposition to reductionism is unnecessary; any “completeness‘ of lower-level models does not imply the redundancy of higher-level descriptions. Emergence transforms reductionism into a constructive and positive principle. (shrink)