Use of a placebo control in surgical trials is a divisive issue. We argue that, in principle, placebo controls for surgery are necessary in the same way as for medicine. However, there are important differences between these types of trial, which both increase justification and limit application of surgical studies. We propose that surgical randomised placebo-controlled trials are ethical if certain conditions are fulfilled: the presence of equipoise, defined as a lack of unbiased evidence for efficacy of an intervention; clinically (...) important research question; the risk to patients is minimised and reasonable; there is uncertainty about treatment allocation rather than deception; there is preliminary evidence for efficacy, which justifies a placebo-controlled design; and ideally, the placebo procedure should have some direct benefit to the patient, for example, as a diagnostic tool. Placebo-controlled trials in surgery will most often be justified when surgery is performed to improve function or relieve symptoms and when objective outcomes are not available, while the risk of mortality or significant morbidity is low. In line with medical placebo-controlled trials, the surgical trial should be sufficiently powered and standardised so that its results are valid, consent should be valid, the standard treatment or rescue medication should be provided if possible, and after the trial, the patients should be told which treatment they received and there should be provision for post-trial care if the study may result in long-term negative effects. We comment and contrast our guidelines with those of the American Medical Association. (shrink)

The National Health Service (NHS) in the UK is currently facing a significant waiting list backlog following the disruption of the COVID-19 pandemic, with millions of patients waiting for elective surgical procedures. Effective treatment prioritisation has been identified as a key element of addressing this backlog, with NHS England's delivery plan highlighting the importance of ensuring that those with ‘the clinically most urgent conditions are diagnosed and treated most rapidly’. Indeed, we describe how the current clinical guidance on prioritisation issued (...) by The Federation of Surgical Specialty Associations serves this aim. However, whilst there are strong reasons to prioritise elective surgery in accordance with clinical need, we argue that it would be a mistake to assume that prioritisation in accordance with clinical need requires only a clinical or scientific judgement. The understanding of clinical need that we choose to employ in a prioritisation system will be grounded by some key ethical judgements. Moreover, we may also have to make trade-offs between addressing clinical need, safeguarding equality, and achieving other benefits. As the UK faces up to the backlog, it is important that surgical prioritisation guidelines enshrine a broad range of values that we believe ought to determine access to care in non-emergency circumstances. Our analysis suggests that the current approach to prioritisation is not a sufficiently nuanced way of balancing the different moral values that are operative in this context. (shrink)

Dependency relationships within the cell cycle allow cells to arrest the cycle reversibly in response to agents or conditions that interfere with specific aspects of its normal progression. In addition, overlapping pathways exist which also arrest the cell cycle in response to DNA damage. Collectively, these control mechanisms have become known as checkpoints. Analysis of checkpoints is facilitated by the fact that dependency relationships within the cell cycle, such as the dependency of mitosis on the completion of DNA synthesis, and (...) the DNA damage checkpoint can be separated genetically. In fission yeast, Schizosaccharomyces pombe, the dependency of mitosis on prior completion of DNA synthesis is mediated through tyrosine‐15 phosphorylation of the ubiquitous mitotic regulator p34cdc2. In contrast, the arrest of mitosis caused by DNA damage acts through a separate mechanism that appears to be independent of tyrosine‐15 phosphorylation. Despite these distinct interactions with the mitotic machinery, the majority of fission yeast mutants that are deficient in mitotic arrest after DNA damage are also unable to respond to inhibition of DNA synthesis. In this essay we survey the current knowledge concerning feedback controls and checkpoints within fission yeast and relate this to information derived from other systems. (shrink)

Over the last decade, aesthetic and art theory has played an increasingly significant role in the way work and its organization has come to be understood. Bringing together the work of an international spectrum of academics, this collection contributes, in an overall more critical vein, to such emerging debates. Combining both empirical and theoretical material, each chapter re-evaluates the emerging relationship between art, aesthetics, and work, exploring its potential as both a medium of critical analysis, and as a site of (...) conflict and resistance. (shrink)

In recent years organisational and management discourse has been akin to a battle-ground. Open challenges to the foundations of these fields and competing truth claims have arisen from the plurality of interpretation that is possible from the variety of new paradigms that has emerged. This proliferation of paradigms seems to undermine the possibility of a single unambiguous voice to guide management practice. The variety of competing voices that has produced this discordant chorus is described. The work of Thomas Barr Greenfield (...) offers a useful circuit breaker. What emerges is a discourse not anchored in rationality, as it has in the past, but anchored in values and a morally concerned scepticism. (shrink)

The hum of a ceiling fan, the mechanical grind of an escalator, Pilates repetitions, treadmills and stationary bicycles, waiting room Muzak and its tedious refrain: such experiences of monotony are ubiquitous. Continuous, unchanging, regular, repetitious: truly predictable, the sameness of monotony is particularly unbearable for it does not stop. Its tedium is an expression of its unbending relationship to time, an excessive duration. Monotony never wavers, never falters, never surprises. Monotony cannot seduce; there is no attraction of fleeting adventure or (...) freedom in monotony, which is absolute prolongation without hesitation or variation, entirely anticipatable.Monotony is often a cause of boredom, yet it is... (shrink)

The article provides an argument on the Soviet system of the early post-Stalinist years reflected in Haidamaky by Yurii Mushketyk. Through the concept of “body economy” inspired by Deleuze and Guattari’s schizoanalysis, it investigates the case of the female corporeality hidden in the novel. The article contests that the female body is part of the economy of desire flows which connected it to the male body. It also states that, after the death of Stalin, the reorganised Soviet regime demonstrates schizophrenic (...) states as reflected in Mushketyk’s Haidamaky. (shrink)

Drosophila neural progenitor cells, or neuroblasts, alter their transcriptional profile over time to produce different neural cell types. A recent paper by Pearson and Doe shows that older neuroblasts can be reprogrammed to behave like young neuroblasts, and to produce early neural cell types, simply by expressing the transcription factor, Hunchback.1 The authors show that competence to respond to Hunchback diminishes over time. Mani pulating neural progenitors in this way may have important implications for therapeutic uses of neural stem cells. (...) BioEssays 26:711–714, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

Intermediality has become a fashionable concept: it appears whenever we speak about what we once referred to easily as the medium or media, of systems and apparatuses, mises en scène and structures. It is used frequently in a number of different traditions, whether European, American or Australian. In some cases it holds the potential to redefine the purpose of an art or a specific medium. Consider the example that cinema provides: “its medium-specific possibility seems to have been well and truly (...) overrun by its tendency to intermediality, its fundamental impurity. That is where its true materiality-effect, today, is situated: in the palpable aura of a mise en scène that is always less than itself and more than.. (shrink)

ObjectiveAlthough childhood adversity can have lasting effects into later life, positive adaptations have also been observed, including an increased tendency toward prosocial behavior. However, little is known about the link between childhood adversity and later life prosocial behavior, with a particular scarcity of research on intrafamilial childhood adversity. Therefore, this study aimed to examine older adult's experiences of childhood adversity and identify mechanisms linked to prosocial behavior. Two adversity contexts were compared to explore individual, as well as broader cultural and (...) contextual mechanisms linking childhood adversity and later life prosocial behavior.MethodSemi-structured interviews were conducted with N = 29 Irish adult survivors of childhood adversity: n = 12 intrafamilial survivors, n = 17 institutional survivors. Interviews were analyzed using the framework analysis method, with reference to the conceptual model of altruism born of suffering.ResultsFive themes were identified on prosocial mechanisms, with three themes in both survivor groups, and two group-specific themes.ConclusionResults identified motivational processes and volitional factors linked to later life prosocial behavior. Connections to caring roles, support, and social norms in childhood, as well as the need for a sense of purpose and meaning from the adversities in adulthood, highlight potential targets for psychotherapeutic intervention to promote prosocial responding and positive adaptation for childhood adversity survivors. (shrink)

Why should we seek and tell the truth? Does anyone know what truth is? Many are skeptical about the relevance of truth. Truth Matters endeavours to show why truth is important in a world where the very idea of truth is contested. Putting philosophers in conversation with educators, literary scholars, physicists, political theorists, and theologians, Truth Matters ranges across both analytic and continental philosophy and draws on the ideas of thinkers such as Aquinas, Balthasar, Brandom, Davidson, Dooyeweerd, Gadamer, Habermas, Kierkegaard, (...) Plantinga, Ricoeur, and Wolterstorff. Some essays attempt to provide a systematic account of truth, while others wrestle with the question of how truth is told and what it means to live truthfully. Contributors address debates between realists and anti-realists, explore issues surrounding relativism and constructivism in education and the social sciences, examine the politics of truth telling and the ethics of authenticity, and consider various religious perspectives on truth. Most scholars agree that truth is propositional, being expressed in statements that are subject to proof or disproof. This book goes a step farther: yes, propositional truth is important, but truth is more than propositional. To recognize how it is more than propositional is crucial for understanding why truth truly matters. Contributors include Doug Blomberg (ICS), Allyson Carr (ICS), Jeffrey Dudiak (King’s University College), Olaf Ellefson (York University), Gerrit Glas (VU University Amsterdam), Gill K. Goulding (Regis College), Jay Gupta (Mills College), Clarence Joldersma (Calvin College), Matthew J. Klaassen (ICS), John Jung Park (Duke University), Pamela J. Reeve (St. Augustine’s Seminary), Amy Richards (World Affairs Council of Western Michigan), Calvin Seerveld (ICS), Ronnie Shuker (ICS), Adam Smith (Brandeis University), John Van Rys (Redeemer University College), Darren Walhof (Grand Valley State University), Matthew Walhout (Calvin College), and Lambert Zuidervaart (ICS). (shrink)