Objective Some researchers claim that the quality of informed consent of clinical research participants in developing countries is worse than in developed countries. To evaluate this assumption, we reviewed the available data on the quality of consent in both settings. Methods We conducted a comprehensive PubMed search, examined bibliographies and literature reviews, and consulted with international experts on informed consent in order to identify studies published from 1966 to 2010 that used quantitative methods, surveyed participants or parents of paediatric participants (...) in actual trials, assessed comprehension and/or voluntariness, and did not involve testing particular consent interventions. Forty-seven studies met these criteria. We compared data about participant comprehension and voluntariness. The paucity of data and variation in study methodology limit comparison and preclude statistical aggregation of the data. Results and Discussion This review shows that the assertion that informed consent is worse in developing countries than in developed countries is a simplification of a complex picture. Despite the limitations of comparison, the data suggest that: (1) comprehension of study information varies among participants in both developed and developing countries, and comprehension of randomisation and placebo controlled designs is poorer than comprehension of other aspects of trials in both settings; and (2) participants in developing countries appear to be less likely than those in developed countries to say they can refuse participation in or withdraw from a trial, and are more likely to worry about the consequences of refusal or withdrawal. (shrink)

Middle childhood, the period from 6 to 12 years of age, is defined socially by increasing autonomy and emotional regulation, somatically by the development of anatomical structures for subsistence, and endocrinologically by adrenarche, the adrenal production of dehydroepiandrosterone (DHEA). Here I suggest that DHEA plays a key role in the coordinated development of the brain and body beginning with middle childhood, via energetic allocation. I argue that with adrenarche, increasing levels of circulating DHEA act to down-regulate the release of glucose (...) into circulation and hence limit the supply of glucose which is needed by the brain for synaptogenesis. Furthermore, I suggest the antioxidant properties of DHEA may be important in maintaining synaptic plasticity throughout middle childhood within slow-developing areas of the cortex, including the insula, thamalus, and anterior cingulate cortex. In addition, DHEA may play a role in the development of body odor as a reliable social signal of behavioral changes associated with middle childhood. (shrink)

In December 1984 Angela Weir and Elizabeth Wilson, two founding members of Feminist Review, published an article assessing contemporary British feminism and its relationship to the left and to class struggle. They suggested that the women's movement in general, and socialist-feminism in particular, had lost its former political sharpness. The academic focus of socialist-feminism has proved more interested in theorizing the ideological basis of sexual difference than the economic contradictions of capitalism. Meanwhile the conditions of working-class and black women have (...) been deteriorating. In this situation, they argue, feminists can only serve the general interests of women through alliance with working-class movements and class struggle. Weir and Wilson represent a minority position within the British Communist Party (the CP), which argues that ‘feminism’ is now being used by sections of the left, in particular the dominant ‘Eurocommunist’ left in the CP, to justify their moves to the right, with an accompanying attack on traditional forms of trade union militancy. Beatrix Campbell, who is aligned to the dominant position within the CP, has been one target of Weir and Wilson's criticisms. In several articles from 1978 onwards, and in her book Wigan Pier Revisited, Beatrix Campbell has presented a very different analysis of women and the labour movement. She has criticized the trade union movement as a ‘men's movement’, in the sense that it has always represented the interests of men at the expense of women. And she has described the current split within the CP as one extending throughout the left between the politics of the ‘old’ and the ‘new’: traditional labour movement politics as against the politics of those who have rethought their socialism to take into account the analysis and importance of popular social movements – in particular feminism, the peace and anti-racist movements. In reply to this debate, Anne Phillips has argued that while women's position today must be analysed in the context of the capitalist crisis, it is not reducible to the dichotomy ‘class politics’ versus ‘popular alliance’. Michèle Barrett, in another reply to Weir and Wilson, has argued that they have presented a reductionist and economistic approach to women's oppression, which caricatures rather than clarifies much of the work in which socialist-feminists have been engaged. To air these differences between socialist-feminists over the question of feminism and class politics, and to see their implications for the women's movement and the left, Feminist Review has decided to bring together the main protagonists of this debate for a fuller, more open discussion. For this discussion Feminist Review drew up a number of questions which were put to the participants by Clara Connolly and Lynne Segal. (Michèle Barrett was present in a personal capacity.) They cover the recent background to socialist-feminist politics, the relationship of feminism to Marxism, the role of feminists in le ft political parties and the labour movement, the issue of racism and the prospects for the immediate future. The discussion was lengthy and what follows is an edited version of the transcript. (shrink)

This study explores African students' use of cultural metaphoric reasoning in classifying everyday situations as hot or cold, as is part of Sotho cultural tradition. It documents the extent to which such metaphoric reasoning is related to the use of science (mis)conceptions of heating. Written probes were used to document cultural metaphoric reasoning and science misconceptions of students entering a university science program. The same instruments were used as postprobes after a 4-week teaching intervention using experimental cognitive conflict strategies for (...) various standard misconceptions on heating. The findings show that almost a third of the sample used metaphoric reasoning consistently. This group was, as expected, significantly dominated by Sotho speakers. Initially, a large percentage of students explained the particulate effect of heating in terms of melting, shrinking, or breaking up of atoms. Most students identified specific materials as good insulators against coldness or against heat. Heat transfer was frequently explained in terms of absorption, diffusion, or reflection rather than conduction. There were no significant differences in the type and frequencies of these alternative concepts held by cultural metaphoric and noncultural metaphoric reasoners before the intervention. The teaching program did not affect cultural metaphoric reasoning, but had significant and equal benefits for the conceptual understanding of both groups, with the exception that the cultural metaphoric reasoners were more persistent in attributing observable properties to atoms. The present study suggests some further modification to the teaching strategies and concludes that, at this level of education, students are able to distinguish between different types of reasoning appropriate for cultural everyday situations and scientific contexts. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Chance to CutBruce H. CampbellMy gloved hand reaches for progressively sharper surgical instruments. The prior radiation therapy and recurrent cancer [End Page E3] have made his neck tissues as stiff and hard as an old block of wood; everything appears too dull and feels too dry under the bright operating room lights. I push, dissect, urge, divide, prod, and spread with little effect.The nursing staff keeps to its (...) routine—completing computer entries, retrieving supplies, counting sponges—only intermittently aware that things are not going well at the point of attack. Nondescript music plays softly and the anesthesia machine continues to emit its gentle sounds. The junior resident—assisting me with the first of many neck dissections she will see during her five years of training—grips the retractor as she has been told and dabs the wound periodically to clear any blood or fluid.I glance up to recheck the CT scan. It confirms that this man’s recurrent cancer is just below the next layer of neck muscles. There are also some large blood vessels and major nerves nearby. I am confident, though, that I will be able to expose the mass, protect all of the critical structures, and safely remove the cancer.Curing cancer with surgery is no small feat, mind you. Cancer is, after all, a molecular disease not easily confined to an obvious lump, even though we sometimes refer to a malignant mass being “like a walnut” or “as hard and round as a marble.” The actual disease rests deep inside each cancer cell where the genetic code—the DNA—makes mistake–after–mistake. If cancer is to be cured with a surgical procedure, the surgeon must remove every last cell that is capable of making the same nonsensical, life–threatening error. Given Science’s rudimentary knowledge of cancer cell dynamics and signaling, it’s a miracle that surgery ever works. Yet, we continue to try. And we succeed just often enough to keep on trying.I rearrange the retractors and alter my approach. My mentors would have known what to do next, I imagine. My training included time well–spent with brilliant and technically–gifted surgeons. How would they have approached this case? Their experience and instincts might have told them to open the wound more widely, work the lateral and deep margins first, or position the instruments differently.Perhaps, one of my mentors would have attacked this man’s tumor using the same approach I am attempting but would have known exactly where to exploit some area of weakness that I cannot locate. A few swift, confident moves and he would have held the mass in his hands. “That’s it. We’re done,” he would have said.I met this patient several months ago when his cancer was first discovered and have seen him throughout his course of treatment. Recently, his daughter had accompanied him to the office to review his options. “Treatment has been rugged, Doc,” he reminded me. “The cancer’s still there and they said I can’t get any more radiation. Chemo would only prolong things. I don’t really want surgery, but what choice do I have if I want to be cured?”“Supportive care is an option, but the only curative approach is surgery.”“Well, I’m not ready to quit yet, Doc. I got grand-kids, y’know. I want to watch them grow up.” He nodded to his daughter. “I’m in charge of spoiling her little boys.”The daughter smiled. We crowded around the computer screen to look at the scans. I showed them how the tumor was invading and destroying surrounding structures. I described the surgery and the risks.“There are many things I will not know about your tumor until we are actually in the operating room,” I explained. Surgery in the setting of recurrent disease involves a series of on–the–spot decisions and course corrections. The odds of success are unknowable. “Sometimes, the only way to find out if we can remove the cancer is simply to try.”He took a deep breath and looked at his daughter. “Well then, Doc, if surgery is the only... (shrink)

The Ozark Highlands’ karst topography of caves and hollows has provided refuge and escape for myriad peoples seeking to evade mainstream society throughout history, ranging from displaced Native Americans to counter-cultural back-to-the-landers. This ethnographic and ethnohistorical research moves beyond the popular misconception that the back-to-the-land movement merely represented an offshoot of the countercultural revolution of the 1960s and 1970s, and situates it within a deeper historical context. In this paper, I present the Arcadian evocations in various Ozark-related media and how (...) they relate to homesteading in the region, and demonstrate the shared agrarian values among diverse waves of agrarian Ozark homesteaders, recent and historical. (shrink)

This article reviews the effects of malnutrition on early brain development using data generated from animal experiments and human clinical studies. Three related processes, each with their own functional consequences, are implicated in the alteration of brain development. (1) Maternal undernutrition at the start of pregnancy results in reduced transfer of nutrients across the placenta, allowing the conservation of effort for future reproductive episodes. (2) Differential allocation to growing organs by the fetus in response to nutritional stress spares the brain (...) to a large though still limited degree, reflecting the organ’s relative contribution to survival and reproductive success. (3) Prenatal malnutrition disrupts developing neurotransmitter systems, which results in the expression of specific cognitive and affective traits. It is argued that the increasing size and therefore cost of the brain, in conjunction with increasing ecological instability and marginality, reinforced selection for maternally controlled growth suppression of offspring, reallocation of organ growth rates by offspring, and behavioral changes related to development of neurotransmitter systems. (shrink)

Many authors suggest the need to define ‘sustainable development’in operational terms. This paper looks at the problems ofattempting to ask whether peasant farming systems are sustainable.Any attempt at sustainability assessment needs to consider issuesrelated to the selected indicators or performance criteria, spatialscale or boundaries, and temporal scale. While there is certainlya need for more rigorous analysis of sustainability issues, thereis limited outlook for an approach based on indicators. Even if themany purely technical problems associated with specific indicatorscan be surmounted, will (...) accurate bio-physical data advance ourknowledge about sustainability? Peasant systems arepolitically-guided management systems, whose boundaries are the state,not the field or the farm. Given the dynamic nature of peasant farmingsystems, where do we draw the line in assessing sustainability?Attempts at sustainability assessment 100 years ago or even 20–30years ago would have been completely superseded by events. We drawattention to the system as a whole, to a web of interconnections,causes and effects – of varying significance over both time andspace. (shrink)

The Value of Trees project, funded bythe International Development Research Council ofCanada (IDRC), supported the joint efforts of theUniversity of Alberta and the University of Zimbabweto investigate the economic costs and benefitsassociated with trees and forests in the small holderfarming sector in Zimbabwe. The Value of Trees project provided funding for graduate students andfaculty from the two participating universities tocarry out studies in the disciplines of forestry,agricultural economics, and sociology in order toprovide policy recommendations regarding the role ofwoodlands in sustainable (...) small holder farming in acontext where agricultural production appears to putincreasing stress on woodlands. The numerous projectsincluded such topics as the following: the use offuelwood under conditions of scarcity, tree tenure andlocal institutions in woodland use and sustainability,gender and wealth as related to tree planting andconservation, time preferences in natural resourceconsumption, ownership and economic impact ofeucalyptus woodlots, cultural and economic valuesassociated with woodlands, and uses and conflictsrelating to woodlands across different land categoriessuch as resettlement land and state forests. Manyother studies were not funded by, but were associatedwith Value of Trees. The findings fall withintwo broad categories. The first set includes thosedirectly related to generating values for differentaspects of the woodlands, particularly from theperspectives of rural households. The main finding isthat despite being highly valued by local people forboth economic and social reasons, woodlands are rankedlower in importance by local farmers than agriculturalland. The second set of findings relates to thecomplexities of the social system of the woodlands.Local institutions, history, resource conflicts, andtenure issues emerge as key to understanding the waythat people interact with the woodlands. Finally,local people have valuable knowledge and strategies tooffer in the design of sustainable management. Thepolicy implications of these findings for Zimbabwe arethat economic incentives could be important in asustainable woodlands strategy, but that anysuccessful program must incorporate an understandingof the profoundly complex and at times contradictoryhuman dynamics of woodland use and values. (shrink)