Many Western nations are emphasizing the importance of population health across health care delivery organizations and education systems. Despite significant momentum to integrate population health into nursing practice, a parallel effort to examine how these efforts impact practicing nurses' views of their professional role and work identity has not occurred. This secondary qualitative analysis, employing an abductive approach, explored processes public health nurses use in creating and maintaining their work identity through three organizing themes: narrative self‐identity, mandated identity, and identity (...) as struggle. The analysis was based on interview data collected from 30 US public health nurses residing in 17 states. ‘Being a real nurse’ describes public health nurses' efforts to balance a contradictory work identity where at times they are expected to focus on populations and at other times, on individuals. The identity work revealed through this study should be further explicated and specific strategies developed for stabilizing a work identity for public health nurses, as well as for any nurse charged with a population health role. (shrink)

The use of targets to direct public health programmes, particularly in global initiatives, has become widely accepted and commonplace. This paper is an ethical analysis of the utilisation of targets in global public health using our fieldwork on and experiences with voluntary medical male circumcision initiatives in Kenya. Among the many countries involved in VMMC for HIV prevention, Kenya is considered a success story, its programmes having medically circumcised nearly 2 million men since 2007. We describe ethically problematic practices in (...) Kenyan VMMC programmes revealed by our fieldwork, how the problems are related to the pursuit of targets and discuss possible approaches to their management. Although the establishment and pursuit of targets in public health can have many benefits, assessments of target-driven programmes tend to focus on quantifiable outcomes rather than the processes by which the outcomes are obtained. However, in order to speak more robustly about programmatic ‘success’, and to maintain community trust, it is vital to ethically evaluate how a public health initiative is actually implemented in the pursuit of its targets. (shrink)

Over the past three decades, more and more students are expressing a desire to attend college, yet for many members of disenfranchised groups, this goal is often not attained. While many factors contribute to these disparities, research has shown that students begin adjusting their expectations (what they think they can achieve) for the future in relation to their idealised aspirations (what they would like to achieve). The current study explores this gap among 207 eighth grade students from two urban middle (...) schools. Using the School Attitude Assessment Survey-Revised, three factors were found to predict expectations which matched student aspirations. These factors were academic motivation and self-regulating behaviours, academic self-perception and attitudes towards teachers. Implications for educational interventions and school reform are discussed. (shrink)

Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. Voluntary medical male circumcision (VMMC) programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of males who, for whatever reason, remain uncircumcised. This paper discusses the ethics of stigma (...) with regard to uncircumcised adolescent males in global VMMC programs, particularly in certain recruitment, demand creation and social norm interventions. Grounded in our own experiences gained while conducting HIV-related ethics research with adolescents in Kenya, we argue that use of explicit or implicit stigma to increase the number of VMMC volunteers is unethical from a public health ethics perspective, particularly in campaigns that leverage social norms of masculinity. Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. VMMC programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of males who, for whatever reason, remain uncircumcised. This paper discusses the ethics of stigma with regard to uncircumcised adolescent males in global VMMC programs, particularly in certain recruitment, demand creation and social norm interventions. Grounded in our own experiences gained while conducting HIV-related ethics research with adolescents in Kenya, we argue that use of explicit or implicit stigma to increase the number of VMMC volunteers is unethical from a public health ethics perspective, particularly in campaigns that leverage social norms of masculinity. (shrink)

Breast cancer treatments have multiple adverse effects, including concerns about body appearance and function that are experienced by most patients. Altered body image negatively affects mental health, social, and relationship functioning. While the relationship with a partner is critical for patients’ psychological wellbeing and partners can promote positive body image, limited research has investigated individual and relational factors affecting the experience of both. This cross-sectional study aimed at exploring rates of body image concerns among breast cancer patients, and identifying dyadic (...) profiles among participating dyads. Couples composed by patients who had undergone surgery and their romantic partners were recruited from the Breast Unit of a hospital in northern Italy. Both partners completed measures of personality characteristics, psychological distress, coping flexibility, dyadic coping, and closeness. Body image and adjustment to cancer measures were completed by patients only. K-mean cluster analyses identified 2-cluster solution among patients and partners, respectively. “Active patients” reported low rates of body image concerns, anxious preoccupation, negative dyadic coping, and self-oriented stress communication, compared to “worried patients”. “Comfortable partners” reported lower anxiety and depression, self-oriented negative dyadic coping and closeness than “uncomfortable partners”. Three different dyadic profiles emerged: functional, dysfunctional, and ambivalent. Significant variations by anxiety, depression, and delegating dyadic coping existed. Results indicate there are groups of couples at greater risk for impaired psychological distress and body image concerns, which should be addressed in the context of dyadic psychosocial interventions. (shrink)

De Marco et al 1 argue that the standard account of medical ‘invasiveness’ (as ‘incision’ or ‘insertion’) fails to capture three aspects of its existing use, namely that invasiveness can come in degrees, often depends on features of alternative medical interventions and can be non-physical. They propose a new schematic account that suggests that medical interventions can possess ‘basic invasiveness’ (which can come in degrees and of which they suggest at least two types: physical and mental), and ‘threshold invasiveness’ which (...) can depend on the alternatives a specific intervention is being compared with. While we agree that the standard account of invasiveness fails to capture existing use and are supportive of their aim, here we express scepticism about the practical utility of De Marco et al ’s revised account. Our scepticism concerns the application of De Marco et al’s revised account in the narrow context of clinician–patient communication and deliberation about medical interventions within clinical practice, which we see as a crucial context for its use. While De Marco et al do not specify the contexts in which their revised account could be used, we assume from their discussion of treatment interventions (e.g. non-invasive prenatal testing, ventilation) and their comparison to ‘more or less invasive’ options, that at least one of the purposes in mind for …. (shrink)

The popularity of direct-to-consumer genetic ancestry services has exploded over the past five years, with as many as 250 direct-to-consumer genetic ancestry testing companies currently operating and estimates that 1 in 5 Americans are customers of one or more of those companies. Marketing of genetic ancestry testing has consistently linked the results of DNA testing to a consumer’s racial and ethnic identity, and, because of that, can help consumers find out “who they really are.” We argue that the “biologization” of (...) race and ethnicity promoted in such marketing violates norms of marketing ethics. In particular, we show that this marketing technique violates a number of the core commitments and values of the American Marketing Association Statement of Ethics. (shrink)

This book is the first complete survey and critical appraisal of the large body of research that has appeared during approximately the last decade concerning the analysis of knowing. Robert K. Shope pays special attention to the social aspects of knowing and proposes a new formulation of the fundamental structure of the Gettier problem. Originally published in 1983. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University (...) Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

An adolescent’s last moment of life is an emotionally and medically complex time. Children may grapple with understanding the things happening to them and with grief of a future lost; caregivers struggle to simultaneously balance deep sorrow, hope, and love; and healthcare providers fight to maintain sound medical and ethical decision making. Increased discussion regarding adolescent end-of-life care is needed so that clinicians may better understand how to engage in ethically based medical management during these events. This holds particularly true (...) in situations where potentially conflicting ideas exist between clinicians and family members. We describe the case of an acutely and terminally ill adolescent who remained cognitively intact but with rapidly advancing multiple organ failure and whose parents requested that he remain uninformed of his critical illness and prognosis. (shrink)

Philosophy of religion has been the object of penetrating critiques concerning its continued near-complete blindness to all but a single religion. The need for philosophy of religion to open up so as to include more than merely occasional and tokenistic treatments of ‘Other’ religions is clearly evident from the slew of recently published titles concerned with diversifying the field. In this light, a book such as Victoria Harrison’s Eastern Philosophy of Religion should surely come as a welcome addition. And yet, (...) unfortunately, this book turns out to be a case study in how not to diversify philosophy of religion in the twenty-first century. (shrink)

EXCERPT.--With exception to early essays by George von Glahn and Mark Sanders, serious critical scholarship on the writings of Ted Kooser began after the 1980 release of the now-classic Sure Signs, Kooser’s fifth major collection of poems. Looking back over the thirty-plus years since then, only about a dozen or so significant studies—none of which book-length—currently boulder out against the relative flatscape of secondary materials constituted mostly by quick and dirty reviews. Aside from the essays by Wes Mantooth, Allan Benn, (...) and Mary K. Stillwell in this special issue of Midwestern Miscellany, the following works particularly stand out and, in my view, must be consulted by the Kooser scholar: David Baker’s “Ted’s Box”; William Barillas’s Chapter 7 of The Midwestern Pastoral; Victor Contoski’s “Words and Raincoats”; Dana Gioia’s “The Anonymity of the Regional Poet”; Jeff Gundy’s “Among the Erratics”; Jonathan Holden’s “The Chekov of American Poetry”; Denise Low’s “Sight in Motion”; David Mason’s “Introducing Ted Kooser”; and both Mary K. Stillwell’s “The ‘In Between’” and her “When a Walk is a Poem.”. (shrink)

Suppose COVID-19 is the runaway tram in the famous moral thought experiment, known as the “Bystander at the Switch.” Consider the two differentiated responses of governments around the world to this new threat, namely the option of quarantine/lockdown and herd immunity. Can we contrast the hypothetical with the real scenario? What do the institutional decisions and strategies for dealing with the virus, in the beginning of 2020, signify in a normative moral framework? This paper investigates these possibilities in order to (...) highlight the similarities and, more importantly, the differences that exist between utilitarianism and Kantian ethics. Analysis shows that the hypothetical scenario can never be fully compared to the complex multifactorial nature of the real world. But if a comparison is attempted, the most obvious difference between the two governmental strategies is the concept of duty within the Kantian perspective. Ultimately, it is a matter of comparing freedom and life. Attributing a moral “priority ticket” to one or the other can be analysed through interpersonal aggregation. (shrink)

This article argues that the literary contexts of Horace's Odes 3.13, especially archaic Greek poetry, have been relatively neglected by scholars, who have focussed on identifying the location of the fons Bandusiae and on understanding the significance of the sustained description of the kid sacrifice. This study presents a more holistic interpretation of the ode by exploring Horace's interactions with previously unnoticed (Alcaeus, frr. 45 and 347) and underappreciated (Hes. Op. 582–96) archaic Greek poetic intertexts, which also offer a fresh (...) perspective on earlier debates. Horace's use of Alcaeus’ fr. 45, a key intertext, firmly places the fons Bandusiae within the literary landscape of Horace's Sabine estate, and offers a structural and argumentative model for Odes 3.13; further, Alcaean and Hesiodic allusions also suggest that the kid is sacrificed as a surrogate for Horace for keeping him safe. These conclusions are used to offer a new interpretation of the ode on metapoetic, political and philosophical levels, and to explore how these different aspects of the ode interact with Horace's other odes. (shrink)

On the basis of the archival materials, first identified by the authors, and the published historical sources that have not yet come to the attention of historians of science, this article reconstructs the biography of Johann Christian Weltzien (1767–1829), doctor of medicine and surgery. In 1785, Weltzien became a court physician. In 1799, in the retinue of Grand Duke Konstantin Pavlovich, he participated in Italian and Swiss military campaigns. After that, Weltzien was assigned to the Сourt of Grand Duke Konstantin (...) Pavlovich of Russia and stayed at his court until 1810. He started his charitable activities in the Medico-Philanthropic Committee. From May 1810 to the middle of 1825, Weltzien was a physician at the Imperial Page Corps. It turned out that around the same time, in 1804–1825, he was a member of the Medical Council. Furthermore, as there were two medical councils under two ministries at the time, in 1811–1822, he was a member of both. Since 1825, Weltzien lived on his estate in Somel, now Vaiatu Manor in Estonia, and died in St. Petersburg. Weltzien’s work as a provincial physician prompted him to write a book on medical police, which was published in 1785. It has been established that this remained his only book on the topic. The article shows that Weltzien became one of the first ideologists of state care for public health in the Russian Empire. Weltzien’s ideas, expressed over 200 years ago, regarding the state having mechanisms to impact public health and the importance of not excluding it from solving health problems have not lost their significance even today. (shrink)

William James is known as a nineteenth-century philosopher, psychologist, and psychical researcher. Less well-known are the medical fixations that united his multiple identities and drove his ambition to change the way American society conceived of itself in body, mind, and soul. William James, M.D. offers an account of the development and cultural significance of James's ideas and works, and establishes, for the first time, the relevance of medical themes to his major lines of thought. James lived at a time when (...) old assumptions about faith and the moral and religious possibilities for human worth and redemption were increasingly displaced by a concern with the medically "normal" and the perfectibility of the body. Woven into treatises warning of the degeneration of humanity, these ideas comprised the origins of the eugenics movement and were manifest in a growing social stigma attached to illness and invalidism, a disturbing intellectual current in which James felt personally implicated. Most chronicles of James's life have portrayed a distressed young man, a psychological or spiritual crisis, followed by the emergence of a mature thinker who threw off his pallor of mental sickness for good. In contrast, Emma Sutton draws on his personal correspondence, unpublished notebooks, and diaries to show that James considered himself a genuine invalid to the end of his days. Sutton makes the compelling case that his philosophizing was not an abstract occupation but an impassioned response to his own life experiences and challenges. To ignore the medical James is to misread James altogether. Sales points: First book to map William James's preoccupation with medical ideas, concerns, and values across the disciplinary breadth of his work Reveals how themes of invalidism, health, and healing underpinned the genesis of many of James's major philosophical, psychological, and political ideas Draws on the approximately 9,400 items of Jamesian correspondence, together with his private notes and reading lists. (shrink)

Bipolar affective disorder (BPAD) can be a devastating disorder for both sufferers and their relatives. In addition to the variety of distressing and severe affective symptoms, the consequences of illness onset may be equally debilitating, particularly as the illness may commonly present in early adulthood. As such, the developmental trajectory between late adolescence and early adulthood is commonly interrupted. Relationships with family, friends and partners may deteriorate, employment or studies may be interrupted, and criminal histories may be acquired. In turn, (...) such events worsen stress, reduce self-esteem, and may make the recovery process more difficult.... (shrink)

The quantum efficiency (QE) of light-induced metastable defect creation in hydrogenated amorphous silicon (a-Si : H) and amorphous As2Se3 (a-As2Se3) by bandgap and subgap illumination has been deduced from photocurrent measurements. The QE decreases with increasing number of absorbed photons. A higher QE for a-As2Se3 than for a-Si : H has been observed and this is interpreted in terms of the higher structural flexibility of a-As2Se3. We have also found that, for both materials, subgap illumination yields a higher QE than (...) does bandgap illumination. (shrink)

Considerable attention has been paid in recent years to Catullus 63. A number of salient features have been discussed: the psychological study of emotions; the use of animal imagery; the theme of marriage and love. There have also been some helpful studies on smaller, though important, aspects of the poem such as its use of ring composition or Catullus′ inventive treatment of the challenging Galliambic metre. But little work has been done on the literary background of poem 63 apart from (...) the question of whether or not Catullus was following an Alexandrian model. I shall suggest that the basic narrative of the poem, and the way in which Catullus has handled it, have literary antecedents which have influenced the poet. The final product, however, still remains a very original piece of work. (shrink)

Considerable attention has been paid in recent years to Catullus 63. A number of salient features have been discussed: the psychological study of emotions; the use of animal imagery; the theme of marriage and love. There have also been some helpful studies on smaller, though important, aspects of the poem such as its use of ring composition or Catullus′ inventive treatment of the challenging Galliambic metre. But little work has been done on the literary background of poem 63 apart from (...) the question of whether or not Catullus was following an Alexandrian model. I shall suggest that the basic narrative of the poem, and the way in which Catullus has handled it, have literary antecedents which have influenced the poet. The final product, however, still remains a very original piece of work. (shrink)

Most commentators apply the phrase ‘vitans onus…iugi’ not only to the heifer but to Attis himself. When they ask what iugum Attis is avoiding, the immediate context provides no obvious answer. They are therefore compelled to interpret the iugum either in the light of a much earlier passage or in the light of a much later one. Neither procedure is satisfactory. On the other hand, at least one editor has proposed that the phrase ‘vitans onus…iugi’ does not apply to Attis (...) himself but to the heifer alone. The comparison between Attis and the heifer then lies only in their frenzied speed; the yoke-avoiding action is external to the comparison and merely heightens the picture of the charging heifer. The obvious difficulty with this view is that the concept of a yoke, and more generally of avoiding servitude, plays an important role relevant to Attis later on in the poem. From line 50 onwards Attis sees himself as an erifuga anxious to escape from slavery to Cybele. And the account of Cybele's lion, sent to round him up, twice refers to the notion of freeing from a yoke . Both these traditional approaches concentrate on the literal meaning of the phrase vitans onus…iugi: they assume that the yoke itself is important and that it either does or does not make sense when applied to Attis. But if we focus instead upon the action which the whole phrase vitans onus…iugi suggests, then the description of the heifer has an apt application to Attis within its own immediate context. (shrink)

Most commentators apply the phrase ‘vitans onus…iugi’ not only to the heifer but to Attis himself. When they ask what iugum Attis is avoiding, the immediate context provides no obvious answer. They are therefore compelled to interpret the iugum either in the light of a much earlier passage or in the light of a much later one. Neither procedure is satisfactory. On the other hand, at least one editor has proposed that the phrase ‘vitans onus…iugi’ does not apply to Attis (...) himself but to the heifer alone. The comparison between Attis and the heifer then lies only in their frenzied speed; the yoke-avoiding action is external to the comparison and merely heightens the picture of the charging heifer. The obvious difficulty with this view is that the concept of a yoke, and more generally of avoiding servitude, plays an important role relevant to Attis later on in the poem. From line 50 onwards Attis sees himself as an erifuga anxious to escape from slavery to Cybele. And the account of Cybele's lion, sent to round him up, twice refers to the notion of freeing from a yoke. Both these traditional approaches concentrate on the literal meaning of the phrase vitans onus…iugi: they assume that the yoke itself is important and that it either does or does not make sense when applied to Attis. But if we focus instead upon the action which the whole phrase vitans onus…iugi suggests, then the description of the heifer has an apt application to Attis within its own immediate context. (shrink)