Rationale Treatment guidelines recommend a more conservative surgical approach than mastectomy for early stage breast cancer and a stronger emphasis on adjuvant therapy. Registry data at South Australian teaching hospitals have been used to monitor survivals and treatment in relation to these guidelines.Aims and objectives To use registry data to: (1) investigate trends in survival and treatment; and (2) compare treatment with guidelines.Methods Registry data from three teaching hospitals were used to analyse trends in primary courses of treatment of breast (...) cancers during 1977–2003 (n = 4671), using univariate analyses and multiple logistic regression. Disease-specific survivals were analysed using Kaplan–Meier product limit estimates and multivariable Cox proportional hazards regression.Results The 5-year survival was 79.9%, but with a secular increase, reaching 83.6% in 1997–2003. The relative risk of death (95% confidence limits) was 0.74 (0.62, 0.88) for 1997–2003, compared with previous diagnoses, after adjusting for tumour node metastasis stage, grade, age and place of residence. Treatment changes included an increase in conservative surgery (as opposed to mastectomy) from 51.7% in 1977–1990 to 76.8% in 1997–2003 for stage I (P < 0.001) and from 31.1% to 52.2% across these periods for stage II (P < 0.001). Adjuvant radiotherapy also became more common (P < 0.001), with 20.6% of patients receiving this treatment in 1977–1990 compared with 60.7% in 1997–2003. Radiotherapy generally was more prevalent when conservative surgery was provided, although also relatively common in mastectomy patients when tumour diameters exceeded 50 mm or when there were four or more involved nodes. The proportion of patients receiving chemotherapy increased (P < 0.001), from 19.6% in 1977–1990 to 36.9% in 1997–2003, and the proportion having hormone therapy also increased (P < 0.001), from 34.3% to 59.4% between these periods.Conclusions Survivals appear to be increasing and treatment trends are broadly consistent with guideline directions, and the earlier research on which these recommendations were based. (shrink)

A pre-test/post-test, intervention-versus-control experimental design was used to examine the effects, mechanisms and moderators of deep breathing on state anxiety and test performance in 122 Primary 5 students. Taking deep breaths before a timed math test significantly reduced self-reported feelings of anxiety and improved test performance. There was a statistical trend towards greater effectiveness in reducing state anxiety for boys compared to girls, and in enhancing test performance for students with higher autonomic reactivity in test-like situations. The latter moderation was (...) significant when comparing high-versus-low autonomic reactivity groups. Mediation analyses suggest that deep breathing reduces state anxiety in test-like situations, creating a better state-of-mind by enhancing the regulation of adaptive-maladaptive thoughts during the test, allowing for better performance. The quick and simple technique can be easily learnt and effectively applied by most children to immediately alleviate some of the adverse effects of test anxiety on psychological well-being and academic performance. (shrink)

This article explores an aspect of women’s transnational labor migration that has been understudied in many labor-sending countries: how men experience shifts in the household labor division triggered by women’s migration. In so doing, we shed light on the diverse ways notions of masculinity and gender identities are being reworked and renegotiated in the transnational family. Drawing on qualitative data collected from in-depth interviews with carers of left-behind children in Northern Vietnam, we show how men are confronted with the need (...) to take on child care duties, which have traditionally been ascribed to women, while at the same time being under considerable pressure to live up to locally accepted masculinity ideals. We provide interesting insights into the changing family structures and dynamics in Vietnamese society where patriarchal norms continue to exert significant influence on different facets of life. (shrink)

Parents of children with terminal illness may try many different types of alternative and unproven treatment, not all recognised by the medical establishment. When active participation is requested difficult ethical dilemmas may arise. We present one such case, a child of five years with an inoperable posterior fossa brain tumour.

Biomedical research involving human participants is highly regulated and subject to stringent ethical requirements. Clinical research ethics, regulation and policy have tended to focus almost exclusively on the protection of participants' interests against harms that might result from taking part in research. Less consideration, however, has been given to the interests that patients may themselves have in research participation, even in trials that may be beyond the bounds of current clinical research practice. In this paper, we consider the case of (...) a suggested extension to clinical trial protocols to explore the ethics of participation in ‘risky’ research. We argue that patients may have a strong interest in taking part in research, and that even when greater-than-usual risks may be present, such research can be both ethically and scientifically justified. Finally, we suggest that there might be scope in some cases to assert a right to participate in research, and that the possibility of such a right merits further consideration. (shrink)

Hong Kong is undergoing a public debate on the need to reform and future directions of reforming its health care system. This paper highlights the debates and considerations brought up by the Hospital Authority, the largest provider of public health care in Hong Kong, on the ethical principles and societal values underlying the upcoming reform. It is recognized that the exact meanings behind each ethical principle and value must be debated and clarified during the reform process. In a modern day (...) society like Hong Kong, societal values are likely to be diversified. A health care system also has to fulfil different and often conflicting objectives of equity, efficiency, quality and choice. It would be difficult for a health care system to satisfy these different values and objectives based on a single value parameter. The Hong Kong experience shows that a society may prefer a combination of strategies in addressing different societal values. The re-structuring of the health care system in Hong Kong should therefore be based on a balanced and optimum combination of various financing and delivery strategies. (shrink)

ObjectivesThis study aimed to describe the experiences and challenges faced by adolescents with moderate and severe congenital heart defects or Chronic Rheumatic Heart Disease and to determine their needs in order to develop an Adolescent Transition Psychoeducational Program.MethodsThe study involved seven adolescents with moderate to severe CHD/CRHD, six parents, and four health care providers in Institute Jantung Negara. Participants were invited for a semi-structured interview. Qualitative data were analyzed through the Atlas.ti 7 program using triangulation methods.Results/conclusionsWe identified five themes concerning (...) the experience and challenges of adolescents relating to: emotional/psychological issues; the progress of the illness; relationship issues; future preparation; and, school and community. These themes were identified together with eleven subcategories. The staff expressed support for the development of the Adolescent Transition Psychoeducational Program and adolescents with CHD/CRHD and their parents were willing to participate in the program if their schedule allowed. Their suggestions to improve the program were classified into six categories, with two main themes, the self-management of illness in life and the future; and, social support. In conclusion, the findings from the situation analysis act as a basis for a conceptual framework that will contribute to the development of an Adolescent Transition Psychoeducational Program that aims to empower adolescents with CHD/CRHD, enabling them to manage challenges during the transition phase between childhood and adulthood. (shrink)

The word _meṇḍaka_, a derivative of _meṇḍa_ (“ram”), is generally translated as “made of the ram” or “about the ram” or “horned.” However, in the Pāli _Milindapañha_ (_Questions of Milinda_), the word _meṇḍakapañha_, literally, a question about the ram, is also rendered as a logical conclusion that refutes an imaginary dilemma. Hence, in this treatise, the word _meṇḍaka_ is a special logical term which means an imaginary dilemma that can be logically refuted. This raises the question as to why the (...) word _meṇḍaka_ has come to be associated with this logical technique. To answer this question, this paper examines various aspects of the word and its possible connections to a dilemma and its refutation. The discussion ranges from the meaning of this word in a tale in the _Jātaka_ (Birth Stories), within the contextual usage in a _meṇḍaka_ question, to a relatively recent commentarial text (_aṭṭhakathā_) which gives a different perspective on the etymology of the word. The _Milindapañha_ is explicit in defining a _meṇḍaka_ question as knotty, hard to penetrate, and difficult to resolve, some of which an opponent puts forth to undermine certain aspects of the Buddhist system. However, the way certain _meṇḍaka_ questions are framed, though not directly stated, seem to utilize the principles of logic in a dilemmatic form of argument. With that, a _meṇḍaka_ question, at least in the _Milindapañha_, could also mean “a dilemmatic expression put forth by a challenger to undermine an opponent, but which can be logically refuted.”. (shrink)

This article re-examines speculations about school affiliation of the Milindapañha (Questions of King Milinda) and traces its presence from North West India in the early centuries CE up to Southeast Asia in the nineteenth century. As there are significant differences between the textual traditions of the Pali Text Society’s Milindapañho and the Siamese printed edition, the Milindapañh?, I will discuss the little-known textual characteristics of the Siamese recensions which were circulating in Central Siam from at least the seventeenth century. This (...) is possible with the discovery of several Ayutthaya period Milindapañha manuscripts kept at a temple and the National Library of Thailand. By the end of the eighteenth century, at least three different recensions were circulating in Central Siam. This paper will present some of their dissimilarities as well as their probable textual lineages. The newly discovered manuscripts also partly demonstrate that the shape of the textual tradition of a text, at least for the Milindapañha in Siam, reflects a function of the textual community that preserved and transmitted it. (shrink)

. In this reply to Dahlman, the focus is on aspects that I take to be of general interest. The point to be emphasised is the absence of a critically reflexive mode of questioning on the part of Dahlman and, in general, on the part of the position he represents, namely, an empiricist and logical paradigm of atemporal cognition and control. It is argued that lawyers’ thinking de lege lata—with its distinctive connection to normativity and morals, through the unity of (...) the temporal and institutional dimensions in fused modality—can never be understood within such a framework. (shrink)

According to the received opinion there is a theoretical incompatibility between Herbert Hart'sThe Concept of Lawand Alf Ross'sOn Law and Justice, and, according to the received opinion, it stems above all from Hart's emphasis on the internal point of view. The present paper argues that this reading is mistaken.The Concept of Lawdoes not go beyondOn Law and Justicein so far as both present arguments to the effect that law is based on a shared understanding between participants in a project perceived (...) by every participant to be a project in common. The paper demonstrates that there are substantive parallels between Hart's combination of “acceptance” or “acknowledgement” and a “critical reflective attitude” and Ross's combination of “motivation” or “feeling” and a “coherent whole of meaning and motivation.” The main conclusion is that the views of norms and normativity put forward inThe Concept of LawandOn Law and Justiceare very close in essential respects, and, more specifically, that the two works are at root identical in their representation of the basis of normativity in reality. (shrink)

The pressure on companies to practice corporate social responsibility (CSR) has gained momentum in recent times as a means of sustaining competitive advantage in business. The pharmaceutical industry has been acutely affected by this trend. While pharmaceutical product recalls have become rampant and increased dramatically in recent years, no comprehensive study has been conducted to study the effects of announcements of recalls on the shareholder returns of pharmaceutical companies. As product recalls could significantly damage a company's reputation, profitability and brand (...) integrity, this paper investigates the effect on shareholder wealth and the extent to which the adoption of CSR practices by pharmaceutical companies in the United Kingdom (U.K.) and the United States (U.S.), the two largest markets for pharmaceutical products in the world, affected market reactions surrounding product recall announcements. The analysis of product recall announcements from 1998 to 2004 compiled from The Pharmaceutical Journal and U.S. Food and Drug Administration enforcement reports revealed marked differences in the way market participants in the two countries responded to news of product recalls. U.S. investors penalised firms according to the severity of product defects while U.K. investors were indifferent. While U.K. investors rewarded product recalls by firms which were not usually CSR-active, U.S. investors punished non-CSR active firms that performed recalls. These observations could pose strategic challenges to pharmaceutical firms operating in both countries. (shrink)

I introduce the concept of ‘fused descriptive and normative proposition.’ I demonstrate that and how this concept has a basis in reality in lawyers' propositions de lege lata, and I point out that and why we do not find fused modality in language qua language, morals and the relationship between parents and children. The concept of ‘fused descriptive and normative proposition’ is of interest in a number of contexts, inter alia in relation to law, cf. the debate about the status (...) of lawyers' propositions de lege lata (“exactly what kind of propositions are lawyers' propositions about what is the law?”), and in relation to philosophy, cf. the debate about the relationship between ‘the is‘ and ‘the ought.’ As a consequence of the reality basis and interest of this concept, I see the concepts of ‘descriptive proposition’ and ‘normative proposition’ as the extreme points on a graduated dimension, from the purely descriptive to the purely normative. (shrink)

In A Theory of Justice (1971), John Rawls introduces the concept of “reflective equilibrium.” Although there are innumerable references to and discussions of this concept in the literature, there is, to the present author's knowledge, no discussion of the most important question: Why reflective equilibrium? In particular, the question arises: Is the method of reflective equilibrium applicable to the choice of this method itself? Rawls's drawing of parallels between Kant's moral theory and his own suggests that his concept of “reflective (...) equilibrium” is on a par with Kant's concept of “transcendental deduction.” Treating these two approaches to justification as paradigmatic, I consider their respective merits in meeting the reflexive challenge, i.e., in offering a justification for choice of mode of justification. My enquiry into this topic comprises three parts. In the first part (Eng 2014a), I raised the issue of the reflexivity of justification and questioned whether the reflexive challenge can be met within the framework of A Theory of Justice. In this second part, I shall outline a Kantian approach that represents a paradigmatic alternative to Rawls. (shrink)

In A Theory of Justice (1971), John Rawls introduces the concept of “reflective equilibrium.” Although there are innumerable references to and discussions of this concept in the literature, there is, to the present author's knowledge, no discussion of the most important question: Why reflective equilibrium? In particular, the question arises: Is the method of reflective equilibrium applicable to the choice of this method itself? Rawls's drawing of parallels between Kant's moral theory and his own suggests that his concept of “reflective (...) equilibrium” is on a par with Kant's concept of “transcendental deduction.” Treating these two approaches to justification as paradigmatic, I consider their respective merits in meeting the reflexive challenge, i.e., in offering a justification for choice of mode of justification. In the first part of this enquiry (Eng 2014a), I raised the issue of the reflexivity of justification and questioned whether the reflexive challenge can be met within the framework of A Theory of Justice. In the second part (Eng 2014b), I outlined a Kantian approach that represents a paradigmatic alternative to Rawls. In this third and final part, I shall argue that Rawls's reflective equilibrium cannot justify the choice of itself and that in the broader perspective thus necessitated, we cannot escape the metaphysical issues integral to the Kantian approach. (shrink)

In A Theory of Justice (1971), John Rawls introduces the concept of “reflective equilibrium.” Although there are innumerable references to and discussions of this concept in the literature, there is, to the present author's knowledge, no discussion of the most important question: Why reflective equilibrium? In particular, the question arises: Is the method of reflective equilibrium applicable to the choice of this method itself? Rawls's drawing of parallels between Kant's moral theory and his own suggests that his concept of “reflective (...) equilibrium” is on a par with Kant's concept of “transcendental deduction.” Treating these two approaches to justification as paradigmatic, I consider their respective merits in meeting the reflexive challenge, i.e., in offering a justification for choice of mode of justification. My enquiry into this topic comprises three parts. In this first part, I raise the issue of the reflexivity of justification and question whether the reflexive challenge can be met within the framework of A Theory of Justice. (shrink)

This article investigates whether acts of plagiarism are predictable. Through a deductive, quantitative method, this study examines 517 students and their motivation and intention to plagiarize. More specifically, this study uses an ethical theoretical framework called the Theory of Reasoned Action and Planned Behavior to proffer five hypotheses about cognitive, relational, and social processing relevant to ethical decision making. Data results indicate that although most respondents reported that plagiarism was wrong, students with strong intentions to plagiarize had a more positive (...) attitude toward plagiarizing, believed that it was important that family and friends think plagiarizing is acceptable, and perceived that plagiarizing would be an easy task. However, participants in the current study with less intention to plagiarize hold negative views about plagiarism, do not believe that plagiarism is acceptable to family, friends or peers, and perceive that the act of plagiarizing would prove difficult. Based on these findings, this study considers implications important for faculty, librarians, and student support staff in preventing plagiarism through collaborations and outreach programming. (shrink)

1. Ethics and public policy .Jonathan.Boston,.Andrew.Bradstock,.and.David.Eng Introduction This book is about ethics and public policy. ...

When people interact with social robots, they treat them as real social agents. How people depict robots is fun to consider, but when people are confronted with embodied entities that move and talk – whether humans or robots – they interact with them as authentic social agents with minds, and not as mere representations.

In the Western media, stories about China seem to fall into one of two categories: China’s astounding economic development or its human rights abuses. As human rights discourses follow increasingly hegemonic conventions, especially with regard to China, many of their key assumptions remain unexamined. This special issue—the second in a two-part series beginning with “Cosmologies of the Human”—critically investigates the relationship between China and the human as it plays out in law, politics, biopolitics, political economy, labor, medicine, and culture. The (...) contributors interrogate the evolving meanings of “China” and “the human,” both inside China and internationally. The issue tracks the ways in which global discourses treat China—still officially socialist—as similar to, different from, and alternative to Western capitalist modernities. Several essays probe the modern theoretical underpinnings of human rights abuses in China, including a crucial distinction between “the human” and “the people.” Others review the impact of Maoism on Marxist debates in China and in the West, as well as the specific influences of Mao’s writings on French politics and theory in the 1960s. A visual dossier compares eight contemporary Chinese artists, directors, and public image-makers in order to discuss the figure of the human from Tiananmen Square to the 2008 Beijing Olympics. While many contributors discuss China and the West comparatively, the issue interrogates the universalizing claims of both Western and Chinese norms of the human by privileging the local, particular, and eccentric. Contributors: Ackbar Abbas, Michael Dutton, David L. Eng, Doug Howland, Petrus Liu, Camille Robcis, Teemu Ruskola, Shuang Shen, Shu-mei Shih, Wang Xiaoming David L. Eng is Professor of English, Comparative Literature, and Asian American Studies at the University of Pennsylvania. He is the author of _The Feeling of Kinship: Queer Liberalism and the Racialization of Intimacy_ and _Racial Castration: Managing Masculinity in Asian America_, both also published by Duke University Press. Teemu Ruskola is Professor of Law at Emory University and Visiting Professor of Law at Georgetown University. Shuang Shen is Assistant Professor of Comparative Literature and Chinese at Pennsylvania State University. (shrink)

The aim of this paper is to point out the salient patterns of agreement and dis‐ agreement between Alf Ross and Hans Kelsen's analyses of valid law and efficacy. I argue that the disagreement has the character of systemic postulation on the part of both interlocutors. My main thesis is that the disagreement is not one of philosophical principle, but one that must be resolved on the basis of pragmatic considerations, i.e., the choice between the two valid‐law schemes pertains neither (...) to necessity nor to truth, but to expediency and values. (shrink)

Transversality occupies a central place in Guattari's thought, appearing in his early writings on institutional analysis and on through to his final work, Chaosmosis. Transversality is thus particularly pertinent to understanding Guattari's critique of semiocapitalism and his goal of re-imagining forms of institutional subjectivisation as a way to free the unconscious from structures of lack and the desire for punishment, the very structures upon which capitalism relies for its reproduction. If there is one institution that has taken advantage of semiocapitalism's (...) ability to mask its role in the reproduction of capitalist subjectivity, however, it is the contemporary neoliberal University. This essay thus brings transversality to bear upon the question of the University in semiocapitalism, focusing on the discourses that speak in defence of the humanities. Though defences of the humanities are intended to argue for the humanities’ usefulness in contemporary society, transversality exposes such discourses as the speech of a ‘subjugated group’ whose only effect is to reinforce existing structures of lack and punishment. (shrink)

This essay conducts a reading of Jean-Luc Nancy’s and Jacques Rancière’s respective theorizations of the image. Using Nancy’s notion of literary communism, I first show how he and Rancière conceive the image as a site of community’s open writing and contestation. My reading then demonstrates how this “communism of the image” exposes Rancière’s repetition of an ontological gesture that he has attempted to dismiss as Heideggerian.

Reviewed: The Obsessions of Georges Bataille: Community and Communication, edited by Andrew J. Mitchell and Jason Kemp Winfree, State University of New York Press, 2009, 232pp., pb. $24.95. ISBN-13: 9781438428246. This review analyzes the extent to which The Obsessions of Georges Bataille: Community and Communication, edited by Andrew J. Mitchell and Jason Kemp Winfree, may contribute to recent treatments of sensibility and affect in critical thought. After first posing the question of why community appeared to recede from the critical attention (...) it received in the 1990s, my discussion then assesses the ways the volume’s essays argue collectively for a renewed engagement with community via the work of Bataille. I attempt to show how Mitchell’s and Winfree’s volume provides an important provocation to recover the exigency of community at a time when popular appeals to community remain no less spectacular, inflated, and cynical than they were at the height of its engagement by critical thought. The essay concludes with a suggestion of how Bataille’s work can intervene in what Fredric Jameson has called the post-09/11 manufacturing of affect. (shrink)

This paper investigates the actual use of truth as a criterion in the setting up of and choice between descriptive characterisations. The consideration for truth is often weighed against other considerations. This weighing character is illuminated through examples from everyday life, politics, law, and science. In everyday life the weighing character shows itself inter alia through the categories of ‘white lies’ and ‘great questions’, and in politics, inter alia through the categories of ‘personal character’ versus ‘the party’. In law there (...) are numerous examples of norms that increase the probability of untrue characterisations being taken as a basis for the application of the law. This paper focuses on the categories of ‘exclusion of evidence’, ‘burden of proof’, and ‘adjusting of facts as a means to concretely reasonable and just results’. The paper concludes by showing that burden of proof considerations are also found in an area in which many people assume that the truth criterion is paramount, namely science. The method is thus casuistic. However, the aim is a certain representativity in relation to the problem aspects. (shrink)