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)

"Throughout history, some books have changed the world. They have transformed the way we see ourselves - and each other. They have inspired debate, dissent, war and revolution. They have enlightened, outraged, provoked and comforted. They have enriched lives - and destroyed them. Now Penguin brings you the works of the great thinkers, pioneers, radicals and visionaries whose ideas shook civilization and helped make us who we are. Plato's retelling of the discourses between Socrates and his friends on such subjects (...) as love and desire, truth and illusion, spiritual transcendence and the qualities of a good ruler, profoundly affected the ways in which we view human relationships, society and leadership - and shaped the whole tradition of Western philosophy."--Publisher's website. (shrink)

Discover the truth about sex in the city (and the country). Mapping Desire explores the places and spaces of sexuality from body to community, from the "cottage" to the Barrio, from Boston to Jakarta, from home to cyberspace. Mapping Desire is the first book to explore sexualities from a geographical perspective. The nature of place and notions of space are of increasing centrality to cultural and social theory. Mapping Desires presents the rich and diverse world of contemporary sexuality, exploring how (...) the heterosexed body has been appropriated and resisted on the individual, community and city scales. Editors David Bell and Gill Valentine have brought together contributors with a wealth of approaches to ways in which the spaces of sex and the sexes of space are being mapped out across contemporary culture. Among the many sexual geographies covered are: Lesbians at home and on the streets; gay men on fantasy islands; bisexual identities; The heterosexualization of the workplace; bachelor farmers and spinsters; surveillance and sexuality; prostitution; queer politics; sexual citizenship, and the transformation of intimacy. The book is divided into four sections: cartographies/identities; sexualized spaces: global/local; sexualized spaces: local/global; sites of resistance. Each section is separately introduced. Beyond the bibliography, an annotated guide to further reading is also provided to help the reader map their own way through the literature. Mapping Desire will be a valuable and accessible travelogue of information for anyone interested in social, cultural and political geography, lesbian and gay studies, cultural studies, or simply those who want to find out more about the sexual landscape of contemporary society. Contents: Part I: Cartographies/Identities; Resolving Riddles: The Sexed Body, Julia Cream ; Locating Bisexual Identities: Discourses of Bisexuality and Contemporary Feminist Theory, Clare Hemmings; Of Moffies, Kaffiers and Perverts: Male Homosexuality and the Discourse of Moral Order in the Apartheid State, Glen Elder; Femme on the Streets, Butch in the Sheets (a Play on Whores), Alison Murray; Body Work: The Performance of Gendered and (Hetero)Sexualized Identities in City Workplaces, Linda McDowell; Part II: Sexualized Spaces: Global/Local; Whenever I Lay My Girlfriend That's My Home: The Performance and Surveillance of Lesbian Identities in Domestic Environments, Lynda Johnston and Gill Valentine; The Lesbian Flaneur, Sally Munt; Fantasy Islands: Popular Topographies of Marooned Masculinities, Gregory Woods; Sexuality and Urban Space: A Framework for Analysis, Lawrence Knopp; Part III: Sexualized Spaces: Local/Global; "And She Told Two Friends...": Lesbians Creating Urban Social Space, Tamar Rothenberg; Trading Places: Consumption, Sexuality and the Production of Queer Space, Jon Binnie; Bachelor Farmers and Spinsters: Gay and Lesbian Identities and Communities in Rural North Dakota, Jerry Lee Kramer; (Re)Constructing a Spanish Redlight District: Prostitution, Space and Power, Angie Hart; Part IV: Sites of Resistance; "Surveilliant Gays": HIV, Space and the Construction of Identities, David Woodhead; Sex, Scale and the "New Urban Politics": HIV-Prevention Strategies from Yaletown, Vancouver, Michael Brown; "Boom, Bye, Bye": Jamaican Ragga and Gay Resistance, Tracey Skelton; The Diversity of Queer Politics and the Redefinition of Sexual Identity and Community in Urban Space, Tim Davis; Perverse Dynamics, Sexual Citizenship and the Transformation of Intimacy, David Bell; Guide to Further Reading; Bibliography. (shrink)

In our everyday moral deliberations, we attend to two central types of considerations – outcomes and moral rules. How these considerations interrelate is central to the long-standing debate between deontologists and utilitarians. Is the weight we attach to moral rules reducible to their conduciveness to good outcomes (as many utilitarians claim)? Or do we take moral rules to be absolute constraints on action that normatively trump outcomes (as many deontologists claim)? Arguments over these issues characteristically appeal to commonsense intuitions about (...) various cases. As a result, an important portion of the debate involves empirically tractable questions — questions that can be investigated by probing for people’s judgments in cases in which the two types of considerations come into conflict with one another. (shrink)

This article explores gender inequities and sexual double standards in teens’ digital image exchange, drawing on a UK qualitative research project on youth ‘sexting’. We develop a critique of ‘postfeminist’ media cultures, suggesting teen ‘sexting’ presents specific age and gender related contradictions: teen girls are called upon to produce particular forms of ‘sexy’ self display, yet face legal repercussions, moral condemnation and ‘slut shaming’ when they do so. We examine the production/circulation of gendered value and sexual morality via teens’ discussions (...) of activities on Facebook and Blackberry. For instance, some boys accumulated ‘ratings’ by possessing and exchanging images of girls’ breasts, which operated as a form of currency and value. Girls, in contrast, largely discussed the taking, sharing or posting of such images as risky, potentially inciting blame and shame around sexual reputation (e.g. being called ‘slut’, ‘slag’ or ‘sket’). The daily negotiations of these new digitally mediated, heterosexualised, classed and raced norms of performing teen feminine and masculine desirability are considered. (shrink)

This paper comments on some of the different senses of the notion of discourse in the various relevant literatures and then overviews the basic features of a coherent discourse analytic programme in Psychology. Parker's approach is criticised for (a) its tendency to reify discourses as objects; (b) its undeveloped notion of analytic practice; (c) its vulnerability to common sense assumptions. It ends by exploring the virtues of 'interpretative repertoires' over 'discourses' as an analytic/theoretical notion.

In the mid-20th century, descriptive meta-ethics addressed a number of central questions, such as whether there is a necessary connection between moral judgment and motivation, whether moral reasons are absolute or relative, and whether moral judgments express attitudes or describe states of affairs. I maintain that much of this work in mid-20th century meta-ethics proceeded on an assumption that there is good reason to question. The assumption was that our ordinary discourse is uniform and determinate enough to vindicate one side (...) or the other of these meta-ethical debates. I suggest that ordinary moral discourse may be much less uniform and determinate than 20th century meta-ethics assumed. (shrink)

This article reviews three recent books that enhance our understanding of the work of French feminist Luce Irigaray: Marine Lover of Friedrich Nietzsche and The Irigaray Reader, and Philosophy in the Feminine, a commentary on Irigaray's work by Margaret Whitford. The author emphasizes a dynamic reading of Irigaray's philosophy and integrates theoretical concepts with poetic/utopian passages from the works.

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 ...

I argue that a policy of presumed consent for cadaveric organ procurement, which assumes that people do want to donate their organs for transplantation after their death, would be a moral improvement over the current American system, which assumes that people do not want to donate their organs. I address what I take to be the most important objection to presumed consent. The objection is that if we implement presumed consent we will end up removing organs from the bodies of (...) people who did not want their organs removed, and that this situation is morally unacceptable because it violates the principle of respect for autonomy that underlies our concept of informed consent. I argue that while removing organs from the bodies of people who did not want them removed is unfortunate, it is morally no worse that not removing organs from the bodies of people who did want them removed, and that a policy of presumed consent will produce fewer of these unfortunate results than the current system. (shrink)

This volume brings together twenty original essays on the changes and continuities in gender relations and intersecting politics of sexuality, race, class and location. The book is located in debates about contemporary culture at a moment of rapid technological change, global interconnectedness and the growing cultural dominance of neoliberalism and postfeminism. The collection traverses disciplines, spaces and approaches. It is marked by an extraordinarily wide focus, ranging from analyses of celebrity magazines and makeover shows to examinations of the experiences of (...) young female migrants, 'mail order brides' and young women who repudiate feminism. The contributions are united by their attempts to think through the ways in which experiences and representations of femininity are changing in the twenty-first century. Are we seeing new femininities? Are neoliberalism and postfeminism constructing new identities and subjectivities? What kinds of analytic tools and cultural politics are needed to critically engage with the current moment? This book will be of interest to everyone studying gender, media or cultural studies. (shrink)

An examination of case law on forced marriage reveals that in addition to physical force, the role of emotional pressure is now taken into consideration. However, in both legal and policy discourse, the difference between arranged and forced marriage continues to be framed in binary terms and hinges on the concept of consent: the context in which consent is constructed largely remains unexplored. By examining the socio-cultural construction of personhood, especially womanhood, and the intersecting structural inequalities that constrain particular groups (...) of South Asian women in the UK, we argue that consent and coercion in relation to marriage can be better understood as two ends of a continuum, between which lie degrees of socio-cultural expectation, control, persuasion, pressure, threat and force. Women who face these constraints exercise their agency in complex and contradictory ways that are not always recognised by the existing exit-centred state initiatives designed to tackle this problem. (shrink)

Existing research has shown that norm violations influence causal judgments, and a number of different models have been developed to explain these effects. One such model, the necessity/sufficiency model, predicts an interac- tion pattern in people’s judgments. Specifically, it predicts that when people are judging the degree to which a particular factor is a cause, there should be an interaction between (a) the degree to which that factor violates a norm and (b) the degree to which another factor in the (...) situation violates norms. A study of moral norms (N = 1000) and norms of proper functioning (N = 3000) revealed robust evidence for the predicted interaction effect. The implications of these patterns for existing theories of causal judgments is discussed. (shrink)

When making moral judgments, people are typically guided by a plurality of moral rules. These rules owe their existence to human emotions but are not simply equivalent to those emotions. And people’s moral judgments ought to be guided by a plurality of emotion-based rules. The view just stated combines three positions on moral judgment: [1] moral sentimentalism, which holds that sentiments play an essential role in moral judgment,1 [2] descriptive moral pluralism, which holds that commonsense moral judgment is guided by (...) a plurality of moral rules2, and [3] prescriptive moral pluralism, which holds that moral judgment ought to be guided by a plurality of moral rules. In what follows, we will argue for all three positions. We will not present a comprehensive case for these positions nor address many of the arguments philosophers have developed against them. What we will try to show is that recent psychological work supports sentimentalist pluralism in both its descriptive and prescriptive forms. (shrink)

This article introduces a special section concerned with precariousness and cultural work. Its aim is to bring into dialogue three bodies of ideas — the work of the autonomous Marxist `Italian laboratory'; activist writings about precariousness and precarity; and the emerging empirical scholarship concerned with the distinctive features of cultural work, at a moment when artists, designers and (new) media workers have taken centre stage as a supposed `creative class' of model entrepreneurs. The article is divided into three sections. It (...) starts by introducing the ideas of the autonomous Marxist tradition, highlighting arguments about the autonomy of labour, informational capitalism and the `factory without walls', as well as key concepts such as multitude and immaterial labour. The impact of these ideas and of Operaismo politics more generally on the precarity movement is then considered in the second section, discussing some of the issues that have animated debate both within and outside this movement, which has often treated cultural workers as exemplifying the experiences of a new `precariat'. In the third and final section we turn to the empirical literature about cultural work, pointing to its main features before bringing it into debate with the ideas already discussed. Several points of overlap and critique are elaborated — focusing in particular on issues of affect, temporality, subjectivity and solidarity. (shrink)

The ethical dilemma of whether autonomous vehicles should protect the passengers or pedestrians when harm is unavoidable has been widely researched and debated. Several behavioral scientists have sought public opinion on this issue, based on the premise that EDs are critical to resolve for AV adoption. However, many scholars and industry participants have downplayed the importance of these edge cases. Policy makers also advocate a focus on higher level ethical principles rather than on a specific solution to EDs. But conspicuously (...) absent from this debate is the view of the consumers or potential adopters, who will be instrumental to the success of AVs. The current research investigated this issue both from a theoretical standpoint and through empirical research. The literature on innovation adoption and risk perception suggests that EDs will be heavily weighted by potential adopters of AVs. Two studies conducted with a broad sample of consumers verified this assertion. The results from these studies showed that people associated EDs with the highest risk and considered EDs as the most important issue to address as compared to the other technical, legal and ethical issues facing AVs. As such, EDs need to be addressed to ensure robustness in the design of AVs and to assure consumers of the safety of this promising technology. Some preliminary evidence is provided about interventions to resolve the social dilemma in EDs and about the ethical preferences of prospective early adopters of AVs. (shrink)

This paper presents a model for the structure of universal frameworks in logic, mathematics, and physics that are closed to logical conclusion by the mechanism of paradox across a dualism of elements. The prohibition takes different forms defined by the framework of observation inherent to the structure. Forms include either prohibition to conclusion on the logical relationship of internal elements or prohibition to conclusion based on the existence of an element not included in the framework of a first element. The (...) model is applied to logical arguments in philosophy, mathematics, and physics and is initially a geometrical analysis of quantum theory and its application in experiment. Conclusion from the analysis is extended to give insight into the complexity of infinities above the two-dimensional boundary of the model. (shrink)

This article addresses the precarious place of transgender and gender non-cis persons in relation to their discrimination-protections in recent legal, medical, and ethical policies in the United States. At present, there exists a contradiction such that trans persons are considered "pathological" enough that they are included in the latest iteration of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) as "gender dysphoric," but they are not included in the category of "disabled" under the Americans with Disabilities Act (ADA). As (...) such, trans persons in America are subject to the stigma of pathology (albeit with medical treatment) without the full protections of the ADA. By contrast, transgender and non-cis-gender Americans find their queer cohorts who are HIV-positive to be fully protected by the ADA. We ask whether transgender and non-cis-gender persons should embrace their (already pathologized) personhood as a disability. Sometimes "choosing disability" affords more rights than it deploys stigma. (shrink)

Moral cognitivists hold that in ordinary thought and language moral terms are used to make factual claims and express propositions. Moral non-cognitivists hold that in ordinary thought and language moral terms are not used to make factual claims or express propositions. What cognitivists and non-cognitivists seem to agree about, however, is that there is something in ordinary thought and language that can vindicate one side of their debate or the other. Don Loeb raises the possibility — which I will call (...) “the variability thesis” — that ordinary moral thought and language contains both cognitivist and non-cognitivist elements, and that there is no principled reason for thinking that either the cognitivist or non-cognitivist elements are conceptually more primary or aberrant than the other. According to the variability thesis, cognitivists accurately capture some aspects of what we think and say when we use moral terms and non-cognitivists capture other aspects, but neither side provides a correct analysis of ordinary moral thought and language as a whole. (shrink)

We claim that the Universe’s fundamental structure is not discoverable through rationalism. The various frameworks studied are logic, mathematics, their application through theories in physics, and finally, the pivotally separate application of logic to historical evidence in formal religious belief. The basis of the prohibition is that rational structure has a limit for consistency that falls short of completeness in absolute terms. The limit of observability reaches only a framework in which correlated elements are formed paradoxically within a parent structure. (...) Apart from our advanced ability in human reasoning, we have the same fundamental sentience possessed by other living creatures. Beyond that limit of awareness, the Universe in its native form is immaculately nonordered. We examine the dimensional relationship between quantum and classical frameworks to justify the theory. Mathematics requires operational consistency across its elements. In contrast, the Universe incorporates a feature of inconsistency in its native form. The companion paper to this document examines in detail how complexity develops from a null condition across dimensional levels. The argument’s foundation applies a general framework of stationary action and self-organization principles to the theory and experimental data on Hardy’s paradox. The complementary format to the dichotomy of paradoxical elements is its sliding scale of uncertainty between their extremes. The argument extends that the root source of societal biases, conflicts, and bigotries is the fundamental and systemic mechanism of paradox. (shrink)

This article outlines the context in which General National Vocational Qualifications (GNVQs) have been developed with particular reference to the independent learning dimension of their principles and practice. It provides an overview of the problems associated with the GNVQ approach from the literature and from a study by the authors of twelve post-16 institutions in the process of implementing Advanced GNVQ programmes. It analyses the dimensions of independent learning and argues that GNVQs provide a hybrid learner experience in which autonomy (...) in the organisation of the individual learning process is mediated by a heavily prescribed GNVQ framework. The article concludes by locating this paradox in four central dilemmas characterising post-16 curricular policy in the UK. (shrink)

One of the most significant disputes in early modern philosophy was between the moral rationalists and the moral sentimentalists. The moral rationalists — such as Ralph Cudworth, Samuel Clarke and John Balguy — held that morality originated in reason alone. The moral sentimentalists — such as Anthony Ashley Cooper, the third Earl of Shaftesbury, Francis Hutcheson and David Hume — held that morality originated at least partly in sentiment. In addition to arguments, the rationalists and sentimentalists developed rich analogies. The (...) most significant analogy the rationalists developed was between morality and mathematics. The most significant analogy the sentimentalists developed was between morality and beauty. These two analogies illustrate well the main ideas, underlying insights, and accounts of moral phenomenology the two positions have to offer. An examination of the two analogies will thus serve as a useful introduction to the debate between moral rationalism and moral sentimentalism as a whole. (shrink)

This book offers a sustained examination of the core Stoic ethical claims and their significance for modern moral theory. The first part considers the Stoic ideas of happiness as the life according to nature and virtue as expertise in leading a happy life and explores the senses of ‘nature’ (both human and universal) relevant for ethics. It also explains the distinction in value between virtue and ‘indifferents’ and analyses virtuous practical deliberation as selection between ‘indifferents’ directed at leading a happy (...) human life. The second part studies Stoic thinking on ethical development (in their terms, learning to live naturally). It brings out the close interconnections between making progress in ethical understanding, in forming and deepening social relationships, and in emotional responses. The third part discusses how Stoic ethics, as interpreted here, can contribute to contemporary moral theory, especially virtue ethics. It suggests that Stoic thinking on the virtue-happiness relationship offers a cogent alternative to Aristotle, currently the main ancient prototype for virtue ethical theory. It explores ways in which Stoic ideas on human and universal nature can contribute to modern ethical debates, notably on how to respond effectively to the pressing challenge of climate breakdown. It also highlights the potential value of Stoic thinking on development and guidance for modern virtue ethics as well as discussing the powerful impact Stoicism has already had in contemporary ‘life-guidance’. (shrink)

Many moral philosophers in the Western tradition have used phenomenological claims as starting points for philosophical inquiry; aspects of moral phenomenology have often been taken to be anchors to which any adequate account of morality must remain attached. This paper raises doubts about whether moral phenomena are universal and robust enough to serve the purposes to which moral philosophers have traditionally tried to put them. Persons’ experiences of morality may vary in a way that greatly limits the extent to which (...) moral phenomenology can constitute a reason to favor one moral theory over another. Phenomenology may not be able to serve as a pre-theoretic starting point or anchor in the consideration of rival moral theories because moral phenomenology may itself be theory-laden. These doubts are illustrated through an examination of how moral phenomenology is used in the thought of Ralph Cudworth, Samuel Clarke, Joseph Butler, Francis Hutcheson, and Søren Kierkegaard. (shrink)

This paper presents a poststructuralist, postcolonial and feminist interrogation of the ‘Girl Effect’. First coined by Nike inc, the ‘Girl Effect’ has become a key development discourse taken up by a wide range of governmental organisations, charities and nongovernmental organisations (NGOs). At its heart is the idea that ‘girl power’ is the best way to lift the developing world out of poverty. As well as a policy discourse, the Girl Effect entails an address to Western girls. Through a range of (...) online and offline publicity campaigns, Western girls are invited to take up the cause of girls in the developing world and to lend their support through their use of social media, through fundraising and consumption. Drawing on a wide range of policy documents, media outputs and offline events, this paper explores the way in which the Girl Effect discourse articulates notions of girlhood, empowerment, development and the Global North/south divide. (shrink)

ABSTRACTThis paper explicates Shaftesbury’s idea that we ought to live our lives as though they are works of art. I show that this idea is central to many of Shaftesbury’s most important claims, and that an understanding of this idea enables us to answer some of the most contested questions in the scholarship on Characteristics.

The Cambridge Platonists were a group of religious thinkers who attended and taught at Cambridge from the 1640s until the 1660s. The four most important of them were Benjamin Whichcote, John Smith, Ralph Cudworth, and Henry More. The most prominent sentimentalist moral philosophers of the Scottish Enlightenment – Hutcheson, Hume, and Adam Smith – knew of the works of the Cambridge Platonists. But the Scottish sentimentalists typically referred to the Cambridge Platonists only briefly and in passing. The surface of Hutcheson, (...) Hume, and Smith's texts can give the impression that the Cambridge Platonists were fairly distant intellectual relatives of the Scottish sentimentalists – great great-uncles, perhaps, and uncles of a decidedly foreign ilk. But this surface appearance is deceiving. There were deeply significant philosophical connections between the Cambridge Platonists and the Scottish sentimentalists, even if the Scottish sentimentalists themselves did not always make it perfectly explicit. (shrink)

We suggest that mammalian endothermy was established amongst Middle Jurassic crown mammals, through reviewing state‐of‐the‐art fossil and living mammal studies. This is considerably later than the prevailing paradigm, and has important ramifications for the causes, pattern, and pace of physiological evolution amongst synapsids. Most hypotheses argue that selection for either enhanced aerobic activity, or thermoregulation was the primary driver for synapsid physiological evolution, based on a range of fossil characters that have been linked to endothermy. We argue that, rather than (...) either alternative being the primary selective force for the entirety of endothermic evolution, these characters evolved quite independently through time, and across the mammal family tree, principally as a response to shifting environmental pressures and ecological opportunities. Our interpretations can be tested using closely linked proxies for both factors, derived from study of fossils of a range of Jurassic and Cretaceous mammaliaforms and early mammals. (shrink)