Bolivian health and social care professionals' experiences of decision-making in oncology and palliative care

In the UK, end-of-life care strategies recommend patients and families are involved in decision making around treatment and care. In Bolivia, such strategies do not exist, and access to oncology services depends on finance, geography, education and culture. Compared to more developed countries, the delivery of oncology services in Latin America may result in a higher percentage of patients presenting with advanced incurable disease. The objective of this study was to explore decision-making experiences of health and social care professionals who cared for oncology and palliative care patients attending the Instituto Oncológico Nacional, Cochabamba (Bolivia). Patients were predominantly from the Quechua tradition, which has its own ethnic diversity, linguistic distinctions and economic systems. Qualitative data were collected during focus groups. Data analysis was conducted using Interpretative Phenomenological Analysis. Three interrelated themes emerged: (i) making sense of structures of experience and relationality; (ii) frustration with the system; and (iii) the challenges of promoting shared decision making. The study uncovered participants' lived experiences, emotions and perceptions of providing care for Quechua patients. There was evidence of structural inequalities, the marginalisation of Quechua patients and areas of concern that social workers might well be equipped to respond to, such as accessing finances for treatment/care, education and alleviating psychological or spiritual suffering.

Luce Irigaray: Back to the Beginning

In 2014 it will be 40 years since Luce Irigaray’s (second) doctoral thesis Speculum de l'autre femme was first published. That book, widely recognized as the most important text in feminist philosophy, was to introduce Irigaray’s critique of western philosophy and psychoanalysis and her ethics of sexual difference for which she was to become so well known. Irigaray, well into her eighties now, has published continuously since Speculum, despite her exclusion from French academic life after her expulsion in 1974 from the Université de Paris VIII Vincennes. That her latest book In the Beginning, She Was, released on the eve of Speculum’s anniversary, is perhaps the most personally revelatory of her works and revisits many of the same themes and issues that concerned her in Speculum cannot be coincidental. In this critical notice we examine Irigaray’s latest offering arguing that her contribution is twofold as she combines with new clarity her longstanding critique of phallocratic culture and her transformative vision of humanity as a culture of sexuate difference. There are a number of important themes addressed in the six chapters of the book, but for the purposes of this discussion our analysis will focus mostly on elaborating her critique of Western culture, on the usefulness of her work for rethinking masculine subject formation and on the figure of Antigone, as a feminine subject on her own terms, as a way of imagining a possible relation between two subjects within a culture of sexuate difference. We argue that this book continues to illustrate Irigaray’s importance as one of the most radical and prophetic philosophers of our time.

Deliberative Perfectionism: Why We Can and Should Talk about the Good

In contemporary political theory, perfectionists believe that the state should promote substantive conceptions of the good through its legislation. Supporters of neutrality, instead, claim that the state should refrain from doing so. In this article I analyse perfectionism in relation to Jürgen Habermas’ theory of discourse and deliberative politics (1996) and critique Habermas’ distinction between ‘ethical’ and ‘moral’ discourses (1984, 1990). By relating Habermas’ theory to George Sher’s account of perfectionism (1997), I argue that we can establish the meta-ethical grounds for a model of deliberation encompassing ethical matters (that is, questions concerning the good life) not confined to the limits of specific communities. I conclude by arguing that ethical deliberation is not only feasible but also desirable. Given the fact of ethical pluralism, and in order to show respect towards their fellow citizens, political perfectionists ought to be ready to show how their ethical claims (which they want to see translated into state policy) relate to deeper meta-ethical human goals on which we can ideally find a consensus through deliberation.

Cough-generated aerosols of Pseudomonas aeruginosa and other Gram-negative bacteria from patients with cystic fibrosis

BACKGROUND: Pseudomonas aeruginosa is the most common bacterial pathogen in patients with cystic fibrosis (CF). Current infection control guidelines aim to prevent transmission via contact and respiratory droplet routes and do not consider the possibility of airborne transmission. It was hypothesised that subjects with CF produce viable respirable bacterial aerosols with coughing.

METHODS: A cross-sectional study was undertaken of 15 children and 13 adults with CF, 26 chronically infected with P aeruginosa. A cough aerosol sampling system enabled fractioning of respiratory particles of different sizes and culture of viable Gram-negative non-fermentative bacteria. Cough aerosols were collected during 5 min of voluntary coughing and during a sputum induction procedure when tolerated. Standardised quantitative culture and genotyping techniques were used.

RESULTS: P aeruginosa was isolated in cough aerosols of 25 subjects (89%), 22 of whom produced sputum samples. P aeruginosa from sputum and paired cough aerosols were indistinguishable by molecular typing. In four cases the same genotype was isolated from ambient room air. Approximately 70% of viable aerosols collected during voluntary coughing were of particles <or=3.3 microm aerodynamic diameter. P aeruginosa, Burkholderia cenocepacia, Stenotrophomonas maltophilia and Achromobacter xylosoxidans were cultivated from respiratory particles in this size range. Positive room air samples were associated with high total counts in cough aerosols (p = 0.003). The magnitude of cough aerosols was associated with higher forced expiratory volume in 1 s (r = 0.45, p = 0.02) and higher quantitative sputum culture results (r = 0.58, p = 0.008).

CONCLUSION: During coughing, patients with CF produce viable aerosols of P aeruginosa and other Gram-negative bacteria of respirable size range, suggesting the potential for airborne transmission.

"No Artist has Ethical Sympathies": Oscar Wilde, Aesthetics, and Moral Evolution

“There is no mode of action, no form of emotion, that we do not share with the lower animals” (137). This evolutionary claim is not attributable to Darwin, but to Oscar Wilde, who allows Gilbert to voice this bold assertion in “The True Function of Criticism.” While critics have long wrestled with the ethical stance and coherence of Wilde's writings, they have overlooked a significant influence on his work: debates concerning the evolution of morality that animated the periodicals in which he was writing. Wilde was fascinated by the proposition that complex human behaviours, including moral and aesthetic responses, might be traced back to evolutionary impulses. Significantly, he also wrote for a readership already engaged with these controversies.

Between Tradition and Modernity: Determining Spatial Systems of Privacy in the Domestic Architecture of Contemporary Iraq

The notion of privacy represents a central criterion for both indoor and outdoor social spaces in most traditional Arab settlements. This paper investigates privacy and everyday life as determinants of the physical properties of the built and urban fabric and will study their impact on traditional settlements and architecture of the home in the contemporary Iraqi city. It illustrates the relationship between socio-cultural aspects of public/private realms using the notion of the social sphere as an investigative tool of the concept of social space in Iraqi houses and local communities (Mahalla). This paper reports that in spite of the impact of other factors in articulating built forms, privacy embodies the primary role under the effects of Islamic rules, principles and culture. The crucial problem is the underestimation of traditional inherited values through opening social spaces to the outside that giving unlimited accesses to the indoor social environment creating many problems with regard to privacy and communal social integration.

The Victorian Press and the Fairy Tale (paperback)

Victorian writers often claimed that the press was killing the fairy tale. In fact, it ensured the genre's popularity, bringing literary tales and folklore to the first mass readerships. Exploring penny weeklies, adult and children's monthlies, little magazines and the labour press, this innovative study is the first to combine media and fairy tale history. Bringing reading communities back into focus, Sumpter explores ingenious political uses of the fairy tale: in debates over socialism, evolution and race, and in the context of women's rights, decadence and gay culture. The book offers new insights into the popularisation of folklore and comparative science, and also recovers neglected visual material. From the fantasies of Kingsley, MacDonald and J. H. Ewing to the writings of Keir Hardie, Laurence Housman and Yeats, Sumpter reveals that the fairy tale was intimately shaped by the press, and that both were at the heart of nineteenth-century culture.

The paperback edition includes a new Preface.