The medical gaze has long been privileged over the voice of the patient as the source of medical knowledge, in western societies. The ontology (that is, the very existence) of symptoms invisible to scientific observation will thus tend to be questioned by medical professionals. Yet any gaze, even the medical one, is refracted through the lenses both of social‐cultural stereotypes and of gender, and its seeings are shaped by these refractions. In this article, two family physicians and an epistemologist examine certain “unexplained” disorders, in a conversation informed by a feminist perspective: they bring a feminist point of view to bear on these issues. Medically unexplained disorders, which occur most frequently in women, are disabling conditions for which objectively observable symptoms and/or scientific causal explanations are not available. The approach taken in this article makes some of the assumptions underlying clinical knowledge more clearly visible: the authors' conversation situates diagnostic activity in medicine as a gendered, power‐infused social interaction within a cultural context where the gold standard of medical knowledge is very narrowly set. The participants propose responsible and responsive knowing as alternative strategies for knowing well. As they are presented here, these strategies incorporate an awareness of the inherent uncertainty of medical knowledge, raise questions about those to whom the knower is accountable, acknowledge the patient's experiences, and attend to the potentially oppressive effects of expert knowing. 相似文献
This article provides an overview of the motivation for digitising Maynard's writings, evaluates the benefits and challenges of reproducing and publishing archives, and considers the implications of greater digitisation. Maynard's writings reveal that she drew on her evangelical belief system as a means of protection and inspiration, and never overcame the concerns of early educationalists to maintain ‘decorum’ and ‘femininity’ in the management of the college. Published and unpublished sources are considered to review Maynard's decision to enter higher education, the inspiration for a Christian college for women, impact of contemporary arguments opposing education for women on Maynard and Westfield College, and Maynard's reaction to the development of a science faculty in the early twentieth century. 相似文献
While block randomized designs have become more common in place-based policing studies, there has been relatively little discussion of the assumptions employed and their implications for statistical analysis. Our paper seeks to illustrate these assumptions, and controversy regarding statistical approaches, in the context of one of the first block randomized studies in criminal justice—the Jersey City Drug Market Analysis Project (DMAP).
Methods
Using DMAP data, we show that there are multiple approaches that can be used in analyzing block randomized designs, and that those approaches will yield differing estimates of statistical significance. We develop outcomes using both models with and without interaction, and utilizing both Type I and Type III sums-of-squares approaches. We also examine the impacts of using randomization inference, an approach for estimating p values not based on approximations using normal distribution theory, to adjust for possible small N biases in estimating standard errors.
Results
The assumptions used for identifying the analytic approach produce a comparatively wide range of p values for the main DMAP program impacts on hot spots. Nonetheless, the overall conclusions drawn from our re-analysis remain consistent with the original analyses, albeit with more caution. Results were similar to the original analyses under different specifications supporting the identification of diffusion of benefits effects to nearby areas.
Conclusions
The major contribution of our article is to clarify statistical modeling in unbalanced block randomized studies. The introduction of blocking adds complexity to the models that are estimated, and care must be taken when including interaction effects in models, whether they are ANOVA models or regression models. Researchers need to recognize this complexity and provide transparent and alternative estimates of study outcomes.
It appears that large-scale population genetic studies are the necessary next step in genomics research. Such studies promise to provide correlative data to permit researchers to understand the etiology of a vast array of complex human diseases. Simultaneously, such studies are increasingly seen as yet another mechanism for the developed world to benefit at the expense of the developing world. In fact, a recent World Health Organization Report suggests that "without explicit attention at the international level, the initial technological fruits of genomics are likely to consist primarily of therapeutic and diagnostic applications for conditions affecting large populations in rich countries." (World Health Organization, Genomics and World Health, 2002). In developed and developing countries alike, there are concerns that the pharmaceutical industry stands to gain at the expense of the population(s) from which population genetic data are derived. In light of the current interest concerning ongoing population genetic studies and an increasing interest by many countries, Canada included, in embarking on large-scale population genetic research, it is appropriate to consider the concept of benefit-sharing as a potential mechanism to assuage these concerns. It is the author's position that by virtue of common law equitable principles and developing norms in international law, including the Human Genome Organization Statement on Benefit-Sharing, that there are principled legal and ethical reasons to compel the sharing of benefits that accrue from the commercialization of the resulting data. Using the United Nations Convention on Biological Diversity and the Bonn Guidelines as a model, I suggest that appropriate benefit-sharing mechanisms have been considered in the context of non-human biological materials and that these same mechanisms may be applicable in the context of international and intra-national population genetic studies. 相似文献