This essay examines the reception of Ivan Pavlov’s work on conditioned reflexes in early to mid-twentieth century Britain. Recent work on the political interpretation of biology has shown that the nineteenth-century strategy of “making socialists” was undermined by August Weismann’s attacks on the inheritance of acquired characters. I argue that Pavlov’s research reinvigorated socialist hopes of transforming society and the people in it. I highlight the work of Pavlov’s interpreters, notably the scientific journalist J. G. Crowther, the biologist Lancelot Hogben, (...) and the science writer H. G. Wells, who made Pavlov’s work accessible to a British audience and embraced the socialist implications of his research – especially the idea that people could be persuaded to become socialists through science writing for a nonspecialist audience and through use of a simplified language such as Basic English. They saw, in the followers of National Socialism, how Pavlovian conditioning could create a national movement, and believed that this could be used for their own more democratic form of socialism. In the final part of the essay, I suggest that this broad socio-cultural movement to reshape humanity proved controversial, especially in the post-war period and in light of Soviet use of brainwashing. The likes of Aldous Huxley and F. A. Hayek feared that conditioning could only lead to totalitarianism, while the historian E. P. Thompson put forward a socialist humanism that left room for human agency. (shrink)

Artificial intelligence (AI) shares many generalizability challenges with psychology. But the fields publish differently. AI publishes fast, through rapid preprint sharing and conference publications. Psychology publishes more slowly, but creates integrative reviews and meta-analyses. We discuss the complementary advantages of each strategy, and suggest that incorporating both types of strategies could lead to more generalizable research in both fields.

The admiration of the Soviet Union amongst Britain's interwar scientific left is well known. This article reveals a parallel story. Focusing on the biologists Julian Huxley and Lancelot Hogben and the scientific journalist J.G. Crowther, I show that a number of scientific thinkers began to look west, to the US. In the mid- to late 1930s and into the 1940s, Huxley, Crowther and Hogben all visited the US and commented favourably on Roosevelt's New Deal, in particular its experimental approach to (...) politics (in the form of planning). Huxley was first to appreciate the significance of the experiment; he looked to the Tennessee Valley Authority as a model of democratic planning by persuasion that could also be applied in Britain. Crowther, meanwhile, examined the US through the lens of history of science. InFamous American Men of Science(1937) and in lectures at Harvard University, he aimed to shed light on the flaws in the Constitution which were frustrating the New Deal. Finally, Hogben's interest in the US was related to his long-standing opposition to dialectical materialism, and when he finally saw the US at first hand, he regarded it as a model for how to bring about a planned socialist society through peaceful persuasion. (shrink)

Differences in infant caregiving behavior between cultures have long been noted, although the quantified comparison of touch-based caregiving using uniform standardized methodology has been much more limited. The Parent-Infant Caregiving Touch scale was developed for this purpose and programming effects of early parental tactile stimulation on infant hypothalamic-pituitary adrenal -axis functioning, cardiovascular regulation and behavioral outcomes, similar to that reported in animals, have now been demonstrated. In order to inform future studies examining such programming effects in India, we first aimed (...) to describe and examine, using parametric and non-parametric item-response methods, the item-response frequencies and characteristics of responses on the PICTS, and evidence for cross-cultural differential item functioning in the United Kingdom and India. Second, in the context of a cultural favoring of male children in India, we also aimed to test the association between the sex of the infant and infant “stroking” in both cultural settings. The PICTS was administered at 8–12 weeks postpartum to mothers in two-cohort studies: The Wirral Child Health and Development Study, United Kingdom and the Bangalore Child Health and Development Study, India. Mokken scale analysis, parametric item-response analysis, and structural equation modeling for categorical items were used. Items for two dimensions, one for stroking behavior and one for holding behavior, could be identified as meeting many of the criteria required for Mokken scales in the United Kingdom, only the stroking scale met these criteria in the sample from India. Thus, while a comparison between the two cultures was possible for the stroking construct, comparisons for the other non-verbal parenting constructs within PICTS were not. Analyses revealed higher rates of early stroking being reported for the United Kingdom than India, but no sex differences in rates in either country and no differential sex difference by culture. We conclude that PICTS items can be used reliably in both countries to conduct further research on the role of early tactile stimulation in shaping important child development outcomes. (shrink)

How did the universe begin? What is truth? How can we live good live? The Little Book of Philosophy answers these questions and more. Packed with simple explanations, witty illustrations, and step-by-step diagrams that untangle complex theories, you'll find plenty of food for thought in this book, whether you're a novice, a student, or an armchair philosopher"--Page 4 of cover.

As the proportion of children with chronic conditions has increased exponentially over the last decades, there has been necessity for evolution of definitions, care models, and systems for their care. Chapter 2 discusses the further refinement of the definition of children with medical complexity and explores in depth the development of models of care for these children and how the workforce has started to meet the needs of this growing population. This chapter also touches on how these systems and models (...) are beginning to integrate into the established pediatric frameworks of clinical care, financial reimbursement, and community supports. This includes discussion of shared decision making, coordination of care, and examples of integration between subspecialities, including palliative care. The burgeoning and critical subfield of transitional care to adulthood for children with medical complexity is also touched on. (shrink)

This chapter focuses on the critical policies and practices aimed at enhancing the value of care for children with medical complexity (CMC). CMC represent a critical demographic within pediatric healthcare, necessitating targeted policies to enhance care value. Despite constituting only 1.5% of the pediatric population, CMC account for a substantial proportion of healthcare utilization and expenditure. Direct costs alone constitute over one-third of total pediatric healthcare expenses, while indirect costs remain challenging to quantify yet significantly high. Over the past two (...) decades, specialized care models have been developed to address the unique needs of CMC. However, existing payment models have struggled to keep pace. Recent advancements include reimbursement for indirect care, care coordination, and waivers to traditional Medicare eligibility. These emerging payment models hold promise for more effectively meeting the needs of the CMC population, improving the quality of their care, and reducing the financial burden on healthcare systems. (shrink)

Children with medical complexity (CMC) are a small, rapidly growing, and impactful pediatric population. Healthcare systems designed for typically developing children cannot singlehandedly meet the needs of CMC and their families. In this chapter, we discuss individual and collective experiences over the last two decades and lessons learned to envision a better future system of care for CMC and their families. Families, providers, payers, policy makers, and community systems agree that CMC and their families require effectively functioning systems of healthcare (...) that are accessible, high-value, and responsive. We are called to prepare a future workforce that will thrive in appropriately resourced models of care delivery. We invite providers, policy makers, and communities to partner with families in designing these systems. CMC and their families remind us that humanism, kindness, and community are the reasons we invest in the public health of caring. (shrink)

Having a child with medical complexity (CMC) greatly impacts parents and siblings, and can negatively affect the socioeconomic status of the family. Supporting families in caring for their children is paramount to improving the health and experiences of CMC. This includes supporting the siblings, seeking out creative ways to provide home nursing, and finding resources such as state Medicaid waiver programs to finance needed equipment and services. National organizations, often parent-led, can provide additional layers of support for families in finding (...) resources. (shrink)

Children with medical complexity are a small but important part of the pediatric population. They make up only 1% of all children but utilize a significant portion of healthcare spending. Their complex medical care can be a source of strain on the families and the health systems in which they participate. Creating systems that support these children are beneficial to the children, their families, and to pediatric healthcare in general. Complex care programs are an emerging part of the solution, leading (...) to more streamlined care. These children need specialized support at school and in the community, and understanding how this all interplays with their health and well-being is essential. This chapter serves as an introduction to the issues that these children and families face which will be further explored in later chapters. (shrink)

The importance of medical ethics in the care of children with medical complexity (CMC) is evidenced across the healthcare continuum, from individual children and their families to provider teams, and from regional to national systems of care. Understanding our recent US history of disability rights and experiences of ableism heightens our awareness of implicit biases and influences our approaches to care. CMC are best served by comprehensive clinical teams that adapt to the changing needs over time, with continuous attention to (...) the unique values and goals of each child and family. Across the lifespan, as CMC and their families encounter critical decision points, shared decision-making processes in goal-directed approaches can support all stakeholders in balancing potential over- and under-utilization of medical care. Medical decisions and healthcare transitions can be optimized when grounded on the pillars of medical ethics: nonmaleficence, beneficence, autonomy, and justice. (shrink)

This book describes the state of the art of pediatric complex care, sharing the authors' decades of experience in an academic health center to illustrate points. The authors are pediatric generalist and subspecialist providers, among others, who care for children with medical complexity in a Pediatric Complex Care program. Children with medical complexity (CMC) are a small yet impactful pediatric population, a subset of children with special healthcare needs that include multi-system, non-categorical, chronic conditions, high resource and technology dependencies, medical (...) fragility, and functional impairments. CMC do not fit into traditional systems of care. They require the continuous collaboration of pediatric subspecialists, community and public health partners, and family caregivers. The field of Pediatric Complex Care is rapidly evolving, yet lacks a well-prepared workforce built on clear educational competencies and clinical guidelines. In this compact volume, the authors review models of care for CMC, and how these models intersect with larger public health systems, dependent on collaborative networks of community-based and family partnerships. They explore ethical considerations, including implications for policy and practice. Among the topics covered are: The Specialty and Scope of Complex Care Pediatrics Ethical Considerations in the Care of Children with Medical Complexity Implications for Policy and Practice Healthcare Delivery for Children with Medical Complexity: The State of the Art and Future Directions is an essential resource for all medical professionals who care for CMC, public policy makers, medical educators, healthcare leaders, and community partners and stakeholders. (shrink)

The successful city of the future must do more than simply foster economic growth. It must also impart a moral, even spiritual, vision that can transcend all racial and social divisions.

Books Reviewed in this Article: Introduction to the Critical Study of the Text of the Hebrew Bible. By J. Weingreen. Pp.vii, 103, Oxford, Clarendon Press; New York, Oxford University Press, 1982, £5.50. The Archaeology of the Land of Israel. By Yohanan Aharoni. Pp.xx, 344, Philadelphia, The Westminster Press, 1982, $27.50, $18.95 ; London, SCM Press, 1982, £12.50. A Commentary on the Gospel of Mark. By Terence J. Keegan. Pp.183, New York, Paulist Press, and Leominster, Fowler Wright Books, 1981, £4.45. The (...) Panorama of Luke: An Introduction to the Gospel of Luke and the Acts of the Apostles. By Neil Richardson. Pp.116, London, Epworth Press, 1982, £3.95. The Synoptic Gospels: An Introduction. By Keith F. Nickle. Pp.119, London SCM Press, 1982, £5.50. What is a Gospel? By Nicholas King. Pp.132, Leigh‐on‐Sea, Kevin Mayhew, 1982, £3.00. The Women Around Jesus: Reflections on Authentic Personhood. By Elisabeth Moltmann‐Wendel, translated by J. Bowden. Pp.xii, 148, London, SCM Press, 1982, £3.95. Paul and Paulinism: Essays in honour of C.K. Barrett. Edited by M.D. Hooker and S.G. Wilson. Pp.xxvii, 404, London, SPCK, 1982, £25.00. Divine Revelation and the Limits of Historical Criticism. By William J. Abraham. Pp.222, Oxford, Oxford University Press, 1982, £15.00. The Social Teaching of Vatican II. By Rodger Charles with Drostan Maclaren. Pp.xxvi, 569, San Francisco, Ignatius Press; Oxford, Plater Publications, 1982, £12.75. Option for the Poor: A Hundred Years of Vatican Social Teaching. By Donal Dorr. Pp.viii, 328, New York, Orbis Books; Dublin, Gill & Macmillan, 1983, £7.95. The Kindness that Kills. Edited by Digby Anderson. Pp.xii, 170, London SPCK, 1984, £3.95. Communism in the Bible. By José Porfiro Miranda. Pp.x, 86, London, SCM Press Ltd. 1982, £3.50. Why I am still a Catholic. Edited by Robert Nowell. Pp.157, London, Collins, 1982, £4.95. Does God Answer Prayer? By Peter Baelz. Pp.55, London, Darton, Longman and Todd, 1982, £1.95. A Cry for Mercy. By Henri J.M. Nouwen. Pp.175, Dublin, Gill and Macmillan, 1982, £3.50. The Living Reminder. By Henri J.M. Nouwen. Pp.80, Dublin, Gill and Macmillan, 1982, £2.95. Making All Things New. By Henri J.M. Nouwen. Pp.95, Dublin, Gill and Macmillan, 1982. £2.95. Picturing God. By Norman Pittenger. Pp.x, 147, London, SCM Press, 1982, £4.50. Christotherapy II, The Fasting and Feasting Heart. By Bernard J. Tyrrell. Pp.xiii, 337, New York, Paulist Press, 1982, £6.70. With Respect: A Doctor's Response to a Healing Pope. By Frank Lake. Pp.xxiii, 327, London, Darton, Longman and Todd, 1982, £6.95. Euthanasia and Clinical Practice: Trends, Principles and Alternatives: The Report of a Working Party. Pp.viii, 88, London, The Linacre Centre, 1982, £2.75. Essays in Religion and Morality. By William James. Pp.xxviii, 345, Cambridge, Harvard University Press, 1982, £17.50. Freud and Jung: Conflicts of Interpretation. By Robert Steele. Pp.vii, 390, London, Routledge and Kegan Paul, 1982, £14.95. Archetype: A Natural History of the Self. By Anthony Stevens. Pp.xi, 324, London, Routledge and Kegan Paul, 1982, £12.50. The Seeing Eye: Hermeneutical Phenomenology in the Study of Religion. By Walter L. Brenneman Jr. and Stanley O. Yarian, in association with Alan M. Olson. Pp.xii, 177, University Park and London, The Pennsylvania State University Press, 1982, £8.10. Contemporary Philosophy of Religion. Edited by S.M. Cahn and D. Schatz. Pp.x, 310, Oxford University Press, 1982, £6.95. Beyond Empiricism: Philosophy of Science in Sociology. By Andrew Tudor. Pp.xii, 213, London, Routledge & Kegan Paul, 1982, £4.95. Philosophy and Human Geography: An Introduction to Contemporary Approaches. By R.J. Johnston. Pp.viii, 152, London, Edward Arnold, 1982, £5.50. The Literate Revolution in Greece and its Cultural Consequences. By Eric A. Havelock. pp.viii, 362, Princeton, Princeton University Press, 1982, £17.70, £6.30. The Philosophy of Robert Grosseteste. By James McEvoy. Pp.xviii, 560, Oxford, Clarendon Press, 1982, £35.00. Kant's Life and Thought. By Ernst Cassirer, translated by James Haden, introduction by Stephan Körner. Pp.xxiii, 429, New Haven, Yale University Press, 1981, £17.50. Kant's Theory of Form: An Essay on the Critique of Pure Reason. By Robert B. Pippin. Pp.xii, 247, New Haven and London, Yale University Press, 1982, £16.50. The Basic Problems of Phenomenology. By Martin Heidegger, translated by Albert Hofstadter. Pp.xxxi, 396, Bloomington, Indiana, Indiana University Press, 1982, £16.50. In the Active Voice By Mary Douglas. Pp.xi, 306, London, Routledge and Kegan Paul, 1982, £9.75. Structural Sociology. Edited by Ino Rossi. Pp.xiv, 363, New York, Columbia University Presss, 1982, £45.50. A Vanquished Hope: The Movement for Church Renewal in Russia, 1905–1906. By J.W. Cunningham. Pp.384, Crestwood, St Vladimir's Seminary Press, 1981, £7.95. Christians in Ulster 1968–1980. By Eric Gallagher and Stanley Worrall. P.241, Oxford University Press, 1982, £10.00. Scotland and the Papacy. By John Cooney. Pp.126, Edinburgh, Paul Harris, 1982, £8.95, £4.95. Scotia Pontificia. Edited by Robert Somerville. Pp.xiii, 177, Oxford, Clarendon Press: Oxford University Press, 1982, £25.00. (shrink)

The Flats, a district near downtown Cleveland, was once was the vibrant heart of Midwestern industry and is now in the throes of change: Some of its warehouses and factories have been transformed into nightclubs and restaurants, while homes in adjacent neighborhoods have been replaced by mini-mansions. In Cleveland, photographer Andrew Borowiec documents the Flats today and evokes the way of life they once embodied. Given the rare opportunity to access one of Cleveland's vast steel mills before it was (...) modernized or destroyed, Borowiec employed his camera to explore the Flats and its monuments of American industry. His striking black and white images reveal the broken power and vulnerability of the once-mighty mill as well as its relation to the surrounding city and its neighborhoods. The commercial buildings, factories, warehouses, and iron bridges that sustained Cleveland's industrial pulse convey a quiet dignity in these compelling photographs, as do the modest frame houses that sheltered those who labored for decades in the Flats. As Clevelanders struggle to redefine themselves as citizens of a twenty-first-century corporate metropolis, the Flats stand as a haunting testament to a time when men worked with their hands and steel was indeed the backbone of our nation. Borowiec's compassionate but unflinchingly honest gaze challenges us to look both at and beyond the images of Cleveland and to meditate on our common history of loss and rebirth. (shrink)

Recent work on the subject speaks to the importance trust has for firm performance (e.g., Hagen and Choe, 1999; Hill, 1995). Yetlittle work has been done to show how context affects the ability of firms to create trust in relationships with key stakeholders. This paperlooks at how the institutional environment may affect the performance of different strategies for managing firm-stakeholder relationships, and in turn, how this affects firm performance. The authors put forward propositions that build on these theoretical insights (...) and offer prospects for future empirical work. (shrink)

One issue concerning Kant’s moral theory discussed in Tom Hill’s “Personal Values and Setting Oneself Ends,” is whether Kant’s conception of rational volition properly interpreted is committed to a strong thesis about the relation between rational volition and the moral law, according to which rational volition is based on practical reasoning aimed at judgments of goodness that make a tacit claim to universality. This thesis amounts to the controversial claim that in Kant’s view all rational volition is guided by (...) the Universal Law formulation of the categorical imperative, or at least something like this formula, as its formal constitutive norm. The aim of this chapter is to examine the textual and doctrinal support for this particular “rationalist thesis about the will” and its implications for Kant’s practical philosophy. It proceeds by developing a conception of rational volition, based on Kant’s writings, as well as doctrinal considerations, according to which the rationalist thesis does hold. (shrink)

Nancy Cartwright begins her recent book, Hunting Causes and Using Them, by noting that while a few years ago real causal claims were in dispute, nowadays “causality is back, and with a vengeance.” In the case of the social sciences, Keith Morrison writes that “Social science asks ‘why?’. Detecting causality or its corollary—prediction—is the jewel in the crown of social science research.” With respect to the health sciences, Judea Pearl writes that the “research questions that motivate most studies in the (...) health sciences are causal in nature.” However, not all data used by people interested in making causal claims come from experiments that use random assignment to control and treatment groups. Indeed, much research in the social and health science depends on non-experimental, observational data. Thus, one of the most important problems in the social and health sciences concerns making warranted causal claims using non-experimental, observational data; viz., “Can observational data be used to make etiological inferences leading to warranted causal claims?” This paper examines one method of warranting causal claims that is especially widespread in epidemiology and the health sciences generally—the use of causal criteria. It is argued that cases of complex causation generally, and redundant causation—both causal overdetermination and causal preemption—specifically, undermine the use of such criteria to warrant causal claims. (shrink)

Ten years ago, I stopped work as a junior doctor at a provincial New Zealand hospital and enrolled in a creative writing degree. I finished on a night shift—quiet, but marred by a particularly upsetting case of domestic violence. I remember getting changed at the end of the night into my own clothes, stuffing the scrubs I’d been wearing into the laundry bag that hung outside the doctor’s lounge, and leaving the hospital to pack for the move to a new (...) city. It was a strange way to finish, on a Sunday morning, without the colleagues in the Woman, Child and Family service with whom I’d spent so much time.For the next year, instead of ward rounds, night shifts, and on-call, I read, wrote poetry, and trekked up the hill.. (shrink)

A review‐article of Loren Baritz, City On a Hill, A History of Ideas and Myths in America, John Wiley and Sons C. Wright Mills, Sociology and Pragmatism, Paine‐Whitman Publishers Roderick M. Chisholm, Herbert Feigl, William K. Frankena, John Passmore, Manley Thompson, Philosophy, Prentice‐Hall Max Black, Philosophy in America, Cornell University Press.

This is a review of Jaegwon Kim's Physicalism, Or Something Near Enough. It focuses (i) on his claim that mental properties can be causally efficacious only if they are, in a certain sense, functionally reducible to the physical, and (ii) on his criticisms of best-explanation arguments for physicalism as advocated by, e.g., Christopher Hill and Brian McLaughlin.

The Red Hills section of northern Florida is composed of Leon County, where Tallahassee is located, and its neighboring counties of Gadsden and Jackson to the west and Jefferson and Madison to the east. The land is distinctive band of rolling red clay hills that extends for 150 miles along the border of Alabama and Georgia. This well-written narrative chronicles the history of the region from the time of first European contact in 1528 through the end of the Civil War, (...) and provides a comprehensive study of this vital section of northern Florida. Recent excavation of the Tallahassee area provided anthropological and archaeological evidence showing that the Red Hills of Florida were sought out by agricultural Indians long before European contact. DeSoto fed his army of more that 700 during the winter of 1539-40 from corn gathered within a few miles of the principal town of the Apalachee. The Spaniards who settled in the Apalachee area during the mission era depended on the corn for survival and used the Indians of the 14 Apalachee mission in a war of empire building with the English of South Carolina. Raids by these enemies wiped out the Indians of the Apalachee area and its mission in 1704. In 1818 Andrew Jackson defeated the successors of the Apalachee in the Red Hills, the Seminoles, and after Florida became American territory in 1821, Governor Du Val planned the town of Tallahassee near the original DeSoto winter campsite. Farsighted Du Val used a site plan that provide for future expansion. Farmers were shipping cotton from the region as early as 1820, but the full development of the plantation economy had to await the removal of the Seminoles. From the 1840s through the Civil War cotton was the major crop which supported the social, political, and economic growth of this pivotal area of north Florida know as the Red Hills. (shrink)

Traditionally, medical professionals have taken a paternalistic stance towards their patients and have relied on a traditional approach to medical ethics. In recent years, in Britain, however, a new ‘managerialism’ has developed in the National Health Service (the NHS). This stresses consumerism and greater patient choice and is changing the relationship between doctors and patients. This paper draws out the implications for patients. It describes the ethical characteristics of the two conflicting approaches and argues the need to stress again the (...) view of the patient as an individual person. (shrink)

In February 1999, I received a call from a lawyer at Hill Abra Dewar stating that she had instructions to retain my services as an expert witness in the case of Sawatzky v. Riverview Health Centre. She was representing the Manitoba League of Persons with Disabilities which had intervenor status.In Canada the admission of expert testimony depends upon the application of four criteria outlined in R. v. Mohan by Justice Sopinka. These criteria are: relevance; necessity in assisting the trier (...) of fact, the absence of any exclusionary rule; and a properly qualified expert. The lawyer believed that I could provide the court with relevant, reliable ethics testimony about surrogate decision-making and about medical futility-information that likely would be outside the experience and knowledge of the trier of fact. (shrink)

Dudgeon, William (1705/6–1743), freethinker and philosopher, is of unknown origins. A tenant farmer who resided at Lennel Hill Farm, near Coldstream, Berwickshire, he was one of several philosophers active in the borders area of Scotland during this period. Other figures in this group include Andrew Baxter, Henry Home (Lord Kames), and most importantly David Hume.....

As the subtitle indicates, this book is concerned with the relationship between consciousness and the physical world. It recommends a novel and disturbingly pessimistic view about this topic that it calls “naturalistic mysterianism.” The view is naturalistic because it maintains that states of consciousness are reducible to physical properties of the brain. It counts as “mysterian” because it asserts that the physical properties in question are entirely beyond our ken—that they lie well beyond the scope of contemporary neuroscience, and quite (...) likely beyond the scope of any body of scientific knowledge that we might develop in the future. Naturalistic mysterianism thus affirms the unity of consciousness with the physical world, while also claiming that the nature of that unity will forever elude us, due to inherent limits of our cognitive capacities. (shrink)

With the progress of science we become more and more aware of the undiscovered, and of our feebleness to visualize or express what is dimly known to us. Geologists estimate that man evolved some 1,000,000 years ago on an earth which astronomers say is some 2,000,000,000 years old. Caution is required in accepting such figures, for we must remember how far out Lord Kelvin was in estimating the age of the earth—before the discovery of radium. Man has been civilized for (...) some 5,000 years, and Galileo, with his telescope and revolutionary ideas, lived some 300 years ago. There may be, we are told, a million million years before the sun grows weak and the earth becomes farther from the sun so that all life freezes. Long before this man may use up the metals available for his machines, and those ready sources of energy now so wastefully used, by which he at present multiplies and swarms in cities. In such case he will return through birth control or famine, or both, to a simple, uncrowded, pastoral existence. There is little likelihood of his being able to use atomic energy, other than that which reaches the earth as sun radiation and is available directly or as energy stored in water-power, wood, coal, and oil. (shrink)

Objectives: To explore how subjects in a placebo-controlled vitamin A supplementation trial among Ghanaian women aged 15–45 years perceive the trial and whether they know that not all trial capsules are the same, and to identify factors associated with this knowledge.Methods: 60 semistructured interviews and 12 focus groups were conducted to explore subjects’ perceptions of the trial. Steps were taken to address areas of low comprehension, including retraining fieldworkers. 1971 trial subjects were randomly selected for a survey measuring their knowledge (...) that not all trial capsules are the same. The subjects’ fieldworkers were also interviewed about their characteristics and trial knowledge. Factors associated with knowledge were explored using multi-level modeling.Results: Although subjects knew they were taking part in research, most thought they were receiving an active and beneficial medication. Variables associated with knowledge were education and district of residence. Radio broadcasts benefited those with some schooling. Fieldworkers’ characteristics were not associated with subjects’ knowledge.Conclusions: Research and debate on new or improved consent procedures are urgently required, particularly for subjects with little education. (shrink)