bluuebunny/crossref_metadata_2025 huggingface dataset:
Fuzzy Logic for Automatic Finite Element Mesh Generation
Authors: Valliappan S. , Pham T. D. , Murti V. , Franklin J.
Published: August 2010

Abstract: This paper presents the development of an automatic two‐dimensional finite element mesh generator where its core algorithm for selecting the optimum splitting line is based on fuzzy logic. With a series of fuzzy IF‐THEN rules, the mesh generator tends to form well‐shaped elements. Most of the elements are quadrilaterals, and for some cases, meshes of all quadrilateral elements are obtained when the fuzzy control is tuned to the basic criteria for creating quadrilaterals. It is observed that furzy control mimics human thinking and performs what one would do. The methodology is simple by its nature, and proved to be elective. In addition, a technique (non‐fuzzy approach) for finding visible nodes in a concave loop as an extension of Talhert and Parkinson's algorithm is also introduced in this paper.
Integrated Information Management Expert System For Structural Engineering of Buildings
Authors: Hong Sung Mok , Kim Chee Kyeong
Published: August 2010

Abstract: This paper describes the development of an integrated Information Management expert system (IMXpert) which enables structural engineers or architects to produce results of high quality within a short time in works related to the structural engineering of buildings. IMXpert gives various data or functions according to the user's request.

The study can be divided into problem analysis and system design. For the systematic representation of building structure and the structural design process, an object‐oriented design method has been used for the problem analysis. Various types of structural components and operations closely related to them have been extracted and defined as independent objects. The complete building structure and structural design process can be represented by combining these objects and operations. A centralized database has been designed for the consistent and integrated management of object instances.
Blocked LU Factorization on a Multiprocessor Computer
Authors: Mohamed A. Gaber , Fox Geoffrey C. , von Laszewski Gregor
Published: August 2010

Abstract: This paper presents implementations of new methods solving LU factorization used in engineering applications. The implementations are done on the Alliant FX/80 mini supercomputer and use Level 3 Basic Linear Algebra Subprograms. Three ways of expressing the LU factorization in terms of blocked algorithms are considered. The performance of the blocked algorithms, using the parallel vector facilities, are compared with a no block algorithm using only subprograms of level I and 2 BLAS.
User Interface Functions for an Analysis Idealization System
Authors: Wentorf Rolf , Shephard Mark S.
Published: August 2010

Abstract: The user interface for an analysis idealization system is described, which is intended for use by design experts. The interface is part of a system to automatically execute analysis for PDEs (Partial Differential Equations), especially by means of the finite element method, and to control the idealizations used in the analysis. The system is designed to be used with commercial modelers and analysis packages, makes use of geometric, attribute and functional models, and addresses the need for multi‐disciplinary analysis support throughout an evolving design. The basics of X/Xt/Motif programming are explained in order to understand the construction of the user interface, and the interface operations are illustrated with examples.
Interactive Craphical Input—Output Systems tor FEM Plate Bending Programs
Authors: Kirchner István
Published: August 2010

Abstract: When supplying finite element model (FEM) plate bending programs with a full‐range interactive graphical input‐output system several graphical problems have to be solved. How can vectors and matrices be found to describe the topology of a figure defined by drawing lines on the screen? How can the information arrays of finite elements be built up when the mesh is given as a set of lines drawn on a screen? What specialities characterise the visualisation processes, in the case of level line figures, pictures according to three‐dimensional visibility, or unfolded cross‐sections? Solutions to some of the most interesting problems will be introduced here.
A Knowledge‐Based System for Concrete Building Structural Design
Authors: Zhong Wanxie , Qiu Chunhang , Liu Xiaojian , Qin Xiaolin , Liu Junxian
Published: August 2010

Abstract: Knowledge representation approaches and knowledge base management strategies in the concrete building structural detail design system KJICAD are described. A load combination algebra system is developed for environmental loads formalization and a code‐based problem‐solving control structure is established to describe design knowledge sources and their relations. By using compiler techniques, the physical knowledge base is made uniform and simplified for quick access. Finally, a practical design example is included to illustrate the effectiveness of KJICAD.
Timber Truss Inspection using a Graphical Object‐Oriented Expert System
Authors: Akhras G. , Foo H. C.
Published: August 2010

Abstract: In order to properly maintain over 200 timber truss buildings, which were built in 1940s by the Department of National Defence of Canada, annual inspection of these buildings by military engineers is required. Because of the large number of buildings involved, coupled with a limited number of knowledgeable and experienced engineers, the task of inspecting deteriorating buildings as often as needed has not been fulfilled. Knowledge‐based systems have been widely accepted and used for their productivity and reliability features. This paper describes the development of a graphical object‐oriented expert system for the overall maintenance of all timber truss buildings. Examples in relation to building inspection are given.
Form Finding and Cutting Pattern Generation for Fabric Tension Structures
Authors: Tabarrok B. , Qin Z.
Published: August 2010

Abstract: This paper discusses the problems of form finding and production of cutting patterns for fabric tension strictures. A computer method is proposed for simultaneous form finding and cutting pattern generation which produces initial principal stresses in the directions of the warp and weft of the fabric. A large‐displacement finite element procedure for computing the initial equilibrium shapes of tension structures is presented Several variations on this basic method are suggested. The cutting pattern generation method is based on the finite element model. A weighted least‐squares minimization flattening approach is developed to minimize the change in general link lengths and to generate plane cloth coordinates. Some design examples are given.
Object‐Oriented Development of Large Engineering Software using CLIPS
Authors: Yoon C. John
Published: August 2010

Abstract: Object‐oriented programming has emerged as one of the most promising paradigms for developing software and it has gained wide acceptance from software reengineers in diverse disciplines. Recent release of CLIPS, the C Language Integrated Production System developed by NASAS Johnson Space Center, includes an object‐oriented language called COOL which is an acronym for CLIPS Object‐Oriented Language. This paper evaluates COOL as an object‐oriented programming language and shows an object‐oriented approach to develop a large engineering software using CLIPS. A CLIPS implementation of an algorithm for a space structure's optimal sensor placement is given as an example.
Use of Spline Interpolation in Slope Stability Analysis
Authors: McClarty D. V. B. , Fredlund D. G. , Barbour S. L.
Published: August 2010

Abstract: Spline Interpolation is a numerical procedure which is widely used to contour variables from irregularly spaced data. It has been shown that, under specific criteria, Spline Interpolation is equivalent to a well known estimation technique known as Kriging. Unlike Kriging, Spline Interpolation does not require a preliminary structural analysis. However, as a result, one should expect that the estimates obtained from Spline Interpolation are not as accurate as those obtained from Kriging. This paper examines the role of the Spline Interpolation technique in the prediction of pore‐water pressures in limit equilibrium slope stability analyses. The pore‐water pressures of interest are those at the base of a slice when the factor of safety is estimated using the method of slices and limit equilibrium techniques.

The results of the study show that the Spline Interpolation technique is more accurate than the 4‐Way Interpolation technique. However, the Spline Interpolation technique requires significant computing time and computer memory. As a result, the number of known data points which can be analyzed (on a microcomputer) within a slope stability computer program is somewhat limited.
Finite Element Analysis of Track Structures
Authors: Thambiratnam David P. , Zhuge Yan
Published: August 2010

Abstract: A simple finite element method, based on the analogy with a beam on an elastic foundation, has been developed and applied to the analysis of track structures subjected to point or uniformly distributed loads, A technique for treating infinitely long tracks by using an equivalent model of finite length has also been developed and incorporated into the analysis. Variations in track and/or foundation properties along the Length of the track are easily handled in the proposed method. The entire analysis can be conveniently programmed to run on a microcomputer, and with a few elements gives fast and accurate results. Important parameters are identified and their effects on the results discussed.
Types of medical social control
Authors: Conrad Peter
Published: August 2010

Summary In recent years there has been considerable interest in the social control aspects of medicine. While medical social control has been conceptualized in several ways, the concern here is with the medical control of deviant behavior, an aspect of what has been called the medicalization of deviance. Medical social control is defined as the ways in which medicine functions (wittingly or unwittingly) to secure adherence to social norms; specifically by using medical means or authority to minimize, eliminate or normalize deviant behavior. This paper catalogues and illustrates a broad range of medical control of deviance, and in so doing conceptualizes three major types of medical social control: medical technology, medical collaboration, and medical ideology. Numerous examples are provided for each. These concepts aid in revealing the breadth of medical social control and the extent and limitations of professional dominance over the medical social control of deviance.
Reality construction, reality exploration and treatment in two therapeutic communities1
Authors: Bloor M. J. , Fonkert J. D.
Published: August 2010

Abstract Data collected by participant observation in two contrasting types of therapeutic community are compared to reveal broad similarities in the treatment process. In both communities treatment was centrally concerned with reality construction: patients/residents learned to follow, assimilate and reproduce accounts of the community structure and prescriptions for behaviour, and these accounts and prescriptions reflexively constituted the social world of patients/residents. Further, in both communities staff recognised and made deliberate therapeutic use of an aspect of accounts and behavioural prescriptions much reported on in sociological literature, namely their essentially contingent and defeasible character. Thus, alongside processes of reality construction we note processes of reality exploration, whereby patients/residents are encouraged to inspect apparently contradictory prescriptions and accounts within the socially constructed reality of the communities. Staff believed that, in coming to terms with the contingent and defeasible character of accounts and prescriptions within the community, patients/residents would be able to deal with the contingent and defeasible character of social life outside the community less pathogenically.
The anomaly, the chronic patient and the play of medical power
Authors: Arney William Ray , Bergen Bernard J.
Published: August 2010

Abstract In the middle of the twentieth century, the anomaly, the person whose body suffered the effects of an accident and who elicited a compassionate response designed to protect the anomaly from the effects of the accident, disappeared. The ‘disabled,’ the ‘handicapped,’ and the ‘chronic patient’ replaced the anomaly in medical discourse. This change is reflected in specific, technical aspects of medicine ‐ medicine's understanding and treatment of two anomalous bodies and in general medical ideology and the organization of medical care. The change extended the medical gaze to the most intimate aspects of life and to the fine seams of society where the anomaly used to wander. We must understand this change as part of the paradoxical play of medical power. Medical power became more totalizing, integrative and rapidly responsive just as it became more unobtrusive, humane and liberating.
Doctor‐patient communication: a social and micro‐political performance
Authors: Fisher Sue
Published: August 2010

In the United States the medical relationship is asymmetrical. Doctors not only control medical knowledge, they also have an institutionally based authority which allows them to act as gatekeepers, providing options to some while denying them to others. This study, conducted in a model family practice clinic of a teaching hospital, examines how decisions to do, or not to do, Pap smears are negotiated as residents and a potentially high‐risk group of patients communicate. Decision‐making occurs in layered phases ‐ opening, medical history, physical examination, and closing. Each phase expresses the doctor's control and the patient's trust. Doctors initiate phases, develop topics and make key choices. They decide when patients undress — a choice which shapes the later Pap smear decision. Decisions to undress patients and to perform Pap smears or decisions not to undress patients and not to perform Pap smears produce no conflict. When there is a conflict, avoidance strategies ‐ bowing to higher‐level specialists, selling and unselling, and letting silence speak ‐ are used as negotiating devices. The doctor's choice and the patient's agreement produce a specific and a more general outcome — managing the presenting complaint and providing medically adequate health care, respectively. Although inter‐actionally accomplished, these outcomes are institutionally constrained, and, thus are both a social and a micro‐political performance.
General practitioners and the pull of prevention
Authors: Davies Celia
Published: August 2010

Sociologists have often criticised notions of preventive health work advocated by doctors. This work has yielded important insights into victim‐blaming and into ways the economic and political causes of ill‐health have been mystified or denied. While this analytical strategy remains an important one, it needs extending in at least three directions. First, we must appreciate changes over time in the forms of arguments about preventive work; secondly, we must situate the argument both in terms of developments within the medical profession and in terms of the relationship of the medical profession to the wider society; finally, we need to make sense of the doctors’ claims that these ideas are radical/progressive.

The paper is based on a recent series of reports on prevention by the Royal College of General Practitioners, and focusses in particular on the one dealing with preventive care for children.
‘Wet children’ and ‘little actresses': going sick in primary school
Authors: Prout Alan
Published: August 2010

Abstract Abstract The material presented here is drawn from a wider ethnographic study of children's sickness absence in a primary school. The particular aspect deals with concerns how children's claims on sickness are handled by teachers and other school staff. Teachers' typifications of the childrearing practices of the parents, especially the description of the children as ‘wet’, and the project that flows from it, are suggested as the framework in which teachers interpret the children's claims. These are shown to be differentiated according to gender and age and placed in the context of the move to secondary school as a key symbolic moment in the transition to adulthood. It is suggested that an ethnographic approach can significantly illuminate the processes and practices underlying (mainly American) questionnaire and attitude studies of the acquisition of sick role conceptions by children.
Social constructionism and medical sociology: a reply to M. R. Bury
Authors: Nicolson Malcolm , McLaughlin Cathleen
Published: August 2010

Abstract M. R. Bury has recently published a wide‐ranging criticism of social constructionism as it has been applied to the sociology of medicine. Bury's major misgivings are identified and replied to. It is argued that the constructionist sociology of medical knowledge is not in fact inherently weakened by incoherence or by a failure to recognise the difficulties which surround the questions of realism, reflexivity, or relativism. Nor does social constructionism necessarily cast doubt upon the sincerity of medical practitioners or the possibility of medical progress.
‘Telling bad news’: physicians and the disclosure of undesirable information
Authors: Taylor Kathryn M.
Published: August 2010

Abstract To address the issue of what physicians tell patients, and how they arrive at that decision, this report focuses on a single episode in breast cancer ‐ the event of telling the patient for the first time that she has cancer. This is a participant‐observation account of 118 events, framed from the physicians' perspective. It describes how the 17 surgeons at the Breast Cancer Clinic developed, organized and implemented their disclosure policies, and what strategies they utilized to routinize a task they defined as difficult and unpleasant.
Innocent murmurs: Echocardiography and the diagnosis of cardiac normality
Authors: Daly Jeanne
Published: August 2010

Abstract Echocardiography (cardiac ultrasound) is a spectacular imaging test. This paper presents results of a two year study of 40 patients referred for the test to ‘reassure’ them that their hearts are normal. Analysis is based on recordings of consultations in private and public practice and interviews with patients and cardiologists. The test is shown to have little technical impact on the diagnosis. The cardiologists diagnose most patients as certainly or most probably normal on clinical examination. This clinical evidence may over‐rule the test result. The major purpose of the test is to mediate social relations with colleagues (to satisfy referring physicians and to justify reversal of their diagnoses) and to reinforce social control over patients. While most patients feel relieved by the test result, many are left worse off as a result of the test. Thus, even when a test is used to diagnose a murmur as ‘innocent’, the process of diagnosis may be harmful to patients.
Do we need a strong programme in medical sociology?
Authors: Bartley Mel
Published: August 2010

Medical sociology has traditionally been concerned with the ways in which medical knowledge is applied. Less work has been done on the construction of knowledge in the laboratories of the basic medical sciences. This paper aims to extend the field of interest of medical sociology by introducing some recent developments in the sociology of science and technology (the ‘strong programme’).
Infant mortality, public policy and inequality – a comparison of 18 industrialised countries 1950–85
Authors: Wennemo Irene
Published: August 2010

Using new comparative data bases this paper examines whether infant mortality rates in industrialised nations are affected by public policies and income inequality. Particular attention is given to the role of the level of economic development, public policy and the distribution of economic resources. The study shows that the level of economic development has a strong, but decreasing impact on the infant mortality rate. Income inequality and relative poverty rates appear to be of greater importance for the variation in infant mortality rates than the level of economic development between rich countries. Levels of unemployment and of social security benefits seems to affect the infant mortality rate; the combination of high unemployment and low unemployment benefits seems to be associated with particularly high mortality rates. A high level of family benefits is also associated with low infant mortality rates.
The new genetics: some issues for social scientists
Authors: Richards M.P.M.
Published: August 2010

This paper considers some of the social consequences of the deployment of techniques arising from recombinant DNA technology, the new genetics. It concentrates on late onset dominantly inherited conditions such as Huntington's disease and hereditary ovarian and breast cancer and recessively inherited disease such as β thalassaemia and cystic fibrosis. It is argued that there are widely held lay beliefs about inheritance which are often at variance with the Mendelian theories of geneticists. The nature of these beliefs and the extent to which people feel prone to genetic disease allow an explanation of the use made of genetic services.

It is argued that there are many issues related to the new genetics, and inheritance more generally, which deserve more systematic study from social scientists and that, in particular, these should be approached as family issues.
Medical, economic and population factors in areas of high mortality: the case of Glasgow
Authors: Williams Rory
Published: August 2010

Regional inequalities in British mortality, though longstanding, also show important patterns of historical change. The case of Glasgow is particularly striking, since its mortality was converging with England's until the 1820s. It then experienced a surge in the death rate between 1831 and 1871, after which relatively high mortality has persisted to the present day. This patterns is not explain by changes in age structure, particular causes of death, or general urban conditions. It has only limited connections with time lags in the diffusion of sanitary or medical developments. It is associated with industrial development only in its early stage, and is not related to consumption of alcohol. However it is strongly associated with poverty and overcrowding, and probably also with inadequate diet. It is also closely associated with the period of heavy immigration from Ireland and the Highlands, though this is not explicable in terms of Irish or Highland mortality in the place of origin. Hypotheses are presented linking the Irish and Highland immigration with still‐enduring features of regional housing and labour markets, and with two nineteenth‐century lags in the development of sanitary measures and poor relief; and an agenda of research questions is outlined, which relate historical to contemporary regional inequalities.
If health promotion is everybody's business what is the fate of the health promotion specialist?
Authors: Nettleton Sarah , Burrows Roger
Published: August 2010

Abstract Abstract Health promotion specialists and health promotion services within the health service have been neglected by policy makers and medical sociologists. This is perhaps surprising, given the high profile of health promotion on the health policy agenda. This paper presents the findings of an exploratory sociological study into the nature and function of health promotion services within the ‘reformed’ British National Health Service. The analysis draws on qualitative interviews with health promotion specialists, directors of public health and other health workers whose work involves the promotion of health. The paper argues that health promotion services do not fit easily into the purchaser provider divide and that they have experienced considerable organisational change and uncertainty. Four factors have further compounded this lack of fit: a lack of consensus as to what health promotion specialists work should be about; a lack of any secure knowledge base; prevailing images of health promotion and of health promotion specialists; and feelings of vulnerability about the future of health promotion. Furthermore, health promotion specialists are finding it difficult to shed their principles and values and take on the dominant enterprise culture which is characteristic of the new public management. The paper concludes by suggesting three further reasons why health promotion specialists have been marginalised: their insecure occupational status which in turn is linked to a lack of jurisdiction associated with the content of their work; the contradictions which are inherent in the knowledge base of health promotion, and the increasing application of ‘modernist’ evaluative frameworks, derived from economics, to health promotion interventions.
Dementia and the phenomenon of social death
Authors: Sweeting Helen , Gilhooly Mary
Published: August 2010

AbstractMany cultures have distinguished between biological and social death, the latter usually occurring some time after the former. More recently social death has been noted to occur before biological death in terminally ill comatose patients. This paper presents the results of an exploratory study which examined the extent to which social death may occur before biological death among elderly people with dementia. One hundred semi‐structured interviews were conducted with the caregiving relatives of dementia sufferers. Ratings were made of the degree to which carers appeared to believe their dementing dependent was socially (or ‘as good as’) dead, as well as note taken of behaviour suggesting that they had discounted the sufferer in social terms. In over one third of caregiving relatives there was evidence of both beliefs and behaviours suggesting that a degree of social death had occurred before the sufferer's biological death. Almost all those categorised as behaving towards a sufferer as if they were socially dead expressed beliefs indicating that this was how the sufferer was perceived. However, perceiving a sufferer in ways which could be characterised as socially dead was not necessarily combined with behaving as though they were. Examples of degrees of social death are presented and discussed against the background of increasing numbers of dementia sufferers in modern Western societies.
Experience of hypoglycemia among insulin dependent diabetics and its impact on the family
Authors: Rajaram Shireen S.
Published: August 2010

Abstract This study explores the biographical disruption that occurs as a result of a hypoglycemic episode (or insulin reaction) among people with insulin dependent diabetes. It focuses on the process of biographical reconstruction that sufferers and their spouses go through, while striving to maintain a positive self‐worth in the ‘world of health’. This paper is a qualitative study of twenty‐three people with diabetes in the stable phase of the illness and their spouses. The findings indicate that hypoglycemia has profound effects on the lives of people with diabetes and their families. It calls forth a renegotiation of the personal and social identities of the sufferer. The intensity, unpredictability, and risk of physical harm of an insulin reaction, all contribute to the complexity of the illness experience. Management of an insulin reaction involves an ongoing discourse between patients and their physical states, their partners, the medical professionals, and the social and ideological constraints, within a social and cultural context. The need for health professionals to adopt a more holistic approach giving due considerations to the everyday behavioural and emotional demands of hypoglycemia is underscored.
The effects of paid and unpaid work on nurses' well‐being: the importance of gender
Authors: Walters Vivienne , French Susan , Eyles John , Lenton Rhonda , Newbold Bruce , Mayr Janet
Published: August 2010

Abstract A handful of studies have started to explore the effects on health of both paid and unpaid work among women and men. This paper reports on a survey of a proportional random sample of 2285 women and men nurses from three regions of Ontario. We examine the effects of paid and unpaid work on their well‐being. The data were analysed for the full sample and then multiple regression analyses were run separately for men and women. In our discussion we emphasise several points: unless such data are analysed in terms of gender, as well as controlling for sex, marked differences between the experiences of men and women may be neglected; that in understanding health, it is important to take into account the influence of both paid and unpaid work; and that certain features of paid and unpaid work are often associated with well‐being ‐ control over work, the degree of challenge that work presents, recognition, satisfaction with work, social support, number of children and the level of overall stress experienced. Workload issues are also associated with women's well‐being.
Social disadvantage and infection in childhood
Authors: Reading Richard
Published: August 2010

Although the literature on health inequalities in childhood is extensive, relatively little has been written about social differences in infectious disease. This is despite the strong association between poverty and infection noted historically, the continuing importance of infection as a cause of childhood mortality and morbidity, the resurgence of infectious disease as a public health problem and the increasing proportions of children living in poverty. This paper reviews the evidence, mainly from the United Kingdom, which shows that wide inequalities continue to occur in most types of infectious disease in childhood and the consequences stretch into adulthood. Possible reasons for the continuing association of poverty and infection in an age of high standards of hygiene, sanitation, and health care are discussed. Environmental and material factors are likely to have a stronger influence than social differences in behaviour, attitudes and lifestyle, and they can affect susceptibility to infection at the level of individuals, family, and community, and in access to health care. More emphasis needs to be placed on structural and community wide interventions than those directed at changing individual behaviour if a reduction in inequalities in childhood infection is to be achieved.
Doctors on the medical profession
Authors: Lupton Deborah
Published: August 2010

Over the past two to three decades there has been vigorous debate in the sociological literature as well as in popular forums concerning the changing social position and status of the medical profession and the extent to which consumerism has entered the doctor‐patient relationship. Few qualitative sociological inquiries, however, have directly sought the views of medical practitioners themselves on these issues. To address this hiatus, this article discusses the findings from an empirical study using semi‐structured indepth interviews with 20 doctors living and working in Sydney about their views on the contemporary status of the medical profession and their experiences of medical practice. Three major aspects are discussed: the extent to which the social position of doctors has changed, the impact of consumerism on medical practice and the qualities of a ‘good’ doctor. The implications of these data for theorising the nature of contemporary medical practice, power and professional status is explored, with particular reference to the insights offered by Foucauldian theory.
The nursing‐medical boundary: a negotiated order?
Authors: Allen Davina
Published: August 2010

In a recent paper in Sociology of Health and Illness, Svensson (1996) makes the case for adopting the negotiated order perspective as the most appropriate theoretical framework for understanding patterns of doctor‐nurse interaction. Analysing interview data with nursing staff from surgical and medical wards in five Swedish hospitals, Svensson identifies key changes in the health care context which he suggests have created ‘negotiation space’ for nurses, leading to the evolution of new working relationships with doctors. In examining the relationship between negotiation processes and the wider structural context, Svensson addresses a theme that has remained an enduring interest of critics and supporters of the negotiated order perspective alike. Drawing on data generated on a surgical and a medical ward in a UK District General Hospital, this paper attempts to make a further contribution to this debate and also to sociological understanding of doctor‐nurse relationships, by analysing some features of hospital work which inhibited face‐to‐face inter‐occupational negotiations but which nevertheless resulted in the modification of the formal division of labour between nursing and medicine. The implications of these findings for the negotiated order perspective are considered, and the question is raised as to what researchers working within this tradition understand by ‘negotiation’ and how it can be studied.
Responding to change: the case of community pharmacy in Great Britain
Authors: Harding Geoffrey , Taylor Kevin
Published: August 2010

In recent years pharmacy has increasingly striven sharply to define and establish its role in the face of technological advance. The pre‐packaging of medicines by the pharmaceutical industry and the use of computers in pharmacies and general practitioners’ surgeries would seem to obviate pharmacists’ traditional activities in the compounding and dispensing of medicines, and challenge their claim to professional status with an associated decline in their social and economic rewards. This paper draws on the literature of the sociology of the professions to analyse the response of this occupational group to threats to its status as a professional primary health care provider. It is argued that pharmacy has the necessary knowledge base to control the symbolic transformation of the pharmacological entity—the drug—into the social object—the medicine, yet has failed to capitalise on this when attempting to define its professional role.
Continuity or discontinuity in the self‐regulation of the Belgian and Dutch medical professions
Authors: Schepers Rita M. J. , Casparie Anton F.
Published: August 2010

This paper looks at the recent developments in the field of medical quality assurance in Belgium and the Netherlands. It takes the viewpoint that there is a strong relationship between regulation and quality assurance on the one hand and the health care environment on the other hand. The reasons for the differences between the two countries, which are conspicuous, will be explored.
Abortion discourse in Bolivian hospital contexts: doctors’ repertoire conflicts and the Saving Women device
Authors: Rance Susanna
Published: August 2010

Abstract  The author proposes going Beyond attitudes (Potter and Wetherell 1987) to a more nuanced assessment of doctors’ discursive variations. Through an application of Gilbert and Mulkay's (1984) interpretative repertoires, she defined three voices – technical, normative and pragmatic – in which Bolivian doctors spoke of abortion. In State and social security hospital contexts, doctors hastened to express compliance with government policy and institutional norms regulating abortion and postabortion care. Technical and pragmatic considerations, however, often entered into conflict with established rules. When contradictions became apparent in their own discourse, doctors regularly drew on the Saving Women device. This accounting strategy enabled them to save face as up‐to‐date professionals through justifying temporary deviance from norms in terms of benefit to women treated. The author describes her development of the repertoires, their validation with different medical audiences, and doctors’ critical appropriation of the model to explain their own discursive variations.
Explaining caesarean section in Salvador da Bahia, Brazil
Authors: McCallum Cecilia
Published: August 2010

Abstract  In Salvador da Bahia the caesarean section rate is excessive, as it is in Brazil as a whole. It is the standard form of delivery in private hospitals, though vaginal delivery still predominates in the public sector. This paper investigates the social context of these styles of childbirth, arguing that the connections between both sectors sustain this situation. Exploring the factors leading to the preference in private and insurance‐funded maternity wards, it examines critically two diverging positions on the cause of the rate: that women's cultural preferences for abdominal birth lie behind it; or that obstetricians’ self‐interest is to blame. The paper critiques the theory of culture behind the first stance and questions the theoretical weight placed on individual action in the second. It argues that no particular social group is the principal cause of the excessive use of caesarean section to deliver babies. Rather, a host of factors converge in sustaining this practice. Finally, the paper stresses that the system as a whole, not any particular group, must be changed if the rate is to be lowered significantly. For this, political will is required.
Social science and bioethics: the way forward
Authors: De Vries Raymond , Turner Leigh , Orfali Kristina , Bosk Charles
Published: August 2010

It is no surprise that bioethics and sociology developed an adversarial relationship: bioethicists value the clear descriptions of ethically charged situations provided by social scientists, but doubt the ability of those trained in social science to logically derive and discern ‘the good’. For their part, social scientists – experts in observing and collecting data about the way the world is– find bioethicists ignorant of the ways elegantly crafted solutions to ethical problems get altered when incarnated in varied social and cultural settings. This discipline‐centred self‐affirmation can be a satisfying exercise, but it offers nothing to the project of promoting more moral medicine and health care. The articles collected in this volume demonstrate the value of collaboration between social scientists and bioethicists. Focusing on four themes found in recent sociological research in bioethics – ethics of research, the creation of moral boundaries, bioethics and social policy, and the bioethical imagination – this anthology offers practical models of co‐operative work where the strengths of each discipline are brought together to advance our understanding of bioethical issues and to show the way toward just and effective social policy.
The field worker's fields: ethics, ethnography and medical sociology
Authors: Anspach Renée R. , Mizrachi Nissim
Published: August 2010

Sociologists who do field work in medical settings face an intractable tension between their disciplinary field, which takes a critical perspective toward medicine, and their ethnographic field, which often includes physicians. This paper explores the ethical problems that result from the collision of the two fields. While in the field, ethnographers are forced to choose between sociology and their obligations to host members, as they decide whether to disclose their actual research agendas, whether to ask tough questions or to reveal their concerns, and whether to give advice. The tension persists when field workers leave the field to write, forcing them to choose between competing interpretations and to decide what to reveal or conceal in the interests of confidentiality.

Through these moral choices about what to ask, record or present to the reader, ethnographers shape the academic field even as it shapes them.
Ethical boundary‐work in the embryonic stem cell laboratory
Authors: Wainwright Steven P. , Williams Clare , Michael Mike , Farsides Bobbie , Cribb Alan
Published: August 2010

Most accounts of the ethics of stem cell research are de‐ contextualised reviews of the ethical and legal literature. In this chapter we present a socially embedded account of some of the ethical implications of stem cell research, from the perspectives of scientists directly involved in this area. Based on an ethnography of two leading embryonic stem cell laboratories in the UK, our data form part of the findings from a larger project mapping the scientific, medical, social and ethical dimensions of innovative stem cell treatment, focusing on the areas of liver cell and pancreatic islet cell transplantation. We explore three key issues: what individual scientists themselves view as ethical sources of human embryos and stem cells; their perceptions of human embryos and stem cells; and how scientists perceive regulatory frameworks in stem cell research. We argue that these dimensions of laboratory practice are all examples of ‘ethical boundary‐work’, which is becoming an integral part of the routine practice and performance of biomedical science. Our work adds to the relatively few sociological studies that explore ethics in clinical settings and to an even smaller body of work that explores scientists’ views on the ethical issues relating to their research.
Gift not commodity? Lay people deliberating social sex selection
Authors: Scully Jackie Leach , Shakespeare Tom , Banks Sarah
Published: August 2010

In this paper we explore lay people's discussions of the controversial topic of social sex selection (SSS). In the UK and many other countries, SSS is prohibited by law. In 2003 the UK Human Fertilisation and Embryology Authority, after an extensive public consultation, decided against changing the existing legislation. However, this initiative and similar consultation exercises have been criticised on the grounds that public opinion is poorly informed and reasoned. In our study, one of the most consistently expressed ideas was that children should be regarded as ‘a gift’ rather than ‘a commodity’. In contrast, the ‘gift not a commodity’ argument is rarely cited positively in Anglo‐American, secular‐liberal bioethics. These metaphorical statements are condensed articulations of complex but coherent moral intuitions. Where much of the bioethics literature stresses parental autonomy, our lay discussants balanced this principle with ideas about the need to respect the personhood of the potential child, and the characteristics of a good parent. We conclude our analysis by considering the implications for expanding bioethics’ knowledge base and improving the input of lay people in bioethical decision making.
It's money that matters: the financial context of ethical decision‐making in modern biomedicine
Authors: Hedgecoe Adam M.
Published: August 2010

While the importance of patient autonomy is widely acknowledged and discussed in the bioethics literature, clinicians’ autonomy, their ability to make the best choices about patients’ care free from outside interference, is far less debated. This paper takes one form of external influence over clinical decisions – the cost of drugs – and applies it to a specific case, that of HER2 positive breast cancer and the use of the drug Herceptin in the UK. Drawing on interviews with clinicians, researchers and policymakers, I explore the way financial decisions about Herceptin shape clinicians’ autonomy, and how clinicians as individuals and as professional groups respond to these limits and seek to provide treatment to the highest number of the most deserving patients they can. The point of this paper is not to castigate bioethicists for misguidedly focusing on patient autonomy but point out that clinicians’ autonomy may be so circumscribed by external factors that it may make no sense to speak of their actions as stemming from ethical decisions. At the same time, I suggest that financial constraints create areas at the margin of clinical practice which are deserving of bioethical consideration.
Explaining the emergence of euthanasia law in the Netherlands: how the sociology of law can help the sociology of bioethics
Authors: Weyers Heleen
Published: August 2010

The debate over the legalisation of voluntary euthanasia is most often seen to be the result of three changes in society: individualisation, diminished taboos concerning death and changes in the balance of power in medicine. The fact that these changes occurred in many western countries but led to legalisation in only a few makes this claim problematic. I examine whether socio‐legal propositions, with respect to the emergence of laws which focus on social control, offer a better approach to understanding the development of rules allowing and governing euthanasia. After a short sketch of the history of the Dutch law regulating euthanasia, I discuss these three societal changes in the light of shifts in the social control of medical behaviour that shortens life. I show that the Dutch relaxation of the prohibition of euthanasia goes together with new forms of social control: doctors’ self control is complemented with second‐party control (by patients), professional third‐party control and governmental control. My work calls attention to the fact that bioethics is part of larger systems of social control.
Taking sociology seriously: a new approach to the bioethical problems of infectious disease
Authors: Tausig Mark , Selgelid Michael J. , Subedi Sree , Subedi Janardan
Published: August 2010

After a history of neglect, bioethicists have recently turned their attention to the topic of infectious disease. In this paper we link bioethicists’ earlier neglect of infectious disease to their under‐appreciation of the extent to which the problem of infectious disease is related to social factors and thus to questions of justice. We argue that a social causation of illness model – well‐known to sociologists of medicine, but incompletely understood by bioethicists – will improve future bioethical analysis of issues related to infectious disease. By emphasising the relationships between social and economic structures of inequality and health, the social causation model provides a richer approach to ethical issues associated with infectious disease than the more commonly used biomedical model.
Biobanks, bioethics and concepts of donated blood in the UK
Authors: Busby Helen
Published: August 2010

In recent years international bioethics bodies have made prominent declarations about the uses of donated tissue and related information in genetic research1. Following the ‘legislative’ mode of bioethics2, these organisations have put forward a number of general principles with a view to promoting the fair and equitable use of donated tissue in such research. However, government policies in this field are shaped differently in different national regimes. In this paper, I use recent debates in the UK about a national genetic ‘biobank’ to illustrate how the shape and texture of policy discussions surrounding the use of donated blood for genetic research have been built upon a prior national consensus that regarded blood as a public good.
Embodiment and ethics: constructing medicine's two bodies
Authors: Armstrong David
Published: August 2010

The first ‘modern’ presentation of medical ethics is generally acknowledged to be Percival's text of 1803. The main theme of this influential pamphlet was the way in which medical practitioners should relate to one another. Two centuries later, clinical practice has very different moral underpinnings: bioethics, which first emerged in the middle of the 20th century, is not concerned with how doctors should interact with each other but with the responsibilities of medical practitioners to their patients. The shift from an ethics based on the relationship between practitioners to one based on the relationship with their patients is viewed as a major advance brought about by a more enlightened society engaging with the consequences of new technologies. But rather than addressing the changing picture of medical ethics in its own terms (which over the last few decades has been from the perspective of bioethics) I examine the history of medical ethics in its close relationship to the form and nature of the medical profession. Further, in a parallel thread I describe contemporary developments in public health and explore the similarities and connections between the two.