It has been argued extensively that diagnostic services are a general good, but that it is offered in excess. So what is the problem? Is not “too much of a good thing wonderful”, to paraphrase Mae West? This article explores such a possibility in the field of radiological services where it is argued that more than 40% of the examinations are excessive. The question of whether radiological examinations are excessive cries for a definition of diagnostic futility. However, no (...) such definition is found in the literature. As a response, this article addresses the issue of diagnostic futility in five steps. First, it investigates whether the concept of therapeutic futility can be adapted to diagnostics. A closer analysis of the concept of therapeutic futility reveals that this will not do the trick. Second, the article scrutinizes whether there are sources for clarifying diagnostic futility in the extensive debate on excessive radiological examination. Investigating the debate’s terms and definitions reveals a disparate terminology and no clear concepts. On the contrary, the study uncovers that quite different and incompatible issues are at stake. Third, the article examines a procedural approach, which is widely used for settling controversies over utility by focusing on the role of the professionals. On scrutiny however, a procedural approach will not solve the problem in diagnostics. Fourth, a value analysis reveals how we have to decide on the negative value of excessive examinations before we can measure excess. The final and constructive part presents a definition of diagnostic futility drawing upon the lessons from the previous analytical steps. Altogether, too much radiological examination is not a good thing. This is simply because radiological examinations are not unanimously good. Excessive radiological examinations can be defined, but not by one simple general and value-neutral definition. We have to settle with contextually framed value-related definitions. Such definitions will state how bad “too much of a good thing” is and make it possible to assess how much of the bad thing there is. Hence we have to know how bad it is before we can tell how much of it there is in the world. (shrink)

(1979). Some Observations on the Problems of Grading Examinations with Several Components: a reply to P. J. Squire. Educational Studies: Vol. 5, No. 3, pp. 225-230.

In this article, I argue that many women lack the epistemic resources that would allow them to recognise the practice of vaginal examinations during childbirth as violent or as unnecessary and potentially declinable. I address vaginal examinations during childbirth as a special case of obstetric violence, in which women frequently lack the epistemic resources necessary to recognise the practice as violent not only because of the inherent difficulty of recognising violence that happens in an ‘essentially benevolent’ setting such (...) as the medical one, but also, and mainly, due to the pervasive sexual reification of women under patriarchy and the pervasive shame to which women are subjected. My argument is that the practice of vaginal examinations is indeed experienced – bodily apprehended – as violent by many women, but that full epistemic recognition of this violence is frequently obstructed because the experience perfectly coincides with the normal phenomenological situation of women within patriarchy and thus cannot really be framed as violent. A phenomenological analysis presenting the embodied experience of women under patriarchy as always already essentially tied to sexual availability and commodification, and to shame, will explain this epistemological impairment. A phenomenological take on Judith Butler’s distinction between ‘recognition’ and ‘apprehension’ informs my analysis: I deploy it to provide a richer, more nuanced response to the question of why vaginal examinations are not fully recognised and expressed as violent – even when they are, frequently, apprehended as such. Furthermore, Butler’s ideas about the epistemic ‘framings’ through which we make sense of different kinds of lives (grievable versus ungrievable) will help me to explain how the patriarchal sexual reification of women in fact already frames sexual violence as not-violence – which ultimately also prevents labouring women (and obstetrics staff) from recognising vaginal examinations during labour as violence. (shrink)

This is the first book to unpack the legal and ethical issues surrounding unauthorised intimate examinations during labour. The book uses feminist, socio-legal and philosophical tools to explore the issues of power, vulnerability and autonomy. The collection challenges the perception that the law adequately addresses different manifestations of unauthorised medical touch through the lens of women's experiences of unauthorised vaginal examinations during labour. The book unearths several broader themes that are of huge significance to lawyers and healthcare professionals (...) such as the legal status of women and their bodies. The book raises questions about women's experiences during childbirth in hospital settings. It explores the status of women's bodies during labour and childbirth where too easily they become objectified, and it raises important issues around consent. The book highlights links to the law on sexual offences and women's loss of power under the medical gaze. The book includes contributions from leading feminist philosophers, medical professionals, and academics in medicine and law, and offers pioneering analysis relevant to lawyers and healthcare professionals with an interest in medical law and ethics; feminist theory; criminal law; tort law; and human rights law. (shrink)

The current study aimed to explore effective strategies for preventing cheating in online examinations by surveying students to determine their cheating strategies. A total of 406 Iranian students at BA, MA, and PhD levels in four programs, including English language teaching, English literature, Linguistics, and English language translation, participated in this study using a convenient sampling technique. The sample was drawn from 83 universities across all 31 provinces of Iran. The researchers developed a 30-item questionnaire and a 4-item interview (...) to collect data. The results revealed that searching in PDFs and using social media groups were the most commonly used cheating strategies. To prevent this form of academic dishonesty, teachers used various strategies, the most effective being the use of conceptual questions and one-by-one oral exams with turned-on webcams. The main reason for students to cheat was their desire to perform better. The implications of this study are relevant for educational stakeholders, particularly teachers, and students, in promoting academic integrity. (shrink)

While courtroom examinations are often recognized as a distinct speech-exchange system, little is known about how participants do an examination beyond its unique turn-taking system. This article attempts to shed some light on this issue by studying the question design during the direct examination in an American criminal court case using Conversation Analysis. It shows that attorneys use different question forms compared to casual conversation: declaratives are far less prevalent and questions are often designed as requests for action. In (...) addition, attorneys make use of forms that are not found in other types of interaction, such as the tag correct. The way in which attorneys design their questions additionally shows that the rules of the courtroom have procedural consequences for how the interaction is done. But these rules have to be enacted, and it is in their violation that participants bring about categories such as leading questions. (shrink)

This is an ambitious book, dealing with an issue which deserves much greater attention from historians than it has received heretofore. Only the work of John Roach comes to mind as a precursor, dea...

Recent media articles have stirred controversy over anecdotal reports of medical students practising educational pelvic examinations on women under anaesthesia without explicit consent. The understandable public outrage that followed merits a substantive response from the medical community. As medical students, we offer a unique perspective on consent for trainee involvement informed by the transitional stage we occupy between patient and physician. We start by contextualising the role of educational pelvic examinations under anaesthesia (EUAs) within general clinical skill development (...) in medical education. Then we analyse two main barriers to achieving explicit consent for educational pelvic EUAs: ambiguity within professional guidelines on how to operationalize ‘explicit consent’ and divergent patient and physician perspectives on harm which prevent physicians from understanding what a reasonable patient would want to know before a procedure. To overcome these barriers, we advocate for more research on patient perspectives to empower the reasonable patient standard. Next, we call for minimum disclosure standards informed by this research and created in conjunction with students, physicians and patients to improve the informed consent process and relieve medical student moral injury caused by performing ‘unconsented’ educational pelvic exams. (shrink)

The purpose of this study is to elucidate various practices for the structuring of images on an ultrasound monitor during prenatal ultrasound examinations. This study focuses on the practices that healthcare providers employ to invite pregnant women to differentiate a gray-tone image on the ultrasound monitor from the image’s background. In sequential environments in which pregnant women display difficulty in differentiating an image on the screen in response to the healthcare provider’s invitation, the healthcare provider employs practices that require (...) additional bodily involvement to structure the images on the screen. Furthermore, on certain occasions, the healthcare provider also points to a particular abdominal location with the ultrasound transducer, which is held against the abdomen to produce the very image being differentiated. This study demonstrates that the image on the ultrasound monitor is intrinsically embodied and spatially and modally distributed. In addition, the study suggests an interaction-organizational ground for an aspect of the ‘personification of the fetus’ through obstetric ultrasound. (shrink)

Magnetic resonance (MR) imaging has proven to be a highly effective medical imaging technique that produces detailed cross-sectional images of organs, tissues, and skeletal structures. Because of its versatility, MR imaging has been called “one of the most powerful diagnostic tools in contemporary clinical medicine.”1 MR imaging is advantageous because it does not rely on potentially harmful ionizing radiation used in other imaging techniques; however, the MR imaging scanner can cause considerable anxiety for individuals with claustrophobia, a fear of confined (...) spaces. The MR imaging scanner is designed as a large tube with a table in the middle. During examinations, the patient lies supine on the table, is slid into the scanner tube, and must remain still so that the MR imaging technologist can produce the precise images needed to facilitate an accurate diagnosis. Depending on the imaging required, the procedure can last from 20 to 50 minutes, which can be distressful for people with claustrophobia because the enclosed space might trigger anxiety-inducing feelings and thoughts. Using concepts from the philosophical tradition of phenomenology, this article attempts to describe what a patient experiences when they feel claustrophobic and to provide clinical strategies that MR technologists can use to navigate situations in which the scanner poses a risk of inducing a claustrophobia-related anxiety episode. (shrink)

The COVID-19 pandemic in 2020 has had a lasting impact on all areas of personal life. However, the political, economic, legal and healthcare system, as well as the education system have also experienced the effects. Universities had to face new challenges and requirements in teaching and examinations as quickly as possible in order to be able to guarantee high-quality education for their students.This study aims to examine how the German-speaking medical faculties of the Umbrella Consortium of Assessment Network have (...) dealt with the challenges but also the opportunities that the outbreak of the COVID-19 pandemic created in medical education and whether digitalisation has been driven forward as a result. In an initial online-survey we focused our questions on the current teaching situation with regard to digitised teaching content, the support or establishment of adequate framework conditions by the medical faculties and IT facilities and also the execution of examinations during the summer semester 2020.Between August and September 2020, a total of 88 examiners, educators, dean of study and/or technical admins from 32 partner faculties took part in the survey. Students were not included in our survey. Most respondents stated that a switch to a digital semester had worked, the use of e-learning increased compared to previous semesters and that most courses could be converted, with the exception of practical courses, which were largely cancelled. The respondents also indicated that most examinations could still be taken, with the exception of practical examination formats, like Objective Structured Clinical Examinations. However, in the case of face-to-face examinations, strict distance and hygiene conditions had to be obeyed or there had to be a switch to distance-online examinations, which raised many open issues such as equal opportunities of students and attempts at deception.In conclusion, we identified several issues regarding the rapid transition to a digital semester due to COVID-19 which were categorised into the following topics: Face-to-face teaching could not take place, know-how of educators, integrity aspects, technical aspects, additional personnel required, additional time and effort required for implementation of digital teaching. Our study shows that a switch to digital teaching and distance online examinations is feasible, but many problems were encountered concerning academic integrity and basic ethical principles still need to be solved. In order to investigate whether above mentioned issued could be solved one year after the transition to a digital semester, we conducted a second survey in which the 32 initially surveyed institutions were questioned again. (shrink)

Sexual assault cases are challenging for both the patient and provider, particularly given the emotional and logistic overlays in the majority of these cases. In this article we offer sexual assault programs information and areas for consideration when developing a policy addressing sexual assault examinations on patients who are either incapacitated or otherwise unable to consent to examination. This information is based on our experience in creating and implementing such a policy for our program. We also offer the written (...) policy and associated consent form that we designed.The protocol manual for sexual assault medical forensic examinations authored by the Department of Justice actually recommends that each and every sexual assault nurse examiner program have “internal policies based on applicable jurisdictional statutes governing consent for treatment of vulnerable adult patients. In cases of adolescents, the jurisdictional statutes governing consent and access to the exam should be followed.“. (shrink)

Coping with assessment tests are known to generate anxiety frequently in the students who face them. In academic circumstances with the continued presence of emotional disturbance, high demand, and stress, emotional and physical fatigue, typical of burnout syndrome, and can be detected. Anxiety and burnout are related to each other and even more closely in high-stakes tests. One of these tests is the examination imposed in Spain for access to the university. The objective of this work is to analyze the (...) presence of anxiety and burnout and the relationship between them in students who face these tests, both during the confinement situation due to the COVID-19 pandemic and during the pandemic after the lockdown. For this purpose, we used a sample of 1,021 students with a mean age of 17.89. Of these, 866 were students who were taking the test, while the rest were university students who had passed it recently. Our results show high levels of anxiety and burnout in students who face the evaluation test during the COVID-19 pandemic, sustained over time and especially in comparison with students who had already taken the exam. The association between higher levels of anxiety and higher levels of burnout in the students who take these exams was also verified. These results link the relationship between these two variables more solidly and suggest the need to include address anxiety to reduce burnout levels in these students. The results are discussed with regard to prior evidence and their applications. (shrink)

As the title of the article suggests, “The Burqa Ban”: Legal Precursors for Denmark, American Experiences and Experiments, and Philosophical and Critical Examinations, the authors embark on a factually investigative as well as a reflective response. More precisely, they use The 2018 Danish “Burqa Ban”: Joining a European Trend and Sending a National Message (published as a concurrent but separate article in this issue of INTERNATIONAL STUDIES JOURNAL) as a platform for further analysis and discussion of different perspectives. These (...) include case-law at the international level while focusing attention on recent rulings and judicial reasoning by the ECtHR and the ECJ; critical thought-experiments in religion, morality, human rights, and the democratic public space; a contextualized account of burqa-wearing interventions by federal and state governments and, moreover, various courts in the United States; and philosophical commentary and, in some instances, criticism of the Danish and/or European (French, etc.) approach. The different contributions have different aims. The section on case-law at the international level reports on those central judgments that, in effect, helped to pave the path for the Kingdom of Denmark’s burqa ban. Concerning the concurring judges at the ECtHR, the opinions served to uphold a preexisting ban and to grant a wide margin of appreciation to the national authorities, thereby limiting the Court’s own review. -/- As regards to the ECJ, the legality of company rules that contain a policy of neutrality for the workplace was examined, with a similar outcome. The authors who discuss religion, morality, human rights and the democratic public space are endeavoring to, respectively, appeal to ethics as a testing stone for law and to both challenge and address several forms of “expressivist worry” in connection with face veils. In doing so, the authors ask a number of thought-provoking questions that hopefully will inspire public policymakers to careful analysis. While the section that is devoted to American perspectives highlights a comprehensive survey of political and legal responses to, in particular, full-face veils like the burqa, the relevant author also incorporates public perceptions and, in the course of examining these, draws a parallel to “the fate” of the hoodie. The constitutionality of burqa-wearing in America, so it also appears, is partially an open question, but differentiating between religious, political, or personal reasons is a de jure premise. Given that the Danish legislators who drafted law L 219 to ban burqa-wearing in public places rely on a reference to political Islam, they relegate religious and personal reasons to the private domain, thereby also adopting secularism as a premise. This is explored in the last author response of the article, more precisely, in an account of the underlying materialism that, in turn, is applied to Muslim women. If policymakers and legislators engaged in Thinking Things Through exercises, they could, as a minimum, avoid law-making strategies that are not in the spirit of the theory they themselves invoke, albeit tacitly. While the aim of, as it were, arresting culturally self-contradicting legislators is unique for the section in question, all the authors who contribute to the joint research project have one end-goal in common, namely to inform about important perspectives while at the same time opening up for parameters for (more) fruitful, constructive and (if need be) critical debate in the future. With this in mind, four recommendations are presented by the research director for the project. Legally, politically, socially and culturally, conflict-resolution should not translate the relationship between rulers and the ruled into a separation ideology, an instance of controllers versus the controlled. All things being equal, that is the objective limit for a democratic society. (shrink)

The purpose of the present studies was to evaluate and predict academic cheating with regard to a national examination in a Middle East country. In Study 1, 4,024 students took part and potential cheaters were classified as those having discrepant scores in multiple administrations that exceeded 1 SD in absolute terms. A latent class mixture analysis suggested two pathways for potential cheating: (a) The first path involved students—most male—who changed city or region of examination during test taking, and (b) the (...) second path described students—most male—who did not change city, region, or center of administration. Study 2 profiled cheaters using a sample of examinees who were actually caught cheating. Participants were 545 students, 253 of whom were caught cheating between 2002 and 2012. Both samples were selected from a pool of 319,219 testees using random sampling procedures. Results indicated that a 4-class solution best fitted the data as in Study 1. Furthermore, a predictive model was tested with an independent cross-validation sample of 112 examinees (56 cheaters, 56 noncheaters). Results indicated that the model classified correctly 78.57 of the new cheating cases (sensitivity) and 94.64% of noncheaters (specificity). (shrink)

In order to conduct medical examinations, physicians transform patients from social subjects into medical objects. The routines associated with conducting medical examinations constitute rituals for effecting this transformation: moving from public space to private space; changing into ritual costumes; taking up ritual positions in an examination room; conducting ritual verbal and physical examinations. The transformations endow participants with a different ontological status from the one they hold in everyday life. They address the phenomenological problem of how a (...) self is inserted into a body. (shrink)

The phrase ‘the edge of race’ can be used both as a description and as a response to two key concerns. The first of these is that while race is increasingly on the periphery of education policy – with a growing disregard shown for racist inequities, as education systems become dominated by market-driven concerns – it is important that we map the shifting relations of race in neoliberal politics and policies. The second concern is that at this time, within and (...) outside the spaces of the academy, even to mention race equity is to risk condemnation, marginalization, and ridicule. The authors in this collection use ‘the edge of race’ as a provocation in order to examine the concepts, methodologies, policies, politics, processes, and practices associated with race and racism in education. The chapters offer empirical examples of the perpetuation and perniciousness of racism that point to the continued salience of research about race. Additionally, the chapters make contributions to conceptual and methodological understandings of race and racism. The contributors illustrate the contingency, productivity, and fragility of race as a concept, and point to how educational research continues to be a contested site in, and from which to study, race and education. This book was originally published as a special issue of _Discourse: Studies in the Cultural Politics of Education. _. (shrink)

Millions of children who were born during the first decade after the Islamic revolution in Iran are now reaching the age of marriage and childbearing. Short spacing between marriage and the birth of the first child has the potential to cause an excessive and costly increase in the growth of population in Iran. Research into the motivations for the birth of first child among newly married couples can create a knowledge base that will enable health centres to help these couples (...) make better decisions about the timing of their first pregnancy. Using a consecutive sampling technique and administering Miller’s Childbearing Questionnaire, data were gathered regarding the childbearing motivations and desires of 300 couples who had been referred to the Shiraz Health Center for premarital counselling. The Childbearing Questionnaire, with some minor modifications, was found to be a valid and reliable instrument for measuring the childbearing motivations of newly married couples of Shiraz County, Fars Province, Iran. The utility of these findings for counselling in health centres is discussed. Based on the results, a longitudinal study is being designed that will allow the development of models for predicting the time of first pregnancy after marriage. (shrink)

Based on conversation analysis, this study investigates central practices in what is defined as a caring interview, in the context of welfare administration. Caring refers to a helpful interviewing in reformulations of questions, taking interviewees’ difficulties to answer into consideration; a caring attitude in the framing of questions, showing understanding of clients’ circumstances and professional’s enactment of expertise in assessments of clients’ disabilities and care needs. Data include a corpus of 43 recorded interviews in which officials at the Swedish Social (...) Insurance Agency interview clients who have applied for benefits. The study adds to research on interactional sensitivity, polar questions and epistemic stance in institutional interaction. The study shows how the interviewer prioritizes confirming polar questions, takes responsibilities of knowing into account and reduces the epistemic gap to the interviewee in practices of a caring interview. This makes the interviewing markedly different from standardized and bureaucratic interviewing. (shrink)

Certain paradoxes set us reeling endlessly. In surprise examination paradoxes, pupils' reasonings lead them to reel between expecting an examination and expecting none. With Newcomb's puzzle, choosers reel between reasoning in favour of choosing just one box and choosing two. The paradoxes demand an answer to what it is rational to believe or do. Highlighting other reelings and puzzles, this paper shows that the paradoxes should come as no surprise. The paradoxes demand an end to our reasoning when the conditions (...) they set ensure no end. They equivocate between, so to speak, reasoning in heaven and reasoning on earth; and, on the conditions set, not even an infinite god could reach a conclusion. (shrink)

First published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.