We raise a problem of applicability of RCTs to validate nuclear diagnostic imaging tests. In spite of the wide application of PET and other similar techniques that use radiopharmaceuticals for diagnostic purposes, RCT-based evidence on their validity is sparse. We claim that this is due to a general conceptual problem that we call Prevalence of Treatment, which arises in connection with designing RCTs for testing any diagnostic procedure in the present context of medical research, and is (...) particularly apparent in this case. We also identify three practical reasons why RCTs do not qualify as the best option for PET validation, which have to do with specific characteristics of nuclear diagnostic imaging, and of radiopharmaceuticals. The paper is meant to contribute both to the philosophical discussion on the EBM hierarchy of evidence, and on the specific debate on radiopharmaceuticals in nuclear medicine. (shrink)

In this paper I will show how the medical image, presented to the patient by the physician, participates in medicine's cold culture of abstraction, objectification and mandated normativity. I begin by giving a brief account of the use of anatomical imaging since the Renaissance to show how images have historically functioned in contrast to how they are currently used in medical practice. Next, I examine how contemporary medical imaging techniques participate in a kind of knowledge production that objectifies (...) the human body. Finally, I elucidate how physicians ought to place the medical image within the context of the lived body so as to create a healing relationship with the patient. In all this I hope to show that the medical image, far from a piece of objective data, testifies to the interplay of particular beliefs, practices and doctrines contemporary medicine holds dear. To best treat her patient, the physician must appreciate the influence of these images and appropriately place them within the context of the patient's lived experience. (shrink)

Advanced medical imaging, such as CT, fMRI and PET, has undergone enormous progress in recent years, both in accuracy and utilization. Such techniques often bring with them an illusion of immediacy, the idea that the body and its diseases can be directly inspected. In this paper we target this illusion and address the issue of the reliability of advanced imaging tests as knowledge procedures, taking positron emission tomography in oncology as paradigmatic case study. After individuating a suitable notion (...) of reliability, we argue that PET is a highly theory-laden and non-immediate knowledge procedure, in spite of the photographic-like quality of the images it delivers; the diagnostic conclusions based on the interpretation of PET images are population-dependent; PET images require interpretation, which is inherently observer-dependent and therefore variable. We conclude with a three-step methodological proposal for enhancing the reliability of advanced medical imaging. (shrink)

This article investigates the origins of the experiences involved in the diagnostics (detection and normative evaluation) of biological entities in image-based medical praxis. Our specific research aim presupposes a vast discussion regarding the origins of knowledge in general, but is narrowed down to the alternatives of anthropomorphism and biomorphism. Accordingly, in the subsequent chapters we will make an attempt to investigate and illustrate what holds the diagnostic experiential situation together—biological regularities, manifestation via movement, conscious synthesis, causal categories, or something (...) else. We argue that as long as knowledge originates out of practices, a promising way forward is to oscillate between the prominent although controversial ideas of the history of philosophy and observations of concrete human practices, such as, in our chosen example, image-based medical diagnostics of biological pathologies. Although a number of thinkers are involved in the discussion, Aristotle and Husserl are most important here as the representatives of historical paradigms on the matter. The body in this research was not taken solely as the physical entity (Körper) but rather as a transcendental, constitutive structure where diagnostic and biological processes synchronize in teleological movement (Leib). However, philosophical speculations are illustrated by actual radiograms, the interpretation of which brings us back to the aforementioned question of primacy regarding cognition. (shrink)

In most areas of medicine, the physician's primary task is to diagnose the patient's presenting problem by correctly identifying the underlying pathology causing that problem. Diagnoses are established through a process of correlating the information obtained from an interview with the patient about his history of illness and circumstances, with additional evidence of the underlying disease derived from physical examination findings and/or the results of laboratory investigations and diagnostic imaging. In contemporary health care, various movements that call for (...) a shift in clinical care away from underlying disease pathology toward understanding people and their experience of disease are receiving growing... (shrink)

This article explores the profound impact of visualism and visual perception in the context of medical imaging diagnostics. It emphasizes the intricate interplay among vision, embodiment, subjectivity, language, and historicity within the realm of medical science and technology, with a specific focus on image consciousness. The study delves into the role of subjectivity in perception, facilitating the communication of opacity and historicity to the perceiving individual. Additionally, it scrutinizes the image interpretation process, drawing parallels to text interpretation and highlighting (...) the influence of personal biases and individuality in medical practice. By revisiting Husserl’s conceptualization of “image consciousness” and introducing the notion of “image theme”, the paper seeks to establish a theoretical framework for making sense of images within the context of technological interpretation. A key objective is to enhance the phenomenology of technology through a systematic analysis of medical imaging diagnosis, contributing to an expanded epistemological foundation for medical practice. The article recognizes that the construction of medical knowledge incorporates subjective elements, especially within a historical context. The interpretation of images involves both instrumental and expert interpretation, with human subjectivity playing a crucial role. The article asserts that human creativity and conscious engagement are indispensable in interpreting all medical images. (shrink)

Motivated by discourses that link early child development and health, nurses engage in seemingly benign surveillance of children. These practices are based on knowledge claims and technologies of developmental science, which remain anchored in assumptions of the child body as an incomplete form with a universal developmental trajectory and inherent potentiality. This paper engages in a critical discursive analysis, drawing on Donna Haraway's conceptualizations of technoscience and figuration. Using a contemporary developmental screening tool from nursing practice, this analysis traces the (...) effects of this tool through production, transformation, distribution, and consumption. It reveals how the techniques of imaging, abstraction, and measurement collide to fix the open, transformative child body in a figuration of the developing child. This analysis also demonstrates how technobiopower infuses nurses' understandings of children and structures developmentally appropriate expectations for children, parents, and nurses. Furthermore, it describes how practices that claim to facilitate healthy child development may inversely deprive children of agency and foster the production of normal or ideal children. An alternative ontological perspective is offered as a challenge to the individualism of developmental models and other dominant ideologies of development, as well as practices associated with these ideologies. In summary, this analysis argues that nurses must pay closer attention to how technobiopower infuses practices that monitor and promote child development. Fostering a critical understanding of the harmful implications of these practices is warranted and offers the space to conceive of human development in alternate and exciting ways. (shrink)

In _ Psychiatry in the Scientific Image, _Dominic Murphy looks at psychiatry from the viewpoint of analytic philosophy of science, considering three issues: how we should conceive of, classify, and explain mental illness. If someone is said to have a mental illness, what about it is mental? What makes it an illness? How might we explain and classify it? A system of psychiatric classification settles these questions by distinguishing the mental illnesses and showing how they stand in relation to one (...) another. This book explores the philosophical issues raised by the project of explaining and classifying mental illness. Murphy argues that the current literature on mental illness -- exemplified by the Diagnostic and Statistical Manual of Mental Disorders -- is an impediment to research; it lacks a coherent concept of the mental and a satisfactory account of disorder, and yields too much authority to commonsense thought about the mind. He argues that the explanation of mental illness should meet the standards of good explanatory practice in the cognitive neurosciences, and that the classification of mental disorders should group symptoms into conditions based on the causal structure of the normal mind. (shrink)

Forensic evidence often involves an evaluation of whether two impressions were made by the same source, such as whether a fingerprint from a crime scene has detail in agreement with an impression taken from a suspect. Human experts currently outperform computer-based comparison systems, but the strength of the evidence exemplified by the observed detail in agreement must be evaluated against the possibility that some other individual may have created the crime scene impression. Therefore, the strongest evidence comes from features in (...) agreement that are also not shared with other impressions from other individuals. We characterize the nature of human expertise by applying two extant metrics to the images used in a fingerprint recognition task and use eye gaze data from experts to both tune and validate the models. The Attention via Information Maximization model quantifies the rarity of regions in the fingerprints to determine diagnosticity for purposes of excluding alternative sources. The CoVar model captures relationships between low-level features, mimicking properties of the early visual system. Both models produced classification and generalization performance in the 75%–80% range when classifying where experts tend to look. A validation study using regions identified by the AIM model as diagnostic demonstrates that human experts perform better when given regions of high diagnosticity. The computational nature of the metrics may help guard against wrongful convictions, as well as provide a quantitative measure of the strength of evidence in casework. (shrink)

This article analyzes how the medical gaze made possible by MRI operates in radiological laboratories. It argues that although computer-assisted medical imaging technologies such as MRI shift radiological analysis to the realm of cyborg visuality, radiological analysis continues to depend on visualization produced by other technologies and diagnostic inputs. In the radiological laboratory, MRI is used to produce diverse sets of images of the internal parts of the body to zero in and visually extract the pathology. Visual extraction (...) of pathology becomes possible, however, because of the visual training of the radiologists in understanding and interpreting anatomic details of the whole body. These two levels of viewing constitute the bifocal vision of the radiologists. To make these levels of viewing work complementarily, the body, as it is presented in the body atlases, is made notational. (shrink)

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)

This paper aims to trace individual as well as collective aspects of ‘sight styles’ in diagnostic computed tomography. Radiologists need to efficiently translate the visualized data from the living human body into a reliable and significant diagnosis. During this process, their visual thinking and the created images are incorporated into a complex network of other visualizations, communication strategies, professional traditions, and (tacit) visual knowledge. To investigate the interplay of collective as well as individual dimensions of diagnostic seeing, the (...) concept of ‘sight collective’ (Sehkollektiv) is developed. On the one hand, this concept is based on critical reading of Ludwik Fleck’s epistemological writings and his notions of thought collective (Denkkollektiv) and thought style (Denkstil). On the other hand, it is tested by means of qualitative empirical studies in a radiological university clinic (participatory observations and informal interviews). By employing this approach, the paper traces the collective foundations of a certain diagnostic sight. Moreover, it shows how the individual abilities of radiologists to perform stylized seeing rely remarkably on software-based interactions with the processed images and on tacit dimensions of visual knowledge. (shrink)

ArgumentIn 1980, when the diagnosis of Posttraumatic Stress Disorder was introduced into the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, survivor guilt – a symptom long associated with trauma of the Holocaust and other extreme experiences – was included in the list of symptom criteria. But in the revised edition of the manual of 1987, survivor guilt was demoted to the status of merely an “associated feature” of the condition. Now that survivor guilt has disappeared from (...) the official lexicon of trauma, shame has come to take its place as the emotion that most defines the traumatic state. This paper examines the rationale for the shift from survivor guilt to shame in the context of the American Psychiatric Association's revisions. It argues that the shift can be understood as yet another manifestation of the oscillation between mimetic and antimimetic theories of trauma that, I have argued in my book Trauma: A Genealogy, has structured the understanding of trauma from the start. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Christopher Norris IMAGE AND PARABLE: READINGS OF WALTER BENJAMIN Marxist literary criticism is a house with many mansions, most of diem claiming a privileged access to the great central chamber of history and truth. Only the most blinkered polemicist could nowadays attack "Marxist criticism" as if it presented a uniform front or even a clearly delineated target. Differences of oudook have developed to a point where debates within Marxism (...) are often more highly charged and polarized man anything brought to bear by its downright opponents. These differences will seem a crippling liability only from the viewpoint of a hard-line determinist creed which insists both on the rightness of its own reductive methodology and on a one-track notion of historical necessity and reason. The alternative, as New Left theorists have argued, is to examine the diversity of present-day Marxist thinking and show how its manifold traditions take rise from various backgrounds of political and cultural development. Perry Anderson's Considerations on Western Marxism is one such attempt to "situate" the work of thinkers like Sartre, Almusser, and Adorno in terms of their beleaguered position as left intellectuals outside the active mainstream of any revolutionary movement.1 Another example is Terry Eagleton's Criticism and Ideology, a book which sets out to rethink the bases of a Marxist-theoretical approach to English literary history.2 Eagleton, like Anderson, takes it as axiomatic that no such critique can get underway without first coming to terms with the problems and dilemmas which others have faced in trying to make new sense of a communal enterprise. For Eagleton this means a diagnostic treatment of the gaps and significant sUences which have marked the texts of those — like Arnold or Leavis — engaged in a class-based mystification ofliterary history and values. The critique extends to what Eagleton sees as the inbuilt problems of a homespun British Marxism, whedier of the crudely determinist variety (Caudwell) or the "left-Leavisite" amalgam of radical mêmes and traditionalist assumptions represented by Raymond Williams. Eagleton's approach lays claim to a power of unmasking die 15 16Philosophy and Literature latent ideology at work both in literary and critical texts. Ramer than simply collapse that distinction — as desired by the current post-structuralists, with whom he is wholly out of sympadiy — Eagleton strives to articulate the different structures and relations of discourse which situate criticism vis-à-vis literary history. He proposes a Marxist "science of the text" which would bring out its ideological modes of production, inscribed in the twists and unconscious blind-spots of meaning where a project comes up against its own impossibility. Criticism "deconstructs" the literary text, but not (like the Yale deconstructors) with a view to breaking down all possible distinctions between literature and commentary, merging both in the infinite freeplay of signs. For Eagleton there is indeed a knowledge of die text which stands at a definite remove from its object, just as literature itself"works" and transforms the raw stuffoflived ideology, mus offering it up to critical knowledge. Eagleton's theory of literary production was worked out in response to a powerful new current of Marxist thought, associated mainly with the French philosopher Louis Akhusser. What mis program involved, very briefly, was a rigorous re-reading of Marx's texts, aimed at defining their precise theoretical structure and die place within mem of such concepts as "knowledge," "ideology," and "structure" itself. Only thus could Marxist science attain the clarity and grasp of its own first principles which would set it apart from other, deviant or "ideological" discourses. This meant drawing a firm critical line (or "epistemological break") between the early, humanist Marx and the later productions —including Das Kapital— where his thought took on the full rigor of its scientific basis. Such a theory, in Althusser^ words, "makes it possible to distinguish a word from a concept, to distinguish the existence or non-existence of a concept behind a word, to discern the existence of a concept by a word's function in the dieoretical discourse...." 3 This structuralist reading of the Marxist text is intended as an immanent critique, a means of salvaging the essential Marx from fhose elements in his... (shrink)

The identification of a reference standard is a major problem in diagnostic imaging. This comment invites reflection on the notion by illustrating three philosophical approaches to truth and evidence.

Feminist scholars have long argued that the pregnant body is erased – both literally and discursively – from mainstream foetal representations. Janemaree Maher argues that the placenta, as point of distinction and connection between pregnant women and foetuses, has the radical potential to refigure understandings of pregnant embodiment and subjectivity, and offer ‘a way to begin thinking through the impasse of pregnant representation’. Drawing on Maher's notion of the ‘placental body’, this article will examine the place of the placenta in (...) the practice of non-diagnostic 4D ultrasound scanning. The analysis seeks to connect Maher's theoretical perspective, and the rich feminist literature around foetal imaging, with observational data from my study of 4D scans. I will argue that the capacity of 3- and 4D sonography to image the placenta and umbilical cord in a way that is newly intelligible to lay viewers might present an opportunity for thinking differently about the interconnections – material and social – between pregnant women and foetuses and to relocate women as the subjects of their pregnancies. (shrink)

The present study examines the work of a group of medical scientists as they identify interpretative ‘pitfalls’ – recurrent sources of error – in the use of a new radiographic technique, formulate suggestions on how these pitfalls can be avoided and communicate their findings in the form of a scientific publication. The analysis focuses on a session in which previously diagnosed cases are discussed, and demonstrates the ways in which a certain source of diagnostic error gradually emerges as a (...) taken-for-granted in the interaction. An increased sense of recognition, recurrence and typicality is discernible in the treatment of the cases. Talk characterized by expansions and elaborations, displays of understanding in the form of reformulations, understanding checks, and so on, leave room for brief typifications and reifications of interpretative difficulties in characteristics of the imaging technique. Topical treatment of perception and interpretation, as well as embodied engagement, become decreasingly salient. It is argued that the abstracted formulations in the published text rely on the case-by-case working up of generality from particularity; from individualized accounts of why ‘I’ interpreted the image in a certain way to proffered generalizations achieved through articulated perceptions of a generalized ‘one’. If these proffers are ratified, a potential ground is established for the consensual formulation of a pitfall. The formulation of novel instructions is consequently made relevant, projecting a re-instructed diagnostic practice. (shrink)

Despite how he begins, suggesting that it is somehow a problem for me that I think "there is such a thing as philosophy, which could then be useful for psychopathology," ultimately it is clear that the possibility of philosophy is not the issue for Ghaemi. Rather, his issue is with academic philosophy of psychiatry, as he sees it, and with my failure to ask what underlying assumptions typically operate in it.I do not dispute that someone like Jaspers would want to (...) ask such a question, nor do I dispute that it is, in general, a perfectly good question. But Ghaemi thinks that my paper is missing out on something by not posing it. The reason he thinks this is because he thinks my paper is an instance of a pattern in the discipline against which he evidently has an axe to grind. In particular, he thinks philosophy in general should be more attendant to the ways in which Diagnostic and Statistical Manual of Mental Disorders (DSM) categories are (problematically) socially constructed. The fact that philosophers have failed to critically point this out allegedly shows philosophy of psychiatry's— and my—unexamined sympathy with the postmodern tendencies—understood as tendencies toward "relativism about truth" and "skepticism about science"—of psychiatry itself. This is odd for a number of reasons, especially in the present context. Firstly, I am not presently in a position to exhaustively defend all of philosophy of psychiatry on the charge of 'postmodernism,' or on the charge of failure to critically engage with the DSM, but it is worth simply stating that I find these to be rather patently unsubstantiated charges. Prominent works that falsify the latter and easily come to mind are by Tsou (2011), Cooper (2004, 2007), Horwitz and Wakefield (2007), Murphy (2006), Poland and von Eckhardt (2013), and Lalumera (2016). Of these, only Lalumera is interested in defending a DSM-style descriptivism (which perhaps Ghaemi would call a kind of "social constructionism"), but even she limits her defense of DSM categories to their role as reference-fixing representations. It is also true that Tsou's paper is an argument that the practical considerations which go into shaping the DSM categories sometimes represent values that permissibly operate in psychiatry. Perhaps this could be construed as a kind of social constructionism as well, and presumably Ghaemi would disagree with it, but no one here is guilty of a failure to engage critically with the DSM and its history. Further, whichever position is taken by these theorists on whether the DSM does, or even one day could, cut nature at its joints, or whether some of the values that shape its construction do so permissibly or impermissibly, one's acceptance or rejection of relativism about truth is an entirely logically independent matter. (shrink)

The article is based on research conducted at the actual radiology department. It presents a range of descriptions and analyses of concrete operations performed by radiologists during their daily professional routine. After careful ethnographic observations, phenomenological analysis is employed with a view to examining the enactive cognition in the radiologist’s “life-world”. The paper uses both ethnography and phenomenology in order to reveal the essential regularities and sedimentations of everyday radiological processes, and the “everyday background” of certain scientific-cognitive operations. The method (...) of research includes “enactive proofs”— observations and analysis of the externalization of a radiologist’s professional memory through the enaction of medical imaging and imageconsciousness. The findings of this research have much to offer to both philosophy and radiological praxis. While the observations strongly support the development of enactive phenomenology, critique of representationalism, primacy of inference in cognition, and shared intentions, they also provide insight into concrete operations in coping with radiology’s paraphernalia, habituality, the origin of mistakes, multilayered communication, and improving professional praxis. (shrink)

Understanding the neural basis of schizophrenia (SZ) is important for shedding light on the neurobiological mechanisms underlying this mental disorder. Structural and functional alterations in the anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC), hippocampus, and medial prefrontal cortex (MPFC) have been implicated in the neurobiology of SZ. However, the effective connectivity among them in SZ remains unclear. The current study investigated how neuronal pathways involving these regions were affected in first-episode SZ using functional magnetic resonance imaging (fMRI). Forty-nine (...) patients with a first-episode of psychosis and diagnosis of SZ—according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision—were studied. Fifty healthy controls (HCs) were included for comparison. All subjects underwent resting state fMRI. We used spectral dynamic causal modeling (DCM) to estimate directed connections among the bilateral ACC, DLPFC, hippocampus, and MPFC. We characterized the differences using Bayesian parameter averaging (BPA) in addition to classical inference (t-test). In addition to common effective connectivity in these two groups, HCs displayed widespread significant connections predominantly involved in ACC not detected in SZ patients, but SZ showed few connections. Based on BPA results, SZ patients exhibited anterior cingulate cortico-prefrontal-hippocampal hyperconnectivity, as well as ACC-related and hippocampal-dorsolateral prefrontal-medial prefrontal hypoconnectivity. In summary, spectral DCM revealed the pattern of effective connectivity involving ACC in patients with first-episode SZ. This study provides a potential link between SZ and dysfunction of ACC, creating an ideal situation to associate mechanisms behind SZ with aberrant connectivity among these cognition and emotion-related regions. (shrink)

With improved diagnostic capability and accuracy, the fields of medicine, neuroscience, psychiatry, and psychology have benefitted remarkably from the dramatic advancements in neuroimaging technology. Not only can surface and subsurface structures of the brain be mapped with incredible anatomical detail, now neural activity can be imaged across time as the brain responds to different stimuli. These sophisticated techniques have been a vital element in the recent increase in neuroimaging-based research. This increase, while producing new diagnostic techniques and improved (...) treatment mechanisms for neurological disease, has also led to a new dilemma for human subjects researchers: how should incidental findings be managed? An incidental finding is a finding concerning an individual research participant that has potential health or reproductive importance and is discovered in the course of conducting research but is beyond the aims of this study. (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 ongoing coronavirus 2019 pandemic caused by the severe acute respiratory syndrome coronavirus 2 has resulted in a severe ramification on the global healthcare system, principally because of its easy transmission and the extended period of the virus survival on contaminated surfaces. With the advances in computer-aided diagnosis and artificial intelligence, this paper presents the application of deep learning and adversarial network for the automatic identification of COVID-19 pneumonia in computed tomography scans of the lungs. The complexity and time limitation (...) of the reverse transcription-polymerase chain reaction swab test makes it disadvantageous to depend solely on as COVID-19’s central diagnostic mechanism. Since CT imaging systems are of low cost and widely available, we demonstrate that the drawback of the RT-PCR can be alleviated with a faster, automated, and reduced contact diagnostic process via the use of a neural network model for the classification of infected and noninfected CT scans. In our proposed model, we explore the benefit of transfer learning as a means of resolving the problem of inadequate dataset and the importance of semisupervised generative adversarial network for the extraction of well-mapped features and generation of image data. Our experimental evaluation indicates that the proposed semisupervised model achieves reliable classification, taking advantage of the reflective loss distance between the real data sample space and the generated data. (shrink)

Recently, there has been increasing interest in methodological aspects of advanced imaging, including the role of guidelines, recommendations, and experts’ consensus, the practice of self-referral, and the risk of diagnostic procedure overuse. In a recent Delphi study of the European Association for Nuclear Medicine (EANM), panelists were asked to give their opinion on 47 scientific questions about imaging in prostate cancer. Nine additional questions exploring the experts’ attitudes and opinions relating to the procedure of consensus building itself (...) were also included. The purpose was to provide insights into the mechanism of recommendation choice and consensus building as seen from the experts’ point of view. Results: Regarding the factors likely to influence the willingness to refer a patient for imaging, the most voted were incorporation into guidelines and data from scientific literature, while personal experience and personal relationship were chosen by a small minority. Regarding the recommendations more relevant to prescribe an imaging procedure, it resulted the incorporation into guidelines promoted by scientific societies (59% of votes); these guidelines also resulted the more trusted. With respect to patients’ preferences considered when prescribing an imaging procedure, the most voted was accuracy, resulted more important than easy access and time to access to the procedure. The majority of the experts expressed the opinion that there is a scarce use of imaging procedures in prostate cancer. With respect to the most relevant factor to build consensus, it resulted the transparency of the process (52% of votes), followed by multidisciplinarity of contributors. The main obstacle to incorporation of modern imaging procedures into guidelines resulted the lack of primary literature on clinical impact. Conclusions: Firstly, the panelists portray themselves as having Evidence-Based Medicine oriented and scientifically inclined attitudes and preferences. Secondly, guidelines and recommendations from scientific societies, especially clinical ones, are positively taken into account as factors influencing decisions, but panelists tend to consider their own appraisal of the scientific literature as more relevant. Thirdly, in respect of overuse, panelists do not think that advanced diagnostic procedures are overutilized in the specific case of Prostate Cancer, but rather they are underutilized. (shrink)

In Philosophy and the Mirror of Nature (1979), Richard Rorty locates the perceived ills of modern philosophy in the "epistemological turn" of Descartes and Locke. This chapter argues that Rorty's accounts of Descartes' and Locke's philosophical work are seriously flawed. Rorty misunderstood the participation of early modern philosophers in the rise of modern science, and he misdescribed their examination of cognition as psychological rather than epistemological. His diagnostic efforts were thereby undermined, and he missed Descartes' original conception of a (...) general physics, and Locke's probabilist analysis of the grounds for rational belief. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 (...) participants (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Precise and timely diagnosis of Parkinson’s disease is important to control its progression among subjects. Currently, a neuroimaging technique called dopaminergic imaging that uses single photon emission computed tomography (SPECT) with 123I-Ioflupane is popular among clinicians for detecting Parkinson’s disease in early stages. Unlike other studies, which consider only low-level features like gray matter, white matter, or cerebrospinal fluid, this study explores the non-linear relation between different biomarkers (SPECT + biological) using deep learning and multivariate logistic regression. Striatal binding (...) ratios are obtained using 123I-Ioflupane SPECT scans from four brain regions which are further integrated with five biological biomarkers to increase the diagnostic accuracy. Experimental results indicate that this investigated approach can differentiate subjects with 100% accuracy. The obtained results outperform the ones reported in the literature. Furthermore, logistic regression model has been developed for estimating the Parkinson’s disease onset probability. Such models may aid clinicians in diagnosing this disease. (shrink)

PurposeTo investigate spontaneous brain activity in patients with dry eye and healthy control using the fractional amplitude of low frequency fluctuation technique with the aim of elucidating the relationship between the clinical symptoms of DE and changes in brain function.Material and MethodsA total of 28 patients with DE and 28 matched healthy volunteers were enrolled. Resting-state functional magnetic resonance imaging scans were performed in both groups. Then all subjects were required to complete a comprehensive Hospital Anxiety and Depression Scale. (...) Receiver operating characteristic curve analysis was used to evaluate the differences in fALFF values between the two groups and their diagnostic value. Linear correlations between HADS and fALFF values in different brain regions of DE patients were analyzed using the Pearson correlation coefficient.ResultsPatients with DE had significantly higher fALFF values in the left calcarine sulcus than the HC group, while fALFF values in the bilateral middle frontal gyrus and right MFG/right inferior frontal gyrus were significantly lower in DE patients than in HC group. fALFF values had a high diagnostic value for differentiating patients with DE from the HC group. Right MFG and right MFG/IFG were significantly correlated with HADS values.ConclusionOur study found that DE mainly involved functional disorders in the brain areas of the left CS, bilateral MFG and right MFG/right IFG, which helped us to find possible clinical features of DE disease and reflected the potential pathological mechanism of DE. (shrink)

This article presents a case study of a recent controversy over the use of computed tomography as a diagnostic technology in South Korean hospitals. The controversy occurred in the wake of a series of conflicts in the late twentieth century over the legitimate placement of healing practices, medicinal substances, and medical technologies within Korea’s separate “Western Medicine” and “Korean Medicine” systems of health care and pharmaceutical distribution. The controversy concerned an attempt to use hi-tech imaging technology—the epitome of (...) modern medicine—in a clinic that maintains a strong ideological attachment to Korean healing traditions. A close study of this dispute, based on interviews, participant observation, and documentary analysis, showed that discursive positions taken about the translatability of medical technologies changed with the context of dispute, and did not reflect a stable epistemic boundary between rival medical paradigms. (shrink)

This article identifies a need to develop an operational theology that responds to migrants in a real and constructive way. It discusses Daniel Groody’s image of God prism in migration theology in order to develop an integrated understanding of the image of God. It argues that Groody’s image of God prism in migration theology is assumed rather than explicit and does not proceed to inform migrant ministry design. To ensure an encompassing understanding of the notion of the image of God, (...) an integrated understanding that integrates the various views is adopted. The adopted integrated understanding of the image of God extends beyond Groody’s image of God prism in migration theology that is systematic theological and theoretical to a development of a migration diagnostic and ministry design framework that employs the various dimensions of the image of God. In doing so, the integrated understanding of the image of God is employed in a practical theological conceptualisation and ministry design to promote and encourage dispositional ethics service, care, acceptance and justice. The first section problematises the challenge of theology and Christian response to migration crisis. The second section discusses Groody’s image of God theological prism in migration theology. The third section discusses the various interpretations of the image of God. The fourth section proposes a diagnostic framework and ministry design that utilises the integrated image of God. (shrink)

Transfer learning can improve the robustness of deep learning in the case of small samples. However, when the semantic difference between the source domain data and the target domain data is large, transfer learning easily introduces redundant features and leads to negative transfer. According the mechanism of the human brain focusing on effective features while ignoring redundant features in recognition tasks, a brain-like classification method based on adaptive feature matching dual-source domain heterogeneous transfer learning is proposed for the preoperative aided (...) diagnosis of lung granuloma and lung adenocarcinoma for patients with solitary pulmonary solid nodule in the case of small samples. The method includes two parts: (1) feature extraction and (2) feature classification. In the feature extraction part, first, By simulating the feature selection mechanism of the human brain in the process of drawing inferences about other cases from one instance, an adaptive selected-based dual-source domain feature matching network is proposed to determine the matching weight of each pair of feature maps and each pair of convolution layers between the two source networks and the target network, respectively. These two weights can, respectively, adaptive select the features in the source network that are conducive to the learning of the target task, and the destination of feature transfer to improve the robustness of the target network. Meanwhile, a target network based on diverse branch block is proposed, which made the target network have different receptive fields and complex paths to further improve the feature expression ability of the target network. Second, the convolution kernel of the target network is used as the feature extractor to extract features. In the feature classification part, an ensemble classifier based on sparse Bayesian extreme learning machine is proposed that can automatically decide how to combine the output of base classifiers to improve the classification performance. Finally, the experimental results (the AUCs were 0.9542 and 0.9356, respectively) on the data of two center data show that this method can provide a better diagnostic reference for doctors. (shrink)

Preoperative diagnosis of gastric cancer and primary gastric lymphoma is challenging and has important clinical significance. Inspired by the inductive reasoning learning of the human brain, transfer learning can improve diagnosis performance of target task by utilizing the knowledge learned from the other domains (source domain). However, most studies focus on single-source transfer learning and may lead to model performance degradation when a large domain shift exists between the single-source domain and target domain. By simulating the multi-modal information learning and (...) transfer mechanism of human brain, this study designed a multisource transfer learning feature extraction and classification framework, which can enhance the prediction performance of the target model by using multisource medical data (domain). First, this manuscript designs a feature extraction network that takes the maximum mean difference based on the Wasserstein distance as an adaptive measure of probability distribution and extracts the domain-specific invariant representations between source and target domain data. Then, aiming at the random generation of parameters bringing uncertainties to prediction accuracy and generalization ability of extreme learning machine network, the 1-norm regularization is used to implement sparse constraints of the output weight matrix and improve the robustness of the model. Finally, some experiments are carried out on the data of two medical centers. The experimental results show that the area under curves (AUCs) of the method are 0.958 and 0.929 in the two validation cohorts, respectively. The method in this manuscript can provide doctors with a better diagnostic reference, which has certain practical significance. (shrink)

La tradición filosófica se ha asentado sobre una serie de presupuestos a propósito de lo que significa pensar, que ha naturalizado una forma dogmática del ejercicio filosófico y que se ha expandido en general a todas las áreas del hacer y del saber. El presente artículo intenta ofrecer, a la luz de la obra de Gilles Deleuze, un diagnóstico de tales presupuestos. Philosophical tradition has grounded itself in a series of assumptions regarding what it means to think. This has naturalized (...) a dogmatic form of philosophical practice, which has extended to all other areas of practice and knowledge. The article presents a diagnostic of those assumptions, on the basis of the work of Gilles Deleuze. A tradição filosófica tem sido estabelecida sobre uma série de pressupostos a propósito do que significa pensar, que tem naturalizado uma forma dogmática do exercício filosófico e que tem se expandido em geral a todas as áreas do fazer e do saber. O presente artigo pretende oferecer, à luz da obra de Gilles Deleuze, um diagnóstico desses pressupostos. (shrink)

This study examines the theology of the fourth-century bishop, Hilary of Poitiers, concentrating particularly on two commentaries written at different times in his life. The main focus of the study is on Hilary's anthropological theology.

Background The integration of artificial intelligence (AI) in radiography presents transformative opportunities for diagnostic imaging and introduces complex ethical considerations. The aim of this cross-sectional study was to explore radiographers’ perspectives on the ethical implications of AI in their field and identify key concerns and potential strategies for addressing them. Methods A structured questionnaire was distributed to a diverse group of radiographers in Saudi Arabia. The questionnaire included items on ethical concerns related to AI, the perceived impact on (...) clinical practice, and suggestions for ethical AI integration in radiography. The data were analyzed using quantitative and qualitative methods to capture a broad range of perspectives. Results Three hundred eighty-eight radiographers responded and had varying levels of experience and specializations. Most (44.8%) participants were unfamiliar with the integration of AI into radiography. Approximately 32.9% of radiographers expressed uncertainty regarding the importance of transparency and explanatory capabilities in the AI systems used in radiology. Many (36.9%) participants indicated that they believed that AI systems used in radiology should be transparent and provide justifications for their decision-making procedures. A significant preponderance (44%) of respondents agreed that implementing AI in radiology may increase ethical dilemmas. However, 27.8%expressed uncertainty in recognizing and understanding the potential ethical issues that could arise from integrating AI in radiology. Of the respondents, 41.5% stated that the use of AI in radiology required establishing specific ethical guidelines. However, a significant percentage (28.9%) expressed the opposite opinion, arguing that utilizing AI in radiology does not require adherence to ethical standards. In contrast to the 46.6% of respondents voicing concerns about patient privacy over AI implementation, 41.5% of respondents did not have any such apprehensions. Conclusions This study revealed a complex ethical landscape in the integration of AI in radiography, characterized by enthusiasm and apprehension among professionals. It underscores the necessity for ethical frameworks, education, and policy development to guide the implementation of AI in radiography. These findings contribute to the ongoing discourse on AI in medical imaging and provide insights that can inform policymakers, educators, and practitioners in navigating the ethical challenges of AI adoption in healthcare. (shrink)

According to policy makers, telemedicine offers “huge opportunities to improve the quality and accessibility of health services.” It is defined as diagnosis, treatment, and monitoring, with doctors and patients separated by space but mediated through information and communication technologies. This mediation is explored through an ethnography of a U.K. teledermatology clinic. Diagnostic image transfer enables medicine at a distance, as patients are removed from knowledge generation by concentrating their identities into images. Yet that form of identity allows images and (...) the expert gaze to be brought into potentially lifesaving proximity. Following Latour’s thread, images must be captured and then mobilized to the knowledge base, where they must be stabilized into standard diagnoses, then combined with different images, waiting lists, skin lesions, dermatologists, paper records, and beds, so that ultimately, outcomes are produced. This huge task requires new knowledges and a widening of agency that, if unacknowledged, may see telemedicine projects continue to founder. (shrink)

Michel Foucault's analysis of "the birth of the clinic" describes the genesis of a unified discourse that, in retrospect, has shaped western medicine for two centuries. However, in looking prospectively toward a 21st century medicine, Foucault's analysis is necessary but not sufficient. To better critically address medicine and medical education in the era of simulation, we could draw on frameworks developed by futurists such as Jean Baudrillard. Foucault's analysis does not account for contemporary, complex developments of the clinical gaze as (...) the gaze is distributed across practitioners in increasing use of sophisticated, representational diagnostic imaging. Further, Foucault's antihumanist rhetoric sometimes strays into the antihumane, and this is disturbing for those who support the development of patient-centered medicine. Yet we are increasingly teaching aspects of medicine, such as communication, in simulated learning environments in which complex reality is absent, perhaps inadvertently creating an "inhumanity" in medical education. (shrink)

Background: Health researchers must weigh the benefits and risks of publishing their findings.Objective: To explore differences in decision making between rural health researchers and managers on the publication of research from small identifiable populations.Method: A survey that investigated the attitudes of Australian rural general practitioners to nurse practitioners was explored. Decisions on the study’s publication were analysed with bioethical principles and health service management ethical decision-making models.Results: Response rate was 78.5% . 84–94% of GP responders considered it to be undesirable (...) for nurse practitioners to initiate referrals to medical specialists , to initiate diagnostic imaging and to prescribe medication .Bioethical analysis: It was concluded that the principle of beneficence outweighed the principle of non-maleficence and that a valid justification for the publication of these results existed.Decision-making models of health service managers: On the basis of models of ethical decision making in health service management, the decisions of the area’s health managers resulted in approval to publish this project’s results being denied. This was because the perceived risks to the health service outweighed benefits. Confidentiality could not be ensured by publication under a regional nom de plume.Conclusions: A conflict of interests between rural researchers and health managers on publication of results is shown by this case study. Researchers and managers at times owe competing duties to key stakeholders. Both weigh the estimated risks and benefits of the effect of research findings. This is particularly true in a rural area, where identification of the subjects becomes more likely. (shrink)

Artificial intelligence (AI) will drastically change the healthcare system. Radiology is one speciality that is most affected as AI algorithms are increasingly used in diagnostic imaging. AI‐enhanced health technologies will, inter alia, increase workflow efficiency, improve diagnostic accuracy, reduce healthcare‐related costs, and help alleviate medical personnel shortages in under‐resourced settings. However, the development of AI‐enhanced technologies in healthcare is fraught with legal, ethical, and human rights concerns. Currently, the use of AI in South African healthcare is not (...) governed by sui generis legislation or ethical guidance focused exclusively and specifically on AI, although various provisions and principles from law and ethics find application. This article outlines these normative principles and explains their relationship with the extant legal obligations and regulatory framework as applied to the use of AI in radiology services in South Africa. The article concludes with three key recommendations for radiology practitioners using AI in South Africa. These are the need for: vigilant monitoring of AI use in practice, reforms to the liability framework, and appropriate guidance from local regulators and the Health Professions Council of South Africa on the ethical use of AI. (shrink)

L’épreuve projective intitulée « spatiographie projective familiale » a pour objectif de comprendre l’image inconsciente du corps familial à travers l’analyse du dessin groupal de la « maison de rêve ». Par cette méthodologie, les auteurs peuvent établir un diagnostic de la structure des liens inconscients de la famille et en faire un objet médiateur pour la prise en charge psychothérapique et une épreuve projective groupale familiale pour le diagnostic. Le dessin de la « maison de rêve » (...) est un outil original qui investigue les dimensions diachronique et synchronique permettant une approche complète de la structuration de l’image du corps familial. (shrink)

Partly diagnostic, this essay explores the religious background to the shift in the dominant political anxieties of our time: from injustice to anarchy. The primordial elements of water, fire, earth, and air supply us with powerful images for the dissolution of institutional forms and structures into chaos. In its response to the threat of chaos, the United States runs the danger currently of shifting in its sense of itself: from leading citizen among the nations to imperial power ruling over (...) all nations. On the domestic scene, the country also shows signs of reconfiguring its life after the pattern of imperial Rome. While both order and justice are fundamental social goods—neither of which can be ignored—the essay argues, in closing, for the priority of justice in God's charitable ordering of all things. This article was the Presidential Address at the 2003 SCE annual meeting in Pittsburgh. (shrink)

The introduction of novel diagnostic techniques in clinical domains such as genomics and radiology has led to a rich ethical debate on how to handle unsolicited findings that result from these innovations. Yet while unsolicited findings arise in both genomics and radiology, most of the relevant literature to date has tended to focus on only one of these domains. In this article, we synthesize and critically assess similarities and differences between “scanning the body” and “sequencing the genome” from an (...) ethical perspective. After briefly describing the novel diagnostic contexts leading to unsolicited findings, we synthesize and reflect on six core ethical issues that relate to both specialties: terminology; benefits and risks; autonomy; disclosure of unsolicited findings to children; uncertainty; and filters and routine screening. We identify ethical rationales that pertain to both fields and may contribute to more ethically sound policies. Considerations of preserving public trust and ensuring that people perceive healthcare policies as fair also support the need for a combined debate. (shrink)

Current diagnostic criteria for schizophrenia place emphasis on delusions and hallucinations, whereas the classical descriptions of schizophrenia by Kraepelin and Bleuler emphasized disorganization and impoverishment of mental activity. Despite the availability of antipsychotic medication for treating delusions and hallucinations, many patients continue to experience persisting disability. Improving treatment requires a better understanding of the processes leading to persisting disability. We recently introduced the term classical schizophrenia to describe cases with disorganized and impoverished mental activity, cognitive impairment and predisposition to (...) persisting disability. Recent evidence reveals that a polygenic score indicating risk for schizophrenia predicts severity of the features of classical schizophrenia: disorganization, and to a lesser extent, impoverishment of mental activity and cognitive impairment. Current understanding of brain function attributes a cardinal role to predictive coding: the process of generating models of the world that are successively updated in light of confirmation or contradiction by subsequent sensory information. It has been proposed that abnormalities of these predictive processes account for delusions and hallucinations. Here we examine the evidence provided by electrophysiology and fMRI indicating that imprecise predictive coding is the core pathological process in classical schizophrenia, accounting for disorganization, psychomotor poverty and cognitive impairment. Functional imaging reveals aberrant brain activity at network hubs engaged during encoding of predictions. We discuss the possibility that frequent prediction errors might promote excess release of the neurotransmitter, dopamine, thereby accounting for the occurrence of episodes of florid psychotic symptoms including delusions and hallucinations in classical schizophrenia. While the predictive coding hypotheses partially accounts for the time-course of classical schizophrenia, the overall body of evidence indicates that environmental factors also contribute. We discuss the evidence that chronic inflammation is a mechanism that might link diverse genetic and environmental etiological factors, and contribute to the proposed imprecision of predictive coding. (shrink)