The aim of the article is to intervene in debates about the digital and, in particular, framings that imagine the digital in terms of epochal shifts or as redefining life. Instead, drawing on recent developments in digital methods, we explore the lively, productive and performative qualities of the digital by attending to the specificities of digital devices and how they interact, and sometimes compete, with older devices and their capacity to mobilize and materialize social and other relations. In doing so, (...) our aim is to explore the implications of digital devices and data for reassembling social science methods or what we call the social science apparatuses that assemble digital devices and data to ‘know’ the social and other relations. Building on recent work at CRESC on the social life of methods, we recommend a genealogical approach that is alive to the ways in which digital devices are simultaneously shaped by social worlds, and can in turn become agents that shape those worlds. This calls for attending to the specificities of digital devices themselves, how they are varied and composed of diverse socio-technical arrangements, and are enrolled in the creation of new knowledge spaces, institutions and actors. Rather than exploring what large-scale changes can be revealed and understood through the digital, we argue for explorations of how digital devices themselves are materially implicated in the production and performance of contemporary sociality. To that end we offer the following nine propositions about the implications of digital data and devices and argue that these demand rethinking the theoretical assumptions of social science methods: transactional actors; heterogeneity; visualization; continuous time; whole populations; granularity; expertise; mobile and mobilizing; and non-coherence. (shrink)

We examine two different descriptions of the behavioral functions of the hippocampal system. One emphasizes spatially organized behaviors, especially those using cognitive maps. The other emphasizes memory, particularly working memory, a short-term memory that requires iexible stimulus-response associations and is highly susceptible to interference. The predictive value of the spatial and memory descriptions were evaluated by testing rats with damage to the hippocampal system in a series of experiments, independently manipulating the spatial and memory characteristics of a behavioral task. No (...) dissociations were found when the spatial characteristics of the stimuli to be remembered were changed; lesions produced a similar deficit in both spatial and nonspatial test procedures, indicating that the hippocampus was similarly involved regardless of the spatial nature of the task. In contrast, a marked dissociation was found when the memory requirements were altered. Rats with lesions were able to perform accurately in tasks that could be solved exclusively on the basis of reference memory. They performed at chance levels and showed no signs of recovery even with extensive postoperative training in tasks that required working memory. In one experiment all the characteristics of the reference memory and working memory procedures were identical except the type of memory required. Consequently, the behavioral dissociation cannot be explained by differences in attention, motivation, response inhibition, or the type of stimuli to be remembered. As a result of these experiments we propose that the hippocampus is selectively involved in behaviors that require working memory, irrespective of the type of material that is to be processed by that memory. (shrink)

Pragmatic clinical trials offer important benefits, such as generating evidence that is suited to inform real-world health care decisions and increasing research efficiency. However, PCTs also present ethical challenges. One such challenge involves the management of information that emerges in a PCT that is unrelated to the primary research question, yet may have implications for the individual patients, clinicians, or health care systems from whom or within which research data were collected. We term these findings as?pragmatic clinical trial collateral findings,? (...) or?PCT-CFs?. In this article, we explore the ethical considerations associated with the identification, assessment, and management of PCT-CFs, and how these considerations may vary based upon the attributes of a specific PCT. Our purpose is to map the terrain of PCT-CFs to serve as a foundation for future scholarship as well as policy-making and to facilitate careful deliberation about actual cases as they occur in practice. (shrink)

The Covid‐19 pandemic has concentrated bioethics attention on the “lifeboat ethics” of rationing and fair allocation of scarce medical resources, such as testing, intensive care unit beds, and ventilators. This focus drives ethics resources away from persistent and systemic problems—in particular, the structural injustices that give rise to health disparities affecting disadvantaged communities of color. Bioethics, long allied with academic medicine and highly attentive to individual decision‐making, has largely neglected its responsibility to address these difficult “upstream” issues. It is time (...) to broaden our teaching, research, and practice to match the breadth of the field in order to help address these significant societal inequities and unmet health needs. (shrink)

Over several decades, ethics and law have been applied to medical education and practice in a way that reflects the continuation during the twentieth century of the strong distinction between facts and values. We explain the development of applied ethics and applied medical law and report selected results that reflect this applied model from an empirical project examining doctors’ decisions on withdrawing/withholding treatment from patients who lack decision-making capacity. The model is critiqued, and an alternative “constitutive” model is supported on (...) the basis that medicine, medical law, and medical ethics exemplify the inevitable entanglement of facts and values. The model requires that ethics and law be taught across the medical education curriculum and integrated with the basic and clinical sciences and that they be perceived as an integral component of medical evidence and practice. Law, in particular, would rank as equal in normative authority to the relevant clinical scientific “facts” of the case, with graduating doctors having as strong a basic command of each category as the other. The normalization of legal knowledge as part of the clinician’s evidence base to be utilized in practice may provide adequate consolation for clinicians who may initially resent further perceived incursions on their traditional independence and discretion. (shrink)

Objectives To determine the role played by law in medical specialists9 decision-making about withholding and withdrawing life-sustaining treatment from adults who lack capacity, and the extent to which legal knowledge affects whether law is followed. Design Cross-sectional postal survey of medical specialists. Setting The two largest Australian states by population. Participants 649 medical specialists from seven specialties most likely to be involved in end-of-life decision-making in the acute setting. Main outcome measures Compliance with law and the impact of legal knowledge (...) on compliance. Results 649 medical specialists (of 2104 potential participants) completed the survey (response rate 31%). Responses to a hypothetical scenario found a potential low rate of legal compliance, 32% (95% CI 28% to 36%). Knowledge of the law and legal compliance were associated: within compliers, 86% (95% CI 83% to 91%) had specific knowledge of the relevant aspect of the law, compared with 60% (95% CI 55% to 65%) within non-compliers. However, the reasons medical specialists gave for making decisions did not vary according to legal knowledge. Conclusions Medical specialists prioritise patient-related clinical factors over law when confronted with a scenario where legal compliance is inconsistent with what they believe is clinically indicated. Although legally knowledgeable specialists were more likely to comply with the law, compliance in the scenario was not motivated by an intention to follow law. Ethical considerations (which are different from, but often align with, law) are suggested as a more important influence in clinical decision-making. More education and training of doctors is needed to demonstrate the role, relevance and utility of law in end-of-life care. (shrink)

Firearm injury in the United States is a public health crisis in which physicians are uniquely situated to intervene. However, their ability to mitigate harm is limited by a complex array of laws and regulations that shape their role in firearm injury prevention. This piece uses four clinical scenarios to illustrate how these laws and regulations impact physician practice, including patient counseling, injury reporting, and the use of court orders and involuntary holds. Unintended consequences on clinical practice of laws intended (...) to reduce firearm injury are also discussed. Lessons drawn from these cases suggest that physicians require more nuanced education on this topic, and that policymakers should consult front-line healthcare providers when designing firearm policies. (shrink)

Over the past decade, the number of clinical trials registered with the Food and Drug Administration has increased dramatically. The business of clinical research has become more diverse, involving academic institutions, clinician-researchers in community settings, pharmaceutical companies, and contract research organizations. This growth has been accompanied by increasing concerns about the ethical conduct of research. Much of this concern has been directed to procedural issues including institutional review board review, data monitoring, and informed consent forms. However, the protection of human (...) subjects cannot be achieved by relying solely on procedural safeguards. There are more nuanced issues related to recruitment and retention of subjects, and to the process of informed consent, that are generated during the interaction between study staff and subjects. It is only through an examination of these relationships that one can more fully define and understand the challenges of protecting subjects in research. (shrink)

Over the past decade, the number of clinical trials registered with the Food and Drug Administration has increased dramatically. The business of clinical research has become more diverse, involving academic institutions, clinician-researchers in community settings, pharmaceutical companies, and contract research organizations. This growth has been accompanied by increasing concerns about the ethical conduct of research. Much of this concern has been directed to procedural issues including institutional review board review, data monitoring, and informed consent forms. However, the protection of human (...) subjects cannot be achieved by relying solely on procedural safeguards. There are more nuanced issues related to recruitment and retention of subjects, and to the process of informed consent, that are generated during the interaction between study staff and subjects. It is only through an examination of these relationships that one can more fully define and understand the challenges of protecting subjects in research. (shrink)

At 41 weeks, the patient had been delivered by Cesarean section for failure to progress at Hospital A in the same city. Three days after birth she suffered a respiratory arrest. Resuscitation and ventilator support were initiated promptly but the child did poorly, and shortly after this first arrest, the parents were told by the child's physician that she had no chance of recovery. Nevertheless, the mother continued to insist that the child be kept on a respirator and aggressive support (...) be maintained. (shrink)

A goal of living as well as possible is central to practice and research with young adults living with home mechanical ventilation (HMV). Significant effort has been put into conceptualizing and measuring the quality of life (QOL) as a proxy for living well. Yet, dominant understandings of QOL have been influenced by normative, ableist, and biomedical discourses about what constitutes a good life that, when applied in practice and systems with those living with HMV, can contribute to exclusion and constrain (...) opportunities to live well. Inquiry into what certain understandings of living well can do is critical to opening up possibilities to reimagine living well with HMV. This paper draws on findings from a critical narrative inquiry that explored the experiences of five young adults (ages 18–40 years) living with HMV. Data were co‐constructed virtually through an initial interview and photo‐elicitation using participant‐generated photographs. A critical narrative analysis of participants' stories made visible the ideological effects of ableist, biomedical, and individualist discourses and how the young adults reproduced and resisted these dominant discourses. Their stories further opened up possibilities for nurses and other healthcare providers to see living well and QOL differently. (shrink)

In this study, we discuss the role of senior nurses who sit on clinical commissioning groups that now plan and procure most health services in England. These nurses are expected to bring a nursing view to all aspects of clinical commissioning group business. The role is a senior level appointment and requires experience of strategic commissioning. However, little is known about how nurses function in these roles. Following Barrientos' methodology, published policy and literature were analysed to investigate these roles and (...) National Health Service England's claim that nursing can influence and advance a nursing perspective in clinical commissioning groups. Drawing on work by Berg, Barry and Chandler on ‘new public management’, we discuss how nurses on clinical commissioning groups work at the alignment of the interests of biomedicine and managerialism. We propose that the way this nursing role is being implemented might paradoxically offer further evidence of the devaluing of nursing rather than the emergence of a strong professional nursing voice at the level of strategic commissioning. (shrink)

There is a growing interest in non-invasive stimulation interventions as treatment strategies to improve functional outcomes and recovery after spinal cord injury. Repetitive transcranial magnetic stimulation is a neuromodulatory intervention which has the potential to reinforce the residual spinal and supraspinal pathways and induce plasticity. Recent reviews have highlighted the therapeutic potential and the beneficial effects of rTMS on motor function, spasticity, and corticospinal excitability modulation in SCI individuals. For this scoping review, we focus on the stimulation parameters used in (...) 20 rTMS protocols. We extracted the rTMS parameters from 16 published rTMS studies involving SCI individuals and were able to infer preliminary associations between specific parameters and the effects observed. Future investigations will need to consider timing, intervention duration and dosage that may depend on the stage, the level, and the severity of the injury. There is a need for more real vs. sham rTMS studies, reporting similar designs with sufficient information for replication, to achieve a significant level of evidence regarding the use of rTMS in SCI. (shrink)

An interview with Gail Weiss concerning her interests and influences, especially the body and embodiment.

Despite general agreement that altered reward sensitivity is involved in attention-deficit/hyperactivity disorder (ADHD), a wide range of different alterations has been proposed. We cite work showing abnormal sensitivity to delay of reward, together with abnormal sensitivity to individual instances of reward. We argue that at the cellular level these behavioural characteristics might indicate that dopamine timing is off in children with ADHD.

This qualitative study describes the lived experience of physicians who work in communities that have experienced a public mass shooting. Semi-structured interviews were conducted with seventeen physicians involved in eight separate mass casualty shooting incidents in the United States. Four major themes emerged from constant comparative analysis: The psychological toll on physicians: “I wonder if I'm broken”; the importance of and need for mass casualty shooting preparedness: “[We need to] recognize this as a public health concern and train physicians to (...) manage it”; massive media attention: “The media onslaught was unbelievable”; and commitment to advocacy for a public health approach to firearm violence: “I want to do whatever I can to prevent some of these terrible events.”. (shrink)

Augmentative and alternative communication brain-computer interface systems are intended to offer communication access to people with severe speech and physical impairment without requiring volitional movement. As the field moves toward clinical implementation of AAC-BCI systems, research involving participants with SSPI is essential. Research has demonstrated variability in AAC-BCI system performance across users, and mixed results for comparisons of performance for users with and without disabilities. The aims of this systematic review were to describe study, system, and participant characteristics reported in (...) BCI research, summarize the communication task performance of participants with disabilities using AAC-BCI systems, and explore any differences in performance for participants with and without disabilities. Electronic databases were searched in May, 2018, and March, 2021, identifying 6065 records, of which 73 met inclusion criteria. Non-experimental study designs were common and sample sizes were typically small, with approximately half of studies involving five or fewer participants with disabilities. There was considerable variability in participant characteristics, and in how those characteristics were reported. Over 60% of studies reported an average selection accuracy ≤70% for participants with disabilities in at least one tested condition. However, some studies excluded participants who did not reach a specific system performance criterion, and others did not state whether any participants were excluded based on performance. Twenty-nine studies included participants both with and without disabilities, but few reported statistical analyses comparing performance between the two groups. Results suggest that AAC-BCI systems show promise for supporting communication for people with SSPI, but they remain ineffective for some individuals. The lack of standards in reporting outcome measures makes it difficult to synthesize data across studies. Further research is needed to demonstrate efficacy of AAC-BCI systems for people who experience SSPI of varying etiologies and severity levels, and these individuals should be included in system design and testing. Consensus in terminology and consistent participant, protocol, and performance description will facilitate the exploration of user and system characteristics that positively or negatively affect AAC-BCI use, and support innovations that will make this technology more useful to a broader group of people.Clinical trial registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018095345, PROSPERO: CRD42018095345. (shrink)

These essays apply influential, pathbreaking psychological studies about women's lives to literature. In their analyses of fictional portraits, contributors both challenge and confirm psychological theories about female identity, about 'connection/separation' as developmental catalysts, and about the impact of gender on 'voice,' moral decision-making, and epistemology in relation to classical and contemporary literary texts, written by both women and men.

The relative reinforcing value of food measures how hard someone will work for a high-energy-dense food when an alternative reward is concurrently available. Higher RRV for HED food has been linked to obesity, yet this association has not been examined in low-income preschool-age children. Further, the development of individual differences in the RRV of food in early childhood is poorly understood. This cross-sectional study tested the hypothesis that the RRV of HED to low-energy-dense food would be greater in children with (...) obesity compared to children without obesity in a sample of 130 low-income 3- to 5-year-olds enrolled in Head Start classrooms in Central Pennsylvania. In addition, we examined individual differences in the RRV of food by child characteristics and food security status. The RRV of food was measured on concurrent progressive-ratio schedules of reinforcement. RRV outcomes included the last schedule reached for cookies and fruit, the breakpoint for cookies in proportion to the total breakpoint for cookies and fruit combined, and response rates. Parents completed the 18-item food security module to assess household food security status and the Behavioral Activation System scale to assess reward sensitivity. Pearson’s correlations and mixed models assessed associations between continuous and discrete child characteristics with RRV outcomes, respectively. Two-way mixed effects interaction models examined age and sex as moderators of the association between RRV and Body Mass Index z-scores. Statistical significance was defined as p < 0.05. Children with obesity had a greater cookie Pmax [F = 4.95, p = 0.03], higher RRV cookie [F = 4.28, p = 0.04], and responded at a faster rate for cookies [F = 17.27, p < 0.001] compared to children without obesity. Children with higher cookie response rates had higher BMIZ ; and RRV cookie was positively associated with BMIZ for older children and boys, but not younger children or girls. The RRV of food did not differ by household food security status. Low-income children with obesity showed greater motivation to work for cookies than fruit compared to their peers without obesity. The RRV of HED food may be an important contributor to increased weight status in boys and future research is needed to better understand developmental trajectories of the RRV of food across childhood. (shrink)

We approach the issue of holophrasis versus compositionality in the emergence of protolanguage by analyzing the earliest combinatorial constructions in child, bonobo, and chimpanzee: messages consisting of one symbol combined with one gesture. Based on evidence from apes learning an interspecies visual communication system and children acquiring a first language, we conclude that the potential to combine two different kinds of semiotic element — deictic and representational — was fundamental to the protolanguage forming the foundation for the earliest human language. (...) This is a form of compositionality, in that each communicative element stands for a single semantic element. The conclusion that human protolanguage was exclusively holophrastic — containing a proposition in a single word — emerges only if one considers the symbol alone, without taking into account the gesture as a second element comprising the total message. (shrink)

Lecturer in social foundations of education and women's studies, Victoria College, Australia.

This paper is a counter to the view that names are always predicates with the same extension as a metalinguistic predicate with the form “is a thing called “N”” (the Predicate View). The Predicate View is in opposition to the Referential View of names. In this paper, I undermine one argument for the Predicate View. The Predicate View’s adherents take examples of uses of names that have the surface appearance of a predicate and generalise from these to treat uses of (...) names that do not have the surface appearance of a predicate. They show that the Predicate View can provide a unified account of these two uses and assume that the Referential account cannot. I propose an alternative view of names, the Polysemy View. This view allows one to resist the pressure to generalise from the cases with the surface appearance of predicates to all uses of names while nevertheless providing connections between the uses. On the Polysemy View names are not, in their core use, metalinguistic predicates. Names are predominantly referring expressions but they also freelance as metalinguistic predicates on occasion. They have a double life. This double life is possible because of the pragmatic and conventional connections between the two aspects of that life. My main aim in this paper is to show that the Predicate View is not the only view that can give a good account of apparently predicative uses of names. In addition, I offer some inconclusive reasons to prefer the Polysemy View over the Predicate View. My paper assumes a background framework that the Predicate and Referentialist Views share and I do not attempt to justify that framework. I ignore many other views of names (notably descriptivist views and relevance theoretic views) in order to focus on the debate between these two opponents. (shrink)

I distinguish between two senses in which feminists have argued that the knower is social: 1. situated or socially positioned and 2. interdependent. I argue that these two aspects of the knower work in cooperation with each other in a way that can produce willful hermeneutical ignorance, a type of epistemic injustice absent from Miranda Fricker's Epistemic Injustice. Analyzing the limitations of Fricker's analysis of the trial of Tom Robinson in Harper Lee's To Kill a Mockingbird with attention to the (...) way in which situatedness and interdependence work in tandem, I develop an understanding of willful hermeneutical ignorance, which occurs when dominantly situated knowers refuse to acknowledge epistemic tools developed from the experienced world of those situated marginally. Such refusals allow dominantly situated knowers to misunderstand, misinterpret, and/or ignore whole parts of the world. (shrink)

Philosophy and the Disdain for History: Reflections on Husserl's Ergiinzungsband to the Crisis GAIL SOFFER HUSSERL'S RECENTLY PUBLISHED Erganzungsband to the Cr/s/s' is a highly inti- mate statement, almost a confession, of hope and despair at the end of a philosophical life, a compendium of urgent, world-historical tasks not yet laid to rest. Above all, it abounds in reflections on history. In these, two things are poignantly clear: the late Husserl is completely convinced that history is of the utmost (...) importance to philosophy; he is not certain why. On a superfi- cial interpretation, the reason may seem obvious: Husserl's philosophical proj- ect is founded on the ideal of presuppositionless rational insight, and hence is Cartesian and ahistorical in its essence. The turn to history is to something external, and an implicit admission of the limitations of phenomenology itself, its inability to address the most pressing and meaningful problems of human existence: the crisis in European society and values, the ultimate significance of a man's life, work, and death. For those who would seek external motives for Husserl's turn to history, material is not lacking in this volume. There are moving philosophical discussions -- set in the atemporal phenomenological present tense -- of nationalism, of territoriality and the search for Lebensraum, of racism and xenophobia, of the forced emigration of families to a "no man's land. '' There is an attack on... (shrink)

It is an ancient view, to be found even in Aristotle’s analysis of friendship, that the other is an alter ego, another myself. More recently, this conception has provoked spirited debate within and without the phenomenological tradition. It can be found in a wide variety of texts, from Husserl’s Cartesian Meditations to Thomas Nagel’s “What is it like to be a bat?” The basic position can be summarized as follows. Intentional experiences are subjective, first-person experiences, not objective, third-person experiences.

This essay argues that Merleau-Ponty’s phenomenology of embodiment can be an extremely helpful ally for contemporary feminist theorists, critical race theorists, and disability studies scholars because his work suggests that the gender, race, and ability of bodies are not innate or fixed features of those bodies, much less corporeal indicators of physical, social, psychic, and even moral inferiority, but are themselves dynamic phenomena that have the potential to overturn accepted notions of normalcy, naturalness, and normativity. Taking seriously Merleau-Ponty’s insistence that (...) our bodies are the means by which we directly engage with the world, I suggest, encourages us to be attentive to how an individual’s or group’s gender, race, and bodily abilities differentially affect how their bodies are responded to by other bodies. The responses of others, in turn, directly influences the significance of an individual’s actions within that situation. This essay provides a critical examination of specific feminist philosophers, critical race scholars, and disability theorists who creatively utilize Merleau-Pontian insights to illustrate, and ultimately combat, the insidious ways in which sexism, racism, and “compulsory able-bodiedness”, impoverish the lived experience of both oppressors and the oppressed, largely by predetermining the meaning of their bodily interactions in accordance with institutionalized cultural expectations and norms. (shrink)

The literature on epistemic injustice has been helpful for highlighting some of the epistemic harms that have long troubled those working in area studies that concern oppressed populations. Nonetheless, a good deal of this literature is oriented toward those in a position to perpetrate injustices, rather than those who historically have been harmed by them. This orientation, I argue, is ill-suited to the work of epistemic decolonization. In this essay, I call and hold attention to the epistemic interests of those (...) who are epistemically marginalized on account of relations of dominance and oppression. To do so, I draw on Kristie Dotson’s work, which uses a systems approach focused on epistemic agency. I develop Dotson’s insights further to argue that epistemic inclusions may be just as pernicious as epistemic exclusions Specifically, I highlight some of the ways in which epistemic agents can be included in epistemic systems in a manner that is epistemically exploitative—extracting epistemic labor coercively or in ways that are distinctly non-reciprocal. I then turn to María Lugones’ distinction between horizontal and vertical practices to discuss avenues of resisting both exclusions and inclusions that thwart the epistemic agency of marginalized knowers. (shrink)

If social, political, and material transformation is to have a lasting impact on individuals and society, it must be integrated within ordinary experience. Refiguring the Ordinary examines the ways in which individuals' bodies, habits, environments, and abilities function as horizons that underpin their understandings of the ordinary. These features of experience, according to Gail Weiss, are never neutral, but are always affected by gender, race, social class, ethnicity, nationality, and perceptions of bodily normality. While no two people will experience (...) the ordinary in exactly the same way, the multiplicities, possibilities, overlaps, and limitations of day-to-day horizons are always intersubjectively constituted. Weiss turns her attention to changing the conditions and experiences of oppression from ordinary to extraordinary. This book is an impressive phenomenological, feminist reading of the complexities of human experience.M. V. Marder, University of Toronto, Feb. 2009. (shrink)