Surgical expertise does not have a clear definition and is often culturally associated with power, authority, prestige, and case number rather than more objective proxies of excellence. Multiple models of expertise progression have been proposed including the Dreyfus model, however, they all currently require subjective evaluation of skill. Recently, efforts have been made to improve the ways in which surgical excellence is measured and expertise is defined using artificial intelligence, video recordings, and accelerometers. However, these aforementioned methods of assessment are (...) still subjective or indirect proxies of expertise, thus uncovering the neural mechanisms that differentiate expert surgeons from trainees may enhance the objectivity of surgical expertise validation. In fact, some researchers have already suggested that their neural imaging-based expertise classification methods outperform currently used methods of surgical skill certification such as the Fundamentals of Laparoscopic Surgery scores. Such imaging biomarkers would not only help better identify the highest performing surgeons, but could also improve residency programs by providing more objective, evidence-based feedback and developmental milestones for those in training and perhaps act as a marker of surgical potential in medical students. Despite the potential advantages of using neural imaging in the assessment of surgical expertise, this field of research remains in its infancy. This systematic review identifies studies that have applied neuromonitoring in assessing surgical skill across levels of expertise. The goals of this review are to identify the strongest neural indicators of surgical expertise, the limitations of the current literature on this subject, the most sensible future directions for further study. We found substantial evidence that surgical expertise can be delineated by differential activation and connectivity in the prefrontal cortex across multiple task and neuroimaging modalities. Specifically, novices tend to have greater PFC activation than experts under standard conditions in bimanual and decision-making tasks. However, under high temporal demand tasks, experts had increased PFC activation whereas novices had decreased PFC activation. Common limitations uncovered in this review were that task difficulty was often insufficient to delineate between residents and attending. Moreover, attending level involvement was also low in multiple studies which may also have contributed to this issue. Most studies did not analyze the ability of their neuromonitoring findings to accurately classify subjects by level of expertise. Finally, the predominance of fNIRS as the neuromonitoring modality limits our ability to uncover the neural correlates of surgical expertise in non-cortical brain regions. Future studies should first strive to address these limitations. In the longer term, longitudinal within-subjects design over the course of a residency or even a career will also advance the field. Although logistically arduous, such studies would likely be most beneficial in demonstrating effects of increasing surgical expertise on regional brain activation and inter-region connectivity. (shrink)

Subject perspectives : the missing element in research ethics -- Personal knowledge and study participation -- The everyday ethics of human research -- The hidden world of subjects : rule-breaking in clinical trials -- Participants as partners in genetic research -- Terminally ill patients and the right to try experimental drugs -- Embedded ethics in developing country research -- Research subjects as literary subjects -- How to hear subjects.

Mathematicians judge proofs to possess, or lack, a variety of different qualities, including, for example, explanatory power, depth, purity, beauty and fit. Philosophers of mathematical practice have begun to investigate the nature of such qualities. However, mathematicians frequently draw attention to another desirable proof quality: being motivated. Intuitively, motivated proofs contain no "puzzling" steps, but they have received little further analysis. In this paper, I begin a philosophical investigation into motivated proofs. I suggest that a proof is motivated if and (...) only if mathematicians can identify (i) the tasks each step is intended to perform; and (ii) where each step could have reasonably come from. I argue that motivated proofs promote understanding, convey new mathematical resources and stimulate new discoveries. They thus have significant epistemic benefits and directly contribute to the efficient dissemination and advancement of mathematical knowledge. Given their benefits, I also discuss the more practical matter of how we can produce motivated proofs. Finally I consider the relationship between motivated proofs and proofs which are explanatory, beautiful and fitting. (shrink)

This investigation addresses the hypothesis that negative affect is associated with decreased ability to shift attention to a new focus. Thirty-nine participants completed a covert attentional orienting task and then viewed a distressing film clip. Mood was measured by self-report at the beginning and end of the session. Correlations between attentional orienting performance and self-reported mood indicated that participants with greater response time costs on invalidly cued trials reported more negative affect in response to the film. These results support the (...) hypothesis that negative affect is associated with a slowness to disengage attention. (shrink)

As virtues of intellectual character are commonly discussed, they aim at _propositional _intellectual goods. But some creative works—especially those in music and the visual arts—are not primarily intended to gain, keep, or share propositional goods such as truth, knowledge, and understanding. They aim at something else. Thus, to conceive of intellectual creativity in a way that accords with standard discussions of intellectual virtue is to exclude paradigmatic works of the creative intellect. There is a kind of puzzle here: it appears (...) that we cannot maintain both the commonly-discussed notion of intellectual virtue and the claim that, say, Beethoven’s Ninth, or Monet’s Water Lilies, are central cases of intellectually virtuous creativity. We provide a two-part solution to the puzzle. First, we suggest that some works of music and visual art can convey propositional goods. Second, we appeal to the notion of _acquaintance _as an epistemic good that is conveyed through creative artistic and musical to an extent not conveyed in standard prose works. In this respect, intellectual creativity is the virtue that breaks the propositional mold of much contemporary virtue epistemology. (shrink)

This essay explores the theorization of moral valuation outlined in Stefan Bargheer’s Moral Entanglements: Conserving Birds in Britain and Germany when extended to the climate crisis. It considers, first, how ‘nature’ is valued when it confronts people and societies as a source of threat, rather than of recreation or resources. Second, the essay critically examines the role of moral discourse in the collective work of addressing climate change and its relationship to practice.

This introduction provides an overview to a special issue on Critical Healing, which draws on queer theory, disability studies, postcolonial theory, and literary studies to theorize productive engagements between the clinical and cultural aspects of biomedical knowledge and practice. The essays in this issue historicize and theorize diagnosis, particularly diagnosis that impacts trans health and sexuality, homosexuality, and HIV/AIDS transmission. The essays also address racialization, disability, and colonialism through discussions of fiction, film, theoretical memoir, and comics, as well as biomedical (...) discourse and knowledge. (shrink)

By acquiring an understanding of the cultural meaning of deafness and acting as a bridge to resources and opportunities, clinicians.

I develop and defend the following neo-Aristotelian account of supererogation: an action is supererogatory if and only if it is overall virtuous and either the omission of an overall virtuous action in that situation would not be overall vicious or there is some overall virtuous action that is less virtuous than it and whose performance in its place would not be overall vicious. I develop this account from within the virtue-ethical tradition. And I argue that it is intuitively defensible and (...) fully compatible with the doctrine of the mean. (shrink)

We review a recent paper in Genome Research by Guantes et al. showing that nuclear gene expression is influenced by the bioenergetic status of the mitochondria. The amount of energy that mitochondria make available for gene expression varies considerably. It depends on: the energetic demands of the tissue; the mitochondrial DNA (mtDNA) mutant load; the number of mitochondria; stressors present in the cell. Hence, when failing mitochondria place the cell in energy crisis there are major effects on gene expression affecting (...) the risk of degenerative diseases, cancer and ageing. In 2015 the UK parliament approved a change in the regulation of IVF techniques, allowing “Mitochondrial replacement therapy” to become a reproductive choice for women at risk of transmitting mitochondrial disease to their children. This is the first time that this technique will be available. Therefore understanding the interaction between mitochondria and the nucleus has never been more important. (shrink)

Realist ideology critique (RIC) is a strand of political realism recently developed in response to concerns that realism is biased toward the status quo. RIC aims to debunk an individual's belief that a social institution is legitimate by revealing that the belief is caused by that very same institution. Despite its growing prominence, RIC has received little critical attention. In this article, I buck this trend. First, I improve on contemporary accounts of RIC by clarifying its status and the role (...) of motivated reasoning. Second, I show that realist ideology critics face a dilemma: either their account makes deeply implausible epistemological assumptions, or they temper its epistemology at the expense of rendering it toothless. I argue for each horn in turn before revealing the dilemma to be a false one by making a novel distinction between varying strengths of RIC based on their underlying epistemological assumptions. I propose Moder-ate RIC as a solution: upon discovering that one reason for your belief that a social institution is legitimate is likely malignantly epistemically circular, the belief should undergo further epistemic testing. I respond to three potential objections and suggest that Moderate RIC would make a fruitful addition to political theorists' methodological toolkit. (shrink)

Care workers and families often engage in deception in everyday interactions with people affected by dementia. While benevolent deception can be justified, there are often more respectful and less risky ways to help people with dementia seeking to make sense of their lives.

Telephone survey of 293 TV viewers in Minneapolis-St. Paul investigated how viewers evaluate ethical issues and problematic content in TV news and entertainment programs, and attitudes toward methods of controlling TV content. In rating eight hypothetical news and entertainment scenarios, viewers appeared more willing to accept ethical breaches in entertainment than in news programs. In evaluating the severity of general problems in TV programming, most viewers considered violence, adult themes, and a lack of family values to be big problems. Different (...) methods of controlling potentially problematic content were evaluated, with viewers overwhelmingly endorsing a system of ratings or warnings, as well as restricting content to certain times or channels. Governmental regulation as a form of controlling TV content was strongly rejected. This article demonstrates the usefulness and appropriateness of empirical research in involving the audience in an active role in the study of media ethics. (shrink)

In this essay I refer to eros as the force that plays on our bodies and connects us to the larger community of life, an embodied form of love that charges the will towards well-being. Analyzing the ways that eros can be engaged and expressed in the "commons" as a life sustaining force, I look to current, on-the-ground work being done in Detroit, MI where a grassroots network of artists, community-builders, educators and neighborhood folk are revitalizing their city. Linking this (...) work and the love I experienced with them to childhood experiences in my own homeplace in northern New York State, I argue for the development of eco-ethical consciousness within an erotic "poetics of place" where the natural world speaks to us within our interpretive, expressive efforts. Finally, in an explication of education as those generative relations that are specifically oriented towards well-being, I look to the relation among eros, language and the creation of the commons as a critical educational endeavor. If we are to stem the tide of ecological destruction now upon us, we will need educators in public schools who recognize and are able to create classroom practices that encourage an "eco-erosic love" and thus inspire students who can protect the fragile relationship of their human communities to the ecosystems upon which we depend. (shrink)

Journal of Social Philosophy, EarlyView.

Proposals to modernise fertility law in the UK In November 2023, the Human Fertilisation and Embryology Authority (HFEA) published recommendations 1 for changes to the Human Fertilisation and Embryology Act. 2 The HFEA regulates fertility treatments and embryo research in the UK. The recommendations were informed by a public consultation process during which the HFEA heard from patients, professionals and others with an interest in the regulations. The consultation ran from February - April 2023 and received just over 6800 responses. (...) The recommendations focus on four main areas that the HFEA consider to be in need of modernisation within the Act – patient protection and safety; consent; access to donor information; and future scientific developments and innovation. The Authority proposes that it should be given greater freedom and flexibility to promote patient safety and good practice. For example, through a wider range of regulatory enforcement powers,... (shrink)

Hastings Center Report, Volume 52, Issue 2, Page 4-6, March‐April 2022.

This collection of essays seeks to challenge the notion of the supremacy of the brain as the key organ of the Enlightenment, by focusing on the workings of the bowels and viscera that so obsessed writers and thinkers during the long eighteenth-century. These inner organs and the digestive process acted as counterpoints to politeness and other modes of refined sociability, drawing attention to the deeper workings of the self. Moving beyond recent studies of luxury and conspicuous consumption, where dysfunctional bowels (...) have been represented as a symptom of excess, this book seeks to explore other manifestations of the visceral and to explain how the bowels played a crucial part in eighteenth-century emotions and perceptions of the self. The collection offers an interdisciplinary and cross-cultural perspective on entrails and digestion by addressing urban history, visual studies, literature, medical history, religious history, and material culture in England, France, and Germany. (shrink)

The empirical evidence for exploration underlying the appeal of imaginary worlds is mostly absent or contradictory. Openness, and the cognitive exploration it represents, provides a better account than the overall drive to explore predicted by evolutionary theory. Furthermore, exploration cannot explain why imaginary worlds foster frequent re-engagement.

Emerging from the internationally recognised Theorising Normalcy and the Mundane conference series, the chapters in this book offer wide-ranging critiques of that most pervasive of ideas, 'normal'. In particular, they explore the precarious positions we are presented with and, more often than not, forced into by 'normal', and its operating system, 'normalcy' (Davis, 2010). They are written by activists, students, practitioners and academics and offer related but diverse approaches. Importantly, however, the chapters also ask, what if increasingly precarious encounters with, (...) and positions of, marginality and non-normativity offers us a chance (perhaps the chance) to critically explore the possibilities of 'imagining otherwise'? The book questions the privileged position of 'non-normativity'; in youth and unpacks the expectation of the 'normal' student in both higher and primary education. It uses the position of transable people to push the boundaries of 'disability', interrogates the psycho-emotional disablism of box-ticking bureaucracy and spotlights the 'urge to know' impairment. It draws on cross-movement and cross-disciplinary work around disability to explore topics as diverse as drug use, The Bible and relational autonomy. Finally, and perhaps most controversially, it explores the benefits of (re)instating 'normal'. By paying attention to the opportunities presented amongst the fissures of critique and defiance, this book offers new applications and perspectives for thinking through the most ordinary of ideas, 'normal'. (shrink)

Can films philosophize rather than simply represent philosophical ideas developed outside of the cinematic medium? Taking up this question crucial to the emergent field of film philosophy, this book argues that the films of the American avant-garde do "do" philosophy and illuminates the ethical and political stakes of their aesthetic interventions. The book traces the avant-garde's philosophy by developing a history and theory of its investment in dimensional, conceptual, and material in-betweens, clarifying how this cinema's reflections on the creation and (...) reception of images construct an ethics of perception itself, a responsibility to perpetuate thought in an enduring re-encounter with the world and with meaning's unfinished production. This entails the avant-garde's locating of cinema's-and thought's-ends or meanings in their means, and their advancement of an image of truth that is made rather than found that unites their films with the philosophies of Ludwig Wittgenstein and Ralph Waldo Emerson who believed the "journey's end is found in every step of the road" (Cavell). Rectifying film-philosophy's neglect of the American avant-garde, the book demonstrates how rather than showing their interest in the revelation of authoritative truths, the avant-garde's interest in the re-encounter and review of the seen and known emerges from an American Transcendentalist tradition that opposes such notions. Sheehan reads the avant-garde's interest in the contingencies of spectatorial experience as also an extension of Pragmatism's commitment to replacing the authority of a priori knowledge with that of individual experience. She also shows how Emerson's influence on Friedrich Nietzsche connects the American avant-garde's philosophies to Deleuze's time-image, premised largely upon Nietzsche's "powers of the false.". (shrink)

In this Introduction to a special section on ‘Visualizing Surfaces, Surfacing Vision’, the authors argue that to conceive vision in the contemporary world it is necessary to examine its embedding within, expression via and organization on the surface. First, they review recent social and cultural theories to demonstrate how and why an attention to surfaces is salient today. Second, they consider how vision may be understood in terms of surfaces, discussing the emergence of the term ‘surface’, and its transhistorical relationship (...) with vision. Third, they introduce the contributions to the special section, which cover written articles and artworks. They make connections between them, including their exploration of reflexivity and recursion, observation, objectivity and agency, ontology and epistemology, relationality, process, and two- and three-dimensionality. Fourth, the authors consider some implications of an understanding of visualizing surfaces/surfacing vision. (shrink)

This essay explores the familiar German ideology according to which a revolution in thought would, in varying proportions, precede, succeed, accommodate, and generally upstage a political revolution whose defining feature was increasingly thought to be its founding violence: the slide from 1789 to 1793. Germany thus sets out to quarantine the political threat of revolution while siphoning off and absorbing the revolution’s intensity and energy for thinking as such. The essay holds that this structure corresponds to the psychoanalytic logic of (...) trauma: the dissolution of the event into a missed event, and the hypertrophic investment in the trivial, the non-event, the negligible remainder. (shrink)

An argument that what is usually dismissed as the “mystical shell” of Hegel's thought—the concept of absolute knowledge—is actually its most “rational kernel.” This book sets out from a counterintuitive premise: the “mystical shell” of Hegel's system proves to be its most “rational kernel.” Hegel's radicalism is located precisely at the point where his thought seems to regress most. Most current readings try to update Hegel's thought by pruning back his grandiose claims to “absolute knowing.” Comay and Ruda invert this (...) deflationary gesture by inflating what seems to be most trivial: the absolute is grasped only in the minutiae of its most mundane appearances. Reading Hegel without presupposition, without eliminating anything in advance or making any decision about what is essential and what is inessential, what is living and what is dead, they explore his presentation of the absolute to the letter. The Dash is organized around a pair of seemingly innocuous details. Hegel punctuates strangely. He ends the Phenomenology of Spirit with a dash, and he begins the Science of Logic with a dash. This distinctive punctuation reveals an ambiguity at the heart of absolute knowing. The dash combines hesitation and acceleration. Its orientation is simultaneously retrospective and prospective. It both holds back and propels. It severs and connects. It demurs and insists. It interrupts and prolongs. It generates nonsequiturs and produces explanations. It leads in all directions: continuation, deviation, meaningless termination. This challenges every cliché about the Hegelian dialectic as a machine of uninterrupted teleological progress. The dialectical movement is, rather, structured by intermittency, interruption, hesitation, blockage, abruption, and random, unpredictable change—a rhythm that displays all the vicissitudes of the Freudian drive. (shrink)

In Ghaidan v. Godin-Mendoza [2004] U.K.H.L. 30, the U.K. House of Lords upheld the right of a man to succeed to the tenancy of his deceased same-sex partner as if he had been the husband or wife of the deceased. This note examines the five judgements delivered by the court and considers the implications of the decision. It argues that, within the context of family law, Mendoza was a welcome decision but an evolutionary dead-end. The case signals a more promising (...) approach to the development of human rights, but the appropriate use and scope of s.3 of the Human Rights Act 1998 remain somewhat unclear. (shrink)

German philosophers and political thinkers of the last century – Jaspers, Arendt and Strauss prominent among them – express shared frustration with the modern situation and candid assessments of its dangers. Jaspers reflects on the atomic age and the modern dissolution of values; Arendt criticizes the bureaucratic machinery of modern society as anti-political; and Strauss expresses distrust of modern logics of science and history as tending towards historical forgetfulness. In this paper, I examine the formative effects of these tendencies in (...) relation to emotional and epistemic considerations of identity and the social and cultural relations which frame them. I argue that, in their audacity to engage with modern crisis in global terms, Jaspers, Arendt and Strauss provide thoughtful perspectives on a thoughtless age, perspectives not only German but germane. (shrink)