Background: Post-mortem needle biopsies have been used in resource-poor settings to determine cause of death and there is interest in using them in Bangladesh. However, we did not know how families and communities would perceive this procedure or how they would decide whether or not to consent to a post-mortem needle biopsy. The goal of this study was to better understand family and community concerns and decision-making about post-mortem needle biopsies in this low-income, predominantly Muslim country (...) in order to design an informed consent process. Methods: We conducted 16 group discussions with family members of persons who died during an outbreak of Nipah virus illness during 2004-2008 and 11 key informant interviews with their community and religious leaders. Qualitative researchers first described the post-mortem needle biopsy procedure and asked participants whether they would have agreed to this procedure during the outbreak. Researchers probed participants about the circumstances under which the procedure would be acceptable, if any, their concerns about the procedure, and how they would decide whether or not to consent to the procedure. Results: Overall, most participants agreed that post-mortem needle biopsies would be acceptable in some situations, particularly if they benefitted society. This procedure was deemed more acceptable than full autopsy because it would not require major delays in burial or remove organs, and did not require cutting or stitching of the body. It could be performed before the ritual bathing of the body in either the community or hospital setting. However, before consent would be granted for such a procedure, the research team must gain the trust of the family and community which could be difficult. Although consent may only be provided by the guardians of the body, decisions about consent for the procedure would involve extended family and community and religious leaders. Conclusions: The possible acceptability of this procedure during outbreaks represents an important opportunity to better characterize cause of death in Bangladesh which could lead to improved public health interventions to prevent these deaths. Obstacles for research teams will include engaging all major stakeholders in decision-making and quickly building a trusting relationship with the family and community, which will be difficult given the short window of time prior to the ritual bathing of the body. (shrink)

A wide array of syntactic phenomena can be categorized as being either direction-sensitive (e.g. coordination) or direction-insensitive (quantification and medial extraction). In the realm of categorial grammar, many frameworks are engineered to handle one class of phenomena at the expense of the other. In particular, Lambek-inspired frameworks handle direction-sensitivity elegantly but struggle with cases of direction-insensitivity, whereas in linear grammars, the situation is just the opposite. One reasonably successful attempt to unify the insights of both types of grammar and allow (...) for the analysis of direction-sensitive as well as direction-insensitive phenomena is hybrid type-logical categorial grammar (HTLCG), which augments the set of syntactic categories of an ordinary linear grammar with the directional slashes of a Lambek grammar. In this paper, the complementary nature of Lambek and linear grammars, with respect to direction-sensitive and direction-insensitive phenomena, is expounded on, as is the nature of how HTLCG attempts to reconcile the two systems. The paper further discusses an alternative to HTLCG—a linear grammar which adds Lambek-like capabilities by augmenting the string-combining (phenogrammatic) mechanism instead of the definition of syntactic categories (the tectogrammar). In particular, LCGϕ\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\hbox {LCG}_\phi $$\end{document} (linear categorial grammar with phenominators) adds a form of subtyping based on phenominators—a class of linear functions which specify various modes of (phenogrammatic) combination. Most importantly, an algorithm is provided for embedding HTLCG into LCGϕ\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\hbox {LCG}_\phi $$\end{document}, thereby demonstrating that LCGϕ\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\hbox {LCG}_\phi $$\end{document} can handle direction-(in)sensitivity at least as well as HTLCG. (shrink)

Advance care planning (ACP) is a process that seeks to elicit patients’ goals, values, and preferences for future medical care. While most commonly employed in adult patients, pediatric ACP is becoming a standard of practice for adolescent and young adult patients with potentially life-limiting illnesses. The majority of research has focused on patients and their families; little attention has been paid to the perspectives of healthcare providers (HCPs) regarding their perspectives on the process and its potential benefits and limitations. Focus (...) groups were conducted with 15 physicians as part of a larger study of adolescent and young adult ACP in hematopoietic stem cell transplant (HSCT) patients. This study identified two categories important to the utility of ACP in pediatric HSCT patients; (1) the temporal context of ACP and decision making and (2) the limitations of pediatric ACP, with subcategories identified as (a) embodied and witnessed knowing, (b) the impact of clinical cascades—when the treatment of one organ system creates complications in another system that needs to be treated—and a creation of a “new normal” following complications of illness and its treatment in the pediatric intensive care unit (PICU), (c) the balancing of adolescents’ autonomy with their capacity to make informed medical decisions, and (d) the epistemological frames that differ between HCP and patients and their families. These findings support ACP in adolescent and young adult HSCT patients, with a number of implications for practice as this process becomes more common. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Consenting for Novel and Dangerous Surgical Procedures with Minimal Supporting EvidenceMichelle J. ClarkeFrank1 was a 19–year–old man referred to me after a workup for back pain led to the discovery of a large, aggressive tumor in his sacrum. The tumor wrapped around the nerves controlling bowel, bladder, and leg function. We performed a needle biopsy and learned that the tumor was an angiosarcoma, an extremely aggressive and (...) usually deadly form of cancer. However, the tumor was unique in that it theoretically could be cured if removed in one piece. But, to do so would necessitate sacrificing the nerves, leaving the patient irreversibly incontinent, lacking sexual function, and confined to a wheelchair.Once we knew the diagnosis, Frank came to the office with his family to discuss treatment options. He appeared terrified and was almost silent through the appointment, deferring most questions to his parents. Due to the speed of tumor growth, we discussed palliative therapy, conventional treatment, and the one–piece or “en bloc” surgery, which was new and unproven for his disease. Based on the remarkable tumor growth we noted during the work–up, with palliative treatment the patient would likely survive for less than six months. Conventional treatment, in which surgery is done to remove part of the tumor while sparing the nerves to bowel and bladder function, was known to have a high rate of recurrence and death. Further, this tumor didn’t respond well to radiation and chemotherapy, so chance of survival was limited, although his life might have been extended for a short period. Thus our conversation turned to the novel “en bloc” procedure.The en bloc procedure offered a hope of long–term survival unlike the other options. However, this came with an enormous cost. The surgery itself would be planned to occur over three days with five separate surgical teams and a very real chance of major complications or death. Nerves to bowel and bladder would be cut, irreversibly leaving the patient without sexual function, and completely incontinent with a urinary catheter and colostomy. Walking was expected to be disrupted or potentially impossible due to the nerve resection. We went to great lengths over the course of many visits to describe the impact of the surgery on the patient’s function, and the impact on his quality of life. To make matters more challenging, as this procedure was so new and the tumor so rare, research did not yet exist to quantify his likelihood of long–term survival.Personally I was very uncomfortable with the situation. From a medical standpoint, the surgery offered was the best distillation of research and professional experience. En bloc surgery offered the best—if not the only—chance for survival in [End Page 5] this young man. Additionally, having treated many spine–injured patients I was aware that many patients with similar deficits led happy and productive lives following an emotional and physical adjustment period. However the surgery was also extreme. I worried that we would not be able to accomplish the goal of a one–piece resection and would accidentally spill some of the tumor, creating all of the deficits but no survival benefit. Frankly, I thought there was a 25% chance that would happen, which was explained to the family preoperatively. Were we overreaching our abilities and making a dying patient’s life worse by proceeding?Second, I was uneasy about the social situation. The patient’s family was very supportive, traveling with him to all appointments and assisting with his care. The patient himself usually deferred all scheduling to his mother, which wasn’t entirely unusual for such a young man. However it was difficult to grasp how much the patient understood of his disease or supported the plan. We attempted to delve more deeply into his thoughts, including without his parents present, but got only short answers, which revealed little. While the family appeared to have accepted the diagnosis and wanted to get to the business of treatment, the patient seemed to me to still carry the shock of his recent cancer diagnosis. Pushed by the rapid tumor growth, we were limited in how long we could wait for... (shrink)

Purpose The search for cause of death is important to improve knowledge and provide answers for the relatives of the deceased. Medical autopsy following unexplained death in hospital is one way to identify cause of death but is difficult to carry out routinely. Post mortem sampling (PMS) of tissues via thin biopsy needle or ‘mini incisions’ in the skin may be a useful alternative. A study was undertaken to assess how this approach is perceived by intensive care doctors (...) and also to evaluate how this practice is considered in ethical terms in France. Methods A study of PMS practices immediately after death in 10 intensive care departments was performed. The medical director of each centre was interviewed by telephone and asked to describe practices in their unit and to outline the questions raised by this practice. Results PMS is routinely performed in 70% of the units which responded, without systematically obtaining formal consent and without precise rules for communicating results. Approaches to PMS differed between centres, but all physicians felt that PMS is useful for the scientific information it gives and also for the information it provides for relatives. All physicians regret the lack of standards to structure PMS practices. Conclusion Information from post mortem examinations is important for society to inform about causes of death, for doctors to improve practices and for decision-makers responsible for organising care. Debate persists regarding the balance between individual rights and community interests. It is suggested that an approach for identifying cause of death could easily be integrated into the relationship between carers and relatives, provided full transparency is maintained. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 3. © 2015 by Feminist Studies, Inc. 571 Moving through Cancer: An Interview with Carol Collins Artist Carol Collins spoke with Feminist Studies editorial collective member Stephanie Gilmore about her experience of cancer, treatment, and recovery and how it gave rise to an art series that examines what nature means in the midst of unnatural treatments. SG: Carol, thank you for the opportunity to speak (...) with you about your artwork. Having just lost my sister to cancer, your work reminds me of much pain and loss, but also of love and the desire to survive. Before we discuss the work itself, I would like to hear about your journey through cancer, treatment, and recovery. CC: The breast cancer patient’s journey is complex and perilous. When I was healthy, I was ignorant about the magnitude of suffering many cancer patients undergo. And, although I am a private person, I’m now publicly sharing my cancer experience in order to be a voice for those who have suffered through similar treatments—and worse—and those who sadly are no longer with us to tell their story. Being bald and nauseated are not the most awful possible side effects of the treatments, although they are the most well known. Some women survive the cancer but can die from the treatments, or others suffer through the treatments and die anyway. Often, it seems many believe patients can overcome their 572 Carol Collins adversity solely with positive thinking and persistence. However, not discussing the array of physical and psychological damage that even those with good prognoses incur propagates ignorance about this malady. I hope that my artwork and story will promote a deeper understanding of a breast cancer patient’s plight and will encourage more support for research for individualized therapies and prevention. My cancer journey began when I received a breast cancer diagnosis in January 2014. Life just before that point was good; the future was bright. Tendon pain, caused by my flat feet and a lot of exercising, was my only known ailment. But one day a routine mammogram revealed three tumors in my right breast. The radiology oncologist said the masses were highly likely to be cancerous, so he immediately did painful core biopsies at the sites of my three tumors. The next day, it became clear that we needed to act quickly. The biopsy results revealed I had a very aggressive invasive breast cancer with estrogen, progesterone, and HER2 receptors. Breast cancer in premenopausal women grows quickly due to the high level of hormones present. The oncologists and surgeons said I would, at a minimum, need a mastectomy and possibly lymph node resection, and they warned that I would likely need chemotherapy, which would destroy my eggs and ovaries. After learning of my limited options, I approved the removal of one breast and my sterilization. I knew I needed to think rationally and face the giant raven before me head on. However, I did not realize the magnitude and multitude of physical and psychological pains, illnesses, and losses that were soon to come. The first year of cancer treatments inflicted much physical pain. I received three extremely painful injections into my right breast with a radiolabeled colloid just prior to the mastectomy. The pain came from the injected dye, not from the needle. The modified radical mastectomy was more excruciatingly painful than I anticipated, even with painkillers and overnight hospitalization. Breast reconstruction was an option that added more pain and discomfort from weekly fillings of the installed “expander” and additional surgeries. Extreme pain after the mastectomy prevented me from lying down for months. Foolishly, I did not get an injection port installed in my chest. Instead, I endured numerous deep (and often unsuccessful) needle pricks into the seemingly few veins of my left arm (which still had its lymph nodes) that were appropriate for infusions over the period of a year. Shooting pains across my chest and arm were the norm. Carol Collins 573 In addition to the surgically induced physical pain, the chemotherapy quickly caused a myriad of undesirable physical side effects. It is scary to realize that the medical community does not often fully understand... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ice Cream for BreakfastMichelle MethvenIn June of 2011, on a warm sunny day in Toronto, Canada, my partner and I brought our daughter Stella into the local hospital emergency room for what we believed would be a routine check–up. She had been exhibiting worsening clumsiness and limping for the previous two weeks and we thought it would be easier just to get her seen and have whatever it was (...) dealt with rather than wait two months to see a specialist. My partner and I believed it was likely a severe ear infection, or maybe Lyme disease from a recent camping trip. We each called our workplaces and said we would be an hour or so late. Nothing could have prepared us for the news 22 hours after arriving at the hospital, that Stella had a cancerous mass in her brain. After a biopsy three days later to confirm the diagnosis, Stella was diagnosed with Diffuse Intrinsic Pontine Glioma (DIPG), and given less than a year to live.Parents most often describe DIPG as “a monster.” The tumour saturates the pons and shuts down nerve pathways one at a time. In no particular order, and in no particular time, sufferers (most often young children) lose the ability to walk, sit up, hold up their head, speak and see. The pons is also responsible for breathing, swallowing and regulating the heartbeat, so death can come in many forms at any given time. Though it destroys the brain’s ability to command, the person continues to think and understand as the main part of the brain is untouched. Different from most cancers, chemotherapy and radiation have almost no effect on DIPG; even trials with the most toxic chemotherapies do not slow its progress.My partner and I were shaken to the core at this diagnosis. Looking at our energetic, redheaded [End Page 31] mop–topped little imp, it was impossible to fathom that she had just been given a fatal diagnosis. Yet we knew the doctors at the hospital were among the best and most sought–after in the world, so denial was never a part of our mantra.A week after Stella was diagnosed, we met with a neuro–oncologist to discuss our plans. The only treatment that is slightly effective for DIPG is focal radiation, which can stall the tumor’s growth, granting what is known as a “honeymoon period” of no new symptoms. The honeymoon lasts approximately six months, but there are no guarantees. Twenty percent of children get no honeymoon whatsoever after radiation, and others get only weeks. The doctor we met with confirmed radiation would not be curative, but would “buy time”. He explained that radiation involved six weeks of treatment, seven days a week. Following the six weeks of treatment, there would be a period of anywhere from one to six months in which Stella would likely be asymptomatic. However, at some point, the symptoms generally return and when they do, children deteriorate relatively quickly. Sometimes it takes a month or two, but on occasion there is as little as two weeks between progression and death.As Stella’s parents, we were not convinced that the prescribed radiation was something we wanted to subject Stella to. Because she was only two, and a very spirited and energetic child, it would have been virtually impossible to have her lie quietly on the table in hospital each day for six weeks while radiation was put behind her ear. The neuro–oncologists’ solution was that Stella be sedated for each daily radiation treatment, which would make her groggy for a big part of the day and necessitate needles and IV. As parents, we were presented with an impossible gamble. Do we risk taking away six weeks of her still somewhat symptom–free life for a possible extra three to six months later? And the timing was difficult as well. It was late June. If we chose to radiate it would mean spending the entire summer shuttling her between hospital and home with no weeks at the cottage, and much less time to attend neighbourhood BBQ’s, parties, trips to the park, the library, science centre and zoo... (shrink)

In many research studies, tumor biopsies are an unavoidable requirement for achieving key scientific aims. Yet some commentators view mandatory research biopsies as coercive and suggest they should be optional, or at least optional until further data are obtained regarding their scientific usefulness. Further complicating the ethical picture is the fact that some research biopsies offer a potential for clinical benefit to trial participants. We interviewed and surveyed a convenience sample of participants in phase I clinical trials at a single (...) institution. Our primary aim was to describe phase I participants’ understanding of whether a research biopsy offered them the prospect of medical benefit. We also endeavored to describe participants’ views about biopsies—specifically, the benefits of biopsies, if any, and whether biopsies were acceptable, risky, or discouraged trial participation. Finally, we collected data on demographics and attitudes to see if any strong correlations with misunderstanding, acceptability, or riskiness existed. Overall, the respondents tended to view research biopsies as acceptable, though they did not succeed in identifying the lack of benefit of a research biopsy. These findings call for renewed efforts in consent conversations and documents to carefully describe the benefits, or lack thereof, of research biopsies. (shrink)

This text deals with a problem concerning processes of the productive power of knowledge. We draw on so called poststructural theories challenging the classical image of thought – as hinged upon a representational logic identifying entities in a rigid sense – when formulating a problem concerning the gap between knowledge and the object of knowledge. More specifically we are looking at this problem in the contexts of sustainable development and childhood using illustrating examples in order to test the validity of (...) these theoretical accounts. The examples we use range from internationally agreed documents claiming universality concerning environmental protection and childhood to national curricula for the pre-school to a Swedish governmentally produced and distributed TV-series called Needle and Stick save the world, addressing the issue of sustainable development. In short, we wish to problematise the rigid positions of the child and the human being in relation to nature. (shrink)

Where research was once strictly confined to one laboratory or office, investigators now widely share and compare their plans, analyses, and results. With the advent of genomic knowledge, researchers are seeking to understand the genetics and genomics of complex human disease. They are combining their efforts into international consortia in order to take on problems that face individuals around the world, such as cancer and malaria — problems that are too large to solve by one country alone. These consortia bring (...) together diverse research groups from different parts of the world to focus on a common goal. Their projects may all focus on one disease or condition, but examine it from different perspectives and share the newly gained information with each other and the wider scientific community. (shrink)

Anton, thirty-two,his profile indicates that he lives with his parents.He's Orthodox, though he never went to church,has a university degree, studied English.He worked as a tattoo artist and had his own style,if you can say that of a tattoo artist.Many locals felthis skillful hands and sharp needle.When it all began, he talked a lotabout politics and history, started attending the demonstrations,picked quarrels with his friends.Friends felt insulted, clients started disappearing.They were afraid, didn't understand, left the city.You feel a person (...) best when you touch him with a needle.A needle stings, a needle sutures. Under its warmmetal you sense the complaisant canvas of women'sskin and the light rigid tarpaulinof men's skin. You penetrate someone'smembrane, you let velvetdrops of blood out of the body, you pierce and pierce and pierceangels’ wings onto the obedient surface of the world.You, tattoo artist, pierce and pierce tattoos, for we are calledto fill this world with sense, fill itwith colors. You, tattoo artist, you pierce thiscover onto our souls and diseases—what we live for and what we die for.Someone told me he was shot at a roadblock,in the morning, he was armed, it happened very quickly—no one really knows what happened.He's buried in a mass grave—they're all buried this way.His personal belongings were returned to his parents.No one has even made any changes to his profile.The time will come when some assholewill write heroic poems about this.The time will come when some assholewill say it's impossible to write about it at all. (shrink)

How should we understand the surveillance state post Snowden? This paper is concerned with the relationship between increased surveillance capacity and state power. The paper begins by analysing two metaphors used in public post Snowden discourse to describe state surveillance practices: the haystack and the panopticon. It argues that these metaphors share a flawed common entailment regarding surveillance, knowledge and power which cannot accurately capture important aspects of state anxiety generated by mass surveillance in an age of big data. The (...) paper shows that the nature of big data itself complicates the power attributed to mass surveillance states by these metaphors and those who use them. Relying heavily on Ezrahi’s distinction between information and knowledge, the paper situates this argument concerning the state and anxiety borne of information overload in the context of literature that concerns the state and information management. Drawing primarily on James Scott’s work on legibility, it argues that the big data born of mass surveillance problematises the concept of information as empowering the state. Instead, understanding mass surveillance in an age of big data requires understanding the relationship between the surveillance state and information in terms of anxiety as well as power. (shrink)

Iris Murdoch’s The Sovereignty of Good—especially the first essay, “The Idea of Perfection”—is often associated with a critique of a certain picture of agency and its proper place in ethical thought. There is implicit in this critique, however, an alternative, much richer one. I propose a reading of Murdochian agency in terms of the continuous activity of cultivating and refining a distinctive practical standpoint, and I apply this reading to her account of moral progress. For Murdoch moral progress depends on (...) transcending egoism and achieving clear perception of a normatively-saturated reality, but it would be a mistake to think of egoism in terms of selfishness, or clarity in terms of altruism. Rather, I argue, Murdochian moral progress requires overcoming socially-conditioned and often ideological forms of alienation, and making the social conditions that inform our practical standpoints self-conscious. (shrink)

The Emergency Medical Treatment and Active Labor Act in 1986 was intended to bring an end to incidents of “patient dumping.” However, due to the conflation of various federal legislative provisions, hospitals faced with the prospect of long‐term unreimbursed care of an immigrant patient, whether legally present in the United States or not, are in some cases having such patients transported to another country. These transfers are often being effectuated without patient consent. After an overview of the flaws in the (...) legal system that have effectively encouraged such patient transfers, this essay uses a clinical case to demonstrate how physicians can collaborate with an interdisciplinary team and with family members to ensure that the best interests of immigrant patients are met. Finally, the essay calls on physicians to advocate for the development of hospital policies and practices that will protect patients from international patient dumping. (shrink)

Those researching HIV prevention measures for people who inject drugs face a dilemma. Regions where baseline HIV prevalence and onward transmission via injecting is sufficiently high to power HIV prevention trials are also those where repressive laws, policies and practices raise concerns about the ethics of research subject protection. Dawson et al, outlining criteria to address ethical challenges in HIV prevention research among PWID, recommend that all trial participants be offered sterile injecting equipment and urge additional strategies to limit research (...) and background risks.1 In light of ethical questions opened by recent clinical trials involving PWID, including several the authors cite favourably, these cautions are timely. Dawson et al urge weighing of costs and benefits of PWID participation in research trials as an essential part of the ethical calculus. Overdose is a particular risk in any trial that uses abstinence from opioids as a precondition for participation or as an outcome of interest, and a risk that institutional review boards and researchers frequently ignore. Given the increased likelihood of fatal overdose for those who return to injection following a period of abstinence, provision to all trial participants of naloxone—the overdose antidote …. (shrink)

United States public health experts have long expressed concern about the prevalence of the human immunodeficiency virus among injection drug users. The United States has the largest reported IDU population in the world: 1.1 to 1.5 million. Recent estimates from the Centers for Disease Control and Prevention suggest that 50 percent of incident HIV infections occur among IDUs, with additional infections occurring among their sex partners and offspring. More than 33 percent of new AIDS cases occur in IDUs, their sexual (...) partners, and their children. Almost one half of all women diagnosed with AIDS in the United States are IDUS. Many of the remaining infected women were infected as a result of sex with a male IDU.While public health agencies, legislators, community leaders, and religious groups have engaged in vigorous debate over the merits of needle exchange programs as an intervention to reduce HIV transmission, the programs, some legal and some illegal, have been implemented in fifty-five cities across the country. (shrink)

United States public health experts have long expressed concern about the prevalence of the human immunodeficiency virus among injection drug users. The United States has the largest reported IDU population in the world: 1.1 to 1.5 million. Recent estimates from the Centers for Disease Control and Prevention suggest that 50 percent of incident HIV infections occur among IDUs, with additional infections occurring among their sex partners and offspring. More than 33 percent of new AIDS cases occur in IDUs, their sexual (...) partners, and their children. Almost one half of all women diagnosed with AIDS in the United States are IDUS. Many of the remaining infected women were infected as a result of sex with a male IDU.While public health agencies, legislators, community leaders, and religious groups have engaged in vigorous debate over the merits of needle exchange programs as an intervention to reduce HIV transmission, the programs, some legal and some illegal, have been implemented in fifty-five cities across the country. (shrink)

Cancer is the second leading cause of death in developed countries, making it a global public health problem. In this scenario, early detection is the key to successful treatment. Tissue biopsy, the current gold standard for cancer diagnosis, offers reliable results, but it is feasible only when the mass becomes detectable. On the other hand liquid biopsy, a promising experimental system, not yet implemented within clinical practice, allows early detection as its functioning relies on the analysis of body (...) fluids. Yet, its results are less reliable if compared to those of tissue biopsy as, for instance, false positives and false negatives might occur. Despite technical features, the tradeoff between a reliable diagnosis available at a later time and a potentially less reliable diagnosis available at an early stage poses significant ethical challenges in the clinical scenario which involve, among other aspects, informed consent, communication, and patient-physician encounter. (shrink)

Cancer is the second leading cause of death in developed countries, making it a global public health problem. In this scenario, early detection is the key to successful treatment. Tissue biopsy, the current gold standard for cancer diagnosis, offers reliable results, but it is feasible only when the mass becomes detectable. On the other hand liquid biopsy, a promising experimental system, not yet implemented within clinical practice, allows early detection as its functioning relies on the analysis of body (...) fluids. Yet, its results are less reliable if compared to those of tissue biopsy as, for instance, false positives and false negatives might occur. Despite technical features, the tradeoff between a reliable diagnosis available at a later time and a potentially less reliable diagnosis available at an early stage poses significant ethical challenges in the clinical scenario which involve, among other aspects, informed consent, communication, and patient-physician encounter. (shrink)

Is it possible for one and the same person to be a feminist and a logician, or does this entail a psychic rift of such proportions that one is plunged into an endless cycle of self-contradiction? Andrea Nye's book, Words of Power (1990), is an eloquent affirmation of the psychic rift position. Although eloquent, I believe it is mistaken in certain serious ways, which I shall address in this paper.Nye advances this position in her concluding essay to Words of Power (...) (Ibid.). In brief, her position is that the logical enterprise is inherently self-contradictory for feminist thinkers. Feminists who attempt to use logic to demonstrate its shortcomings are doomed to failure; arguing against logical claims is self-defeating, for the critic will be sucked into the maelstrom of logical tradition. Hydra-headed, the logical monster will thrive rather than perish under the sharpened edge of argument; hence the critic succeeds only in strengthening the very endeavour whose shortcomings she attempts to expose. This is guaranteed to happen, according to Nye, because in entering the debate, one is thereby committed to the terms of the debate. The critic herself will be devoured in the process, for logic was constructed to eliminate the voices and concerns of women. ‘The feminist logician speaks from a script in which the master always wins' (Ibid., p. 180).If feminists cannot use logic itself to attack the arrogant and unsupportable assumptions of logic, what are our alternatives? Nye sketches two alternatives - one is to simply turn our backs on logic, ignoring it in all of its masculine arrogance, and talk among ourselves in our own women's language about our own concerns. Nye does not recommend this alternative, for although it escapes the criticism of arrogance, it does so at the price of impotence. What she does recommend is the second alternative, that as feminists we direct our energy towards reading other people's work, including that of the logicians, and responding to it in ways ‘that can mortally wound’ (Ibid., p. 184) the authors; women, Nye believes, are particularly adept at reading. ‘It is a skill we have perfected’ (Ibid.) in the course of our oppression.In what follows, I shall discuss Nye's proscription of logic as well as her perceived alternatives of a woman's language and reading. This will be followed by a discussion more sharply focused on Nye's feminist response to logic, namely, her claim that feminism and logic are incompatible. I will end by offering a sketch of a class in the life of a feminist teaching logic, a sketch which is both a response to Nye (in Nye's sense of the word) and a counter-example to her thesis that logic is necessarily destructive to any genuine feminist enterprise. (shrink)

In Tanzania, the encounter between a traditional malady called degedege and the modern malady malaria is a fight to participate in the making of the bodies of women and children as well as the agents that afflict them. In their respective settings,degedege and malaria are considered two of the most common threats to the well-being of pregnant women and their young children. Local, national, and international public-health concerns for the early treatment of malaria compel biomedical practitioners to claim that degedege (...) is malaria. This article explores the power of this translation through an examination of the processes involved in treating degedege and the processes involved in treating malaria. I examine what is gained and what is lost through scientific or public health efforts to translate concepts, objects of practice, and agents of affliction from one form of care to another. (shrink)

This review of Corporate Responsibility: The American Experience expands and clarifies the book’s concept of corporate responsibility by emphasizing the centrality of social, moral, and stakeholder dimensions, with special attention given to the emergence of these key ideas in mid-twentieth-century America. These developments are seen as supplements to an otherwise comprehensive discussion of corporate responsibility found in this volume.

Acupuncture, like many alternative health care modalities, allows for and encourages a bodily experience of transformation. Clients (as well as practitioners) often experience a new body in the making. Within the context of ethnographic work focusing on the emergent bodies of acupuncturists and their clients, this paper focuses on the third, and perpetually more hidden, member of this ethnographic triad: the anthropologist. How do anthropologists position themselves in relation to alternative health care? Where is the anthropologists' body in relation to (...) an alternative health modality like acupuncture? Certainly fieldwork is never solely a discursive venture. Where are our bodies when we are doing fieldwork? (shrink)

Mainstream breast cancer social movements such as that of Susan G. Komen have called on all women to race or fight for the cure for breast cancer. They suggest that the fight can be won by buying and wearing pink ribbons, taking part in races and walks, donating money, and participating in research. For some patients with breast cancer, research participation may involve non-diagnostic tumor biopsies. While this clinical research is performed in the hope of gaining new knowledge through the (...) removal and study of breast cancer tissue, these procedures have been heavily criticized because they offer little potential benefit to the patient providing the tissue (Helft and Daugherty 2006; Kimmelman et al. 2012;... (shrink)

This article offers a critical contribution to the debate on a problematic ‘type’ of injecting drug use referred to as needle fixation. At the heart of this debate, is a questioning of the existence, prevalence and usefulness of the needle fixation concept for academics and drug treatment practitioners working with injecting drug users. The aim of this article is to extend and develop this discussion by examining the historical conditions of the needle fixation discourse. Drawing upon Michel (...) Foucault’s concept of governmentality, it uses primary and secondary sources from the 19th century to the present to trace the historical trajectory of the problematic relationship between the injecting drug user, the syringe and truth. By reconceptualizing needle fixation as a technology of government, this article will argue that needle fixation can be seen to be incompatible with contemporary rationalities found in treatment policy and practice, suggesting that we have moved beyond needle fixation as a way of governing injecting drug use and into the domain of risk management. Beyond revealing this tension, the article highlights new lines that are currently being drawn between the injecting drug user, the syringe and truth from the field of neuroscience and the risk-management potential of psychopharmacology. (shrink)

We argue that certain modal questions raise serious problems for a modal metaphysics on which we are permitted to quantify unrestrictedly over all possibilia. In particular, we argue that, on reasonable assumptions, both David Lewis's modal realism and Timothy Williamson's necessitism are saddled with the remarkable conclusion that there is some cardinal number of the form ℵα such that there could not be more than ℵα-many angels in existence. In the last section, we make use of similar ideas to draw (...) a moral for a recent debate in meta-ontology. (shrink)

Bertrand’s paradox ) can be considered as a cautionary memento, to practitioners and students of probability calculus alike, of the possible ambiguous meaning of the term ‘at random’ when the sample space of events is continuous. It deals with the existence of different possible answers to the following question: what is the probability that a chord, drawn at random in a circle of radius R, is longer than the side of an inscribed equilateral triangle? Physics can help to remove the (...) ambiguity by identifying an actual experiment, whose outcome is obviously unique and prescribes the physical variables to which the term ‘random’ can be correctly applied. In this paper, after briefly describing Bertrand’s paradox, we associate it with an experiment, which is basically a variation of the famous Buffon’s needle experiment for estimating the value of π. Its outcome is compared with the analytic predictions of probability calculus, that is with the probability distribution of variables whose uniform distribution can be considered a sound implementation of complete randomness. (shrink)