: Although others have focused on Catharine MacKinnon's claim that pornography subordinates and silences women, I here focus on her claim that pornography constructs women's nature and that this construction is, in some sense, false. Since it is unclear how pornography, as speech, can construct facts and how constructed facts can nevertheless be false, MacKinnon's claim requires elucidation. Appealing to speech act theory, I introduce an analysis of the erroneous verdictive and use it to make sense of MacKinnon's constructionist claims. (...) I also show that the erroneous verdictive is of more general interest. (shrink)

Although others have focused on Catharine MacKinnon's claim that pornography subordinates and silences women, I here focus on her claim that pornography constructs women's nature and that this construction is, in some sense, false. Since it is unclear how pornography, as speech, can construct facts and how constructed facts can nevertheless be false, MacKinnon's claim requires elucidation. Appealing to speech act theory, I introduce an analysis of the erroneous verdictive and use it to make sense of MacKinnon's constructionist claims. I (...) also show that the erroneous verdictive is of more general interest. (shrink)

In cognitive science, there is a tacit norm that phenomena such as cultural variation or synaesthesia are worthy examples of cognitive diversity that contribute to a better understanding of cognition, but that other forms of cognitive diversity (e.g., autism, attention deficit hyperactivity disorder/ADHD, and dyslexia) are primarily interesting only as examples of deficit, dysfunction, or impairment. This status quo is dehumanizing and holds back much-needed research. In contrast, the neurodiversity paradigm argues that such experiences are not necessarily deficits but rather (...) are natural reflections of biodiversity. Here, we propose that neurodiversity is an important topic for future research in cognitive science. We discuss why cognitive science has thus far failed to engage with neurodiversity, why this gap presents both ethical and scientific challenges for the field, and, crucially, why cognitive science will produce better theories of human cognition if the field engages with neurodiversity in the same way that it values other forms of cognitive diversity. Doing so will not only empower marginalized researchers but will also present an opportunity for cognitive science to benefit from the unique contributions of neurodivergent researchers and communities. (shrink)

This paper reports on a micro-ethnography of social interaction in an urban plaza in Colombia, focusing on the plaza’s role as an arena for the acquisition of interaction skills. We investigate how children of different ages initiate and sustain interactions with same-age and older peers and the efforts they make to be recognized and ‘visible’. We interpret our data in light of three theories of socialization: Corsaro’s conception of childhood as “interpretive reproduction”, Vygotsky’s model of the “zone of proximal development”, (...) and the “structural approach” to social cognition and development. While a social form like the plaza, which is collectively enacted by members of all age groups of the local community, provides children with an extraordinarily rich array of opportunities to develop social communication skills by interacting with older and younger peers, our analysis also demonstrates that children, as they are building zones of proximal development for themselves, play a central role in assembling, integrating, and sustaining the neighborhood as a face-to-face society. In this fashion, the paper illustrates how the micro-analysis of social interaction can contribute to the analysis of social ‘macro’ forms. (shrink)

Disasters incurred by natural hazards affect young people most. Schools play a vital role in safeguarding the wellbeing of their pupils. Consideration of schools’ psychosocial influence on children may be vital to resilience-building efforts in disaster-vulnerable settings. This paper presents an evidence-based conceptualization of how schools are psychosocially meaningful for children and youth in disaster settings. Drawing on Social Representations and Place Attachment Theories, we explore the nature of group-based meaning-making practices and the meanings that emerge concerning school environments in (...) disaster settings. We contribute a novel understanding of how schools may mitigate psychosocial risk for young people by considering how schools are conceptualised at four levels: (1) as physical environment, (2) as social arena, (3) as a place with individual and (4) group-based significance. In each of these domains schools can foster disaster resilience in young people. This paper highlights the evidence concerning the functions of schools beyond their capacity as educational institutions, critically considering their social and physical functions in their communities. This evidence can inform stakeholders involved in disaster resilience building. (shrink)

SummaryThis study seeks to investigate what influences intelligence in early childhood. The Singapore Cohort Study of the Risk Factors of Myopia is used to assess determinants of childhood IQ and changes in IQ. This longitudinal data set, collected in 1999, includes a wealth of demographic, socioeconomic and prenatal characteristics. The richness of the data allows various econometric approaches to be employed, including the use of ordered and multinomial logit analysis. Mother's education is found to be a consistent and key determinant (...) of childhood IQ. Father's education and school quality are found to be key drivers for increasing IQ levels above the average sample movement. (shrink)

To find more information about Rowman and Littlefield titles, please visit www.rowmanlittlefield.com.

Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. (...) A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom -based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician’s duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to. (shrink)

The precarious rights of senior citizens, especially those who are highly educated and who are expected to counsel and guide the younger generations, has stimulated the creation internationally of advocacy associations and opinion leader groups. The strength of these groups, however, varies from country to country. In some countries, they are supported and are the focus of intense interest; in others, they are practically ignored. For this is reason we believe that the creation of a network of all these associations (...) is essential. The proposed network would act as a support for the already-existing policies of the United Nations’ High Commission for Human Rights, of independent experts, and of the Global Alliance for the Rights of Older People. All three have long ago recommended the creation of a recognized instrument for uniting presently scattered efforts. The proposed network, therefore, will seek to promote the international exchange of relevant expertise, and it will reinforce the commitments and actions that single countries are currently taking to meet these objectives. For example, informative public events can be organised to promote particular support initiatives and to provide an opportunity for new members of the network to be presented. The network will promote health for senior citizens, disease prevention, senior mobility, safe free time for seniors, alimentary education, protection against new risks and dangers, as well as equity in the services necessary for seniors to adopt new information and communication technologies. In the case of retired academic members, the network will promote equality with respect to continuing use of digital technologies (particularly email), continuing access to research libraries, and the guaranteed ability for seniors to fund their own research programs and to deliver free seminars. (shrink)

This article focuses on the ways that sexual risk behaviors are related to race, class, and gender among low-income, culturally diverse women in South Florida. Data concerning sexual risk and gender are presented in terms of race and class variations. Results indicate that, in general, these women have a high degree of knowledge about acquired immune deficiency syndrome, a quite contemporary awareness of women's gendered subordination, and a lack of trust in heterosexual relationships. Attitudes, beliefs, and knowledge, however, are not (...) translated into sexual behaviors with men partners that would reduce their vulnerability to infection with the human immunodeficiency virus. The data indicate that race is a major factor that places women into an underclass position. Consequently, without socioeconomic resources, gendered behaviors have a direct influence on sexual risk. Multivariate analyses indicate that those women who are sex workers are significantly more likely to negotiate safe sex with clients than with main partners. The research not only challenges mainstream thinking about race, class, and gender but also provides overdue information on the vulnerability of women to HIV infection. (shrink)

In this anthology of new and classic articles, fifteen noted feminist philosophers explore contemporary ethical issues that uniquely affect the lives of women. These issues in applied ethics include autonomy, responsibility, sexual harassment, women in the military, new technologies for reproduction, surrogate motherhood, pornography, abortion, nonfeminist women and others. Whether generated by old social standards or intensified by recent technology, these dilemmas all pose persistent, 'nagging,' questions that cry out for answers.

Many parents are hesitant about, or face motivational barriers to, vaccinating their children. In this paper, we propose a type of vaccination policy that could be implemented either in addition to coercive vaccination or as an alternative to it in order to increase paediatric vaccination uptake in a non-coercive way. We propose the use of vaccination nudges that exploit the very same decision biases that often undermine vaccination uptake. In particular, we propose a policy under which children would be vaccinated (...) at school or day-care by default, without requiring parental authorization, but with parents retaining the right to opt their children out of vaccination. We show that such a policy is likely to be effective, at least in cases in which non-vaccination is due to practical obstacles, rather than to strong beliefs about vaccines, ethically acceptable and less controversial than some alternatives because it is not coercive and affects individual autonomy only in a morally unproblematic way, and likely to receive support from the UK public, on the basis of original empirical research we have conducted on the lay public. (shrink)

Preparing the Next Generation of Oral Historians is an invaluable resource to educators seeking to bring history alive for students at all levels. Filled with insightful reflections on teaching oral history, it offers practical suggestions for educators seeking to create curricula, engage students, gather community support, and meet educational standards. By the close of the book, readers will be able to successfully incorporate oral history projects in their own classrooms.

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert Advisory Group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since (...) the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs Programme. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating and integrating evidence to identify causes of human cancer. The advancements adopted include strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

Mari Mikkola identifies three primary forms of social injustice—oppression, domination, and discrimination—and asks what makes them wrong. She argues that feminist philosophy has thus far focused heavily on gender as a lens or anchor through which to understand and respond to injustice. In Mikkola's view, this orientation around gender is limiting feminist philosophers' theoretical engagement with the roots of injustice. To remedy this problem, she builds a case for moving toward a more broadly humanist conception of injustice. The humanist feminism (...) that she puts forth centers dehumanization as a way to theorize injustice; dehumanization, for Mikkola, is the very... (shrink)

The nineteenth-century British historian Lucy Aikin's ambitious four-part poem Epistles on Women (1810) marks both her first important contribution to women's historiography and a compelling example of Enlightenment feminist historiography. To some extent, Aikin is building on the work of male Enlightenment historians who had evaluated the status of women in different times and places and correlated it to social progress. However, she not only restricts her focus exclusively to women, but also makes a concerted effort to resolve some of (...) the tensions apparent in previous accounts of the relationship between women and social progress. Especially striking is her mediation of two distinct historical models of femininity, which I have called the republican and commercial models of femininity, the outlines of both of which we can trace in the work of male Enlightenment historians. By suggesting that through proper education women might combine the best aspects of each model, Aikin strategically advances the project of controversial feminists like Catherine Macaulay and Mary Wollstonecraft, who had taken inspiration from the republican model of femininity in their demands for improvements to female education. ☆ Revised for the History of European Ideas, October 2, 2004 by Kathryn Ready. (shrink)

This volume considers challenges to forgiveness in the most difficult circumstances, such as in criminal justice contexts, when the victim is dead or when bystanders disagree, and when anger and resentment seem preferable and important. Contributing philosophers include Myisha Cherry, Jonathan Jacobs, Barrett Emerick, Alice MacLachlan, David McNaughton and Eve Garrard. Contributing psychologists include Pumla Gobodo-Madikizela, Robert D. Enright and Mary Jacqueline Song, C. Ward Struthers, Joshua Guilfoyle, Careen Khoury, Elizabeth van Monsjou, Joni Sasaki, Curtis Phills, Rebecca Young, and Zdravko (...) Marjanovic. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:preface The essays in this special issue on Indigenous Feminisms in Settler Contexts engage feminist politics from multiple Indigenous geographies, histories, and standpoints. What emerges is a panoramic view of Indigenous feminist scholarship’s conceptual, linguistic, and artistic activism at this moment in time. We learn of praxis aimed at reclaiming Indigenous languages and ecological perspectives and the varied modes of resistance, survivance, and persistence. We also unpack the complex (...) racial/gender politics of colonial encounters in contexts where white women cared intimately for Indigenous children, or where they helped to recover Indigenous oral traditions, and we note how modes of help can also reproduce imperial power relations. Some essays, art works, and poems extend the geographic ambit of critiques of settler colonialism beyond American contexts: they deploy feminist rubrics to critique the continuing violent settlement of Palestine and Kashmir to demonstrate that the occupation of “marginal” places is constitutive of state-​ society relations; others describe how Australian Aboriginal and Sámi artists engage the question of Indigenous visibility. In different ways, they each show how staying in place, against all odds, can be radical. Our first two articles examine the politics of praxis. Michelle M. Jacob, Virginia R. Beavert, Regan Anderson, Leilani Sabzalian, and Joana Jansen analyze Indigenous feminist praxis surrounding Ichishkíin Indigenous language education. The “artivism” of Sámi artists Maxida 284Preface and Timimie Märak, which expresses concern for land and water rights, gender and sexuality, and Indigenous rights in Northern Europe takes center stage in Kyle Bladow’s essay. The next three articles interrogate historical records shaping Indigenous lives in northern Canada, southwest Pacific, and southwestern United States and Mexico. Val Marie Johnson examines how white women staff members’ intimate care relations at residential schools for Inuvialuit, Inuinnait, and Iñupiat peoples in Canada were bound up with the latter’s dispossession. Carolyn J. Eichner recounts the encounter between the Indigenous Kanak people and Louise Michel, a feminist and participant in the revolutionary Paris Commune of 1871 who was banished to New Caledonia for seven years; Eichner argues that although Michel was staunchly anti-imperialist, her liberatory political project bore the temporal logics of colonization. Drawing on examples of Nahua reconfigurations of Christian scripture, Kenna Neitch proposes the language of “persistence” as a heuristic for avoiding the reactive, relational connotations that can pervade scholarly usages of “resistance” rhetoric. Next, our review essay by Jennifer McLerran describes recent Indigenous feminist scholarship that recasts the concept of sovereignty. Our News and Views piece focuses on modalities of occupation in the context of Kashmir: Nosheen Ali, Mona Bhan, Sahana Ghosh, Hafsa Kanjwal, Zunaira Komal, Deepti Misri, Shruti Mukherjee, Nishant Upadhyay, Saiba Varma, and Ather Zia argue that occupation is foundational to the making and reproduction of nationstates, and not exceptional to state power. The varied forms of resistance to occupation are examined by Sara Ihmoud in her article about how a group of Palestinian women, the Murabitat al-Haram, agitate for religious freedom simply by “staying in place.” Rabab Abdulhadi comments on shifts in contemporary settler colonial discourse in Israel, noting the increasingly overt and unapologetic deployment of highly sexualized and gendered images. Marina Tyquiengco examines the art of Australian Aboriginal artist Fiona Foley, specifically her Black Velvet series. Art and myth are also fused in Shantell Powell’s textual and visual rendering of Inuit memory. This issue features a range of poetry on topics such as language loss, human-land relationships, and sexual violence, written by Katherine Agyemaa Agard, Kei Kaimana, and Kai Minosh Pyle, and curated by our creative writing editor, Alexis Pauline Gumbs. In “Átaw Iwá Ichishkíin Sínwit: The Importance of Ichishkíin Language in Advancing Indigenous Feminist Education,” Michelle M. Jacob, Preface 285 Virginia R. Beavert, Regan Anderson, Leilani Sabzalian, and Joana Jansen examine Indigenous feminist praxis surrounding Ichishkíin-language education. They critique how Western education systems inflict pernicious forms of violence within Native communities, engaging in practices of linguistic genocide and alienating Indigenous peoples from their homelands. In response, Native peoples, along with non-Native allies, are engaging in educational and political activism to reclaim and revitalize Indigenous languages and ecological perspectives. In examining the foundational teaching of Ichishk... (shrink)

In “Constitutivism without Normative Thresholds,” Kathryn Lindeman raises two objections to what she aptly calls Threshold Constitutivism. My aim in this short discussion is to respond to her first objection. Although I will argue that this objection fails, I will also argue that thinking through how to respond to it reminds us of something important, namely, that many of the Norm-Governed Kinds that are directly related to intentional action are social kinds, that is, kinds whose existence conditions we ourselves (...) collectively write. Everyone, whether constitutivist or not, needs to think seriously about what those existence conditions should be. [1] Journal of Ethics and Social Policy 12 (3): 231-258 (2017). [2] Lindeman’s second objection depends on her view, which I do not share, that “Normative Constitutivism has ambitions to be an explanatory strategy for norms in general” (238, my emphasis). (shrink)

Although the testimony of mental health experts in custody cases is supposed to be scientific and objective, the experts' testimony in the Mary Beth Whitehead case was imbued with prevailing middle-class biases about good mothers and good parenting. Close review of the experts' reports fails to substantiate many of their assessments and recommendations and demonstrates instead a consistent bias in favor of the Sterns and against Mary Beth Whitehead.

To show how the case of Mary Shelley’s Victor Frankenstein brings light to the ethical and moral issues raised in Institutional Review Board protocols, we nest an imaginary IRB proposal dated August 1790 by Victor Frankenstein within a discussion of the importance and function of the IRB. Considering the world of science as would have appeared in 1790 when Victor was a student at Ingolstadt, we offer a schematic overview of a fecund moment when advances in comparative anatomy, medical experimentation (...) and theories of life involving animalcules and animal electricity sparked intensive debates about the basic principles of life and the relationship between body and soul. Constructing an IRB application based upon myriad speculations circulating up to 1790, we imagine how Victor would have drawn upon his contemporaries’ scientific work to justify the feasibility of his project, as well as how he might have outlined the ethical implications of his plan to animate life from “dead” tissues. In Mary Shelley’s Frankenstein, Victor failed to consider his creature’s autonomy, vulnerability, and welfare. In this IRB proposal, we show Victor facing those issues of justice and emphasize how the novel can be an important component in courses or workshops on research ethics. Had Victor Frankenstein had to submit an IRB proposal tragedy may have been averted, for he would have been compelled to consider the consequences of his experiment and acknowledge, if not fulfill, his concomitant responsibilities to the creature that he abandoned and left to fend for itself. (shrink)

The word ``deme'' was coined by the botanists J.S.L. Gilmour and J.W.Gregor in 1939, following the pattern of J.S. Huxley's ``cline''. Its purposewas not only to rationalize the plethora of terms describing chromosomaland genetic variation, but also to reduce hostility between traditionaltaxonomists and researchers on evolution, who sometimes scorned eachother's understanding of species. A multi-layered system of compoundterms based on deme was published by Gilmour and J. Heslop-Harrison in1954 but not widely used. Deme was adopted with a modified meaning (...) byzoologists leading the evolutionary synthesis – Huxley, Simpson, Wright,and Mayr. Connections are shown between Gilmour's ideas around definingthe deme, his role in founding the Systematics Association, and his chapter``Taxonomy and Philosophy'' in the book The New Systematics. Thishistorical episode raises questions about the role of carefully-definedwords in scientific practice. (shrink)

I was optimistic of a new beginning in an open society when I came to America in 1999. Since then, I have indeed benefited from many aspects of American life. I have learned a lot – especially through my experience with small farms and farmers. But now, it's time to move on. And it was reading Debt and Dispossession, a book about American agriculture and human values, that crystallized in me why I wanted to leave. By telling the story of (...) the 1980s farm crisis through the words of the residents of a Minnesota town, the book prizes open many of the contradictions of American society. The 1970s were boom times for mid-western farms; farmers took advantage of “easy” farm credit to finance expansion. By the 1980s, the boom burst and slump loomed. Lenders wanted their money back and thousands of farmers were dispossessed. Debt and Dispossession probes beneath the surface of a community apparently united in protest against the dispossessions. Underneath, it finds a tangled picture of a society at war with itself, pitting farmer against farmer in a fratricidal struggle. The book let me glimpse the paradox of American individualism, all-American contradictions centering on government and consumerism, frugality and morality. Just like my experience of American agriculture and farmers as a whole, Debt and Dispossession helped me see the best side of America, but also revealed the fragility of life in a one-on-one society. (shrink)

The article challenges conventional assumptions regarding the question of incest survival within contemporary discourses. A textual analysis of Kathryn Harrison's autobiographical novel tracing her consensual sexual relationship with her father is used to address the issue of failed or unresolved mourning as a prototypically ‘modern’ cultural phenomenon. Psychoanalytically informed feminist literary criticism is used to explore the parallels between the cultural construction of femininity and failed or postponed mourning in western historical and philosophical traditions. Following the work of (...) Juliana Schiesari and Kathleen Woodward, the article contends that melancholia is a gendered discourse that has historically privileged male theorists and film-makers, such as Barthes and Fassbinder. The article suggests that contemporary women writers, such as Harrison, are engaged in a revisionary approach to the construction of loss within their writing. By situating themselves at the heart of the contemporary family narrative, instead of the ‘melancholic’ margins, they are able to produce a counter-discourse that dispels the conventional dynamics of the traditional family romance. By using the ‘writing cure’ to overcome ideological loss, the desiring daughter is able to challenge misogynist constructions of femininity within contemporary literature. (shrink)

How Doctors Think defines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness. How Doctors Think is divided into four parts. Part one introduces the (...) concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment. (shrink)