In the complex environment, the suddenly changing structural parameters and abrupt actuator failures are often encountered, and the negligence or unproper handling method may induce undesired or unacceptable results. In this paper, taking the suddenly changing structural parameters and abrupt actuator failures into consideration, we focus on the robust adaptive control design for a class of heterogeneous Takagi–Sugeno fuzzy nonlinear systems subjected to discontinuous multiple uncertainties. The key point is that the switch modes not only vary with the (...) system time but also vary with the system states, and the intrinsic heterogeneous characteristics make it difficult to design stable controllers. Firstly, the concepts of differential inclusion are introduced to describe the heterogeneous fuzzy systems. Meanwhile, a fundamental lemma is provided to demonstrate the criteria of the boundness for a Filippov solution. Then, by using the set-valued Lie derivative of the Lyapunov function and introducing a vector of specific continuous functions, the closed-loop T-S fuzzy differential inclusion systems are proved to be ultimately bounded. The sufficient conditions for system stability are derived in term of linear matrix inequalities, which can be solved directly. Finally, a numerical example is provided to illustrate the effectiveness of the proposed control algorithm. (shrink)

This paper investigates the leaderless and leader-follower time-varying formation design and analysis problems for a group of networked agents subject to discontinuous communications. Firstly, a leaderless time-varying formation control protocol is proposed via the intermittent control strategy, where the control input of each agent is constructed by the distributed local state information and formation instructions in the communication time unit, but it is zero in the noncommunication time unit. Then, an explicit formulation of the formation center (...) function is determined to describe the formation movement trajectory of the whole networked agents. Leaderless time-varying formation design and analysis with discontinuous communications are given in the form of linear matrix inequalities. Moreover, the main results of the leaderless cases are extended to the leader-follower cases. Finally, two numerical examples are provided to illustrate the theoretical results of leaderless and leader-follower cases, respectively. (shrink)

The assumption that the onset of puberty is a context-sensitive marker of a reproductive strategy is tested by comparing parental and filial childhood context and somatic development in West and East Germany. Sixty-eight mother-daughter dyads and 35 father-son dyads were taken from two samples of families from Osnabrück in West Germany and Halle in East Germany. According to the observed context discontinuity between the generations in the male dyads, linear regression models show that no indicator of male sexual maturation was (...) influenced significantly by the somatic development of the father. Instead of an inherited timing of maturation, antecedent distal factors like socioeconomic childhood context variables and critical life events lead to an acceleration of male sexual maturation. Finally we test the effect of two different conditions of childhood context continuity on daughter’s age at menarche with maternal age at menarche controlled. Linear regression models show that mother’s age at menarche predicts daughter’s age at menarche only under the condition of contextual continuity between generations, which was the case in the West German sample only. In East Germany, where mother’s age at menarche had no significant effect, the amount of variance explained by childhood context variables was almost the same. These results indicate the context sensitivity of somatic development which seems to follow an evolutionary rationale. (shrink)

This paper elaborates on administrative sorting, a threat to internal validity that has been overlooked in the regression discontinuity (RD) literature. Variation in treatment assignment near the threshold may still not be as good as random even when individuals are unable to precisely manipulate the running variable. This can be the case when administrative procedures, beyond individuals’ control and knowledge, affect their position near the threshold non-randomly. If administrative sorting is not recognized it can be mistaken as manipulation, preventing (...) fixing the running variable and leading to discarding viable RD research designs. (shrink)

In this article, complete synchronization and antisynchronization in the identical financial chaotic system are presented. The proposed control strategies depend on first-order sliding mode and adaptive integral sliding mode for complete synchronization and antisynchronization of the identical financial chaotic system. In the primary case, the system parameters should be known, and first-order sliding mode control is utilized for synchronization and antisynchronization while in the second case, the system parameters are considered unknown. An adaptive integral sliding mode control (...) strategy is utilized for synchronization and antisynchronization of the system considering the parameters unknown. The error system is changed into a particular structure containing a nominal part and several unknown terms to utilize the adaptive integral sliding mode control. Then, this error system is stabilized using integral sliding mode control. The stabilizing controller is usually developed based on the nominal part plus the compensator control part. To suppress the high-frequency oscillation phenomenon, smooth continuous compensator control can be used rather than conventional discontinuous control. The compensator controller along with the adapted law is derived such that the time derivative of the Lyapunov function becomes strictly negative. The effectiveness of the proposed method was tested through computer simulations. The proposed control strategies are verified for that Identical 4D hyperchaotic financial system to attain complete synchronization and antisynchronization along with the improved performance. (shrink)

China’s export-led manufacturing model has been built on extensive exploitation of its migrant workforce under a despotic labor regime, but the methods of control have shifted considerably during the past decade and a half. This article examines new modes of domination over Chinese factory workers, based on fieldwork conducted while the author was living with workers at a foreign-invested garment factory in southern China. The article shows how mechanisms to control the workers are embedded today not only in (...) directly coercive practices but also in a new shop floor culture with affective personal ties and implicit bargaining in wage systems. Against the scholarly literature of management controls that emphasizes rupture and discontinuity between labor regimes, this article argues that China’s emerging labor regime, here referred to as “conciliatory despotism,” inherits despotic features of the labor regime exercised in the 1990s but adds new normative measures of soft control that seek to conciliate worker resentments. This hybrid form of management control represents a stage in China’s evolving labor-management relations in which workers possess more implicit power and can push management into greater concessions than previously. (shrink)

Methadone maintenance treatment (MMT) is a harm reduction approach for persons who wish to stop using opioids and is rather effective if used for a minimum of 12 months. Notably, research demonstrates that many persons enrolled in MMT programs discontinue care before this time, limiting its effects. To better understand this process, we undertook an exploratory descriptive qualitative study and interviewed 12 men and women who were using MMT. Using the theoretical work of Foucault and Hardt and Negri, the interview (...) data highlighted that MMT continues to be strongly stigmatized, and that it is a system of care that involves rewards and penalties, based on if patients behave according to prescribed norms. These results suggest that MMT is a disciplinary mechanism, albeit one that impedes its own access. We consequently recommend that healthcare providers work to facilitate access to MMT, which means altering care delivery. (shrink)

One distinguishing feature of vertebrate oocyte meiosis is its discontinuity; oocytes are released from their prophase I arrest, usually by hormonal stimulation, only to again halt at metaphase II, where they await fertilization. The product of the c‐mos proto‐oncogene, Mos, is a key regulator of this maturation process. Mos is a serine‐threonine kinase that activates and/or stabilizes maturation‐promoting factor (MPF), the master cell cycle switch, through a pathway that involves the mitogen‐activated protein kinase (MAPK) cascade. Oocytes arrested at prophase I (...) lack detectable levels of Mos, which must be synthesized from a pool of maternal mRNAs for proper maturation. While Mos is necessary throughout maturation in Xenopus, it seems to be required only for meiosis II in the mouse. The translational activation of c‐mos mRNA at specific times during meiosis requires cytoplasmic polyadenylation. Cis‐ and trans‐acting factors for polyadenylation are, therefore, essential elements of maturation. (shrink)

Human-computer interaction today has got a touch of magic: Without understanding the causal coherence, using a computer seems to become the art to use the right spell with the mouse as the magic wand — the sorcerer's staff. Goethes's poem admits an allegoric interpretation. We explicate the analogy between using a computer and casting a spell with emphasis on teaching magic skills. The art to create an ergonomic user interface has to take care of various levels of skills for the (...) human operators. The problem of logical discontinuities as opposed to continuous control is the most serious obstacle for human-computer interaction. (shrink)

The (dis)continuism debate—the debate over whether remembering is a form of imagining—is a prominent one in contemporary philosophy of memory. In recent work, Langland-Hassan (2021) has argued that this debate is best understood as a dispute over whether remembering is a form of constructive imagining. In this paper, I argue that remembering is not a form of constructive imagining because constructive processes in remembering and imagining are constrained, and hence controlled, in different ways at the level of consciousness. More specifically, (...) I argue that remembering and imagining differ in terms of the interventions we can make on the constructive processes as they unfold. If this is correct, then a form of discontinuism is vindicated: remembering and imagining are, on this view, processes of different kinds. (shrink)

The digital represents an oppressive apparatus of control or a new horizon for liberation? This article frames a post-deleuzian and post-guattarian line of though about the digital and the politics. Control and discontinuity of affections are the two poles for a reasoning about our involvment in the digital and our awareness of risks and opportunities. If we assume that the contemporary is characterized by the pulverization of the real, and that from the thanatology of the twentieth century could (...) hardly be born a 'providential' technology at the same time thanatology can’t stop the entropic being, which transcends all ambition of autonomy of matter. The machines were built in the frame of segmentation, but the ontological instability is able to give form to a different and new releases. However, a reflection on new technologies leads us to understand that the affectivity of matter, its discontinuities, while constituting a virtual source of potentiality with 'machinic heterogenesis', does not 'escape' the power, but urges the control to raise new challenges not in opposition but in affinity. In this mimetic interaction, then, should continue to reflect, remembering always the lure of Deleuze to irony and humour, on possible differential practices for limiting the disciplines in order to move the entropy in the logic of the database, under the sign of an aesthetics of affection, renewing the an-aestheticized subjectivity of contemporary. (shrink)

Sections include: experiments and generalised causal inference; statistical conclusion validity and internal validity; construct validity and external validity; quasi-experimental designs that either lack a control group or lack pretest observations on the outcome; quasi-experimental designs that use both control groups and pretests; quasi-experiments: interrupted time-series designs; regresssion discontinuity designs; randomised experiments: rationale, designs, and conditions conducive to doing them; practical problems 1: ethics, participation recruitment and random assignment; practical problems 2: treatment implementation and attrition; generalised causal inference: a (...) grounded theory; generalised causal inference: methods for single studies; generalised causal inference: methods for multiple studies; a critical assessment of our assumptions. (shrink)

Two central assumptions of current models of language acquisition were addressed in this study: (1) knowledge of linguistic structure is "mapped onto" earlier forms of non-linguistic knowledge; and (2) acquiring a language involves a continuous learning sequence from early gestural communication to linguistic expression. The acquisition of the first and second person pronouns ME and YOU was investigated in a longitudinal study of two deaf children of deaf parents learning American Sign Language (ASL) as a first language. Personal pronouns in (...) ASL are formed by pointing directly to the addressee (YOU) or self (I or ME), rather than by arbitrary symbols. Thus, personal pronouns in ASL resemble paralinguistic gestures that commonly accompany speech and are used prelinguistically by both hearing and deaf children beginning around 9 months. This provides a means for investigating the transition from prelinguistic gestural to linguistic expression when both gesture and language reside in the same modality.\nThe results indicate that deaf children acquired knowledge of personal pronouns over a period of time, displaying errors similar to those of hearing children despite the transparency of the pointing gestures. The children initially (ages 10 and 12 months) pointed to persons, objects, and locations. Both children then exhibited a long avoidance period, during which one function of the pointing gesture (pointing to self and others) dropped out completely. During this period their language and cognitive development were otherwise entirely normal, and they continued to use other types of pointing (e.g., to objects). When pointing to self and others returned, it was marked with errors typical of hearing children; one child exhibited consistent pronoun reversal errors, thinking the YOU point referred to herself, while the other child exhibited reversal errors inconsistently. Evidence from experimental tasks conducted with the first child revealed that pronoun errors occurred in comprehension as well. Full control of the ME and YOU pronouns was not achieved until 25-27 months, around the same time when hearing children master these forms. Thus, the study provides evidence for a discontinuity in the child's transition from prelinguistic to linguistic communication. It is argued that aspects of linguistic structure and its acquisition appear to involve distinct, language-specific knowledge. (shrink)

Why are negative emotions so central in art reception far beyond tragedy? Revisiting classical aesthetics in the light of recent psychological research, we present a novel model to explain this much discussed (apparent) paradox. We argue that negative emotions are an important resource for the arts in general, rather than a special license for exceptional art forms only. The underlying rationale is that negative emotions have been shown to be particularly powerful in securing attention, intense emotional involvement, and high memorability, (...) and hence is precisely what artworks strive for. Two groups of processing mechanisms are identified that conjointly adopt the particular powers of negative emotions for art's purposes. The first group consists of psychological distancing mechanisms that are activated along with the cognitive schemata of art, representation, and fiction. These schemata imply personal safety and control over continuing or discontinuing exposure to artworks, thereby preventing negative emotions from becoming outright incompatible with expectations of enjoyment. This distancing sets the stage for a second group of processing components that allow art recipients to positively embrace the experiencing of negative emotions, thereby rendering art reception more intense, more interesting, more emotionally moving, more profound, and occasionally even more beautiful. These components include compositional interplays of positiveandnegative emotions, the effects of aesthetic virtues of using the media of (re)presentation (musical sound, words/language, color, shapes) on emotion perception, and meaning-making efforts. Moreover, our Distancing-Embracing model proposes that concomitant mixed emotions often help integrate negative emotions into altogether pleasurable trajectories. (shrink)

This chapter contains sections titled: Hunting as the Pursuit of Wild “Life” Carnal Bonds and the Way of All Flesh Saintly Chewing and the Corruption of the Flesh The Vital Paradox: The Acceptance of Death as Affirmation of Life Notes.

This article considers the relevance of time theory for Beck's theory of reflexive modernization and vice versa. It focuses in particular on discontinuity in the context of continuity, on decontextualization, naturalization and responsibility as key concerns of both perspectives on the industrial way of life. It makes explicit the temporal underpinnings of that cultural form with respect to five Cs: the creation of time to human design, the commodification of time, the compression of time, the control of time and (...) the colonization of time. It concludes that explicit concern with temporal relations shows reflexive modernization in action and facilitates improved knowledge for deliberative change. (shrink)

Some maladaptive thought processes are characterized by reflexive and habitual patterns of cognitive and emotional reactivity. We review theoretical and empirical work suggesting that mindfulness—a state of nonjudgmental awareness of the present moment—can facilitate the discontinuation of such automatic mental operations. We propose a framework that suggests a series of more specific mechanisms supporting the de-automatizing function of mindfulness. Four related but distinct elements of mindfulness (awareness, attention, focus on the present, and acceptance) can each contribute to de-automatization through subsequent (...) processes, including discontinuing automatic inference, enhancing cognitive control capacity, facilitating metacognitive insight, and preventing suppression or thought distortion. De-automatizing can, in turn, allow enhancement of adaptive self-control ability and increased well-being. (shrink)

The Royal College of Physicians of London published the 2013 national clinical guidelines on prolonged disorders of consciousness in vegetative and minimally conscious states. The guidelines acknowledge the rapidly advancing neuroscientific research and evolving therapeutic modalities in PDOC. However, the guidelines state that end-of-life decisions should be made for patients who do not improve with neurorehabilitation within a finite period, and they recommend withdrawal of clinically assisted nutrition and hydration . This withdrawal is deemed necessary because patients in PDOC can (...) survive for years with continuation of CANH, even when a ceiling on medical care has been imposed, i.e., withholding new treatment such as cardiopulmonary resuscitation for acute life-threatening illness. The end-of-life care pathway is centered on a staged escalation of medications, including sedatives, opioids, barbiturates, and general anesthesia, concurrent with withdrawal of CANH. Agitation and distress may last from several days to weeks because of the slow dying process from starvation and dehydration. The potential problems of this end-of-life care pathway are similar to those of the Liverpool Care Pathway. After an independent review in 2013, the Department of Health discontinued the Liverpool Care pathway in England. The guidelines assert that clinicians, supported by court decisions, have become the final authority in nonconsensual withdrawal of CANH on the basis of “best interests” rationale. We posit that these guidelines lack high-quality evidence supporting: 1) treatment futility of CANH, 2) reliability of distress assessment from starvation and dehydration, 3) efficacy of pharmacologic control of this distress, and 4) proximate causation of death. Finally, we express concerns about the utilitarian-based assessment of what constitutes a person’s best interests. We are disturbed by the level and the role of medical authoritarianism institutionalized by these national guidelines when deciding on the worthiness of life in PDOC. We conclude that these guidelines are not only harmful to patients and families, but they represent the means of nonconsensual euthanasia. The latter would constitute a gross violation of the public’s trust in the integrity of the medical profession. (shrink)

We recognize a paradox of power and promise in the context of legislative and organizational changes in nurse regulation which poses constraints on nursing's capacity to bring voice and influence to pressing matters of healthcare and public policy. The profession is at an important crossroads wherein leaders must be well informed in political, economic and legislative trends to harness the profession's power while also navigating forces that may put at risk its central mission to serve society. We present a critical (...) policy analysis of the impact of recent regulatory trends on what the International Council of Nurses considers nursing's three ‘pillars’ – the profession of nursing, socioeconomic welfare of nurses and nurse regulation. Themes surfacing from this analysis include regulatory discontinuity, a tightening of regulatory control, and an increasingly managerial governance culture. These themes illuminate insights and strategies required to renew and revitalize the social mandate of our profession amidst a climate of urgency in the questioning of nurse scholars with respect to the future of the profession. At this historic juncture, nurses must clearly understand the implications of legislative and organizational regulatory changes to ensure the profession contributes to full capacity in achieving health and health equity globally. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

Background and aimsFew Polish hospitals have Hospital Ethics Committee (HECs) and the services are not always adequate. In this situation, the role of HECs, in providing, among others, ethical advice on the discontinuation of persistent therapies, may be taken over by other entities. The aim of our research was to investigate, how often and on what issues hospital chaplains are asked for ethical advice in reaching difficult medical decisions.MethodsA survey of 100 Roman Catholic chaplains was conducted, that is, at least (...) 10% of all chaplains currently working in Polish hospitals.ResultsOf the participants, 29% confirmed receiving requests for advice in making a morally difficult medical decision. Receiving this type of request was not conditional on the place of their service, duration of their pastoral mission or HEC membership. The largest group of chaplains (21%) encounter questions concerning the ethical dilemmas associated with discontinuing persistent therapy. Patients and their families most often raise issues related to the methods of birth control, and the medical staff raise the issue of termination of pregnancy—as reported by 9% and 15% of chaplains, respectively. Most of the chaplains asked for help (79%) experience a deficit of specialist knowledge in the area of medicine or ethics.ConclusionsIn order to improve the quality of ethical consultations in Polish hospitals, in addition to further development of HECs, it is postulated to develop a system for bioethical education of chaplains. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

Models of dream analysis either assume a continuum of waking and dreaming or the existence of two dissociated realities. Both approaches rely on different methodology. Whereas continuity models are based on content analysis, discontinuity models use a structural approach. In our study, we applied both methods to test specific hypotheses about continuity or discontinuity. We contrasted dream reports of congenitally deaf-mute and congenitally paraplegic individuals with those of non-handicapped controls. Continuity theory would predict that either the deficit itself or compensatory (...) experiences would surface in the dream narrative. We found that dream form and content of sensorially limited persons was indifferent from those of non-handicapped controls. Surprisingly, perceptual representations, even of modalities not experienced during waking, were quite common in the dream reports of our handicapped subjects. Results are discussed with respect to feedforward mechanisms and protoconsciousness theory of dreaming. (shrink)

Graphical displays of simple moving geometrical figures have been repeatedly used to study the attribution of animacy in human observers. Yet little is known about the relevant movement characteristics responsible for this experience. The present study introduces a novel parametric research paradigm, which allows for the experimental control of specific motion parameters and a predictable influence on the attribution of animacy. Two experiments were conducted using 3D computer animations of one or two objects systematically introducing variations in the following (...) aspects of motion: directionality, discontinuity and responsiveness. Both experiments further varied temporal kinematics. Results showed that animacy experience increased with the time a moving object paused in the vicinity of a second object and with increasing complexity of interaction between the objects . The experience of animacy could be successfully modulated in a parametric fashion by the systematic variation of comparably simple differential movement characteristics. (shrink)

Obsessive-compulsive disorder (OCD) is a deeply enigmatic psychiatric condition associated with immense suffering worldwide. Efficacious therapies for OCD, like exposure and response prevention (ERP) are sometimes poorly tolerated by patients. As many as 25 percent of patients refuse to initiate ERP mainly because they are too anxious to follow exposure procedures. Accordingly, we proposed a simple and tolerable (immersive yet indirect) low-cost technique for treating OCD that we call “multisensory stimulation therapy.” This method involves contaminating a rubber hand during the (...) so-called “rubber hand illusion” (RHI) in which tactile sensations may be perceived as arising from a fake hand. Notably, Jalal and Ramachandran (2015), showed that such fake hand contamination during the RHI provokes powerful disgust reactions in healthy volunteers. In the current study, we explored the therapeutic potential of this novel approach. OCD patients (n = 29) watched as their hidden real hand was being stroked together with a visible fake hand; either synchronously (inducing the RHI) (i.e., the experimental condition; n = 16) or asynchronously (i.e., the control condition; n = 13). After 5 minutes of tactile stimulation, the rubber hand was contaminated with fake feces, simulating conventional exposure therapy. Intriguingly, results suggested sensory assimilation of contamination sensations into the body image via the RHI: patients undergoing synchronous stimulation did not report greater contamination sensations when the fake hand was initially contaminated relative to asynchronous stroking. But contrary to expectations, they did so after the rubber hand had been contaminated for 5 minutes; as assessed via disgust facial expressions (a secondary outcome) and in vivo exposure (upon discontinuing the illusion). Further to our surprise, synchronous and asynchronous stroking induced an equally vivid and fast emerging illusion, which helps explain why both conditions initially (5 minutes after initiating tactile stimulation) provoked contamination reactions of equal magnitude. This study is the first to suggest heightened malleability of body image in OCD. Importantly, it may pave the way for a tolerable technique for the treatment of OCD—highly suitable for poorly resourced and emergency settings, including low-income and developing countries with minimal access to high-tech solutions like virtual reality. (shrink)

In the burgeoning debate about neuroscience’s role in contemporary society, the issue of brain optimization, or the application of neuroscientific knowledge and technologies to augment neurocognitive function, has taken center stage. Previous research has characterized media discourse on brain optimization as individualistic in ethos, pressuring individuals to expend calculated effort in cultivating culturally desirable forms of selves and bodies. However, little research has investigated whether the themes that characterize media dialogue are shared by lay populations. This article considers the relationship (...) between the representations of brain optimization that surfaced in a study of British press coverage between 2000 and 2012 and interviews with forty-eight London residents. Both data sets represented the brain as a resource that could be manipulated by the individual, with optimal brain function contingent on applying self-control in one’s lifestyle choices. However, these ideas emerged more sharply in the media than in the interviews: while most interviewees were aware of brain optimization practices, few were committed to carrying them out. The two data sets diverged in several ways: the media’s intense preoccupation with optimizing children’s brains was not apparent in lay dialogue, while interviewees elaborated beliefs about the underuse of brain tissue that showed no presence in the media. This article considers these continuities and discontinuities in light of their wider cultural significance and their implications for the media–mind relationship in public engagement with neuroscience. (shrink)

Participants were asked to carry out a series of simple tasks while following mental control instructions. In advance of each task, they either suppressed thoughts of their intention to perform the task, concentrated on such thoughts, or monitored their thoughts without trying to change them. Suppression resulted in reduced reports of intentionality as compared to monitoring, and as compared to concentration. There was a weak trend for suppression to enhance reported intentionality for a repetition of the action carried out (...) after suppression instructions had been discontinued. (shrink)

The release of over 6,000 genetically modified mosquitoes (GMM) into uninhabited Malaysian forests in 2010 was a frantic step on the part of the Malaysian government to combat the spread of dengue fever. The field trial was designed to control and reduce the dengue vector by producing offspring that die in the early developmental stage, thus decreasing the local Aedes aegypti population below the dengue transmission threshold. However, the GMM trials were discontinued in Malaysia despite being technologically feasible. The (...) lack of systematic studies in terms of cost-benefit analysis, questionable research efficacy and safety-related concerns might have contributed to the termination of the field trial. Hence, this research aims to evaluate the feasibility of GMM release in Malaysia by using a holistic approach based on an Islamic ethical-legal assessment under the maslahah-mafsadah (benefit-risk) concept. Three main strategies based on the maslahah-mafsadah concept approach have been applied: 1) an evidence-based approach, 2) an impact-based approach and, 3) a priority approach. The analysis concluded that GMM could be categorised as zanniyyah (probable). GMM is a promising alternative for dengue control, but many issues must be addressed before its widespread adoption. (shrink)

This article comments on the treatment of critical-care ethics in four preceding articles about critical-care medicine and its ethical challenges in mainland China, Hong Kong, Japan, and the Philippines. These articles show how cultural values can be in both synchrony and conflict in generating these ethical challenges and in the constraints that they place on the response of critical-care ethics to them. To prevent ethical conflict in critical care the author proposes a two-step approach to the ethical jus tification of (...) critical-care management: (1) the decision to resuscitate and initiate critical-care management, which is based on the obligation to prevent imminent mortality without permanent loss of consciousness; and (2) the decision to continue critical-care management, which is based on the obligation both to prevent imminent death without permanent loss of consciousness and to avoid unnecessary, significant iatrogenic costs to the patient and psychosocial costs to the family when the reduction of morta lity risk is marginal. Physicians and hospitals should restore the critical-care physician's authority and power - against prevailing cultural values, if necessary - to control when critical-care intervention is offered, when it is recommended to continue, and when it is recommended to be discontinued and the patient allowed to die. (shrink)

How is distributive justice possible with respect to immigration if political decisions about entry and membership cannot be grounded in the symmetry of a prior commonality, human or otherwise, that could guarantee reciprocal relations between members and nonmembers? This paper deals with both aspects of this question. Initially, it engages critically with Seyla Benhabib's plea for ‘dialogical universalism,’ showing why the strong discontinuity between political and moral reciprocity precludes understanding distributive justice as the process of mediating between political particularity and (...) moral universality. Subsequently, it suggests that a way out of this conceptual and normative impasse can be found in the fact that boundaries create a double asymmetry. This double asymmetry is constitutive for the ‘dia’ of the political dialogue that separates and joins members and nonmembers. This ‘in between,’ which eludes control by the parties to a dialogue, is the realm of distributive justice. (shrink)

The history of the self is a flourishing field. Nevertheless, there are some problems that have proven difficult to overcome, mainly concerning teleology, the universality or particularity of the self and the gap between ideas and experiences of the self. In this article, I make two methodological suggestions to address these issues. First, I propose a ‘queering’ of the self, inspired by recent developments in the history of sexuality. By destabilizing the modern self and writing the histories of its different (...) and paradoxical aspects, we can better attend to continuities and discontinuities in the history of the self and break up the idea of a linear and unitary history. I distinguish 4 overlapping and intersecting axes along which discourses of the self present themselves: interiority and outer orientation; stability and flexibility; holism and fragmentation; and self-control and dispossession. Second, I propose studying 4 ‘practices of self’ through which the self is created, namely: techniques of self; self-talk; interpreting the self; and regulating practices. Analysing these practices allows one to go beyond debates about experience versus expression, and to recognize that expressions of self are never just expressions, but make up the self itself. (shrink)

The potential societal impacts of automation using intelligent control and communications technologies have emerged as topics in a number of recent writings and public policy initiatives. Many of these expressions have referenced the writings and research efforts of Herbert Simon (1961), Norbert Wiener (1948), and contemporaries from their early technological and social vantage points concerning the future of technology and society. Constructed entities labeled as “thinking machines” (such as IBM’s Watson as well as intelligent chatbot and robotic systems) have (...) also played significant roles in this discourse. This paper provides an historical sequencing then analyzes a selection of writings produced since the 1940s concerning the economic and social issues involving artificial intelligence (AI) research and applications. The paper explores how overstatements and hyperbolic themes and concepts, often stemming from AI’s early periods, are being employed in characterizations of current AI approaches in apparently opportunistic attempts to provide rhetorical support for various large-scale business and societal initiatives. It also addresses the relative neglect of the consideration of many of AI’s sociotechnical failures and discontinued approaches in recent examinations of automation and social welfare issues. The paper discusses the moral logic of AI researchers and developers providing reasonable and measured narratives in public discourse rather than hyperbole, efforts that can empower decision makers to make sounder judgments concerning the technology’s current and future applications as well as allocate the rewards of the technology more equitably. (shrink)

We investigate whether air pollution harms business ethics from the perspective of earnings manipulation, which exerts a real effect on the economy and social welfare. Using a large sample and a comprehensive air quality index in China, we find that firms located in cities with more severe air pollution exhibit higher levels of discretionary accruals and are more likely to restate their financial statements, consistent with exposure to air pollution leading to more earnings manipulation. We further provide causal evidence using (...) propensity score matching and a discontinuity regression design exploiting the Qinling Mountain–Huai River Heating Policy Line, which exogenously leads to more air pollution to cities located immediately north of the Line but not those in the south. Our findings are robust to controlling for weather conditions and alternative samples and measures of air pollution and earnings manipulation. Overall, this study unveils how the ecological environment shapes business ethics. (shrink)

How is distributive justice possible with respect to immigration if political decisions about entry and membership cannot be grounded in the symmetry of a prior commonality, human or otherwise, that could guarantee reciprocal relations between members and nonmembers? This paper deals with both aspects of this question. Initially, it engages critically with Seyla Benhabib's plea for ‘dialogical universalism,’ showing why the strong discontinuity between political and moral reciprocity precludes understanding distributive justice as the process of mediating between political particularity and (...) moral universality. Subsequently, it suggests that a way out of this conceptual and normative impasse can be found in the fact that boundaries create a double asymmetry. This double asymmetry is constitutive for the ‘dia’ of the political dialogue that separates and joins members and nonmembers. This ‘in between,’ which eludes control by the parties to a dialogue, is the realm of distributive justice. (shrink)

This investigation examines the discursive history and contemporary courtroom discourse of expert witnesses in Anglo-American courts, incorporating the methods of Michel Foucault into a Critical Discourse Analysis framework. The history of experts is marked by a profound discontinuity in the role of experts, during the late medieval period, with experts relegated to a witness role instead of a juror role - that of the privately knowledgeable investigator - they previously held. Examination of the discourse of contemporary experts in three high-profile (...) US trials documents a different witness status for experts along three parameters: amplification of question responses; the use of the contrastive discourse marker well to express professional disagreement with their interlocutors; and the embedding of professional practices into so clauses. These parameters stand in sharp contrast to ordinary witness discourse. The study concludes with a discussion of the stakes in legal control of expert witnesses including asymmetrical access to experts by economic status, the possible suppression of some expert testimony by recent US Supreme Court decisions, and the hierarchicalization of expert knowledge. (shrink)

For Augustin Thierry, rewriting the story of the past was, until 1830, explicitly a way of making the future, and after 1830, implicitly a way of justifying the present. In subverting traditional historiography perceived as a legitimation of royal authority Thierry did not follow the Enlightenment strategy of opposing history and reason. Writing after 1789, he discovered reason in history. Constant and the Saint-Simonians had already distinguished two ages of history an age of conquest or violence, and an age, just (...) beginning, of commerce and reason but these appeared as discontinuous. Thierry's aim, especially after 1830, was to reveal history as a continuous, providential unfolding of reason, culminating in the bourgeois nation state. The violence of history was thus to be subsumed by reason. Historiographically, narrative and commentary were not to be discontinuous, as in Enlightenment historiography; meaning was to emerge instead from the narrative itself. Correspondingly, the historian's role was to be construed as a mediating, not a constructive one. The historian is the mouthpiece of history, as the bourgeois, the true hero of history, uniting in himself conquered and conqueror, re-presents what in history was divided the nation. In neither case is control to be viewed as a mark of division or violence; historian and hero are alike agents or representatives of totality . Violence reasserts itself thematically, however, in the stark, unresolved opposition of conquered and conqueror, subject and lord, female and male, victim and executioner, which structures Thierry's most successful historical narratives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 357-359 [Access article in PDF] Learning From Disunity Jennifer Radden In describing his four cases, Lloyd Wells (2003) throws out a challenge. He asks his readers to recognize similarities between their own more ordinary self-identity and the discontinuous narrative and seeming absence of a steady authorial subject resulting from disorders such as depression, schizophrenia, and Multiple Personality Disorder (MPD). In light of (...) these cases, he implies, the unity of the self we have unreflectively assumed until now to be universal requires reconsideration. Psychopathology seems to force a sharpening, clarification, and closer conceptualization of our philosophical theories of self-identity.While acknowledging that philosophical categories and theories of narrative identity can help us to assess the ravages wrought by mental disorder, James Phillips (2003) is also respectful of the contribution of psychopathology to theorizing about identity: he ends his thoughtful discussion of Wells' cases by looking not at how philosophy can enlighten us about psychopathology but at how cases such as these can illuminate philosophical categories. Speculating on the tragic absence of narrative identity in schizophrenia and advanced Alzheimer's disease, Phillips concludes that, as he puts it, psychopathology "reconfigures the contours of our notion of narrative identity and requires a looser, minimized, nonsubstantial notion of the narrative self" and argues for a self that "transcends the limits and loss of narrative identity" (2003, 326).I also support the approach, shared by Wells and Phillips, that allows psychopathology to clarify and illuminate philosophical concepts and categories. Here, in a handful of footnotes to their insights, I want to point out ways that cases from psychopathology reveal distinguishable elements or aspects of self-identity often confused because, in the normal case, they form an unquestioned and apparently indissoluble unity. One of these is the difference between synchronic and diachronic subjective unity. Another is the difference between the elements of authorship and temporality in conceptions of narrative identity. And last is the difference between what I shall call constitutional identity and self-identity. Synchronic and Diachronic Identity The difference between synchronic and diachronic identity, elements so seamlessly blurred in more ordinary subjectivity, is nicely illustrated by Wells' cases. Mary's dissociative states leave her with interruptions in her diachronic identity: the memory of her experiences is fragmented and incoherent. Yet at any given moment, her synchronic unity is unimpaired. She recognizes and can describe the oneness of her experiences and their boundaries; she is aware which are her experiences and which are not. For all her scatteredness and dissociation, as Phillips puts it in describing Mary's case: "there is a strong and [End Page 357] articulate narrator... the fact remains that this I is there" (2003, 318).In contrast, the shy and self-conscious adolescent Edward seems to suffer not from diachronic but from synchronic disunity. (And if anything, as Melvin Woody [2003] points out, Edward's "narrative" seems to fuel the comparisons which so distress him about his uncomfortable and distressing subjective experiences.) Edward struggles to "delineate what's inside my mind and what's outside it... " When he thinks about what he sees as a firm boundary around the self in others which is not well demarcated in his own case, he remarks "... I completely lose any sense of myself" (p. 330).Thought insertion or "made" feelings in psychosis provide similar instances of such fracturing of their sufferer's synchronic identity (it is perhaps such experiences that Edward alludes to here; Wells' quotations are too sparse for us to tell). Just as Edward complains of losing any sense of himself, so other sufferers from these alarming conditions complain of losing a sense of the self's boundaries, of possession and mind control, and of being the unwelcome host to alien thoughts, feelings, and intentions.In normal experience diachronic and synchronic unity—my oneness across time and at a time—form a seamless whole. These cases, where one or the other is compromised, vividly remind us that these two forms of unity must be distinguished. Narrative Identity Phillips (2003) explicates an analysis of narrative identity which comprises entwined but distinguishable features: a narrating... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Foucault’s Renaissance Episteme Reassessed: An Aristotelian CounterblastIan MacleanThere seem to me to be two good reasons for looking at Foucault’s Renaissance episteme again, even though specialists of the Renaissance have given it short shrift and Foucault himself does not seem to have set great store by it in his later writings. 1 The first is that in general books on Foucault accounts of it are still given in a (...) neutral or even approving way, as though neither the concept of episteme (which suggests both that mind-sets or paradigms or epistemes are all-constraining) nor the account of the Renaissance episteme in particular (which is given a predominantly Platonic and hermetic character) require modification, if not refutation. 2 I shall suggest that although in some sense we are all prisoners of our mind-sets, there are ways in which we can escape from this prison 3 ; and with respect to the Renaissance in particular, I shall claim that Aristotelianism, not Platonism, is the appropriate context in which to see the dominant universe of discourse of the day and that this philosophy can be shown to possess the resources for escaping its limitations. To do this I shall [End Page 149] give a brief resume of Foucault’s episteme in general and the Renaissance episteme in particular. Then I shall show first, that the Platonist features which he cites as typical are actively refuted at that time and cannot be described as dominant without severe qualification; second, that the versions of Aris-totelianism widely taught in universities and schools give quite different accounts of these features; and third, that this form of thinking can be shown to have the freedom of self-critique in the very areas in which Foucault chooses to see Renaissance philosophy as both constraining and constrained.In 1969 Foucault produced his “theoretical work” L’Archéologie du savoir as the methodological systematization of his earlier historical writings, L’Histoire de la folie à l’âge classique (l961), La Naissance de la clinique (l963), and Les Mots et les choses (1966). In this work man is described as a modern self-invention, fashioned from a particular configuration of knowledge and destined soon to disappear. Foucault’s history of man is a story about the way he constituted himself as a subject and then made his body, his behavior, his reason, and his consciousness the object of his study and a field to be controlled, regulated, trained, and coerced. In this analysis man’s “rationality” becomes not a faculty but an authoritarian straitjacket. What Foucault sets out to investigate is a very fundamental form of ontology but not one associated with profound knowledge; it is a superficial and finite, if largely invisible, field, which is discontinuous, not defined by the agenda of the modern state of any associated discipline, and peopled by “utterances” (énoncés) which are only graspable in their differences and their dispersion. If coagulations of these “utterances” (formations discursives) occur at all, they appear only in the form of consistent relations: the objects to which they “refer” are no more than objectifications whose scientific status cannot be established and whose meaning cannot be recovered by semantic or rhetorical analysis. In calling his previous book Les Mots et les choses, he was being explicitly ironic, for neither the words nor the things of the title have any substance to them: they are not presences but absences. The description made by the historian is remote from his object, indirect, incomplete; it describes a “preconceptual field” in which the “preconcepts” are no more than organizing operators or functions revealing relationships of dependence, processes of validation, contingent theories of truth. The “utterances” which these “preconcepts” inform come together in “discourses” which are neither systems nor mere aggregations of knowledge; archaeological history as practiced by Foucault uncovers not a “mentality” but an “episteme,” which he defines as follows:By episteme we mean... the total set of relations that unite, at a given period, the discursive practices that give rise to epistemological figures, sciences, possibly formalized systems.... The episteme is not a form of knowledge or type of rationality which, crossing the boundaries [End Page 150] of the most... (shrink)

This article calls for an end to the use of the term ‘invasive species’, both in the scientific and public discourse on wildlife conservation. There are two broad reasons for this: the first problem with the invasive species narrative is that this demonisation of ‘invasives’ is morally wrong, particularly because it usually results in the unjust killing of the animals in question. Following on from this, the second problem is that the narrative is also incoherent, both from scientific and philosophical (...) perspectives. At the heart of both of these issues is the problem that the invasive species narrative oversimplifies what are in fact very complex biological processes. As a result, the policies carried out with the stated aim of ‘controlling’ these animals are often unethical. In light of the current global species decline, this article asserts that the way we think and talk about these animals should be changed and the term ‘invasive species’ should be discontinued, in the hope that this leads to changes in practice. (shrink)

Humans regularly pursue activities characterized by dramatic success or failure outcomes where, critically, the chances of success depend on the time invested working toward it. How should people allocate time between such make‐or‐break challenges and safe alternatives, where rewards are more predictable (e.g., linear) functions of performance? We present a formal framework for studying time allocation between these two types of activities, and we explore optimal behavior in both one‐shot and dynamic versions of the problem. In the one‐shot version, we (...) illustrate striking discontinuities in the optimal time allocation policy as we gradually change the parameters of the decision‐making problem. In the dynamic version, we formulate the optimal strategy—defined by a giving‐up threshold—which adaptively dictates when people should stop pursuing the make‐or‐break goal. We then show that this strategy is computationally inaccessible for humans, and we explore boundedly rational alternatives. We compare the performance of the optimal model against (a) a myopic giving‐up threshold that is easier to compute, and even simpler heuristic strategies that either (b) only decide whether or not to start pursuing the goal and never give up or (c) consider giving up at a fixed number of control points. Comparing strategies across environments, we investigate the cost and behavioral implications of sidestepping the computational burden of full rationality. (shrink)

Jus post Bellum is, like Jus ad Bellum and Jus in Bello, a part of just war theory. Jus post Bellum is distinguished from the other parts of just war theory by being primarily concerned with the principles necessary for securing a just and lasting peace after the end of a war. Traditionally, jus post bellum has focused primarily on three goals: [1] compensating those who have been the victims of unjust aggression, while respecting the rights of the aggressors, [2] (...) punishing and rehabilitating those guilty of war crimes and other violations of the principles of Jus ad Bellum and Jus in Bello and [3] developing measures that will prevent future war and violence (Orend 2000 and May 2012). In this chapter, I outline an account of political forgiveness and explain the role that political forgiveness can have in promoting the goals of jus post bellum. My conception of political forgiveness requires some unpacking. Let me begin with individual forgiveness, which I understand along familiar Butlerian lines as the renunciation of resentment (Butler, Sermon IX in McNaughton 2017: 75-83), though with a bit of a twist. More exactly, ● An individual, I, forgives J for doing F if and only if I renounces all her own warrant for resenting J for doing F. Resentment is a judgment-sensitive attitude, and, therefore, it tends to track judgments concerning its warrant (Scanlon 1998: 20 and Smith 2015). In cases of perfect forgiveness, I’s renunciation causes her to cease feeling resentment toward J for doing F, though, of course, less perfect cases are possible. I reject the idea that there is a sharp discontinuity between individual and political forgiveness, a position argued for by, e.g., Peter Digeser (1998 and 2001). By contrast, I understand political forgiveness as the renunciation of resentment by the relevant political body in question. With greater precision, ● A sovereign political body, P, forgives J for doing F if and only if P renounces all warrant that its citizens have for resenting, as part of their public lives, J for doing F. A little more explanation is in order. Sovereign political bodies, such as national governments, claim degrees of control over the lives of their citizens, in both their public and their private aspects, though the claims with respect to the former tend to be considerably more expansive than the claims with respect to the latter. I assume here that, at least in the case of legitimate governments, these claims of control are often valid. Such governments may reasonably renounce certain grounds for motivating action in the public sphere. For example, governments may renounce all warrant that its citizens have, as part of their public lives, for hating members of marginalized groups. In practice, this means that, while citizens might continue to act in their private lives out of hatred for members of these groups, their appeal to this hatred is seen by the state as irrelevant to matters of law and public policy as well as being wholly out-of-place in public discourse. Political forgiveness toward J for doing F, as I understand it, involves an analogous rejection of resentment, on the part of citizens in their public lives, toward J for doing F. I turn now to the matter of how political forgiveness supports securing a just and lasting peace between former belligerents. With respect to the first goal of jus post bellum, political forgiveness helps to balance compensation for victims and respect for the rights of defeated aggressors by countering the all-too-human tendency to overvalue harms done to oneself and to members of one’s group. As regards the second goal, political forgiveness plays a similar role but also provides a model for rehabilitation by exemplifying among the victorious the behavior to be emulated by the vanquished. Finally, political forgiveness promotes the third goal of jus post bellum by providing a space for nations to meet as moral equals rather than allowing one nation to have the moral high ground over the other. None of this, of course, means that political forgiveness should be unearned or that it should be confused with condonation (Kolnai 1973 and Pettigrove 2004). However, the question of what is required to put oneself in a position to be forgiven as part of jus post bellum is a matter that goes beyond the scope of this chapter. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Breaking the Readmission CycleBrian HattenI want to share the story of my difficult patient Ms. L. She has twenty-seven current medical issues. Thirty-five active prescriptions. Limited mobility requiring the use of a motorized scooter. Non-medical care gaps. And over twenty hospital admissions since 2020. I met Ms. L approximately five years ago as her hospital attending and have continued to care for her during her frequent hospitalizations. I could (...) recite this 77-year-old female's litany of medical problems. But sufficed to say, her history is complex, with her admitting diagnoses running the gambit from cellulitis to gastrointestinal bleeding to altered mental status. But, her diagnosis and frequent exacerbations of congestive heart failure (CHF) are particularly frustrating for us both and will be my focus today.CHF makes her susceptible to fluid overload leading to feelings of shortness of breath, which progresses to respiratory distress. Like other individuals with CHF, she uses diuretics to prevent herself from becoming fluid overloaded. And, like many individuals who take diuretics, she hates them. She (un)affectionately calls her water pills "the bomb" because the effect is sudden, profound, and explosive when they begin working. The combination of the diuretic effect and her limited mobility causes significant emotional stress for Ms. L, a woman who values presenting herself outwardly as in control, well-dressed, and put together. Her dislike of the medical effect of her diuretics has led to her either taking them less often or outright discontinuing them. So, while discontinuation avoids those frustrating effects, it leads to fluid accumulation, subsequent respiratory distress, and readmission to the hospital.Her medical records mention she has memory issues. It is unclear how much her mild cognitive impairment affects her frequent readmissions. We have had many conversations where I would never suspect something was amiss. But sometimes, she can be forgetful and does not recall our recent discussions. That being said, she knows the names and uses of her medications. She can report to me her home weights when she checks them and knows what her "dry" weight should be. Yet, she does not act when her scales begin reading heavier or when she develops leg swelling. Instead, she presents to the emergency department in extremis. When directly questioned about why she lets her situation deteriorate to such a state that she requires hospitalization, she demurs. She comments that she can often be stubborn, that the diuretic effect of "the bomb" is burdensome, but always reminds me she is honest in admitting she wasn't taking her water pills.During several admissions, I worried for her survival after she had self-discontinued her medications and showed up at the emergency department in respiratory failure. For any patient with recurrent admissions, I discuss their overall goals of care to ensure we are working together toward achievable medical ends. But this conversation was essential to have with Ms. L. The possibility existed that she would present to the hospital too late in her disease process, and we would not be able to correct her respiratory failure. I wanted to ensure that the hospital staff and I respected her wishes regarding her care. Despite raising my concerns, she would [End Page 22] decline to discuss her wishes. Even worse, attempting to have her complete advance care planning documents like advance directives or a Physician Orders for Life-Sustaining Treatment (POLST) form was a futile endeavor. Ms. L was always vague and non-committal. She simply did not want to engage in those types of conversations. When asked why she declined to discuss these issues, Ms. L would reply that she was doing okay, the discussion was unnecessary, and she had family members to make those decisions for her.Caring for her during her hospital stays was a source of professional frustration for me. Her recurrent admissions made me feel like I was failing her. During each hospital stay, we would go over her medications. We repeatedly discussed how she should check her weights daily and monitor for lower extremity edema. We created multiple action plans for when to call her physicians so we could head off another hospital visit. We completed all the... (shrink)

How might experimental media art help theorise what falls by the wayside in the digital public sphere? Working in the years immediately following the launch of YouTube in 2005, some media artists centred their creative praxis towards the end of that decade upon rescuing, revalorising, and placing back into digital circulation audiovisual media formats and technologies that appeared aged or obsolete. Although there may be a degree of nostalgia behind such practices, these artworks articulate a cogent critique of the drive (...) towards constant innovation that was responsible for the invention and global expansion of cinema, but in recent decades has been responsible for its decay—or, perhaps more accurately, for its perpetual transformation. The article explores this 'media-archaeology' sensibility as a way of thinking about AI more widely: an approach that sees histories of media not as a linear, chronological search for origins, but as a critical recovery of artefacts lodged discontinuously in multiple layers of the past. Although digital technologies form a central part of the creative process of the artists considered in this article, their works also act as a critical conscience about digital change, asking what the so-called digital revolution is leaving out, and leaving behind. In so doing, it illuminates some potential positive and negative impacts of digital technologies' mediation of new forms of public engagement, whether in art, archives, or on social media. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:When Is Enough, Enough?Megan HomsyThis was a case that stuck with many members of our transplant team for a long time. The patient was a 44-year-old Caucasian male evaluated for a liver transplant with a diagnosis of hepatitis C virus (HCV), originally diagnosed 11 years before the transplant evaluation. The patient met the criteria for the following substance use diagnoses: alcohol use disorder moderate in sustained remission, in a (...) controlled environment, opioid use disorder, severe, in sustained remission, on maintenance therapy, in a controlled environment, stimulant use disorder, amphetamine-type, severe, in early remission, in a controlled environment and stimulant use disorder, cocaine-type, severe in early remission, in a controlled environment.The patient had been living in a sober living housing program for approximately ten months prior to his transplant evaluation with me, his social worker. He had also been diagnosed with depression and bipolar disorder. He had been intermittently linked with mental health services and had participated in numerous detox and substance abuse programs over the last ten years, with varying degrees of success. He was in dual diagnosis treatment (i.e., treatment for co-occurring substance use and mental health disorders) through his Suboxone clinic and was completing toxicology screenings on a biweekly basis.After concluding the minimum three months of drug and alcohol treatment set forth by the state's Organ Transplantation Consortium, the patient graduated from his sober living program, moved in with his sister, and was listed for a liver transplant.The patient was transplanted five months after his clinic evaluation. At the time of the surgery, the patient's Suboxone was abruptly discontinued and replaced with IV Dilaudid. Within days of his transplant, the patient frequently expressed concerns about his pain. Several medical services attempted to manage the pain medications, resulting in his pain management plan being changed repeatedly and much confusion over his current medication regimen. During his liver transplant hospitalization, the RN found the patient with a needle in his arm, and after a search of the patient's hospital room, the hospital police found drug paraphernalia and illicit substances. The patient was eventually discharged to an inpatient substance abuse program, which he left before completing the program and against medical advice.During his first year post-transplant, I attempted to arrange other various treatment programs for him (most of which he did not follow through with) and to find housing for him (as he had been forced to leave his sister's home after his relapse). Eventually, the patient was incarcerated on drug-related charges. Numerous times, the patient missed completing his labs and his post-transplant appointments. He did not refill his immunosuppressant medications, and for lengthy periods of time, he was unreachable by the transplant care team, which resulted in my team members and I calling the patient's family, other providers, and the police for safety checks.In the aftermath of these issues, my colleagues and I had to reckon with the realization that we had failed the patient. As a team, our transplant center created a task force to review this case and what to do in the future to prevent such breakdowns in patient care. We created protocols for managing patients who, at the time of their transplant, are on Medication Assisted Treatment (MAT) such as Suboxone and methadone. Staff across the multidisciplinary team attended trainings regarding addiction, pain management, and best practices for MAT services. Additionally, our transplant center collaborated with our hospital's addiction treatment program for a streamlined referral process for transplant patients to addiction services.This patient's case and its sensational nature resulted in many conversations, both professional and unprofessional. Members of the social worker department became aware that personnel within transplant, though not involved in patient care, were inappropriately discussing this patient's case and engaging in unprofessional behavior. Said actions led to the termination of a member of the transplant team. I was placed in the unenviable [End Page E3] position of having to report this behavior to hospital management and legal teams to protect a vulnerable patient.The ethical challenge behind this case really stems from the transplant team attempting to balance two... (shrink)