“Additional needs children” is a term often used in the education system to describe children with school-based problems characterised by learning difficulties arising from academic, social and emotional stressors including, but not limited to, clinically diagnosed Neurodevelopmental Disorders (NDD). What has seldom been investigated is what biopsychosocial characteristics and other common comorbid behaviours are associated with academic learning difficulties. Thus, the aim of this study was to investigate the relationship between anxiety levels (Spence Children’s Anxiety Scale- Parent Report), autism (...) traits (Autism Spectrum Quotient – Child Version) and sleep quality (Sleep Disturbance Scale for Children) in ‘additional needs children’ with a diagnosis of Autism Spectrum Disorder (ASD), Language Impairment or Mixed Diagnosis without an intellectual disability. The results demonstrated that the ASD group reported more impairments associated with comorbid anxiety and sleep compared to the other clinically diagnosed groups. Similarly, greater anxiety level was positively associated with a greater number of autism traits and poorer sleep quality regardless of diagnostic group. This suggests that higher anxiety symptoms are a core biomarker of children who often first come to their teacher’s attention with reading and learning difficulties (i.e. “additional needs”), irrespective of the primary cause of school-based problems. (shrink)

1. GENERAL The term "diagnostics" refers to the general theory of diagnosis, not to the study of specific diagnoses but to their general framework. It borrows from different sciences and from different philosophies. Traditionally, the general framework of diagnostics was not distinguished from the framework of medicine. It was not taught in special courses in any systematic way; it was not accorded special attention: students absorbed it intuitively. There is almost no comprehensive study of diagnostics. The instruction in (...) class='Hi'>diagnosis provided in medical schools is exclusively specific. Clinical instruction includes (in addition to vital background information, such as anatomy and physiology) specific instruction in nosology, the theory and classification of diseases, and this includes information on diagnoses and prognoses of diverse diseases. What is the cause of the neglect of diagnostics, and of its integrated teaching? The main cause may be the prevalence of the view of diagnostics as part-and parcel of nosology. In this book nosology is taken as a given, autonomous field of study, which invites almost no comments; we shall freely borrow from it a few important general theses and a few examples. We attempt to integrate here three studies: ll of the way nosology is used in the diagnostic process; of the diagnostic process as a branch of applied ethics; ~ of the diagnostic process as a branch of social science and social technology. (shrink)

With the development of artificial intelligence technologies, it is possible to use computer to read digital medical images. Because Alzheimer’s disease has the characteristics of high incidence and high disability, it has attracted the attention of many scholars, and its diagnosis and treatment have gradually become a hot topic. In this paper, a multimodal diagnosis method for AD based on three-dimensional shufflenet and principal component analysis network is proposed. First, the data on structural magnetic resonance imaging and functional (...) magnetic resonance imaging are preprocessed to remove the influence resulting from the differences in image size and shape of different individuals, head movement, noise, and so on. Then, the original two-dimensional ShuffleNet is developed three-dimensional, which is more suitable for 3D sMRI data to extract the features. In addition, the PCANet network is applied to the brain function connection analysis, and the features on fMRI data are obtained. Next, kernel canonical correlation analysis is used to fuse the features coming from sMRI and fMRI, respectively. Finally, a good classification effect is obtained through the support vector machines method classifier, which proves the feasibility and effectiveness of the proposed method. (shrink)

This paper presents a case in whom a differential diagnosis of akinetic mutism with a disorder of consciousness was made using diffusion tensor tractography. A 69-year-old female patient was diagnosed with subarachnoid hemorrhage, intraventricular hemorrhage, and intracerebral hemorrhage produced by the subarachnoid hemorrhage. She exhibited impaired consciousness with a Coma Recovery Scale-Revised score of 13 until 1 month after onset. Her impaired consciousness recovered slowly to a normal state according to the Coma Recovery Scale-Revised at 7 weeks after onset. (...) On the other hand, she exhibited the typical clinical features of akinetic mutism. On the DTT performed at 1-month, the upper, and lower dorsal ascending reticular activating systems, which are related to a disorder of consciousness, showed an almost normal state. In contrast, the prefronto-caudate and prefronto-thalamic tracts, which are related to akinetic mutism, showed severe injuries. These DTT results suggested that the patient's main clinical features were not a disorder of consciousness but akinetic mutism. Therefore, DTT for the ascending reticular activating system, and the prefronto-caudate and prefronto-thalamic tracts could provide additional evidence for a differential diagnosis of DOC and AM at the early stages of stroke. (shrink)

Psychiatrists diagnose mental illness in patients against a climate of opinion in which the value of diagnosis is questioned and non-medical formulations of the problems of psychiatric patients are put forward. Nevertheless the classic diagnostic terminology shows no sign of disappearing. The patients may find that a psychiatric diagnostic label is a stigma and has bad consequences. They may also object to standard methods of treatment. Given this situation the right of the patient to a full explanation of the (...) diagnosis and the rationale of the treatment offered seems to be incontrovertible. If this information were given to patients it would, in addition, help them to make sense out of their often puzzling experiences and indicate that fellow sufferers existed. (shrink)

The possibility of early diagnosis and intervention is radically changed by the advent of genetic testing. The recent report of the Nuffield Council on Bioethics is timely and helpful. I have suggested, that not only the severity of the disability indicated by genetic information, and the accuracy of the data, ought to govern the approach to the implementation of screening for genetic disorders. In addition, assessment of the value of the information to those involved should be considered. The efficacy (...) of the available therapeutic measures, combined with the prognostic data are important indices of the value of the information. These measures fall into three categories and thus indicate that three different courses of intervention may be appropriate. Three approaches to diagnosis and intervention are then outlined, drawing on the experience of various clinical initiatives. (shrink)

e understanding of the etiology and pathogenesis of these psyc hiatric disorders such as schizophrenia and depression is still n ot completely clear. At present, there is a lack of objective ne urobiological markers that can be used in clinical routine work such as clinical diagnosis, curative effect evaluation and progn osis evaluation of psychiatric disorders. Therefore, it is of great clinical significance to find biomarkers to improve the diagnos is level and evaluate the curative effect. Electroencephalogram (EEG) is (...) a non-invasive technique to record the potential activi ty of biological brain, through which researchers can analyze th e mechanisms underlying psychiatric disorders. In addition, mac hine learning can be used to further verify the role of these el ectrophysiological indicators in clinical diagnosis and curative e ffect evaluation of psychiatric disorders. The goal of this resear ch topic is to advance research on neurobiomarkers and EEG/ MEG-based diagnostic methods for mental disorders. We hope to conduct in-depth research on the pathogenesis and diagnostic measures of mental diseases such as schizophrenia and depressi ve disorder through EEG/MEG, in order to improve the perfor mance of artificial intelligence for mental diseases diagnosing.Under this research theme, the following is a brief overview of nine published articles, which respectively studied the diagnosis, The work in this special issue may fall into three categories of research: 1) method... (shrink)

Many European countries uphold a ‘high risk of a serious condition’ requirement for limiting the scope of preimplantation genetic diagnosis (PGD). This ‘front door’ rule should be loosened to account for forms of PGD with a divergent proportionality. This applies to both ‘added PGD’ (aPGD), as an add‐on to in vitro fertilization (IVF), and ‘combination PGD’ (cPGD), for a secondary disorder in addition to the one for which the applicants have an accepted PGD indication. Thus loosening up at the (...) front has implications at the back of PGD treatment, where a further PGD rule says that ‘affected embryos’ (in the sense of embryos with the targeted mutation or abnormality) should not be transferred to the womb. This ‘back door’ rule should be loosened to allow for transferring ‘last chance’ affected embryos in aPGD and cPGD cases, provided this does not entail a high risk that the child will have a seriously diminished quality of life. (shrink)

Sadegh-zadeh [23] has proposed a theory of the relativity of medical diagnosis in terms of the time at which a diagnosis is accepted, the patient to whom the diagnosis applies, the physician who renders the diagnosis, the medical knowledge used, the diagnostic method applied, and the set of patient observations. Use of classical formal logic as the diagnostic method may result in three paradoxes: the paradoxes of consistency, completeness, and justifiable ignorance. These paradoxes may be resolved (...) by the addition of two non-classical operators, the certainty and effort operators, akin to the non-classical operators of modal logic. (shrink)

IntroductionCerebral visual impairment is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in (...) CVI according to the grade method.Patients and MethodsWe developed the guidelines according to the GRADE method 5 searches on CVI were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic.ResultsBased on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23. 2. Ophthalmological and orthoptic assessment 37. 3. Neuropsychological assessment 5. 4. Neuroradiological evaluation and magnetic resonance imaging 9. 5. Genetic assessment 5.ConclusionIn medical history taking, prematurity low birth weight and APGAR Scores are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups. In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments can be necessary to complete the diagnosis of CVI and/or to reveal the etiology. (shrink)

This paper articulates a dilemma posed by philosophical counseling literature that presupposes diagnostic recognition. In addition, guests often bring self-ascribed mental health diagnoses from their previous experience, and requests the philosophical counselor to de-diagnose or otherwise reinterpret their problems. Although philosophical counselors can do this, we cannot skirt philosophical diagnosis. The paper’s thesis is that it behooves philosophical counselors to differentiate these types of diagnosis and to know when we are doing one or the other, including the utilization (...) of diagnostic recognition. Anecdotes from the author’s philosophical counseling sessions are included to illustrate the discussion. The paper concludes that the space of philosophical diagnosis is neither incommensurate with, nor incompatible with clinical diagnosis. On the contrary, the space of philosophical diagnosis ought to harbor the possibility of clinical diagnostic recognition. The philosophical counselor’s repertoire of diagnostic intuitions should cultivate the intuitive recognition of clinical prototypes. (shrink)

Termination of pregnancy after a certain gestational age and following prenatal diagnosis, in many nations seem to be granted with a special status to the extent that they by law have to be discussed within a predominantly medical context and have physicians as third parties involved in the decision-making process (‘indication-based’ approach). The existing legal frameworks for indication-based approaches, however, do frequently fail to provide clear guidance for the involved physicians. Critics, therefore, asked for professional ethics and professional institutions (...) in order to provide normative guidance for the physicians in termination of pregnancy on medical grounds. After outlining the clinical pathway in an indication-based approach and the involved types of (clinical) judgements, this paper draws upon different understandings of professional ethics in order to explore their potential to provide normative guidance in termination of pregnancy on medical grounds. The analysis reveals that professional ethics will not suffice—neither as a set of established norms nor as internal morality—in order to determine the normative framework of indication-based approaches on termination of pregnancy. In addition, there seem to be considerable inconsistencies regarding the target and outcome between prenatal testing on the one hand and following termination of pregnancy on the other hand. A source of morality external to medicine has to be the basis of evaluation if a consistent and workable normative framework for termination of pregnancy and prenatal testing should be established. (shrink)

BackgroundAs the use of AI becomes more pervasive, and computerised systems are used in clinical decision-making, the role of trust in, and the trustworthiness of, AI tools will need to be addressed. Using the case of computational phenotyping to support the diagnosis of rare disease in dysmorphology, this paper explores under what conditions we could place trust in medical AI tools, which employ machine learning.MethodsSemi-structured qualitative interviews with stakeholders who design and/or work with computational phenotyping systems. The method of (...) constant comparison was used to analyse the interview data.ResultsInterviewees emphasized the importance of establishing trust in the use of CP technology in identifying rare diseases. Trust was formulated in two interrelated ways in these data. First, interviewees talked about the importance of using CP tools within the context of a trust relationship; arguing that patients will need to trust clinicians who use AI tools and that clinicians will need to trust AI developers, if they are to adopt this technology. Second, they described a need to establish trust in the technology itself, or in the knowledge it provides—epistemic trust. Interviewees suggested CP tools used for the diagnosis of rare diseases might be perceived as more trustworthy if the user is able to vouchsafe for the technology’s reliability and accuracy and the person using/developing them is trusted.ConclusionThis study suggests we need to take deliberate and meticulous steps to design reliable or confidence-worthy AI systems for use in healthcare. In addition, we need to devise reliable or confidence-worthy processes that would give rise to reliable systems; these could take the form of RCTs and/or systems of accountability transparency and responsibility that would signify the epistemic trustworthiness of these tools. words 294. (shrink)

Cognitive diagnosis models allow classifying respondents into a set of discrete attribute profiles. The internal structure of the test is determined in a Q-matrix, whose correct specification is necessary to achieve an accurate attribute profile classification. Several empirical Q-matrix estimation and validation methods have been proposed with the aim of providing well-specified Q-matrices. However, these methods require the number of attributes to be set in advance. No systematic studies about CDMs dimensionality assessment have been conducted, which contrasts with the (...) vast existing literature for the factor analysis framework. To address this gap, the present study evaluates the performance of several dimensionality assessment methods from the factor analysis literature in determining the number of attributes in the context of CDMs. The explored methods were parallel analysis, minimum average partial, very simple structure, DETECT, empirical Kaiser criterion, exploratory graph analysis, and a machine learning factor forest model. Additionally, a model comparison approach was considered, which consists in comparing the model-fit of empirically estimated Q-matrices. The performance of these methods was assessed by means of a comprehensive simulation study that included different generating number of attributes, item qualities, sample sizes, ratios of the number of items to attribute, correlations among the attributes, attributes thresholds, and generating CDM. Results showed that parallel analysis, factor forest model, and model comparison are suitable alternatives to determine the number of attributes in CDM applications, with an overall percentage of correct estimates above 76% of the conditions. The accuracy increased to 97% when these three methods agreed on the number of attributes. In short, the present study supports the use of three methods in assessing the dimensionality of CDMs. This will allow to test the assumption of correct dimensionality present in the Q-matrix estimation and validation methods, as well as to gather evidence of validity to support the use of the scores obtained with these models. The findings of this study are illustrated using real data from an intelligence test to provide guidelines for assessing the dimensionality of CDM data in applied settings. (shrink)

Recently, an agonizing twist intersecting predictive genetic tests and surrogacy contracts made news headlines in Canada. The intended parents, a couple from British Columbia, instructed the surrogate mother with whom they were working to undergo First Trimester Screening and Chorionic Villi Sampling, which revealed the fetus likely had Down syndrome. The parents directed the surrogate to terminate the fetus or they would abdicate their parental claim upon birth. This story raised numerous legal and ethical questions relating to the transferability of (...) decision making for prenatal screening, diagnostic tests, and the connected decision of termination when additional interested parties – the intended parents – are involved in the medical decision-making relationship. First, although the surrogate is the patient, what are the implications when the intended parents' wishes influence or even dictate the relationship between her and her obstetrician and genetic counselor? Second, if the intended parents' level of authority reaches explicit demands, may the intended parents ethically and legally require the surrogate to waive her right to informed consent for prenatal screening and diagnosis? (shrink)

In coal mining industry, the running state of mine ventilators plays an extremely significant role for the safe and reliable operation of various industrial productions. To guarantee the better reliability, safety, and economy of mine ventilators, in view of early detection and effective fault diagnosis of mechanical faults which could prevent unscheduled downtime and minimize maintenance fees, it is imperative to construct some viable mathematical models for mine ventilator fault diagnosis. In this article, we plan to establish a (...) data-based mine ventilator fault diagnosis method to handle situations where engineers are absent or they are incapable of coming to a conclusion from multisource data. In the process of building the mine ventilator fault diagnosis model, considering that probabilistic rough sets could reduce the errors triggered by incompleteness, inconsistency, and inaccuracy without needing any additional assumptions and Pythagorean fuzzy multigranulation rough sets over the two universes’ model could effectively handle data representation, fusion, and analysis issues, we generalize the existing PF MGRSs over the two universes’ model to the PRS setting, as well as to further establish a novel model named Pythagorean fuzzy multigranulation probabilistic rough sets over two universes. In the granular computing paradigm, three types of PF MG-PRSs over two universes based on the risk attitude of engineers are proposed at first. Afterwards, several basic propositions of the newly proposed model are explored. Moreover, a PF multigranulation probabilistic model for mine ventilator fault diagnosis based on PF MG-PRSs over two universes is investigated. At last, a real-world case study of dealing with a mine ventilator fault diagnosis problem is given to illustrate the practicality of the presented model, and a validity test, a sensitivity analysis, and a comparison analysis are further explored to demonstrate the effectiveness of the presented model. (shrink)

The rapidly increasing number of cases of Zika virus and limited understanding of its congenital sequelae (e.g., microcephaly) led to stories of fear and uncertainty across social media and other mass communication networks. In this study, we used techniques generic to netnography, a form of ethnography, using Internet‐based computer‐mediated communications as a source of data to understand the experience and perceptions of families with infants diagnosed with Zika‐related microcephaly. We screened 27 YouTube™ videos published online between October 2015 and July (...) 2016, during which the Zika epidemic started, peaked, and declined. We identified three themes: (a) experiencing the news of a diagnosis of Zika‐associated microcephaly; (b) experiencing feelings and expectations of the ‘imperfect’ child; and (c) seeking to understand microcephaly to care for the child. We found that families experienced distressing feelings of shock, sadness, hopelessness, and pain, while dealing with emerging and sometimes conflicting information being transmitted by news outlets, uncertainty about the child's health, and healthcare providers’ lack of clarity to guide the family members. The ‘unknown’ factor of ZIKA was an additional stressful factor in the experience of the families. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Bittersweet Score:A Father’s Account of His Family’s 20-Year Journey After a Pediatric Brain Tumor DiagnosisChristopher RileyI hadn’t seen him for 20 years, not since the day he drilled a hole in Peter’s head and left the stainless steel drill and bloody bit on the bedside table. He figured prominently in the story I often told of that day when he, a doctor in training, [End Page 3] informed (...) my wife Kathy and me that, “Wow,” our five-year-old son had “an impressive tumor” in his brain. He announced it with the admiration I reserve for a touchdown pass or stunning sunset. Since that day, he had become a venerable physician. Back then he was the resident who met us in the ER after our pediatrician told us that the MRI of Peter’s brain was “not normal,” that “there might be a growth.” As if there might not be. I imagined that Peter’s brain might simply have an unusual shape, or that the scan revealed some undiscovered fracture and the authorities only wanted to lock me up and all with my son would be well. The thrilled young doctor slew those hopes with an ice pick: “Wow, that’s an impressive tumor.” I said, “That’s the first time anyone has used the word tumor.” The doctor appeared mortified and started over.Now 20 years later we found ourselves at the same party and I felt a compulsion to introduce myself, remind him we’d met that day in 1993, and tell him what had become of Peter and his family in the decades since he’d made that mortifying mistake, one I hoped had become for him a defining moment. To my disappointment, he didn’t seem to remember.Peter was my red-haired boy. Fearless and whip smart, he told a stream of knock-knock jokes and performed dance routines choreographed by his 8-year-old sister Rachel. Six months of headaches, vomiting and clumsy falls led to discovery of the tumor. When I phoned my parents with the news, I couldn’t speak the words, words that felt as if they spelled my boy’s doom. My body refused to pronounce them.The war for Peter’s life began with surgery. I sat with Kathy in the surgical waiting area, fearing every minute that I would see the surgeon approaching with his shoulders slumped in mortal defeat. I learned during those hours that fear of your child’s death is a physical pain, a constriction in the chest, a suffocation. At the end of that wait, the surgeon told us the tumor was out and Peter had survived. The pathology indicated the tumor was a medulloblastoma. Without additional treatment, including radiation, it was certain to come back. Kathy’s knees buckled. Having just endured one life-and-death battle, we were plunged into another. To complicate matters, Peter wasn’t waking from surgery. Even after the anesthesia wore off, Peter remained groggy, unable to move or focus his eyes.Through the following days, Peter failed to rouse or speak. Sores formed at the back of his neck where his unswallowed saliva pooled. Neurologists doubted he knew us. His doctors hoped Peter would recover but it was possible he would remain as he was indefinitely. As I sat holding his useless hand, watching his useless body, I thought I’d never loved him as much as I did now.Peter’s doctors presented two treatment options. The first consisted of relatively high doses of daily radiation, the most effective known method for preventing the return of the cancer. But radiation wasn’t good for young brains. It “shaved IQ points,” they said in wild understatement. So they offered a second, experimental option, one that reduced radiation by a third and added months of chemotherapy. The doctors hoped this new regimen would be as effective as the old but cause less cognitive damage. They asked us to choose. It seemed impossible. We gathered the scant available data. We weighed the risks. We prayed. We took a leap. Without asking him, we made a decision for Peter we knew... (shrink)

There are complex considerations when planning to disclose an attenuated psychosis syndrome diagnosis. In this review, we evaluate ethical, legal, and clinical perspectives as well as caveats related to full, non- and partial disclosure strategies, discuss societal implications, and provide clinical suggestions. Each of the disclosure strategies is associated with benefits as well as costs/considerations. Full disclosure promotes autonomy, allows for the clearest psychoeducation about additional risk factors, helps to clarify and/or correct previous diagnoses/treatments, facilitates early intervention and (...) bolsters communication between providers but there are important considerations involving heritability, comorbidity, culture, and stigma. Non-disclosure advances nonmaleficence by limiting stigma and stress, and confusion in a sensitive developmental period but is complicated by varying patient preferences and the possibility that, as new treatments without adverse effects become available, the risk with false positives no longer justifies the accompanying loss of autonomy. Partial disclosure balances ethical considerations by focusing on symptoms instead of labels, but evidence that laypersons may interpret this information as a pseudo-diagnosis and that symptoms alone also contribute to stigma limits the efficacy of this approach. In addition, there are notable societal considerations relating to disclosure involving conservatorship, the reach of insurance companies, and discrimination. We advocate a hybrid approach to disclosure and recommend future research aimed at understanding the effects of stigma on clinical course and a renewed focus on those help-seeking cases that do not transition but remain clinically relevant. (shrink)

Preimplantation genetic diagnosis generates a series of ethical and legal questions: Which goals does it pursue? Does it protect the embryo? Should this technique be regulated by the legal system? And if so, which is the incumbent criteria? This research describes the limits that some international laws regulating this technique have considered. Additionally, a series of judgments about the legal problems that have occurred with the application of this technique will be analyzed, among them, the misdiagnosis.

This paper proposes a new method that can diagnose nodes which consist of a large scale structure system including intermitted fault and analyzes its capability through simulations for comparisons between our method and Adaptive DSD, one of on-line distributed diagnosis methods. Our method based on ideas of a disconnecter and token node. The disconnecter is a function to cope with an intermitted fault, while the token node can collect and exchange fault node informations from other token nodes. Our simulation (...) results have confirmed that an autonomous distributed diagnosis method with token node works well in many cases, however, in some cases where the length between normal nodes is more than two links, our method cannot diagnoses correctly. In addition to this result, the following advantages of our method are founded in comparison with the Adaptive DSD: (1) our method does not need global connections among nodes but need only two link connections; (2) our method can cope with intermitted fault; (3) our method require less information exchange than Adaptive DSD; and (4) our method can get a correct fault information faster than Adaptive DSD. (shrink)

BackgroundThe diagnosis of Attention deficit hyperactivity disorder is primarily dependent on parents’ and teachers’ reports, while children’s own perspectives on their difficulties and strengths are often overlooked.GoalTo further increase our insight into children’s ability to reliably report about their ADHD-related symptoms, the current study examined the associations between children’s self-reports, parents’ and teachers’ reports, and standardized continuous performance test data. We also examined whether the addition of children’s perceptions of ADHD-symptoms to parents’ and teachers’ reports would be reflected by (...) objective and standardized data.MethodsThe study included 190 children with ADHD, aged 7–10 years, who were referred to a pediatric neurologic clinic. A retrospective analysis was conducted using records of a clinical database. Obtained data included children’s self-reports of their attention level and ADHD-related symptoms, parent, and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist, Teacher’s Report Form, and CPT scores.ResultsChildren’s self-evaluations of their functioning were globally associated with their teachers’ and parents’ evaluations, but not uniquely. Children’s self-reports of ADHD symptoms were not uniquely linked to a specific CPT impairment index, but to a general likelihood of having an impaired CPT. The CPT performance successfully distinguished between the group of children who defined themselves as inattentive and those who did not.ConclusionPrimary school children with ADHD are able to identify their limitations and needs difficulties and that their perspectives should inform clinical practice and research. The clinical and ethical imperative of taking children’s perspectives into account during ADHD diagnosis and treatment is highlighted. (shrink)

The diagnosis of attention-deficit hyperactivity disorder is a subject of controversy, for a host of reasons. This paper seeks to explore the manner in which children's interests may be subsumed to those of parents, teachers, and society as a whole in the course of diagnosis, treatment, and labeling, utilizing a framework for children's citizenship proposed by Elizabeth Cohen. Additionally, the paper explores aspects of discipline associated with the diagnosis, as well as distributional pathologies resulting from the application (...) of the diagnosis in potentially biased ways. (shrink)

Although the “Introduction” to the DSM makes it clear that the presence of “clinical” distress or impairment is insufficient for a diagnosis of “mental disorder” , in practice the clinician is completely unshackled from the conceptual definition and is free to decide on a case-by-case basis if “enough” distress or impairment is present, regardless of circumstances, to judge that “mental disorder” can be diagnosed. It is argued that reference to a biological or psychological dysfunction cannot raise “mental disorder” from (...) a judgment quite like “This is pornography, not literature” to a technical–scientific term because “biological dysfunction” must be tied to an outcome that is itself less ambiguous than “mental disorder,” and “psychological dysfunction” erroneously assumes that how people are supposed to think, feel, and act, regardless of circumstances, can be as uncontentious as ideas about physical well being, and in addition erroneously assumes that human behavior can be causally explained. (shrink)

Early and accurate diagnosis of glaucoma is critical for avoiding human vision deterioration and preventing blindness. A deep-neural-network model has been developed for the diagnosis of glaucoma based on Heidelberg retina tomography, called “Seeking Common Features and Reserving Differences Net” to make full use of the HRT data. In this work, the proposed SCRD-Net model achieved an area under the curve of 94.0%. For the two HRT image modalities, the model sensitivities were 91.2% and 78.3% at specificities of (...) 0.85 and 0.95, respectively. These results demonstrate a significant improvement over earlier results. In addition, we visualized the network outputs to develop an interpretation of the learned mechanism for discriminating glaucoma and normal images. Thus, the SCRD-Net can be an effective diagnostic indicator of glaucoma during clinical screening. To facilitate SCRD-Net utilization by the scientific community, the code implementation will be made publicly available. (shrink)

In this important addition to the stroke literature, highly experienced clinicians set out the patterns to be expected in patients with stroke, drawing on illustrative case histories where appropriate. The book is intended as a guide to patterns and syndromes for clinicians encountering an unfamiliar presentation in a stroke patient. It will enable them to differentiate between possible locations on the basis of symptoms and signs, recognise lesion patterns found in patients with infarcts and haemorrhages in various vascular territories, and (...) refer to the clinical features associated with rare but important causes of stroke. Drawing on the experience and clinical authority of distinguished international contributors, this is a practical, highly illustrated companion and reference for students, trainees and physicians who wish to improve their skills in the accurate diagnosis of stroke syndromes, and their understanding of its clinical consequences. (shrink)

Suppose we accept prenatal diagnosis and the selective abortion of fetuses that test positive for severe genetic disorders to be both morally and socially acceptable. Should we consider prenatal diagnosis and selective abortion (or other genetic interventions such as preimplantation diagnosis, genetic therapy, cloning, etc.) for nontherapeutic purposes to be acceptable as well? On the one hand, the social aims to promote liberty in general, and reproductive liberty in particular, provide reason for thinking that individuals should be (...) free to make their own decisions about whether or not to employ whatever genetic services might be developed and offered by private enterprise. On the other hand, interventions aimed at enhancement would (in many cases) presumably only be available to those who are financially fortunate. A worry is that unequal access to enhancements that provide competitive advantages to offspring will further and more permanently increase existing unjust disparities between the haves and have-nots. The aim to promote liberty might thus conflict with the social aim of equality. An additional worry is that the development and provision of nontherapeutic genetic interventions would drain limited medical resources away from therapeutic purposes which would ultimately be more fruitful. The promotion of liberty might also thus conflict with the aim to promote aggregate utility. Assuming there is no reason to think that the promotion of liberty should be given absolute priority over both equality and aggregate utility, we need to think more about how to make trade-offs between these three legitimate social aims. (shrink)

Some patients who have been diagnosed as “dead by neurologic criteria” continue to exhibit certain brain functions, most commonly, neuroendocrine functions. This preservation of neurologic function after the diagnosis of “brain death” or “brainstem death” is an ongoing source of controversy and concern in the medical, bioethics, and legal literatures. Most obviously, if some brain function persists, then it is not the case that all functions of the entire brain have ceased and hence, declaring such a patient to be (...) “dead” would be a false positive, in any nation with so-called “whole brain death” laws. Furthermore, and perhaps more concerning, the preservation of any brain function necessarily entails the preservation of some amount of brain perfusion, thereby raising the concern as to whether additional areas of neural tissue may remain viable, including areas in the brainstem. These and other considerations cast significant doubt on the reliability of diagnosing either “brain death” or “brainstem death.”. (shrink)

Contemporary psychiatry finds itself in the midst of a crisis of classification. The developments begun in the 1980s—with the third edition of the Diagnostic and Statistical Manual of Mental Disorders —successfully increased inter-rater reliability. However, these developments have done little to increase the predictive validity of our categories of disorder. A diagnosis based on DSM categories and criteria often fails to accurately anticipate course of illness or treatment response. In addition, there is little evidence that the DSM categories link (...) up with genetic findings, and even less evidence that they... (shrink)

This paper explores the ethics of introducing genome-editing technologies as a new reproductive option. In particular, it focuses on whether genome editing can be considered a morally valuable alternative to preimplantation genetic diagnosis. Two arguments against the use of genome editing in reproduction are analysed, namely safety concerns and germline modification. These arguments are then contrasted with arguments in favour of genome editing, in particular with the argument of the child’s welfare and the argument of parental reproductive autonomy. In (...) addition to these two arguments, genome editing could be considered as a worthy alternative to PGD as it may not be subjected to some of the moral critiques moved against this technology. Even if these arguments offer sound reasons in favour of introducing genome editing as a new reproductive option, I conclude that these benefits should be balanced against other considerations. More specifically, I maintain that concerns regarding the equality of access to assisted reproduction and the allocation of scarce resources should be addressed prior to the adoption of genome editing as a new reproductive option. (shrink)

In this article I argue that characterizations of anger as a hostile emotion may be mistaken. My project is empirically informed and is partly descriptive, partly diagnostic. It is descriptive in that I am concerned with what anger is, and how it tends to manifest, rather than with what anger should be or how moral anger is manifested. The orthodox view on anger takes it to be, descriptively, an emotion that aims for retribution. This view fits well with anger being (...) a hostile emotion, as retribution is punitive. I will argue that a different view of anger deserves our attention. On this alternative view, anger aims for recognition of harms done, rather than for the punishment of those who have committed them. I argue that we have reason to favour a strong view that excludes retribution from anger’s main aims. In addition, I offer a diagnosis of the reasons that led the retributive view of anger to become, and remain, orthodoxy. This diagnosis provides indirect reason to give my descriptive proposal serious consideration, for it highlights that the orthodox view has dominated folk and philosophical conceptions of anger for reasons that do not speak in favour of the view’s veracity. The view that anger is a hostile emotion will therefore emerge as in need of serious scrutiny. (shrink)

As scholars envision a new regulatory or statutory neurorights schema it is important to imagine unintended consequences if reforms are implemented before their implications are fully understood. This paper critically evaluates provisions proposed for a new Chilean Constitution and evaluates this movement against efforts to improve the diagnosis of, and treatment for, individuals with disorders of consciousness within the broader context of disability law, international human rights, and a capabilities approach to health justice as advanced by Amartya Sen and (...) Martha Nussbaum. Framed in this way, any neurorights regime would need to satisfy several criteria. First it would be obliged to balance both positive and negative rights in the furtherance of human capabilities. Second, it would need to be future oriented and informed about the science it sought to regulate and not fall prey to science fiction fantasies that remain ungrounded in reality. Third, it would need to be specific and avoid generalizations that would lead to conceptual confusion and litigation that could delay scientific progress. Finally, it would need to harmonize novel neurorights with long-established norms in international disability and human rights law. A failure to meet these criteria will destine any novel neurorights regime to the periphery. At this juncture Chile’s nascent constitutional venture into neurorights fails to satisfy these criteria. While there yet may be a role for a more capacious and bivalent articulation of neurorights that account for capabilities and precedent, the current Chilean neurorights reforms are vague and premature. As such they should undergo additional scholarly scrutiny and should not be adopted by other jurisdictions. (shrink)

Some critics argue that the types of psychiatric diagnosis found in the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Disease are superfluous and should be abandoned. These are known as categorical polythetic psychiatric diagnoses. To receive a categorical polythetic psychiatric diagnosis an individual need only exhibit some, rather than all, of the symptoms on the diagnostic criteria. Consequently, categorical polythetic psychiatric diagnoses only associate an individual with a range of symptoms rather than specify which (...) symptoms they have. Drawing on Giere’s account of scientific models, I portray categorical polythetic psychiatric diagnoses as abstract models that guide the building of less abstract models. These models can specify which symptoms a particular individual has. Additionally, categorical polythetic psychiatric diagnoses can guide investigation of symptoms towards difficult to spot symptoms, guide investigation towards changing symptoms, and guide investigation towards how symptoms manifest. These important roles mean categorical polythetic psychiatric diagnoses should not be abandoned. (shrink)

"Well over one half of this brilliant new Monograph constitutes a major sequel to Professor Grunbaum's highly influential 1984 book The Foundations of Psychoanalysis: A Philosophical Critique, which was labeled "magisterial" by Frank J. Sulloway, and "the most important book ever written on Freud's status as a scientist" by J. Allan Hobson. The importance of the present Monograph lies in the extent to which the author now goes beyond that earlier volume to offer new original ideas on fundamental themes." "Validation (...) in the Clinical Theory of Psycho-analysis: A Study in the Philosophy of Psycho-analysis contains Adolf Grunbaum's new basic critique of the psychoanalytic theory of transference in its role of an etiologic theory; it turns out that etiologic transference interpretations rest on fallacious causal inferences from so-called "meaning connections" between mental states: moreover, just these unsound inferences are the stock-in-trade of the "hermeneutic" reconstruction of psychoanalysis, which charges Freud with a "scientistic self-misunderstanding."" "This volume joins the issue with Marshall Edelson's defenses of the investigative viability of the single-subject case study method. As a spin-off from the import of the serious placebo challenge to psychoanalysis, this Monograph presents the author's widely recognized new account of the placebo concept across all of medicine and psychotherapy. Whereas Foundations of Psychoanalysis objected that Freud's dream theory was evidentially ill-founded, the burden of the present book is to give two new basic reasons for presuming the theory to be false. It also develops the import of the author's appraisal of psychoanalytic theory for the scrutiny of Freud's triadic psychology of religious belief in theism." "Since Sir Karl Popper's most detailed charge of pseudoscience against psychoanalysis in 1983 could not be examined for inclusion in the 1984 book, the present monograph shows in what ways it is wide of the mark as an incoherent diagnosis of the scientific liabilities of psychoanalytic theory. In addition, four important papers that had antedated Foundations by a few years and were scattered over diverse publications have been updated and integrated with the other chapters herein."--BOOK JACKET.Title Summary field provided by Blackwell North America, Inc. All Rights Reserved. (shrink)

In recent years, neuroscience has begun to transform itself into a “big data” enterprise with the importation of computational and statistical techniques from machine learning and informatics. In addition to their translational applications such as brain-computer interfaces and early diagnosis of neuropathology, these tools promise to advance new solutions to longstanding theoretical quandaries. Here I critically assess whether these promises will pay off, focusing on the application of multivariate pattern analysis (MVPA) to the problem of reverse inference. I argue (...) that MVPA does not inherently provide a new answer to classical worries about reverse inference, and that the method faces pervasive interpretive problems of its own. Further, the epistemic setting of MVPA and other decoding methods contributes to a potentially worrisome shift towards prediction and away from explanation in fundamental neuroscience. (shrink)

The main objective of this paper was to examine the involuntary nature of music-evoked autobiographical memories. For this purpose, young adults, older adults, and patients with a clinical diagnosis of probable Alzheimer’s disease were asked to remember autobiographical events in two conditions: after being exposed to their own chosen music, and in silence. Compared to memories evoked in silence, memories evoked in the “Music” condition were found to be more specific, accompanied by more emotional content and impact on mood, (...) and retrieved faster. In addition, these memories engaged less executive processes. Thus, with all these characteristics and the fact that they are activated by a perceptual cue , music-evoked autobiographic memories have all the features to be considered as involuntary memories. Our paper reveals several characteristics of music-evoked autobiographical memories in AD patients and offers a theoretical background for this phenomenon. (shrink)

A large campaign has sought to destigmatize psychiatric disorders by disseminating the view that they are in fact brain disorders. But when psychiatric disorders are associated with neurobiological correlates, laypeople's attitudes toward patients are harsher, and the prognoses seem poorer. Here, we ask whether these misconceptions could result from the essentialist presumption that brain disorders are innate. To this end, we invited laypeople to reason about psychiatric disorders that are diagnosed by either a brain or a behavioral test that were (...) strictly matched for their informative value. Participants viewed disorders as more likely to be innate and immutable when the diagnosis was supported by a brain test as compared to a behavioral test. These results show for the first time that people spontaneously essentialize psychiatric conditions that are linked to the brain, even when the brain probe offers no additional diagnostic or genetic information. This bias suggests that people consider the biological essence of living things as materially embodied. (shrink)

Essential Philosophy of Psychiatry is a concise introduction to the growing field of philosophy of psychiatry. Divided into three main aspects of psychiatric clinical judgement, values, meanings and facts, it examines the key debates about mental health care, and the philosophical ideas and tools needed to assess those debates, in six chapters. In addition to outlining the state of play, Essential Philosophy of Psychiatry presents a coherent and unified approach across the different debates, characterized by a rejection of reductionism and (...) an emphasis on the ineliminability of uncodified skilled judgement. The first part, Values, outlines the debate about whether diagnosis of mental illness is essentially value-laden and argues that the prospects for reducing illness or disease to plainly factual matters are poor. It also explains the important role of skilled contextual judgement, rather than a principles-based deduction, in ethical judgement. The second part, Meanings, examines the central role of understanding and a shared first person perspective, both against attempts to reduce meaning to basic information-processing mechanisms and to explain away the difficulties of understanding psychopathology in recent models of delusion. The third part, Facts, shows the importance of uncodified clinical judgements, both in assessing the validity of psychiatric taxonomy and in the application of Evidence Based Medicine. Despite advances in the codifaction of practice and operationalism of diagnosis, an element of judgement remains in the assessment both of what, at one level, is good evidence for diagnosis and treatment and what, at a higher level, is good evidence for the validity of classification overall. (shrink)

This paper presents an active fault-tolerant control strategy for quadrotor helicopters to simultaneously accommodate sensor faults and external disturbances. Unlike most of the existing fault diagnosis and fault-tolerant control schemes for quadrotor helicopters, the proposed fault diagnosis scheme is able to estimate sensor faults while eliminating the effect of external disturbances. Moreover, the proposed fault-tolerant control scheme is capable to eliminate the adverse effect of external disturbances as well by designing a disturbance observer to effectively estimate the unknown (...) external disturbances and integrating with the designed integral sliding-mode controller. In this case, the continuous operation of the quadrotor helicopter is ensured while avoiding the unexpected control chattering. In addition, the stability of the closed-loop system is theoretically proved. Finally, the effectiveness and advantages of the proposed scheme are validated and demonstrated through comparative numerical simulations of the quadrotor helicopter under different faulty and uncertain scenarios. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Care of the terminal patient:Are we on the same page?Lauren WancataIn surgical training a “service” or care team consists of sick patients admitted to the hospital and the medical team caring for the patient. Each service consists of an attending physician, a chief resident, a senior resident and junior residents structured as a hierarchy. The chief was gone for the week. As a senior trainee I would be the (...) acting chief—a role I had assumed many times before this month. To prepare for the week of his absence, I read through each patient’s chart, and the chief and I discussed each patient—diagnosis, procedures, and plans.One was a 41–year–old male with cancer—he was young, but a patient like him was not uncommon at my institution. He originally came in through the emergency department with abdominal pain and difficulty with urination. His admitting medical team started the work–up for his symptoms—blood tests, a CAT scan, and consults to other physician services with specialized knowledge. He eventually underwent endoscopy with biopsies of his stomach and placement of stents into his ureter and kidney for his urinary issues. With return of the biopsies, he had a diagnosis—cancer. He required additional procedures, including the placement of stents into his bile ducts, as they, like his ureter, had become affected by the cancer. The next step was staging the cancer to determine his treatment options. Our surgical service was consulted for a diagnostic laparoscopy with washing—we would take a look inside his abdomen with a camera and obtain a fluid sample to be sent to the pathologist for review, the standard of care for this type of cancer. When the camera was placed nodules were seen—a sample of the nodules and the fluid were sent to a pathologist and determined to be positive for cancer: metastatic disease, stage IV. A special feeding tube was placed into his small intestine to aid in nutritional support, as he had already lost a significant amount of weight, and improving his nutrition would be imperative for any further treatments. Following this operation, oversight of his day–to–day care was taken on by our surgical service, and he had been under our care for a period of time before I rotated onto the service for the month.What was the plan for his care in the hospital, and what was his–long–term plan? His cancer could not be surgically removed due to the extent of its spread within his body. He had recently undergone another CAT scan due to an elevation in his white blood cell count (this elevation was a sign of possible infection) and a thoracentesis, a procedure to remove some of the fluid that was collecting around his lungs. Nephrologists (kidney specialist) had been consulted due to his declining kidney function. Throughout the days, his tube feeds, his source of nutrition, would often be turned off due to bloating and feeling full.Each morning, I rounded with our team, and we would see how he was doing. We would discuss how his night went, and make a plan for the day. He was a man of few words, but his wife was always at his bedside, to support him, listen to updates and keep tract of his progress. She had worked at the hospital and had seen a wide range of patients. She would ask about his kidney function, his tube feeds, and his labs. But, she never asked about his prognosis. I would leave his room each day with the unnerving feeling that the patient, family members and care team were not on the same page. Yes, we all wanted him to get better and to leave the hospital. [End Page 28] But, was he really going to get better? What defined better? Did the patient and his family really know the extent of his disease and his prognosis?Towards the end of my week as chief, I started to ask if they had any other questions. It had been a few weeks since his operation. Was there anything that they wanted to discuss or ask me about? At the... (shrink)

Several prominent attacks on the objects of 'folk ontology' argue that these would be omitted from a scientific ontology, or would be 'rivals' of scientific objects for their claims to be efficacious, occupy space, be composed of parts, or possess a range of other properties. I examine causal redundancy and overdetermination arguments, 'nothing over and above' appeals, and arguments based on problems with collocation and with property additivity. I argue that these share a common problem: applying conjunctive principles to cases (...) in which the claims conjoined are not analytically independent. This unified diagnosis provides a way of defending ordinary objects against these common objections, while also yielding warnings about certain uses of general conjunctive principles. (shrink)

In this article, we investigate the role of scientific and patient narratives on perceptions of the medical debate around gestational diabetes testing. Among medical scientists, we show that the narrative surrounding GDM testing affirms that future research and data will lead to medical consensus. We call this narrative trajectory the “deferred quest.” For patients, however, diagnosis and their subsequent discovery that biomedicine does not speak in one voice ruptures their trust in medical authority. This new distrust creates space for (...) patients to develop a Frankian quest narrative where they become the protagonist in their story. Additionally, across these different narratives, we observe how character is constructed and employed to negotiate trust. We conclude that healthcare providers should assess the narrative trajectory adopted by patients after diagnosis. Also, we suggest that providers acknowledge the lack of medical consensus to their patients. This veracity would foster women’s sense of trust in their provider as well as allow women to be active interlocutors in a debate that ultimately plays out in their deliberation about their body, pregnancy, and risk. (shrink)

While neuroethics is generally thought to be a modern addition to the broader field of bioethics, this subdiscipline has existed in clinical practice throughout the course of the 20th century. In this essay, Fins describes an older tradition of clinical neuroethics that featured such physician-humanists as Sir William Osler, Wilder Penfield, and Fred Plum, whose work and legacy exploring disorders of consciousness is highlighted. Their normative work was clinically grounded and focused on the needs of patients, in contrast to modern (...) neuroethics, which is more speculative and distant from the lived reality of the clinic. Using recent developments in the diagnosis and treatment of disorders of consciousness, and the history of the vegetative and minimally conscious states, Fins asks why modern neuroethics has taken this turn and what can be done to restore clinical neuroethics to a more proportionate place in the field. (shrink)

In formulating a theory of perception that does justice to the embodied and enactive nature of perceptual experience, proprioception can play a valuable role. Since proprioception is necessarily embodied, and since proprioceptive experience is particularly integrated with one’s bodily actions, it seems clear that proprioception, in addition to, e.g., vision or audition, can provide us with valuable insights into the role of an agent’s corporal skills and capacities in constituting or structuring perceptual experience. However, if we are going to have (...) the opportunity to argue from analogy with proprioception to vision, audition, touch, taste, or smell, then it is necessary to eschew any doubts about the legitimacy of proprioception’s inclusion into the category of perceptual modalities. To this end, in this article, I (1) respond to two arguments that Shaun Gallagher ( 2003 ) presents in “Bodily self-awareness and objectperception” against proprioception’s ability to meet the criteria of object perception, (2) present a diagnosis of Gallagher’s position by locating a misunderstanding in the distinction between proprioceptive information and proprioceptive awareness, and (3) show that treating proprioception as a perceptual modality allows us to account for the interaction of proprioception with the other sensory modalities, to apply the lessons we learn from proprioception to the other sensory modalities, and to account for proprioceptive learning. Finally, (4) I examine Sydney Shoemaker’s ( 1994 ) identification constraint and suggest that a full-fledged notion of object-hood is unnecessary to ground a theory of perception. (shrink)

Introduction: In 2020, according to the Global Cancer Observatory, nearly 10 million people died of cancer. Amongst all cancers, breast cancer had the highest number of new cases and lung cancer had the highest number of deaths. Even though the literatures suggest a possible connection between psychological factors and cancer risk, their association throughout studies remains inconclusive. The present systematic review studied the connection between psychological factors and the risk of breast and lung cancer, prior to a cancer diagnosis. (...) The psychological factors of trauma, grief, and depression were studied.Methods: The current systematic review was carried out across multiple databases in two phases, an initial exploratory research in June 2020, refined with a second electronic research in December 2020. The inclusion criteria included studies describing the association between trauma, posttraumatic stress disorder, grief, and depression with breast and lung cancer risk. The psychological data collection must have been carried out prior to a confirmed breast or lung cancer diagnosis, and accessed through self-report measures, questionnaires, clinical interviews, or clinical diagnoses. Study reports had to contain information about the incidence of cancer and effect size. The exclusion criteria were studies in which psychological factors were collected after cancer diagnosis.Results and Conclusion: A total of 26 studies were included. Although non-consensual, the findings from the present systematic review suggest that, in addition to the known risk factors, psychological factors may play an important role in the etiology of both breast and lung cancer. To include psychological factors as a variable that affects cancer development may be fundamental to opening new avenues for prevention and intervention.Systematic Review Registration: [www.ClinicalTrials.gov], identifier [CRD42020209161]. (shrink)

ABSTRACT This article addresses the growing literature in critical race studies, which holds that racism is permanent or incurable, and that by adopting this pessimistic view of racism, we can enact improved and healthier racialized lives. I argue that the focus on curing anti-Black racism, and the failure to do so in the civil rights era and its aftermath has left people of all races, to varying degrees, stuck in pessimistic states of racialized anger, resentment, guilt, and shame. These pessimistic (...) states have brought about an additional level of oppression for targets of racialized oppression. I call it “meta-oppression,” and it is the oppression of being oppressed. I argue that this oppression has exacerbated the effects of the social disease of racism, and it has literally affected the physiologies of many African Americans. This article provides a diagnosis of these existential and physiological states of meta-oppression and a clarification of its characteristics. This diagnosis is an initial step in a larger project of formulating and enacting effective treatments for it. I then argue that meta-oppression is a helpful diagnostic tool for clarifying the characteristics and ramifications on Blacks of US systemic racism during the post–civil rights movement period. I aim to establish meta-oppression as an existential and physiological condition that requires attention so as to expand the social imaginations of people of color and to allow us to engage in more systemic joyful affirmations of our racialized lives while still living within racist conditions. (shrink)