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)

Addiction is a central issue in a liberal society of autonomous citizens, as the nodal point of addiction is self-control - or rather the lack of it. By looking at different ways of problematizing and working upon addiction, one might also get some idea of different ways of conceptualizing and practicing freedom. The point of departure for my paper is practices of methadone maintenance in different regimes of drug treatment. The article illustrates how treatment practices produce different forms (...) of subjectification of drug addicts, depending on the discourses and technologies these practices articulate, and by implication, how they constitute different ways of problematizing freedom as something to be worked upon. My argument is based on interviews with managers of the drug treatment system in Copenhagen, documents concerning drug policy and drug treatment on a local and national level as well as addiction research. My analyses in this paper are tentative and a first report from a study currently under way. (shrink)

Methadone maintenance therapy is a cost-effective, evidence-based treatment for heroin dependence. In the USA, a majority of heroin-dependent offenders are forced to detox from methadone when incarcerated. Recent research published in The Lancet has demonstrated the negative health and economic outcomes associated with such policies. Methadone Continuation Versus Forced Withdrawal on Incarceration in a Combined US Prison and Jail: A Randomised, Open Label Trial. The Lancet, 386, 350–359). This novel evidence raises questions as to the justification (...) for current policies of forced detox in American prisons. Opponents of methadone provision in prisons might offer arguments from retributivism, resource allocation and curative effectiveness to justify their position. This article contends that these arguments do not stand up to ethical scrutiny. In light of this, we hold that American policymakers should reform criminal justice policies to allow the initiation and continuation of methadone treatment in correctional settings. This would be consistent with both international recommendations and the example set by a number of other Western countries. (shrink)

Heroin use poses a significant health and economic burden to society, and individuals with heroin dependence are responsible for a significant amount of crime. Owing to its efficacy and cost-effectiveness, methadone maintenance therapy (MMT) is offered as an optional alternative to imprisonment for drug offenders in several jurisdictions. Some object to such 'MMT offers' on the basis that they involve coercion and thus invalidate the offender's consent to MMT. While we find these arguments unpersuasive, we do not attempt (...) to build a case against them here. Instead, we explore whether administration of MMT following acceptance of an MMT offer might be permissible even on the assumption that MMT offers are coercive, and in such a way that the resulting MMT is non-consensual. We argue that non-consensual MMT following an MMT offer is typically permissible. We first offer empirical evidence to demonstrate the substantial benefits to the offender and society of implementing non-consensual MMT in the criminal justice system. We then explore and respond to potential objections to such uses of MMT. These appeal respectively to harm, autonomy, bodily and mental interference, and penal theoretic considerations. Finally, we introduce and dismiss a potential response to our argument that takes a revisionist position, rejecting prevailing incarceration practices. (shrink)

Promoting student’s school engagement is a major goal in our society. The literature has shown that students’ proximal sources of social support can play a fundamental role in facilitating this engagement. The purpose of this study was to compare perceived support from four sources as a function of two different middle-school student backgrounds, a priority education area and a privileged area; and to examine the contribution of these main sources of social support, either directly or indirectly to school engagement; and (...) to test whether perceived social support is more strongly related to school engagement, directly or indirectly, among students from priority education school compared to students from the advantaged area. In all, 623 middle-school students from either a privileged or priority education area participated in this study. The results showed that the mother was perceived as providing more support, followed by the father, the teachers, and the peers. Students from the priority education area perceived more support from their teachers than their counterparts from the more privileged area did. A path analysis showed that each source of social support, except for maternal support, contributed to school engagement. Peers and teachers emerged as the best source of support for school engagement, having significant direct effects among students from the priority education area and both direct and indirect effects among students from the advantaged area. Peer support also appears to have a double-edged effect on school engagement among students in the priority education area. This study contributes to enlightening the phenomenon of school engagement in adolescence by clarifying the role of social support and the related mediating process. Being perceived as an important source of social support by students is not enough to contribute to their sense of school belonging and school engagement. (shrink)

This chapter sets the scene for the subsequent philosophical discussions by surveying a number of biological interventions that have been used, or might in the future be used, for the purposes of crime prevention. These interventions are pharmaceutical interventions intended to suppress libido, treat substance abuse or attention deficit-hyperactivity disorder (ADHD), or modulate serotonin activity; nutritional interventions; and electrical and magnetic brain stimulation. Where applicable, we briefly comment on the historical use of these interventions, and in each case we discuss (...) the evidence that they are effective, or might become so with further refinement. The chapter concludes with a comment on some potentially significant differences between the varieties of intervention that we canvass. (shrink)

PurposeThe aim of this study was to investigate and compare impulsiveness, negative emotion, cognitive function, and P300 components among gamma-hydroxybutyrate -addicted patients, heroin-dependent patients, and methadone maintenance treatment subjects.MethodsA total of 48 men including 17 GHB addicts, 16 heroin addicts, 15 MMT subjects, and 15 male mentally healthy controls were recruited. All subjects were evaluated for symptoms of depression, anxiety, impulsiveness, and cognitive function through the Patient Health Questionnaire, the Generalized Anxiety Disorder 7-item, the Barratt Impulsiveness Scale version (...) II, the Beijing version of the Montreal Cognitive Assessment, the behavioral test, and event-related potential P300 detection.Results The mean scores of BIS-II in the GHB addiction group, heroin dependence group, and MMT group were significantly higher than those of the HC group. The total scores of BJ-MOCA in GHB addiction group was the worst among the four groups, followed by heroin addiction, MMT group and HC group. The response time in the GHB addiction group was the longest among the four groups, followed by the heroin addiction, MMT, and HC groups. The amplitude and latency of P300 in GHB addiction subjects were significantly lower and longer than those of the MMT group and the HC group. For the three types of addiction, the P300 amplitudes at Fz, Cz, Pz, T5, and T6 were negatively correlated with the scores of GAD-7, PHQ-9, and BIS-II; the P300 latencies were positively correlated with the response time and negatively correlated with the scores of the BJ-MoCA.ConclusionPeople with an addiction were likely to have increased impulsiveness. The cognitive function of the GHB and heroin-addicted subjects, including the heroin detoxification and the MMT groups, was severely impaired, especially for the GHB-addicted patients. The impairment manifested as abnormalities of BJ-MoCA, response time, and P300 components. (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)

Opioid agonist treatment, including methadone, is the safest and most effective method for treating opioid use disorders and reduces opioid overdose deaths. While access to methadone is highly regulated by federal law, a substantial portion of states impose stricter barriers.

What can we learn about the nature of technology by studying practices of maintenance and repair? This volume addresses this question by bringing together scholarship from philosophers of technology working at the forefront of this emerging and exciting topic. -/- The chapters in this volume explore how attending to maintenance and repair can challenge and complement existing ways of thinking about technology focused on use and design and introduce new philosophical perspectives on the relationship between technology, time and (...) human practice. They examine the significance of maintenance and repair practices at different scales in relation to a diverse range of philosophical traditions and a wide variety of technologies, from urban infrastructure such as bridges and buildings to data technologies such as servers and software systems. Together, the contributions highlight common themes in the philosophical study of maintenance, including the role of skill, the significance of social values and the potential of these practices to transform the technologies to which they are applied. By reflecting on the different ways in which we keep technologies going, from the devices we use in our homes to the large technical systems which surround us, this volume reveals the philosophical significance of practices of maintenance, not only as a source of new insights but also as a resource for enriching our understanding of a variety of existing topics in philosophy. -/- Maintenance and Philosophy of Technology will appeal to scholars and advanced students working in philosophy of technology, philosophy of engineering and science & technology studies. (shrink)

Through a fieldwork study of the practice of methadone substitution at a French addiction clinic, the classic ‘theory of action’ is criticized and an alternative one proposed. A sketch of the debates among French drug specialists, drug users and legislators shows the pertinence for these practitioners of such a theoretical question; further, the ethnographic data suggest that they can be seen as actually trying out an alternative to this ‘theory of action’.

Smaldino suggests that patterns that give rise to group-level cultural traits can also increase individual-level cultural diversity. I distinguish social roles and related social network structures and discuss ways in which each might maintain diversity. I suggest that cognitive analogs of “cohesion,” a property of networks that helps maintenance of diversity, might mediate the effects of social roles on diversity.

The ethics of geoengineering has gained momentum in recent academic debate. The current debates, however, is typically framed in terms of (i) the first-order question about the moral permissibility of geoengineering, and (ii) the second-order question about the distributive and compensatory issues associated with geoengineering. Both (i) and (ii) are central to decision-making about geoengineering, but they have not cover all ethical issues related to geoengineering. I argue that a preoccupation with (i) and (ii) may lead to an oversight of (...) post-implementation scenarios (PISs), which introduce different ethical issues relevant to decision-making on geoengineering. More specifically, I use the requirement of maintenance for geoengineering as an example to draw attention to PISs, and to illustrate the limit of the existing discussion in the ethics of geoengineering. (shrink)

The Constitution of the Republic of Lithuania1 determines that both parents have to maintain their minors, while the state has to establish conditions under which parents would be able to do their duties, i.e. undertakes responsibility to maintain the children who lack the maintenance from their parents. Latter obligations are concretized in the Civil Code of the Republic of Lithuania2 (3.192–3.204 art.). It also anticipates the principles under which the child’s maintenance should be provided, its forms, size criteria (...) and the definition of its use and control. There is a theory that when parents are not able to fully perform the duty to maintain their children, the guarantees of the child’s constitutional rights oblige the State to secure quick reception of necessary financial support from other resources. Considering the existing social, economic, legal and other changes and sustaining both the analysis of court practice and doctrine attitude the article analyses present topicality concerning children maintenance, i.e. correspondence between child’s needs, parent’s wealth status and the prosecution of court’s decision, the correlation of state’s duty to children maintenance and parent’s responsibility, the peculiarities of majors maintenance. (shrink)

We examine the framing mechanisms used to maintain a cross-sector partnership that was created to address a complex long-term social issue. We study the first 8 years of existence of an XSP that aims to create a market for recycled phosphorus, a nutrient that is critical to crop growth but whose natural reserves have dwindled significantly. Drawing on 27 interviews and over 3000 internal documents, we study the evolution of different frames used by diverse actors in an XSP. We demonstrate (...) the role of framing in helping actors to avoid some of the common pitfalls for an XSP, such as debilitating conflict, and in creating sufficient common ground to sustain collaboration. As opposed to a commonly held assumption in the XSP literature, we find that collaboration in a partnership does not have to result in a unanimous agreement around a single or convergent frame regarding a contentious issue. Rather, successful collaboration between diverse partners can also be achieved by maintaining a productive tension between different frames through “optimal” frame plurality—not excessive frame variety that may prevent agreements from emerging, but the retention of a select few frames and the deletion of others toward achieving a narrowing frame bandwidth. One managerial implication is that resources need not be focussed on reaching a unanimous agreement among all partners on a single mega-frame vis-à-vis a contentious issue, but can instead be used to kindle a sense of unity in diversity that allows sufficient common ground to emerge, despite the variety of actors and their positions. (shrink)

Connected vehicle fleets have formed significant component of industrial internet of things scenarios as part of Industry 4.0 worldwide. The number of vehicles in these fleets has grown at a steady pace. The vehicles monitoring with machine learning algorithms has significantly improved maintenance activities. Predictive maintenance potential has increased where machines are controlled through networked smart devices. Here, benefits are accrued considering uptimes optimization. This has resulted in reduction of associated time and labor costs. It has also provided (...) significant increase in cost benefit ratios. Considering vehicle fault trends in this research predictive maintenance problem is addressed through hybrid deep learning-based ensemble method (HDLEM). The ensemble framework which acts as predictive analytics engine comprises of three deep learning algorithms viz modified cox proportional hazard deep learning (MCoxPHDL), modified deep learning embedded semi supervised learning (MDLeSSL) and merged LSTM (MLSTM) networks. Both sensor as well as historical maintenance data are collected and prepared using benchmarking methods for HDLEM training and testing. Here, times between failures (TBF) modeling and prediction on multi-source data are successfully achieved. The results obtained are compared with stated deep learning models. This ensemble framework offers great potential towards achieving more profitable, efficient and sustainable vehicle fleet management solutions. This helps better telematics data implementation which ensures preventative management towards desired solution. The ensemble method's superiority is highlighted through several experimental results. (shrink)

Minichromosome maintenance (Mcm) proteins are well‐known for their functions in DNA replication. However, their roles in chromosome segregation are yet to be reviewed in detail. Following the discovery in 1984, a group of Mcm proteins, known as the ARS‐nonspecific group consisting of Mcm13, Mcm16‐19, and Mcm21‐22, were characterized as bonafide kinetochore proteins and were shown to play significant roles in the kinetochore assembly and high‐fidelity chromosome segregation. This review focuses on the structure, function, and evolution of this group of (...) Mcm proteins. Our in silico analysis of the physical interactors of these proteins reveals that they share non‐overlapping functions despite being copurified in biochemically stable complexes. We have discussed the contrasting results reported in the literature and experimental strategies to address them. Taken together, this review focuses on the structure‐function of the ARS‐nonspecific Mcm proteins and their evolutionary flexibility to maintain genome stability in various organisms. (shrink)

This study aimed to describe and compare the views of nurses and older patients' relatives on factors restricting the maintenance of patient integrity in long-term care. The purposive sample comprised 222 nurses and 213 relatives of older patients in four Finnish long-term care institutions. The data were collected using a self-developed questionnaire addressing five sets of factors relating to patients, relatives, nurses, the organization and society. The maintenance of patient integrity was restricted by: (1) social factors, including lack (...) of respect for long-term geriatric care and lack of adequate resources; (2) patient factors relating to forgetfulness; and (3) factors relating to nurses and relatives in maintaining patient integrity. Better maintenance of patient integrity requires that more consideration is paid to issues of social respect and to the availability of adequate resources. Closer attention must be given to patients who are forgetful and unable to take part in decision making. (shrink)

In recent times developments in the natural sciences and in the sphere of environmental politics have compelled social scientists, and also some natural scientists, to rethink the relations that hitherto have been held, in Western thought generally and within particular disciplines, to characterize ‘nature’ on the one side and ‘culture’ on the other. This article considers the history of this conceptual boundary and looks at new conceptualizations of nature/culture, stimulated by developments both in biotechnology and in the ongoing controversies about (...) environmental degradation. It argues that while some of the contributions to reconfiguring, or abolishing, the nature/ culture division have been productive and stimulating of new ways of conceiving the world, there has nonetheless been an unfortunate tendency for social scientists to bring to bear inherited analytic dispositions on biotechnological and environmental matters. Instead of using these issues as means of challenging social scientific disciplinary dogmas and of engaging in constructive rapprochement with natural scientists, social scientists have in their analyses of such matters often merely asserted the hegemony of ‘culture’ over ‘nature’, and thus in effect the superiority of social scientific over natural scientific conceptualizations of the world. Far from overcoming the nature/culture boundary, social scientists have too often merely asserted the primacy of the sorts of subject matters and analytic techniques they feel comfortable with, rather than subjecting their practices to fully reflexive self-scrutiny. (shrink)

Because actual social experience is often damaging to conceptions of self, individuals in all societies engage in identity work beyond ordinary social interaction. For people in religious groups, identity work may involve the subjective experience of interactions with spirit beings as in altered states of consciousness such as dreams, reverie, or trance. In memories, anticipations, and fantasies, secular Americans, too, may experience gratifying imaginary social interactions when they gain recognition and acclaim from imagined others. Unlike spirit relations these fantasies are (...) not culturally defined as “real.” However, like spirit relations, they may have very real effects on self‐maintenance. (shrink)

Many kinds of health compromising norms, habits, and beliefs are highly resistant to change thereby preventing new knowledge about health maintenance from advancing widespread better health. Persons would be more responsive if they used a health ethic to harmonize personal behavior with health-maintaining practices. We argue that common sense morality includes a portion of a health ethic in the guise of responsibilities to maintain health as well as avoid self destruction. We discuss an example in which its application can (...) retard decline in older age that results from a sedentary lifestyle. (shrink)

Human concern with problems of being and becoming promotes conceptions of ideal states of being, exemplified by paragons and heroes and projected as Utopias or visions of salvation; it leads to regimens for cultivating and maintaining individual ability to meet social expectations; and it produces fantasies, as in myth and popular literature, that rehearse the problems and that offer escape from them and roles to emulate in dealing with them. Many of these regimens and fantasies appear in the rituals and (...) teachings of organized religion. Many also figure in private devotions apart from established religions. The many forms they take constitute much of the religious life of ordinary people. From this viewpoint, there is much to examine in American life. (shrink)

Game theory has played a critical role in elucidating the evolutionary origins of social behavior. Sober and Wilson model altruism as a prisoner's dilemma and claim that this model indicates that altruism arose from group selection pressures. Sober and Wilson also suggest that the prisoner's dilemma model can be used to characterize punishment; hence, punishment too originated from group selection pressures. However, empirical evidence suggests that a group selection model of the origins of altruistic punishment may be insufficient. I argue (...) that examining dominance hierarchies and coalition formation in chimpanzee societies suggests that the origins of altruistic punishment may be best captured by individual selection models. I suggest that this shows the necessity of coupling of game-theoretic models with a conception of what our actual social structure may have been like to best model the origins of our own behavior. ‡I would like to thank Zachary Ernst and Emma Marris for their many helpful comments which greatly improved this paper. †To contact the author, please write to: Department of Philosophy, University of Maryland, Skinner Building, College Park, MD 20742; e-mail: [email protected]. (shrink)

Shared intentions supporting cooperation and other social practices are often used to describe human social life but not the social lives of nonhuman animals. This difference in description is supported by a lack of evidence for rebuke or stakeholding during collaboration in nonhuman animals. We suggest that rebuke and stakeholding are just two examples of the many and varied forms of social maintenance that can support shared intentions. Drawing on insights about mindshaping in social cognition, we show how apes (...) can be stakeholders of a different sort in joint action. Drawing on pluralistic social maintenance methods of behavior enforcement, we show ape joint action can be supported by different forms of positive and negative social pressures, and not just protest. We explain how diverse relationships, contexts, social structures, and forms of communication may play a role in forming and successfully fulfilling joint commitments for humans, great apes, and other animals. (shrink)

Based on an ethnographic project in a public high school in a low-income neighborhood in South Los Angeles, this paper argues that access to information and communication technologies cannot be taken as helpful or empowering on its own terms; instead, concerns about justice must be accounted for by the local communities technology is meant to benefit. This paper juxtaposes the concept of technological access with recent work in feminist science and technology studies on infrastructure, maintenance, and ethics. In contrast (...) to popular descriptions of ICTs as emancipatory and transformative, in the setting of an urban school, access produced extensive demands for attention, time, and information. This paper focuses on the labor of a group of student workers, Student Technology Leaders, and how they became responsible for the significant amount of repair and maintenance work involved in keeping hundreds of new computing devices available for use. An expanded process of accounting can more realistically frame issues of justice and its relationship to ICTs. I use a town hall meeting held with these students as an example of a processual vision of justice, one that encourages the beneficiaries of technological access to evaluate costs, benefits, and ethical concerns together. (shrink)