Introduction Deep brain stimulation (DBS) is approved under a humanitarian device exemption to manage treatment-resistant obsessive-compulsive disorder (TR-OCD) in adults. It is possible that DBS may be trialed or used clinically off-label in children and adolescents with TR-OCD in the future. DBS is already used to manage treatment-resistant childhood dystonia. Evidence suggests it is a safe and effective intervention for certain types of dystonia. Important questions remain unanswered about the use of DBS in children and adolescents with TR-OCD, including whether (...) mental health clinicians would refer pediatric patients for DBS, and who would be a good candidate for DBS.Objectives To explore mental health clinicians’ views on what clinical and psychosocial factors they would consider when determining which children with OCD would be good DBS candidates.Materials and Methods In depth, semi-structured interviews were conducted with n = 25 mental health clinicians who treat pediatric patients with OCD. The interviews were transcribed, coded, and analyzed using thematic content analysis. Three questions focused on key, clinical, and psychosocial factors for assessing candidacy were analyzed to explore respondent views on candidacy factors. Our analysis details nine overarching themes expressed by clinicians, namely the patient’s previous OCD treatment, OCD severity, motivation to commit to treatment, presence of comorbid conditions, family environment, education on DBS, quality of life, accessibility to treatment, and patient age and maturity.Conclusions Clinicians generally saw considering DBS treatment in youth as a last resort and only for very specific cases. DBS referral was predominantly viewed as acceptable for children with severe TR-OCD who have undertaken intensive, appropriate treatment without success, whose OCD has significantly reduced their quality of life, and who exhibit strong motivation to continue treatment given the right environment. Appropriate safeguards, eligibility criteria, and procedures should be discussed and identified before DBS for childhood TR-OCD becomes practice. (shrink)

In this in ter view, the pres ti gious an thro - pol o gist, his to rian and T.V. anaouncer, Alan Macfarlane com ments on some of the is sues that have been ad dressed in his writ ings. His main the o ret i cal con cern has been to study the pe cu - liar con di tions that gave rise to the mod e..

O tendinţă relativ nouă în filosofia contemporană a matematicii este reprezentată de nemulţumirea manifestată de un număr din ce în ce mai mare de filosofi faţă de viziunea tradiţională asupra matematicii ca având un statut special ce poate fi surprins doar cu ajutorul unei epistemologii speciale. Această nemulţumire i-a determinat pe mulţi să propună o nouă perspectivă asupra matematicii – una care ia în serios aspecte până acum neglijate de filosofia matematicii, precum latura sociologică, istorică şi empirică a cercetării matematice (...) şi care acordă astfel o atenţie deosebită practicii matematice. (shrink)

The resting-state human electroencephalogram power spectrum is dominated by alpha and theta oscillations, and also includes non-oscillatory broadband activity inversely related to frequency. Gratton proposed that alpha and theta oscillations are both related to cognitive control function, though in a complementary manner. Alpha activity is hypothesized to facilitate the maintenance of representations, such as task sets in preparation for expected task conditions. In contrast, theta activity would facilitate changes in representations, such as the updating of task sets in response to (...) unpredicted task demands. Therefore, theta should be related to reactive control, while alpha may be more relevant to proactive control. Less is known about the possible relationship between 1/f activity and cognitive control, which was analyzed here in an exploratory fashion. To investigate these hypothesized relationships, we recorded eyes-open and eyes-closed resting-state EEG from younger and older adults and subsequently tested their performance on a cued flanker task, expected to elicit both proactive and reactive control processes. Results showed that alpha power and 1/f offset were smaller in older than younger adults, whereas theta power did not show age-related reductions. Resting alpha power and 1/f offset were associated with proactive control processes, whereas theta power was related to reactive control as measured by the cued flanker task. All associations were present over and above the effect of age, suggesting that these resting-state EEG correlates could be indicative of trait-like individual differences in cognitive control performance, which may be already evident in younger adults, and are still similarly present in healthy older adults. (shrink)

BackgroundThe health sector aims to improve health outcomes and access to healthcare. At the same time, the sector relies on unsustainable environmental practices that are increasingly recognised to be catastrophic threats to human health and health inequities. As such, a moral imperative exists for the sector to address these practices. While strides are currently underway to mitigate the environmental impacts of healthcare, less is known about how health researchers are addressing these issues, if at all.MethodsThis paper uses an interview methodology (...) to explore the attitudes of UK health researchers using data-intensive methodologies about the adverse environmental impacts of their practices, and how they view the importance of these considerations within wider health goals.ResultsInterviews with 26 researchers showed that participants wanted to address the environmental and related health harms associated with their research and they reflected on how they could do so in alignment with their own research goals. However, when tensions emerged, their own research was prioritised. This was related to their own desires as researchers and driven by the broader socio-political context of their research endeavours.ConclusionTo help mitigate the environmental and health harms associated with data-intensive health research, the socio-political context of research culture must be addressed. (shrink)

Picture books are an important source of new language, concepts, and lessons for young children. A large body of research has documented the nature of parent-child interactions during shared book reading. A new body of research has begun to investigate the features of picture books that support children's learning and transfer of that information to the real world. In this paper, we discuss how children's symbolic development, analogical reasoning, and reasoning about fantasy may constrain their ability to take away content (...) information from picture books. We then review the nascent body of findings that has focused on the impact of picture book features on children's learning and transfer of words and letters, science concepts, problem solutions, and morals from picture books. In each domain of learning we discuss how children's development may interact with book features to impact their learning. We conclude that children's ability to learn and transfer content from picture books can be disrupted by some book features and research should directly examine the interaction between children's developing abilities and book characteristics on children's learning. (shrink)

In this paper we argue the need to reimagine research ethics frameworks to include notions of environmental sustainability. While there have long been calls for healthcareethics frameworks and decision-making to include aspects of sustainability, less attention has focused on howresearchethics frameworks could address this. To do this, we first describe the traditional approach to research ethics, which often relies on individualised notions of risk. We argue that we need to broaden this notion of individual risk to consider issues associated with (...) environmental sustainability. This is because research is associated with carbon emissions and other environmental impacts, both of which cause climate change health hazards. We introduce how bioethics frameworks have considered notions of environmental sustainability and draw on these to help develop a framework suitable for researchers. We provide a case study of data-driven health research to apply our framework. (shrink)

While ethical and empirical interest in so-called secondary variants and incidental findings in clinical genetics contexts is growing, critical reflection on the ethical foundations of the various recommendations proposed is thus far largely lacking. We examine and critique the ethical justifications of the three most prominent disclosure positions: briefly, the clinical geneticist decides, a joint decision, and the patient decides. Subsequently, instead of immediately developing a new disclosure option, we explore relevant foundational ethical values and norms, drawing on the normative (...) and empirical ethical literature. Four ethical signposts are thereby developed to help guide disclosure discussions. These are: respectful sharing of the clinician’s expertise; transparent communication; epistemic modesty; and respect for the embedded nature of the patient. We conclude by considering the most common current disclosure positions in the light of the four ethical signposts. (shrink)

Cet article s’inscrit dans le cadre d’une recherche doctorale portant sur les représentations de la séparation chez des enfants placés en Protection de l’enfance. Il s’intéresse ici spécifiquement au dessin de la famille de deux enfants d’âge de latence placés en foyer. L’article analyse chaque dessin en profondeur puis tente de dégager les éléments saillants communs aux enfants rencontrés, tout en les mettant en lien avec les mouvements transféro-contretransférentiels à l’œuvre dans ces rencontres-séparations. Ces dessins montrent de grandes difficultés de (...) représentation, les personnes dessinées sont peu différenciées. Cette indistinction pourrait être mise en lien avec le concept de mentalisation qui aurait été mis à mal par les traumatismes vécus par ces enfants. Mais ce trouble de la mentalisation semble aussi fonctionner comme un mécanisme de défense contre les reviviscences traumatiques et des mouvements pulsionnels agressifs. (shrink)

Forensic DNA phenotyping (FDP) is an emerging technology that seeks to make probabilistic inferences regarding a person’s observable characteristics (“phenotype”) from DNA. The aim is to aid criminal investigations by helping to identify unknown suspected perpetrators, or to help with non-criminal missing persons cases. Here we provide results from the analysis of 36 interviews with those who have a professional stake in FDP, including forensic scientists, police officers, lawyers, government agencies and social scientists. Located in eight EU countries, these individuals (...) were asked for their views on the benefits and problems associated with the prospective use of FDP. While all interviewees distinguished between those phenotypic tests perceived to either raise ethical, social or political concerns from those tests viewed as less ethically and socially problematic, there was wide variation regarding the criteria they used to make this distinction. We discuss the implications of this in terms of responsible technology development. (shrink)

Patients are increasingly turning to medical crowdfunding as a way to cover their healthcare costs. In the case of Charlie Gard, an infant born with encephalomyopathic mitochondrial DNA depletion syndrome, crowdfunding was used to finance experimental nucleoside therapy. Although this treatment was not provided in the end, we will argue that the success of the Gard family’s crowdfunding campaign reveals a number of potential ethical concerns. First, this case shows that crowdfunding can change the way in which communal healthcare resources (...) are allocated. Second, within the UK’s National Health Service, healthcare is ostensibly not a market resource; thus, permitting crowdfunding introduces market norms that could commodify healthcare. Third, pressures inherent to receiving funds from external parties may threaten the ability of patients-cum-recipients to voluntarily consent to treatment. We conclude that while crowdfunding itself is not unethical, its use can have unforeseen consequences that may influence conceptions of healthcare and how it is delivered. (shrink)

I develop an interpretation of Maurice Merleau-Ponty's concept of motor intentionality, one that emerges out of a reading of his presentation of a now classic case study in neuropathology—patient Johann Schneider—in Phenomenology of Perception. I begin with Merleau-Ponty's prescriptions for how we should use the pathological as a guide to the normal, a method I call triangulation. I then turn to his presentation of Schneider's unusual case. I argue that we should treat all of Schneider's behaviors as pathological, not only (...) his abstract movements, as is commonly acknowledged in the secondary literature, but also crucially his concrete movements. Using these facts of Schneider's illness, I reconstruct a ‘fundamental function’ of consciousness, as Merleau-Ponty called it, in which there are two kinds of bodily agency: the power of the body to be solicited by a situation and the power of the body to project a situation. I propose that these powers became dissociated in Schneider's case, as evidenced by his abstract and concrete movements, while in the normal case, these powers comprise a dynamic unity, enacted as motor intentionality. I also discuss how my interpretation complements Merleau-Ponty's assertion that motor intentions exist between mind and matter. (shrink)

In her paper, Galasso contends that transitioning precision medicine from its current emphasis on healthcare benefits, to a focus on precision public health, may help address the equity concerns th...

This paper examines the consequences of a culture of “personal ethics” when using new methodologies, such as the use of social media sites as a source of data for research. Using SM research as an example, this paper explores the practices of a number of actors and researchers within the “Ethics Ecosystem” which as a network governs ethically responsible research behaviour. In the case of SM research, the ethical use of this data is currently in dispute, as even though it (...) is seemingly publically available, concerns relating to privacy, vulnerability, potential harm and consent blur the lines of responsible ethical research behaviour. The findings point to the dominance of a personal, bottom-up, researcher-led, ‘ethical barometer’ for making decisions regarding the permissibility of using SM data. We show that the use of different barometers by different researchers can lead to wide disparities in ethical practice - disparities which are compounded by the lack of firm guidelines for responsible practice of SM research. This has widespread consequences on the development of shared norms and understandings at all levels, and by all actors within the Ethics Ecosystem, and risks inconsistencies in their approaches to ethical decision-making. This paper argues that this governance of ethical behaviour by individual researchers perpetuates a negative cycle of academic practice that is dependent on subjective judgements by researchers themselves, rather than governed by more formalised academic institutions such as the research ethics committee and funding council guidelines. (shrink)

Justice must both be done and be seen to be done. A legal principle designed to give effect to this fundamental proposition is that a judge must not sit to determine a dispute if he or she is biased, or if there exists a reasonable perception that he or she is biased. Across many common law jurisdictions – including the UK, Australia, Canada, New Zealand and many jurisdictions in the United States – the judge in question himself or herself is (...) required to undertake the assessment of whether bias, or an apprehension of bias, exists. Drawing on insights from behavioural psychology and a series of case studies from across these jurisdictions, this paper offers an extended analysis of this practice and identifies and evaluates alternative proposals. (shrink)

L’article s’intéresse aux hommes et aux femmes passés dans l’histoire à l’ombre de la figure « hermaphrodite ». Pour ce faire, il s’intéresse à eux dans le cadre familial, en cessant de les réduire à leurs particularités corporelles et génitales pour les replacer dans une perspective sociale. L’état hermaphrodite permet en effet d’interroger doublement la famille : d’une part parce qu’il brouille le jeu des projections identitaires habituellement à l’œuvre entre parents et enfants et entre membres de la fratrie, de (...) l’autre parce qu’il pose le problème majeur de l’infécondité et du mariage aussi bien pour celui ou celle qui en est victime que pour la cellule familiale dans son ensemble. L’extrême diversité des relations et des affects intrafamiliaux rencontrés rappelle que si l’hermaphrodisme a été puissamment structuré au xixe siècle en catégorie médicale, il ne peut être opérant en catégorie sociale. (shrink)

Sally Haslanger offers the following concept of “woman”: If one is perceived as being biologically female and, in that context, one is subordinated owing to the background ideology, then one “functions” as a woman (2012b, 235). An implication of this account is that if someone is not regarded by others as their self-identified gender, they do not function as that gender socially. Therefore, one objection to this ascriptive account of gender is that it wrongly undermines the gender identities of some (...) trans people. In this paper, I will argue that Haslanger’s definition can be defended against this objection and that her account inevitably aids in liberatory efforts not only for cisgender women, but for all sexual and gender minorities. While Katharine Jenkins’s dual account of gender aims to rectify this objection (2016, 407), I will point out two important problems with her argument: “the inclusion dilemma” and “the abolition problem.” Finally, I will argue that Haslanger’s account of gender is preferable to Jenkins’s because it outlines the reality of gender as an oppressive, hierarchical system whose categories ought to be dismantled. (shrink)

The moral standing of involuntary sterilization has long been subject to debate but has only recently been looked upon with disfavor. When sterilization of a mentally handicapped minor is entertained, issues of eugenics, medical ethics, and legal precedent specially arise. Ethics consultants and ethics committees have been asked to consider such cases.

In lieu of an abstract, here is a brief excerpt of the content:How Deafness May Emerge as a Disability as Social Interactions UnfoldGabrielle HodgeMy hearing loss ranges from moderate to profound in both ears. I use spoken English, written English and Auslan (Australian sign language) to communicate, and rely heavily on two hearing aids, speach reading skills and my vision to interact with other people. Here I demonstrate how my deafness tends to emerge as a disability through interactions with other (...) people within the health and wellbeing context of group yoga practice. I compare two experiences from practicing yoga in group classes (which involves physical interaction and requires attendance to non–spoken tasks), and use these experiences to explore what the label ‘disability’ does not capture, how this term reflects my lived experience of deafness, and what this might mean for health and wellbeing [End Page 193] professionals engaging with clients who experience types of deafness.All human interactions are uniquely and intersubjectively shaped by the actors, how they communicate, and what they are doing while interacting. In my case, if someone is simultaneously attending to some task while talking with me, this may mean that I cannot see their face and therefore cannot access their spoken utterances. During group conversations, others may overlap their spoken turns at a pace faster than I can visually track and therefore I cannot access the dynamic content of the group conversation. In these situations, my deafness may manifest as disability. This contrasts with interactions where I engage with other signers using Auslan, where my deafness does not manifest as disability at all. For me, deafness as disability tends to be an emergent characteristic of my interactions with other people, rather than a constant feature of all interactions, or all moments of a single interaction. It emerges most prominently through interactions with strangers, and less during interactions with social intimates. This characterisation contradicts the concept of disability as a fixed feature of an individual that impacts uniformly on all aspects of their experience.I regularly practice yoga and have done so for many years. I enjoy participating in classes with other students, as we jointly learn and develop practices that challenge and illuminate different aspects of our lives. “At the heart of all yogas lies the manipulation of visible, accessible means to reach invisible, intangible ends” (Givón 2005, p. 23). How one manipulates their visible, accessible means depends on one’s personal physiology, psychology and sociality. Over the years I have developed various strategies that enable me to participate in group practice and engage with other students and teachers without over–reliance on teachers or mediation from Auslan interpreters. I have mostly come to depend on observing how the teacher and other participants move (or even how shadows on the wall infer that they move) and interpreting their movements in context of the group practice.For example, by placing myself at the front or the middle of the class, I can observe the movements of others from several viewpoints in order to synchronise my own with theirs as the practice unfolds. Through experience, I can distinguish when these movements are intentional and when they may be accidental. By combining these strategies with one–on–one discussions with teachers before or after class, as well as doing my own research, I can subsequently learn about teachings that may be verbally expressed during classes and later match these with various teachers and practices over time. These strategies enable me to adapt to a situation where it is impossible to experience consistent face–to–face interaction and where it is difficult to access spoken instruction.Group yoga classes usually begin with the teacher sharing some comments or a story to prompt the theme of the class. This helps us to integrate our exploration of action with the exploration of “invisible and intangible” goals. As a class, we observe our teacher’s intentional movements and mirror these both mentally and physically. As the class progresses, the teacher migrates around the class observing and attending to individual students with adjustments and other assistance. Throughout the class, the teacher alternates between observing, demonstrating and assisting, while simultaneously instructing the class verbally.Most of the students in these group classes... (shrink)

Rarement oeuvre littéraire aura autant pâti de l'éclat ­ des éclats ­ de son auteur. En effet, si George Sand bénéficie aujourd'hui d'une cote de popularité exceptionnelle parmi les personnalités qui ont marqué le XIXe siècle, ce n'est certes pas en raison de la réputation peu flatteuse qui s'attache à une production romanesque riche de plusieurs dizaines de titres. Les romans de Sand demeurent pour une large part mal aimés ­ trop vite jugés fades ou simplistes ­ mais ils sont (...) surtout .. (shrink)

Gilbert Ryle famously wrote that practical knowledge (knowing how) is distinct from propositional knowledge (knowing that). This claim continues to have broad philosophical appeal, and yet there are many unsettled questions surrounding Ryle’s basic proposal. In this article, I return to his original work in order to perform some intellectual archeology. I offer an interpretation of Ryle’s concept of action that I call ‘adverbialism’. Actions are constituted by bodily behaviours performed in a certain mode, style or manner. I present various (...) challenges to adverbialism – scenarios in which it seems we publicly behave one way, but privately feel another. And I offer a response – Ryle’s stated practice of re-describing those situations in ways that pose no threat to his adverbialism. I also present an interpretation of practical knowledge in Ryle’s work. Knowing how is a special kind of action, undertaken only when we progressively self-modify our behaviours in the presence of new challenges or opportunities. (shrink)

Concerns about research’s environmental impacts have been articulated in the research arena, but questions remain about what types of role responsibilities are appropriate to place on researchers, if any. The research question of this paper is: what are the views of UK health researchers who use data-intensive methods on their responsibilities to consider the environmental impacts of their research? Twenty-six interviews were conducted with UK health researchers using data-intensive methods. Participants expressed a desire to take responsibility for the environmental impacts (...) of their research, however, they were unable to consolidate this because there were often obstacles that prevented them from taking such role responsibilities. They suggested strategies to address this, predominantly related to the need for regulation to monitor their own behaviour. This paper discusses the implications of adopting such a regulatory approach as a mechanism to promote researchers’ role responsibilities using a neo-liberal critique. (shrink)

Philippe Lejeune, spécialiste international de l'écriture autobiographique, enseigne au département de littérature de l'université Paris-Nord ; l'entretien, réalisé par Gabrielle Houbre et Florence Rochefort, s'est déroulé le 1er mars 1996, dans son bureau privé, à Fontenay-aux-Roses. Le texte qui suit en est une version réduite et légèrement réécrite. Vous avez publié plusieurs ouvrages analysant la pratique de l'écriture autobiographique - L'Autobiographie en France (1971), Le Pacte...