ObjectiveTo investigate the attitudes of Chinese parents regarding the storage of dried blood spots collected for newborn screening (NBS) and their use in research.MethodsWe conducted a hospital-based survey of parents and examined parental attitudes regarding (a) allowing NBS sample storage, (b) permitting use of children’s NBS samples for research with parental permission, and (c) permitting use of children’s NBS samples for research without parental permission.ResultsThe response rate was 52 percent. Of parents surveyed, 68 percent would permit their infant’s (...) NBS sample to be stored for at least some length of time. If permission is obtained, 69 percent of parents “strongly agreed” or “agreed” to permit use of the NBS sample for research. If permission is not obtained, only 14 percent of parents “strongly agreed” or “agreed.” There was no significant association between permitting use of NBS samples for research and parental gender, education, household income, number of children, or site of residence.ConclusionsThis is the first survey of Chinese parents regarding the use of NBS samples for different types of research, with results indicating that most parents would permit their infant’s sample to be stored and would support the use of NBS dried blood spots for research purposes. (shrink)

Though in existence for over thirty-five years, due to the increasing panoply of possible tests. Newborn screening programs are drawing public attention. Many jurisdictions have mandatory newborn screening programs for treatable disorders. Disorders are detected through tests on blood spots drawn from a newborn’s heel soon after birth and verified through a diagnostic test with follow-up. Unbeknownst to most parents, these blood spot cards are also stored thereafter. Indeed, while dried blood spots are primarily used (...) for screening for health problems, experience demonstrates that they can be made useful in various contexts unrelated to screening.Newborn dried blood spots have taken on a new life as a result of developments in genetics and the increasing ability of bioinformatics to link DNA information with clinical data. Additionally, storage and secondary uses have been documented to occur without parental consent. (shrink)

Workplace‐collected blood spots deposited on filter paper were analysed with multiplexed affinity‐based protein assays and found to be suitable for proteomics analysis. The protein extension assay (PEA) was used to characterize 92 proteins using 1.2 mm punches in repeated samples collected from 20 workers. Overall, 97.8% of the samples and 91.3% of the analysed proteins passed quality control. Both within and between spot correlations using six replicates from the same individual were above 0.99, suggesting that comparable levels are (...) obtained from multiple punches from the same spot and from consecutive spots. Protein levels from dried blood and wet serum from the same individuals were compared and the majority of the analysed proteins were found to be significantly correlated. These results open up for simplified sample collection of blood in field conditions for proteomic analysis, but also highlight that not all proteins can be robustly measured from dried whole blood. (shrink)

Background Residual dried blood spots (rDBS) from newborn screening programmes represent a valuable resource for medical research, from basic sciences, through clinical to public health. In Hong Kong, there is no legislation for biobanking. Parents’ view on the retention and use of residual newborn blood samples could be cultural-specific and is important to consider for biobanking of rDBS. Objective To study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among (...) Hong Kong Chinese parents. Methods A mixed-method approach was used to study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese parents of children 0–3 years or expecting parents through focus groups (8 groups; 33 participants) and a survey (n = 1012, 85% mothers) designed with insights obtained from the focus groups. We used framework analysis to summarise the themes as supportive factors, concerns and critical arguments for retention and secondary use of rDBS from focus group discussion. We used multiple logistic regression to assess factors associated with support for retention and secondary use of rDBS in the survey. Results Both in focus groups and survey, majority of parents were not aware of the potential secondary use of rDBS. Overall secondary use of rDBS in medical research was well accepted by a large proportion of Hong Kong parents, even if all potential future research could not be specified in a broad consent. However parents were concerned about potential risks of biobanking rDBS including leaking of data and mis-use of genetic information. Parents wanted to be asked for permission before rDBS are stored and mainly did not accept an “opt-out” approach. The survey showed that parents born in mainland China, compared to Hong Kong born parents, had lower awareness of newborn screening but higher support in biobanking rDBS. Higher education was associated with support in rDBS biobanking only among fathers. Conclusion Long-term storage and secondary use of rDBS from newborn screening for biomedical research and a broad consent for biobanking of rDBS are generally acceptable to Hong Kong parents given their autonomy is respected and their privacy is protected, highlighting the importance of an accountable governance and a transparent access policy for rDBS biobanks. (shrink)

It is estimated that 300,000 children 0–14 years of age are diagnosed with cancer worldwide each year. While the absolute risk of cancer in children is low, it is the leading cause of death due to disease in children in high‐income countries. In spite of this, the etiologies of pediatric cancer are largely unknown. Environmental exposures have long been thought to play an etiologic role. However, to date, there are few well‐established environmental risk factors for pediatric malignancies, likely due to (...) technical barriers in collecting biological samples prospectively in pediatric populations for direct measurements. In this review, we propose the use of novel or underutilized biospecimens (dried blood spots and teeth) and molecular approaches for exposure assessment (epigenetics, metabolomics, and somatic mutational profiles). Future epidemiologic studies of pediatric cancer should incorporate novel exposure assessment methodologies, data on molecular features of tumors, and a more complete assessment of gene‐environment interactions. (shrink)

The inauguration of Michigan’s BioTrust for Health, a research biobank for leftover neonatal blood spots, posed several novel questions for the state’s Department of Community Health institutional review board. The IRB’s response to these questions affirmed that respect for persons requires consent from donors for tissue donation to a public health biorepository with a research mission. It also acknowledged that the existence of potential risks and benefits to groups as well as to individuals necessitated new institutional collaborations between (...) the IRB and the appointed community oversight board for the BioTrust to foster consideration of the impacts on all stakeholders. (shrink)

The Michigan Department of Community Health stores almost 4 million dried blood spot specimens in the Michigan Neonatal Biobank. DBS are collected from newborns under a mandatory public health program to screen for serious conditions. At 24 to 36 hours of age, a few drops of blood are taken from the baby’s heel and placed on a filter paper card. The card is sent to the state public health laboratory for testing. After testing, MDCH retains the spots (...) indefinitely for the personal use of the patient and also, pursuant to a 2000 law, for possible research. (shrink)

Parents, providers, policy makers, and the public need to talk about the implications of advances in genomic technologies for state run newborn metabolic screening programs. Technologies, such as highly multiplex testing and whole genome sequencing, are raising old issues with new urgency and are posing new challenges that threaten to overwhelm newborn screening programs.Newborn screening programs in their current form were born in the late 1960s. Robert Guthrie developed a screening test for phenylketonuria that could be performed on blood (...) spots collected on filter cards that Guthrie also developed. States rapidly established newborn screening programs, which were almost always mandatory, in response to advocacy by geneticists and parents. Although the programs initially varied in form and experienced significant pushback from the medical community, by the early 1970s, all states had established programs with centralized laboratories, and the medical community had come on board. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Night ShiftCalvin R. GrossI don't like working at night anymore. Too much goes wrong when you're alone.I'm sitting at my desk in the middle of the cardiac intensive care unit, and it's far later than I'd like to be awake—two or three in the morning. Things are calm, almost pleasant. I can hear the occasional alarm going off—an imperfectly positioned blood pressure cuff, a pulse oximeter with a (...) poor waveform, a ventilator with secretions in it. The night's initial frenzied work is done; my new admissions are tucked away, and my overnight to-dos are completed. Now it's just time to sit and wait. I could sleep, but despite the calm, I'm too afraid to leave the unit to rest. The fellow has gone to bed hours ago, and now it's just me. Sure, I'm surrounded by experienced nurses who know their work well, but somehow, I'm the one in charge. A brand-new second-year resident, the only doctor there. I'm no intern, that's for sure, but I've never led a code before, and I've only ever placed one central line without supervision. As second years go, I'm as fresh as they come.The daytime, you see, is far different than nights. There's a large (and even bloated) team of two attendings, two fellows, two pharmacists, and more importantly, multiple other residents. When you don't know what to do for a patient, there's always someone there to bounce ideas off of. When something difficult or surprising happens, there are peers and mentors to process with. At night, it's the opposite—no peers, no mentors, only a group of experienced nurses, whose circle is closed to me, the outsider. I long to be a part of that large and bloated daytime team."Can you come into 23? I think his pupils are a different size."I'm startled out of my thoughts. 23 … All I can remember from sign-out that evening is that he's young, close to my age, and supposedly stable. I look at my notes, a catalogue of tragedies: early onset heart failure, multiple prior suicide attempts, intubated because of pulmonary edema, and a left-ventricular assist device (LVAD) that's malfunctioning. I walk over to the room and look at the nurse at the other side of the bed. She's in the early phases of her career too—less than a year on the job—but she's still more experienced than me. I take a flashlight, open his eyelids, and look at the pupils. Sure enough, one of them is much larger than the other. When I shine the light into each eye, the large one doesn't change. When I turn his head from side to side, his eyes stay fixed. We look [End Page 83] at each other, she and I. We both know something terrible is happening."Should we maybe wake the fellow up?" she asks tentatively.I nod my head in agreement, glad to have been offered a suggestion. It's the right thing to do. I walk to the fellow's call room, knock on the door, and wake him up. He's set to work 24 hours and would like nothing more than to keep resting. He sleepily comes with me to the bedside, looks at the pupils as well, and says, "With the sedation on, your exam isn't going to be the most accurate. We should start by scanning his head, and then go from there. Wake me back up if you need me, but I know you've got this one."I don't think that I deserve the confidence he has in me. I walk back to my desk, open the patient's chart, and place the order for an urgent CT scan. The machinery of the hospital starts to rumble as the imaging schedulers find a spot in the queue for the scan, the patient's nurse and respiratory therapist disconnect and reconnect cables and tubes, the technicalities of the scan are ironed out, and he is... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:An Encounter with the Art and Science of MedicineAnonymous Five“Let Nothing Upset YouLet Nothing Frighten YouEverything is ChangingOnly God is Changeless”—St. Theresa of AvilaSt. Teresa’s prayer is on the front cover of each of four binders dedicated to storing insurance authorizations, studies, references, and reports about our daughter’s brain tumor treatment. They represent our experience, what we learned, the information we were given, and the information we sought out. (...) I kept them in case our daughter ever wanted to understand how my husband and I arrived at a decision for her treatment that was in direct opposition to the strong recommendation of her primary treatment team of physicians.On December 10, 2003, I received an urgent call from our daughter’s neurologist requesting that we meet with the doctor late that afternoon. For six months prior to that appointment, our daughter had been telling us about odd sensations with breathing, nausea, and balance. Sometimes she would seem extremely distressed for a short period of time or report that her friends told her about doing or saying things that didn’t make sense and that she didn’t remember. We consulted a series of physicians as her symptoms became steadily more intense and more prevalent. Our family practice physician referred us to an allergy specialist and a pulmonologist. There were a number of tests for allergies and lung problems. As the tests and treatments did not help, our daughter became increasingly unwilling to go to doctor’s appointments. My husband and I were confused and deeply concerned about the lack of progress. The next series of referrals included a gastroenterologist and a neurologist. The gastroenterologist suggested our daughter had partial–complex epilepsy, concurred with our plan to see a neurologist, and mentioned she should have an MRI.I remember the neurologist putting the MRI scans up, pointing to the large dark spot which he called a “large mass” (5 cm), that could be either a cluster of blood vessels or a neoplasm. He said his office had arranged for us to meet a neurosurgeon the following day. We all remember the same thing about that visit—the image of the large dark mass on the scan—and the neurologists flat, brisk tone. We met with the neuro-surgeon the next day. Her team was kind and sympathetic—she was positive, up beat and direct. She did not think this mass was blood vessels. She thought it was a large tumor that needed to be removed right away. Our daughters surgery was scheduled for the following Friday—December 19, 2003. She had turned 15 on November 5.Four and a half hours after our daughter was wheeled into the operating room, her surgeon told us they had removed 98% of the tumor. She said there was no cure, but there was a good prognosis based on the surgical outcome. Several days later, she called us and said she had more data, and it looked like the resection was closer to 90%. The first pathology report, a “first impression” directly after surgery, described our daughter’s tumor as an astrocytoma, probably high grade. Three weeks after surgery, we met with a panel of doctors—two oncologists and radiologist—who explained that based on the final pathology report, our daughter’s tumor was classified as an ependymoma, grade 2. We were dismayed. First, there had been the change in the estimated success of the resection and now a complete shift in both grade and tumor type.The team recommended radiation to follow her surgery, which they said was standard treatment. We began to try to inform ourselves about her tumor. Her father, an agronomist, did an extensive search in PubMed to evaluate and sort through the literature on low–grade gliomas and radiation. What he could find was inconclusive and grim. Most reports in the literature suggested at best delayed mortality at five years after radiation. [End Page E7] Meanwhile, our daughter went through a spinal MRI and the preparatory “fitting” of the mask to immobilize her head during radiation.E7I consulted with a friend who had worked as an EKG tech. She urged... (shrink)

“Artworks are not being but a process of becoming” —Theodor W. Adorno, Aesthetic Theory In the everyday use of the concept, saying that something is grotesque rarely implies anything other than saying that something is a bit outside of the normal structure of language or meaning – that something is a peculiarity. But in its historical use the concept has often had more far reaching connotations. In different phases of history the grotesque has manifested its forms as a means of (...) subversive resistance against society’s prevailing notions of form and power. What aids this impact and distinguishes two of its basic stylistic features is the grotesque’s dissolution of form and its hyperbole. Such grotesqueries, however, soon solidify into new forms, new structures of meaning, hierarchy and practice, and in this sense the history of the grotesque is, on one hand, a continual opposition and transgression of the prevailing notions of art as well as of God and humanity, while on the other hand it offers continual resistance to its own solidifying process. As such the grotesque will not and cannot be contained in form without it losing the very thing that makes it grotesque. Even though it is somewhat easy to point out certain stylistic features of the grotesque, the sum of those features tell us very little about what is at play within it. Definitions concerned with the grotesque’s content rather than its form faces similar difficulties. Throughout history, expressions relating to the grotesque have been used in defense of a whole host of different social and cultural discourse including, for instance, Catholicism (See Erhard Schön’s Der Teufel mit der Sackpfeife , 1536), Protestantism (See Lucas Cranach’s Der Papstesel , 1523), a material folk culture (see Mikhail Bakhtin’s Rabelais and his World , 1984) and an idealistic romantic structure of meaning (see Wolfgang Kayser’s The Grotesque in Art and Literature , 1957). Thus though the grotesque cannot be reduced to the expression of certain forms or meanings, in order to examine what the grotesque is about one has to try to see how it’s relationship to flow and process and how, by maintaining this relationship, it attempts to avoid solidifying into form and meaning. The process of the grotesque alluded to here revolves around a play between periphery and center, the marginalized and the dominant. Most often this is expressed as a direct negation of the center of power. In the medieval grotesque tradition of the carnival, for example, it is expressed by its emphasis on the nether regions of the body as the center of creation of meaning. Spirit does not come from above, but from the belly, buttocks and genitals, and there is, expressed in this manner, a mockery of the predominant Christian notion of truth and meaning. Such inversions of the sites of meaning most often explicitly express an increased interest in materiality instead of ideal content which comes to the fore through the play between periphery and center. Even in early grotesque Renaissance art (for example in the works of Raphael) the depiction of the mythological or ideal reveals an exploration of the possibilities of the material. The works of art thus explore their own boundaries rather than act as vessels of the divine and in this way the grotesque explores the limits of form and materiality. This in turn brings to the fore a metaphysical dimension in the workings of the grotesque: It is an immanent exploration of its own boundaries. Materiality and metaphysics are joined together, because it is through the awareness of itself as a structuring (dis)order that it places itself in opposition to the prevailing notions of form and power. This way the grotesque expresses an awareness of the division of sign and reality and a search for this reality. It implicitly expresses the awareness that meaning is not something God-given and static, but fluctuating and man-made. In modern explorations of the history of the grotesque it is commonly seen as a form of realism that manifests a shift from the ideal towards the material, freeing art from representing some hidden higher order and instead making the work of art the very site of creation and meaning. Going even further, the grotesque actively opposes the notions of the ideal by marking a shift from an ahistorical view of the world towards the historical. However, this also makes clear why the grotesque has a tendency to solidify into new static forms of meaning, for by establishing itself as a subversive counterforce there is an idea of transgression and emancipation. That is why the grotesque often historicizes and relativizes only to repeat the mistakes of that which it negates: putting itself in the king’s chair. The exploration of the material seems to create new forms and notions of the ideal. The representation of an otherness outside the prevailing notions of meaning and truth becomes a positive manifestation of this otherness as truth itself. Thus the historical “truths” of the grotesque are superseded by history itself. When the expressions of the grotesque solidify into static form and meaning, they become mere objects like anything else in the world. Instead of being this elusive thing of process and flow, it becomes tangible to the existing hierarchy of power as well as history itself. In this way the grotesque can be expunged, included or simply revealed as yet another false notion of truth, which is precisely what has happened with the grotesque throughout the course of history. If from the beginning the expression of the grotesque has not already been in the service of some structure of meaning and truth, it has quickly been included or has quickly included itself in such a structure. But by doing so it rejects its own basis: the tension between periphery and center is replaced by the attempt to create a new center, a new structure of meaning and truth. The doubleness, ambiguity and flow of the grotesque are then rejected by the grotesque itself. THE NON-FORM OF FORM In the critical thinking of Theodor W. Adorno (1903-69) the problem of art, caught between a reductive and prevalent notion of truth and meaning and a peripheral and alienated otherness, is reexamined and reformulated. For Adorno, the instrumental rationality of Enlightenment itself reverts into a new form of mythology which is every bit as static and exclusive as the hierarchies of religion it supersedes. All is excluded that is non-identical to the instrumental mastery of the objects of the world, "For the Enlightenment, anything which cannot be resolved into numbers, and ultimately into one, is illusion; modern positivism consigns it to poetry." 1 As such the non-identical has been banished from the realm of thought and action, and banished specifically to the realm of art. But the realm of art is not able to provide a decent home for it because even modern art is not something entirely autonomous. While it is excluded from the notions of truth and meaning provided by instrumental rationality, it still originates from society. Just like instrumental rationality art is about mastery, structuring and exclusion. Therefore, the problem for art is that it cannot directly provide a space for the non-identical because its mode of operation is similar to that of instrumental rationality. Even worse, art has very few possibilities to free itself from this. If it becomes l’art pour l’art it is at the same time reduced to the very thing instrumental rationality claims it to be: a subjective judgment of taste.expressionism also stands as an example of this. Conversely, art cannot work within the framework of the identity-thinking of society, because any notion of freedom or emancipation would reproduce the exclusive practices of instrumental rationality. For example: Explicit socialist literature may establish itself in opposition to instrumental rationality while at the same time reproducing it. Its language may seem different, but in reality it merely provides a different set of reductive schematics for human life and experience. The problem for the art of the grotesque was, as I mentioned earlier, that far too often it was merely a symbolic manifestation of a notion of otherness—not otherness itself. Because of this the subversive character of the grotesque ends up shaping and containing otherness instead of providing a space for it. According to Adorno the only way to avoid this is to radicalize the grotesque. In order to avoid solidifying into form the work of art has to be an object which cannot be contained in thought or form—a non-form of form. The work of art has to work in a way that it strives for autonomy but without entirely leaving a discernible reality. In other words, it has to pull in two directions at once. Thus the work of art is a paradox. It is autonomous in the sense that it closes itself off from everything outside of the work of art, trying to shy away from the contaminating influence of the identity thinking of instrumental rationality. At the same time though the work of art is heteronomous in the sense that it originates from a specific historical context and is bound to be what society is not. Autonomy and heteronomy are inseparably intertwined. Unable to display otherness itself, but still trying to be a refuge for it, there is only one option for art: It has to turn against itself and destroy its own logic of form, thereby demonstrating how any representation of otherness is impossible. Art becomes a lamentation of the victims of the identity thinking of instrumental rationality and shows the traces of the otherness that is unable to appear. Adorno’s pessimistic theory of art and history stages art as a negative dialectical process where the work of art closes itself off and rejects everything outside, while the individual elements in the work of art destroys its very own logic of form from within: Artworks synthetize ununifiable, nonidentical elements that grind away at each other; they truly seek the identity of the identical and nonidentical processually because even their unity is only an element and not the magical formula of the whole […]. The resistance to them of otherness, on which they are nevertheless dependent compels them to articulate their own formal language, to leave not the smallest unformed particle as remnant. This reciprocity constitutes art’s dynamic; it is an irresolvable antithesis that is never brought to rest in the state of being. 2 Relative to a traditional understanding of the grotesque, Adorno radicalizes the tension between center and periphery, autonomy and heteronomy. In the traditional understanding of the grotesque, as we find it for example in the writings of Mikhail Bakhtin, the grotesque establishes the display of otherness as a new center of meaning and truth. However Adorno rejects such notions and argues instead for a modernism of the grotesque in which both center and periphery are included in a negative dialectical process and continually synthesizing and destabilizing each other’s positions. A modernism of the grotesque works on the inside of the sign or the artwork, continually outlining and questioning the boundaries between materiality and form. This moves the focus away from the relation between the sign or work of art as a conceptual manifestation on one side and the object it refers to on the other side. Instead it implicitly points to the amorphous mass from which the signs and thereby meaning have been carved, the remnants that have been left behind. Modernism of the grotesque does not imply that it is emancipatory or that it reconciles man with nature, and does not represent a new position or a new ideology. It merely remembers and insists on the double nature of man and art: to write or paint yourself or an artwork whole by inscribing meaning in life or by applying form on a canvas is at the same time both creation and destruction. The very signs we use to center meaning in our lives carry its own alienation in them. Meaning surfaces only when process and flow comes to a halt—solidifying, but at the same time excluding parts that do not fit into that particular structure of meaning. NOTHING DONE AND NOTHING UNDONE It has always been difficult for art historians to find a suitable category for the works of the Danish artist Leif Lage (b. 1933). In his paintings the sensitive figuration seems so fragile that it is on the verge of turning into abstraction. Or conversely: the figurative emerges cautiously and hesitantly out of abstraction. As an art critic once wrote, he can almost paint things away. 3 Working in some undefinable space between abstraction and figuration, the Lage’s works shy away from the realm of words, and as a result few critics have been able to write anything meaningful about his works. In fact even fewer have been able to write more than one or two pages. The Danish author and art critic Leif Hjernøe is one of those few, but even he starts off by saying how impossible it is to write about Lage, confessing that his works exist both as process and in a field of in-between which words cannot reach. He writes: Always you find yourself in a place where nothing is done and nothing left undone, and where the elements of the work of art rest in a continuous motion. Always there is the open wound, where infection rather than surgical intervention is considered as an opportunity. And the conflict between matter and antimatter makes all diagnoses uncertain and allows conditions of uncertainty to spread in a place of raw presence. 4 The art works against the diagnosis and the certainty. Words are being eaten up by what is outside the realm of words: tension, process and doubleness. An approach to an understanding of the work of Lage could be to follow his connection to Samuel Beckett (1906-89). One can note, therefore, that Lage has illustrated several of the Danish translations of Beckett’s works. Though one is an author and the other a painter both seek a place where figuration, where the word, erodes. For both this entails an attempt to question and examine and so move in behind the façade of the surface in an exploration of that something or nothing that may be behind representation. At the same time even in the vanishing point of figuration or words, the meaningless words or the disjointed lines still stand as signs of human activity—signs of movement in emptiness. With very few exceptions Lage’s artworks revolve around one motif: Man—most often “en face.” But unlike traditional portraitures Lage’s people are found within. The artworks do not sense the reality of appearances, but rather the existential dimensions within man. As a seismograph they are sensitive to the utmost subjectivity in order to display an objective, sensuous depiction of the very problem of subjectivity. Instead of a static façade of a man, Lage’s “en face” shows the process-character of man. The people in Lage’s paintings are always in process—in the midst of becoming or dissolving. I will take a closer look in the following at the ways in which Lage establishes this sense of being in constant process, of being in-between modes or categories. THE DOUBLENESS OF THE STROKE Lage’s etchings attract attention in particular for the tension conveyed there between the material and the form. The material physically opposes the violence of the needle. But instead of embracing the violence of the needle and the victory over matter—instead of making the artistic creation and figuration express a heroic mastery of the background it is made out of—Lage uses the stroke to express the very tension between stroke and material, figuration and background. In the drypoint etching Untitled from 1983, which illustrated the Danish translation of Beckett’s Ill Seen, Ill Said , the needle tears up the material in long rough lines: Together, the primarily horizontal and vertical lines form a face. Thus the force needed to etch a line in the metal-plate draws attention to itself: It is there in the absence of curves and nuances. Man emerges on the metal-plate after great exertion and in a very simplistic form. This way Lage enhances the nature of the material, as the material’s resistance is not something to overcome. On the contrary the figuration is smitten by its very resistance and as such expresses the violence of its own becoming. Even more pronounced is the fact that the lines do not just show the violence of creation—it actively erases figuration in the same process that creates it. For example the mouth consists of 8-10 horizontal strokes, of which some seem to be connected to each other as if the mouth has been quickly scratched out. The mouth speaks of the inability to speak. In the same way, the eyes are black holes due to a large amount of criss-cross cuts, which together form a dark middle. Those lines, at the same time, form the eyes of the figuration and scratch out the eyes of the figuration. The extroverted aspects of the face—connected to speech and sight—are portrayed as introverted as well. Just as the etchings down into the metal-plate makes something appear. Leif Lage, Untitled , 1983 (etching) The figuration of the etching is connected to creation. It expresses that something is wrought into existence out of nothing by sheer artistic force. However, this force is at the same time presented as a violence of creation, which makes it impossible for form to truly emerge. Herein lies one of the basic principles of Lage’s art, namely that art cannot be that nothing or something behind the realm of words or signs. Without form, art would lose its ability to express anything at all. Form is a necessity if art is to avoid becoming as devoid of expression as the reality is that we cannot reach behind the appearance of things. On the other hand, art cannot raise itself above its own material in joyous celebration of the beauty of form. This would use the material in the manner of an instrument and thus would suppress the otherness it attempts to rescue. When art becomes mere form, any traces of otherness will have dissolved. Then art would be a question of technique, in no way different from the instrumental rationality of society. Therefore art works in a particular space between form and non-form. As Hjernøe says of the works of Lage, it is in the center of the event, in the in-between where things neither are nor are not, "And everything takes place just before it changes character. As the blood just before it coagulates, as the milk just before it separates, as fried egg just before it turns white […]." 5 The precise emphasis on the in-between of Lage’s art points in particular to the work of art as both outside of and in time. The work of art is a singular point in time, but at the same time it is continually in process. In the borderland between form and non-form, between creation and destruction, it shimmers like a fata morgana . The work is done but at the same time undone. It is only there as a cry in response to the inability to come into being. Akin to the etching is the drawing, but while both, of course, use the stroke or line as their main instrument, the paper does not resist the line in the same sense as the metal-plate of the etching. As a result in Lage’s drawings the stroke frolics in a space with almost no tension at all. There is nothing there to keep the pencil stroke at bay, but at the same time this means that there is nothing there to keep it together. One of the more expressive examples of this is found in an untitled drawing from Tegninger og Text ( Drawings and Text ) from 1999. The drawing consists of one unbroken pencil stroke. It is as if the stroke is confused—it darts around on the paper making doodles on the way or gathers itself in more straight lines in the center of the paper. It is in this manner that the semblance of a body is established. A couple of small circles serve as eyes and are the reason that the rest can be read as both face and body instead of pure abstraction. In fact the unbroken stroke serves as both abstraction and figuration as on the one hand it is the stroke that seemingly outlines the shape of a figure, while on the other hand the unbroken stroke dissolves any truly recognizable figuration by continuously, without end or aim, overflowing the boundaries of the figure. Seen again here is a doubleness to the stroke and the act of creation. In the etching it was all about the tension between the resistance of the material which created the doubleness. Here it is the opposite. It is the lack of tension. The stroke is free to do anything, but has no aim: without some kind of resistance, there is nothing to hold figuration together. It threatens to dissolve into nothingness. Conversely, the drawing can also be seen as a process of becoming. Like a form of automatic writing, the pencil darts around until it finds a point of densification. But even in such an interpretation of the drawing, the figuration appears artificial—it points to itself as the result of the artistic act of creation. The stroke is primarily stroke and only secondarily figuration. With its wild movement it calls attention to itself as stroke. Thus the figuration never becomes something in its own right. It points to the basic principle of creation: Someone has drawn me, I am the result of artistic endeavors, and therefore I am not for myself but always overflowing the boundaries that contain me. It is the stroke that in the very same movement creates figuration and dissolves it. Leif Lage, Untitled , 1999 (drawing) THE LIGHTNESS OF COLOR, THE DENSITY OF PAPER Often the watercolor is used as a precursor for larger paintings, because it has an immediacy in which one can quickly paint the main lines of a composition. However, Lage’s watercolors are not temporary points in a process leading to another final painting. They are not sketches, later to be filled with details in another material. For him watercolor is an end in itself. This also implies that he doesn’t try to work against the paper’s absorption of the water color and its tendency to absorb detail. On the contrary, he examines the possibilities inherent in this blurring of the line and absorption of color. As in the previous examples, there are of course recognizable shapes in Lage’s water colors. But these shapes are rarely separable from color, line or even paper. In other words: the figurative and the abstract more or less become one. One of the reasons for this is that Lage often works on wetted paper which means that the paper hungrily absorbs color into its fabric instead of it being on top of the paper. The paper becomes line because it is the absorption of the color which, together with the brush stroke itself, separates the colors from each other. The line is also color and the color is also line, because there is no separation between the different colors other than the colors themselves. At times this results in almost complete abstraction. In such cases Lage add lines with a pencil as if he wants to hold some sort of figuration together. At other times it is the other way around: the strokes of the pencil are a being dissolved by the water color blurring out the figuration. Untitled 1 from 1999 displays various tones of green. The contour of the colors appears unusually rough. Most of all it is reminiscent of a shoreline which has found its form through the work of thousands of years between water and land. Pockets of resistance surface as islands not yet drowned in color—as paper or color not yet consumed by the dominant color. The shape of the colors does not seem created by the hand of the artist, but rather by the inner workings of the watercolor: color against color over time has resulted in this very image, as if it is all a part of a natural process of change and decay. Despite the fact that there are no strong differences in color there seems to be a struggle taking place in the watercolor. For example, inexplicable holes in the dark color, which cover most of the right side of the watercolor, appear as if the underlying color is eating away the dark color, or that the dark color is in the process of covering up the underlying color. The small pockets of resistance demonstrate a process and development that, almost as a happy accident, evokes a couple of small eyes and a large mouth. Behind the colors a few slanted lines can be discerned, but the hand of the artist has long ago disappeared behind the life of the colors. Thus the watercolor seems to be held at precisely the point in time where figuration randomly appears. The small eyes and wide mouth seemingly express the realization of the figuration’s temporality. It is just a moment in time, soon to be consumed again in the life of the colors. The nature, the background it stems from and is part of, moves on undeterred, continuing its everlasting process of creation and decay. In this sense, the watercolor provides an experience of how neither artist nor man is able to transcend the materiality they consist of. The colors of man, the materials man consists of are “becoming” and “progress” but also “decay” and “disappearance”. The artist’s pencil strokes have been eaten up long ago, and the figuration is living on borrowed time. Human or artistic activity is about creating form, transcending mere matter by shaping and applying meaning to it. But Untitled 1 shows the doubleness of such creation: the transience and fragility of human life. Should the figuration come into being, should it rise and transcend the material, which binds it to its temporal existence, it would become nothing because its very existence is conditioned by the life and work of the colors. In the same sense man cannot escape his own temporality. He too, for better or worse, must accept a life in the volatility of sensation. Leif Lage, Untitled 1 , 1999 (watercolor) In most of Lage’s watercolors there seem to be a stronger artistic control than in Untitled 1 . Most often both the arrangement of colors and the technique in which they are painted express the hand of the artist. An example of this is Untitled 2 from 1999. While figuration in Untitled 1 seemed to appear as a happy accident, the figuration is much more “created” in Untitled 2 . Here the most important parts of the figuration, the eyes, the mouth and part of the skull, are colored black and painted on top of the background’s play of colors. The background primarily consists of blue and yellow tones. Only parts of the paper are covered in color, however, which yet again stresses the act of painting: There is a surface which is being filled by color by an artist. The blue tones are concentrated in the figuration, while the yellow tones surround it. All this means that the figuration stands out more clearly in this watercolor. This is also underlined by the fact that the blue and dark tones cover part of the yellow tones as spots here and there. Thus it is not a background which is in the process of consuming figuration, but rather the emerging figuration which blots out the background. Such an understanding is even suggested by how the mouth and eyes are placed in the larger blue color field. The eyes and mouth are in the center of the watercolor, while the blue color field is placed from center out towards the left side. This gives the impression of a face turned slightly to the right and slightly upwards, which again makes the mouth appear to emerge from the paper. It also helps that the mouth cuts the center axis of the watercolor. In other words, the arrangement of the blue and black colors create some depth and perspective which gives the illusion of a figuration, seen partially in profile, emerging from the background. Seen in profile, the eyes and mouth seem extroverted—they almost seem as if they are put on top of the face. But at the same time they are painted as black holes, sucking in the gaze of the onlooker. The watercolor is even more challenging if one follows what may be the faint outline of the skull, which, on the right side of the watercolor, no longer works together with the blue color, but rather alone postulates the outline of the skull. If not the blue color field, but this line, is the outline of the skull, then all of a sudden the face is not in profile but “en face”—staring directly towards the onlooker. Outline and color seemingly work against each other and establish two different expressions. Without the slightly upward tilted expression of the profile, the eyes and mouth do not seem to emerge from the paper. On the contrary, seen “en face,” the eyes and mouth are really gaping pits of darkness. In this sense Untitled 2 is at the same time surface and depth of perspective. The line gives form but at the same time it dissolves the form created by the colors, and vice versa. Leif Lage, Untitled 2 , 1999 (watercolor) As the last example of Lage’s artistic method, I have chosen another untitled work (as indeed nearly all of Lage’s artworks are)—this time from 2000. This is perhaps one of the most figurative watercolors Lage has created, though that doesn’t tell us too much. The painting depicts a human face in blue and green tones on a yellow toned background. The colors create a clear demarcation between the figure and the background, which compensate for the watercolor’s lack of outline. Beneath the face darker tones imply the beginning of the torso, and nuances of color even hint at something which could be a collar. The hair is in even darker tones and its structure is emphasized using pencil strokes on top of the water color. One eye is marked by a brown spot with a darker spot in the middle, while the other eye is added by pencil. The mouth is a round, red dot. In Untitled from 2000 the work between abstraction and figuration is much less pronounced than in the previous examples cited here. Nonetheless the watercolor has a delicacy to it which almost makes the figuration disappear, even as it appears. This has something to do with the fact that all the individual brush strokes have dissolved. The only outlines are those created by the clash of colors. Even the red mouth seems to be more paint than mouth—unable to be formed truly as anything other than a speck of color with some small semblance to a mouth. In contrast to the other watercolors, there is no movement, no progress or decay, just a vibrating standstill. The figure is not emerging or disappearing but embedded in and as surface, and as such it makes the figure seem stuck in its condition rather than freed by the act of giving form: mouth open as a wound. Pencil strokes add detail and life to the hair as an attempt to help the figure emerge. But all this does is create two levels in the watercolor: The pencil strokes are put on top of the figuration rather than being part of it. Thus they end up highlighting the endless distance between the movement and form-giving of the pencil strokes and the static and stuck figure behind these strokes. Leif Lage, Untitled , 2000 (watercolor) MAN AND THE VIEW OF THE ONLOOKER Lage’s works seem at the same time to be an examination of tensions between form and material in art and a display of an image of man full of the same tensions. This is because the people who are emerging in Lage’s images are not just in his works, They are his works. This means that man is not something emerging from a background but is part of this background and vice versa. The art of Lage inscribes man in its surroundings and background. Man is not the ruler of nature. Man does not rise above matter; there is no truly transcendent position for man to occupy in the art of Lage. Instead man is a part of the very matter, it, at the same time, tries to distance itself from in order to distinguish itself from its surroundings. Man emerges in an attempt not to be line, stroke, color. In an attempt to free itself of matter. Should it succeed in this, however, it would turn into nothing. On the other hand, if man fully accepted itself as mere matter it would disappear in it—in instincts, urges and lack of reflection. The appearance of man is thus subject to a state of being in-between. Only in the tension between material and its negation can the outlines of man be traced. However this also means that in the art of Lage man is never something in itself but always in process—on the way to its freedom and its loss. However, Lage’s art is not just about showing the tensions inherent in man but also about showing such tension on the verge of breaking point. In the moment before everything is done, or when nothing yet has been done, the delicate tension between form and material has been stretched to its utmost in such a way that man’s character of process emerges and is contained on the paper or canvas. Therefore, Lage’s art contain traces of human life. Not only is it an autonomous unity of tensions where man is stretched out between its singularity and the surroundings it is a part of. It is also this pulsation between figuration and material which brings about the traces of human endeavor and activity. Even when man almost seems to have disappeared into the material, strokes and lines are still there as a reminder of human activity and potential creative power—as a reminder that hope is still possible and that man is still there. The view of the onlooker seeks out forms and meaning. It seeks outlines and edges. But first and foremost it is the eyes in Lage’s works of art that allow the onlooker to decode the figuration at play. This creates a distinctive relationship between the onlooker and the artwork. The onlooker tries to wrest the enigma from the artwork, tries to reduce it to solid, meaningful form. But the very same moment that hints at such a possibility sees the view of the onlooker confronted with a gaze of its own. The eyes of the figure in the work of art are most often dark pits, as if they were an illustration of the violence committed against the eyes of the onlookers and their search for meaning. Or as if they were a dark reflection of the onlooker’s failed attempts to delineate the traces of life in the artwork to a solid meaningful form. Therefore, the gaze of the figuration speaks not only of its own powerlessness but also of the powerlessness of the onlooker. When the view or sight has trouble finding solid meaningful forms, it has something to do with the fact that the precondition for sight, light, no longer stems from something transcendent. In Lage’s art there is nothing outside the works of art, nothing outside of human life, and as such nothing to shed light on the works of art or human life and reveal solid meaningful forms. All light comes from within. In a western context, light as a medium for sight is central to the understanding of meaning. People speak of the clarity of thought, while knowledge is tied together with enlightenment, and so forth. But the light no longer originates from a divine point of view. It originates from man, who has created himself in the image of God. The problem with this is that light always covers up its own base. Light illuminates something but at the same time it hides itself. 6 While it was previously God who was unknowable, now it is man. It is also problematic that sight and the medium of sight stem from the same place. Following this thought one can posit two final problems. Firstly, the immediacy and presence established by light by making forms and objects accessible to sight is fake. Light is not some independent entity which present things in a neutral manner for the onlooker. It is inextricably tied together with the gaze’s desire after meaning. In other words: Light perverts the appearance of things because it doesn’t originate from some objective entity which allows them to appear as they are. Instead light is based upon and originates from the subject and its conquering gaze, seeking out meaning and form constantly. Secondly, the joining of sight and light makes introspection within human life impossible. Everything can be illuminated by its use value for the subject but only as long as it is separated from the subject, as long as it is an object. But the subject itself cannot be illuminated. Lage’s art tears down such a dividing line between subject and matter, but it does so without reestablishing a divine position from where the light emanates. Therefore, the light in Lage’s art may not illuminate very well. It may not have the certainty presented by modern science or the religions of yesterday. But it does show what such light tries to hide, namely, the subject as it is in its material reality—inscribed in time and death, which are the basic conditions of materiality, but at the same time also full of life in its joy and will to create. For the onlooker the meeting of the gaze in Lage’s works of art is thus also a destruction of the view of the onlooker. The ability to see is challenged in a radical way. Those outlines will not solidify into static form, as if the light was too dim to see. Just as in Lage’s figurations, the view of the onlooker turns to black: turns towards the onlooker in recognition and becoming—or disappearance. NOTES Max Horkheimer and Theodor W. Adorno. Dialectic of Enlightenment . (Palo Alto: Stanford University Press, 2002): 4-5. Theodor W. Adorno. Aesthetic Theory . (London & New York, 2002): 176. Carsten Bach-Nielsen. “Mere glæde end gru.” Kristeligt Dagblad . September 24, 2002. Leif Hjernøe. “Den yderliggående inderlighed.” LEIF LAGE—Retrospektiv udstilling 1983 . (Copenhagen: Brøndum, 1983): 18. Ibid. Maurice Blanchot. The Infinite Conversation . (Minneapolis: University of Minnesota Press, 1993): 162-163. (shrink)

Spike Lee’s film 25 th Hour begins with an act of violence that it does not show: instead, the viewer hears the sounds of a dog being beaten. The dog’s menacing growl is then transformed into the growling image of Montgomery ‘Monty’ Brogan’s car speeding through New York. Monty spots the dog, and stops. It is only then that the viewer witnesses the results of the film’s ‘foundational’ act of violence: the bloody body of a dog beaten to pulp. (...) When Monty approaches the dog, it turns out the animal ‘still has some bite left in him’. Perhaps because the dog is a fighter, Monty decides to save him. Although the dog resists, he ultimately manages to get the dog in the trunk of his car. But Monty does not emerge from the rescue operation unscathed: blood is trickling from a cut in his neck. This scene can be read as a pre-figuration of a stomach-turning scene towards the end of the film, in which Monty’s friend Francis ‘Frank’ Slaughtery will beat up Monty’s face beyond recognition so that Monty will not be raped on his first night in jail. Monty’s face recalls the dog at the beginning of the film. It is through the bloody mess of their bodies that Monty and the dog begin to communicate, to enter into communion. This essay explores how this communion, this communication between Monty and the dog, comes about. I am interested, specifically, in what the significance of such an exploration might be for contemporary conceptions of community. The essay initially approaches this topic against the background of Emmanuel Levinas’ work on ethics, in which the notion of the face has played a crucial role. But its aim is really to situate the film, through the references to the work of Francis Bacon that it includes, in a more contemporary, post-Levinasian debate on an ethics of defacement. I am particularly interested in exploring the significance of such an ethics in the post-September 11 era, which is explicitly evoked at the beginning of Lee’s film. My argument is that Monty and the dog begin to communicate, to enter into a communion, and thus to form a community, through a process of defacement that simultaneously strips them from their ways of life and propels them into a shared ethical and political becoming. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Advocates, Not Problem ParentsAnonymous TwoNothing could have prepared us for the shock of hearing that our son had a brain tumor.Rob* was 13½, an active, healthy eighth grader, when he developed a headache so bad he couldn’t get out of bed in the morning. We saw the pediatrician three times over the next ten days. On the third visit, after ruling out problems at home, stress at school, strep (...) throat and mono, he sent us for an MRI. When the radiology tech handed me the films and told us to drive back to the pediatrician’s office, I knew we were in trouble. Sure enough, after all the other patients had left, our long–time doctor called us into his tiny office, shut the door and fumbled with the films as he pointed to a white spot that he said was a brain tumor.So began the experience that would change the course of our lives. We remember the diagnosis in detail and relive it in slow motion. We recall packing suitcases, driving to the hospital, waiting to be seen in the emergency room, and walking through doors marked “Pediatric Hematology/Oncology” for the first time.We date everything “BC” (Before Cancer) or “AD” (After Diagnosis). We are grateful every day that [End Page 13] our son is alive, but we know he is forever changed. We are changed: Our nuclear family, our extended family, everyone who knew us and supported us at the time was affected. A pediatric cancer diagnosis is a bomb that shatters your world without warning. If you’re lucky, you can pick up a lot of the pieces, maybe even most of them, but the world you re–enter is never the one you inhabited before.Our doctor delivered the diagnosis to Rob and me at the same time. I’ve thought about this many times and perhaps one day will ask him: Why did he choose to do it that way? Was it a conscious decision or just happenstance? Was it kinder, in the long run—like pulling off a band–aid quickly—or terribly risky? What if I had collapsed at the news? I asked to step into the hall to use the phone. In a state of numbness, I called my husband. He knew we had had an MRI a few hours earlier. “Come quickly,” I said. “There’s a mass.”We chose to go to a top-ranked major medical center and were admitted that evening. A couple of days later, the discovery of tumor markers in Rob’s cerebrospinal fluid and blood confirmed a central nervous system mixed germ cell tumor. We were told he would require six cycles of chemotherapy, followed by six weeks of radiation, and possibly second–look surgery and high-dose chemo with stem cell rescue on top of that. We were given a consent form listing a catalogue of short–and long–term side effects, among them the likelihood of infertility. We were urged to start treatment as soon as possible.By sheer coincidence I had just completed a project for a small, nonprofit organization that existed to inform young adult cancer patients about their fertility rights and options. I knew that infertility concerns were usually pushed aside at diagnosis to make way for other priorities, namely the urgency of starting treatment. And that’s exactly the kind of pressure we were facing.But my husband and I were not ready to sign away our son’s fertility in what felt like a no–confidence vote, a capitulation. We needed to believe that he would survive and put this horror behind him, that he would look forward to marriage and starting a family. We were willing to cede nothing to the disease at this early stage of the game. Was this rational, naive or selfish on our part? I don’t know.The medical team seemed surprised when we asked for a delay in treatment in order to collect sperm samples. They warned that our son’s condition could decline suddenly—and that postponing treatment by even several days might be dangerous. However, at our insistence, they agreed to the delay... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diacritics 30.3 (2000) 13-27 [Access article in PDF] David Painting Death Didier Maleuvre Our life has no end in just the way in which our visual field has no limit. —Wittgenstein, Tractatus Logico-Philosophicus Dates It was the "terrible year." The Revolution was in danger, the enemies of France marched on the borders, the Reign of the Terror had begun. There lay Marat in his blood bath, a letter (...) in his hand dated July 13, 1793, the day he died. There he still lies, in his sacrificial tub, behind a yellow panel etched with the revolutionary calendar date, Year Two, the year Marat the martyr rose to historical sainthood. There, in the depth of the image, Marat lay in 1793, a revolutionary murdered in his bath; here, on the canvas, still lies the cluster of paint and brushstrokes suspended in Year Two of his painted embalming. There, in 1793, Marat died; here, in the mythic year of the historical image, Marat remains dead. This "remaining dead" is the time of the painting, its date and signature: "À Marat, David. —L'an deux." The tablet, like a tombstone, is what remains standing in the wake of death. An ex voto, the painting offers itself to the dead man, to his memory. In so doing, however, the painting calls attention to itself, as though making sure we understand it devotes itself to the task of taking us to Marat. It says, "this is a painting 'à Marat', 'for,' 'to' or 'toward' Marat, 1 on the way to him, a painting that makes us see Marat and thereby gives Marat the gift of being seen."Oddly, the patch of painting that beckons to Marat also lays out the spot where the canvas signals it is made of matter: a slab of yellow paint, an obtrusive plane emphasizing that there is paint, that painting is taking place on this Proustian "petit pan de mur jaune." One way to understand this contradiction is to say that the headstone displays the twofold nature of seeing an image: on the one hand, the flight of spellbound vision that goes to ("à") Marat, dead and risen, back from the year 1793; on the other hand, the object-bound perception that stays at the canvas level, the paint, lines, and brushstrokes, the corporeality of paint shaped ceremoniously for ("à") Marat. In short, the event of seeing occurs on this headstone to and for Marat: 2 the eye hits the material slab of canvas, where miraculously, it stumbles into the netherworld of representation where (where?) it catches a glimpse of a wooden box, a bloody bathtub, a dead man. One cannot help marvel at this conjurer's trick that makes the human eye see more than what it is given. And part of marveling at this sleight-of-hand entails wondering why, in David's Marat, the trick of representation calls attention to itself specifically on a tombstone: plainly put, the question is to understand what death has to do with seeing images, with this sudden leap of faith whereby we casually trust there is more to a [End Page 13] canvas than meets the eye, that there is something beyond paint (where?), in the hereafter of images, a corpse in a bathtub. Miraculously.When the image appears, in the leap, the painting dies in the flesh and is reborn as idea, as appearance, the waxen figure of a dead man. Thus the painting dies for Marat, it sacrifices itself for ("à") him. Correspondingly, it erects its own yellow tombstone to commemorate the sacrifice: see what I am doing, I am opening myself up to ("à") Marat. A painter in the grip of revolutionary zeal humbly lets the subject of his painting (the heroic, tremendous Marat) take precedence over the painting that enshrines him. The painting is both glorious and humble: glorious inasmuch as it calls on the tribunal of history to see the martyr; humble because, to do so, the painting must bow before the historical fact. On the yellow tombstone, on its own gravestone, the painting sacrifices itself, vanishes as physical object so that Marat may live forever in the image. For there to... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Chance to CutBruce H. CampbellMy gloved hand reaches for progressively sharper surgical instruments. The prior radiation therapy and recurrent cancer [End Page E3] have made his neck tissues as stiff and hard as an old block of wood; everything appears too dull and feels too dry under the bright operating room lights. I push, dissect, urge, divide, prod, and spread with little effect.The nursing staff keeps to its (...) routine—completing computer entries, retrieving supplies, counting sponges—only intermittently aware that things are not going well at the point of attack. Nondescript music plays softly and the anesthesia machine continues to emit its gentle sounds. The junior resident—assisting me with the first of many neck dissections she will see during her five years of training—grips the retractor as she has been told and dabs the wound periodically to clear any blood or fluid.I glance up to recheck the CT scan. It confirms that this man’s recurrent cancer is just below the next layer of neck muscles. There are also some large blood vessels and major nerves nearby. I am confident, though, that I will be able to expose the mass, protect all of the critical structures, and safely remove the cancer.Curing cancer with surgery is no small feat, mind you. Cancer is, after all, a molecular disease not easily confined to an obvious lump, even though we sometimes refer to a malignant mass being “like a walnut” or “as hard and round as a marble.” The actual disease rests deep inside each cancer cell where the genetic code—the DNA—makes mistake–after–mistake. If cancer is to be cured with a surgical procedure, the surgeon must remove every last cell that is capable of making the same nonsensical, life–threatening error. Given Science’s rudimentary knowledge of cancer cell dynamics and signaling, it’s a miracle that surgery ever works. Yet, we continue to try. And we succeed just often enough to keep on trying.I rearrange the retractors and alter my approach. My mentors would have known what to do next, I imagine. My training included time well–spent with brilliant and technically–gifted surgeons. How would they have approached this case? Their experience and instincts might have told them to open the wound more widely, work the lateral and deep margins first, or position the instruments differently.Perhaps, one of my mentors would have attacked this man’s tumor using the same approach I am attempting but would have known exactly where to exploit some area of weakness that I cannot locate. A few swift, confident moves and he would have held the mass in his hands. “That’s it. We’re done,” he would have said.I met this patient several months ago when his cancer was first discovered and have seen him throughout his course of treatment. Recently, his daughter had accompanied him to the office to review his options. “Treatment has been rugged, Doc,” he reminded me. “The cancer’s still there and they said I can’t get any more radiation. Chemo would only prolong things. I don’t really want surgery, but what choice do I have if I want to be cured?”“Supportive care is an option, but the only curative approach is surgery.”“Well, I’m not ready to quit yet, Doc. I got grand-kids, y’know. I want to watch them grow up.” He nodded to his daughter. “I’m in charge of spoiling her little boys.”The daughter smiled. We crowded around the computer screen to look at the scans. I showed them how the tumor was invading and destroying surrounding structures. I described the surgery and the risks.“There are many things I will not know about your tumor until we are actually in the operating room,” I explained. Surgery in the setting of recurrent disease involves a series of on–the–spot decisions and course corrections. The odds of success are unknowable. “Sometimes, the only way to find out if we can remove the cancer is simply to try.”He took a deep breath and looked at his daughter. “Well then, Doc, if surgery is the only... (shrink)

INTRODUCTION WHEN, in As You Like it, Shakespeare makes Touchstone ask William, "Hast any philosophy in thee, Shepherd?" the thing that Touchstone means is ...

_Pluriverse_, the final work of the American poet and philosopher Benjamin Paul Blood, was published posthumously in 1920. After an experience of the anaesthetic nitrous oxide during a dental operation, Blood came to the conclusion that his mind had been opened, that he had undergone a mystical experience, and that he had come to a realisation of the true nature of reality. This title is the fullest exposition of Blood’s esoteric Christian philosophy-cum-theology, which, though deemed wildly eccentric (...) by commentators both during his lifetime and later in the twentieth century, was nonetheless one of the most influential sources for American mystical-empiricism. In particular, Blood’s thought was a major inspiration for William James, and can be seen to prefigure the latter’s concept of Sciousness directly. (shrink)

This article draws attention to the ethical complexity researchers may be confronted with during fieldwork should an adult participant with intellectual disabilities disclose that harm or an illegal activity is occurring or has occurred in the past. The need to gain ethical approval and the positioning of people with intellectual disabilities as vulnerable within ethics review procedures can result in the adoption of paternalistic approaches as researchers are encouraged to break confidentiality to report concerns to other professionals. Whilst this may (...) fulfil a researcher’s duty to ensure no harm occurs to participants, if it takes place against the participant’s wishes it may also violate participant autonomy, reinforce unequal relations of power, and may unwittingly contribute to subsequent harm occurring. Whilst the article begins from our experience as two UK-based researchers working with people with intellectual disabilities, it draws on existing literature and guidelines to expose the ethical tensions which may be encountered. It is intended that the paper acts as a starting point for researchers wishing to reflect on their practice and ethical decision-making, whilst contributing to wider debates on the position of people with intellectual disabilities within society. (shrink)

For any system that uses previous experience to solve problems in new situations, it is necessary to identify the features in the situation that should match features in the previous cases through some process ofsituation analysis. In this paper, we examine this problem in the legal domain, where lawyers know it asissue spotting. In particular, we present an implementation of issue spotting in CHASER, a legal reasoning system that works in the domain of tort law.This approach is a compromise between (...) generality and efficiency, and is applicable to a range of problems and domains besides legal reasoning. In particular, it presents a principled way to use multiple cases for a single problem by exploiting the inherent structure present in many domains. (shrink)

When confronted with an ethical dilemma, most of us like to think we would stand up for our principles. But we are not as ethical as we think we are. In Blind Spots, leading business ethicists Max Bazerman and Ann Tenbrunsel examine the ways we overestimate our ability to do what is right and how we act unethically without meaning to. From the collapse of Enron and corruption in the tobacco industry, to sales of the defective Ford Pinto, the (...) downfall of Bernard Madoff, and the Challenger space shuttle disaster, the authors investigate the nature of ethical failures in the business world and beyond, and illustrate how we can become more ethical, bridging the gap between who we are and who we want to be. Explaining why traditional approaches to ethics don't work, the book considers how blind spots like ethical fading--the removal of ethics from the decision--making process--have led to tragedies and scandals such as the Challenger space shuttle disaster, steroid use in Major League Baseball, the crash in the financial markets, and the energy crisis. The authors demonstrate how ethical standards shift, how we neglect to notice and act on the unethical behavior of others, and how compliance initiatives can actually promote unethical behavior. They argue that scandals will continue to emerge unless such approaches take into account the psychology of individuals faced with ethical dilemmas. Distinguishing our "should self" from our "want self", the authors point out ethical sinkholes that create questionable actions. Suggesting innovative individual and group tactics for improving human judgment, Blind Spots shows us how to secure a place for ethics in our workplaces, institutions, and daily lives. (shrink)

My topic is the fundamental Aristotelian division between the animate and the inanimate. In particular, I discuss the transformation that occurs when an inanimate body comes to be ensouled. When nutriment is transformed into flesh it is first changed into blood. I argue that blood is unique in being, at one and the same time, both animate and inanimate; it is inanimate nutriment in actuality (or in activity) and animate flesh in potentiality (or in capacity). I provide a (...) detailed exposition of these manners of being (covering individual substances, artifacts, and mixtures), apply these insights to the case of blood, and then argue that blood's curious status is central to understanding hylomorphism in living organisms. (shrink)

_Blood_, according to Gil Anidjar, maps the singular history of Christianity. As a category for historical analysis, blood can be seen through its literal and metaphorical uses as determining, sometimes even defining Western culture, politics, and social practices and their wide-ranging incarnations in nationalism, capitalism, and law. Engaging with a variety of sources, Anidjar explores the presence and the absence, the making and unmaking of blood in philosophy and medicine, law and literature, and economic and political thought from (...) ancient Greece to medieval Spain, from the Bible to Shakespeare and Melville. The prevalence of blood in the social, juridical, and political organization of the modern West signals that we do not live in a secular age into which religion could return. Flowing across multiple boundaries, infusing them with violent precepts that we must address, blood undoes the presumed oppositions between religion and politics, economy and theology, and kinship and race. It demonstrates that what we think of as modern is in fact imbued with Christianity. Christianity, Blood fiercely argues, must be reconsidered beyond the boundaries of religion alone. (shrink)

Our epistemic access to the past is infamously patchy: historical information degrades and disappears and bygone eras are often beyond the reach of repeatable experiments. However, historical scientists have been remarkably successful at uncovering and explaining the past. I argue that part of this success is explained by the exploitation of dependencies between historical events, entities, and processes. For instance, if sauropod dinosaurs were hot blooded, they must have been gluttons; the high-energy demands of endothermy restrict sauropod grazing strategies. Understanding (...) such dependencies extends our reach into the past in spite of incomplete data. In addition, this serves as a counterexample to two accounts of method in the historical sciences. By one, historical science proceeds by identifying ‘smoking guns’: traces that discriminate between live hypotheses. By the other, historical hypotheses are supported by consilience: the convergence of independent lines of evidence. However, testing for ‘coherency’ between past hypotheses also plays a critical role in historical confirmation. Just as historical scientists exploit dependencies between past entities and present entities to infer what the past was like, they also exploit dependencies between past entities themselves. I do not suggest that archetypical historical science proceeds in this manner. Rather, the lesson I draw is that historical methodology cannot be characterized as archetypically relying on one method or another. Historical science is at base opportunistic, and is resistant to unitary analyses. 1 Introduction2 Snowballs and Explosions: The Basic Idea3 Were Sauropods Endothermic?4 Dependent Entities and Interdependent Explanations5 Smoking Guns and Consilience. (shrink)

This essay examines the symbolic significance of blood in the twentieth century and its role in determining the composition of a national community along racial lines. By drawing parallels between Nazi notions of blood and racial purity and historically contemporaneous U.S. policies regarding blood and blood products, Polsky reveals a disturbing proximity in discourse and policy. While the Nazis attempted to locate Jewish racial essence and inferiority in blood and instituted eugenic measures and laws forbidding (...) racial admixture, similar policies existed in the U.S. based on the so-called one drop rule that systematically discriminated against African Americans. (shrink)

Wright, Ken Review(s) of: Blind spots: Why We Fail to Do What's Right And What to Do about It, by Max H. Bazerman and Ann E. Tenbrunsel Princeton University Press 2011, x, 191pp.

Recently, we identified myeloid‐derived growth factor (MYDGF) as a blood flow‐induced angiocrine signal that promotes human and mouse hepatocyte proliferation and survival. Here, we review literature reporting changes in blood flow after partial organ resection in the liver, lung, and kidney, and we describe the angiocrine signals released by endothelial cells (ECs) upon blood flow alterations in these organs. While hepatocyte growth factor (HGF) and MYDGF are important angiocrine signals for liver regeneration, by now, angiocrine signals have (...) also been reported to stimulate hyperplasia and/or hypertrophy during the regeneration of lungs and kidneys. In addition, angiocrine signals play a critical role in tumor growth. Understanding the mechano‐elastic properties and flow‐mediated alterations in the organ‐specific microvasculature is crucial for therapeutic approaches to maintain organ health and initiate organ renewal. (shrink)

NEW BLOOD EDITION: Contains three new chapters from Season 3. This new edition is available as an E-BOOK ONLY and contains three chapters not found in the print book! The first look at the philosophical issues behind Charlaine Harris's _New York Times_ bestsellers _The Southern Vampire Mysteries_ and the _True Blood_ television series! Teeming with complex, mythical characters in the shape of vampires, telepaths, shapeshifters, and the like, _True Blood_, the popular HBO series adapted from Charlaine Harris's bestselling The (...) Southern Vampire Mysteries, has a rich collection of themes to explore, from sex and romance to bigotry and violence to death and immortality. The goings-on in the mythical town of Bon Temps, Louisiana, where vampires satiate their blood lust and openly commingle with ordinary humans, present no shortages of juicy metaphysical morsels to sink your teeth into. Now _True Blood and Philosophy_ calls on the minds of some of history's great thinkers to perform some philosophical bloodletting on such topics as Sookie and the metaphysics of mindreading; Maryann and sacrificial religion; werewolves, shapeshifters and personal identity; vampire politics, evil, desire, and much more. The first book to explore the philosophical issues and themes behind the _True Blood_ novels and television series Adds a new dimension to your understanding of _True Blood_ characters and themes The perfect companion to the start of the third season on HBO and the release of the second season on DVD Smart and entertaining_, True Blood and Philosophy_ provides food -- or blood -- for thought, and a fun, new way to look at the series. (shrink)

In The Gift Relationship, Richard Titmuss argued that the practice of altruistic blood donation fosters social solidarity while markets in blood erode it. This paper considers the implications of this line of argument for the organ market debate. I defend Titmuss’ arguments against a number of criticisms and respond to claims that Titmuss’ work is not relevant to the context of live donor organ transplantation. I conclude that Titmuss’ arguments are more resilient than many advocates of organ markets (...) suggest, and more relevant to the debate than is commonly appreciated. (shrink)

This article concerns the so-called irrigation system in the Timaeus' biology (77a–81e), which replenishes our body’s tissues with resources from food delivered as blood. I argue that this system functions mainly by the natural like-to-like motion of the elements and that the circulation of blood is an important case study of Plato’s physics. We are forced to revise the view that the elements attract their like. Instead, similar elements merely tend to coalesce with each other in virtue of (...) their tactile features as the atomists describe. The notion of attraction is replaced with this notion of mere coalescence. I begin by outlining how blood is made from food. I then argue that an understanding of health and disease compels us to read Plato as if he were an atomist and to abandon the popular scholarly interpretations according to which the elements attract each other. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Blind Spots and Avenues for Transformation within the Utopian Canon: Toward A Terrestrial EcotopianismHeather Alberro (bio)Limitations and Exclusions of the (Western) Utopian CanonUtopianism in all of its manifestations often powerfully (re)surfaces during times of significant socio-ecological upheaval as a response to oppressive and exploitative realities. As such it is a fervent refusal against a given status quo and its purported inevitability. Utopianism and hope are rendered possible by, (...) and draw their transformative potential from, the boundless terrain of potentiality surrounding any given reality.1 Indeed, without such conditions of radical uncertainty, hope and utopianism would not be possible. Often and understandably, the seminal works of Plato, Thomas More, William Morris, H. G. Wells and others come to mind when we think of utopian studies. Hence Kumar’s parochial observation that there is no discernible utopian tradition beyond the West because other cultures lack the foundational myth of the Golden Age—that is, the Garden of Eden, Atlantis, and Arcadia—that has been so formative to the development of utopia in the West.2 These traditional or “transcendental” utopian modalities often feature a dichotomous opposition to their present reality, depicting time and historical movement [End Page 528] as linear successions of stages proceeding from an archaic past and toward a future wherein the utopian ideal is seen as occupying a “fixed space outside time and history.”3 Such temporally “transcendent” utopias marked the dawn of the modern phase of utopian thought, originating in the seventeenth century alongside new theories of social evolution that coalesced into modern Enlightenment notions of linear historical progress.4Prioritizing Pluralism: Critical Heterotopias of the “Here and Now”What kind of life? We are still confronted with the demand to state the “concrete alternative.” The demand is meaningless if it asks for a blueprint of the specific institutions and relationships which would be those of the new society: they cannot be determined a priori; they will develop, in trial and error, as the new society develops.5Tom Moylan’s notion of “critical utopianism,” which emerged during the “historic block” of political opposition of the 1960s and 1970s, marks one important step within the utopian canon toward praxis and the essential “Nowness” of critique and imaginative projection.6 This “critical” strand of utopianism is fueled by a fervent opposition to the exploitation and domination of people and the natural world that is increasingly characteristic of Western-capitalist societies.7 This opposition is coupled with a utopian desire for mutual aid, ecological resilience, liberation, and peaceful living—in effect, a longing for community.8 The “critical” in Moylan’s formulation has a bivalency: first, in the sense of critique through the debunking and deconstruction of the utopian genre itself, which was “colonized” by capitalism toward the 1970s and infused with technocratic dreams of material abundance through boundless economic expansion; and second, in the sense of the critical mass required to effect fundamental societal transformations.9 If the better is the enemy of the good, then perfection serves as “a stick with which to beat the possible.”10 Utopias do not offer rigid blueprints of a fixed or perfect ideal world but rather head toward “the ideal” by offering “a rich blending of creative fantasy, critical thinking, and oppositional activism” predicated on a demand for radically new relations between social and natural systems.11 Ever critically self-reflective, critical utopias continually remind us of the limitations of the utopian impulse, particularly the dangers of pursuing rigid and transcendental visions of “the better.” Nevertheless, these are desperate times that demand some orientation toward a better; utopianism’s [End Page 529] denunciative function is not enough. Thus, in his impassioned recent work Becoming Utopian, Moylan denotes the need for an intersectional, democratically unified leadership structure that can help sustain a political movement for counteracting the “global/neoliberal superpower order while reaching for a utopian horizon.”12 With a focus more on process than a fixed ideal, the critical utopia explores and articulates vibrant post-capitalist futures that are simultaneously open-ended, and far more socio-ecologically resilient than the “now” of late capitalism.Akin in function and style to critical utopias are the grounded and transgressive... (shrink)

The subject of this paper is Georg Ernst Stahl's reflections on epilepsy. In the German physician's work, the concept of disease is stratified: it is the morbid idea which causes dysfunctions in the animal economy, as well as irregular motion, overabundance and ultimately an alteration of the corporeal humours. In particular, epilepsy is an affection deriving from an altered functioning of the bodily motions, caused by abnormal blood flow, intestinal worms, anatomical defects, foreign bodies, and the passions of the (...) soul. While a certain medical tradition attributed a nervous origin to epilepsy, Stahl, giving it a humoural genesis, openly shows the theoretical premises on which his physiology rests. So, Stahlian physiology appears to be a non-mechanistic, teleological-inspired, hydraulicism. (shrink)

The possible differential effects of ABO blood group materno-paternal (fetal) incompatibility on completed reproductive performance were investigated on a sample of 100 couples (100 fathers and 100 mothers) from three villages in the Jind district of Haryana state, India. The average number of live births per mating couple was slightly higher for the incompatible matings (5·32) than the compatible ones (5·05). This advantage was offset by higher postnatal mortality in the former. Consequently, the average number of living children in (...) the compatible matings (4·64) was higher than in the incompatible ones (4·18). With reference to individual ABO matings, the index of relative fertility (Irf) was the highest in A×AB followed by B×A type of incompatible matings. No decrease in live births in O×A and O×B incompatible matings was observed compared with their reciprocal compatible ones, i.e. A×O and B×O matings, as has been hypothesized in previous studies. The total pregnancy wastage was substantially higher in ABO-incompatible matings (24·59%) than compatible matings (8·45%). About 71% of the postnatal deaths took place within one year of the birth in the case of incompatible matings compared with 50% in the case of compatible matings. The study supports the hypothesis that selection is operative at the ABO locus as revealed by the measures of selection intensity. The loss of fitness in the present sample was associated with differential mortality. There were no differences in the proportions of average number of male live births in the compatible (0·55) and incompatible matings (0·58). However, in the individual mating types, there was some evidence of higher or lower proportions of male live births. (shrink)

Problems of logical theory choice are current being widely dis- cussed in the context of anti-exceptionalist views on logic. According to those views, logic is not a special science among others, so, in particular, the methodology for theory choice should be the same in logic as for other scientific disciplines. Richard Routley advanced one such methodology which meshes well with anti-exceptionalism, and argued that it leads one to choosing one single logic, which is a kind of ultralogic. We argue that (...) the choice for only one correct system of logic may be rejected on the basis of the methodology proposed by Routley and, furthermore, that taking anti-exceptionalism about logic seriously recommends that a pluralist view of logic should be accepted. We call this view “full-blooded anti-exceptionalism”, and the resulting view on logic, lacking a proper name, “local pluralism”. (shrink)

ArgumentAfter World War II, blood groups became a symbol of anti-racial science. This paper aims to shed new light on the post-WWII history of blood groups and race, illuminating the postcolonial revitalization of racial serology in South Korea. In the prewar period, Japanese serologists developed a serological anthropology of Koreans in tandem with Japanese colonialism. The pioneering Korean hematologist Yi Samyŏl (1926–2015), inspired by decolonization movements during the 1960s, excavated and appropriated colonial serological anthropology to prove Koreans as (...) biologically independent from the Japanese. However, his racial serology of Koreans shared colonial racism with Japanese anthropology, despite his anti-colonial nationalism. (shrink)

Clinical success with human hematopoietic stem cell (HSC) transplantation establishes a paradigm for regenerative therapies with other types of stem cells. However, it remains generally challenging to therapeutically treat tissues after engineering of stem cells in vitro. Recent studies suggest that stem and progenitor cells sense physical features of their niches. Here, we review biophysical contributions to lineage decisions, maturation, and trafficking of blood and immune cells. Polarized cellular contractility and nuclear rheology are separately shown to be functional markers (...) of a hematopoietic hierarchy that predict the ability of a lineage to traffic in and out of the bone marrow niche. These biophysical determinants are regulated by a set of structural molecules, including cytoplasmic myosin‐II and nuclear lamins, which themselves are modulated by a diverse range of transcriptional and post‐translational mechanisms. Small molecules that target these mechanobiological circuits, along with novel bioengineering methods, could prove broadly useful in programming blood and immune cells for therapies ranging from blood transfusions to immune attack of tumors. (shrink)

The unsettling language of blood has been invoked throughout the history of Christianity. But until now there has been no truly sustained treatment of how Christians use blood to think with. Eugene F. Rogers Jr. discusses in his much-anticipated new book the sheer, surprising strangeness of Christian blood-talk, exploring the many and varied ways in which it offers a language where Christians cooperate, sacrifice, grow and disagree. He asks too how it is that blood-talk dominates when (...) other explanations would do, and how blood seeps into places where it seems hardly to belong. Reaching beyond academic disputes, to consider how religious debates fuel civil ones, he shows that it is not only theologians or clergy who engage in blood-talk, but also lawmakers, judges, generals, doctors and voters at large. Religious arguments have significant societal consequences, Rogers contends; and for that reason secular citizens must do their best to understand them. (shrink)

U.S. Food and Drug Administration policy prohibits blood donation from men who have had sex with men even one time since 1977. Growing moral criticism claims that this policy is discriminatory, a claim rejected by the FDA. An overview of U.S. blood donation, recent donor deferral policy, and the conventional ethical debate introduce the need for a different approach to analyzing discrimination claims. I draw on an institutional understanding of injustice to discern and describe five features of the (...) MSM policy and its FDA context that contribute to its discriminatory effect. I note significant similarities in the 1980s policy of deferring Haitians, suggesting an historical pattern of discrimination in FDA deferral policy. Finally, I point to changes needed to move toward a nondiscriminatory deferral policy. (shrink)

It is often suggested that during development the brain barriers are immature. This argument stems from teleological interpretations and experimental observations of the high protein concentrations in fetal cerebrospinal fluid (CSF) and decreases in apparent permeability of passive markers during development. We argue that the developmental blood–CSF barrier restricts the passage of lipid‐insoluble molecules by the same mechanism as in the adult (tight junctions) rendering the paracellular pathway an unlikely route of entry. Instead, we suggest that both protein and (...) passive markers are transferred across the epithelium through a transcellular route. We propose that changes in volume of distribution can largely explain the decrease in apparent permeability for passive markers and that developmentally regulated cellular transfer explains changes in CSF protein concentrations. The blood–CSF tight junctions are functionally mature from very early in development, and it appears that transfer from blood into embryonic brain occurs predominately via CSF rather than the vasculature. BioEssays 30:237–248, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

In this paper I first address what I consider a central issue in the account of perception in Plato’s Timaeus, namely, how the pathemata pass through the body to reach the soul, and thus become aistheseis. My point in Section 1 is that in tackling this issue Plato aims to provide a firm physiological basis to the notion of perception that starts to emerge in the Theaetetus and the Philebus and is crucial to the late development of his theory of (...) cognition. In the ensuing section I try to put the account of perception in the Timaeus into a historical perspective, aiming to highlight two points: a) Plato’s description of the way in which sensible impressions “travel” inside the body and interact with its parts and other constituents is largely indebted to previous theories, such as those we find, for example, in Empedocles and a few Hippocratic writers; b) The leading role in this story (where internal air plays a significant supporting role) is played by blood flowing through the vascular system and thus performing a crucial cognitive function. Moreover, emphasizing the role of blood as well as analyzing the elaborate way in which perceptions are transmitted through the body to the soul proves vital to appreciate (in Section 3) the cognitive status of the lower parts of the soul (which are more involved in perception) and their relation to reason. Overall, the paper adds further elements to our understanding of Plato’s embodied approach to cognition. I had already written (and submitted) this article when Johansen (2021) was published. The latter’s approach to the role of blood in Plato’s physiology of knowledge in the Timaeus converges in part with mine (as I was pleased to find out), partly due to our overlapping sources and bibliography. (shrink)