From Standardization to Adaptation: Clinical Trials and the Moral Economy of Anticipation

Hailed as the gold standard, the randomized controlled trial (RCT) occupies a hegemonic position at the top of evidence-based medicine’s hierarchy of knowledge. It is testament to the methodology’s capacity for standardization that it can so readily be spoken of in the singular: the RCT. Under what conditions, then, is it possible to speak of change in the gold standard? Since the 1950s, alternative versions of the RCT have been advocated for under the banner of ‘adaptive design’. Adaptive designs allow investigators to make pre-planned changes to a trial on the basis of accruing information while the experiment is ongoing. Initially a niche topic of methodological debate among biostatisticians, the approach is becoming widespread in mainstream drug development. A genealogical analysis exposes the discursive moves used to justify and popularize adaptation, from a focus on patient well-being and the greater good in the 1960s and 1970s, to efficiency and virtualism in the 1990s and 2000s. Changing discourses of time and patienthood have facilitated a move away from standardization as the singular logic of trials towards an appreciation of flexibility, undergirded by probabilistic methodologies. Adams et al.’s [(2009). Anticipation: Technoscience, life, affect, temporality, Subjectivity, 28, pp. 246–265] conceptual framework of anticipation illuminates this evolving moral economy of medical research, in which modes of knowledge production which claim to know the future are supplanting the traditional certainties of fixed and standardized experimental designs. Predictable uncertainty is the currency of this emerging economy, which capitalizes on computer simulation and ever more sophisticated tools of prediction to leverage credibility.     

The role of executive functions in human prospective interval timing

Human timing is thought to be based on the output of an internal clock. Whilst the functioning of this clock is well documented, it is unclear which other cognitive resources may moderate timing. Brown (2006) and Rattat (2010) suggest that the central executive of working memory may be recruited during timing. However it seems likely that the fractionated executive component processes identified by Miyake et al. (2000) and Fisk and Sharp (2004) may differentially contribute to timing performance; further exploration of this was the aim of the present study. An interference paradigm was employed in which participants completed an interval production task, and tasks which have been shown to tap the four key executive component processes (shifting, inhibition, updating and access) under single and dual-task conditions. Comparison of single and dual-task performance indicated that timing always became more variable when concurrently performing a second task. Bidirectional interference only occurred between the interval production task and the memory updating task, implying that both tasks are competing for the same executive resource of updating. There was no evidence in the current study to suggest that switching, inhibition or access was involved in timing, however they may be recruited under more difficult task conditions.     

The role of cognitive, emotional and personality factors in the experience of fatigue in a university and community sample

The aim of this study was to investigate the contribution of cognitive, emotional and personality factors to the experience of fatigue severity in healthy adult individuals. Specifically, the study examined whether fatigue catastrophising and emotional distress mediated the relationships between neuroticism, general irrational and rational thoughts to fatigue severity. One hundred and eighty nine university students and community volunteers completed self-report questionnaires assessing fatigue catastrophising and symptom severity, neuroticism, general rational and irrational thoughts and emotional distress. A series of correlational and path analyses were conducted to test the study hypotheses. Neuroticism and more general negative, irrational cognitions were associated with elevated fatigue catastrophising and fatigue severity, whereas more adaptive, rational cognitions were related to lower fatigue catastrophising and fatigue severity. Both elevated fatigue catastrophising and emotional distress uniquely and simultaneously mediated the relationships between irrational and rational cognitions and neuroticism to fatigue severity. These findings demonstrate that cognitions play a role in fatigue severity. The results have implications in the assessment and treatment of fatigue disturbances in the general community.     

Feminist Resources for Biomedical Research: Lessons from the HPV Vaccines

Several feminist philosophers of science have argued that social and political values are compatible with, and may even enhance, scientific objectivity. A variety of normative recommendations have emerged regarding how to identify, manage, and critically evaluate social values in science. In particular, several feminist theorists have argued that scientific communities ought to: 1) include researchers with diverse experiences, interests, and values, with equal opportunity and authority to scrutinize research; 2) investigate or “study up” scientific phenomena from the perspectives, interests, and conditions of marginalized stakeholders potentially affected by the research; and 3) make gender, ethnicity, class, and geographical location “visible,” or use them as categories of analysis when appropriate. Yet, more work is needed to determine what exactly these recommendations would require, and the benefits they would yield, in specific research contexts. Using the recent development of the human papillomavirus (HPV) vaccines, we examine how these three feminist recommendations would have applied. We argue that these principles would have yielded several epistemic and social benefits in the HPV case, as well as in biomedical research more generally. That is, biomedical research guided by these principles would not only be epistemically superior, but also more socially responsible.     

From mimesis to agency: Clinical steps in the work of psychic two‐ness1

In this paper, through the study of the clinical process of a girl starting treatment at the age of 3 years 10 months, who was thought of as a dummy by her family and who came for consultation when the assumed genetic aetiology was questioned, the authors build upon Tustin's contributions on the context of togetherness and the crisis of two‐ness, and upon Eugenio and Renata Gaddini's on the precursor object. The mimetic phenomena enacted with an older brother and at the kindergarten are found to result from cumulative trauma at her contacting a loving but mind–blind mother. After an initial stage of transference autism, enactment in the session of the traumatic situation was the first step in surmounting her autistic pseudo–stupidity. Mimetic transference dynamics took place principally at the level of the gaze, leading to the unfolding of the work of two–ness to a differentiation from the analyst as psychic breast, on the road to symbol formation and personal agency.     

Serendipity in the Theater: Maude Adams as James M. Barrie's American Muse

A special niche in theatre history is addressed to begin to fill a void in the contemporary creativity literature. The present essay focuses on Maude Adams and James M. Barrie in an attempt to demonstrate that, serendipitously, Adams initially impacted Barrie's creative process, and thereafter became his platonic source of inspiration for the plays he created for her, meriting the belated title of muse. Set change theory is underscored as a plausible cognitive explanation for Barrie's illumination. The psychoanalytic theory of transference is proposed as an underlying mechanism for facilitating the change of mental set during the incubation stage. A brief discussion on a selective theoretical integration from the fields of cognitive psychology, psychoanalysis, and neuroscience is followed by conclusions.     

Promoting traffic safety among young male drivers by means of elaboration-based interventions

Previous research in social psychology has brought about significant changes in attitudes and behaviour by merely asking respondents to imagine, or reflect, on a phenomenon and arrive at their own conclusions. To test the potential of such interventions in the traffic safety area, an experiment comprising 353 young men 18–23 years old with a driver’s licence was conducted. Two experimental groups were induced to imagine a severe accident scenario and to visualize their feelings and the consequences on their future lives. A control group was interviewed about neutral issues. Attitudes towards risk-taking were measured post-intervention and at follow-up. The experimental groups showed more “ideal” attitudes than the control group post-intervention. At follow-up the attitudes of the experimental group remained unchanged, whereas the control group had changed towards more “ideal” attitudes. Self-reported risk-taking behaviour was measured pre-intervention and at follow-up. At follow-up all groups reported significantly less risk-taking behaviour than at pre-intervention. It is suggested that answering the questionnaires increased mental elaboration concerning risky driving, and it is concluded that interventions that unobtrusively make drivers reflect on their driving should be explored further as a means to promote traffic safety.     

IS LIBERAL NATIONALISM INCOMPATIBLE WITH GLOBAL DEMOCRACY?

Abstract: To respond to globalization-related challenges, many contemporary political theorists have argued for forms of democracy beyond the level of the nation-state. Since the early 1990s, however, political theory has also witnessed a renewed normative defense of nationhood. Liberal nationalists have been influential in claiming that the state should protect and promote national identities, and that it is desirable that the boundaries of national and political units coincide. At first glance, both positions—global democracy and nationalism—seem to contradict each other. We do not share this oppositional picture. Developing a more harmonic picture of nationalist ideals and cosmopolitan visions is the aim of this essay.