Can the Experience of Participatory Development Help Think Critically about ‘Patient and Public Involvement’ in UK Healthcare?

The expansion of spaces for ‘patient and public involvement’ (PPI) in health systems in the UK is a relatively recent phenomenon, and yet ‘participation’ as a principle for planned interventions in international development is well established as a field of practice and controversy. Development workers and scholars have passed through moments of enchantment and disenchantment with the idea that the true source of innovation, expertise and workable (and sustainable) solutions is to be found not in the professionals but in communities of experience. Making ‘local knowledge’ the basis of interventions has proved unexpectedly problematic. How could incommensurable forms of knowing, across steep gradients of power be bridged? This article describes a decade-long experiment in participatory development in a remote Adivasi (tribal) region of western India in order to suggest the relevance of this experience for the very different context of PPI in healthcare settings. In particular, it highlights some general points about knowledge practices at the interface, and the human tendency to adjust, mirror, mimic, loop and in other ways make the ‘patient-professional’ interface itself hard to navigate. The article suggests that self-reflective insight into these social processes is necessary for effective ‘engagement’ by professional and lay actors alike

Visual product architecture modelling for structuring data in a PLM system

Part 8: Formalization for PLMInternational audienceThe goal of this paper is to determine the role of a product architecture model to support communication and to form the basis for developing and maintaining information of product structures in a PLM system. This paper contains descriptions of a modelling tool to represent a product architecture in a company to support the development of a family of products, as well as the reasons leading to the use of the specific model and its terminology. The fundamental idea for using the architecture model is that an improved understanding of the whole product system, will lead to better decision making. Moreover, it is discussed how the sometimes intangible elements and phenomena within an architecture model can be visually modeled in order to form the basis for a data model in a PLM system

On equal temperament

In this article, I use Stengers’ (2010) concepts of ‘factish’, ‘requirements’ and ‘obligations’, as well as Latour’s (1993) critique of modernity, to interrogate the rise of Equal Temperament as the dominant system of tuning for western music. I argue that Equal Temperament is founded on an unacknowledged compromise which undermines its claims to rationality and universality. This compromise rests on the standardization which is the hallmark of the tuning system of Equal Temperament, and, in this way, it is emblematic of Latour’s definition of modernity. I further argue that the problem of the tuning of musical instruments is one which epitomizes the modern distinction between the natural and the social. In turn, this bears witness to what Whitehead calls the ‘bifurcation of nature’. Throughout this article, using the work of Stengers and Latour, I seek to use tuning as a case study which allows social research to talk both of the natural and of the social aspects of music and tuning, without recourse to essentialism or simple social construction. In this way, my argument seeks to avoid bifurcating nature

Pictures of Synthetic Biology: A reflective discussion of the representation of Synthetic Biology (SB) in the German-language media and by SB experts

This article is concerned with the representation of Synthetic Biology in the media and by biotechnology experts. An analysis was made of German-language media articles published between 2004 and 2008, and interviews with biotechnology-experts at the Synthetic Biology conference SB 3.0 in Zurich 2007. The results have been reflected in terms of the definition of Synthetic Biology, applications of Synthetic Biology and the perspectives of opportunities and risks. In the media, Synthetic Biology is represented as a new scientific field of biology with an engineering-like thinking, while the scientists interviewed mostly define Synthetic Biology as contrary to nature and the natural system. Media articles present Synthetic Biology broadly with positive potential and inform the publics less about the potential risks than about the benefits of Synthetic Biology. In contrast, the experts interviewed reflect more on the risks than the opportunities of Synthetic Biology. Both used metaphors to describe Synthetic Biology and its aspects

Meaning in hoarding: perspectives of people who hoard on clutter, culture, and agency

Hoarding has become increasingly prominent in clinical practice and popular culture in recent years, giving rise to extensive research and commentary. Critical responses in the social sciences have criticised the cultural assumptions built in to the construct of ‘hoarding disorder’ and expressed fears that it may generate stigma outweighing its benefits; however, few of these studies have engaged directly with ‘hoarders’ themselves. This paper reports on in-depth, semi-structured interviews with ten individuals living in England, who received assessment and intervention for hoarding from Social Services. Their narratives drew on the cultural repertoire of values and discourses around waste and worth, the mediation of sociality and relationships through material objects, physical constraints on keeping order, and the role played by mental health. Analysing these perspectives anthropologically shows how dominant models of hoarding, such as the DSM-5 paradigm, potentially lend themselves to reductionist understandings that efface the meaning ‘hoarding’ may have and thereby deny agency to the person labelled as ‘hoarder’. More culturally informed analysis, by contrast, affords insights into the complex landscape of value, waste, social critique, emotion, interpersonal relationships and practical difficulties that may underlie hoarding cases, and points the way to more person-centred practice and analysis

Beyond relationalism in peacebuilding

This conclusion notes the rise of relationalism in theorizing peacebuilding and the advantages of this approach as evident in the contributions to this special issue. Nevertheless, it cautions against such a move and in particular, some of the ontological and epistemological consequences of the relational turn as evident in recent poststructuralism, postcolonial approaches and practice theory. It contrasts this with the critical realist approach – whose relationalism has been ignored by the current turn – allowing both relationalism and a belief in objectivity and preference for certain knowledge claims

Grounding knowledge and normative valuation in agent-based action and scientific commitment

Philosophical investigation in synthetic biology has focused on the knowledge-seeking questions pursued, the kind of engineering techniques used, and on the ethical impact of the products produced. However, little work has been done to investigate the processes by which these epistemological, metaphysical, and ethical forms of inquiry arise in the course of synthetic biology research. An attempt at this work relying on a particular area of synthetic biology will be the aim of this chapter. I focus on the reengineering of metabolic pathways through the manipulation and construction of small DNA-based devices and systems synthetic biology. Rather than focusing on the engineered products or ethical principles that result, I will investigate the processes by which these arise. As such, the attention will be directed to the activities of practitioners, their manipulation of tools, and the use they make of techniques to construct new metabolic devices. Using a science-in-practice approach, I investigate problems at the intersection of science, philosophy of science, and sociology of science. I consider how practitioners within this area of synthetic biology reconfigure biological understanding and ethical categories through active modelling and manipulation of known functional parts, biological pathways for use in the design of microbial machines to solve problems in medicine, technology, and the environment. We might describe this kind of problem-solving as relying on what Helen Longino referred to as “social cognition” or the type of scientific work done within what Hasok Chang calls “systems of practice”. My aim in this chapter will be to investigate the relationship that holds between systems of practice within metabolic engineering research and social cognition. I will attempt to show how knowledge and normative valuation are generated from this particular network of practitioners. In doing so, I suggest that the social nature of scientific inquiry is ineliminable to both knowledge acquisition and ethical evaluations

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Background: Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs). Methods: We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature. Findings: From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece. Interpretation: Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases