Tinkering with care: Implementing extended-release buprenorphine depot treatment for opioid dependence

We examine how extended-release buprenorphine depot (BUP-XR) is put to use and made to work in implementation practices, attending to how care practices are challenged and adapted as a long-acting technology is introduced into service in opioid agonist treatment (OAT) in Australia. Our approach is informed by ideas in science and technology studies (STS) emphasising the irreducible entanglement of care practices and technology, and in particular the concept of 'tinkering' as a practice of adaptation. To make our analysis, we draw on qualitative interview accounts (n = 19) of service providers involved in BUP-XR implementation across five sites. Our analysis considers the disruptive novelty of BUP-XR. Tinkering to make a novel technology work in practice slows down the expectation of implementation in relation to transformative innovation, despite the promise of dramatic or rapid change. Tinkering allowed for more open relations, for new care practices that departed from the routine and familiar, opening potential for how BUP-XR could be put to use and made to work in its new situation, and as its situation evolved along-with its implementation. Flexibility and openness of altering relations was, however, at times, held in tension with inflexibility and closure. This analysis identifies a concern for what is made present and what is made absent in the altered care network affected by BUP-XR, with the multiple effects of supervised daily dosing practices thrown into relief as they become absented. Tinkering to implement BUP-XR locally connects with a broader assemblage of trial and movement in the constitution of treatment. The introduction of long-acting technologies prompts new questions about embedded implementation practices, including supervised dosing, urinalysis, the time and place of psychosocial support, and how other social aspects of care might be recalibrated in drug treatment.

Wrangling for health: Moving beyond 'tinkering' to struggling against the odds

This article proposes and outlines a new metaphor - 'wrangling for health'- to think about the health seeking efforts occurring within the complex and exhausting everyday realities of resource-poor communities. It draws on fieldwork carried out in a rural community in Sri Lanka (in 2019) with the aim of generating data on the therapeutic practices and health seeking activities of 20 households in the face of everyday ill-health matters. For people in such resource-poor communities, achieving a 'good' health outcome(s) means a constant and ongoing struggle against the challenges of a low-income household, inhospitable healthcare settings and a diverse therapeutic landscape. Based on my findings, I present four key trends in this struggle: a) negotiating the costs and economies of healthcare, b) seeking treatment only as a desperate measure, c) navigating the diverse therapeutic alternatives and d) circumventing the system. These give a glimpse into the ongoing and painstaking efforts by which people creatively mobilise and manipulate whatever resources accessible to them, balance the pros and cons of potential outcome(s) and persevere courageously against adverse circumstances. As such, the struggle for health mirrors their ongoing struggle to 'tie it up together' or wrangle it in everyday life ("jeewithaya gatagaha-gannava"). Wrangling for health - in its sense of struggling against the odds - is therefore proposed as a metaphor for health engagements that challenge the notion of 'tinkering' (Mol, 2008; Mol et al., 2015) so as to depict more accurately the broad range of health seeking efforts that occur within the diverse healthcare landscapes around the world.

The old, the new, or the old made new? Everyday counter-narratives of the so-called fourth agricultural revolution

Prevalent narratives of agricultural innovation predict that we are once again on the cusp of a global agricultural revolution. According to these narratives, this so-called fourth agricultural revolution, or agriculture 4.0, is set to transform current agricultural practices around the world at a quick pace, making use of new sophisticated precision technologies. Often used as a rhetorical device, this narrative has a material effect on the trajectories of an inherently political and normative agricultural transition; with funding, other policy instruments, and research attention focusing on the design and development of new precision technologies. A growing critical social science literature interrogates the promises of revolution. Engagement with new technology is likely to be uneven, with benefits potentially favouring the already powerful and the costs falling hardest on the least powerful. If grand narratives of change remain unchallenged, we risk pursuing innovation trajectories that are exclusionary, failing to achieve responsible innovation. This study utilises a range of methodologies to explore everyday encounters between farmers and technology, with the aim of inspiring further work to compile the microhistories that can help to challenge robust grand narratives of change. We explore how farmers are engaging with technology in practice and show how these interactions problematise a simple, linear notion of innovation adoption and use. In doing so, we reflect upon the contribution that the study of everyday encounters can make in setting more inclusionary, responsible pathways towards sustainable agriculture.

Hopeful adaptation after acquired brain injury: The case of late referrals in the Netherlands

A substantial number of people with 'mild' acquired brain injury (ABI) suffer from cognitive impairments that are not immediately acknowledged as such. Some are eventually referred to multidisciplinary rehabilitation care after months or years of suffering, which is why we have labelled them 'late referrals'. The aim of this paper is to add to the discussion on hopeful adaptation by focussing on the diverse adaptive strategies of late referrals. Hope is typically discussed as a positive emotion that can contribute to transformative processes, but that is also mirrored by despair. We conducted in-depth interviews with ten late referrals in the Netherlands. Our findings demonstrate that the trajectories of late referrals are characterised by wandering and navigating. Wandering is predominantly associated with feeling lost, and not knowing where one is going. While navigating is more purposeful, we found that our participants sometimes navigated in directions that turned out to be dead-end streets. We conclude that hopeful adaptation encompasses a circuitous way of trying and adapting and trying again. As a key recommendation for practice, we suggest that people with cognitive problems due to mild ABI should be supported in reducing the complexities of their everyday lives by taking up challenges one place at a time.

Lay participation with medical expertise in online self-care practices: Social knowledge (co)production in the Running Mania injury forum

Recent literature on the public understanding of science has focused on replacing the deficit model of public communication in which experts disseminate information with one that encourages public participation and dialogue. Situated within this call for increased participation, this study looks at self-care practices in which medical expertise is not passively consumed by the layperson, but shared and (re)produced through arenas of lay practice. This collective knowledge production is facilitated by the online environment, which provides access to mediated medical knowledge and the ability to form communities in which users can negotiate this expertise and share their experiences. The laypersons examined here are members of the Canadian online collective, Running Mania, highlighting how this negotiation of expertise occurs in a "wellness" community. Drawing from member interviews and website observations of the site's injury forum, the study examines collective injury management using two dominant theoretical discourses surrounding lay knowledge and participation in medical expertise: the lay expert whose knowledge arises from experience and the expert patient whose knowledge base parallels dominant biomedical discourse. Using the coproduction model and the related concepts of tinkering and logic of care from material semiotics, the research examines how these knowledge forms articulate to produce an intermediary discourse unique to this collective's articulation of running and caring practices, a discourse that is enacted in individuals' embodied negotiation of these multiple forms of medical expertise. It suggests that the logic of care has the potential to bridge the expert/lay boundary since the need for persistent, attentive tinkering applies across epistemological divides: in "good" care practices, multiple expertises are needed, both expert and lay, to hold the body together.

Tinker, tailor, deliberate. An ethnographic inquiry into the institutionalized practice of bar-coded medication administration technology by nurses

AIM

Explore the practice of nurses working with bar-coded medication administration technology, to gain insight in the impact it has on their work.

BACKGROUND

The widespread presumption of using Barcoded Medication Administration Technology (BCMA) is that it will effectively reduce the number of errors in the dispensing of medication to patients. However, it remains unclear whether this is the case in actual practice.

METHOD

Two distinct but overlapping research methodologies of Institutional Ethnography and Praxeology were combined as a means to uncover the highly complex practice of BCMA by nurses.

RESULTS

The implementation of BCMA creates a series of problems leading to nurses constantly tinkering with the technology. At the same time they are continuously deliberating the best ways of tailoring the BCMA to each of their patients.

CONCLUSION

Although working with BCMA is often misconstrued as being mindless and automatic, conforming to the technology, this tinkering with BCMA in fact always entails thorough deliberation by nurses.

Towards a phronetic space for responsible research (and innovation)

The term Responsible Research and Innovation has recently gained currency, as it has been designated to be a key-term in the European research framework Horizon 2020. At the level of European research policy, Responsible Research and Innovation can be viewed as an attempt to reach a broader vision of research and innovation as a public good. The current academic debate may be fairly enriched by considering the role that phronesis may have for RRI. Specifically, in this paper we argue that the current debate might be fruitfully enriched by making a categorial shift. Such a categorial shift involves moving away from the temptation to interpret responsible research and innovation in a technocratic way towards a more pluralistic vision that is rooted in the idea of phronesis. In the present context phronesis points the attention to the cultivation and nurturement of the researcher's formation as a type of engagement with the actual practice of researching, a practice in which researchers (and other parties concerned) are called to apply judgment and exercise discretion in specific and often unique situations without the re-assuring viewpoint of the technician.

Looking Beyond the Genes: The Interplay Between Signaling Pathways and Mechanics in the Shaping and Diversification of Epithelial Tissues

The core of Evo-Devo lies in the intuition that the way tissues grow during embryonic development, the way they sustain their structure and function throughout lifetime, and the way they evolve are closely linked. Epithelial tissues are ubiquitous in metazoans, covering the gut and internal branched organs, as well as the skin and its derivatives (ie, teeth). Here, we discuss in vitro, in vivo, and in silico studies on epithelial tissues to illustrate the conserved, dynamical, and complex aspects of their development. We then explore the implications of the dynamical and nonlinear nature of development on the evolution of their size and shape at the phenotypic and genetic levels. In rare cases, when the interplay between signaling and mechanics is well understood at the cell level, it is becoming clear that the structure of development leads to covariation of characters, an integration which in turn provides some predictable structure to evolutionary changes. We suggest that such nonlinear systems are prone to genetic drift, cryptic genetic variation, and context-dependent mutational effects. We argue that experimental and theoretical studies at the cell level are critical to our understanding of the phenotypic and genetic evolution of epithelial tissues, including carcinomas.