Reproductive materialism and justice for women with abortion care needs in Uganda.

While reproductive health justice is often assumed to be inherent in reproductive health interventions, the nature of injustices, and the reasons for and mechanisms of concealment, are often unclear. In this article, we draw on an ethnography of priority setting and healthcare practice in eastern Uganda to illuminate these injustices and the mechanisms of concealement. We focus on discursive practices as the mechanisms through which power is activated and navigated, such that health practitioners are able to evade state surveillance and retribution. While language discourses conceal and normalise reproductive health injustices, discursive practices of care and priority setting enable reproductive controls to be navigated in ways that amplify these injustices and create new ones. In interventions, precarious conditions that impact women's reproductive health and living circumstances are often overlooked or concealed. We illustrate the convergence of biopower and necropolitical strategies to illuminate these conditions. Using the concept of reproductive materialism, we show how neoliberalism cultivates particular conditions of everyday life, in which populations are positioned as instruments for pecuniary motives, and normative controls are used to further financial gain.

Clínica psicológica ampliada em IST/HIV-Aids: sentidos produzidos por psicólogas no SUS / Amplified clinic in STI/HIV-AIDS: meanings produced by psychologists in Brazilian health public system (SUS) / Clínica psicológica ampliada en ITS/VIH-sida: sentidos producidos por psicólogas en el sistema único de salud (SUS)

Este estudo buscou compreender as práticas discursivas de psicólogas(os) sobre a atuação psicológica na abordagem às IST/HIV-Aids em serviços especializados em uma cidade da Bahia. Para tanto, foram realizadas nove entrevistas semiestruturadas com profissionais ligadas(os) a serviços da rede pública de saúde. A perspectiva teórico-metodológica da psicologia social construcionista inspirou o processo de produção e análise das informações. Os resultados apontaram para importantes rupturas e ressignificações dos repertórios linguísticos gestados no cotidiano das práticas em saúde (tempo vivido e tempo curto), em atenção às necessidades dos contextos de atuação, ainda que elementos da formação clássica da psicologia também sejam utilizados para caracterizar a atuação nesses espaços. Nos serviços pesquisados, as(os) psicólogas(os) têm conseguido enxergar e reconhecer demandas de ordens biológica e social, que indicam aspectos objetivos da vivência dos(as) usuários(as) (menos afeitos ao ideário individualista), apontando para uma contextualização da clínica psicológica no campo da saúde pública, embora nem todas(os) admitam que essas demandas devam ser cuidadas também pela(o) profissional de psicologia. Do ponto de vista teórico, partimos de reflexões sobre as noções de clínica ampliada e de atuação psicológica coletiva até alcançarmos a noção de clínica psicológica ampliada, situada em relação às especificidades da atuação psicológica no campo do HIV-Aids. Nessa direção, a clínica psicológica ampliada apresenta-se em potencial construção, situando-se entre aproximações e recuos do que seria uma prática desenvolvida de modo contextualizado e comprometido com os processos subjetivos de pessoas vivendo com HIV-Aids ou tentando se proteger em situações concretas de vulnerabilidade, que geram sofrimento psicossocial.(AU)

This study aimed to understand the discursive practice of psychologists regarding the psychological practice in the approach to STI/HIV-AIDS in specialized services in a city of Bahia. To do so, we conducted nine semi-structured interviews with professionals related to health public services. The theoretical-methodological perspective of social constructionist psychology inspired the process of information production and analysis. The results pointed towards important ruptures and resignifications of the linguistic repertoires created in the everyday health practices (lived time and short time), attentive to the needs of the contexts of practice, although elements of traditional psychology training are also used to characterize the work in these contexts. In the surveyed services, the psychologists have been noticing and recognizing biological and social demands, which indicate objective aspects of the users' experience (less adept to individualistic values). This fact points towards a contextualization in the psychological work in the public health field, although not all interviewed psychologists admit that this type of demand should also be addressed by psychology professionals. From a theoretical point of view, we started from reflections on the notions of amplified clinic and the collective psychological practice resulting in the concept of amplified psychological clinic that relates to specificities of the psychological work in the field of HIV-AIDS. In this respect, the amplified psychological clinic is in potential construction, approaching and retreating from what would be a developed practice contextualized and committed to the subjective processes of people living with HIV-AIDS or trying to protect themselves in concrete vulnerable situations, which produces psychosocial suffering.(AU)

Este estudio pretende comprender las prácticas discursivas de psicólogas/os sobre la acción psicológica para abordar las infecciones de transmisión sexual y el sida (ITS/VIH-sida) en servicios asistenciales especializados en una ciudad de Bahía (Brasil). Con este fin, se realizaron nueve entrevistas semiestructuradas con profesionales vinculados a los servicios de salud pública. La perspectiva teórico-metodológica de la psicología social construccionista inspiró el proceso de producción y análisis de datos. Los resultados apuntaron a importantes rupturas y resignificaciones de los repertorios lingüísticos producidos en la práctica diaria de la salud (tiempo vivido y tiempo corto), atentos a las necesidades de los contextos de acción, aunque también se utilizan elementos de la formación clásica de la psicología para caracterizar la práctica en esos espacios. En los servicios investigados, las/los psicólogas/os han podido ver y reconocer las demandas y sus dimensiones biológicas y sociales, que indican aspectos objetivos de la experiencia de los/as usuarios/as (poco afectados por los ideales individualistas), apuntando a una contextualización de la clínica psicológica en el contexto de la salud pública, aunque no todos admiten que estas demandas también deban ser atendidas por el profesional de la psicología. Del punto de vista teórico, partimos de reflexiones sobre las nociones de clínica ampliada y acción psicológica colectiva hacia llegar a la noción de clínica psicológica ampliada, situada en la relación con las especificidades de la acción psicológica en el campo del VIH/sida. En ese sentido, la clínica psicológica ampliada es una potencial construcción, que tiene lugar entre aproximaciones y retrocesos de lo que sería una práctica desarrollada de manera contextualizada y comprometida con los procesos subjetivos de las personas que viven con VIH/sida o que intentan protegerse en situaciones concretas de vulnerabilidad, que generan sufrimiento psicosocial.(AU)

Power, policy and abortion care in Uganda.

Unsafe abortion practices remain the major contributor to maternal death in Uganda, impeding the achievement of universal health coverage and quality of maternal health care. Using an ethnographic design and critical discourse analysis, we explored the operations of power in setting maternal healthcare priorities, as evident at the 2018 Reproductive, Maternal, Neonatal, Child and Adolescents Health Conference. Observational data were collected of the policy-making activities, processes and events and key informant interviews were conducted with 27 participants. We describe how neoliberal and state governance through the structure and organization of policy-making, epistemic governance and universal concepts of 'high-impact' interventions, results-based financing, cost-effectiveness and accountability converge to suppress the articulation of local conditions associated with unsafe and risky abortion. By defining maternity along the continuum of birth and emphasizing birthing women, priority-setting was directed towards interventions promoting women's normative role as mothers while suppressing unmet abortion care needs. Finally, discursive and communicative materials controlled how women of reproductive age in Uganda managed reproduction.

Your evidence? Machine learning algorithms for medical diagnosis and prediction.

Computer systems for medical diagnosis based on machine learning are not mere science fiction. Despite undisputed potential benefits, such systems may also raise problems. Two (interconnected) issues are particularly significant from an ethical point of view: The first issue is that epistemic opacity is at odds with a common desire for understanding and potentially undermines information rights. The second (related) issue concerns the assignment of responsibility in cases of failure. The core of the two issues seems to be that understanding and responsibility are concepts that are intrinsically tied to the discursive practice of giving and asking for reasons. The challenge is to find ways to make the outcomes of machine learning algorithms compatible with our discursive practice. This comes down to the claim that we should try to integrate discursive elements into machine learning algorithms. Under the title of "explainable AI" initiatives heading in this direction are already under way. Extensive research in this field is needed for finding adequate solutions.

Analyzing How Discursive Practices Affect Physicians' Decision-Making Processes: A Phenomenological-Based Qualitative Study in Critical Care Contexts.

An intensive care unit (ICU) is a demanding environment, defined by significant complexity, in which physicians must make decisions in situations characterized by high levels of uncertainty. This study used a phenomenological approach to investigate the decision-making (DM) processes among ICU physicians' team with the aim of understanding what happens when ICU physicians must reach a decision about the infectious status of a patient. The focus was put on the identification of how the discursive practices influence physicians' DM processes and on how different ICU environments make different discursive profiles emerge, particularly when a key issue is at the center of the physicians' discussion. A naturalistic approach used in this study is particularly suitable for investigating health care practices because it can best illuminate the essential meaning of the "lived experiences" of the participants. The findings revealed a common framework of elements that provide insight into DM processes in ICUs and how these are affected by discursive practices.

Problem-solving for STEM learning: navigating games as narrativized problem spaces for 21st century competencies.

Identifying educational competencies for the 21st workplace is driven by the need to mitigate disparities between classroom learning and the requirements of workplace environments. Multiple descriptors of desired 21st century skill sets have been identified through various wide-scale studies (e.g., International Commission on Education for the 21st Century) and consistently within the context of science, technology, engineering, and mathematics (STEM) learning, the ability to problem solve, particularly complex problem-solving, remains a crucial competency. In this paper, we look at how current contemporary spaces such as the immensely popular, massively multiplayer online role-playing game(MMORPG), World of Warcraft, (WoW) afford problem-solving skill acquisition in the context of Singaporean youth learners. Given that WoW exists as a contextual space with an overarching narrativized problem to be solved, our investigation focused on two important related constructs that underpin learners' problem-solving trajectory-learning and identity becoming within contemporary domains of technology learning. We present findings of an ethnographic investigation of one youth gamer within the affinity spaces of WoW. Moving away from traditional mentalistic construals of problem-solving, our findings indicate that problem-solving within WoW may be characterized by a triadic-D model of domain, disquisitional, and discursive practices within self, social, and structural dialectics. Theoretical considerations for broadening the understanding of a situated and embodied notion of problem-solving and identity becoming within STEM learning are proposed.

Micro-naciones del sí-mismo en tiempos de guerra: análisis de discurso y psicología / Micro-Nations of the Self in Times of War: Discourse Analysis and Psychology

Este artículo considera problemas del análisis de discurso contemporáneo referidos a los siguientes tópicos: su foco en la conversación cotidiana, las secuencias formales, la explicación correcta y la segregación disciplinaria. Problemas que replican dificultades generales que muestra la disciplina de la psicología, tales como la mirada puesta sobre aquellos que están fuera de su dominio, el reduccionismo a nivel del individuo, la abstracción de la conducta y los procesos cognitivos, los reclamos a la autoridad interpretativa y la evitación de la política como tal. Se describen aproximaciones a la práctica discursiva desde dentro de una de las recién formadas micronaciones, la cual, a su vez, provee una nueva manera de pensar el papel de la psicología en procesos sociales más amplios. Los siguientes principios alternativos para la práctica discursiva se derivan de esta descripción: dirigir la mirada de nuevo sobre la psicología y las fuerzas ideológicas que le dieron cabida; tratar las formas de representación como puntos para el ejercer el poder; analizar las formas sociales de manera situada contextual e históricamente; destacar formas de práctica discursiva que abren espacios para la argumentación acerca de la naturaleza de la interpretación y conectar las contradictorias fuerzas afectivas individuales con la lucha política.

This paper outlines problems with contemporary discourse analysis - a focus on everyday conversation, interpersonal interaction, formal sequences, correct explication and disciplinary segregation - problems which replicate general problems with the discipline of psychology (the gaze upon those outside its domain, reduction to the level of the individual, abstraction of behaviour and cognitive processes, claims to interpretative authority, and avoidance of politics as such). Approaches to discursive practice are described from within one of the recently-formed micro-nations which also provide a new way of thinking about the role of psychology in broader social processes. Alternative principles for discursive practice are derived from this description: turning the gaze back onto psychology and the ideological forces that give rise to it; treating forms of representation as sites for the relay of power; tracing how social forms are treated as contextually and historically situated; highlighting forms of discursive practice that open up spaces for interpretation and argument about the nature of interpretation; and connecting contradictory individual affective forces with the realm of political struggle.