Abstract Discussing and debating expertise is close to the heart of science, technology, and society studies (STS). The field arose in the 1960s and 1970s as part of a new political situation in modern industrial societies centering on controversies over expertise and technical decision-making. Through its engagements with expertise, STS has strived in different ways to respectfully move beyond a traditional understanding of it as simply the certified knowledge and skills of experts. This has been done through a series of interrogations highlighting questions of political legitimacy, social substance, and socio-technical networks. Needless to say, these interrogations don’t see eye to eye on expertise, butthis is at least partly due to them starting from different places in science, technology, and society and relying on alternative units of analysis. The overall result, however, is that they collectively envision expertise as a contingent achievement that is “not so much found as made.” It is confirmed as the very lifeblood of technological societies preventing collapse.

What are the current challenges and opportunities for bringing actor-network theory (ANT) into issues-based science education? This article discusses experiences gained from introducing an educational version of ANT deploying digital technology into an upper secondary school science class. This teaching innovation, called controversy mapping, has been pioneered in different contexts of higher education before being adapted to school education. Experimenting with controversy mapping in a Swedish science class raised both conceptual and practical issues. These centre on: (1) how ANT-inspired controversy mapping redesigns the citizenship training enacted by institutionalized approaches to issues-based education as socioscientific issues (SSI); (2) how controversy mapping reconfigures the interdisciplinarity of issues-based science education; and (3) how controversy mapping displaces scientific literacy and knowledge of the nature of science as guiding concerns for teaching in favour of new preoccupations with digital literacy and digital tools and methods as contemporary infrastructures of free and open inquiry.

ABSTRACT Science and technology studies (STS) has cultivated a positive vision of technological controversies. By raising new issues to address, controversies are seen as generating more thorough and exhaustive processes of technology assessment. However, the ability to view controversies in this light remains dependent upon how technology is collectively imagined and understood. If it is envisioned as a classic technological fix then broader controversy is just what is intended to be overcome, not positively indulged. Albert Hirschman’s distinction between divisible and non-divisible conflicts captures such varying evaluations of controversy. In particular, it helps analyse how the long-standing fix of geological disposal of nuclear waste has been persistently defended as a non-negotiable object of technological concern – a recipe for escaping controversy by permanently isolating nuclear waste from the biosphere. Comparing the Swedish and French programmes for the geological disposal of nuclear waste shows how defending the technological integrity of a non-divisible disposal concept has remained an institutional fixation for Swedish nuclear waste management for over 30 years. In contrast, legislative demands for a reversible disposal concept introduced in France in the late 1990s have arguably served to unravel a technological fix into a divisible object of collective concern.

How can young people make use of digital tools and methods to get to grips with the risks and dilemmas arising out of contemporary science, technology and society relations? This chapter addresses the forms of agency enabled through a set of techniques for exploring and visualizing controversial technoscientific issues on the web. Given the particular orientation of these techniques, the empirical focus is on tensions and disruptions they give rise to in educational practice as they are appropriated by students in a Swedish upper secondary school context. Designed to aid the visual representation of complex processes of issue formation, the mapping tools worked against the primary inclination of teachers and students to conceive of them as aids for sorting issues out by demarcating more reliable sources of information from less reliable ones. However, extending such goals, the controversy maps students produced invited discussion and engagement with unresolved issues still-in-the-making as well the performative role of mediating technologies in enacting these issues. In this way they provided opportunities for more open forms of classroom deliberation and critical engagement consistent with Dewey's vision of the vital role of education in democratic societies.

In recent decades, the 'tenacious assumptions' of biomedicine regarding the neutrality and universality of its knowledge claims have been significantly challenged by the growth of new collaborative and patient-focused models of Healthcare delivery. In this article, we discuss and critically reflect upon one such alternative Healthcare model developed at the University of Gothenburg Centre for Person-Centred Care in Sweden. This centre uses three clinical routines of narrative, partnership and documentation to provide Healthcare to people recognized as unique individuals rather than patients. Person-centred care in Gothenburg and more broadly is based on the assumption that a person is independently capable of reasoning and verbal expression and willing to provide clear and genuine narratives and cooperate with Healthcare professionals. However, we argue that by emphasizing individual capabilities of reasoning and verbal expression, an unnecessarily limited conception of personhood risks being imposed on these routines. Drawing upon semi-structured interviews with researchers in three very different Gothenburg Centre for Person-Centred Care research projects - about healthy ageing in migrant communities, neurogenic communication disorders, and psychosis - we highlight that how persons are recognized as unique and capable varies significantly in practice across different Healthcare settings. Thus, we assert that person-centred care's own potentially tenacious assumptions about the attributes of personhood risk distracting attention away from the variety of creative ways that professionals and persons promisingly find for translating the ideal of person-centred care into practice.

Objective Although conceptual definitions of person-centred care (PCC) vary, most models value the involvement of patients through patient-professional partnerships. While this may increase patients’ sense of responsibility and control, research is needed to further understand how this partnership is created and perceived. This study aims to explore the realities of partnership as perceived by patients and health professionals in everyday PCC practice. Design Qualitative study employing a thematic analysis of semistructured interviews with professionals and patients. Setting Four internal medicine wards and two primary care centres in western Sweden. Participants 16 health professionals based at hospital wards or primary care centres delivering person-centred care, and 20 patients admitted to one of the hospital wards. Results Our findings identified both informal and formal aspects of partnership. Informal aspects, emerging during the interaction between healthcare professionals and patients, without any prior guidelines or regulations, incorporated proximity and receptiveness of professionals and building a close connection and confidence. This epitomised a caring, respectful relationship congruent across accounts. Formal aspects, including structured ways of sustaining partnership were experienced differently. Professionals described collaborating with patients to encourage participation, capture personal goals, plan and document care. However, although patients felt listened to and informed, they were content to ask questions and felt less involved in care planning, documentation or exploring lifeworld goals. They commonly perceived participation as informed discussion and agreement, deferring to professional knowledge and expertise in the presence of an empathetic and trusting relationship. Conclusions In our study, patients appear to value a process of human connectedness above and beyond formalised aspects of documenting agreed goals and care planning. PCC increases patients’ confidence in professionals who are competent and able to make them feel safe and secure. Informal elements of partnership provide the conditions for communication and cooperation on which formal relations of partnership can be constructed.

BACKGROUND:Person-centred care (PCC) is increasingly advocated as a new way of delivering health care, but there is little evidence that it is widely practised. The University of Gothenburg Centre for Person-Centred Care (GPCC) was set up in 2010 to develop and implement person-centred care in clinical practice on the basis of three routines. These routines are based on eliciting the patient's narrative to initiate a partnership; working the partnership to achieve commonly agreed goals; and using documentation to safeguard the partnership and record the person's narrative and shared goals.OBJECTIVE:In this paper, we aimed to explore professionals' understanding of PCC routines as they implement the GPCC model in a range of different settings.METHODS:We conducted a qualitative study and interviewed 18 clinician-researchers from five health-care professions who were working in seven diverse GPCC projects.RESULTS:Interviewees' accounts of PCC emphasized the ways in which persons are seen as different from patients; the variable emphasis placed on the person's goals; and the role of the person's own resources in building partnerships.CONCLUSION:This study illustrates what is needed for health-care professionals to implement PCC in everyday practice: the recognition of the person is as important as the specific practical routines. Interviewees described the need to change the clinical mindset and to develop the ways of integrating people's narratives with clinical practice.

BACKGROUND:The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC); and secondly, to explore how the recipients of PCC understand these strategies.METHODS:This paper is based on a qualitative study of the implementation of PCC in a Swedish context. It draws on semi-structured interviews with 18 researchers and 17 practitioners who adopted a model of PCC on four different wards and 20 patients who were cared for in one of these wards. Data from these interviews were first coded inductively and emerging themes are analysed in relation to normalization process theory (NPT).RESULTS:In addition to deliberate strategies, we identify emergent strategies to normalize PCC by (i) creating and sustaining coherence in small but continuously communicating groups (ii) interpreting PCC flexibly when it meets specific local situations and (iii) enforcing teamwork between professional groups. These strategies resulted in patients perceiving PCC as bringing about (i) a sense of ease (ii) appreciation of inter-professional congruity (ii) non-hierarchical communication.CONCLUSION:NPT is useful to identify and analyse deliberate and emergent strategies relating to mechanisms of normalization. Emergent strategies should be interpreted not as trivial solutions to problems in implementation, but as a possible repertoire of tools, practices and skills developed in situ. As professionals and patients may have different understandings of implementation, it is also crucial to include patients' perceptions to evaluate outcomes.

BACKGROUND:To empower patients and improve the quality of care, policy-makers increasingly adopt systems to enhance person-centred care. Although models of person-centredness and patient-centredness vary, respecting the needs and preferences of individuals receiving care is paramount. In Sweden, as in other countries, healthcare providers seek to improve person-centred principles and address gaps in practice. Consequently, researchers at the University of Gothenburg Centre for Person-Centred Care are currently delivering person-centred interventions employing a framework that incorporates three routines. These include eliciting the patient's narrative, agreeing a partnership with shared goals between patient and professional, and safeguarding this through documentation.AIM:To explore the barriers and facilitators to the delivery of person-centred care interventions, in different contexts.METHOD:Qualitative interviews were conducted with a purposeful sample of 18 researchers from seven research studies across contrasting healthcare settings. Interviews were transcribed, translated and thematically analysed, adopting some basic features of grounded theory.ETHICAL ISSUES:The ethical code of conduct was followed and conformed to the ethical guidelines adopted by the Swedish Research Council.RESULTS:Barriers to the implementation of person-centred care covered three themes: traditional practices and structures; sceptical, stereotypical attitudes from professionals; and factors related to the development of person-centred interventions. Facilitators included organisational factors, leadership and training and an enabling attitude and approach by professionals. Trained project managers, patients taking an active role in research and adaptive strategies by researchers all helped person-centred care delivery.CONCLUSION:At the University of Gothenburg, a model of person-centred care is being initiated and integrated into practice through research. Knowledgeable, well-trained professionals facilitate the routines of narrative elicitation and partnership. Strong leadership and adaptive strategies are important for overcoming existing practices, routines and methods of documentation. This study provides guidance for practitioners when delivering and adapting person-centred care in different contexts.

BACKGROUND:E-cigarettes are currently hotly debated as threatening to re-normalize cigarette smoking and make nicotine addiction publicly acceptable once more. In this paper I contextualize the e-cigarette controversy in light of longstanding disagreements about the meaning and significance of nicotine replacement technologies. A concerted effort to develop such technologies first emerged in Sweden at the end of the 1960s, embodying a vital tension. Two competing 'scripts' vied to influence and shape innovative designs. On the one hand, Nicorette chewing gum was conceived as a therapeutic device aiding smoking cessation. On the other hand, it was cast as a cigarette substitute designed to deliver nicotine 'in the right way', thereby advancing the creative destruction of the combustible cigarette as a drug delivery platform. METHOD:Drawing on historical and archival research I outline how these two alternative innovation scripts started out entangled with each other before becoming disentangled, leading to the eventual stabilization of Nicorette gum as a therapeutic product to be deployed in the treatment of smoking as a dependence disorder. RESULTS AND CONCLUSION:While a post-therapeutic future for nicotine replacement was charted by Michael Russell at the beginning of the 1990s, it is only with the rise of e-cigarettes after 2003 that such a future has started to verge on reality. E-cigarettes can be seen as resurrecting the historically marginalized script of nicotine replacement as dedicated to righting nicotine consumption and freeing it from the wrongful drug delivery of the modern cigarette.

This report is the product of research activity within the EC Seventh Framework Programme “Monitoring Developments for Safe Repository Operation and Staged Closure” (MoDeRn) Project. This project aims to further develop understanding of the role of monitoring in staged implementation of geological disposal to a level of description that is closer to the actual implementation of monitoring. It focuses on monitoring conducted to confirm the basis of the long term safety case and on monitoring conducted to inform on options available to manage the stepwise disposal process from construction to closure (including e.g. the option of waste retrieval). This report investigates the potential of citizen stakeholder engagement in the identification of monitoring objectives and the development of monitoring strategies for geological disposal of high level waste (HLW) or spent nuclear fuel (SNF). It builds on an earlier MoDeRn report describing monitoring the safe disposal of radioactive waste as a socio-technical activity (Bergmans, Elam, Simmons and Sundqvist 2012).

AIM - To discuss how scientific confirmation of cigarette smoking as a major contemporary drug problem during the 1980s was preceded by a rising tide of clinical and pharmaceutical innovation dedicated to treating smoking as a problem of addiction. BACKGROUND - This current of innovation, commencing already in the 1950s, carried the smokers’ clinic and nicotine replacement therapies (NRTs) into the world, both of which were originally invented and pioneered in Sweden. It is argued that both of these inventions were vital for advancing the problematization of smoking as a matter of nicotine addiction. While the British doctor Lennox Johnston is well-known for his early attempts to demonstrate the reality of smoking as nicotine addiction through auto-experimentation, the historical significance of Börje Ejrup’s founding of the first smokers’ clinics in Stockholm in the late 1950s has not been widely commented upon. Attempting to remedy this situation, the rise and fall of Ejrup’s clinics deploying lobeline substitution therapy as a cure for ‘nicotinism’ is outlined in the main body of the paper. FINDINGS - Although the clinical treatment of smoking as addiction lost momentum during the 1960s, the invention of Nicorette gum in southern Sweden at the end of the decade provided renewed impetus. Commencing in Helsingborg and Lund in 1970, the smokers’ clinic and NRTs entered into the long-term service of each other; a new combination that in just over a decade would succeed in propagating the reality of smoking as nicotine addiction on to a global stage.

In recent decades, addiction has been medicalized anew through the rise of an influential ‘brain disease paradigm’. This questions the equivalence of addiction to drug dependence by re-emphasizing loss of self-control over unhealthy impulses as the disease locus. While showing continuities with the nineteenth-century vision of addictions as ‘diseases of the will’, neurobiology objectifies disease as disrupted neurochemical transmission and lasting neuroadaptation. The brain disease paradigm emerged together with rapid advances in neuroimaging technology as well as intensified research efforts to confirm cigarette smoking as nicotine addiction. After smoking achieved such recognition in the late 1980s, numerous other unhealthy impulses and appetites have likewise come under neurobiological investigation as prospective cases of addiction. Despite its technoscientific sophistication, neurobiology's biomedicalization of addiction remains as partial and ambiguous as past medicalizations. By confirming moral self-transformation anew as an indispensable component of treatment and recovery, neurobiology revives addiction as a moral disease in the process of its objectification. Furthermore, through its rediscovery of a classic nineteenth-century ‘liberal disease’ at the molecular level, the neurobiology of addiction is acting as a vital moralizing resource in the biomedicalization of health and illness more generally today.

A major theme in the later work of Foucault is the rise of a new form of power over life — bio-power. While the sovereign exercised power over life by commanding ‘the right to take life or let live’, the advent of capitalist society was preceded by a new concern with the productive administration of life, and the power ‘to foster life or disallow it to the point of death’ (Foucault 1990). Bio-power aspires to power over life ‘throughout its unfolding’ and understands death as marking the limit of its dominion. Foucault also saw bio-power as corresponding with a re- spatialization of power. While the generic space of operation for sovereign power is the territory, the equivalent space of bio-power is that of circulation. Due to its overriding concern with fostering life, optimizing it and multiplying it, bio-power favours circulation, but it recognizes the ambiguous and dual nature of productive patterns of exchange and intercourse. The circulation of food may avert famine, but the greater free-flow of people, goods and services also allows for the broader spread of infectious diseases. Thus, bio-power is concerned with ‘organizing circulation, eliminating its dangerous elements, making a division between good and bad circula-tion, and maximizing the good circulation by diminishing the bad’ (Foucault 2007).

Purpose – With reference to the long-term struggle to confirm cigarette smoking as a manifestation of nicotine addiction, this chapter explores the extent to which new understandings of addictions as ‘appetitive disorders’ rather than ‘dependence disorders’ derive from treatment technology development as well as advances in basic scientific research.Approach – Through historical analysis it is discussed how cigarette smoking only became widely accepted as a real drug problem in the 1980s after it had been shown to be amenable to treatment as such through the use of novel nicotine replacement therapies.Findings – These replacement therapies succeeded in showing that the same drug that drew users into addiction could be redeployed to help draw up them out of it. Nicorette® could serve as at least the partial antidote to nico-wrong (cigarettes). However, as relapse to smoking has remained the most likely outcome of any smoking cessation attempt, so medicinal nicotine has also served to demonstrate that nicotine addiction is ultimately a problem of an uncontrollable appetite for cigarettes in excess of drug dependence.Implications – Pharmaceutical incursion on cigarette smoking commencing in the late 1970s pointed to the need for a new mental disease model of drug-related problems while also providing valuable new tools and insights for ensuing brain research.

Monitoring geological repositories for high-activity radioactive wastes has both technical and social dimensions, which are closely interrelated. To investigate the implications of this for geological disposal, data on experts’ expectations of repository monitoring and the functions that it is expected to serve were analysed. The analysis drew on strategic and technical documents on monitoring produced by national agencies and by international organisations or projects; interviews with specialists in radioactive waste management organisations on monitoring and on their perceptions of societal concerns and expectations; and observations from technical workshops on repository monitoring. Three main rationales for monitoring were found: performance confirmation; decision support in a step-wise process; and public and stakeholder confidence building. The expectation that monitoring will enhance public confidence is then examined from a social scientific perspective and the potential for and challenges to using monitoring in this way are reviewed. In conclusion, implications for stakeholder engagement in the development of monitoring objectives and strategies are discussed.