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1
McGill, David Graham. The effects of differential feedback on negative hypothesis testing. Sudbury, Ont: Laurentian University, Department of Psychology, 2002.
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2
Tsui, C. K. Behavior of Ontario-type bridge deck on steel girders: Negative moment region and load capacity. [Austin]: The Center, 1986.
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3
Fay, Kurt F. von. Review of negative pore pressure: Its measurement, and testing of the CRL apparatus. Denver, Colo: Geotechnical Branch, Division of Research and Laboratory Services, Engineering and Research Center, 1985.
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Leacock, Claudia. Automatic assessment of vocabulary usage without negative evidence. Princeton, N.J: Educational Testing Service, 2001.
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Torrance, Harry. Do summative assessment and testing have a positive or negative effect on post 16 learners motivation for learning in the learning and skills sector: A review of the research literature on assessment in post compulsory education in the UK. London: Learning and Skills Research Centre, 2004.
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(Editor), N. J. Wald, und Richard Doll (Editor), Hrsg. Interpretation of Negative Epidemiological Evidence for Carcinogenicity (I a R C Scientific Publication). Oxford University Press, USA, 1986.
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7
Young, Thomas P. Laboratory Testing Strategies. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190493097.003.0008.
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Laboratory confirmation of HIV infection is primarily through the detection of HIV antibodies in an individual. Using the current immunoassays and confirmatory testing, false-positive results are exceedingly rare. However, providers should use clinical judgment when interpreting test results and consider additional follow-up testing when appropriate. False-negative immunoassays are also exceedingly rare except for individuals who are early in their infection and have yet to produce HIV antibodies that are detectable by current assays. Rapid HIV tests have similar testing accuracies as compared to those of currently available immunoassays and can be useful testing options for settings such as health fairs, nonclinical locations, and other situations in which quickly receiving preliminary test results would be beneficial.
8
E, Bonilla Francisco, Texas. State Dept. of Highways and Public Transportation., United States. Federal Highway Administration. und Texas Transportation Institute, Hrsg. Composite action of precast panel bridge decks in negative moment regions. College Station, Tex: Texas Transportation Institute, Texas A&M University, 1987.
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9
J, Wald Nicholas, Doll Richard und International Agency for Research on Cancer., Hrsg. Interpretation of negative epidemiological evidence for carcinogenicity: Proceedings of a symposium held in Oxford, 4-6 July 1983. Lyon: International Agency for Research on Cancer, 1985.
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10
Rubenzer, Steven J. Assessing Negative Response Bias in Competency to Stand Trial Evaluations. Oxford University Press, 2018. http://dx.doi.org/10.1093/med-psych/9780190653163.001.0001.
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Assessing Negative Response Bias in Competency to Stand Trial Evaluations provides a comprehensive guide to assessing malingering, feigning, poor effort, and lack of cooperation in competency to stand trial (CST) examinations. It draws on both the author’s extensive experience as a CST examiner and the vast, dynamic professional literature from forensic psychology, clinical psychology, and neuropsychology on assessing response style. The assessment process is considered from beginning to report writing and testimony, with tips regarding interview strategies, fact patterns and behaviors suggestive of feigning, testing, and creative and ethical use of collateral data. Every major validity test used by CST examiners is thoroughly and critically reviewed, as are others that are promising and not yet widely adopted. This includes self-report inventories such as the MMPI-2, MMPI-2-RF, PAI, and SIMS; structured interviews like the SIRS, SIRS-2, and M-FAST; performance validity tests like the TOMM, VIP, 15 item Test, and WMT; and CST-specific tests like the ILK and ECST-R Atypical Presentation Scales. A complete chapter is devoted to means to summarize and combine data from different tests and sources, and another to special populations such as defendants who claim amnesia, are intellectually disabled, or are adolescents. Report writing and testimony considerations are discussed in detail, with implications for the assessment and practice. In Chapter 10, CST examiners’ practices, including preferences for tests and collateral sources, are reported along with the perceived prevalence of various invalid presentation styles. Finally, policy implications of feigning and suggestions for cost-effective practice are provided.
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United States. Office of Educational Research and Improvement., Hrsg. TESTING POSITIVE VERSUS NEGATIVE CLAIMS: A PRELIMINARY INVESTIGATION OF THE ROLE OF COVER STORY ON THE ASSESSMENT OF EXPERIMENTAL DESIGN... [S.l: s.n., 2003.
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12
Mathiesen, Amber, und Kali Roy. Prenatal Screening. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190681098.003.0003.
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This chapter provides information about a genetic counselor’s role in prenatal screening, including discussing and offering options to a patient, interpreting and providing results, or managing referrals based on abnormal results. It discusses how a screen is evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and personal utility. It provides a detailed description of both maternal serum screening and cell-free DNA testing. The maternal serum screening discussion includes information on multiples of median, calculating risk, timing, pattern association, limitations, and follow-up. The review of cell-free DNA testing includes fetal fraction, methodology, test performance, limitations and considerations for testing, and follow-up. This chapter also provides a list of additional resources to use for cell-free DNA testing.
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Silva, Alcino J., und John Bickle. The Science of Research and the Search for Molecular Mechanisms of Cognitive Functions. Herausgegeben von John Bickle. Oxford University Press, 2009. http://dx.doi.org/10.1093/oxfordhb/9780195304787.003.0005.
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This article considers research methodologies relevant to the search for molecular mechanisms of cognitive functions. It proposes a new general framework for understanding contemporary science called the science of research (SR). It discusses two scientific puzzles concerning the neurobiology of cognitive functions and some recently noticed inefficiencies in institutionalized science across the board. It suggests that both of these puzzle can be addressed by the SR framework for discovering and testing hypotheses about science. It also discusses the so-called positive and negative alteration and describes Koch's postulates, John Stuart Mill's methods, and reductionism in actual scientific practice.
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Cetin, Derrick. Medical Evaluation of the Bariatric Surgery Patient. Herausgegeben von Tomasz Rogula, Philip Schauer und Tammy Fouse. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190608347.003.0002.
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Evaluation of the obese patient requires identification of all comorbidities and health conditions, including underlying cardiac and pulmonary conditions that could have a negative outcome on noncardiac surgery. Once comorbidities have been recognized, aggressive optimization of these medical conditions can provide improved outcomes after bariatric surgery. Estimating medical risk can be performed by several validated classification systems. The preoperative checklist and clinical practice guidelines (CPG) were updated in 2013. The CPG recommendations for preoperative evaluation of the bariatric surgery patient include lab testing, nutritional screening, endocrine assessment, and cardiopulmonary assessment, including sleep apnea screening. The CPG suggest an extensive multidisciplinary team approach to the preoperative bariatric surgery patient. Finally, the medical evaluation includes an algorithm for a seven-step approach to the preoperative visit. Also recommended for evaluation of the morbidly obese patient is an algorithm that uses a five-step approach after a comprehensive history and physical exam and lab testing.
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Merten, Thomas. False Symptom Claims and Symptom Validity Assessment. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190612016.003.0012.
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False symptom claims and distorted symptom presentations are not at all rare in civil and criminal forensic cases where secondary gain is immanent. They reach from reported nonspecific memory and attention problems to intellectual disability, full-blown autobiographical memory loss, or crime-related amnesia. Symptom validity assessment has, to a large extent, been developed by clinical neuropsychologists to distinguish between authentic and nonauthentic symptom presentations. Malingering is only one of several manifestations of uncooperativeness. Today, most forensic neuropsychology experts would agree that neuropsychological testing is incomplete if not adequately checked for possible negative distortions. This chapter reviews modern methods of symptom validation, with emphasis on forced-choice response formats.
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Douaihy, Antoine, Neeta Shenai, Kimberly Clinebell und Mary Ann Cohen. HIV Discrimination, Stigma, and Gender-Based Violence. Herausgegeben von Mary Ann Cohen, Jack M. Gorman, Jeffrey M. Jacobson, Paul Volberding und Scott Letendre. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199392742.003.0006.
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Stigma, discrimination, and gender-based violence complicate and perpetuate the human immunodeficiency virus (HIV) pandemic. Although remarkable strides have transformed AIDS from a rapidly fatal infectious illness to a chronic manageable illness, HIV-based stigma, discrimination, and gender-based violence, together known as AIDSism, still exist and have not been transformed in the same way as the illness itself. These barriers continue to have a negative impact on prevention and testing as well as in engagement, retention, and adherence to care. This chapter explores the role that clinicians can play in recognizing and ameliorating HIV stigma, discrimination, and gender-based violence in order to diminish both suffering and HIV transmission and lead to compassionate and competent approaches to care.
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Phillips, Lawrence M., und Leslee J. Shaw. Cost Effectiveness of Imaging with Nuclear Cardiology. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0032.
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This chapter focuses on the economic data available for cardiovascular (CV) imaging. The total costs of testing are substantively lower than those associated with invasive procedures. There are several ongoing randomized trials, such as the PROMISE trial, that may further add to our evidence base on the cost implications of CV imaging. Data for stress nuclear cardiology supports its utility in terms of a high prognostic accuracy and that this test is economically attractive; notably for patients with a high likelihood of coronary artery disease. Data also supports that this benefit does not only include patients with known coronary artery disease but also the high likelihood subsets of the elderly or functionally impaired where ischemic findings play a fundamental role in ischemia-guided management. Importantly, more recent data support that alternative testing strategies have reduced cost in subsets of patients including lower risk women with stable chest pain and in the acute evaluation of low risk chest pain in the ED. Negative evidence is extremely important for the field of CV imaging and this more recent data should be embraced as defining our limitations in nuclear cardiology.
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Wise, Matt, und Paul Frost. ICU treatment of sepsis and septic shock. Herausgegeben von Patrick Davey und David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0152.
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Bacteria are the most frequent causes of severe sepsis and septic shock, while viruses, fungi, and parasites are implicated less often. Positive cultures are found in only 60% of cases; this may be the result of previous antibiotic therapy or inadequate sampling or testing. The etiology of sepsis is constantly changing; whereas Gram-negative organisms used to make up the majority of cases, Gram-positive bacteria now predominate. Sepsis due to fungal disease has also seen a dramatic rise. These changes may be explained by alterations in patient demographics, such as an increasingly elderly population with multiple comorbidities; an increased frequency of indwelling catheters or devices; and greater numbers of patients with immunosuppression as a result of disease or drug therapy. This chapter covers symptoms, demographics, diagnosis, investigation, prognosis, and treatment within the ITU environment.
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Pitt, Matthew. Results of the clinical application of SPACE in suspected disorders of the neuromuscular junction. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198754596.003.0011.
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Findings in a large cohort of children with disorders of the neuromuscular junction are presented along with those in non-primary neuromuscular junction abnormalities. From these results it is possible to derive test parameters for stimulated potential analysis using concentric needle electrodes (SPACE) including sensitivity and specificity, along with positive and negative predictive values. The differences between performing stimulation techniques to determine jitter in children and adults are highlighted as are technical aspects and the effects of the differential diagnosis on interpretation of results. An investigative strategy is outlined to be used with SPACE. The chapter concludes with discussion of the occurrence of normal jitter measurements with SPACE in proven cases of myasthenia as well as the phenomenon of delayed diagnosis of myasthenia and its relationship to the availability of neurophysiological testing.
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Edgeworth, Jonathan. Antibiotic resistance in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0289.
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The two objectives of ensuring early appropriate antimicrobial treatment for septic patients on the intensive care unit (ICU), and limiting emergence and spread of antimicrobial resistance are both complicated and potentially conflicting. Increasingly unpredictable resistance, particularly amongst Gram-negative bacteria, through both local selection and transmission, and importation of globally successful resistant clones encourages the use of broad-spectrum empiric antimicrobials for septic patients, including in combination. This may lead to a vicious cycle whereby increasing antibiotic use increases resistance, which in turn leads to higher levels of inappropriate therapy. In response, the multi-disciplinary ICU-team implements infection prevention and control, and antimicrobial stewardship programmes. Antimicrobial stewardship programmes provide interventions and guidance to optimize appropriate therapy,whilelimiting unnecessary use through a variety of measures. The development of rapid molecular testing for bacterial identification and antimicrobial susceptibility prediction could potentially bring useful microbiological information to the bedside at the time of therapeutic decision making.
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Martin, Jeffrey J. Physical Activity Interventions. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190638054.003.0036.
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In addition to theory testing, researchers have also examined if exercise interventions serve to enhance psychological constructs such as self-esteem and behavior such as functional fitness, activities of daily living (ADL), and physical activity. The purpose of this chapter is to review the physical activity (PA) intervention research and offer criticisms and future research directions. Laboratory PA interventions have been effective at increasing physical capacity, muscular strength, walking ability, and reducing body weight, stress, depression, and pain. However, laboratory research has been criticized for lacking ecological validity, thus researchers have also investigated whether lifestyle-type community or field-based interventions are effective. Researchers have shown that increasing social support for PA is effective for adults, and water-based activities help children with cerebral palsy increase their functional fitness. Nontraditional approaches such as yoga, massage, relaxation, and mindfulness training might be considered potential antecedents of reduced negative affect, increased positive affect, and enhanced functional fitness.
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Todd, Stacy, und Nick Beeching. Fungal infection. Herausgegeben von Patrick Davey und David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0315.
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Fungi, comprising yeasts, moulds, and higher fungi, have a worldwide distribution and are uncommon causes of disease in healthy individuals. However, over the last 20 years, invasive fungal disease (IFD) has become an increasing cause of morbidity and mortality. This is probably due to the increasing numbers of patients with underlying host conditions, which predispose to opportunistic IFD (e.g. transplant and anti-tumour necrosis factor immunosuppression, HIV, or chronic lung disease), and to increased recognition of endemic IFD (e.g. histoplasmosis), which cause disease in both immunocompetent and immunocompromised hosts in selected geographic locations. Diagnosis of IFD remains a challenge. Symptoms are often non-specific, and a definite diagnosis requires invasive sampling with appropriate laboratory testing of these samples. Non-invasive tests are being developed, but their positive and negative predictive values still need validation. Diagnostic criteria (‘proven, probable, and possible’) established primarily for use in research and clinical trials can also prove useful in clinical environments. However, the most important step in identifying patients with IFD is to consider the diagnosis in those at risk. This chapter will focus on the commonest causes of IFD (Candida spp., Aspergillus spp., Cryptococcus spp., and histoplasmosis).
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Peacock, Sharon J., und David A. B. Dance. Glanders. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0029.
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Glanders is a serious zoonotic disease that primarily affects equids (horses, mules and donkeys). A disease eradication programme based on case detection and destruction of infected domestic animals has been highly successful and the number of reported glanders cases in animals worldwide is now very low. Human glanders is extremely rare and associated with occupations associated with extensive contact with equids. Glanders is caused by Burkholderia mallei, a Gram-negative, non-motile, facultative intracellular organism that is an obligate parasite of equids with no other known natural reservoir. B. mallei is transmitted by direct contact with infected animals, or indirectly via communal food and water sources that have become contaminated by an infected animal. The clinical presentation in equids can be acute or chronic and has been categorized into nasal, pulmonary and cutaneous forms. Diagnosis is based on culturing B. mallei from lesions or exudates and skin or serological testing. Infected animals are usually euthanized. Optimal antimicrobial therapy for human glanders is unknown, and current advice is to adopt antimicrobial treatment guidelines for human melioidosis. There is no vaccine available for either humans or other animals. B. mallei is considered a potential biological weapon and is a Centers for Disease Control and Prevention category B select agent.
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Heidet, Laurence, Bertrand Knebelmann und Marie Claire Gubler. Alport syndrome. Herausgegeben von Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0323.
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The diagnosis of Alport syndrome is suspected from the clinical features and confirmed by identifying the almost pathognomonic ultrastructural changes to the basement membrane in a family member with early disease (so that glomeruli are not too sclerosed), or in modern times by identifying a causative mutation in one or more of the three implicated COL4 genes. Genetic testing is becoming simpler and cheaper, but is still out of the reach of many. Eighty-five per cent of cases are caused by COL4A5 mutations and 10–15% by autosomal recessive disease. A significant proportion of morbidity in X-linked disease occurs in female ‘carriers’ heterozygous for the disease. Changes by light microscopy are non-specific, and can be misleading unless accompanied by electron microscopy. Immunohistology can be helpful but may not be definitive as some causative mutations are not associated with absence of protein product. As COL4A5 is expressed in skin, skin studies are theoretically useful, but they are technically challenging and only a definite negative result is helpful. It is important to distinguish other disorders causing renal disease with deafness, and other causes of glomerular haematuria. Two rare syndromes are caused by extended deletions beyond the COL4A5 gene: X-linked Alport syndrome with diffuse oesophageal leiomyomatosis in which smooth muscle leoimyomas is transmitted in a dominant fashion, and X-linked Alport syndrome with mental retardation.
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Giannitsis, Evangelos, und Hugo A. Katus. Biomarkers in acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0036.
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Biomarker testing in the evaluation of a patient with acute chest pain is best established for cardiac troponins that allow the diagnosis of myocardial infarction, risk estimation of short- and long-term risk of death and myocardial infarction, and guidance of pharmacological therapy, as well as the need and timing of invasive strategy. Newer, more sensitive troponin assays have become commercially available and have the capability to detect myocardial infarction earlier and more sensitively than standard assays, but they are hampered by a lack of clinical specificity, i.e. the ability to discriminate myocardial ischaemia from myocardial necrosis not related to ischaemia such as myocarditis, pulmonary embolism, or decompensated heart failure. Strategies to improve clinical specificity (including strict adherence to the universal myocardial infarction definition and the need for serial troponin measurements to detect an acute rise and/or fall of cardiac troponin) will improve the interpretation of the increasing number of positive results. Other biomarkers of inflammation, activated coagulation/fibrinolysis, and increased ventricular stress mirror different aspects of the underlying disease activity and may help to improve our understanding of the pathophysiological mechanisms of acute coronary syndromes. Among the flood of new biomarkers, there are several novel promising biomarkers, such as copeptin that allows an earlier rule-out of myocardial infarction in combination with cardiac troponin, whereas MR-proANP and MR-proADM appear to allow a refinement of cardiovascular risk. GDF-15 might help to identify candidates for an early invasive vs conservative strategy. A multi-marker approach to biomarkers becomes more and more attractive, as increasing evidence suggests that a combination of several biomarkers may help to predict individual risk and treatment benefits, particularly among troponin-negative subjects. Future goals include the acceleration of rule-in and rule-out of patients with suspected acute coronary syndrome, in order to shorten lengths of stay in the emergency department, and to optimize patient management and the use of health care resources. New algorithms using high-sensitivity cardiac troponin assays at low cut-offs alone, or in combination with additional biomarkers, allow to establish accelerated rule-out algorithms within 1 or 2 hours.
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Shaibani, Aziz. Pseudoneurologic Syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0022.
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The term functional has almost replaced psychogenic in the neuromuscular literature for two reasons. It implies a disturbance of function, not structural damage; therefore, it defies laboratory testing such as MRIS, electromyography (EMG), and nerve conduction study (NCS). It is convenient to draw a parallel to the patients between migraine and brain tumors, as both cause headache, but brain MRI is negative in the former without minimizing the suffering of the patient. It is a “software” and not a “hardware” problem. It avoids irritating the patient by misunderstanding the word psychogenic which to many means “madness.”The cause of this functional impairment may fall into one of the following categories:• Conversion reaction: conversion of psychological stress to physical symptoms. This may include paralysis, hemisensory or distal sensory loss, or conversion spasms. It affects younger age groups.• Somatization: chronic multiple physical and cognitive symptoms due to chronic stress. It affects older age groups.• Factions disorder: induced real physical symptoms due to the need to be cared for, such as injecting oneself with insulin to produce hypoglycemia.• Hypochondriasis: overconcern about body functions such as suspicion of ALS due to the presence of rare fasciclutations that are normal during stress and after ingestion of a large amount of coffee. Medical students in particular are targets for this disorder.The following points are to be made on this topic. FNMD should be diagnosed by neuromuscular specialists who are trained to recognize actual syndrome whether typical or atypical. Presentations that fall out of the recognition pattern of a neuromuscular specialist, after the investigations are negative, they should be considered as FNMDs. Sometimes serial examinations are useful to confirm this suspicion. Psychatrists or psychologists are to be consulted to formulate a plan to discover the underlying stress and to treat any associated psychiatric disorder or psychological aberration. Most patients think that they are stressed due to the illness and they fail to connect the neuromuscular manifestations and the underlying stress. They offer shop around due to lack of satisfaction, especially those with somatization disorders. Some patients learn how to imitate certain conditions well, and they can deceive health care professionals. EMG and NCS are invaluable in revealing FNMD. A normal needle EMG of a weak muscles mostly indicates a central etiology (organic or functional). Normal sensory responses of a severely numb limb mean that a lesion is preganglionic (like roots avulsion, CISP, etc.) or the cause is central (a doral column lesion or functional). Management of FNMD is difficult, and many patients end up being chronic cases that wander into clinics and hospitals seeking solutions and exhausting the health care system with unnecessary expenses.It is time for these disorders to be studied in detail and be classified and have criteria set for their diagnosis so that they will not remain diagnosed only by exclusion. This chapter will describe some examples of these disorders. A video clip can tell the story better than many pages of writing. Improvement of digital cameras and electronic media has improved the diagnosis of these conditions, and it is advisable that patients record some of their symptoms when they happen. It is not uncommon for some Neuromuscular disorders (NMDs), such as myasthenia gravis (MG), small fiber neuropathy, and CISP, to be diagnosed as functional due to the lack of solid physical findings during the time of the examination. Therefore, a neuromuscular evaluation is important before these disorders are labeled as such. Some patients have genuine NMDs, but the majority of their symptoms are related to what Joseph Marsden called “sickness behavior.” A patient with carpal tunnel syndrome (CTS) may unconsciously develop numbness of the entire side of the body because he thinks that he may have a stroke.
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Eastwood, John, Cathy Corbishley und John Grange. Mycobacterial infections. Herausgegeben von Vivekanand Jha. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0196.
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The genus Mycobacterium contains over a hundred species including the M. tuberculosis complex and M. leprae, the causative agents of, respectively, tuberculosis and leprosy. The many other species are environmental saprophytes, present particularly in free and piped water sources, and some species are causes of opportunist disease in humans, especially in those who are immune compromised.The genitourinary tract is a common site of both primary and post-primary tuberculosis. In most cases of renal tuberculosis there are gross lesions consisting of caseating granulomas from which tubercle bacilli enter the urinary tract, often with the development of secondary lesions in the ureters, bladder, epididymis, and testis. Tuberculous interstitial nephritis is a less common condition with an insidious course and may result in renal failure. The urine is often negative for tubercle bacilli, emphasizing the need for biopsy in those with renal insufficiency.The risk of developing pulmonary or disseminated tuberculosis after infection is greatly enhanced by any form of immune compromise including renal failure and post-renal transplant immunosuppression.
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Govind, Nikhil. Inlays of Subjectivity. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780199498727.001.0001.
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Inlays of Subjectivity is an incisive exposition of the question of subjectivity in modern Indian literature. Seeking to foreground subjectivity through literary expressions of intense emotionality, whether suffering, humiliation, creativity or strife, it also raises the timely question of the relation of justice and speech. This book studies select influential Indian literary texts across the last hundred years in various Indian languages to find overlapping preoccupations with selfhood. As the first chapter on K. R. Meera’s fiction demonstrates, it is the experience of felt injustice that first opens up the realm of subjectivity. Subjectivity is equally opened up by intense negative affect—such as the experience of humiliation—the memoirs of the Dalit writer Urmila Pawar testify to this in the second chapter. The next two chapters trace the historical and literary origins of this question of subjectivity through the novels of canonical writers such as Agyeya, Ismat Chughtai, Saratchandra Chatterjee, and Rabindranath Tagore. The fifth chapter turns to the subtle and powerful writer Krishna Sobti to bring together all these strands of subjectivity, affect and moral agency required in navigating an unequal and harsh world. The book thus hopes to provoke questions of the literary modes for exploring subject positions in a defined Indian literary milieu, and to reflect upon the relationship of literature, subjectivity, and affect.