Wider Literature Research Articles

The role of early years care providers in supporting continued breastfeeding and breast milk feeding

This paper discusses challenges faced by mothers who seek to continue breastfeeding and/or breast milk feeding (B/BMF) whilst using daytime childcare, and early years’ practitioners’ attitudes towards their role in the support of these feeding practices. The data-set being reported comes from a small-scale feasibility study that was conducted in the summer of 2015 at a childcare provider site in a highly deprived urban area of Scotland. Focus groups with B/BMF mothers, as well as with early years’ practitioners were conducted. We report data pertaining to where responsibility lies for facilitating continued B/BMF, and on the perception of practitioners’ attitudes, knowledge about, skills and providers’ facilities for B/BMF. We recommend that care providers actively engage prospective parents in a discussion about how they can support continued B/BMF. These original data are contextualised and critically discussed within the wider literature with special attention being paid to the concept of unintended consequences.

A randomized trial of female-specific cognitive behavior therapy for alcohol dependent women.

This study compared Female-Specific Cognitive Behavioral Therapy (FS-CBT) to evidence-based, gender-neutral CBT (GN-CBT; Epstein & McCrady, 2009) for women with alcohol use disorder (AUD). Women (N = 99) with AUD, mean age 48, were randomly assigned to 12 outpatient manual-guided sessions of FS-CBT (n = 44) or GN-CBT (n = 55). Women were assessed at baseline and 3, 9 and 15 months after baseline for drinking and for specific issues common among women with AUD. A FS-CBT protocol was developed that was discriminable on treatment integrity ratings from GN-CBT. No treatment condition differences were found in treatment engagement, changes in drinking, alcohol-related coping, abstinence self-efficacy, motivation to change, or constructs directly targeted in FS-CBT (sociotropy, autonomy, depression, anxiety). Women in both conditions were highly engaged and satisfied with treatment, and reported significant reductions in drinking and changes in desired directions for all other variables except social support for abstinence. In the year following treatment, women in the FS-CBT but not in the CBT condition reported an increase in percentage of abstainers in their social networks (0.69% per month, SE = 0.21, p = .002). The value and appeal of female-specific programming in AUD treatment has been established in the wider literature (Epstein & Menges, 2013), and the current study provides support for the use of the Female-Specific Cognitive Behavioral Therapy (FS-CBT) manual as an option that may yield outcomes similar to standard gender-neutral CBT for women with AUD. Future research should examine whether FS-CBT enhances treatment utilization for women. (PsycINFO Database Record

Socially Responsible Supply Chains in Emerging Markets: Some Research Opportunities

This article seeks to provide research opportunities in “socially responsible supply chains”. I first provide some background and context from the wider literature. Then I outline case studies in emerging countries where large companies engage the poor as producers and the poor as distributors. Next, I discuss different research topics arising from socially responsible supply chains.

Emergency presentations for shocks in patients with implantable cardioverter-defibrillators

Despite significant improvement in the management of patients with implantable cardioverter-defibrillators (ICDs), many patients still receive ICD shocks in the community and present to emergency departments. These urgent admissions are poorly described in the wider literature. To describe the characteristics of emergency presentations for ICD shocks. From November 2011 to November 2014, all patients admitted to the cardiac emergency department of Lille University Hospital for ICD shock(s) were prospectively enrolled. Patient characteristics, investigation results, and details of electrical activities from ICD interrogation were recorded at presentation. In total, 109 emergency presentations for ICD shocks were recorded in 90 patients (85% male; 57 ± 16 years; ischemic cardiomyopathy: 49%; LVEF 34 ± 13%; secondary prevention: 68%). Overall, 83 (76%) were provoked by an appropriate index shock (AS), and 26 (24%) by an inappropriate index shock (IS). The majority of patients received multiples shocks (AS: 60%, IS: 81%). Of the 83 presentations for AS, 66 (80%) were triggered by monomorphic VTs and 43 (52%) were caused by electrical storms. The main reasons for IS were atrial fibrillation or flutter (62%) and sinus node tachycardia (19%). Overall, hospitalization was required in 82 cases (75%), with a median length of stay of 7 days [4–11]. Following presentation, the following measures were taken: change in ICD programming (45%), loading dose of amiodarone (33%), increase of β-blockers dosage (32%), VT ablation (18%), reintervention on the ICD system (6%). Emergency presentations for ICD shocks remain frequent, and are caused by appropriate ICD therapies in 3 out of 4 cases. These admissions place a considerable burden on emergency and cardiology departments. Evidence-based strategies capable of reducing the incidence of emergency presentations for ICD shocks in the community should be more widely implemented.

Nurse Led Follow Up: Is It The Best Way Forward for Post-Operative Endometriosis Patients?

The benefits of nurse led follow-up are well documented in the wider literature and include higher patient satisfaction rates, improved information delivery and quicker discharge rates. Unfortunately there is a paucity of data when it comes to benign gynaecology and the aim of this study was to establish the efficacy of outpatient services offered by an endometriosis specialist nurse compared to standard medical follow up in women undergoing operative laparoscopy for severe endometriosis. Outcome measures included both patient satisfaction and the duration of follow-up until discharge. Our findings highlight that a nurse led service is highly acceptable to patients and leads not only to higher satisfaction rates, but also a reduced duration of follow-up resulting in a significantly more cost effective service without any detriment to the patient.

A meta-analytic perspective on the valid use of subjective human judgement to make medical school admission decisions

ABSTRACTWhile medical educators appear to believe that admission to the medical school should be governed, at least in part, by human judgement, there has been no systematic presentation of evidence suggesting it improves selection. From a fair testing perspective, legal, ethical, and psychometric considerations, all dictate that the scientific evidence regarding human judgement in selection should be given consideration. To investigate the validity of using human judgements in admissions, multi-disciplinary meta-analytic research evidence from the wider literature is combined with studies from within medical education to provide evidence regarding the fairness and validity of using interviews and holistic review in medical school admissions. Fourteen studies, 6 of which are meta-analytic studies that summarized 292 individual studies, were included in the final review. Within these studies, a total of 33 studies evaluated the reliability of the traditional interview. These studies reveal that the interview has low to moderate reliability (~.42) which significantly limits its validity. This is confirmed by over 100 studies examining interview validity which collectively show interview scores to be moderately correlated with important outcome variables (corrected value ~.29). Meta-analyses of over 150 studies demonstrate that mechanical/formula-based selection decisions produce better results than decisions made with holistic/clinical methods (human judgement). Three conclusions regarding the use of interviews and holistic review are provided by these meta-analyses. First, it is clear that the traditional interview has low reliability and that this significantly limits its validity. Second, the reliable variance from interview scores appears moderately predictive of outcomes that are relevant to consider in medical school admission. And third, the use of holistic review as a method of incorporating human judgement is not a valid alternative to mechanical/statistical approaches as the evidence clearly indicates that mechanistic methods are more predictive, reliable, cost efficient, and transparent.

Rethinking policy \u2018impact\u2019: four models of research-policy relations

Political scientists are increasingly exhorted to ensure their research has policy ‘impact’, most notably via Research Excellence Framework (REF) impact case studies, and ‘pathways to impact’ statements in UK Research Council funding applications. Yet the assumptions underpinning these frameworks often fail to reflect available evidence and theories. Notions of ‘impact’, ‘engagement’ and ‘knowledge exchange’ are typically premised on simplistic, linear models of the policy process, according to which policy-makers are keen to ‘utilise’ expertise to produce more ‘effective’ policies. Such accounts overlook the rich body of literature in political science, policy studies, and sociology of knowledge, which offer more complex and nuanced accounts. Drawing on this wider literature, this paper sets out four different approaches to theorising the relationship: (1) knowledge shapes policy; (2) politics shapes knowledge; (3) co-production; and (4) autonomous spheres. We consider what each of these four approaches suggests about approaches to incentivising and measuring research impact.

Qualitative experiences of disengagement in assertive outreach teams, in particular for "black" men: Clinicians' perspectives.

Introduction Engagement with services is often poor amongst people with severe mental health problems, yet key to improving clinical outcomes. Aims This study explores the perception of clinicians on patients with severe mental health problems, in particular the experiences of black men, who disengage from mental health services. Method Two focus groups consisting of a combined total of twelve, mainly white, experienced clinicians in the UK were recruited. Transcripts were analysed using interpretative phenomenological analysis. Results Clinicians understood that patients' awareness of stigma impacted upon engagement with mental health services. Clinicians were aware that medication negatively impacted on engagement. The passage of time was perceived as impacting upon engagement. Discussion The perspectives of the clinicians in this study and the experiences of the patients in a former study converged. The participants had an understanding of the complexities that black men faced when engaging with mental health services. Implications for practice This is the first study to highlight that AOT staff need to be aware of the key role that stigma plays in engagement in treatment, continue to focus on efforts to reduce the stigma surrounding mental health, consider the significance medication and be aware of how patients' attitudes towards mental health services develop over time.

A Mechanism for Symmetry Breaking and Shape Control in Single-Crystal Gold Nanorods.

The phenomenon of symmetry breaking-in which the order of symmetry of a system is reduced despite manifest higher-order symmetry in the underlying fundamental laws-is pervasive throughout science and nature, playing a critical role in fields ranging from particle physics and quantum theory to cosmology and general relativity. For the growth of crystals, symmetry breaking is the crucial step required to generate a macroscopic shape that has fewer symmetry elements than the unit cell and/or seed crystal from which it grew. Advances in colloid synthesis have enabled a wide variety of nanocrystal morphologies to be achieved, albeit empirically. Of the various nanoparticle morphologies synthesized, gold nanorods have perhaps been the most intensely studied, thanks largely to their unique morphology-dependent optical properties and exciting application potential. However, despite intense research efforts, an understanding of the mechanism by which a single crystal breaks symmetry and grows anisotropically has remained elusive, with many reports presenting seemingly conflicting data and theories. A fundamental understanding of the symmetry breaking process is needed to provide a rational framework upon which future synthetic approaches can be built. Inspired by recent experimental results and drawing upon the wider literature, we present a mechanism for gold nanorod growth from the moments prior to symmetry breaking to the final product. In particular, we describe the steps by which a cuboctahedral seed particle breaks symmetry and undergoes anisotropic growth to form a nanorod. With an emphasis on the evolving crystal structure, we highlight the key geometrical and chemical drivers behind the symmetry breaking process and factors that govern the formation and growth of nanorods, including control over the crystal width, length, and surface faceting. We propose that symmetry breaking is induced by an initial formation of a new surface structure that is stabilized by the deposition of silver, thus preserving this facet in the embryonic nanorod. These new surfaces initially form stochastically as truncations that remove high-energy edge atoms at the intersection of existing {111} facets and represent the beginnings of a {011}-type surface. Crucially, the finely tuned [HAuCl4]:[AgNO3] ratio and reduction potential of the system mean that silver deposition can occur on the more atomically open surface but not on the pre-existing lower-index facets. The stabilized surfaces develop into side facets of the nascent nanorod, while the largely unpassivated {111} facets are the predominant site of Au atom deposition. Growth in the width direction is tightly controlled by a self-sustaining cycle of galvanic replacement and silver deposition. It is the [HAuCl4]:[AgNO3] ratio that directly determines the particle size at which the more open atomic surfaces can be stabilized by silver and the rate of growth in the width direction following symmetry breaking, thus explaining the known aspect ratio control with Ag ion concentration. We describe the evolving surface faceting of the nanorod and the emergence of higher-index facets. Collectively, these observations allow us to identify facet-size and edge-atom effects as a simple fundamental driver of symmetry breaking and the subsequent development of new surfaces in the presence of adsorbates.

Sun, S. Socio‐Economics of Personalized Medicine in Asia. London and New York: Routledge. 2017. 198 pp. £110 (hbk) ISBN 978‐1138933835

Personalised medicine – tailoring medical practices to individuals based on genetic constitution to enhance diagnosis and treatment – is poised for rapid growth in Asia. However, most literature focuses on scientific perspectives in European and North American contexts. Shirley Sun's new book bucks this trend with a sociological investigation of personalised medicine in Asian countries. It breaks new ground by problematising the obsession in medicine and drug development with ethnicity and race as a proxy for human genetic diversity. The book focuses on cancer treatment and research, the most popular application of personalised medicine, and the Human Genome Organisation's (HUGO) Pan-Asian Single Nucleotide Polymorphism (SNP) Consortium which conducted the largest survey of genetic diversity among Asians. The first chapter sets the scene with a succinct introduction to ethnicity, race, and personalised medicine, and the emphasis on a tension between the promise of targeting individuals and the reality of group and population approaches. According to Sun, limited availability of cost-effective genetic testing for individuals underpins a tendency to take ethnic and racial groups as genetically distinctive populations. This uncritical conversion of socially constructed concepts into genetically meaningful categories is challenged further in the second chapter, with reference to research findings by the SNP Consortium which reported that most ethnic and linguistic populations show genetic relatedness. Sun teases out the limitations of using ethnic and racial categories in genetics research, and draws analogies with other examples of categorisation errors in history, such as nation-state building in Europe and Japan. Chapters three and four examine these issues in drug development, and public health and genomic research policy-making. In chapter three, Sun alleges that a major pharmaceutical company began targeting a lung cancer drug to Asian countries following poor performance in clinical trials in the United States. Although successful treatment depended on the presence of mutations in tumour tissues, clinical trial results hinged on race (Asian or non-Asian) rather than mutation status. Sun argues that this was a misappropriation which only served the interests of the pharmaceutical industry through mitigating costs, gaining regulatory approval, and targeting overseas markets. In chapter four - a case study of cost-effectiveness analysis in public health resources in Singapore - scientists reported using the country's official population indicators as genetically-distinct populations, despite the availability of alternative criteria. Sun rebuts Singapore's public policymaking with a review of the historical formation of ‘Malay’, which demonstrates the reification of simple ethnic and racial categories. Chapter five considers the perspectives of medical oncologists in Singapore who argue that genetic testing should be available for every patient, and treatment decisions should only be based on ethnicity or race as a last resort or in preliminary research. Ironically, despite these arguments, limited resources and training requirements mean that they still rely on these socially constructed categories when prescribing drugs to patients. Chapter six highlights other barriers impeding personalised medicine, such as accessibility, training needs of doctors, prohibitive costs, privacy, and racial discrimination. Notably, high costs mean that personalised medicine is priced out of reach for many patients with low incomes or no health insurance – an ethical dilemma for doctors. Treatment costs are also a challenge for healthcare funders, such as governments, insurance companies, and society. Limited long-term benefits also mean patients and families face moral questions about the value of a few extra months of life. In what follows, Sun questions whether personalised medicine should become the gold-standard for cancer treatment. Overall, the book offers intriguing insights about how cutting-edge developments in medicine and scientific research are embedded in complex social and historical contexts. Its sociological and Asian foci are welcome additions to a literature dominated by scientists in Europe and the United States. It should have wide appeal as the number of clinical trials in Asian countries is increasing. However, the book has a number of weaknesses. There is, for example, a lack of engagement with wider literature on identities and ethnicity in health research and practice. In addition, detail about the methodology of Sun's interviews and data analysis is slim. Interview quotations in several chapters require further analysis as well as interweaving within the main storyline. There are also issues with organisation, style, and clarity. Some sections could be combined, expanded or moved to other chapters. The chapter conclusions do not always summarise their respective chapters, but introduce new data and quotes, as does the concluding chapter. However, these minor issues do not detract from the book's important take-home message, namely, that although personalised medicine will continue to improve cancer diagnosis and treatment, we must consider its limitations. I highly recommend Sun’s book to social scientists, doctors, scientists, politicians, and anyone interested in the history and practice of medicine and drug development.

Participatory research. Part 2: Practical considerations

Participatory research can make heavy demands upon both the researcher and the community with whom they work. Nonetheless, it can also be a very rewarding process for all involved and lead to real changes. It is important that a number of issues are considered and addressed both before the research commences and during the life of the research project. This paper explores five key areas: participatory, ethical, financial, time, and personal considerations. In each instance, personal experience and wider literature is used to explore the practical issues which need to be identified and managed. It is concluded that while not all research will be participatory, consideration of these issues should assist readers in developing participatory research studies.

Narratives of performance measurement in philanthropic foundations

Philanthropic foundations with a permanent endowment are among the few organisations that have no requirement to measure and prove their performance to ensure sustainability. This article begins by outlining the puzzle of performance measurement in endowed foundations and then briefly reviews the literature. Findings from an exploratory study of Australian foundations’ approaches to measurement are presented. We suggest that beneath the broad adoption of the language of measurement there is a more complex story. There were three broad narratives in relation to measurement, which we label resistance, qualification and realism. These three narratives explain differences in levels of commitment and practice, and go some way towards understanding foundations’ ambiguous relationship with performance measurement, as illustrated in this study and the wider literature.

The incidence of non-melanoma skin cancer and post-transplant lympho-proliferative disorders in the Scottish cardiac transplant population and the provision of specialist dermatological follow-up.

Background Immunosuppression helps prevent acute rejection post-cardiac transplant but has been linked to malignancy development. This may be due to a reduction in T-lymphocyte function, a direct oncogenic effect or the increased impact of environmental carcinogens. There has been shown to be significant increases in non-melanoma skin cancers and post-transplant lympho-proliferative disorders, particularly in those treated with OKT3. Aim To investigate the survival and incidence of malignancy in the Scottish cardiac transplant population and whether rates of non-melanoma skin cancers justify the provision of specialist dermatological follow-up. Methods and results Retrospective case note analysis of patients transplanted (363) or followed up (2) in Scotland from 1992 to 2016. Kaplan-Meier survival analysis generated a survival curve. Patients had a 1-year survival of 82% and a median survival of 10.9 years. There were 60 (95% CI 47.5, 75.2) NMSCs and 8 (3.7, 12.4) post-transplant lympho-proliferative disorders diagnosed in the cohort (3110 person years follow-up). Fisher's exact test was employed to analyse the association between induction therapy (via OKT3 or rabbit antithymocyte globulin) and post-transplant lympho-proliferative disorder development. Patients treated with OKT3 had a 6.7 times greater risk ( P = 0.014) and a shorter experience of patients treated with rabbit antithymocyte globulin has so far shown no significantly altered risk ( P = 1.00) of developing a post-transplant lympho-proliferative disorder. Conclusion Incidences of non-melanoma skin cancers and post-transplant lympho-proliferative disorders were increased in the Scottish cardiac transplant population and there was a significant association between post-transplant lympho-proliferative disorder development and OKT3 therapy but not rabbit antithymocyte globulin therapy. These findings in Scottish patients reflect what is published in wider literature and support the provision of a dedicated post-transplant dermatology clinic.

Modelling Online Innovation Among IR and Politics Lecturers

ABSTRACTThis article discusses the use of collaborative online technology in the teaching of international relations and politics. Using a case study from Australia, it finds low levels of online innovation in these discipline areas that correlate with broader examinations of technology use in higher education teaching. Themes of time poverty, technical competence, and lack of career reward are frequently cited as barriers to trying new approaches. The data indicate that at present the most common outcome of any aspiration for IR/politics staff considering innovation is that the effort required to incorporate collaborative online learning is not repaid. These findings are meaningful, since the current lack of innovation and the perceptions of staff regarding support for such approaches are at odds with the marketplace pressures staff and their institutions are under. Based upon the data collected and the wider literature on technology adoption, this article proposes a “Technology-Assisted Teaching Adoption Model” (TATAM) that attempts to encapsulate the innovation judgements made by academic staff and the steadily diminishing incentives they feel towards changing their online teaching methods.

Generating demand for and use of evaluation evidence in government health ministries: lessons from a pilot programme in Uganda and Zambia

BackgroundThe Demand-Driven Evaluations for Decisions (3DE) programme was piloted in Zambia and Uganda in 2012–2015. It aimed to answer evaluative questions raised by policymakers in Ministries of Health, rapidly and with limited resources. The aim of our evaluation was to assess whether the 3DE model was successful in supporting and increasing evidence-based policymaking, building capacity and changing behaviour of Ministry staff.MethodsUsing mixed methods, we compared the ex-ante theory of change with what had happened in practice, why and with what results (intended and unintended), including a qualitative assessment of 3DE’s contribution. Data sources included a structured quality assessment of the five impact evaluations produced, 46 key informant interviews at national and international levels, structured extraction from 170 programme documents, a wider literature review of relevant topics, and a political economy analysis conducted in Zambia.ResultsWe found that 3DE had a very limited contribution to changing evidence-based policymaking, capacity and behaviour in both countries as a result of having a number of aspirations not all compatible with one another. Co-developing evaluation questions was more time-consuming than anticipated, Ministry evidence needs did not fit neatly into questions suitable for impact evaluations and constricted timeframes for undertaking trials did not necessarily produce the most effective results and value for money. The evaluation recommended a focusing of objectives and a more strategic approach to strengthening evaluative demand and capacity.ConclusionsLessons emerge that are likely to apply in other low- and middle-income settings, such as the importance of supporting evaluative thinking and capacity within wider institutions, of understanding the political economy of evidence use and its uptake, and of allowing for some flexibility in terms of programme targets. Fixating on one type of evidence is unhelpful in the context of institutions like ministries of health, which require a wide range of evidence to plan and deliver programmes. In addition, having success tied to indicators, such as number of ‘policy decisions made’, provides potentially perverse incentives and neglects arguably more important aspects such as incremental programmatic adjustments and improved implementation.

The Challenges of Empowering Women: The Experience of Pulse Innovation Project in Southern Ethiopia

Within the last two decades, women’s empowerment has been the central theme of international development policy and practice. This article seeks to elucidate the challenges of integrating gender in a development project to empower women. Drawing on the wider literature on women’s empowerment, it constructs a framework to analyze the meaning of empowerment. The article then draws on the framework and empirical data gathered to illuminate the challenges of integrating gender in a pulse innovation project, implemented in Southern Ethiopia. The article elucidates gender hierarchies that limit the extent of women’s involvement in crop production processes. It demonstrates social and cultural factors that restrict women from fully participating in high value pulse markets and their involvement in production and exchange decision-making. It also illustrates how existing social networks, relations, and links disadvantage women. The article then recommends solutions to help facilitate the integration of gender in the project toward the empowerment of women.

Does psychological resilience buffer against the link between the 5-HTTLPR polymorphism and depression following stress

The comparative strength of the 5-HTTLPR polymorphism as a ‘predictor’ of depression after major stress, versus the ‘protective’ effect of psychological resilience (PR) against depression after major stress, was tested in a homogeneous sample of older men who had all received a diagnosis and treatment for prostate cancer. Results supported the association between PR and lower depression after stress, but did not support the association between the 5-HTTLPR and elevated depression after stress. Examination of PR at scale, factor, and item level identified the specific PR-related behaviour that was the most powerful predictor of low depression. These data suggest that the carriage of the short form of the 5-HTTLPR may negate the protective effect of PR against depression in these men, or that PR may nullify the depression vulnerability of this form of the 5-HTTLPR. These findings may explain some of the ‘null’ findings regarding the link between the 5-HTTLPR and depression in the wider literature by arguing for an interaction between these two factors in the association between major stress and depression.

Empowerment: challenges in measurement

Empowerment is core to health promotion; however, there is a lack of consensus in the wider literature as to how to define it and at what level it may occur. Definitional inconsistency inevitably leads to challenges in measuring empowerment; yet if it is as important as is claimed, this must be addressed. This paper discusses the complexities of measuring empowerment and puts forward a number of recommendations for researchers and policy makers as to how this can be achieved noting some of the tensions that may arise between theoretical considerations, research and practice. We argue that empowerment is a culturally and socially defined construct and that this should be taken into account in attempts to measure it. Finally we conclude that, in order to build up the evidence base for empowerment, there is a need for research clearly defining what it is and how it is being measured.

'I just don't want to connect my life with this occupation': working-class young men, manual labour, and social mobility in contemporary Russia.

A key strand in the Western literature on working-class masculinities focuses on whether young men are capable of the feminized performances apparently required of them in new service economies. However, the wider literature on processes of neoliberalization - emphasizing the 'hollowing out' of labour markets, the cultural devaluation of lower-skilled forms of employment, and the pathologization of working-class lives - would suggest that it is as much a classed as a gendered transformation that is demanded of young men leaving school with few qualifications. This dimension of neoliberalization is highlighted by ethnographic data exploring the experiences and subjectivities of young workers in St Petersburg, Russia, where traditional forms of manual labour have not given way to 'feminized' work, but have become materially and symbolically impoverished, and are perceived as incapable of supporting the wider transition into adult independence. In this context, young workers attempt to emulate new forms of 'successful masculinity' connected with novel service sector professions and the emergent higher education system, despite the unlikelihood of overcoming a range of structural and cultural barriers. These acquiescent, individualized responses indicate that, while ways of being a man are apparently being liberated from old constraints amongst the more privileged, neoliberalization narrows the range of subject positions available to working-class young men.

Cryptomarkets as a libertarian counter-conduct of resistance

Cryptomarkets function as self-regulating forms of governance, close to what Hayek would describe as a spontaneous order. At the same time, in cases like the online market Silk Road, they construct an identity that portrays their illegal activities as operating within a framework of individual rights and voluntary transactions. As has already been examined in the wider literature, the political and economic philosophy of libertarianism has been mobilized by participants in such markets in order to provide a moral theoretical background to their activities. This article examines: (1) why libertarianism indeed provides a suitable narrative for such activities and how the theoretical work of Foucault on power and resistance (and, more specifically, his notion of ‘counter-conduct’) can help us understand the contentious relationship between the state and cryptomarkets; and (2) how libertarian practices such as the ones taking place in cryptomarkets are at odds with neoliberal governmentality.