Research in computer systems often involves the engineering, implementation, and measurement of complex systems software and data. The availability of these artifacts is critical to the reproducibility and replicability of the research results, because system software often embodies numerous implicit assumptions and parameters that are not fully documented in the research article itself. Artifact availability has also been previously associated with higher paper impact, as measured by citations counts. And yet, the sharing of research artifacts is still not as common as warranted by its importance. The primary goal of this study is to provide an exploratory statistical analysis of the artifact-sharing rates and associated factors in the research field of computer systems. To this end, we explore a cross-sectional dataset of papers from 56 contemporaneous systems conferences. In addition to extensive data on the conferences, papers, and authors, this analyze dataset includes data on the release, ongoing availability, badging, and locations of research artifacts. We combine this manually curated dataset with citation counts to evaluate the relationships between different artifact properties and citation metrics. Additionally, we revisit previous observations from other fields on the relationships between artifact properties and various other characteristics of papers, authors, and venue and apply them to this field. The overall rate of artifact sharing we find in this dataset is approximately 30%, although it varies significantly with paper, author, and conference factors, and it is closer to 43% for conferences that actively evaluated artifact sharing. Approximately 20% of all shared artifacts are no longer accessible four years after publications, predominately when hosted on personal and academic websites. Our main finding is that papers with shared artifacts averaged approximately 75% more citations than papers with none. Even after controlling for numerous confounding covariates, the release of an artifact appears to increase the citations of a systems paper by some 34%. This metric is further boosted by the open availability of the paper’s text. Many scientific experimental results cannot be successfully repeated or reproduced, leading to the so-called “reproducibility crisis” . An expeGiven the central role of research artifacts in reproducibility, it is not surprising to find major initiatives to increase artifact sharing and evaluation. As Childers and Chrysanthis wrote in 2017:Experimental computer science is far from immune [from the reproducibility crisis], although it should be easier for CS than other sciences, given the emphasis on experimental artifacts, such as source code, data sets, workflows, parameters, etc. The data management community pioneered methods at ACM SIGMOD 2007 and 2008 to encourage and incentivize authors to improve their software development and experimental practices. Now, after 10 years, the broader CS community has started to adopt Artifact Evaluation (AE) to review artifacts along with papers .Unfortunately, the sharing and evaluation of artifacts are still not as commonplace as warranted by their importance. One challenge in addressing this topic is that definitions and expectations for research artifacts are not always clear. The Association of Computing Machinery (ACM) defines a paper’s artifact as follows:By “artifact” we mean a digital object that was either created by the authors to be used as part of the study or generated by the experiment itself. For example, artifacts can be software systems, scripts used to run experiments, input datasets, raw data collected in the experiment, or scripts used to analyze results .computer systems (or “systems” for short). Systems is a large research field with numerous applications, used by some of the largest technology companies in the world. For the purpose of this study, we define systems as the study and engineering of concrete computing systems, which includes research topics such as: operating systems, computer architectures, data storage and management, compilers, parallel and distributed computing, and computer networks.This paper aims to shed some light on artifact sharing in one particular field of CS, namely system software itself. System software is software that is not on its own a user-facing application, but rather software that manages system resources or facilitates development for the actual applications, such as compilers, operating system components, databases, and middleware. System software can be fairly complex and tightly coupled to the system it is designed to run on.The study of these topics often involves the implementation, modification, and measurement of Research artifacts, and especially software artifacts, are therefore paramount to the evaluation and reproduction of systems research. Whereas in other fields of science—or even CS—research results can often be replicated from the original equations or datasets, systems software can embody countless unstated assumptions in the code and parameters. The significance is that reproducing research findings by recreating its artifacts from the terse descriptions in a paper is often unfeasible, rendering software artifacts all that more important.The hypothesis of this paper is therefore that because of its importance to reproducibility, artifacts sharing in systems significantly increases a paper’s influence, as measured by citations. Citations are not only a widely used metric of impact for papers and researchers but also an indirect measure of the work’s quality and usefulness, which presumably are both helped by the availability of artifacts. Citations may also stand in as proxy metrics for the transparency, reusability, reproducibility, and credibility of papers—if we assume that any of these qualities encourage subsequent researchers to cite the original work. The main observational goal of this paper is to evaluate the quantitative association between artifacts availability and citations in the research field of computer systems. An additional goal of this study is an exploratory data analysis of associated factors to identify relationships between the availability of research artifacts in systems research papers and other statistical properties of these papers.To evaluate our main hypothesis, this study uses an observational, cross-sectional approach, analyzing 2,439 papers from a large subset of leading systems conferences. The study population comes from a hand-curated collection of 56 peer-reviewed systems and related conferences from a single publication year (2017). Among other characteristics, it includes manually collected data on artifact availability and paper citation counts 3.5 years from publication, as detailed in the next section. By comparing the post-hoc citations of papers with released artifacts to those with none, we find that we can reject the null hypothesis that artifact availability does not impact paper citations. Even after controlling for demographic, paper, and conference factors using a multilevel mixed-effects model, papers with artifacts still receive 34% more citations on average than papers without.Our expansive dataset also offers the opportunity for a descriptive and correlational study of the following additional questions. These questions are ancillary to the main research question of the relationship between artifacts and citations. Nevertheless, they may interest the reader and provide a fuller context and quantitative understanding of the state of artifact sharing in the field, and are provided as secondary contributions. These questions, and a short answer to each, are listed here and are elaborated in the results section: 1.What is the ratio of papers in systems for which artifacts are available? (Approximately 30%.) 2.How many of these artifacts are actually linked from the paper? (Approximately 80%.) 3.How many of these artifacts have expired since publication? What characterizes these artifacts?  4.What are the per-conference factors and differences that affect the ratio of artifact sharing?  5.Does conference prestige affect artifact availability? (Papers that release artifacts tend to appear in more competitive conferences.) 6.What is the relationship between artifact accessibility and paper accessibility?  7.vs. 27% in the rest.)What is the relationship between artifact accessibility and paper awards? As a final contribution, this study provides a rich dataset of papers , tagged The rest of this paper is organized as follows. The next section presents in detail the dataset, methodology, and limitations of our study. An extensive set of descriptive and explanatory statistics is presented in the results section and then used to build a mixed-effects multilevel regression model for citation count. The discussion section presents potential implications from these findings, as well as potential threats to the validity of this analysis. These findings are then placed in historical and cross-disciplinary context in the related-work section. Finally, the concluding section summarizes the main findings of this study and suggests some future research directions.The most time-consuming aspect of this study was the collection and cleaning of the data. This section describes the data selection and cleaning process for paper, artifact, and citation data.The primary dataset we analyze comes from a hand-curated collection of 56 peer-reviewed systems and related conferences from a single publication year (2017), to reduce time-related variance. Conference papers were preferred over journal articles because in CS, and in particular, in its more applied fields such as systems, original scientific results are typically first published in peer-reviewed conferences :health, A few of these conferences, such as MobiCom and SLE, specifically encouraged artifacts in their call-for-papers or websites. Four conferences—SC, OOPSLA, PLDI, and SLE—archived their artifacts in the ACM’s digital library. In addition to general encouragement and archival, six conferences specifically offered to evaluate artifacts by a technical committee: OOPSLA, PACT, PLDI, PPoPP, SC, and SLE.For each conference, we gathered various statistics from its web page, proceedings, or directly from its chairs. We also collected historical conference metrics from the websites of the ACM, the Institute of Electrical and Electronics Engineers (IEEE), and Google Scholar (GS), including past citations, age, and total publications, and downloaded all papers in PDF format. The dataset includes extensive data on the authors and the textual properties of the papers, and the relevant features are discussed in the next section.We are also interested in measuring the post-hoc impact of each paper, as approximated by its number of citations. Citation metrics typically lag publication by a few months or years, allowing for the original papers to be discovered, read, cited, and then the citations themselves published and recorded. The time duration since these papers had been published, approximately 3.5 years, permits the analysis of their short-to-medium term impact in terms of citations. In practice, this duration is long enough that only 46 papers (1.89%) have gathered no citations yet.For this study, the most critical piece of information on these papers is their artifacts. Unfortunately, most papers included no standardized metadata with artifact information, so it had to be collected manually from various sources, as detailed next.The only existing form of standardized artifact metadata was for the subset of conferences organized by the ACM with artifact badge initiatives. In the proceedings page in the ACM’s digital library of these conferences, special badges denote which papers made artifacts available, and which papers had artifacts evaluated (for conferences that supported either badge). In addition, the ACM digital library also serves as a repository for the artifacts, and all of these ACM papers included a link back to the appropriate web page with the artifact.Unfortunately, most papers in this dataset were not published by the ACM or had no artifact badges. In the absence of artifact metadata or an automated way to extract artifact data, these papers required a manual scanning of the PDF text of every paper in order to identify such links. When skimming these papers, several search terms were used to assist in identifying artifacts, namely: “github”, “gitlab”, “bitbucket”, “sourceforge”, and “zenodo” for repositories; variants of “available”, “open source”, and “download” for links; and variations of “artifact”, “reproducibility”, and “will release” for indirect references. Some papers make no mention of artifacts in the text, but we can still discover associated artifacts online by searching github.com for author names, paper titles, and especially unique monikers used in the paper to identify their software.extant or expired. From the availability of a URL, we can classify an artifact as released or unreleased (the latter denoting papers that promised an artifact but no link or repository was found). And from the host domain of the URL we can classify the location of the artifact as either an Academic web page, the ACM digital library, a Filesharing service such as Dropbox or Google, a specialized Repository such as github.com, Other (including .com and .org web sites), or NA.We also recorded for each paper: whether the paper had an “artifact available” badge or “artifact evaluated” badge, whether a link to the artifact was included in the text, the actual URL for the artifact, and the latest date that this artifact was still found intact online. All of the searches for these artifacts are recent, so from the last field above we can denote the current status of an artifact as either In all, 722 papers in our dataset (29.6%) had an identifiable or promised artifact, predominantly as software but occasionally as data, configuration, or benchmarking files. Artifacts that had been included in previous papers or written by someone other than the paper’s authors were excluded from this count. This statistic only reflects artifact availability, not quality, since evaluating artifact quality is both subjective and time-consuming. It is worth noting, however, that most of the source-code repositories in these artifacts showed no development activity—commits, forks, or issues—after the publication of their paper, suggesting limited activity for the artifacts alone.The following list summarizes the data-collection process for reproducibility purposes. 1.etc.Visit the website and proceedings of each conference and record general information about the conference: review policy, open-access, rebuttal policy, acceptance rate, program committee,  2.Also from these sources, manually copy the following information for each paper: title, author names, and award status (as noted on the website and in proceedings). 3.Double-check all paper titles and author names by comparing conference website and post-conference proceedings. Also compare titles to GS search results and ensure all papers are  discovered by GS with the title corrected as necessary. Finally, check the same titles and author names against the Semantic Scholar database and resolve any discrepancies. 4.via institutional digital library access.Download the full text of each paper in PDF format  5.Record all papers with artifact badges. These are unique to the ACM conferences in our dataset and are clearly shown both in the ACM digital library and in the PDF copy of such papers. 6.Collect and record GS citation counts for each paper as close to possible to exactly 42 months after the conference’s opening day. The dataset includes citation counts for each paper across multiple time points, but the analysis in this paper only uses one data point per paper, closest to the selected duration. 7.Record artifact availability and links for papers. This is likely the most time-consuming and error-prone process in the preparation of the data specific to this study and involves the following steps: Using a search tool on each document (“pdfgrep”) on each of the search terms listed above and perusing the results to identify any links or promises to artifacts; skimming or reading papers with negative results to ensure such a link was not accidentally missed; Finally, searching github.com for specific system names if a paper describes one, even if not linked directly from the paper.t-test; differences between distributions of two categorical variables were tested with χ2 test; and comparisons between two numeric properties of the same population were evaluated with Pearson’s product-moment correlation. All statistical tests are reported with their p-values.For statistical testing, group means were compared pairwise using Welch’s two-sample All of the data for this study was collected from public online sources and therefore did not require the informed consent of the papers’ authors.The complete dataset and metadata are available in the supplementary material, as well as a github repository .Before addressing our main research question, we start with a simple characterization of the statistical distributions of artifacts in our dataset. Of the 722 papers with artifacts, we find that about 79.5% included an actual link to the artifact in the text. The ACM digital library marked 88 artifact papers (12.2%) with an “Artifact available” badge, and 89 papers (12.3%) with an “Artifact evaluated” badge. The majority of artifact papers (86.7%) still had their artifacts available for download at the time of this writing. This ratio is somewhat similar to a comparable study that found that 73% of URLs in five open-access (OA) journals were live after five years . Of the Looking at the differences across conferences, χ2= 3.6, p = 0.06).Another indicator for artifact availability is author affiliation. As observed in other systems papers, industry-affiliated authors typically face more restrictions for sharing artifacts , likely 1At the time of this writing during summer 2021, the papers from December 2017 had been public for 3.5 years, so this 42-month duration was selected for all papers to normalize the comparison.Turning now to our main research hypothesis, we ask: does the open availability of an artifact affect the citations of a paper in systems? To answer this question, we look at the distribution of citations for each paper 42 months after its conference’s opening day, when its proceedings presumably were publishedt = 4.07, p < 10−4). Since the citation distribution is so right-skewed, it makes sense to also compare the median citations with and without artifacts . Both statistics suggest a clear and statistically significant advantage in citations for papers that released an artifact. Likewise, the 675 papers that actually released an artifact garnered more citations than the 47 papers that did promise an artifact that could later not be found , and extant artifacts fared better than expired ones .Citations range from none at all (49 papers) to about a thousand, with two outlier papers exceeding 2,000 citations . The dist = −2.02, p = 0.04; W = 22865, p < 10−3). Curiously, the inclusion of a link in the paper, presumably making the artifact more accessible, was associated with fewer citations.In contradistinction, some positive attributes of artifacts were actually associated with fewer citations. For example, the mean citations of the 573 papers with a linked artifact, 47, was much lower than the 71.3 mean for the 102 papers with artifacts we found using a Web search . Papers who received an “Artifact available” badge did fare a little worse than artifact papers who did not . These findings appear to contradict the premise that such badges are associated with increased artifact sharing, as has been found in other fields . However, only 2.3% of the “Repository” artifacts were inaccessible. In contrast, 22.2% of the artifacts in university pages have already expired, likely because they had been hosted by students or faculty that have since moved elsewhere. Also, a full half of the artifacts on file-sharing sites such as Dropbox or Google Drive are no longer there, possibly because these are paid services or free to a limited capacity, and can get expensive to maintain over time.χ2 = 49.15, p < 10−9).Accessibility is also closely related to the findability of the artifact, which in the absence of artifact DOIs in our dataset, we estimate by looking at the number of papers that explicitly link to their artifacts. The missing (expired) artifacts consisted of a full 31.1% of the papers with no artifact link, compared to only 8.7% for papers that linked to them (via other means. One way to gauge the availability of the paper’s text is to look it up on GS and see if an accessible version (eprint) is linked, which was recorded in our dataset. Of the 2,439 papers, 91.8% displayed at some point an accessible link to the full text on GS. Specifically, of the papers that released artifacts, 96.7% were associated with an eprint as well, compared to 90% of the papers with no artifacts .Another related question to artifact accessibility is how accessible is the actual paper that introduced the artifact, which may itself be associated with higher citations . A substt =  − 5.48, p <  10−7). Both of these qualitative and quantitative differences are statistically significant, but keep in mind that the accessibility of papers and artifacts are not independent: some conferences that encouraged artifacts were also open-access, particularly those with the ACM. Another dependent covariate with accessibility is citations; several studies suggested that accessible papers are better cited  that it took GS to display this link, offering a quantitative measure of accessibility speed. It shows that for papers with artifacts, GS averaged approximately 4 months post-publication to display a link to an eprint, compared to 5.8 months for papers with no artifacts .Many conferences present competitive awards, such as “best paper”, “best student paper”, “community award”, Again, it is unclear whether this relationship is causal since the two covariates are not entirely independent. For example, a handful of awards specifically evaluated the contribution of the paper’s artifact. Even if the relationship is indeed causal, its direction is also unclear, since 20% of award papers with artifacts did not link to it in the paper. It is possible that these papers released their artifacts after winning the award or because of it.Some of the textual properties of papers can be estimated from their full text using simple command-line tools. Our dataset includes three such properties: the length of each paper in words, the number of references it cites, and the existence of a system’s moniker in the paper’s title.more pages than papers without , more words , and more references . Keep in mind, however, that longer papers also correspond to more references , and are further confounded with specific conference factors such as page limits.The approximate paper length in words and the number of references turn out to be positively associated with the release of an artifact. Papers with artifacts average e.g., “Widget: An Even Faster Key-Value Store”). This feature is easy to extract automatically for all paper titles.As previously mentioned, many systems papers introduce a new computer system, often as software. Sometimes, these papers name their system by a moniker, and their title starts with the moniker, followed by a colon and a short description .We could hypothesize that a paper that introduces a new system, especially a named system, would be more likely to include an artifact with the code for this system, quite likely with the same repository name. Our data support this hypothesis. The ratio of artifacts released in papers with a labeled title, 41.9%, is nearly double that of papers without a labeled title, 22.8% , more paper submissions , higher historical mean citations per paper , and a higher h5-index from GS metrics . Also note that papers in conferences that offered some option for author response to peer review  were slightly more likely to include artifacts, perhaps as a response to peer review .Several proxy metrics for prestige appear to support this hypothesis. Papers with released artifacts tend to appear in conferences that average a To explain these relationships, we might hypothesize that a higher rate of artifact submission would be associated with more reputable conferences, either because artifact presence contributes to prestige, or because more rigorous conferences are also more likely to expect such artifacts. Observe, however, that some of the conferences that encourage or require artifacts are not as competitive as the others. For example, OOPSLA, with the highest artifact rate, had an acceptance rate of 0.3, and SLE, with the fourth-highest artifact rate, had an acceptance rate of 0.42. The implication here is that it may not suffice for a conference to actively encourage artifacts for it to be competitive, but a conference that already is competitive may also attract more artifacts.Finally, we combine all of these factors to revisit in depth our primary research interest: the effect of artifact sharing on citations. We already observed a strong statistical association between artifact release and higher eventual citations. As cautioned throughout this study, such associations are insufficient to draw causal conclusions, primarily because there are many confounding variables, most of which relating to the publishing conference. These confounding factors could provide a partial or complete statistical explanation to differences in citations beyond artifact availability.In other words, papers published in the same conference might exhibit strong correlations that interact or interfere with our response variable. One such factor affecting paper citations is time since publication, which we control for by measuring all citations at exactly the same interval, 42 months since the conference’s official start. Another crucial factor is the field of study—which we control for by focusing on a single field—while providing a wide cross-section of the field to limit the effect of statistical variability.positive results, papers’ length, number of figures and images, and even more obscure features such as the presence of punctuation marks in the title. We can attempt to control for such confounding variables when evaluating associations by using a multilevel model. To this end, we fit a linear regression model of citations as a function of artifact availability, and then add predictor variables as controls, observing their effect on the main predictor. The response variable we model for is ln(citations) instead of citations, because of the long tail of their distribution. We also omit the 49 papers with zero citations to improve the linear fit with the predictors.There are also numerous less-obvious paper-related factors that have shown positive association with citations, such as review-type studies, fewer equations, more references, statistically significant p-value for this predictor is exceedingly low (less than 2 × 10−16) but the simplistic model only explains 4.61% of the variance in citations (Adjusted R2 = 0.046). The Bayesian Information Criterion (BIC) for this model is 7693.252, with 2388 degrees of freedom (df).In the baseline form, fitting a linear model of the log-transformed citations as a function of only artifact released yields an intercept (baseline log citations) of 2.6 and a slope of 0.59, meaning that releasing an artifact adds approximately 81% more citations to the paper, after exponentiation. The paper length (words), number of coauthors, number of references, colon in the title, award given, and accessibility speed . However, the coefficient for artifact released went down to 0.35 (42% relative citation increase) with an associated p-value of 3.8 × 10−13.It turns out that all these paper-level factors except award given have a statistically significant effect on citations, which brings the model to an increased adjusted Similar to paper variables, some author-related factors such as their academic reputation, country of residence, and gender have been associated with citation count . We next •Whether all the coauthors with a known affiliation came from the same country . •Is the lead author affiliated with the United States ? •www.topuniversities.com (27% of papers) or a top company , based on the definitions of a similar study , (p < 10−9), so one may cancel the other out.Note that the past publication counts and h-index are correlated , so for the remainder of the analysis, we ignore author-related factors and proceed with the previous model.Only the maximum h-index and top-university affiliation had statistically significant coefficients, but hardly affected the overall model.We can now add the last level: venue factors. Conference  factors—such as the conference’s own prestige and competitiveness—can have a large effect on citations, as discussed in the previous section. Although we can approximate some of these factors with some metrics in the dataset, there may also be other unknown or qualitative conference factors that we cannot model. Instead, to account for conference factors we next build a mixed-effects model, where all the previously mentioned factors become fixed effects and the conference becomes a random effect , Ch. 8.p-value for this coefficient via Satterthwaite’s degrees of freedom method using R’s lmerTest package . But this coefficient still represents a relative citation increase of about a third for papers with released artifacts (34%), which is substantial. We can approximate a  package , which iThe regression model described in the preceding section showed that even with multiple controlling variables we observe a strong association between artifact release and citations. We can therefore ask, does this association allow for any causal or practical inferences? This association may still not suffice to claim causation due to hidden variables , but it One implication of this model is that even if we assume no causal relation between artifact sharing and higher citation counts, the association is strong enough to justify a change in future scientometric studies of citations. Such studies often attempt to control for various confounders when attempting to explain or predict citations, and this strong link suggests that at least for experimental and data-driven sciences, the sharing of research artifacts should be included as an explanatory variable.That said, there may be a case for a causal explanation with a clear direction after all. First, the model controls for many of the confounding variables identified in the literature, so the possibility of hidden, explanatory variables is diminished. Second, there is a clear temporal relationship between artifact sharing and citations. Artifact sharing invariably accompanies the publication of a paper, while its citations invariable follow months or years afterward. It is therefore plausible to expect that citation counts are influenced by artifact sharing and not the other way around.If we do indeed assume causality between the two, then an important, practical implication also arises from this model, especially for authors wishing to increase their work’s citations. There are numerous factors that authors cannot easily control, such as their own demographic factors, but fortunately, these turn out to have insignificant effects on citations. Even authors’ choice of a venue to publish in, which does influence citations, can be constrained by paper length, scope match, dates and travel, and most importantly, the peer-review process that is completely outside of their control. But among the citation factors that authors can control, the most influential one turns out to be the sharing of research artifacts.A causal link would then provide a simple lever for systems authors to improve their citations by an average of some 34%: share and link any available research artifacts. Presumably, authors attempting to maximize impact already work hard to achieve a careful study design, elaborate engineering effort, a well-written paper, and acceptance at a competitive conference. The additional effort of planning for and releasing their research artifact should be a relatively minor incremental effort that could improve their average citation count. If we additionally assume causality in the link between higher artifact sharing rates and acceptance to more competitive conferences, the effect on citations can be compounded.Other potential implications of our findings mostly agree with our intuition and with previous findings in related studies, as described in the related-work. For example, all other things being equal, papers with open access and with long-lasting artifacts receive more citations.Two factors that do not appear to have a positive impact on citations, at least in our dataset, are the receipt of artifact badges or the linking of artifacts in the paper. This is unfortunate because it implicitly discourages standardized or searchable metadata on artifacts, which is critical for studies on their effect, as described next.Perhaps the greatest challenge in performing this study or in replicating it is the fact that good metadata on research artifacts is either nonexistent or nonstandard. There is currently no automated or even manual methodology to reliably discover which papers shared artifacts, how they were they shared, and how long did they survive. There are currently several efforts underway to try to standardize artifact metadata and citation, but for this current study, the validity and scalability of the analysis hinge on the quality of the manual process of data collection.One way to address potential human errors in data collection and tagging is to collect a sizeable dataset—as was attempted in this dataset—so that such errors disappear in the statistical noise. Although a large-enough number of artifacts was identified for statistical analysis, there likely remain untagged papers in the dataset that did actually release an artifact . Nevertheless, there is no evidence to suggest that their number is large or that their distribution is skewed in some way as to bias statistical analyses. Moreover, since the complete dataset is  released as an artifact of this paper, it can be enhanced and corrected over time.Additionally, there is the possibility of errors in the manual process of selecting conferences, importing data about papers and authors, disambiguating author names, and identifying the correct citation data on GS. In the data-collection process, we have been careful to cross-validate the data we input against the one found in the official proceedings of each conference, as well as the data that GS recorded, and reconciled any differences we found.Citation metrics were collected from the GS database because it includes many metrics and allows for manual verification of the identity of each author by linking to their homepage. This database is not without its limitations, however. It does not always disambiguate author names correctly, and it tends to overcount publications and citations . The namOur dataset also does not include data specific to self-citations. Although it is possible that papers with released artifacts have different self-citations characteristics, thus confounding the total citation count, there is no evidence to suggest such a difference. This possibility certainly opens up an interesting question for future research, using a citation database with reliable self-citation information (unlike GS).This paper investigates the relationship between research artifacts and citations in the computer systems field. This relationship has been receiving increasingly more attention in recent years for CS papers in general. For example, a new study on software artifacts in CS research observed that while artifact sharing rate is increasing, the bidirectional links between artifacts and papers do not always exist or last very long, as we have also found . Some ofSoftware artifacts have often been discussed in the context of their benefits for open, reusable, and reproducible science . Such reWhen analyzing the relationship between artifact sharing and citations, one must be careful to consider the myriad possibilities for confounding factors, as we have in our mixed-effects model. Many such factors have been found to be associated with higher citation counts. Some examples relating to the author demographics include the authors’ gender , countryAmong the many paper-related factors studied in relation to citations is the paper’s text availability, which our data shows to be also linked with artifact availability. there exists a rich literature examining the association between a paper’s own accessibility and higher citation counts, the so-called “OA advantage” .For example, Gargouri et al. found that articles whose authors have supplemented subscription-based access to the publisher’s version with a freely accessible self-archived version are cited significantly more than articles in the same journal and year that have not been made open . A few oTurning our attention specifically to the field of systems, we might expect that many software-based experiments should be both unimpeded and imperative to share and reproduce . But insWithout directly comparable information on artifact availability rates in all of systems or in other fields, it is impossible to tell whether the overall rate of papers with artifacts in our dataset, 27.7%, is high or low. However, within the six conferences that evaluated artifacts, 42.86% of papers released an artifact, a very similar rate to the ≈40% rate found in a study of of a smaller subset of systems conferences with an artifact evaluation process .In general, skimming the papers in our dataset revealed that many “systems” papers do in fact describe the implementation of a new computer system, mostly in software. It is plausible that the abundance of software systems in these papers and the relative ease of releasing them as software artifacts contributes directly to this sharing rate, in addition to conference-level factors.Several studies across disparate fields found a positive association between the sharing of research artifacts and increased citation of the research work. In this cross-sectional study of computer systems research, we also observed a strong statistical relationship between the two, although there are numerous potential confounding and explanatory variables to increased citations. Still, even when controlling for various paper-related and conference-related factors, we observe that papers with shared artifacts receive approximately one-third more citations than papers without.Citation metrics are a controversial measure of a work’s quality, impact, and importance, and perhaps should not represent the sole or primary motivation for authors to share their artifacts. Instead, authors and readers may want to focus on the clear and important benefits to science in general, and to the increased reproducibility and credibility of their work in particular. If increased citation counts are not enough to incent more systems authors to share their artifacts, perhaps conference organizers can leverage their substantial influence to motivate authors. Although artifact evaluation can represent a nontrivial additional burden on the program committee, our data show that it does promote higher rates of artifact sharing.While many obstacles to the universal sharing of artifacts still remain, the field of computer systems does have the advantage that many—-if not most—of its artifacts come in the form of software, which is easier to share than artifacts in other experimental fields. It is therefore not surprising that we find the majority of shared and extant artifacts in computer systems hosted on github.com, a highly accessible source-code sharing platform. That said, a high artifact sharing rate is not enough for the goals of reproducible science, since many of the shared artifacts in our dataset have since expired or have been difficult to locate.Our analysis found that both the findability and accessibility of systems artifacts can decay significantly even after only a few years, especially when said artifacts are not hosted on dedicated open and free repositories. Conference organizers could likely improve both aspects by requiring—and perhaps offering—standardized tools, techniques, and repositories, in addition to the sharing itself. The ACM has taken significant steps in this direction by not only standardizing various artifact badges but also offering its own supplementary material repository in its digital library. A few conferences in our dataset, like SC, are taking another step in this direction by also requesting a standardized artifact description appendix and review for every technical paper, including a citeable link to the research artifacts.To evaluate the impact of such efforts, we must look beyond the findability and accessibility of artifacts, as was done in this study. In future work, this analysis can be expanded to the two remaining aspects of the FAIR principles: interoperability and reusability, possibly by incorporating input from the artifact review process itself. The hope is that as the importance and awareness of research artifacts grows in computer systems research, many more conferences will require and collect this information, facilitating not only better, reproducible research, but also a better understanding of the nuanced effects of software artifact sharing.10.7717/peerj-cs.887/supp-1Supplemental Information 1A list of all conferences used for this analysis, including conference acronym and full name; country and date taking place; number of papers submitted and accepted; number of PC members; and conference URL.Click here for additional data file.10.7717/peerj-cs.887/supp-2Supplemental Information 2Please refer to all *.md files for detailed data descriptions.Click here for additional data file.


Ketamine, synthesized in 1962 as phencyclidine derivate, is denominated a “dissociative anesthetic” because of its side-effects, such as dissociative episodes and psychotic-like symptoms, which have limited its applicability on clinical practice. Otherwise, in the last decades the non-medical use of ketamine has been growing and today is one of the most popular illicit substances consumed between adolescents and young adults.Increasing the knowledge and understanding of the factors related to crescent use of ketamine and the experiences and consequences associated to its consumption.Clinical interview with patients diagnosed with ketamine use disorder and bibliographic research in Pubmed database using the terms “Ketamine use” and “Ketamine addiction”.Pat et al. (2002) describes a clinical case of a young male, diagnosed with substance use disorders, specifically alcohol and cocaine use disorders, that started a treatment with ketamine. After the treatment, pleasant depersonalization experiences contributed to the development of patient’s ketamine dependence. Other patient’s reports confirm the association of ketamine use with psychedelic effects and dissociative episodes and pointed these effects as main reason for its consumption.The adverse effects that limited the medical use of ketamine are the same that promote its utilization with recreational purposes by adolescents and young adults in parties and nightclubs. About the ketamine dependence, the literature is scarce and doesn´t clearly identify a physical withdrawal syndrome, pointing only to a serious psychological dependence. Thus, with the crescent non-medical use of ketamine, it’s urgent to develop an intervention plan directed to this problem.No significant relationships.


Here, well-known reasons for avoidance of “the biological” are briefly summarized and an argument is advanced for meta-theoretical centering of creatureliness. A three-pronged agenda is proposed that embraces the creaturely body without the “-isms”  and “-izings”  that subvert feminist commitments. By unsettling HHE, executing the agenda would promote broader feminist coalitions and new scholarly collaborations aimed at fleshing out gender.People are living, breathing creatures. Dominant feminist discourses are situated within  The universe began with a bang about 14 billion years ago. Transformations of stardust, energy, and gravity over the next 10 billion years yielded, among other things, Earth. After a billion years of cooling and declining acidity, life debuted, with every living thing from then on carrying hydrogen as old as the cosmos . Since tCertain individuals spend time as a cell adrift in an aqueous milieu before metamorphosing into a bilaterally symmetrical tetrapod tethered to a host and then embarking on terrestrial life. There, they breathe air, eat, and defecate. They participate in a complex society in flexible ways contingent on, and constitutive of, body form and size, behavioral repertoires, social structure and composition, other life forms, and features of geography and climate .These life forms—bonobos, elephants, humans, wolves, and others—live in ways that are enabled and constrained by their bodies, from the trillions of microbes each body hosts to overall mass, organ systems and specialized attunements to the world within and beyond the skin. They share some ways of living with blue whales, bluebirds, and bluebells. At the same time, each is in some ways distinctive at species, population, group, and individual levels and mutable on time scales from evolutionary to momentary. Sooner or later, they die.What are the implications for gender studies of regarding humans not as “exceptional,” as minds housed in bodies that are inert input/output devices, as nodes or relations in networks, as wrought through human meaning-making, but rather as fully embodied creatures—as animals, as vertebrates, as mammals, as primates, as a particular sort of hominid? Taking up this question can spur scholarly and curricular innovation in service to feminism.The rub: As gender should be distinguished from sex because “‘sex’ implies biological mechanisms” (p. 1085). Unger did not refute human corporeality or biological sciences. The concern was with connotations of “the biological”: genetic determinism, reductionism, sex-typed behaviors as “hard wired.” The specter of an immutable sex binary was antithetical to feminist knowledge and commitments. Defining gender as sociocultural aimed to disrupt “-izing”– the binarizing, essentializing, and so-called “naturalizing” that sex evoked.Nurture/fluid is to mind/human as nature/immutable is to body/animal. Thus, a gender [social/mind/human] cluster that enacts hegemonic human exceptionalism (HHE) is split from a sex [biological/body/animal] cluster. This G/S split reflects and perpetuates gender-and race-based segregation and stratification in academia as in society at large To realize feminist goals, the G/S split and its proxies must be replaced with richer formulations.new materialists in psychology and other disciplines  and es e.g.,  into a pbiological should be used to refer to academic enterprises. This shift attends to the suffix of biology, the study of living things, and what biologists do. This institutional meaning is routinely conflated with the stuff of life at low levels of organization . Biologists also take up how life is organized at higher levels , but such work is less schematic for “the biological.” The topics that draw the biologist’s eye and how they are studied vary wildly. Dumping them into a bucket labeled “the biological” and distinguishing them from “the social” makes no sense, especially given that the latter lacks institutional meaning comparable to biological. More precise terms, such as genes or nervous system, should be used when referring to topics in biological sciences. Similarly, sociocultural constructs should be identified with specificity  will need to be negotiated.Replacing “the biological vs. the social” with a bigger, better lexicon will make the G/S split obsolete. Because this reform explodes exceptionalist dichotomies that remove humans from nature . Far from an exception, gender/sex expressions at all levels vary across time and contexts in many species cf. . Anybody primate .variation and constraint. An example at the subcellular level: allosomes . An XX/XY scheme is not necessary for reproduction, and being homogametic  is not “essentially female.” Across deep time, allosomes have been a flexible tool in the adaptation kit. Vertebrate species have 0–10 allosomes. In some reptiles and birds, the heterogametic individuals lay eggs, and some can reproduce either sexually or parthenogenetically. Moreover, allosomes do not determine sex-typed mating behavior. Every A. uniparens lizard, for instance, has XXX allosomes, is a parthenogen, and displays mating behaviors typical of egg-and sperm-producing members of related species . An XY zygote will not grow a uterus—regardless of sex assigned at birth and adult identity—and will not gestate a fetus, seek an abortion, or die giving birth. Human allosomes do not generate two human “kinds,” nor do they determine identity, behavior, lived experience, or social organization, validate treating gender as binary, or justify injustices. But they are matter that matters.On an evolutionary timescale, then, allosomes are flexibly related to bodies and behavior. On a developmental timescale, gene expression is probabilistic and context dependent so, for example, an XY human zygote will not necessarily grow up to have a penis, produce sperm, identify as a gender is compatible with conceptualizing bodies in symbolic, discursive, and cultural terms. In fact, it compels doing so. But it exposes the insufficiency of those (and any other) conceptualizations by illuminating domains of inquiry that are not tractable from those standpoints. These frameworks also illuminate paths to integration. Events at various levels of organization are presumed to interact through recursive loops on various time scales, and those loops pull for “cross-country” work. Research by Lisa Diamond, Sari van Anders, and Felicia Pratto exemplifies effective use of multi-level/scale, dynamical systems, and multi-method approaches to the complexity of gender.Using levels/scales frameworks to grapple with Roe v. Wade as partly about women and partly about members of a mammalian species able to gestate a fetus. Reproductive rights (or lack thereof) have everything to do with the traditional stocks-in-trade of feminists, such as challenging patriarchy, championing sexual and economic autonomy, and interrogating how family is defined. They also have everything to do with risks borne only by individuals on the receiving end of internal fertilization and gestation. If, like salmon and sparrows, humans laid eggs, gendering would play out differently in policy, practice, and everyday life.Reclaiming the body will allow feminists to take up in a more fulsome way the role of unmediated corporeal realities in individual and social well-being. For instance, it affords seeing the project of overturning all stakeholders .Becoming earth. Becoming animal. Becoming, in this manner, fully human… Corporeal life is indeed difficult… Thus do we shelter ourselves from the harrowing vulnerability of bodied existence. But by the same gesture we also insulate ourselves from the deepest wellsprings of joy… Awakening to citizenship in this broader commonwealth… has real ramifications for how we humans get along with one another. It carries substantial consequences for the way a genuine democracy shapes itself – for the way that our body politic gender into an inclusive rubric that subsumes sex – to wit, a large repertoire of loosely associated characteristics that vary and are constrained at various levels of organization and on various time scales. Comprehensive understanding may elude, but a shared vision of an expanded scope of inquiry that is not rooted in HHE can move feminist scholarship in new directions.The reforms proposed here transform the term The author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the author and do not necessarily represent those of the affiliated organizations, or those of the publisher, the editors and the reviewer. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Almost always, Congo red-stained amyloid between polariser and analyser is said to show “green birefringence” or “apple-green birefringence”. In 2010, we found that not all published images showed green, and not all that did showed only green. This systematic review of more recent papers was to find if there had been any improvement in the accuracy of reporting.MEDLINE was searched on 15 March 2021 for papers published between 2010 and 2020 inclusive mentioning amyloid and Congo red. These were examined for descriptions of colours, which were compared with images. Papers were searched for mentions of anomalous colours, errors in physical optics, and misquotation of references about polarisation./444 (56%), and green, 105/444 (24%). The description agreed with colours seen in 116/511 images (23%) . Green was seen in 342/511 images (67%) , but not in 169/511 (33%), although each image was reported to show green. Green alone was seen in 103/511 images (20%) , and was combined with at least one other colour in 239/511 (47%). Ten papers included the term anomalous. Eight papers incorrectly said that there was green dichroism, three incorrectly used the term green metachromasia, and two incorrectly mentioned green fluorescence. Twenty-seven papers misquoted references.In 374 papers, there were 444 descriptions of colours, with 511 images in 257 papers. The commonest descriptions were apple-green, 249“Green birefringence” and “apple-green birefringence” are inappropriate terms to describe the findings in amyloid stained with Congo red and examined between crossed polariser and analyser, because green is not always seen, and even when it is, other colours are commonly seen as well. The proportions of colour images showing any green and green alone, and the proportion of descriptions that agreed with illustrated colours, significantly decreased in 2010–2020 compared with earlier. The most appropriate and scientific description of the findings is anomalous colours.There is widespread and increasing inaccuracy of reporting of colours seen in Congo red-stained amyloid. People persist in saying “green birefringence” or “apple-green birefringence”, even when no green is seen, or there are also other colours. Few appear to appreciate that the other colours are genuine, respectable, and helpful, the physical optical principles that explain the colours are now understood, and the best expression to use is anomalous colours. Most people working on amyloid say that it shows “green birefringence” or “apple-green birefringence” when stained with Congo red and examined between crossed polariser and analyser . In thisUnfortunately, these ideas are wrong, as can be easily confirmed by inspection of published images of Congo red-stained amyloid. If green is indeed necessary for the diagnosis, every relevant illustration should show green. Because green is almost always the only colour mentioned, with the implication that no other colour is seen, most illustrations should only show green. In 2010 we published a study of 160 papers on Congo red-stained amyloid containing 191 colour images, which suggested widespread inaccurate and unscientific reporting, because, as examples, not all images showed green, few showed green alone, and two thirds had a discrepancy between colours claimed to be seen in images and what was actually illustrated , we found that in 2010 to 2020 inclusive, discrepancies between what was illustrated and what was claimed to be seen increased from 66% to 77% of figures, the proportion of figures showing no green increased from 17% to 33%, and the proportion showing green alone decreased from 31% to 20%. This inaccurate and unscientific reporting reflects badly on the objectivity of observers, who rather than relying on their own experience and questioning received opinions, which is what clinical scientists such as physicians and pathologists are expected to do, report what long-standing but erroneous tradition has conditioned them to see and to report.With so many papers in the systematic review, if any had been missed, say, that other databases would have identified, or if any had been wrongly categorised, the proportions of discrepancies are unlikely to be misleading to an important amount. Even though interpretation of colours is subjective, most discrepancies were between descriptions of a single colour in an image, almost always green or apple-green, and two or more colours included in the image, which observers had no doubt and agreed were multiple. There was consistency between the current study and the previous one , becauseWe have also shown that most people persisted in saying “green birefringence”, or more commonly, “apple-green birefringence”, even when there was no green in an image, or there were other colours that were ignored. The Nomenclature Committee of the International Society of Amyloidosis recognised in 2020 that “in reality, red, green and yellow are commonly seen” and “green may be very weak and difficult to see”, and so recommended that “the findings should be described in detail in order to avoid a statement that is not fully correct” . This reAnomalous colours have started to be mentioned in papers, although there is evidence that the physical optical principles of Congo red-stained amyloid are still misunderstood by many authors. This is shown by the misuse of the technical expressions, dichroism, metachromasia, and fluorescence, and by the misquotation of either historical references, or references that explain the physical optical principles underlying the colours . “Green There is still a widespread insistence that Congo red-stained amyloid shows “green birefringence” or, more usually, “apple-green birefringence”, when examined between polariser and analyser, even though green is not always seen, and even when it is, is not always on its own. Other colours are frequently overlooked. Observers have been trained that green is essential for the diagnosis of amyloid. Accordingly, they expect to see and report it, even when it is not there. Why authors persist in this is an interesting example of force of habit, or unquestioning acceptance of orthodoxy, in the face of everyday evidence to the contrary. Physical optical principles can explain the range of colours seen, which should be called anomalous colours.Click here for additional data file.Click here for additional data file.


Seen as a crucial historical step in the development of ‘modern’ institutional healthcare, eighteenth-century British naval medicine has traditionally been studied from the point of view of the state and of physicians and surgeons: naval sailors’ attitudes towards health, medicine and their own bodies remain virtually unexplored. Using official and personal sources, this article sketches a ‘patient’s history’ of late-eighteenth- and early-nineteenth-century British ratings. Aiming to counterbalance Foucauldian interpretations, it highlights some of the ways in which individuals, even when apparently most powerless, confined in ships far from home, and controlled by rigidly disciplined institutions, could take responsibility for their health, successfully or otherwise, within, against or alongside the system. If the unprecedented administrative requirements of the French Wars strengthened and standardised top-down medical authority, they also brought opportunities for evasion and negotiation. This complicates established narratives of the relationship between modern medicine, the armed forces and power. Shannon fought a violent action against the American USS Chesapeake.On 1 June 1813, the British frigate HMS assigned as a reason for not applying at the time of the injury, that he did not wish to be on the sick list, whilst he was able to do any thing, at a time we were so short of hands, as after an action, and having another frigate in charge.When questioned about his behaviour, the young seamanthat the man could not make himself understood readily being able to speak only his own native Irish and [was] not at all acquainted with the customs of the service, having served in it only two days prior to the action.‘Add to this’, the surgeon continued,The story of Patrick Ferreter offers us a glimpse into a topic that is largely absent from the historiography on the Georgian Navy: a seaman’s attitude towards injury, medicine and his own body.In Britain and Europe, the ‘long eighteenth century’ appears to mark a watershed in the relative position of patients and doctors. N. D. Jewson has famously argued that the rise of hospitalised medical care turned the ‘sick-man’, a significant, independent unit, into a ‘passive’ target of doctors’ practice, etymologically a ‘patient’.Compounding this position are the enduring views of eighteenth-century observers, who portrayed seamen as ‘imprudent’, carefree and reckless—an extreme example of the lower classes’ need for direction.So far, naval medical historians have mainly debated the extent to which the new military medical regimes brought positive or negative scientific and therapeutic contributions. While James Watt highlights the benefits of controlled experiments, systematic record-keeping and ‘medical arithmetick’, and Patricia Crimmin those of improved prevention, others, like Geoffrey Hudson, qualify the notion of military medicine as ‘a good thing’, and J. D. Alsop criticises its instrumentality and potential ‘narrowness’, due to the exclusive focus on white male servicemen.The extent to which the early-modern sick person truly was a subordinated entity, a passive ‘patient’ deferring to ‘closed’, ‘esoteric’ medical knowledge and authority, has long been questioned.During the Revolutionary (1793–1802) and Napoleonic Wars (1803–15), the Navy recruited an unprecedented number of men—by 1809 over 140,000 were in active service, nearly 70 per cent more than in 1760.methods chosen to reach certain goals could differ, and what say the individual could have on such methods. Naval sailors’ medical culture did not necessarily entail evading the surgeons and spurning their expertise, unless further motives intervened; but interactions with the Navy’s medical personnel were negotiated, dosed, calculated and supplemented by other options and beliefs, often specific to the wartime context. The delicate power compromises that, according to N. A. M. Rodger, operated in the mid-century fleet instead of discipline still survived in medical matters by the turn of the nineteenth century.The concept of ‘agency’ has been criticised by some scholars because of the main senses in which it is usually deployed: as a synonym on the one hand of ‘humanity’, which leads the historian to state the obvious, and possibly validate unsavoury socio-political doctrines , and on the other of ‘rebellion’, which is reductive.A final caveat is needed. All the historian can do is to observe these men’s behaviour, whether it fitted within the rules of the service, and sometimes whom it benefited. Beyond that, motivations are difficult to assess in their true depth. Numbness to death, self-harm, ‘concealment’, and often malingering, all treated in what follows, are actions to which no superficial explanation could ever do justice. The question of mental health in the Navy is a complex and important one, which is currently receiving long overdue attention.Overall, there are at least three reasons why naval sailors of the French Wars offer an important example of medical autonomy vis à vis the Foucauldian state: their professional and military value, their unusually broad range of experiences, and finally, it can be suggested, a certain peculiar mindset, or at least attitude, that came with a dangerous and often forced job.The quality of life in the eighteenth-century British Navy has been a matter of lively debate among historians. Traditional narratives highlight miseries and suffering, ruthless impressment (forced recruitment) practices, harsh punishments and general neglect of the individual’s welfare.widen the portion of the medical marketplace at his disposal. Dr Thomas Trotter, ex-Navy surgeon and Physician to the Channel Fleet in 1794–95, wrote that he had ‘frequently known seamen enter on board a man of war, for no other reason but the cure of the Venereal Disease, which they were not able to pay for, on shore’.Therefore, whilst life at sea itself caused medical dangers, in some cases a seaman, by enlisting in the Navy, could in fact Union hospital ship, in 1795, the surgeons personally stood in the ward with the patients, who, they claimed, developed great ‘faith’ in the procedure, and even assisted in performing it.Most problematic, to our eyes, is the frequency of medical experimentation on eighteenth-century servicemen, facilitated by the fact that they were ‘coerced, plentiful, and the intended beneficiaries of any improvements’.less reckless and unjustified than those on other groups, at least at the level of institutional strategy. As shown by Charters, even in the middle of the eighteenth century, when recruitment pressures were lower, the Admiralty Sick and Hurt Board were indeed very cautious in selecting which cures to authorise for trial, and in proceeding gradually, starting with small groups, and interrupting the tests if necessary.In general, the Admiralty dedicated growing attention and substantial resources to seamen’s health, mainly because the British state needed skilled seafarers, and faced an increasing shortage.If seamen’s value to the state ensured that they were offered some medical treatment, this does not automatically mean that the standardised care provided would be sufficient, appropriate or congenial to the individual. The sailors then acted to address this discrepancy, often using special knowledge and tools.Long confinement at sea obviously limits individuals’ options: a primary issue are the environmental conditions from which disease springs, which were the object of much attention among eighteenth-century medical practitioners.In his 1795 text on naval medicine, Gilbert Blane, ex-Physician to the Fleet, repeatedly emphasised the importance of ‘discipline’ and good ‘management’ for shipboard health, laying the responsibility squarely on the officers’ shoulders, and thus questioning the ‘unthinking’ ratings’ discernment.However, sparse mentions in Reynolds’s very text reveal a broader picture, with seamen taking the initiative: moving their hammocks up on deck when disease was raging , or, if they had the skill, re-sewing the poor clothes issued to them into garments more suitable to the climate.Contest, treated 23-year-old Ellis Eslam for a very bad cough, pains and expectoration, noting that the seaman had ‘been always Subject to a difficulty in Breathing, particularly in cold weather’ or when exercising heavily. ‘I am given to understand the Source of His disease is Hereditary’, he initially wrote. A few days later, however, a detailed patient anamnesis changed his thinking:I find from very minute inquiry that this poor man attributes the origin of His complaint to working at the trade to which He was brought up (namely the needle making) from which time (as well as while employed) He always laboured under ill Health, and through medical advice went to Sea for recovery. I was (at first) at a loss to find how his ailment could have made so great a Progress in so short a time as p[e]r journal. He further states the bad Effects he always found to result from Colds.We should be wary, anyway, of seeing seamen’s medical interventions only when they took the shape of rebellion. Many sailors trusted their surgeons and actively collaborated with them in formulating a diagnosis, and even the treatment. In December 1807, Thomas Crew, the surgeon of HM Brig London, in the summer of 1800, the seaman John Schull was sick with catarrhal fever: ‘Being accustomed to be bled in Hanover and different parts of Prussia for every disease he had in that Country: requested that he again might be bled’. ‘Accordingly’, the surgeon concluded, ‘ten ounces\blood/was taken from his Arm’. A side note in the journal further clarifies: ‘It is a common request among the Foreigners on board here, especially Germans, Prussians and Maltize to be bled for every disorder’.Phthisis, ‘grinders’ consumption’ (asthma) and early mortality were indeed common among needle-makers, due to the inhalation of stone and steel dust.What about choice of treatments beyond interaction with naval surgeons? Ashore, we saw, people could draw on a vast and diverse ‘marketplace’ for all purses, including not only university-educated practitioners, but also home remedies, neighbourly help, ‘alternative’ medicine, magic, and what the medical establishment classed as ‘quacks’.Princess Royal had a spate of seamen who openly told the surgeon that they had suffered from venereal ulcers and cured them autonomously , or had ‘been under the direction of some person on shore’ in Portsmouth, ‘taking some mercurial preparation’.Dr William Turnbull, in condemning the former practice of fining seamen for venereal diseases , remarked that this led them to ‘put themselves into improper hands’, rather than relying on their surgeon.Le Pegase, suffering from bubonocele, had it ‘reduced by his comrades’ .Sailors found remedies and preventatives for various conditions, more or less successfully. In October 1804, an ordinary seaman in the crew of the prison ship Similarly, the travelling itself, and the heterogeneous crews, could perhaps make seamen aware of different treatments and lifestyle regimes, even though this question requires further study. As shown by Wendy Churchill, non-European servicemen in particular were often allowed some ‘autonomy’ in their victualling, living and clothing choices; this stemmed, again, from a desire for military efficiency, coupled with contempt and racial beliefs that different ‘constitutions’ had different needs.Life at sea, of course, remained extremely dangerous. Sailors’ constant exposure to death and sickness, however, had two consequences: first, it gave them an in-depth knowledge of what ‘illness’ looked like, what provoked it and what the naval establishment’s reactions to it were. This was very precious information for men whose goals had ceased to be aligned with those of the Navy—that is, for men who wished to exit the system. Second, and more tentatively, it could be argued that a precarious, high-stakes life, with abundant reminders of the fragility of human bodies, could raise seamen’s bar for what was tolerable suffering, making them more difficult to coerce into anything. These two aspects will be examined in turn.The most simple way in which seamen could use medical conditions as their ticket to freedom was exploiting the difficulty for some hospital structures, especially those based on land, to contain desertions.there are a vast number who avowedly come in to gain a point, which is, either through a long struggle and great Imposition to be put on the list for survey, with the hope of Invaliding, to hang on the Hospital as long as possible from the great comfort of their situation or endeavor at effecting their escape.Even if he could not escape, moreover, managing to be sent to a land hospital had multiple advantages for a sailor. As the Governor of Haslar complained in 1797, among the incoming patientsAs a solution, he suggested sending those whose ill intent was clear to the ‘Convalescent Ship’, ‘which they hate to go to on account of the confinement’: allowing them to stay at the hospital only made them ‘daily… more hardened’ and ‘set the ingenuity of others at work’, acting as inspiration.The easiest route to a hospital was of course genuine illness. Another way to obtain this result, however, immediate respite from duty, or even official discharge from the service, was a sufficiently convincing performance of illness. Malingering has always been common in armed forces around the world, and a substantial historical and medical literature exists on this phenomenon during different conflicts.Even today, mental health conditions are still mostly diagnosed on the basis of self-reports, which means that they lend themselves to simulation: post-traumatic stress disorder (PTSD) is estimated to be the most commonly feigned complaint in modern Western militaries.Dreadnought in 1803, compiled a short essay ‘Of Impostors’, attempting to explain and classify malingering behaviour. The men, he wrote, were ‘induced’ to it ‘from fear, bashfulness or from lucre’. As he explained, the problem was that a physician or surgeon ‘can only judge from the symptoms’, ‘their presence or absence’. Yet ‘artful people, by a specious tale, and by feigning disorders where much is to be known from their own confession, may cause a good deal of difficulty to discover the truth’. He then proceeded to suggest a method to attempt to counter this behaviour, through thorough examination of symptoms and appearance, interrogation of the patient and other witnesses with questions ‘so framed as to confound them’, or frequent sudden visits when the sick man ‘least expects it’. A proper power struggle of wiles thus raged between the sailors and their doctors: the latter used their position of authority and scientific expertise, but the former used their own lived and witnessed experience of sickness to refine their impostures. As Carruthers observed, ‘many diseases’ could ‘be feigned, particularly by a person who has before suffered from them’, and if they did not entail fever, but had diagnoses depending entirely on the patient’s word. However, he downplayed sailors’ ability, stating that only ‘a few’ were ‘generally’ used: ‘Epilepsy, melancholy, foolishness, possession by evil spirits, and fascinations’. Some methods suggested for uncovering pretended epilepsy were brutal, like pressing a hand on the man’s mouth and nose to prevent him from breathing, or applying burning coals to his hands during a supposed episode, and observing his reactions.Thomas Carruthers, surgeon in HMS Carruthers was a very alert and severe doctor: the butcher’s assistant on his ship, William Carters, complained of a stiff left arm from an old wound, requiring a sling, but showed no convincing symptoms, and ‘was observed making use of both hands’ at work. Carruthers had the man’s grog stopped, and him put ‘to swing Shot on the poop every day to shame him, and as an Example to others not to do the like’.First of all, medical records only report the cases of men whose deception was discovered. Yet many more seamen may have succeeded in their goal, making their trick invisible to the historian. We know that a few sailors started off with a relatively high opinion of surgeons’ expertise, and therefore sceptical of their chances, but were pleasantly surprised. Just after the end of the American War, the American seaman Joshua Davis was eager to return home, but could not find a passage, so he had to join a Navy ship stationed in the Medway. Finally, he managed to obtain a spot in a merchant vessel bound to the United States, just before his ship was due to sail: he decided to pretend sickness to be discharged to hospital. He confided in a messmate, who believed that Davis ‘could not deceive the doctor’, but agreed to help him. Davis proceeded to ‘go to my hammock, drink a pint of vinegar a day, rub allum on my tongue to make it white, and rap my elbow against the ceiling to make the pulse beat’. Surely enough, the surgeon fell for his trick and sent him to hospital, where Davis secured a discharge by bribing a surgeon’s mate. .sic] pit [sick berth]’ of HMS Captain ‘from the day he came on board’, complaining of rheumatisms and a lame right arm, but he had failed to persuade Mr Farquhar, the surgeon, to put him on the sick list. Farquhar ‘had great reason to believe that this Man pretended to be much worse than he really was’; ‘by perseverance however he at last gained his point’, the surgeon eventually wrote in May 1798, ‘both his Officers and myself being glad to get clear of him by sending him to the Hospital’.Moreover, even when they suspected malingering, surgeons could have good reasons to look the other way. Sometimes, getting rid of a man who was clearly not eager to work and became a drain on the medics’ time benefited both parties. Private Marine James Robinson ‘had been a constant attendant in the Cocke [Lion in 1813, complained of back pain from an accident which his petty officer denied had even taken place, showed no external signs of injury, claimed contrasting and varying symptoms, and changed position ‘when he thought himself unobserved’: his surgeon, John Todd, declared him an impostor and sent him back to duty, but the man ‘continued to make the same complaint, stooping & of no use on board’, turning into ‘a burthen to the ship’. Exasperated, the surgeon discharged him to hospital with a terrible reference and no smart ticket, ‘in order that I might comply with the frequent appeals he has made against my humanity, and that if really Ill he might derive benefit from your treatment, if skulking he might be placed under more rigorous discipline than I have in my power to enforce’.This process, however, tested the very edge of shipboard officers’ and surgeons’ authority. John Rose, seaman in HMS Arethusa in 1806, reports a case of headache: the patient, a marine notorious aboard for imitating animals in exchange for grog, wasa sottish drunken fellow, of such a ghastly wretched appearance in general that it is a difficult matter to ascertain at anytime whether he is in health or otherwise especially if it is convenient for him to affect indisposition – which is very often the case.Todd was sure about Rose’s case; surgeons were even more disempowered when they were not, and had to concede a victory to the simulator out of caution, rather than simply annoyance. Thomas Simpson, for instance, surgeon of HMS Ambuscade in 1801, suspected that the marine Bernard Wels(h)ford was a simulator. The young man complained of heavy pain in the head and side, often ‘roared so loud as to prevent the Ship Company resting’, refused food, did not leave his hammock, and vomited after taking tea or gruel. The vomit, according to Hendry, was possibly self-induced, and there were no other symptoms of illness. Yet he still sent the man to Plymouth Hospital, albeit with a bad character reference: ‘Altho’ I had every reason to suppose this Man feigning Sickness’, he wrote, ‘still I was convinced that serious complaint may exist, without any marked dangerous symptoms’.The man, Simpson assumed, was probably just feigning sickness to avoid being punished for drunkenness, but even a case like this was given the benefit of the doubt and put off-duty.Overyssel, Alexander Gordon, in his ‘General Remarks’ for the year 1797–98:I have to regret that we have had a great deal of trouble & perplexity with feigned & artificial complaints, & that the present times compel surgeons to proceed with caution, as severity, in such cases, though proper, might be productive of unpleasant consequences.A telling comment was included by the surgeon of HMS The surgeons undoubtedly feared medical mistakes, as was the case for Hendry, but a clear disciplinary concern is also evident in Gordon’s text: he worried about spreading discontent, given that his ship was stationed at the Nore, and the great mutinies had just been suppressed that year (‘the present times’). Harshness would not be tolerated too well by the men in the specific circumstances, and the implications of an error of judgement on his part—mistrust towards his medical provision—could be catastrophic. This situation was perhaps peculiar to the precarious disciplinary balance of the fleet in the 1790s, a decade in which draconian repression had to be weighed against the threat of revolutionary ideals, and social negotiation acquired a new, sharper edge.In addition to this, naval surgeons often had to deal with patients who could be ruthless towards their own bodies, thus undermining the very essence of a doctor’s authority.Recollections, Commander Anthony Gardner describes how, during an action he fought aboard HMS Panther in the American War, a man was ‘cut in two by a double-headed shot… and the lining of his stomach (about the size of a pancake) stuck on the side of the launch’. The ship butcher allegedly ‘began to scrape it off with his nails, saying, “Who the devil would have thought the fellow’s paunch would have stuck so? I’m damned if I don’t think it’s glued on!”’.A leitmotiv in seamen’s memoirs from the time, deeply entangled with social precepts of performative masculinity, is an acquired indifference or numbness towards danger, injury and death.employs caustics to produce ulcers; inflates the urethra, to give the scrotum the appearance of hernia; and drinks a decoction of tobacco, to bring on emaciation, sickness at stomach, and quick pulse.In the constant struggle against surgeons seen above, which required high levels of plausibility, seamen’s malingering easily blurred into self-inflicted injury. Again, ‘disease forgery’ , is a common occurrence in militaries.In a text praising the brave British Tars, Trotter dismissed these as rare, temporary occurrences, patiently dealt with by the paternal surgeons, and not resulting in any punishment. The story that we distinguish through his lines, however, is potentially very different. In his 1843 treatise on malingering, Hector Gavin presents a 366-page-long list of tricks and deceptions used by soldiers and sailors, often during the French Wars, to pretend illness; many of these, such as introducing foreign objects into orifices, or smearing the gums with corrosive substances to simulate the symptoms of scurvy, frequently caused real damage, if not the very complaint that had been feigned.In 1807, the Black Spanish prisoner of war Peter Salagara, with family at home in Cuba, ‘cut off three Fingers from his left Hand to prevent his being able to serve in His Majesty’s Navy’.Cambridge, and 2 days later he was discharged as ‘unserviceable’, due to a ‘lame arm’ which the captain strongly suspected to predate the enlistment. Not only did he walk away with the £10, but he subsequently applied to be paid the remainder, and Admiralty lawyers were forced to rule that he effectively had a ‘right’ to it, and his ‘disqualification’ was ‘not sufficient to justify withholding it’.Seamen could also harm themselves less directly, by concealing their illness. This behaviour went against the expectations of the naval medical establishment that seriously injured or sick men come forward, to be disposed of or cured and made fully effective again (and to prevent contagion or other danger to the rest of the crew). Concealment was in many ways opposite to malingering, but often it too aimed for specific personal gain, such as being able to enter or remain in the service, or avoiding punishment. The Navy had a serious ongoing problem with the quality of the men recruited at its rendezvous, with many being later found ‘improper’ or outright ‘unserviceable’ upon closer survey.Arethusa, found a man with the ‘itch’, and had to examine the whole crew before discovering five more who had not come forward.Ambuscade was stationed in Sheerness; aboard it, William Mortimore had ‘been ailing a considerable time’ with genital chancroid (‘bubo chancres’), ‘but concealed his complaints on account of having his wife on board’—‘who’, the surgeon added, ‘I am inclined to believe must have infected him’. Perhaps the seaman wanted to spare his wife the humiliation, or perhaps he feared that she would be put ashore—women in naval ships were tolerated rather than officially allowed. He was marked as recovered after over a month of treatment, and we do not know what became of her.Some seamen, however, may have also kept their conditions secret to avoid discharge or disgrace. This extended to officers: Carpenter Richard Bennet, 26 years of age in 1801, suffered from advanced phthisis; he had ‘recently entered into the Service, being unable to procure a living on shore owing to Ill Health—and willing to conceal His Indisposition he had not made it known to the Surgeon’.Here we return to the young Patrick Ferreter, with whom we started this article—ignoring his luxated arm to help at a critical time, and thus likely making himself a permanent invalid. It is crucial to note that, when seamen had a motive for failing to report an ‘illness’, this could be personal advantage, but also, on the contrary, loyalty to the service, leading them to dismiss their pain in order to perform their duties. Authors celebrating the heroism of British Tars emphasised their patriotic resilience in the face of wounds, pain and death.Naval institutionalisation undoubtedly subjected seamen to high levels of control. However, despite their condition as the state’s ‘tools’, and the strictures of military discipline, this article has argued that in fact late eighteenth-century naval seamen had significant leeway to exert medical agency—and must be treated as central protagonists of naval medical history. Healthy and effective sailors were fundamental to the prolonged war effort: this in itself gave them bargaining power, both collectively and as individuals. Medical autonomy fit into a broader tapestry of negotiation patterns, some derived from earlier paternalistic frameworks, others conditioned by the new power dynamics and the revolutionary threat, as well as the shared knowledge, experiences and opportunities stemming from ever-increasing global deployment. Of course, life in the Navy carried high risks of disease and injury. Such risks, however, combined with the oppressing conditions of extended and (for many) forced service, often produced a very particular mindset—a conviction of not having much to lose—and a familiarity with pain and discomfort. This could lead the men to seize control of their own bodies, and use them against the very system that had first instrumentalised them. The standardised and depersonalised forms of treatment which were enhanced by large-scale mobilisation flattened the patient as an individual. Yet they could also offer him scope to wriggle out of and around the system: the unpredictability of individuals’ behaviour is key to short-circuiting the (necessarily) superficial flattening gaze and routines of the state.At the same time, it is clear that sailors’ challenge to medical authority was not always a default cultural attitude, nor necessarily a challenge to the values and goals of the service. Some men simply sought better ways to take care of their own health, and others even sacrificed it to do what they perceived as their duty. Therefore, if depicting them as passive recipients of medical care is reductive, it would be equally reductive to cast all their decisions as calculated ‘rebellion’ or resistance. Whatever the reason—gain or desperation, shame or fear, shyness, psychological suffering, naivety or differing constructions of disease, culturally assimilated ideals of heroism and manliness, or something else altogether—seamen often behaved in ways that escaped the institutional framework and rules, using their own body as a tool, or as they pleased.Some revisions to this article were conducted during a Scouloudi Fellowship at the Institute of Historical Research, London, an International Fellowship at the Deutsches Schifffahrtsmuseum, Bremerhaven, and a W. M. Keck Foundation Fellowship at the Huntington Library, San Marino.


He emphasized that dementia praecox is a central nervous system disease, involving permanent lesions on cerebral cortex. Besides biological deterioration, it appears as the result of psychic degenerative process. From the mid-20th century onward, antipsychotic drugs had been robustly generalized, and in parallel to the current classifications, residual symptoms in schizophrenia tend to be rare but still prevail in our patients.In the late XIXThe aim of our work is to report a clinical case of residual schizophrenia in parallel with the classic classification of Dementia Praecox and also do an overview of this disorder and its historical perspective.We conducted clinical interviews with the patient and family members, reviewed clinical records and conducted a query in the MEDLINE database using the terms " Dementia Praecox ", “Psychosis”, “Paranoia”, “Kraepelin”, “History”.We present the clinical case of a 74-year-old man with onset of psychotic symptoms on his twenties and diagnosed with Schizophrenia. In the past years, after acute psychotic episodes it was increasingly difficult to return to prior levels of functioning. Currently, he was brought to psychiatric emergency ward presenting bizarre behavior, stereotyped movements and speech disturbances, which reveal disorganized thinking and inability to express his emotions.Although these syndromes are nowadays relatively rare, it is important to keep them in mind, in order to understand the natural progression of psychotic diseases, improve their rehabilitative treatment and prognosis.No significant relationships.