Background The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit (...) staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. Methods A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. Results All 178 respondents (response rate: 25–32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to ‘team cooperation’, ‘team solidarity’ and ‘work ethic’. Lessons learned were mostly related to ‘quality of care’ and ‘professional qualities’. Conclusions Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals’ dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. Trial registration The trial was registered on The Netherlands Trial Register, number NL9177. (shrink)

Vaccine mandates played a critical role in the success of New York City’s COVID-19 response. By relying on evidence as a substantive basis for the mandates and adhering to procedural requirements and precedent, New York City leveraged its position and expertise as a local governmental authority to devise mandatory vaccine policies that withstood numerous legal challenges. New York City’s experience highlights the role of municipal government in mounting a meaningful public health response, and the strategies adopted by NYC may provide (...) a blueprint for municipalities around the world facing the ongoing COVID-19 pandemic and the threat of future public health emergencies. (shrink)

Recovery is a model of care in (forensic) mental health settings across Western nations that aims to move past the paternalistic and punitive models of institutional care of the 20th century and toward more patient‐centered approaches. But as we argue in this paper, the recovery‐oriented services that evolved out of the early stages of this liberating movement signaled a shift in nursing practices that cannot be viewed only as improvements. In effect, as “recovery” nursing practices became more established, more codified, (...) and more institutional(ized), a stasis developed. Recovery had been reterritorialized. The purpose of this paper is to examine some of the threads of recovery, from its early days of antipsychiatry activism to its codification into mental health—including forensic mental health—institutions through the lens of poststructuralist philosophers Gilles Deleuze and Felix Guattari. We believe that Deleuze and Guattari's scholarship provides the necessary, albeit uncomfortable, framework for this critical examination. From a conceptualization of recovery as an assemblage, we critically examine how we can go about creating something new, caught in a tension between stasis and change. (shrink)

Nurses working in forensic psychiatric settings face unique challenges in practice, where they take on a dual role of custody and caring. Patient resistance is widespread within these restrictive settings and can take many forms. Perhaps the most disturbing form of resistance entails a patient's weaponization of their bodily fluids, with nurses as their target. The tendency in assigning motive for this act is to relegate to the psychopathology of the patient. This paper will adopt a poststructuralist perspective to reexamine (...) this phenomenon as an act of resistance through the lens of Kristeva's concept of abjection. Patients confined in these settings have little sense of control, and in resistance may resort to the only thing available: their bodily fluids. By weaponizing the abject, patients actively violate and permeate the physical and psychological boundaries of nurses—the very boundaries considered crucial to safe and professional forensic psychiatric nursing practice. By recognizing this phenomenon as an act of resistance to confinement and loss of control, nurses may reorient their approach to care in forensic psychiatric settings. (shrink)

Nurses working in correctional and forensic mental health settings face unique challenges in the provision of care to patients within custodial settings. The subjectivities of both patients and nurses are subject to the power relations, discourses and abjection encountered within these practice milieus. Using a poststructuralist approach using the work of Foucault, Kristeva, and Deleuze and Guattari, this paper explores how both patient and nurse subjectivities are produced within the carceral logic of this apparatus of capture. Recognizing that subjectivities are (...) fluid and dynamic, and capable of change, Deleuze and Guattari's concept of deterritorialization will illustrate opportunities for resistance, where nurses can begin to practice outside the dominant carceral logic (and restrictions) of the system. (shrink)

Group sex among men who have sex with men may be understood as a ‘radical’ practice insofar as it transgresses dominant social discourses around appropriate sexual relations—prioritizing heteronormative, monogamous and risk‐averse sex. These practices are generally defined as steeped in risk, most commonly due to the potential for transmitting human immunodeficiency virus and sexually transmitted infections and accompanied by the possibility of legal and social repercussions. Our ethnographic research study explored the desires, practices and contexts of group sex participants (n (...) = 10) within a popular group sex party destination located in the United States. We employ a poststructuralist perspective (utilizing the work of Deleuze and Guattari) to understand group sex events with the pretext that bodies have no inherent ethics, meaning or essence: they are ‘bodies without organs’. We identify group sex as a form of boundary play, in which participants pursue new limits to what their bodies can do but within a carefully constructed environment that establishes norms of interaction meant to secure trust and safety between participants. A variety of risk reduction practices are shown to be promoted and honoured within these eventful sexual(ized) spaces. The application of poststructuralist concepts of ‘boundary play’ and ‘bodies without organs’ helped to depict the construction and navigation of pleasure, safety and risk among group sex participants. (shrink)

The susceptibility of online learning to cheating behavior remains a contentious and unresolved issue. A cross-sectional explanatory research design was utilized to test the hypothesized factors influencing academic cheating in online learning. Our study involved 562 participants, selected through a non-probability sampling technique, who were surveyed using online questionnaires designed to measure the identified factors. We tested the hypotheses by utilizing path analysis through the partial least square regression approach within the SMART-PLS software. The demographics such as gender and age (...) of the students, along with the roles of teachers and school administration significantly influenced the students’ instances of self-reported academic cheating. The students’ attitude toward academic cheating emerged as an important factor in predicting cheating behaviors. The paper concludes with recommendations for future research explorations into other potential factors that may contribute to academic dishonesty in online learning. (shrink)

Of two contending models for eukaryotic evolution the “archezoan“ has an amitochondriate eukaryote take up an endosymbiont, while “symbiogenesis“ states that an Archaeon became a eukaryote as the result of this uptake. If so, organelle formation resulting from new engulfments is simplified by the primordial symbiogenesis, and less informative regarding the bacterium‐to‐mitochondrion conversion. Gradualist archezoan visions still permeate evolutionary thinking, but are much less likely than symbiogenesis. Genuine amitochondriate eukaryotes have never been found and rapid, explosive adaptive periods characteristic of (...) symbiogenetic models explain this. Mitochondrial proteomes, encoded by genes of “eukaryotic origin“ not easily linked to host or endosymbiont, can be understood in light of rapid adjustments to new evolutionary pressures. Symbiogenesis allows “expensive” eukaryotic inventions via efficient ATP generation by nascent mitochondria. However, efficient ATP production equals enhanced toxic internal ROS formation. The synergistic combination of these two driving forces gave rise to the rapid evolution of eukaryotes.Also watch the Video Abstract. (shrink)

An eye-opening tour of the political tricks that subvert scientific progress. The Butter-Up and Undercut. The Certain Uncertainty. The Straight-Up Fabrication. Dave Levitan dismantles all of these deceptive arguments, and many more, in this probing and hilarious examination of the ways our elected officials attack scientific findings that conflict with their political agendas. The next time you hear a politician say, "Well, I’m not a scientist, but…," you’ll be ready.

Nurses working in outreach capacities frequently encounter disaffiliated or ‘hard to reach’ populations, such as those experiencing homelessness, those who use substances, and those with mental health concerns. Despite best efforts, nurses regularly fail to find meaningful engagement with these populations. Mobilizing the work of Deleuze and Guattari, this paper will critically examine conventional outreach nursing practices as rooted in the royal science of psychiatry, which many ‘survivors’ of psychiatric interventions reject. The field of Mad Studies offers an understanding of (...) patient resistance to outreach nursing interventions. Delueze and Guattari's concepts of packs and sorcerers provide a framework to envision alternative nursing practices as a form of resistance and creativity, where new alliances may be formed outside the coercive confines of traditional practices. In response to patient resistance, outreach nurses themselves must assemble packs and engage in acts of sorcery. (shrink)

Despite the importance of effective observational analysis in the technical aspects of climbing performance, limited research informs this aspect of climbing coach education. Thus, the purpose of the present research was to explore cognitive-perceptual mechanisms underpinning visual search strategies of expert and novice climbing coaches through the novel combination of eye-tracking technology and retrospective think-aloud methodology. Analysis of gaze data revealed expert climbing coaches to demonstrate fewer fixations of greater duration, and fixate on distinctly different areas of the visual display, (...) than their novice counterparts. Retrospective think-aloud interviews further demonstrated differences in the cognitive-perceptual mechanisms underpinning these visual search strategies, with expert coaches more cognisant of their visual search strategy. To expand, the gaze behaviour of expert climbing coaches was underpinned by hierarchical and complex knowledge structures relating to principles of climbing movement. This enabled expert coaches to actively focus on the most relevant aspects of a climber’s performance for analysis. Findings demonstrate the utility of combining eye tracking and retrospective think-aloud interviewing as a new, efficient methodology of capturing the cognitive-perceptual processes of climbing coaches to inform coaching education/strategies. (shrink)

In this richly argued and provocative book, David Davies elaborates and defends a broad conceptual framework for thinking about the arts that reveals important continuities and discontinuities between traditional and modern art, and between different artistic disciplines. Elaborates and defends a broad conceptual framework for thinking about the arts. Offers a provocative view about the kinds of things that artworks are and how they are to be understood. Reveals important continuities and discontinuities between traditional and modern art. Highlights core topics (...) in aesthetics and art theory, including traditional theories about the nature of art, aesthetic appreciation, artistic intentions, performance, and artistic meaning. (shrink)

We present a specific elaboration and partial defense of the claims that cognition is enactive, embodied, embedded, affective and (potentially) extended. According to the view we will defend, the enactivist claim that perception and cognition essentially depend upon the cognizer’s interactions with their environment is fundamental. If a particular instance of this kind of dependence obtains, we will argue, then it follows that cognition is essentially embodied and embedded, that the underpinnings of cognition are inextricable from those of affect, that (...) the phenomenon of cognition itself is essentially bound up with affect, and that the possibility of cognitive extension depends upon the instantiation of a specific mode of skillful interrelation between cognizer and environment. Thus, if cognition is enactive then it is also embodied, embedded, affective and potentially extended. (shrink)

This introduction to a special issue of Topoi introduces and summarises the relationship between three main varieties of 'enactivist' theorising about the mind: 'autopoietic', 'sensorimotor', and 'radical' enactivism. It includes a brief discussion of the philosophical and cognitive scientific precursors to enactivist theories, and the relationship of enactivism to other trends in embodied cognitive science and philosophy of mind.

Recently, constructive neutral evolution has been touted as an important concept for the understanding of the emergence of cellular complexity. It has been invoked to help explain the development and retention of, amongst others, RNA splicing, RNA editing and ribosomal and mitochondrial respiratory chain complexity. The theory originated as a welcome explanation of isolated small scale cellular idiosyncrasies and as a reaction to ‘overselectionism’. Here I contend, that in its extended form, it has major conceptual problems, can not explain observed (...) patterns of complex processes, is too easily dismissive of alternative selectionist models, underestimates the creative force of complexity as such, and – if seen as a major evolutionary mechanism for all organisms – could stifle further thought regarding the evolution of highly complex biological processes. (shrink)

Reasons.js is an open-source, loosely-coupled, web-based argument mapping library that can be integrated into a range of online coursewares and websites. The javascript library can be embedded into any HTML page and allows users to create, edit, share, and export argument maps . The API is designed to permit the integration of the three stages of informal logical analysis — identification of truth claims within arguments, the analysis of logical structure, and synthesis of logical structure into written form.

The concept of the three domains of reality is widely used in empirical critical realist research. However, there has been little scrutiny of how the domains are conceptualized and what they contribute to critical realism and how they should be applied in empirical research. This paper involves four arguments. First, Tom Fryer and Cristián Navarrete argue that the three domains of reality are redundant, confusing, and unsupported by Bhaskar’s theorizing. Second, Dave Elder-Vass argues that the three domains schema embodies (...) a distinction between the actual and the non-actual real. Regardless of whether we call them domains we need to retain this distinction. Third, Tobin Nellhaus argues that there are several reasons to uphold the three domains, but ‘the empirical’ is flawed and must be enfolded within a more encompassing theory. Fourth, Ruth Groff argues that the metaphor of ontological stratification is a problem when readers take it literally, often misconstruing the actual metaphysical content that it is meant to capture. (shrink)

As free‐living organisms, alpha‐proteobacteria produce reactive oxygen species (ROS) that diffuse into the surroundings; once constrained inside the archaeal ancestor of eukaryotes, however, ROS production presented evolutionary pressures – especially because the alpha‐proteobacterial symbiont made more ROS, from a variety of substrates. I previously proposed that ratios of electrons coming from FADH2 and NADH (F/N ratios) correlate with ROS production levels during respiration, glucose breakdown having a much lower F/N ratio than longer fatty acid (FA) breakdown. Evidently, higher endogenous ROS (...) formation did not hinder eukaryotic evolution, so how were its disadvantages mitigated? I propose that the resulting selection pressures favoured the evolution of a variety of eukaryotic ‘innovations’: peroxisomes for FA breakdown, carnitine shuttles, the linkage of beta‐oxidation to antioxidant properties, uncoupling proteins (UCPs) and using mitochondrial uncoupling during beta‐oxidation to reduce ROS. Recently observed relationships between peroxisomes and mitochondria further support the model. (shrink)

The aim of this article is to bring to the attention of the international nursing community the discrepancy between a pervasive ‘caring’ nursing discourse and a most unethical nursing practice in the United States. In this article, we present a duality: the conflict in American prisons between nursing ethics and the killing machinery. The US penal system is a setting in which trained healthcare personnel practice the extermination of life. We look upon the sanitization of deathwork as an application of (...) healthcare professionals’ skills and knowledge and their appropriation by the state to serve its ends. A review of the states’ death penalty statutes shows that healthcare workers are involved in the capital punishment process and shielded by American laws (and to a certain extent by professional boards through their inaction). We also argue that the law's language often masks that involvement; and explain how states further that duplicity behind legal formalisms. In considering the important role healthcare providers, namely nurses and physicians, play in administering death to the condemned, we assert that nurses and physicians are part of the states’ penal machinery in America. Nurses and physicians (as carriers of scientific knowledge, and also as agents of care) are intrinsic to the American killing enterprise. Healthcare professionals who take part in execution protocols are state functionaries who approach the condemned body as angels of death: they constitute an extension of the state which exercises its sovereign power over captive prisoners. (shrink)

Police and pastoral power: governmentality and correctional forensic psychiatric nursing Since 1978, the federal inmates of Canada have had access to a full range of psychiatric care within the penitentiary system. Several psychiatric units are now integrated into the correctional services of Canada. This paper presents the results of a grounded theory doctoral study undertaken in a multilevel secured psychiatric ward within the Canadian federal penitentiary system. The author describes and discusses the results of qualitative data that emerged from his (...) fieldwork. The concept of governmentality, as defined by the late French philosopher Michel Foucault, constitutes one of the major theoretical tools that were helpful in analyzing these data. Police and pastoral power, two dimensions of the security apparatus of governmentality, were found to be useful in understanding and characterizing nursing practice caught between the penal and the psychiatric dispositifs. A Foucauldian perspective allows one to understand the manner in which forensic psychiatric nursing is involved in the governance of mentally ill inmates through three forms of power — sovereign, disciplinary and pastoral — which have posited nursing practice as a strategic tool of the correctional services. This research consists of a study of nursing practice in an extreme setting that deserves a radical analysis. (shrink)

Our team at the Centre for Clinical Ethics has long been engaged in internal discussion about the purpose and value of ethics debriefs and their purported role in reducing moral distress (Morley an...

Skepticism about the limits of online learning is as old as online learning itself. As with other technologically-driven innovations in pedagogy, there are deep-seated worries that important educational goods might be effaced or obscured by the ways of teaching and learning that online methods allow. One family of such worries is inspired by reflections on the bodily basis of an important kind of understanding, and skepticism over whether this bodily basis can be inculcated in the absence of actual, flesh-and-blood, classroom (...) interactions. This paper focuses on the ways in which such worries arise in the influential work of Hubert Dreyfus. The negative conclusion for which I argue is that endorsing Dreyfus's Merleau-Pontian picture of the relationship between bodily skill and understanding does not commit us to his general pessimism concerning online learning—bodily, emotional, and interactive dimensions might be essential to learning, but we lack reasons to think that online learning necessarily lacks these dimensions. The negative argument motivates a positive claim: rather than giving up on online learning we should focus on designing courses and pedagogies that scaffold the bodily, affective and interactive dynamics constitutive of understanding in a particular domain. (shrink)

In this paper, we argue that nurses need to be aware of how the production of space in specific contexts – including health care systems and research institutions – perpetuates marginalized populations' state of social otherness. Lefebvre's idea regarding spatial triad is mobilized in this paper, as it pertains to two‐spirited, lesbian, gay, bisexual, trans and queer populations (2SLGBTQ*). We believe that nurses can create counter‐spaces within health care systems and research institutions that challenge normative discourses. Lefebvre's work provides us (...) the necessary tools to understand how various places or environments produce identities. In understanding Lefebvre's principles, we believe that nurses can play an essential role in creating counter‐spaces, thereby instigating counter‐institutional practices, for those who experience otherness. (shrink)

Many teacher candidates get their first taste of life as a full-time teacher in their practicums, during which they confront a host of challenges, pedagogical and ethical. Because ethics is fundamental to the connection between teachers and students, teacher candidates are often required to negotiate dilemmas in ways that keep with the ethical ideals espoused both by the professional body and the community at large. Presenting the case of a teacher candidate who finds herself emotionally depleted in her devotion to (...) students, we look to the ethics of care and virtue for clarifying insights. Care ethics extols intersubjectivity and reciprocity, while virtue ethics enjoins commitment to a noble ideal for its own sake; both perspectives offer useful insights for our case. We argue that the perspectives and practices of contemplative traditions can facilitate the integration of care and virtue ethics, mitigating the risk of disruption in caring relations while minimizing the possibility of a personal p... (shrink)

Although inquiry-based instruction has been a centerpiece of progressive visions of social studies education almost since its inception as a school subject a century ago, teachers often struggle to conceptualize it in ways that make true inquiry possible for their students. In this essay I suggest that social educators strengthen their connection with John Dewey’s pragmatic epistemology as the foundation of inquiry-based teaching in social studies, arguing in support of an approach that holds the promise of advancing goals associated with (...) meaningful democratic citizenship education. (shrink)

A short review of Bence Nanay's 'Between Action and Perception'.

This paper stages an encounter between Foucault and Althusser on the question of strategy. By contrasting a few passages in La Volonté de savoir with some of Althusser’s writings on Machiavelli and Lenin, I propose an alternative between the two thinkers according to a schema of strategic thought (Foucault) and a philosophy for strategy (Althusser). This narrow focus enables me to generate a working definition of strategy as the anticipation of an encounter which modifies, abolishes, or otherwise alters the relations (...) constituting its conjuncture. By staging the encounter between the Foucault and Althusser, I propose this definition as a reflection on the phrase “intervention into conjuncture,” and conclude by sketching implications concerning theory, practice, and the discipline of the conjuncture. (shrink)

There are those who would argue that, recently, the profession of nursing has made a radical shift, while others believe that a schism has been created among both scholars and clinicians as a result of the emerging dominance of the evidence‐based nursing movement. This paper offers a philosophical critique of this movement using Gilles Deleuze and Felix Guattari’s concept of schizoanalysis. As a conclusion, the authors posit that nursing professionals maintain a stance of academic freedom of thought and scientific integrity (...) through the acceptance of multiplicity, diversity, and polyvocality, and by challenging with politically charged concepts the totalizing perspectives that often spread through the profession/discipline of nursing. (shrink)

Synaesthetes persistently perceive certain stimuli as systematically accompanied by illusory colours, even though they know those colours to be illusory. This appears to contrast with cases where a subject’s colour vision adapts to systematic distortions caused by wearing coloured goggles. Given that each case involves longstanding systematic distortion of colour perception that the subjects recognize as such, how can a theory of colour perception explain the fact that perceptual adaptation occurs in one case but not the other? I argue that (...) these cases and the relationship between them can be made sense of in light of an existing view of colour perception. Understanding colours as ways in which objects and surfaces modify light, perceived through grasping patterns and variations in colour appearances, provides a framework from which the cases and their apparent disanalogy can be predicted and explained. This theory’s ability to accommodate these cases constitutes further empirical evidence in its favour. (shrink)

Recently, the group of McBride reported a stunning observation regarding peroxisome biogenesis: newly born peroxisomes are hybrids of mitochondrial and ER-derived pre-peroxisomes. What was stunning? Studies performed with the yeast Saccharomyces cerevisiae had convincingly shown that peroxisomes are ER-derived, without indications for mitochondrial involvement. However, the recent finding using fibroblasts dovetails nicely with a mechanism inferred to be driving the eukaryotic invention of peroxisomes: reduction of mitochondrial reactive oxygen species generation associated with fatty acid oxidation. This not only explains the (...) mitochondrial involvement, but also its apparent absence in yeast. The latest results allow a reconstruction of the evolution of the yeast's highly derived metabolism and its limitations as a model organism in this instance. As I review here, peroxisomes are eukaryotic inventions reflecting mutual host endosymbiont adaptations: this is predicted by symbiogenetic theory, which states that the defining eukaryotic characteristics evolved as a result of mutual adaptations of two merging prokaryotes. See also the video abstract here: https://youtu.be/HtyKhQ3DSxg Eukaryotic peroxisomes illustrate effects of symbiogenesis, following the non-phagocytotic merger of an archaeon and a bacterium. Internal ROS formation upon fatty acid oxidation was reduced by the invention of peroxisomes for extra-mitochondrial FA oxidation. Both peroxisomal membranes and their oldest enzymes seem ultimately derived from the pre-mitochondrion. (shrink)

The first complete history of Minneapolis and St Paul published in two decades. The book spans their ramshackle beginnings as cross-river rivals to their thriving metropolitan partnership today.