In this article, I discuss the structural domination of whiteness as it intersects with the potential of individual critique and reflexivity. I reflect on my positioning as a white nurse researcher while researching international nurse migration. I draw on two large qualitative studies and one small focus group study to discuss my reactions as a white researcher to evidence of institutional racism in the British health services and my growing awareness of how racism is reproduced in the British nursing profession.

The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile's (Practice‐based education: Perspectives and strategies, Rotterdam: Sense, 2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the healthcare assistant. In the British context, delegation and supervision are thought of as skills which are learnt (...) “on the job.” We suggest that learning “on‐the‐job” is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011 to 2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and healthcare assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the “invisible learning” which occurs as newly qualified nurses learn to delegate and supervise. (shrink)

In conversation with the ethical-theological-philosophical role of love in the Abrahamic traditions and U.S. immigration, personal testimonies of refugee families seeking asylum join the witness of the interfaith community of greater San Antonio to explain the gift received when love of God is expressed as radical hospitality.

This paper develops previous work on theories of embodiment by drawing on empirical data from a study into the experiences of infertile women in the UK. I suggest experiences of embodiment shape the preferences of infertile women for a female nurse as chaperone during intimate medical procedures. I explore the impact of this role on the understandings and meanings of nursing in a highly gendered field of practice. I present data from an ethnographic study of infertile women who chose to (...) attend a British infertility clinic for investigation and fertility treatment cycles. Data were collected over 2 years using participant observation and semistructured interviews with 15 women and 20 members of staff in a British fertility unit. Data analysis was completed using a modified thematic analysis following Boyle and McEvoy. I discuss women's experiences of intimacy and bodily care and how these experiences might be understood by exploring the phenomenological concept of embodiment. I argue that women benefit from having a female nurse as chaperone because of their expectations of gender, nursing and caring. Women's expectations reinforce both notions of gendered caring and the gendered role of nursing. These data challenge notions of patriarchal professionalism prevalent in nursing, which seek to move away from the gendered role of the nurse (which traditionally included a chaperone role) towards a model of professional development based on a mind–body split. I suggest that these data offer a way of understanding the female embodied subject in the field of gendered caring, which is potentially transgressive because they suggest ways in which both mind and body can be integrated through the role of the female chaperone. (shrink)

The COVID-19 pandemic crisis has necessitated widespread adaptation of revised treatment regimens for both urgent and routine medical problems in patients with and without COVID-19. Some of these alternative treatments maybe second-best. Treatments that are known to be superior might not be appropriate to deliver during a pandemic when consideration must be given to distributive justice and protection of patients and their medical teams as well the importance given to individual benefit and autonomy. What is required of the doctor discussing (...) these alternative, potentially inferior treatments and seeking consent to proceed? Should doctors share information about unavailable but standard treatment alternatives when seeking consent? There are arguments in defence of non-disclosure; information about unavailable treatments may not aid a patient to weigh up options that are available to them. There might be justified concern about distress for patients who are informed that they are receiving second-best therapies. However, we argue that doctors should tailor information according to the needs of the individual patient. For most patients that will include a nuanced discussion about treatments that would be considered in other times but currently unavailable. That will sometimes be a difficult conversation, and require clinicians to be frank about limited resources and necessary rationing. However, transparency and honesty will usually be the best policy. (shrink)

Mindfulness and compassion meditation are thought to cultivate prosocial behavior. However, the lack of diverse representation within both scientific and participant populations in contemplative neuroscience may limit generalizability and translation of prior findings. To address these issues, we propose a research framework calledIntersectional Neurosciencewhich adapts research procedures to be more inclusive of under-represented groups. Intersectional Neuroscience builds inclusive processes into research design using two main approaches: 1) community engagement with diverse participants, and 2) individualized multivariate neuroscience methods to accommodate neural (...) diversity. We tested the feasibility of this framework in partnership with a diverse U.S. meditation center (East Bay Meditation Center, Oakland, CA). Using focus group and community feedback, we adapted functional magnetic resonance imaging (fMRI) screening and recruitment procedures to be inclusive of participants from various under-represented groups, including racial and ethnic minorities, gender and sexual minorities, people with disabilities, neuropsychiatric disorders, and/or lower income. Using person-centered screening and study materials, we recruited and scanned 15 diverse meditators (80% racial/ethnic minorities, 53% gender and sexual minorities). The participants completed the EMBODY task – which applies individualized machine learning algorithms to fMRI data – to identify mental states during breath-focused meditation, a basic skill that stabilizes attention to support interoception and compassion. All 15 meditators’ unique brain patterns were recognized by machine learning algorithms significantly above chance levels. These individualized brain patterns were used to decode the internal focus of attention throughout a 10-min breath-focused meditation period, specific to each meditator. These data were used to compile individual-level attention profiles during meditation, such as the percentage time attending to the breath, mind wandering, or engaging in self-referential processing. This study provides feasibility of employing an intersectional neuroscience approach to include diverse participants and develop individualized neural metrics of meditation practice. Through inclusion of more under-represented groups while developing reciprocal partnerships, intersectional neuroscience turns the research process into an embodied form of social action. (shrink)

Cognition is readily seen to be connected to evolution through plots of the ratio of cranial capacity to body size of hominids which show two regions of sharply increasing ratios beginning at 2.5 and 0.5 million years ago – precisely the critical times inferred by the author from his study of tools. A similar correlation exists between current human brain growth spurts and the onsets of the Piagetian stages of reasoning development. The first goal of the author's target article is (...) stated to be “to make a case for the relevance of archeological contributions to studies of the evolution of cognition” (sect. 1, Introduction). His analysis focuses on spatial cognition. (shrink)

Pulvermüller's discussion needs more explanation of how the proposed assemblies remain assembled after formation and how they can be accessed later among all the possible assemblies, many of which involve many of the same neurons. Alternative Hebbian strengthening mechanisms may provide additional information, and, developmental studies of the assemblies might provide insights into their evolution.

Analyses of bodies of data usually omit some relevant studies. Geary omits some studies looking at functional correlates of basic biological data, studies of developmental implications for functioning, and the recent achievement of acceleration of cognitive development.

Moral distress is a phenomenon increasingly recognized in healthcare that occurs when a clinician is unable to act in a manner consistent with his or her moral requirements due to external constraints. We contend that some experiences of moral distress are self-inflicted due to one’s under-assertion of professional authority, and these are potentially avoidable. In this article we outline causes of self-inflicted moral distress and offer recommendations for mitigation.

The recent dramatic development of molecular neurobiology has focused almost entirely on biological events in individual brain cells, and it seems that many of the goals of such work will soon be attained. Yet, when we attain those goals, we will still have to ask how this information will enable us to understand the properties of brain cell collectivities and their presumptive roles in higher brain functions. Even general ideas about those functions are not yet well defined. Therefore, it seems (...) worthwhile to start studying correlations of the molecular events to these higher functions to help delineate the molecular aspects that need study.It is readily appreciated that we cannot tell what other animal species see, hear, taste, smell and feel when touching something, though we can foresee the time when we will be able to detail the biochemical and biophysical consequences of all inputs to those senses. Thus, however deep our understanding of the biology of those species, we are unable to establish relations between their biological responses to inputs and their presumptive mental perceptions. Even though humans can use language to talk about those perceptions, we cannot even verify whether someone else's perceptions are the same as our own, as with the old question of whether two individuals see the same thing when viewing something blue. Questions about still higher mental functions of human brains are even less accessible to analysis and can be approached at best, by using correlations. In this article are a number of such questions and their current correlation‐level answers. (shrink)

The voices of children and young people have been largely neglected in discussions of the extent to which the internet takes into account their needs and concerns. This paper aims to highlight young people’s lived experiences of being online.

Live coding is an embodied, sensorial and live technological–human relationship that is recursively iterated through sonic and visual outputs based on what we argue are kinship relations between and through bodies and technology. At the same time, and in a familiar moment of déjà vu for feminist scholars, live coding is most often discussed not in relation to the lived and sensory human–technology kinship, but in terms of fetishised code or software, output and agency. As feminist scholars have long argued, (...) emphasising and fetishising code or software, and celebrating output and agency are normatively masculine, white and Western conceptions of technology that feed into the growing valorisation of accelerationist logic whilst also negating embodied, not to mention other (non-white, Western, masculine) bodies, expertise or histories per se. In this article, we want to redress this by drawing on our empirical material on live coding to focus on human–technology kinship and, in so doing, think about failure, slowness and embodiment and about human–technology relations that are more akin to what Alison Kafer (drawing on the work of Donna Haraway) has termed ‘becoming with’ or ‘making kin’. This, we argue, has the potential to shift the focus from the potentialities of technologies on or through the body, towards the generative capacities of mediation (including failure), which are caught up in lived experiences. The question is not only about how the relations of bodies and technologies are played out in certain circumstances but about what might be played out if we reconceptualise these relations in these terms. (shrink)

This article seeks the origin, in the theories of Ibn al-Haytham (Alhazen), Descartes, and Berkeley, of two-stage theories of spatial perception, which hold that visual perception involves both an immediate representation of the proximal stimulus in a two-dimensional ‘‘sensory core’’ and also a subsequent perception of the three dimensional world. The works of Ibn al-Haytham, Descartes, and Berkeley already frame the major theoretical options that guided visual theory into the twentieth century. The field of visual perception was the first area (...) of what we now call psychology to apply mathematics, through geometrical models as used by Euclid, Ptolemy, Ibn al-Haytham, and Descartes (among others). The article shows that Kepler’s discovery of the retinal image, which revolutionized visual anatomy and entailed fundamental changes in visual physiology, did not alter the basic structure of theories of spatial vision. These changes in visual physiology are advanced especially in Descartes' Dioptrics and his L'Homme. Berkeley develops a radically empirist theory vision, according to which visual perception of depth is learned through associative processes that rely on the sense of touch. But Descartes and Berkeley share the assertion that there is a two-dimensional sensory core that is in principle available to consciousness. They also share the observation that we don't usually perceived this core, but find depth and distance to be phenomenally immediate, a point they struggle to accommodate theoretically. If our interpretation is correct, it was not a change in the theory of the psychology of vision that engendered the idea of a sensory core, but rather the introduction of the theory into a new metaphysical context. (shrink)

What I would like to do in the next few minutes is to outline very briefly some of my research on the authenticity of the Shurangama-sutra. Although the material is rather complex, I'll do my best to omit what is tedious without sacrificing important points. However, it will be necessary to omit most of the details just in order to get through the material.

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube (...) feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care. (shrink)

Hélène BOUCHILLOUX. — Apologie et théologie dans les Pensées de Pascal, p. 3. Comment concilier l’entreprise apologétique de Pascal avec sa théologie du péché et de la grâce? L’apologiste peut-il persuader de la vérité du christianisme celui dont le cœur n’a pas été préalablement converti par Dieu? S’il ne le peut, quel sens y a-t-il à prétendre précéder l’action divine en proposant à l’incrédule un discours de la preuve? On montre 1 / que la réflexion pascalienne sur l’art de persuader (...) exclut une persuasion sans conversion, puis 2 / qu’en dissociant efficacité et utilité des preuves, les Pensées ne visent autre chose qu’à faire apercevoir une vérité qu’on ne saurait pourtant recevoir sans une humiliation de la raison et une conversion du cœur. (shrink)

We examine the computably enumerable (c.e.) degrees of prime models of complete atomic decidable (CAD) theories. A structure has degree d if d is the degree of its elementary diagram. We show that if a CAD theory T has a prime model of c.e. degree c, then T has a prime model of strictly lower c.e. degree b, where, in addition, b is low (b' = 0'). This extends Csima's result that every CAD theory has a low prime model. We (...) also prove a density result for c.e. degrees of prime models. In particular, if c and d are c.e. degrees with d < c and c not low₂ (c" > 0"), then for any CAD theory T, there exists a c.e. degree b with d < b < c such that T has a prime model of degree b, where b can be chosen so that b' is any degree c.e. in c with d' ≤ b'. As a corollary, we show that for any degree c with 0 < c < 0', every CAD theory has a prime model of low c.e. degree incomparable with c. We show also that every CAD theory has prime models of low c.e. degree that form a minimal pair, extending another result of Csima. We then discuss how these results apply to homogeneous models. (shrink)

Surveys and routine clinical procedures applied in research protocols are typically considered only minimally risky to participants. The apparent benign nature of "minimal risk" tasks increases the chance that investigators and Institutional Review Boards (IRBs) will overlook the probability that clinical tools will identify signs, symptoms, or definitive test results that are clinically-relevant to subjects' welfare. "Minimal risk" procedures may also pose a particular hazard to participants in clinical research by increasing the therapeutic misconception because the tasks mimic clinical care (...) and are often conducted in clinical settings. Investigators should anticipate which measures could yield clinically-important findings and should describe explicit plans for data monitoring, disclosure, and follow-up. Protocols that include reliable and valid clinical measures should prompt a more detailed risk assessment by the IRB, even when the tasks meet the regulatory criteria for minimal physical, psychological, or emotional risk. (shrink)

Background: Frailty is a natural consequence of the aging process. With the increasing aging population in Mainland China, the quality of life and end-of-life care for frail older people need to be taken into consideration. Advance Care Planning has also been used worldwide in long-term facilities, hospitals and communities to improve the quality of end-of-life care, increase patient and family satisfaction, and reduce healthcare costs and hospital admissions in Western countries. However, it has not been practiced in China. Research objective: (...) This study aimed to evaluate the effectiveness of a modified Advance Care Planning intervention in certainty of end-of-life care, preferences for end-of-life care, quality of life concerns, and healthcare utilization among frail older people. Research design: This study used a quasi-experimental design, with a single-blind, control group, pretest and repeated posttest approach. Participants and research context: A convenience sample of 74 participates met the eligibility criteria in each nursing home. A total of 148 frail older people were recruited in two nursing homes in Zhejiang Province, China. Ethical considerations: The study received ethical approval from the Clinical Research Ethics Committee, the Faculty of Medicine, and The Chinese University of Hong Kong, CREC Ref. No: 2016.059. Findings: The results indicated the Advance Care Planning programme was effective at increasing autonomy in decision making on end-of-life care issues, decreasing decision-making conflicts over end-of-life care issues, and increasing their expression about end-of-life care. Discussion: This study promoted the participants’ autonomy and broke through the inherent custom of avoiding talking about death in China. Conclusion: The modified Advance Care Planning intervention is effective and recommended to support the frail older people in their end-of-life care decision in Chinese society. (shrink)

I develop a nontheistic (quasi-)Berkeleyan idealism. The basic strategy is to peel away the attributes of God that aren't essential for role he plays in idealist metaphysics. God's omnibenevolence, his desires, intentions, beliefs, his very status as an agent ... aren't relevant to the work he does. When we peel all these things away, we're left with a view on which reality is a vast unity of consciousness, weaving together sensory experiences of colors, shapes, sounds, sizes, etc. into the trees, (...) electrons, black holes, and central nervous systems that fill the world around us. This phenomenal unity is governed by laws analogous to those posited by materialists, governing the unfolding of reality. I argue that if reality is fundamentally phenomenal in this way, we can give a unique account of perception that robustly captures direct realist intuitions of reality forming the "constituents" of our experiences: In perception, our finite unities of consciousness come to literally overlap with the unity of consciousness that is reality. I assess the unique virtues and challenges such a view faces, paying particular attention to the question of whether idealism entails a profligacy of physical laws. (shrink)