Working in and around the ‘chain of command’: power relations among nursing staff in an urban nursing homeBy most accounts, the discipline of nursing enjoys considerable hegemony in US nursing homes. Not surprisingly, the ethos of this setting is influenced, in large part, by nursing’s value system. This ethos powerfully impacts both the residents who live in nursing homes and the staff who work there. Using ethnographic methods, this project explored power relations among nursing assistants and nurses in an urban (...) nursing home in the United States. Factors contributing to tensions among nursing staff were the stigma attached to nursing homes and those who work in them, as well as the long history of class conflict and power struggles within the discipline of nursing. The latter struggles, in turn, reflected nursing’s quest for professional status in the face of medicine’s hegemony over health‐care. Ultimately, these factors coalesced to produce a local work environment characterized by conflict — and by aides’ resistance to nurses’ domination. (shrink)

Recent research indicates that among young women, Blacks have lower employment rates than whites. Evidence is provided about whether young Black women's lower employment rates stem from structural features of the labor market, discrimination, or changing family or individual characteristics. Data show that Black women exit full-time employment at higher rates because they are more likely to be laid off, to leave because they work in temporary/seasonal jobs, and to leave for other reasons. Structural features of the labor market are (...) key in explaining Black women's higher rates of lay-offs, exits from temporary/seasonal work, and exits for other reasons. Individual characteristics and discrimination play a role in Black women's higher rates of lay-offs and exits for other reasons while family characteristics are important in explaining Black women's higher rates of leaving temporary/seasonal work and leaving for other reasons. Evidence suggests that Black women's higher exit rates are indicative of disadvantage in the labor market. (shrink)

This paper describes how I came to know a younger, mentally ill resident during fieldwork in an urban nursing home. I describe my efforts to establish a connection with this man, revealing the manner in which the academic and personal become fused in ethnographic research. In his discourse David conveys an unsettling universe filled with extreme power asymmetries, where he continually gravitates between the roles of victim and victimizer. His various identities are in a state of constant flux, at times (...) blurring the boundaries of culturally recognized categories. While fragmentation and multiplicity are often glorified within postmodernism, I suggest that persons with psychosis may find them imprisoning rather than liberating. (shrink)

There isn’t much understanding in some marriages. My sister has six [children] and another has eight. I said to one of them that she shouldn’t have any more. And she said “What can I do? When my husband comes home drunk, he foxes me to sleep with him.” And that is what happens to a lot of women. And if the women don’t do it, the men hit them, or treat them badly. Or the men get jealous and think their (...) wives are with other men.—Rene, a 29-year old Peruvian womanGender violence is a major yet often underrecognized obstacle to reproductive choice. In both the abortion rights movement in the United States and the reproductive health movement globally, the “enemy” of self-determination and choice is usually seen as imposing from the top down. In the North, it is the government—through the courts, the legislature, and bureaucratic rulemaking—that threatens to “take away” women’s reproductive autonomy. The image is one of the public sphere invading that which is private—of the state interfering with a woman’s right to control her own body. (shrink)

There isn’t much understanding in some marriages. My sister has six [children] and another has eight. I said to one of them that she shouldn’t have any more. And she said “What can I do? When my husband comes home drunk, he foxes me to sleep with him.” And that is what happens to a lot of women. And if the women don’t do it, the men hit them, or treat them badly. Or the men get jealous and think their (...) wives are with other men.—Rene, a 29-year old Peruvian womanGender violence is a major yet often underrecognized obstacle to reproductive choice. In both the abortion rights movement in the United States and the reproductive health movement globally, the “enemy” of self-determination and choice is usually seen as imposing from the top down. In the North, it is the government—through the courts, the legislature, and bureaucratic rulemaking—that threatens to “take away” women’s reproductive autonomy. The image is one of the public sphere invading that which is private—of the state interfering with a woman’s right to control her own body. (shrink)

The DNA in a eukaryotic nucleus is packaged into a nucleosome array, punctuated by variations in the regular pattern. The local chromatin structure of inducible genes appears to fall into two categories: preset and remodeling. Preset genes are those in which the binding sites for trans‐acting factors are accessible (;i.e. in a non‐nucleosomal, DNase I hypersensitive configuration) prior to activation. In response to the activation signal, positive factors bind to cis‐acting regulatory elements and trigger transcription with no major alterations in (...) the chromatin structure of the promoter region. In contrast, remodeling genes are those in which some of the required cis‐acting regulatory elements are packaged into nucleosomes. The nucleosomes must be perturbed in response to an activation signal in order for the trans‐acting factors to gain access to cis‐acting elements; a chromatin remodeling process which forms DNase I hypersensitive sites must occur. In both cases, precise positioning of nucleosomes along the promoter region of a gene appears to be critical for appropriate regulation of expression. (shrink)

Multiple acoustic dimensions signal speech categories. However, dimensions vary in their informativeness; some are more diagnostic of category membership than others. Speech categorization reflects these dimensional regularities such that diagnostic dimensions carry more “perceptual weight” and more effectively signal category membership to native listeners. Yet perceptual weights are malleable. When short-term experience deviates from long-term language norms, such as in a foreign accent, the perceptual weight of acoustic dimensions in signaling speech category membership rapidly adjusts. The present study investigated whether (...) rapid adjustments in listeners’ perceptual weights in response to speech that deviates from the norms also affects listeners’ own speech productions. In a word recognition task, the correlation between two acoustic dimensions signaling consonant categories, fundamental frequency and voice onset time, matched the correlation typical of English, and then shifted to an “artificial accent” that reversed the relationship, and then shifted back. Brief, incidental exposure to the artificial accent caused participants to down-weight perceptual reliance on F0, consistent with previous research. Throughout the task, participants were intermittently prompted with pictures to produce these same words. In the block in which listeners heard the artificial accent with a reversed F0 × VOT correlation, F0 was a less robust cue to voicing in listeners’ own speech productions. The statistical regularities of short-term speech input affect both speech perception and production, as evidenced via shifts in how acoustic dimensions are weighted. (shrink)

Although speech categories are defined by multiple acoustic dimensions, some are perceptually weighted more than others and there are residual effects of native-language weightings in non-native speech perception. Recent research on nonlinguistic sound category learning suggests that the distribution characteristics of experienced sounds influence perceptual cue weights: Increasing variability across a dimension leads listeners to rely upon it less in subsequent category learning (Holt & Lotto, 2006). The present experiment investigated the implications of this among native Japanese learning English /r/-/l/ (...) categories. Training was accomplished using a videogame paradigm that emphasizes associations among sound categories, visual information, and players’ responses to videogame characters rather than overt categorization or explicit feedback. Subjects who played the game for 2.5 h across 5 days exhibited improvements in /r/-/l/ perception on par with 2–4 weeks of explicit categorization training in previous research and exhibited a shift toward more native-like perceptual cue weights. (shrink)

Access to a deep pool of talent is essential to the success of every professional services firm. The supply of that talent is contingent upon the available rewards for the exercise of that talent, and both the existence of the potential rewards and the beliefs that individuals hold about the existence of the rewards affect the decision to remain in the field. One structural factor that may affect the judgment about whether to remain in a profession concerns promotions based on (...) the gender of the employee. In this study, we examine the “glass ceiling” within the context of the accounting profession. While advances have been made within the accounting profession to address the glass ceiling, the continued existence—and perceptions about the continued existence—of the issue exert adverse effects upon the available talent pool and may create long-term problems for the profession. In this study, we investigate glass ceiling perceptions among a large sample of female accounting professionals employed in accounting; the sample includes both public accountants, and those employed in industry accounting. Our study yields the finding of beliefs in bias-driven effects, structural effects, and cultural effects among these accounting professionals. Glass ceiling perceptions are also influenced by several demographic factors. Furthermore, accounting professionals employed by industry are more likely to report a glass ceiling within their firms than accounting professionals employed by public accounting firms. The findings are of interest to researchers who explore gender-related issues in professional service firms such as the field of accounting, and to senior members of practice who are tasked with ensuring the integrity and quality of the talent pool and the equitable distribution of rewards to employees. (shrink)

Cognitive systems face a tension between stability and plasticity. The maintenance of long‐term representations that reflect the global regularities of the environment is often at odds with pressure to flexibly adjust to short‐term input regularities that may deviate from the norm. This tension is abundantly clear in speech communication when talkers with accents or dialects produce input that deviates from a listener's language community norms. Prior research demonstrates that when bottom‐up acoustic information or top‐down word knowledge is available to disambiguate (...) speech input, there is short‐term adaptive plasticity such that subsequent speech perception is shifted even in the absence of the disambiguating information. Although such effects are well‐documented, it is not yet known whether bottom‐up and top‐down resolution of ambiguity may operate through common processes, or how these information sources may interact in guiding the adaptive plasticity of speech perception. The present study investigates the joint contributions of bottom‐up information from the acoustic signal and top‐down information from lexical knowledge in the adaptive plasticity of speech categorization according to short‐term input regularities. The results implicate speech category activation, whether from top‐down or bottom‐up sources, in driving rapid adjustment of listeners' reliance on acoustic dimensions in speech categorization. Broadly, this pattern of perception is consistent with dynamic mapping of input to category representations that is flexibly tuned according to interactive processing accommodating both lexical knowledge and idiosyncrasies of the acoustic input. (shrink)

The effects of lexical context on phonological processing are pervasive and there have been indications that such effects may be modulated by attention. However, attentional modulation in speech processing is neither well documented nor well understood. Experiment 1 demonstrated attentional modulation of lexical facilitation of speech sound recognition when task and critical stimuli were identical across attention conditions. We propose modulation of lexical activation as a neurophysiologically plausible computational mechanism that can account for this type of modulation. Contrary to the (...) claims of critics, this mechanism can account for attentional modulation without violating the principle of interactive processing. Simulations of the interactive TRACE model extended to include two different ways of modulating lexical activation showed that each can account for attentional modulation of lexical feedback effects. Experiment 2 tested conflicting predictions from the two implementations and provided evidence that is consistent with bias input as the mechanism of attentional control of lexical activation. (shrink)

We read with interest Lanphier and Anani’s manuscript on trauma-informed ethics consultation. Their model rightly integrates trauma-informed principles within the ethics c...

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the protocol, summarize the protocol, and discuss the major ethical challenges (...) encountered, along with our answers to the challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments.We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the pandemic and similar public health emergencies. (shrink)

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Pleiotropically acting eukaryotic corepressors such as retinoblastoma and SIN3 have been found to physically interact with many widely expressed “housekeeping” genes. Evidence suggests that their roles at these loci are not to provide binary on/off switches, as is observed at many highly cell‐type specific genes, but rather to serve as governors, directly modulating expression within certain bounds, while not shutting down gene expression. This sort of regulation is challenging to study, as the differential expression levels can be small. We hypothesize (...) that depending on context, corepressors mediate “soft repression,” attenuating expression in a less dramatic but physiologically appropriate manner. Emerging data indicate that such regulation is a pervasive characteristic of most eukaryotic systems, and may reflect the mechanistic differences between repressor action at promoter and enhancer locations. Soft repression may represent an essential component of the cybernetic systems underlying metabolic adaptations, enabling modest but critical adjustments on a continual basis. (shrink)

Background and AimsEnd-of-life discussions can be difficult for seriously ill adolescents and young adults. Researchers aimed to determine whether completing Voicing My CHOiCES —a research-informed advance care planning guide—increased communication with family, friends, or health care providers, and to evaluate the experience of those with whom VMC was shared.MethodsFamily, friends, or HCPs who the AYAs had shared their completed VMC with were administered structured interviews to assess their perception of the ACP discussion, changes in their relationship, conversation quality, and whether (...) the discussion prompted changes in care. Open-ended responses underwent thematic analysis.ResultsOne-month post-completion, 65.1% of AYA had shared VMC completion with a family member, 22.6% with a friend, and 8.9% with an HCP. Among a sample of respondents, family and friends reported a positive change in their relationship with the AYA. Participant descriptions of the experience fell into five themes: positive experience, difficult experience, appreciated a guide to facilitate discussion, provided relief, and created worry/anxiety. Only 1 HCP noted a treatment change. Family, friends, and HCP did not think the AYA would have discussed EoL preferences without completing VMC.ConclusionsVMC has potential to enhance communication about ACP between AYA and their family and friends, though less frequently with HCPs. Participants reported a positive change in their relationship with the AYA after discussing VMC, and described experiencing the conversation as favorable, even when also emotionally difficult. (shrink)

Adolescence is an important developmental period marked by a transition from primarily parental-controlled eating to self-directed and peer-influenced eating. During this period, adolescents gain autonomy over their individual food choices and eating behavior in general. While parent-feeding practices have been shown to influence eating behaviors in children, little is known about how these relationships track across adolescent development as autonomy expands. The purpose of this qualitative study was to identify factors that impact food decisions and eating autonomy among adolescents. Using (...) the food choice process model as a guide, four focus groups were conducted with 34 adolescents. Focus group discussion was semi-structured, asking teens about influences on their food choices across different food environments, their involvement with food purchasing and preparation, and perceived control over food their choices. Focus group transcripts were analyzed using deductive and inductive code creation and thematic analysis. This study found six leading influences on adolescents' food choices and identified additional factors with prominence within specific environmental contexts. This study distinguished a broader spectrum of factors influencing adolescent food choice that extend beyond “convenience” and “taste” which have previously been identified as significant contributors. The degree of control that teens reported differed by eating location, occasion, and social context. Finally, adolescents demonstrated various levels of engagement in behaviors related to their eating autonomy. Identifying the emergent themes related to adolescent autonomy was the first step toward the goal of developing a scale to evaluate adolescent eating autonomy. (shrink)

Notion essentielle au croisement de la psychologie, de l'ethique et de l'esthetique de la tradition occidentale, la phantasia des Grecs, devenue imaginatio dans le monde latin avant d'etre traduite dans les differentes langues europeennes, a connu un echo considerable tout au long de l'histoire de la pensee philosophique. Les etudes rassemblees dans le present volume sont issues d'un seminaire et d'une journee d'etudes qui se sont tenus en 2001 a l'Universite catholique de Louvain et aux Facultes Notre-Dame de la Paix (...) de Namur. Elles visent a eclairer l'evolution du sens et du role de la notion au travers d'etapes historiques particulieres, surtout anciennes, s'echelonnant du VIe siecle avant Jesus-Christ au XVIIe siecle de notre ere. (shrink)

Dans une communication interpersonnelle, l’échange se fait avec des mots mais aussi avec le corps. Les comportements corporels sont souvent considérés comme un langage dont le code est directement interprétable. Dans la plupart des cas, les comportements corporels sont codés de manière continue, probable et iconique. Il faut alors prendre en compte le processus d’inférence à la base d’une représentation de l’état de la personne qui interagit. L’article présente les outils théoriques et méthodologiques de la psychologie qui permettent d’analyser et (...) interpréter les comportements non verbaux. Il propose une perspective d’interprétation qui tient compte des fonctions des comportements corporels dans la communication et du contexte dans lequel ils sont produits. (shrink)

Dix ans apres la mort de Hans Jonas, qu'en est-il de la reception de sa philosophie? L'incroyable succes qu'elle connut s'explique par l'actualite d'un de ses themes principaux: la necessite d'une responsabilite nouvelle a l'egard des generations futures. Mais la reception largement negative que provoqua sa vulgarisation dans les domaines de l'ethique envireonnementale ou de la bioethique ne laisse pas de masquer le fondement de cette philosophie et les conditions memes de la mise en place des thematiques nouvelles qui retinrent (...) d'abord l'attention. S'alimentant a des sources tantot cachees, tantot eclectiques, elle s'est developpee au cours de plusieurs periodes dont le philosophe lui-meme disait ne pas voir ce qu'elles avaient en commun... Susceptible d'etre abordee par des voies multiples, cette oeuvre reste encore un defi pour le penseur et l'historien de la philosophie qui veulent la prendre au serieux et qui sont soucieux de la reconstruire et d'en lever tous les mysteres. (shrink)

Les prédications eckhartiennes qui nous sont parvenues, sont au nombre d’environ 100 en latin, et de 120 en moyen haut allemand. La critique situe la plus grande partie de ces prédications allemandes dans la dernière décennie de la vie d’Eckhart. Mais son intérêt pour la prédication est présent dans son œuvre dès le début et accompagne toute sa carrière. En particulier, ce qui caractérise son travail homilétique par rapport aux maîtres en théologie, ses contemporains, semble bien être l’usage de la (...) langue vulgaire et le soin particulier apporté à la mise en forme littéraire et à la publication de ces prédications. D’où la question posée : pourquoi cet intérêt pour l’usage de la langue vulgaire? L’attention dans cette étude se concentre donc sur les prédications allemandes et à ce propos sont traités deux arguments qui paraissent particulièrement significatifs. Le premier se concentre sur la nécessité de leur recontextualisation liturgique. En effet, l’aspect liturgique a été complètement occulté dans l’édition critique et la littérature. Le second se manifeste par la nécessité d’explorer le caractère littéraire des prédications, qui ne sont pas de fait “reportées” par des auditeurs (-trices), mais ont été rédigées et publiées par les soins de l’auteur lui-même. Enfin il faut noter comme caractéristique de l’homilétique eckhartienne, le lien essentiel entre locutio emphatica et discours démonstratif (« natiurlîche rede ») : l’examen de quelques textes tirés de la Défense d’Eckhart (1326) tente d’éclairer ce concept. (shrink)

The vast corpus attributed to Jābir b. Ḥayyān includes important elements of shī‘ī doctrine. Alchemy itself is described as an ‘imamic’ science, the purpose of which is to help mankind achieve eschatological fulfillment. This article aims to determine whether these shī‘ī elements are a fundamental part of the original Corpus Jābirianum, or if they are the result of a later set of interpolations. On the basis of one of the oldest jābirian texts, the Kitāb al-Usṭuqus al-uss I, II and III, (...) this article concludes that in jābirian alchemical doctrine, the role of the Imam is fundamental to the reception and spreading of alchemy. At the same time, the idea expressed in this text that the alchemist could achieve a level of wisdom equal to that of the Imam purely through his own research ultimately leads to a weakening of these shī‘ī positions. (shrink)

HARWOOD L and CLARK AM. Nursing Inquiry 2012; 19: 29–38Understanding health decisions using critical realism: home-dialysis decision-making during chronic kidney diseaseThis paper examines home-dialysis decision making in people with Chronic Kidney Disease (CKD) from the perspective of critical realism. CKD programmes focus on patient education for self-management to delay the progression of kidney disease and the preparation and support for renal replacement therapy e.g.) dialysis and transplantation. Home-dialysis has clear health, societal and economic benefits yet service usage is low despite (...) efforts to realign resources and educate individuals. Current research on the determinants of modality selection is superficial and insufficient to capture the complexities embedded in the process of dialysis modality selection. Predictors of home-dialysis selection and the effect of chronic kidney disease educational programmes provide a limited explanation of this experience. A re-conceptualization of the problem is required in order to fully understand this process. The epistemology and ontology of critical realism guides our knowledge and methodology particularly suited for examination of these complexities. This approach examines the deeper mechanisms and wider determinants associated with modality decision making, specifically who chooses home dialysis and under what circumstances. Until more is known regarding dialysis modality decision making service usage of home dialysis will remain low as interventions will be based on inadequate epistemology. (shrink)