Moral distress, is, at its core, an organizational problem. It is experienced on a personal level, but its causes originate within the system itself. In this commentary, we argue that moral distress is not inherently good, that effective interventions must address the external sources of moral distress, and that while there is a place for resilience in the healthcare professions, it cannot be an effective antidote to moral distress.

Forty years after Dax Cowart fought to have his voice heard regarding his medical treatment, patient autonomy and rights are at the heart of patient care today. Yet, despite its centrality in patient care, the tension between a severely burned patient’s right to stop treatment and the physician’s role in saving a life has not abated. As this case study explores, barriers remain to hearing and respecting a patient’s treatment decisions. Dismantling these barriers involves dispelling the myths that burn patients (...) must grin and bear intense pain to recover and that a patient’s choice to discontinue treatment equals physician failure. Moreover, in these situations, sustained, direct engagement between physician and patient can reduce the moral distress of all involved and enable physicians to hear and better accept when a patient is calling for the end of the day. (shrink)

Attentional control theory suggests that high cognitive demands impair the flexible deployment of attention control in anxious adults, particularly when paired with external threats. Extending this...

While many persons within westernised or westernising nations such as the United States of America and South Africa continue to place importance on matters of faith, a growing number of those persons approach matters of faith informally rather than formally and individually rather than institutionally. The implications of this are that among 21st century populations informal religious formation may be as important as or more important than the formation taking place via formal religious channels. A central emphasis of this article (...) is that this is especially true among more socially marginalised populations, not simply because they may not enjoy the same level of access to formal institutions, but also because they may regard those institutions as spiritually and culturally restrictive and exclusionary. The contributions of the article are, firstly, its use of original and unique survey data generated from neighbourhood studies the author directed in low-income contexts within several U.S. cities and within Pretoria, South Africa, and, secondly, its analysis of informal ways the urban poor engage Christian ideas and practices − an aspect of urban religion that has not received adequate scholarly attention. (shrink)

In Eum. 1028–9 the Furies mark their transformation into Eumenides by donning red robes over their black costumes in imitation of the robes worn in the Panathenaea by metics . Greek epic was sensitive to the symbolic value of clothing and Aeschylus had experimented in the Persians with the greater scope that drama offered for clothing-symbolism. Scholars have detected a wealth of associations in the Furies' robing-scene: this culmination of the trilogy echoes the red carpet upon which Agamemnon walks to (...) his death in the first play, which is actually referred to as ‘garments’ , and the net in which Agamemnon is caught , which is brought on stage in the middle play . Another series of stage-actions of equal importance in preparing for the robing of the Furies has not been so well explained. (shrink)

In Aristophanes’ Clouds, Socrates vents his frustration at his new pupil Strepsiades’ inability to see the eponymous chorus with the line ‘You would see them unless you have drops of rheum in your eyes as big as gourds (κολοκύνταις).’ This line is problematic, because gourds relate to eyesight in no obvious way. However, Aristophanes might have ended the verse by referring to Socrates’ initiation of Strepsiades sixty-five lines earlier by a liberal sprinkling of barley, and written ‘or you're blear-eyed with (...) barley-groats (οὐλοχύταισι)’. If some reader added κρομ(μ)ύοις ‘with onions’ to his text as a more universally valid explanation for an eye-affliction, a later scribe might have thought this an attempted correction, and substituted κολοκύνταις, which is both metrically correct and palaeographically closer to οὐλοχύταισι than is κρομ(μ)ύοις. (shrink)

Revising Clouds for publication some five years after its third-place showing in the City Dionysia of 423 b.c., Aristophanes retooled the first parabasis to praise the play's propriety, omitting as it did distasteful matter and gratuitous buffoonery, which—along with the judges’ crassness—accounted, he says, for its failure.

This article endorses with substantial modifications M. Bernal's claim that the Greeks based Memnon on Ammenemes II of Egypt. An Egyptian origin for Memnon appears likely from Zeus' weighing of his fate against Achilles' in the Aethiopis, which is similar to an early spell of the Book of the Dead; from his Amazonian ally, who resembles the Nile-god, clad in a girdle with a single breast; and from his apotheosis, which is unlike Homer's usual view that the soul is witless (...) in death, yet is reminiscent of the soteriological Osiris-cult, which was known to the Mycenaeans. Bernal's view that Memnon was specifically Ammenemes, however, rests on one word in Strabo, judged by editors to be a scribal error. Cases for two other proposed models, Khumben-numena I of Elam and Sethos I of Egypt, are too complex and fragile to accept. Since at least the first century, the Greeks themselves linked Memnon to Amenhotep III of Egypt, calling a portrait-colossus of that pharaoh "Memnon." This identification was based, I argue, on the fact that the statue faces sunrise on the winter solstice and so was linked to the dawn. Amenhotep's name is too unlike Memnon's to have attracted to him a preexisting Greek figure, but, as P. Gilbert proposed, Amenhotep may have been the basis for that figure, for archaeological evidence shows his contact with the Aegean. Like Memnon, Amenhotep formed military pacts with eastern kings, was son of a solar deity, and was exceptionally handsome. Moreover, his father's name was Tuthmosis . In short, Bernal argues well that epic based Memnon on a real person, rightly seeks him in Egypt, but fails to rule out Amenhotep. (shrink)

In their article “A Broader Understanding of Moral Distress,” Campbell, Ulrich, and Grady (2016) correctly assert that moral distress is well established in the nursing literature and is gaining at...

Kolbe and de Melo-Martin’s (2023) arguments draw attention to what is most useful about moral distress—identifying its causes is at least as important as measuring its severity. Jameton’s original...

In this article, we are exploring a methodological approach to research on faith and religious expressions in urban Africa. We are committed to trans-disciplinary work that pursues research methods mutually liberating for researchers, co-researchers and community participants and that results in long-term benefits and strengthened agency on the part of the host communities. Our reflections in this article are based on a collaborative research project1 in two regions of Pretoria, Tshwane2 – Pretoria Central and Mamelodi East – in which we (...) explore how religious innovation and competition in and amongst churches contribute to the healing or perpetuation of urban fractures. (shrink)

Developing a care plan in a critical care context can be challenging when the therapeutic alliance between clinicians and families is compromised by anger. When these cases occur, clinicians often turn to clinical ethics consultants to assist them with repairing this alliance before further damage can occur. This paper describes five different reasons family members may feel and express anger and offers concrete strategies for clinical ethics consultants to use when working with angry families acting as surrogate decision makers for (...) critical care patients. We reviewed records of consults using thematic analysis between January 2015 and June 2016. Each case was coded to identify whether the case involved a negative encounter with an angry family. In our review, we selected 11 cases with at least one of the following concerns or reasons for anger: perceived or actual medical error, concerns about the medical team’s competence, miscommunication, perceived conflict of interest or commitment, or loss of control. To successfully implement these strategies, clinical ethics consultants, members of the medical team, and family members should share responsibility for creating a mutually respectful relationship. (shrink)

In this article, we consider infants’ acquisition of foundational aspects of language and emotion through the lens of statistical learning. By taking a comparative developmental approach, we highlight ways in which the learning problems presented by input from these two rich communicative domains are both similar and different. Our goal is to encourage other scholars to consider multiple domains of human experience when developing theories in developmental cognitive science.

Racial inequities in medicine are the consequence of intersecting, multidimensional factors. As detailed in the articles by Braddock, Mithani, Cooper, and Boyd, and Yearby, the...

To examine the ethical duty to patients and families in the setting of the resuscitation bay, we address a case with a focus on providing optimal care and communication to family members. We present a case of nonsurvivable traumatic injury in a minor, focusing on how allowing family more time at the bedside impacts the quality of death and what duty exists to maintain an emotionally optimal environment for family grieving and acceptance. Our analysis proposes tenets for patient and family-centric (...) care that, in alignment with trauma-informed care principles, optimize the long-term well-being of the family, namely valuing family desires and sensitivity to location. (shrink)

Abnormalities in the ability of cells to properly degrade proteins have been identified in many neurodegenerative diseases. Recent work has implicated synaptojanin 1 (SynJ1) in Alzheimer's disease and Parkinson's disease, although the role of this polyphosphoinositide phosphatase in protein degradation has not been thoroughly described. Here, we dissected in vivo the role of SynJ1 in endolysosomal trafficking in zebrafish cone photoreceptors using a SynJ1‐deficient zebrafish mutant, nrca14. We found that loss of SynJ1 leads to specific accumulation of late endosomes and (...) autophagosomes early in photoreceptor development. An analysis of autophagic flux revealed that autophagosomes accumulate because of a defect in maturation. In addition we found an increase in vesicles that are highly enriched for PI(3)P, but negative for an early endosome marker in nrca14 cones. A mutational analysis of SynJ1 enzymatic domains found that activity of the 5'phosphatase, but not the Sac1 domain, is required to rescue both aberrant late endosomes and autophagosomes. Finally, modulating activity of the PI(4,5)P2 regulator, Arf6, rescued the disrupted trafficking pathways in nrca14 cones. Our study describes a specific role for SynJ1 in autophagosomal and endosomal trafficking and provides evidence that PI(4,5)P2 participates in autophagy in a neuronal cell type. -/- . (shrink)

This study examines how one student teaching seminar employed collective critical observation and reflection of an experienced high school social studies teacher's pedagogy using a multimedia representation of teaching. Pre-service teachers watched this teacher implement two full class lessons and reflections on teaching about freedom of speech. This study's pre-service social studies teachers exhibited a developing ability, through collective observation, to critically reflect on their individual methodological and philosophical goals, social studies teaching and learning, and professional and curricular visions in (...) relation to their student teaching experiences and future practice. The study's findings offer implications for how pre-service social studies teachers critically reflect on their practice, while also developing knowledge of learners, subject matter, and teaching social studies. (shrink)

Should there be a female age limit on public funding for assisted reproductive technology (ART)? The question bears significant economic and sociopolitical implications and has been contentious in many countries. We conceptualise the question as one of justice in resource allocation, using three much-debated substantive principles of justice—the capacity to benefit, personal responsibility, and need—to structure and then explore a complex of arguments. Capacity-to-benefit arguments are not decisive: There are no clear cost-effectiveness grounds to restrict funding to those older women (...) who still bear some capacity to benefit from ART. Personal responsibility arguments are challenged by structural determinants of delayed motherhood. Nor are need arguments decisive: They can speak either for or against a female age limit, depending on the conception of need used. We demonstrate how these principles can differ not only in content but also in the relative importance they are accorded by governments. Wide variation in ART public funding policy might be better understood in this light. We conclude with some inter-country comparison. New Zealand and Swedish policies are uncommonly transparent and thus demonstrate particularly well how the arguments we explore have been put into practice. (shrink)

ImportancePrevious studies of post-acute COVID-19 syndrome have focused on critical cases with severe disease. However, most cases are mild to moderate in disease severity.ObjectiveWe aimed to examine cognitive outcomes in cases of non-critical, mild-to-moderate COVID-19. Design, Setting, and Participants: In this cross-sectional study, we enrolled 72 adults aged 22 to 65 years in Central Texas who had non-critical, mild-to-moderate COVID-19 infection between 13 January 2021 and 20 April 2021.Main Outcomes and MeasuresWe remotely administered cognitive-behavioral testing to determine the frequency of (...) cognitive impairment and examine demographic, clinical, and psychosocial contributors to impairment.ResultsThe frequency of objective cognitive impairment was 40%. The largest number of participants showed impairment on a measure of executive functioning. Attention and processing speed was more impaired in males. Males endorsed lower adherence to social distancing guidelines, which was in turn associated with cognitive impairment across participants. Younger age was correlated with impairment but was also associated with racial/ethnic minority status and increased psychological symptoms. Moderate COVID-19 severity was associated with attention/processing speed impairment, increased pain, and higher number of COVID-19 symptoms.Conclusion and RelevanceMild or moderate COVID-19 infection may be associated with cognitive impairments, especially in the domain of executive functioning. A subgroup of younger individuals may be more vulnerable to cognitive and psychosocial effects of COVID-19.HighlightsQuestion: How frequent is cognitive impairment among non-critical, mild-to-moderate COVID-19 survivors?FindingsIn this cross-sectional study of 72 adults, 40% demonstrated cognitive impairment, particularly in executive function.MeaningNeurologic sequelae, such as cognitive impairment, may be common following COVID-19 infection. (shrink)

We make three points: (1) Overlooked studies of nonhuman communication originally inspired, but no longer support, the blinkered view of mental continuity that Penn et al. critique. (2) Communicative discontinuities between animals and humans might be rooted in social-cognitive discontinuities, reflecting a common lacuna in Penn et al.'s relational reinterpretation mechanism. (3) However, relational reinterpretation need not be a qualitatively new representational process.

The devastating impact of the national opioid epidemic has given rise to hundreds of lawsuits. This article details the extremely broad range of legal claims, compares the opioid cases to other public health litigation efforts, including tobacco, and describes the special mechanism — a multidistrict litigation — through which more than 700 opioid-related cases have been consolidated thus far, with settlement almost certain to follow.

As gene editing technologies such as CRISPR have become increasingly prominent, so have media portrayals of them. With this in mind, the present study builds on theoretical accounts of framing effects, cultivation effects, and genre-specific viewing effects to examine how different forms of media use predict attitudes toward applications of gene editing. Specifically, the study tests how news use, overall television viewing, and science fiction viewing are related to such attitudes. The analyses draw on original data from two surveys of (...) the U.S. public, one conducted in 2020 and the other in 2021. The results from both surveys indicate that news use and overall television viewing predict support for uses of gene editing, whereas science fiction viewing is not significantly related to opinion. The findings suggest that media frames and images may carry implications for the trajectory of public opinion about gene editing technologies and, ultimately, the social context for their development and adoption. (shrink)