It describes and explains the patient-centered model examining and evaluating qualitative and quantitative research. It comprehensively covers the evolution and the six interactive components of the patient-centered clinical method, taking the reader through the relationships between the patient and doctor and the patient and clinician. All the editors are professors in the Department of Family Medicine at the University of Western Ontario, London, Canada.

Recently ethical implications of human resource management have intensified the focus on care perspectives in management and organization studies. Appeals have also been made for the concept of organizational care to be grounded in philosophies of care rather than business theories. Care perspectives see individuals, especially women, as primarily relational and view work as a means by which people can increase in self-esteem, self-develop and be fulfilled. The ethic of care has received attention in feminist ethics and is often socially (...) construed as a feminine ethic. Although well developed in the caring professions there remains no model or definition of the care ethic in management literature with little care research undertaken. This paper develops the concept of the care ethic using Heidegger’s philosophy, namely, care is fundamental to human being. To show Heideggerian care, an individual notices, pays attention to another and responds in ways to empower and enable. In a study which aimed to analyze women’s lived experience of career, we applied the philosophically grounded methodology hermeneutic phenomenology. Findings revealed the power of Heideggerian care, Sorge, as a key factor in creating meaning. From this, we propose that care has potential as a theoretical and philosophically based construct with strong practical implications. It provides a way of understanding the care ethic, lies at the heart of our being, and is essential to meaning in our grelationships and undertakings. Crucially, it can provide reprieve from the existential angst that trademarks our being. (shrink)

Production and comprehension have long been viewed as inseparable components of language. The study of vision, by contrast, has centered almost exclusively on comprehension. Here we investigate drawing—the most basic form of visual production. How do we convey concepts in visual form, and how does refining this skill, in turn, affect recognition? We developed an online platform for collecting large amounts of drawing and recognition data, and applied a deep convolutional neural network model of visual cortex trained only on natural (...) images to explore the hypothesis that drawing recruits the same abstract feature representations that support natural visual object recognition. Consistent with this hypothesis, higher layers of this model captured the abstract features of both drawings and natural images most important for recognition, and people learning to produce more recognizable drawings of objects exhibited enhanced recognition of those objects. These findings could explain why drawing is so effective for communicating visual concepts, they suggest novel approaches for evaluating and refining conceptual knowledge, and they highlight the potential of deep networks for understanding human learning. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 22 (2002) 31-46 [Access article in PDF] Remedying Globalization and Consumerism: Joining the Inner and Outer Journeys in "Perfect Balance" Judith Simmer-Brown Naropa University One hundred forty years ago, Abraham Lincoln wrote in a prophetic voice: I see in the near future a crisis approaching that unnerves me and causes me to tremble for the safety of my country.... Corporations have been enthroned and an (...) era of corruption in high places will follow, and the money power of the country will endeavor to prolong its reign by working upon the prejudices of the people until all wealth is aggregated in a few hands and the Republic is destroyed. 1As the global economy has grown and the economic gap between the poor nations and the rich nations has become enormous, we are realizing Lincoln's nightmare.Globalization has effects more devastating than Lincoln could have imagined. What do we mean by globalization? The president of Nabisco once defined it as "a world of homogeneous consumption." 2 It is a world in which everyone, no matter what latitude or longitude, eats the same food, wears the same clothing, and derives pleasure from the same entertainment. It is the world of McDonald's, Holiday Inn, James Bond movies, Nike shoes, and Coca-Cola. Noam Chomsky, in a lecture at Boston College, described globalization as the "new face of capitalism." 3 It is a network of power centered in corporate interests and financial institutions that controls the flow of capital in order to promote the financial interests of those in power to the detriment of all others. The strategies of globalization have to do with centralizing all power in financial interest, reducing all value to money, and subsuming governments to the interests of the corporations. According to Chomsky, the strategies employed by the transnational network are designed to consolidate this control:Buy the executive branch of the states involved;Own the legislative branch through lobbyists, campaign contributions, and term extensions, or whatever else may work; [End Page 31]Set the conditions in which policy is determined, asserting the power of global capital;Control the doctrine and information systems, especially to invent new needs in order to bolster a culture of fashionable consumption. 4The players in this transnational network reside in the wealthy countries of the world, especially the governments of the G8, and most especially the United States. The global dominance of the International Monetary Fund and the World Trade Organization is funded by U.S. dollars funneled to them by the network. Yet this capital is not really exchange of cash; instead, it is speculation. Chomsky commented: In the last twenty-five years, there has been a huge explosion of financial institutions and financial capital, most of it speculative, with little actual capital in the economy. The flow of capital is $1.5 trillion per day, very little of it productive. Ninety-five percent of it is destructive and speculative. The return time on investments is very rapid; eighty percent has a return time of a week, and often it is less than a day. This daily flow of capital in international markets is twice the total foreign exchange of all states together. This concentrated power is interlinked, determining states' decisions. 5States are no longer autonomous agents; transnational economic interests have taken precedence over national sovereignty, regional power, and military concerns.The impact on developing countries and rural economies is devastating. The global monoculture is eradicating cultural diversity, replacing locally adapted forms of production with industrial systems divorced from natural cycles. Agriculture has become centrally managed and chemically dependent, delivering a narrower range of transportable foods to the international market. This, of course, robs the vitality of local communities and moves a greater proportion of villagers into urban life, creating megalopolises. Because everyone becomes dependent upon the same resources, "globalization creates efficiency for corporations, but it also creates artificial scarcity for consumers, thus heightening competitive pressures.... Globalization means the undermining of the livelihoods and cultural identities of the majority of the world's peoples." 6... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Listening Dangerously”: Dialogue Training as Contemplative PedagogyJudith Simmer-BrownContemplative pedagogies in higher-education classrooms employ methods adapted from meditative practices in great religious traditions in order to enhance student learning and to fulfill the historic purpose of a liberal arts education: to discover the nature of human life. Our Western education systems were originally derived from religious settings in which questions about what it means to be human were paramount. Over (...) the centuries, through the influences of the European Enlightenment, modern science, and postmodernism, questions about personal identity and the meaning of life increasingly have been removed from our classrooms and deemed inappropriate for the university. Now, in a rebalancing of priorities in higher education, the pendulum is swinging the other direction, largely driven by the insistence of our students, who indicate the centrality of religion and spirituality in their expectations of college curricular and cocurricular offerings. The Higher Education Research Institute (HERI) at the University of California Los Angeles conducted a seven-year study that surveyed more than one hundred thousand college students, matriculating freshmen attending 236 diverse colleges and universities across the country, and reported this:The study reveals that today’s college students have very high levels of spiritual interest and involvement. Many are actively engaged in a spiritual quest and in exploring the meaning and purpose of life. They are also very engaged and involved in religion, reporting considerable commitment to their religious beliefs and practices. As they begin college, freshmen have high expectations for the role their institutions will play in their emotional and spiritual development. They place great value on their college enhancing their self-understanding, helping them develop personal values, and encouraging their expression of spirituality.1The HERI report goes on to say that three-fourths of college freshmen say they are searching for meaning or purpose in their lives; nearly half of the students surveyed say that they consider it “essential” or “very important” to seek opportunities to help [End Page 33] them grow spiritually. Two-thirds reported that they derive strength, support and guidance from their spiritual or religious beliefs.2 Now our students are asking us to return higher education to the meaningful journey that it was intended to be.However, it is not sufficient to assume that we have fulfilled our responsibility merely by making minor adjustments to the contents of our courses. Certainly, students are asking for information, but they are particularly asking for mentorship and methods of study that require introspection, silence, and aids to inner transformation. Methods like these were customary at the foundations of liberal education, where religious reading, memorization, contemplation, and debate were central to learning.3 In higher education classrooms throughout the country, similar methods are finding their way back into learning strategies, enriching the lives of our students.Of course, this does not mean that our students are asking for religious instruction, conversion, or proselytizing. We have been through all of that over the last forty years, and finally religious studies as an academic field has secured methodologies that bring critical perspectives to the study of religion. However, we have often stripped the classroom of exploration of the Big Questions and of equipping students for the journey of self-knowledge that is so essential in contemplating these questions. Given our history as a discipline, it is important to distinguish between religious or spiritual practice and educational pedagogy in the methods we are bringing into our classrooms. We must skillfully develop precise and appropriate approaches that remove any prerequisite of religious belief from our pedagogies, and design them to serve the larger educational journeys of our students. And it is important to address the ethical issues inherent in bringing contemplative practices into our classrooms. I have addressed these issues elsewhere,4 and in this paper I will take a different tack.Buddhist-Christian Contemplative Pedagogies?I propose this question: What kind of contemplative pedagogy would be most appropriate to introduce students to the priorities of the work of the Society for Buddhist-Christian Studies? Especially, how could our emphasis on “study, reflection, interchange, and practice arising out of Buddhist-Christian encounters”5 be reflected, not just in the contents, but... (shrink)

Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical perspectives that foster (...) a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Rita Gross's Contribution to Contemporary Western Tibetan BuddhismJudith Simmer-BrownI first met Rita Gross on 2 January 1978, on the day of my arrival to take a professor's post at Naropa University. She opened the front door of Reggie Ray's house, where she was a houseguest. Little did I know how long and active our friendship would be, and I'm delighted to contribute to this very special panel on her (...) work. During the decades since, she has been the only person in my life who has intersected academia, dharmic realms, feminism, and interreligious dialogue, the four most important areas of my life; still, I think it is in the area of her scholarly and personal contributions to Tibetan Buddhism that I can speak most directly.When I met Rita, she was new to Tibetan Buddhism and had faced many challenges in her religious and spiritual journey. When she was excommunicated from the German Lutheran Church at age twenty-one, it was because she asked too many questions and expressed too many opinions. She has never stopped. She briefly explored Judaism, and then became enamored in her feminist studies with the goddess traditions of India, also an interest of mine. She has been able to bring her critical mind, her devotional heart, her connection to practice, and her appreciation of community directly into her life as a Tibetan Buddhist, and I have had the privilege of being by her side during most of it.After Rita began her meditation practice in the mid-1970s, she became a student of the great Kagyu-Nyingma master Chogyam Trungpa Rinpoche, who is also my teacher. She and I have done meditation and study retreats from a few days to three months in length, sharing ritual practice, teachings and discussions, and challenging lives together as members of a vibrant spiritual community around a charismatic teacher. Together we served as the senior members of the Task Force on Women and the Feminine Principle in the large, international Shambhala community. Eventually, she took on another teacher, the female tulku Ven. Khandro Rinpoche, whom I also dearly love, and she has become one of her senior dharma teachers, or lopons. All of this has occurred while I became a senior dharma teacher, an ācārya, of Shambhala, where we both began.In her time in these two lively Western Tibetan Buddhist communities, she has [End Page 69] Buddhist-Christian Studies 31 (2011) 69-74. © by University of Hawai'i Press. All rights reserved. served as an accomplished dharma teacher and at alternating times a scholar, activist, and critic, while committing to thousands of hours of service to the development of a genuinely Western dharma. While doing this, she has made many contributions equivalent to those of many dedicated dharma students. My comments address the unique contributions she has made as a feminist scholar, historian of religion, and theologian to this western dharmic world.Ironically, our areas of specialty have also intertwined. Early in the 1980s we began a book project with SUNY that was to be a feminist critique of Buddhism (hers) and a Buddhist critique of feminism (mine). After several years of conversation and discussion, Rita and I decided that our agendas were sufficiently different and our styles sufficiently independent to warrant separate books. As our books emerged (mine two babies later than hers), our friendship has continued its evolution.The Prophetic VoiceThe first of Rita's unique contributions to Tibetan Buddhism in the West revolve around what she has called her "prophetic voice," a notion that first appeared in her landmark book, Buddhism after Patriarchy, in 1993. Rita has consistently asserted that the prophetic voice is "the missing element" in Buddhism, leading Buddhists to a kind of double standard in which teachings concerning compassion coexist with Buddhism's traditional disregard for social and political inequities in society. She claims that "Buddhists have generally not been willing to engage in social action to see the realization of that ethic" in these social and political realms, and speculates that for the Buddhist, individual liberation has taken precedence over societal transformation. Instead, Buddhists have a long-standing history of acceptance of the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Wide Open to Life”:Thomas Merton’s Dialogue of Contemplative PracticeJudith Simmer-BrownThrough my decades of Tibetan Buddhist practice and interreligious dialogue experience, I have often contemplated an encounter that took place in a bar in the Central Hotel in Calcutta, October 19, 1968. It is the encounter between Thomas Merton in the last year of his life with my Tibetan Buddhist teacher, Chogyam Trungpa, Rinpoche, early in his teaching career in (...) the West. This encounter has deeply influenced my life of dialogue, for they initiated what I came to understand as a new kind of interreligious dialogue—the dialogue of contemplative practice. It is the kind of dialogue Trungpa introduced to Naropa University in the late 1970s in Merton’s honor, and it has influenced our university ever since.Thomas Merton, Father Louis, was fifty-three years old when stepped off the plane in India for his much-anticipated Asian journey. Excited and jet-lagged, he met the twenty-eight-year-old Tibetan monk Chogyam Trungpa, who had returned to India and Bhutan for a retreat after five years of study at Oxford University and a new venture of teaching dharma to Westerners. Trungpa’s English would have been accented but comprehensible, and his curiosity about Christian monasticism was at its peak. Merton was “coming home” to a place he had never been, visiting Asia to look for true spiritual masters about whom he had read for so many decades. He was later to admit to a special attraction to the Tibetans.On Merton’s first day in India, he and Trungpa found each other over many gin and tonics at the Central Hotel in Calcutta, talking about the contemplative life and its challenges in the twentieth century. It was the first of a number of conversations over the next few months. In his journals Merton commented:the important thing is that we are people who have been waiting to meet for a long time. Chogyam Trungpa is a completely marvelous person. Young, natural, without front or artifice, deep, awake, wise. I am sure we will be seeing a lot more of each other, whether around northern India and Sikkim or in Scotland, where I am now determined to go to see his Tibetan monastery if I can … The newsletter he puts out is good. His own meditations and talks, from what I have seen, are extraordinary.1 [End Page 193]Trungpa had a similar rapport with Merton. In the 1971 edition of his autobiography, he wrote, “Father Merton himself was an open, unguarded, and deep person. During these few days, we spent much time together and grew to like one another immensely. He proposed that we should collaborate on a book bringing together sacred writings of the Catholic and Vajrayana Buddhist traditions.”2 In another reflection, Trungpa commented, “Meeting Thomas Merton was wonderful; he was like a child, and at the same time, he was full of energy and life.”3 Still later, Trungpa was to conclude, “I had the feeling that I was meeting an old friend, a genuine friend … [Father Merton] was the first genuine person I met from the West.”4Later, Trungpa was deeply saddened by Merton’s premature death, feeling he had lost a heart friend, a genuine dialogue partner. Thirteen years later, Trungpa launched a series of seven landmark dialogue conferences at the fledgling university that he had founded, Naropa Institute in Boulder, Colorado. From the beginning, Trungpa dedicated these gatherings to “Fr. Merton” and said that he sought to cultivate the kind of conversations between genuine contemplatives that he had discovered with Merton. Sister Pascaline Coff, from the Benedictine community of Osage Monastery in Oklahoma, wrote that the inaugural conference was “a major breakthrough in the Christian-Buddhist dialogues.”5 This breakthrough gave impetus to the development of the international Monastic Interreligious Dialogue (DIM in Europe) and other contemporary dialogue developments.6 What kind of dialogue is this, and how did Merton stimulate this movement?I’ve written elsewhere about Merton’s encounter with the Tibetans and their view of him.7 I’ve also described Merton as a Dzogchen yogi, especially in relationship with his contact with Tibetan... (shrink)

Considered together, Butler and Whitehead draw from a wide palette of disciplines to develop distinctive theories of becoming, of syntactical violence, and creative opportunities of limitation. The contributors of this volume offer a unique contribution to and for the humanities in the struggles of politics, economy, ecology, and the arts.

Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case‐based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from (...) moral philosophy, including consequentialism, deontology, and principlism.In this article we hope to make a case for augmenting the focus of education in medical ethics. We propose complementing the traditional approach to medical ethics with a more embedded approach, one that has been described by others as “microethics,” the ethics of everyday clinical practice. (shrink)

This paper considers the use of outcome measures in the British National Health Service (NHS). Measuring outcomes is a major conceptual and practical problem. Many different measures are currently available yet no consensus has been reached on which should be preferred over others, or about which should take priority when they conflict. Some currently used measures are described, the relationship between these measures and the measured activities are discussed, and fundamental problems with both the measures and their use are revealed. (...) It is shown that however assiduous the search, the ‘perfect’ outcome measure will always remain elusive. (shrink)

Production and comprehension have long been viewed as inseparable components of language. The study of vision, by contrast, has centered almost exclusively on comprehension. Here we investigate drawing—the most basic form of visual production. How do we convey concepts in visual form, and how does refining this skill, in turn, affect recognition? We developed an online platform for collecting large amounts of drawing and recognition data, and applied a deep convolutional neural network model of visual cortex trained only on natural (...) images to explore the hypothesis that drawing recruits the same abstract feature representations that support natural visual object recognition. Consistent with this hypothesis, higher layers of this model captured the abstract features of both drawings and natural images most important for recognition, and people learning to produce more recognizable drawings of objects exhibited enhanced recognition of those objects. These findings could explain why drawing is so effective for communicating visual concepts, they suggest novel approaches for evaluating and refining conceptual knowledge, and they highlight the potential of deep networks for understanding human learning. (shrink)

This comprehensive Gandhi reader provides an essential new reference for scholars and students of his life and thought. It is the only text available that presents Gandhi's own writings, including excerpts from three of his books—An Autobiography: The Story of My Experiments with Truth, Satyagraha in South Africa, Hind Swaraj —a major pamphlet, Constructive Programme: Its Meaning and Place, and many journal articles and letters, along with a biographical sketch of his life in historical context and recent essays by highly (...) regarded scholars. (shrink)

In this paper we continue an ongoing dialogue that has as its goal the critical appraisal of theoretical perspectives on culture and health, in an effort to move forward scholarship on culture and health. We draw upon a programme of scholarship to explicate theoretical tensions and challenges that are manifest in the discourses on culture and health and to explore the possibilities Bourdieu's theoretical perspective offers for reconciling them. That is, we hope to demonstrate the need to move beyond descriptions (...) ‘of’ culture to an understanding of cultures as dynamic, and to show ways cultural practices create contexts that have the potential to foster or impede health.In our early research, largely undertaken in Canada's multicultural context, we sought to make visible the ways in which culture shaped conceptions of health and influenced health practices of immigrant groups. In recent years this focus has expanded to include populations that reflect the cultural and social diversity of our region. From the outset we attempted to move towards a conception of culture as negotiated, unifying, transformative and dynamic. While this position continues to hold appeal we are continually reminded that, despite our leanings towards constructivism, there is salience to the notion of culture as having enduring elements. It is this tension between the view of culture as embodied and enduring and culture as constructed and dynamic that we seek to examine.We explore whether Bourdieu's theoretical perspective offers promise for reconciling these apparently competing views. Using exemplars from our research we share insights that Bourdieu's work has offered to our analyses, thereby enabling us to move towards a view of culture that holds in tension these apparently contradictory positions of culture as both essence (albeit unstable, negotiated) and constructed. (shrink)

Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress.

First published in 1998. Routledge is an imprint of Taylor & Francis, an informa company.

Basement membranes are thin sheets of extracellular proteins situated in close contact with cells at various locations in the body. They have a great influence on tissue compartmentalization and cellular phenotypes from early embryonic development onwards. The major constituents of all basement membranes are collagen IV and laminin, which both exist as multiple isoforms and each form a huge irregular network by self assembly. These networks are connected by nidogen, which also binds to several other components (proteoglycans, fibulins). Basement membranes (...) are connected to cells by several receptors of the integrin family, which bind preferentially to laminins and collagen IV, and via some lectin‐type interactions. The formation of basement membranes requires cooperation between different cell types since nidogen, for example, is usually synthesized by cells other than those exposed to the basement membranes. Thus many molecular interactions, of variable affinities, determine the final shape of basement membranes and their preferred subanatomical localization. (shrink)

This is a unique, groundbreaking study in the history of philosophy, combining leading men and women philosophers across 2600 years of Western philosophy, covering key foundational topics, including epistemology, metaphysics, and ethics. Introductory essays, primary source readings, and commentaries comprise each chapter to offer a rich and accessible introduction to and evaluation of these vital philosophical contributions. A helpful appendix canvasses an extraordinary number of women philosophers throughout history for further discovery and study.

Growth mindset is an important aspect of children’s socioemotional development and is subject to change due to environmental influence. Orchestral music education may function as a fertile context in which to promote growth mindset; however, this education is not widely available to children facing economic hardship. This study examined whether participation in a program of orchestral music education was associated with higher levels of overall growth mindset and greater change in levels of musical growth mindset among children placed at risk (...) by poverty. After at least 2 years of orchestral participation, students reported significantly higher levels of overall growth mindset than their peers; participating students also reported statistically significant increases in musical growth mindset regardless of the number of years that they were enrolled in orchestral music education. These findings have implications for future research into specific pedagogical practices that may promote growth mindset in the context of orchestral music education and more generally for future studies of the extra-musical benefits of high-quality music education. (shrink)