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)

Food sharing may be used for mate attraction, sexual access, or mate retention in humans, as in many other species. Adult humans tend to perceive more intimacy in a couple if feeding is observed, but the increased perceived intimacy may be due to resource provisioning rather than feeding per se. To address this issue, 210 university students (66 male) watched five short videos, each showing a different mixed-sex pair of adults dining together and including feeding or simple provisioning or no (...) food sharing. A survey concerning attraction and intimacy in the dyad was completed after each video. Both provisioning and feeding produced higher ratings of “Involvement,” with feeding producing the highest ratings. Similarly, the perceived attraction of each actor to the other was lowest when no food sharing was shown and highest when feeding was displayed. These findings are consistent with a view of feeding as a courtship display in humans. (shrink)

Contemporary bioethics education has been developed predominately within Euro-American contexts, and now, other global regions are increasingly joining the field, leading to a richer global understanding. Nevertheless, many standard bioethics curriculum materials retain a narrow geographic focus. The purpose of this article is to use local cases from the Asia-Pacific region as examples for exploring questions such as ‘what makes a case or example truly local, and why?’, ‘what topics have we found to be best explained through local cases or (...) examples?’, and ‘how does one identify a relevant local case?’ Furthermore, we consider the global application of local cases to help extend the possible scope of the discussion, opening new avenues for the development of practical bioethics educational materials. We begin with a background description and discussion of why local cases enhance bioethics education, move to an overview of what is currently available and what is not for the region, and then outline a discussion of what it means to be local using example cases drawn from Hong Kong, Australia, Pakistan, and Malaysia. We are not creating a casebook but rather constructing by example a toolbox for designing active and dynamic learning cases using regional diversity as contextualised cases with generalised principles. (shrink)

Background Moral sensitivity and academic integrity discernment hold paramount importance for healthcare professionals. Owing to distinct undergraduate educational backgrounds, nurses and physicians may exhibit divergent moral perspectives, academic integrity cognisance, and moral sensitivity within clinical environments. A limited number of studies have investigated the disparities and congruencies pertaining to moral sensitivity and academic ethical awareness among nursing and medical students. Objective The study compares moral sensitivity and academic ethical awareness of undergraduate nursing and medical students with and without clinical exposure. (...) Research design A self-administered cross-sectional survey conducted from January to February 2022 was used to collect data from a medical school in Hong Kong. Participants and research context A total of 545 respondents, including 137 nursing students and 408 medical students, completed the questionnaire. Ethical consideration Ethics approval of the study was obtained. Written consent was waived to maintain anonymity because completing the questionnaire was considered implied consent. Findings Both groups of undergraduates demonstrated a high level of bioethics knowledge. In terms of academic integrity, medical students were found to have a less concerned attitude towards punctuality, attendance, and skipping classes. Regarding moral sensitivity, senior medical students with clinical experience put less emphasis on decision-making involving patient participation, while senior nursing students were more hesitant in withholding treatment for incompetent patients who refused treatment. Both nursing and medical students showed decreased moral sensitivity in the ‘conflicts’ domain with increased clinical exposure. Conclusion Study findings contribute to the discussion comparing the ethical attitudes of nursing and medical students. More effort should be made in nursing and medical education to promote practices in line with high academic integrity and to develop the ability to be morally sensitive in professional settings. (shrink)

Several studies have illuminated how processing manual action verbs (MaVs) affects the programming or execution of concurrent hand movements. Here, to circumvent key confounds in extant designs, we conducted the first assessment of motor–language integration during handwriting—a task in which linguistic and motoric processes are co‐substantiated. Participants copied MaVs, non‐manual action verbs, and non‐action verbs as we collected measures of motor programming and motor execution. Programming latencies were similar across conditions, but execution was faster for MaVs than for the other (...) categories, regardless of whether word meanings were accessed implicitly or explicitly. In line with the Hand‐Action‐Network Dynamic Language Embodiment (HANDLE) model, such findings suggest that effector‐congruent verbs can prime manual movements even during highly automatized tasks in which motoric and verbal processes are naturally intertwined. Our paradigm opens new avenues for fine‐grained explorations of embodied language processes. (shrink)

Adult-based suicide theories have determined much of what we know about suicidal ideation. Here, we investigate the extent to which elements of theIntegrated Motivational-Volitional(IMV) model generalize to adolescence, a period when rates of suicidal ideation increase dramatically. In a sample of community-based adolescents (n= 74), we tested whether defeat and entrapment related to suicidal ideation, and whether poor positive future thinking abilities exacerbated this association. Consistent with the IMV model, we found that defeat/entrapment was associated specifically with history of suicidal (...) ideation, and not with history of suicide attempt. Defeat/entrapment was related to baseline suicidal ideation severity above and beyond depressive symptoms. While defeat/entrapment predicted future suicidal ideation controlling for history of ideation, it did not do so controlling for depressive symptoms. Counter to the IMV model, we initially found that the association between defeat/entrapment and suicidal ideation was strongest among adolescents withgreaterpositive future thinking abilities. This was driven by the tendency to imagine more positive future events, particularly those that are less realistic and achievable. These findings call for a more nuanced understanding of defeat/entrapment and positive future thinking among adolescents, particularly in how they interact to predict recurrent suicidal ideation. (shrink)

This article discusses the triage response to the COVID-19 delta variant surge of 2021. One issue that distinguishes the delta wave from earlier surges is that by the time it became the predominant strain in the USA in July 2021, safe and effective vaccines against COVID-19 had been available for all US adults for several months. We consider whether healthcare professionals and triage committees would have been justified in prioritising patients with COVID-19 who are vaccinated above those who are unvaccinated (...) in first-order or second-order triage. Given that lack of evidence for a correlation between short-term survival and vaccination, we argue that using vaccination status during first-order triage would be inconsistent with accepted triage standards. We then turn to notions of procedural fairness, equity and desert to argue that that there is also a lack of justification for using vaccination status in second-order triage. In planning for future surges, we recommend that medical institutions base their triage decisions on principles meant to save the most lives, minimise inequity and protect the public’s trust, which for the time being would not be served by the inclusion of vaccination status. (shrink)

School performance and cognitive competence can be conceptualized as social and relational constructs. Thus, we expect their association to vary as a function of other socially-embedded variables which have proven meaningful in the academic domain. The present study takes a critical theory approach to assess gender-related and contextual variability in the association between peer-assessed school performance and self-perceived cognitive competence. The sample consisted of 719 preadolescents living in lower- and upper-middle-class neighborhoods in Montreal, Canada and Barranquilla, Columbia. Multigroup comparisons revealed (...) that peer-assessed school competence was more strongly associated with self-perceived cognitive competence for upper-middle-class than lower-middle-class participants from Barranquilla, whereas the opposite pattern was observed with Montreal participants, and that the association between communal orientation and self-perceived cognitive competence was stronger for girls than for boys across the sample, especially in the upper-middle-class school in Montreal. These findings highlight the nuanced degree of gender differences in preadolescents’ perceived academic competence and emphasize the role of SES in shaping self-perceptions. (shrink)

In this study, we explore the future of work by examining differences in productivity when teams are composed of only humans or both humans and machine agents. Our objective was to characterize the similarities and differences between human and human–machine teams as they work to coordinate across their specialized roles. This form of research is increasingly important given that machine agents are becoming commonplace in sociotechnical systems and playing a more active role in collaborative work. One particular class of machine (...) agents, bots, is being introduced to these systems to facilitate both taskwork and teamwork. We investigated the association between bots and productivity outcomes in open source software development through an analysis of hundreds of project teams. The presence of bots in teams was associated with higher levels of productivity and higher work centralization in addition to greater amounts of observed communication. The adoption of bots in software teams may have tradeoffs, in that doing so may increase productivity, but could also increase workload. We discuss the theoretical and practical implications of these findings for advancing human–machine teaming research. (shrink)

Working memory (WM) deficits are pervasive co-morbidities of epilepsy. Although the pathophysiological mechanisms underpinning these impairments remain elusive, it is thought that WM depends on oscillatory interactions within and between nodes of large-scale functional networks. These include the hippocampus and default mode network as well as the prefrontal cortex and frontoparietal central executive network. Here, we review the functional roles of neural oscillations in subserving WM and the putative mechanisms by which epilepsy disrupts normative activity, leading to aberrant oscillatory signatures. (...) We highlight the particular role of interictal epileptic activity, including interictal epileptiform discharges and high frequency oscillations (HFOs) in WM deficits. We also discuss the translational opportunities presented by greater understanding of the oscillatory basis of WM function and dysfunction in epilepsy, including potential targets for neuromodulation. (shrink)

Background Some have hypothesized that changing attitudes toward medical aid in dying (MAID) contribute to increased suicide rates, perhaps by increasing interest in dying or the perceived acceptability of suicide. This would represent a strong criticism of MAID policies. We sought to evaluate the association between the legalization and implementation of MAID across the U.S. and changing suicide rates.Methods We evaluated state-level monthly suicide death rates from 1995 to 2021. Because suicide rates vary by state, we constructed geographically-weighted regression models (...) controlling for annualized state-level sociodemographic factors, such as racial distribution (percent Caucasian), average age, income levels, unemployment rates, rates of spiritual engagement, firearm ownership rates, gender ratios, and education levels. We applied a difference-in-difference analysis within our geographically-weighted models.Results 927,929 Suicide deaths were represented in the study. Ten states and the District of Columbia had legalized MAID within the study period. In an univariable analysis, states that legalized MAID differed significantly from non-MAID states with respect to mean monthly suicide rate (non-MAID States: 1.46; MAID states: 1.78; p < 0.0001), as well as several covariates. Monthly suicide death rates were spatially autocorrelated (Moran’s I = 0.607, p < 0.0001). In separate geographically-weighted difference-in-difference analyses, changes in suicide rates were not significantly associated with MAID legalization (β = 0.042, p = 0.33) or with later MAID implementation (β = 0.030, p = 0.63), with differences in suicide rates in MAID and non-MAID states being attributable to baseline between-state differences.Conclusions Our study failed to find evidence that suicide rates were positively associated with MAID legalization or MAID implementation, when controlling for geographic variation and multiple sociodemographic factors associated with suicide risk. This finding contrasts with other studies that have reported a positive association between suicide rates and MAID, and so calls into question one argument against MAID legalization. (shrink)

Early exposure to stressful life events is associated with greater risk of chronic diseases and mental health problems, including anxiety. However, there is significant variation in how individuals respond to environmental adversity, perhaps due to individual differences in processing and regulating emotional information. Differences in cognitive control – processes necessary for implementing goal directed behavior – have been linked to both stress exposure and anxiety, but the directionality of these links is unclear. The present study investigated the longitudinal pathway of (...) environmental stress exposure during early adolescence on later adolescent anxiety, and the possible mediating mechanism of cognitive control. Participants were 674 Mexican-origin adolescents (mean age = 10.8 years, 50% male) enrolled in the California Families Project, an ongoing longitudinal study of Mexican-origin families. In the current analysis, we examined self-reports of environmental stressors at age 14 (Time 1), cognitive control at age 16 (Time 2), and anxiety at age 18 (Time 3). Structural equation modeling revealed that environmental stressors (Time 1) had both direct and indirect effects on later anxiety (Time 3) through their effects on cognitive control (Time 2), even when accounting for prior levels of anxiety (Time 2). Cognitive control accounted for 18% of the association between environmental stressors and adolescent anxiety: an increase in stressors decreased cognitive control (β = −0.20, p p = 0.004). These findings deepen our understanding of the mechanisms underlying the development of anxiety and highlight the importance of cognitive control as a potential protective factor. (shrink)

Accumulating evidence indicates that simulated natural settings can engage mechanisms that promote health. Simulations offer alternatives to actual natural settings for populations unable to travel outdoors safely; however, few studies have contrasted the effects of simulations of natural settings to their actual outdoor counterparts. We compared the impacts of simulated and actual natural settings on positive and negative affect (mood) levels using a pooled sample of participants enrolled in extant experimental studies. Relevant articles were identified from a review of research (...) published/in press by March 2020 and updated during the peer review of the current study. Of 16 articles identified, 6 met the inclusion criteria and administered a single cross-cutting, standardized instrument [the Positive and Negative Affect Schedule (PANAS)] before and after exposure. Random effects meta-analysis of pooled effects showed that positive affect increased in the actual settings but not in their simulated counterparts (Hedge's g = 0.87; 95% CI, 0.54, 1.20). We observed little difference in effects on negative affect change scores ( g = −0.28; 95% CI, −0.62, 0.06), with studies generally showing reductions in negative affect in both settings. Further research with additional populations, settings, antecedent conditions, and durations would provide a more robust understanding of differences in effects between these two ways to enhance mood by viewing nature. (shrink)

Shamatha, Transcendental, and Stillness Meditation are said to aim for “contentless” experiences, where mental content such as thoughts, perceptions, and mental images is absent. Silence is understood to be a central feature of those experiences. The main source of information about the experiences is texts by experts from within the three traditions. Previous research has tended not to use an explicit scientific method for selecting and reviewing expert texts on meditation. We have identified evidence synthesis as a robust and transparent (...) method that is suitable for this purpose. In this paper we use evidence synthesis based on expert texts to examine silence/quietness as a feature of the contentless experiences in the three practices. Objective criteria were used to select a sample of 135 expert texts. A database containing the expert descriptions of the meditation techniques and experiences was produced by extracting the relevant material from the publications and coding that material to differentiate individual features. The database, which forms part of the Supplementary Material for this paper, identifies each feature of the contentless experiences referred to in the expert texts, including silence/quietness. Our key finding is that the experts indicate silence/quietness has a particular connection with stillness, and the absence of concepts, mental activity/noise, thoughts, and disturbance. Further analysis leads to the following insights. The silence/quietness reflects the absence of thoughts and sounds, and this fits neatly with a conception of silence/quietness as the absence of internal and external noise. In some cases the terms silence and quietness may also reflect the absence of other disturbances such as non-auditory perceptions, mental images, and negative feelings. That would fit with a conception of silence/quietness as complete calm or absence of disturbance. It is not clear from the expert texts how silence/quietness is distinct from other features such as stillness that also reflect the absence of disturbances. As a separate matter, silence/quietness has connections with all the other features of the contentless experiences, but the closeness of the connections varies. Our work uncovers fine distinctions and ambiguities which lead to new research questions that can be explored in future studies. (shrink)

Background Some have hypothesized that talk about suffering can be used by clinicians to motivate difficult decisions, especially to argue for reducing treatment at the end of life. We examined how talk about suffering is related to decision-making for critically ill patients, by evaluating transcripts of conversations between clinicians and patients’ families.Methods We conducted a secondary qualitative content analysis of audio-recorded family meetings from a multicenter trial conducted in the adult intensive care units of five hospitals from 2012–2017 to look (...) at how the term “suffering” and its variants were used. A coding guide was developed by consensus-oriented discussion by four members of the research team. Two coders independently evaluated each transcript. We followed an inductive approach to data analysis in reviewing transcripts; findings were iteratively discussed among study authors until consensus on key themes was reached.Results Of 146 available transcripts, 34 (23%) contained the word “suffer” or “suffering” at least once, with 58 distinct uses. Clinicians contributed 62% of first uses. Among uses describing the suffering of persons, 57% (n = 24) were related to a decision, but only 42% (n = 10) of decision-relevant uses accompanied a proposal to limit treatment, and only half of treatment-limiting uses (n = 5) were initiated by clinicians. The target terms had a variety of implicit meanings, including poor prognosis, reduced functioning, pain, discomfort, low quality of life, and emotional distress. Suffering was frequently attributed to persons who were unconscious.Conclusions Our results did not support the claim that the term “suffering” and its variants are used primarily by clinicians to justify limiting treatment, and the terms were not commonly used in our sample when decisions were requested. Still, when these terms were used, they were often used in a decision-relevant fashion. (shrink)

Recent arguments claim that behavioral science has focused – to its detriment – on the individual over the system when construing behavioral interventions. In this commentary, we argue that tackling economic inequality using both framings in tandem is invaluable. By studying individuals who have overcome inequality, “positive deviants,” and the system limitations they navigate, we offer potentially greater policy solutions.

This research explores the contextual approach within Christian-Jewish religious education, addressing a notable gap in existing literature and offering fresh insights into the application of the Contextual Teaching and Learning (CTL) model within Christian contexts. Through a qualitative literature study employing a three-step methodology, including an in-depth analysis of Deuteronomy 11:19–20, this study reveals that this biblical text provides both educational guidance and theological significance, serving as a foundational support for the CTL model in Christian-Jewish religious education. The integration of (...) digital media into biblical sources holds promise for future research, while the central challenge lies in harmonising life experiences and empirical phenomena with biblical reflections to seamlessly integrate inquiry processes and pedagogical phases, with potential avenues for further exploration in scripture models endorsing CTL. This research provides valuable insights for educators, parents and policymakers in Indonesia and beyond, advancing educational research in contextualised teaching models within religious education.Contribution: This article demonstrates that the CTL model in the digital era has the potential to revolutionise religious education and profoundly impact learners, making it a significant scientific contribution in the context of Christian-Jewish religious education. (shrink)

Volume 24, Issue 7, July 2024, Page 6-12.

Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor alike. During pregnancy, we tend to note the risks of medical interventions without adequately noting those of failing to intervene, yet when it's time to give birth, interventions are seldom questioned, even when they don't work. Meanwhile, outside the clinic, advice given to pregnant women on how to stay healthy in everyday life can seem capricious and overly cautious. This kind of reasoning reflects fear, (...) not evidence. (shrink)

Contentless experience involves an absence of mental content such as thought, perception, and mental imagery. In academic work it has been classically treated as including states like those aimed for in Shamatha, Transcendental, and Stillness Meditation. We have used evidence synthesis to select and review 135 expert texts from within the three traditions. In this paper we identify the features of contentless experience referred to in the expert texts and determine whether the experiences are the same or different across the (...) practices with respect to each feature. We identify 65 features reported or implied in one or more practices, with most being reported or implied in all three. While there are broad similarities in the experiences across the traditions, we find that there are differences with respect to four features and possibly many others. The main difference identified is that Shamatha involves substantially greater attentional stability and vividness. Another key finding is that numerous forms of content are present in the experiences, including wakefulness, naturalness, calm, bliss/joy, and freedom. The findings indicate that meditation experiences described as contentless in the academic literature can in fact involve considerable variation, and that in many and perhaps most cases these experiences are not truly contentless. This challenges classical understandings in academic research that in these so-called contentless experiences all content is absent, and that the experiences are therefore an identical state of _pure consciousness_ or consciousness itself. Our assessment is that it remains an open question whether the experiences aimed for in the three practices should be classed as pure consciousness. Implications of our analysis for neuroscientific and clinical studies and for basic understandings of the practices are discussed. (shrink)

In contentless experience (sometimes termed _pure consciousness_) there is an absence of mental content such as thought, perception, and mental imagery. The path to contentless experience in meditation can be taken to comprise the meditation technique, and the experiences (“interim-states”) on the way to the contentless “goal-state/s”. Shamatha, Transcendental, and Stillness Meditation are each said to access contentless experience, but the path to that experience in each practice is not yet well understood from a scientific perspective. We have employed evidence (...) synthesis to select and review 135 expert texts from those traditions. In this paper we describe the techniques and interim-states based on the expert texts and compare them across the practices on key dimensions. Superficially, Shamatha and Transcendental Meditation appear very different to Stillness Meditation in that they require bringing awareness to a meditation object. The more detailed and systematic approach taken in this paper indicates that posturally Shamatha is closer to Stillness Meditation, and that on several other dimensions Shamatha is quite different to both other practices. In particular, Shamatha involves greater measures to cultivate attentional stability and vividness with respect to an object, greater focusing, less tolerance of mind-wandering, more monitoring, and more deliberate doing/control. Achieving contentless experience in Shamatha is much slower, more difficult, and less frequent. The findings have important implications for taxonomies of meditation and for consciousness, neuroscientific, and clinical research/practice, and will provide new and useful insights for meditation practitioners. (shrink)

Deception has evolved to become a fundamental aspect of human interaction. Despite the prolonged efforts in many disciplines, there has been no definite finding of a univocally “deceptive” signal. This work proposes an approach to deception detection combining cognitive load manipulation and T-pattern methodology with the objective of: (a) testing the efficacy of dual task-procedure in enhancing differences between truth tellers and liars in a low-stakes situation; (b) exploring the efficacy of T-pattern methodology in discriminating truthful reports from deceitful ones (...) in a low-stakes situation; (c) setting the experimental design and procedure for following research. We manipulated cognitive load to enhance differences between truth tellers and liars, because of the low-stakes lies involved in our experiment. We conducted an experimental study with a convenience sample of 40 students. We carried out a first analysis on the behaviors’ frequencies coded through the observation software, using SPSS (22). The aim was to describe shape and characteristics of behavior’s distributions and explore differences between groups. Datasets were then analyzed with Theme 6.0 software which detects repeated patterns (T-patterns) of coded events (non-verbal behaviors) that regularly or irregularly occur within a period of observation. A descriptive analysis on T-pattern frequencies was carried out to explore differences between groups. An in-depth analysis on more complex patterns was performed to get qualitative information on the behavior structure expressed by the participants. Results show that the dual-task procedure enhances differences observed between liars and truth tellers with T-pattern methodology; moreover, T-pattern detection reveals a higher variety and complexity of behavior in truth tellers than in liars. These findings support the combination of cognitive load manipulation and T-pattern methodology for deception detection in low-stakes situations, suggesting the testing of directional hypothesis on a larger probabilistic sample of population. (shrink)

Organic crosstalk or intercommunication among different organs is an interesting medical concept based on the biosemiotic perspective which considers the organism as a process maintained by the vital information flow between structural plane and biosemiotic plane, both with their different layers of biological complexity. From this point of view the organ is not merely the structure which produces crosstalk but just as much its product. The crosstalk perspective seeks two main goals: to investigate the characteristic serum biosemiotic patterns of pathogenic (...) organic crosstalk in order to achieve early diseases diagnosis, and to learn how to correct it. These achievements could allow physicians to evolve from a medical practice that focuses on misbiosemiotic effects, diagnosing and treating damaged organs, to a medical practice that focuses on misbiosemiotic processes, in this way diagnosing and treating pathogenic organ crosstalk before it culminates in organ damage. (shrink)

Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are (...) extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity. (shrink)

This paper is a study about Philadelphia’s comprehensive user engagement sites (CUESs) as the authors address and examine issues related to the upcoming implementation of a CUES while seeking solutions for its disputed questions and plans. Beginning with the federal drug schedules, the authors visit some of the medical and public health issues vis-à-vis safe injection facilities (SIFs). Insite, a successful Canadian SIF, has been thoroughly researched as it represents a paradigm for which a Philadelphia CUES can expand upon. Also, (...) the existing criticisms against SIFs are revisited while critically unpackaged and responded to in favor of the establishment. In the main section, the authors propose the layout and services of the upcoming CUES, much of which would be in congruent to Vancouver’s Insite. On the other hand, the CUES would be distinct from Insite, as the authors emphasize, in that it will offer an information center run by individuals in recovery and place additional emphasis on early education for young healthcare professionals by providing them a platform to work at the site. The paper will also briefly investigate the implementation of a CUES site under an ethical scope of the Harm Reduction Theory. Lastly, the authors recommend some strategic plans that the Philadelphia City government may consider employing at this crucial stage. (shrink)

When recalling autobiographical events, people not only retrieve event details but also the feelings they experienced. The current study examined whether people are able to consistently recall the intensity of past feelings associated with two consequential and negatively valenced events, i.e. the 9/11 attack (N = 769) and the COVID-19 pandemic (N = 726). By comparing experienced and recalled intensities of negative feelings, we discovered that people systematically recall a higher intensity of negative feelings than initially reported – overestimating the (...) intensity of past negative emotional experiences. The COVID-19 dataset also revealed that individuals who experienced greater improvement in emotional well-being displayed smaller biases in recalling their feelings. Across both datasets, the intensity of remembered feelings was correlated with initial feelings and current feelings, but the impact of the current feelings was stronger in the COVID-19 dataset than in the 9/11 dataset. Our results demonstrate that when recalling negative autobiographical events, people tend to overestimate the intensity of prior negative emotional experiences with their degree of bias influenced by current feelings and well-being. (shrink)

Photo ID 279661800 © Sidewaypics|Dreamstime.com ABSTRACT Decolonization is complex, vast, and the subject of an ongoing academic debate. While the many efforts to decolonize or dismantle the vestiges of colonialism that remain are laudable, they can also reinforce what they seek to end. For decolonization to be impactful, it must be done with epistemic and cultural humility, requiring decolonial scholars, project leaders, and well-meaning people to be more sensitive to those impacted by colonization and not regularly included in the discourse. (...) INTRODUCTION Decolonization is complex. To successfully achieve decolonization, projects should incorporate the voices of those subjugated or silenced. Including such voices requires sincerely exploring who has been affected by colonialism or neocolonialism and how, as well as cultural sensitivity. In its basic use, decolonization refers to countries under colonial rule gaining independence or freedom from forms of subjugation. Additionally, scholars use the term to refer to efforts to dismantle neocolonialism and vestiges of colonialism. The process includes de-silencing subjugated voices.[1] I use decolonization in the latter way to refer to countries with technical independence. While arguably colonization ended formally with independence from colonizing powers, neocolonialism is the indirect, informal, and sometimes subtle control of the people, their economy, and political life despite formal independence from colonizing authorities. I conceptualize neocolonialism as a system that involves direct and involuntary control of another’s political, economic, or social life, impacting their worldview and ways of encountering the world. Decolonization may target actions, places, or systems like health care or AI to overcome the ills of colonialism and neocolonialism. It also may target knowledge and require rethinking how people develop their knowledge base. For example, if people grew up seeing an outside colonizer as superior, they would need to change their knowledge of superiority. Decolonization may target power, for example, changing who owns and distributes COVID-19 vaccines and who distributors exclude in the distribution of vaccines. Decolonization could require looking at those disempowered in the distribution process. Additionally, decolonization may target autonomy of persons by freeing people, ensuring human and individual rights, and respecting cultural traditions. Decolonization projects that try to de-silence by including the voices of those affected by colonialism and neocolonialism must examine inclusiveness in the context of the culture of the subrogated individuals. Examples of decolonization projects include making datasets inclusive of diverse peoples and places, returning to traditional food and eating practices, making sure hospitals in developing countries are led by locals and respectful of cultural traditions, returning unethically obtained artefacts or objects. Another project would be laying the groundwork for equality in formerly colonized countries to ensure that business ownership, education, and financial success will flow fairly to those previously victimized by colonization. Summarily, there are many strategies for decolonizing. However, it is worth asking whether the strategies have risks that undermine the goal of decolonization. I. Understanding Decolonization Discourses Many fields, from AI to politics, economics, health care, aviation, and academia, discuss decolonization. The content of the discourse on decolonization depends on the region and field discussing it. Rather than just reporting on decolonization, the discussions may be calls to action. For example, decolonization discourses reflect activism for cognitive justice, such as equal consideration of Indian or African knowledge systems in global health discourses.[2] In politics and political science, some scholars frame decolonization as an anti-western, anti-colonial movement by Africans to emancipate Africa/ns from subjugation or shift the continent to postcolonialism and post-neo-colonialism. This framing walls off non-African participants and may undermine their capacity to benefit the conversation.[3] There are other political scientists who actively support decolonization and see it as a field of activism in support of anyone and countries where colonization harmed people and development.[4] The point is that two ways of conceptualizing decolonization in politics and political science are discernible. One conceptualization is less inclusive since it alienates scholars and professionals from Western, high-income, or developed countries. The other is more inclusive. In humanitarian studies, including philosophy, some decolonization articles and conversations are efforts to end the destructive force of colonization. They focus on either the form, such as ecocide, genocide, and many others, or the geographic location, such as Africa, Asia, Latin America, and Oceania.[5] Finally, the feelings one brings into this conversation can adversely impact how one engages in them and who they listen to or are willing to hear from. For example, anger, rage, bitterness, and hatred are emotions that are not uncommon in spaces of decolonization conversations. Decolonization conversations that originate from a place of negativity risk deepening the psychological state of victimhood and prevent people from disrupting constructively or critically engaging in the conversation.[6] II. Understanding Decolonization Strategies Decolonization strategies mainly aim to de-silence victims of domination or subjugation. People have proposed many strategies for decolonizing. These strategies may be informed by what the target is for decolonization. Decolonization can target power relations in global health. For example, during the COVID-19 pandemic, public health organizations noted the power imbalance in vaccine distribution. Decolonization could involve de-silencing those affected by neocolonialism to bring about a more balanced distribution of power and a more fair distribution of the vaccine. By analyzing who was adversely impacted by the distribution and who ought to wield power, those engaged in decolonizing advocated for positive change and equitable power relations. Equally, when being is the target of decolonization, the language of unlearning or relearning and mental decolonization take centre stage in the decolonization discourse. For example, the quest to decolonize colonized minds aims to demythologize African inferiority and Western superiority. Demythologizing African inferiority enables those engaged in the decolonization discourse to cultivate and foster African agency.[7] Finally, when knowledge production is the target of decolonization, scholars use inclusion and cognitive justice. For example, they try to alter the knowledge that underlies global health ethics.[8] “[D]decolonizing researchers aim to respectfully understand and integrate theory from Other(ed) perspectives, while also critically examining the underlying assumptions that inform their Western research framework.”[9] One common strategy that scholars use in decolonization is inclusion. It is worth asking, does including people who have been subrogated foster decolonization? Whether that is effective depends on whether included people are more heard or whether the strategies to include them create new forms of silencing. III. Inclusion and the Quest to Decolonize Evaluating how effective inclusion is in the quest to de-silence subjugated voices is important. First, inclusive strategies are not neutral. They are epistemically situated. This situatedness constrains meaning-making in different ways: how and what questions are asked, how social roles are constructed, organized or assigned, and who is admitted to the room where these conversations occur.[10] Inclusion strategies may reinforce (unchallenged) assumptions. For example, to address prejudices and stereotypes in global health images, Arsenii Alenichev and his colleagues[11] successfully inverted “one stereotypical global health image” by prompting a generative AI to produce “an image of a traditional Indian or African healer healing a White Child.” Although there were some problems with the image of the White child, this innovation is a significant, useful effort to de-embed or strip global health images of problematic pictures that mythologize White superiority and Black inferiority. Yet it is possible that using categories like traditional Indian or African reinforces unchallenged assumptions, raising key questions regarding how language and words create new stereotypes. It is common to define traditional as non-conventional, unorthodox, and informal. Yet studies continue to reveal that non-scientifically appraised healing approaches in India or Africa are not only effective but also real, meaningful, fundamental, and primary care-seeking behaviours in many communities in these regions.[12] Suppose inclusive strategies are not un-situated. These conversations may be had within the structures, language, and spaces built by or connected to colonialism. The spaces, language, places, and structures in which these conversations occur can limit who can participate and how they participate. Importantly, some conditions are not conducive to participation as equals. The allocated time for the discussion could also constrain how individuals express themselves. It is unclear who is ultimately heard. Furthermore, epistemic situatedness of inclusion can impact decolonization conversations when participants are beneficiaries of, products of, and trained by structures and systems they seek to dismantle. To enhance the decolonization project and its goals, a pressing task is to unveil and question how the circumstances may inhibit activism. If the vestiges of colonialism continue to structure the decolonization discourse invisibly, the vestiges may undermine decolonization. For example, a public health discussion that includes white Western doctors and Western pharmaceutical executives in Africa may have many local Africans at the table but could still effectively devalue their input based on built-in assumptions and biases that are vestiges of colonialism. Second, exclusion and inclusion are also not binary. Individuals may experience exclusion, even while included (the phenomenon called internal exclusion). In other words, inclusion can fail to be substantial or become a means of enhancing optics, “a way of (un)consciously weakening the radical claims being pursued.”[13] For example, in South Africa, many institutions have made significant efforts to diversify their faculties due to the promulgation of the Employment Equity Act 55.[14] The act requires South African institutions to implement employment equity that redresses the history of harmful discrimination in the country. The act further requires transforming departments and institutional administrations. Although many recognize and support the need to transform departments in South Africa, the rhetoric of transformation departs sharply from the lived experiences.[15] This misalignment between the plan and practice is evident in the underrepresentation of black people and females in senior management teams, professorships in many universities and health departments, and positions of power in some South African institutions. Those selected in the transformation of the departments have also complained of being overworked. The burden of extra work undermines their ability to develop agency and voice in the space they now occupy or fulfil key requirements that have implications for their career trajectory.[16] This is called the minority tax. Notably, "the minority tax… is the burden of extra responsibilities [placed] on faculty of colour to achieve diversity and inclusion and contributes to attrition and impedes academic promotion."[17] One challenge for decolonializing projects will be for decolonial scholars and those selected for decolonization objectives to have the humility to decline invitations, requests, roles, and platforms for which they are either unqualified or lack the capacity to fulfil. At its heart, decolonization strategies must empower those included rather than weaken them. Finally, inclusion can lead to a phenomenon known as elite capture.[18] Elite capture occurs when socially advantaged individuals in a group monopolize or exploit activism to their own benefit at the expense of the larger, struggling group. Elite capture weakens decolonization efforts from within, revealing that those likely to benefit from global inclusive efforts are those who fulfil globally constructed standards, those “already present in the room.” There is no better strategy to weaken decolonial movements than weakening the project from within by strategically positioning individuals who share physical properties with the victims of exclusion and silencing but intellectually, behaviourally, psychologically, and emotionally share more common ground with the colonizer. Such insiders may be unaware they are furthering neocolonial conditions rather than decolonizing. In relation to decolonization, particularly in global health, elite capture reveals that those whose voices are loudest in the room are not necessarily those more impacted by colonialism. They may benefit more from reinforcing colonialism. Opportunism weakens meaningful activism from within, preventing good initiatives and strategies from having their intended impact or taking substantive root.[19] This paper cannot do justice to elite capture, but it is worth noting its negative impacts. IV. Improving the Impact of Decolonization To end neo-colonialism, it is important to understand how it manifests and what to do at each level. Beyond the academic discourse, many tangible efforts exist to decolonize through de-silencing. Examples of these efforts include the ME2 movement that seeks to centre the concerns and experiences of sexually abused or harassed victims in the public discourse. At the funding level, many grant-awarding agencies like Wellcome Trust have dedicated huge budgets to studies that help them understand how they may have perpetrated colonialism or neocolonialism and what they can do differently going forward.[20] In South Africa, promulgating the Employment Equity Act 55 was a tangible attempt to entrench decolonization concerns in a country's regulatory framework. Yet, these decolonization efforts could fail to be substantive if they do not reflect cultural sensitivity. Two key components of cultural sensitivity are worth highlighting here: epistemic and cultural humility. Epistemic humility is an intellectual virtue described as knowing one’s limitations and the limitations of the learning methods employed. At its simplest, it is the ability to admit when one is wrong. Cultural humility includes genuine attempts to learn about and embrace other cultures. Epistemic and cultural humility are signs of academic excellence and strength. Epistemic and cultural humility seriously acknowledge how the state of our knowledge, cognitive limitations, experiences, and backgrounds, while constraining us, also invite us to listen, learn, grow, and change. The limitations-owing account of epistemic and cultural humility suggests that “a person who is aware of her cognitive limitations and owns them is much better positioned to achieve such epistemic goods as true beliefs and understanding than someone who… simply has insight into the epistemic status of her beliefs.”[21] Epistemic and cultural humility may help prevent decolonization projects that unintentionally reinforce what they seek to dismantle. Epistemic humility calls on decolonizers to defer tasks for which they are not qualified to suitably qualified persons. Beyond this, humility supports brave scholarship that imagines and reimagines how featuring the same voices, faces, and perspectives possibly introduces new forms of domination or silencing. Cultural knowledge can lead to a more intentional way of seeking out the right people or a more diverse group than those frequently featured in decolonization conversations. This would give others more opportunities to navigate these spaces and should do so in ways that are familiar to them. One ought to be more sensitive to those who would ordinarily not be included in these conversations. Unless we radically and boldly reimagine these discussions, we risk alienating those most negatively impacted by neocolonialism. CONCLUSION Decolonization conversations are complex and the subject of academic debate. The strategies employed to decolonize can harm or help the victims of neo-colonialism. Inclusion of previously silenced individuals may not be enough to overcome the vestiges of colonialism, leading to a false inclusion, where those included feel excluded or contribute in ways reflecting their own biases and circumstances. Inclusion of an elite or people who do not truly represent the subjugated can lead to elite capture. For decolonization strategies to be impactful, for example, in the context of global health, project leaders and participants must engage in conversations employing epistemic and cultural humility. In many ways, epistemic and cultural humility can help us demythologize our assumptions of any cultural superiority or cognitive authority, allowing for diverse voices, cultures, and perspectives to emerge without domination. - [1] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [2] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [3] Anye-Nkwenti Nyamnjoh 2023. Is decolonisation Africanisation? The politics of belonging in the truly African university. Social Dynamics, 1-20. [4] Rianna Oelofsen 2015. Decolonisation of the African mind and intellectual landscape. Phronimon, 16, 130-146. [5] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [6] Pedro Alexis Tabensky 2008. The Postcolonial Heart of African Philosophy. South African Journal of Philosophy, 27, 285-295. [7] Nicholas M. Creary 2012. African Intellectuals and Decolonization, Ohio, Ohio University Press. [8] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [9] Vivetha Thambinathan & Elizabeth Anne Kinsella 2021. Decolonizing Methodologies in Qualitative Research: Creating Spaces for Transformative Praxis. International Journal of Qualitative Methods, 20, 16094069211014766. [10] Abimbola Seye 2023. Knowledge from the global South is in the global South. Journal of Medical Ethics, 49, 337. [11] A. Alenichev, P. Kingori & K. P. Grietens 2023. Reflections before the storm: the AI reproduction of biased imagery in global health visuals. Lancet Glob Health. [12] Jonathan K. Burns & Andrew Tomita 2015. Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 50, 867-877. [13] Anye-Nkwenti Nyamnjoh & Cornelius Ewuoso 2023. What type of inclusion does epistemic injustice require? Journal of Medical Ethics, jme-2023-109091. [14] 1998. Employment Equity Act. In: GOVERNMENT, S. A. (ed.) 19370. [15] Dina Zoe Belluigi & Gladman Thondhlana 2019. ‘Why mouth all the pieties?’ Black and women academics’ revelations about discourses of ‘transformation’ at an historically white South African university. Higher Education, 78, 947-963. [16] Juliet Ramohai & Khomotso Marumo 2016. Women in Senior Positions in South African Higher Education: A Reflection on Voice and Agency. 231, 135-157. [17] J. Trejo 2020. The burden of service for faculty of color to achieve diversity and inclusion: the minority tax. Mol Biol Cell, 31, 2752-2754. [18] Olufemi Taiwo 2020. Being-in-the-Room Privilege: Elite Capture and Epistemic Deference. The Philosopher, 108, 7. [19] Margarita Kurbatova & Elena Kagan 2016. Opportunism of University Lecturers As a Way to Adaptate the External Control Activities Strengthening. Journal of Institutional Studies, 8, 116-136. [20] Jeremy Farrar. 2022. An update on Wellcome's anti-racist programme. An update on Wellcome's anti-racist programme [Online]. Available from: https://wellcome.org/news/update-wellcomes-anti-racism-programme [Accessed August 10, 2022 2022]. [21] Katherine Dormandy 2018. Does Epistemic Humility Threaten Religious Beliefs? Journal of Psychology and Theology, 46, 292-304. (shrink)

Background and ObjectivesBecause of high skin cancer risks for young women, it is vital that effective interventions reach and influence this demographic. Visual social media platforms, like Instagram, are popular with young women and are an appropriate intervention site; yet, they also host competing images idealizing tan skin. The present study tested the ability of digital sun-safety interventions to affect self-control-related emotions and visual attention to subsequent tan-ideal images as well as sun-safety attitudes.MethodsWomen were recruited from a large public Mid-Atlantic (...) university in the United States. Participants were randomly assigned to view an appearance benefits intervention, a self-control emotions intervention, or a control message, each designed to look like an Instagram sponsored story. After self-reporting self-compassion and anticipated pride, participants then viewed seven pairs of Instagram posts featuring either tan or pale women while an eye tracker assessed visual attention. Finally, participants self-reported their responses to questions assessing sun-safety-related norms, efficacy, and attitudes.ResultsA mixed design analysis of covariance revealed that women who first viewed the appearance benefits intervention story spent less time visually fixated on Instagram images of tan women than did those who viewed the self-control emotions intervention or control message. Regressions also revealed interactions between the intervention conditions and feelings of anticipated pride on both visual attention and sun-safety attitudes.ConclusionSponsored stories on Instagram can promote sun-safety attitudes, depending on the emotional responses they generate. Additionally, sponsored interventions can affect subsequent visual attention. (shrink)

M. C. Dillon was widely regarded as a world-leading Merleau-Ponty scholar. His book Merleau-Ponty’s Ontology is recognized as a classic text that revolutionized the philosophical conversation about the great French phenomenologist. Dillon followed that book with two others: Semiological Reductionism, a critique of early-1990s linguistic reductionism, and Beyond Romance, a richly developed theory of love. At the time of his death, Dillon had nearly completed two further books to which he was passionately committed. The first one offers a highly original (...) interpretation of Nietzsche’s ontology of becoming. The second offers a detailed ethical theory based on Merleau-Ponty’s account of carnal intersubjectivity. The Ontology of Becoming and the Ethics of Particularity collects these two manuscripts written by a distinguished philosopher at the peak of his powers—manuscripts that, taken together, offer a distinctive and powerful view of human life and ethical relations. (shrink)

Peace; Egypt; education conditions; history.

M. R. Ayers; V*—Some Thoughts, Proceedings of the Aristotelian Society, Volume 73, Issue 1, 1 June 1973, Pages 69–86, https://doi.org/10.1093/aristotelian/73.1.

Let κ be a regular cardinal, and let B be a subalgebra of an interval algebra of size κ. The existence of a chain or an antichain of size κ in B is due to M. Rubin (see [7]). We show that if the density of B is countable, then the same conclusion holds without this assumption on κ. Next we also show that this is the best possible result by showing that it is consistent with 2 ℵ 0 = (...) ℵ ω 1 that there is a boolean algebra B of size ℵ ω 1 such that length(B) = ℵ ω 1 is not attained and the incomparability of B is less than ℵ ω 1 . Notice that B is a subalgebra of an interval algebra. For more on chains and antichains in boolean algebras see, e.g. [1] and [2]. (shrink)