Multimodal prehabilitation is increasingly recognized as an important component of the pre-operative pathway in oncology. It aims to optimize physical and psychological health through delivery of a series of tailored interventions including exercise, nutrition, and psychological support. At the core of this prescription is a need for considerable health behavior change, to ensure that patients are engaged with and adhere to these interventions and experience the associated benefits. To date the prehabilitation literature has focused on testing the efficacy of devised (...) exercise and nutritional interventions with a primary focus on physiological and mechanistic outcomes with little consideration for the role of behavioral science, supporting individual behavior change or optimizing patient engagement. Changing health behavior is complex and to maximize success, prehabilitation programs should draw on latest insights from the field of behavioral science. Behavioral science offers extensive knowledge on theories and models of health behavior change to further advance intervention effectiveness. Similarly, interventions developed with a person-centered approach, taking into consideration individual needs and preferences will increase engagement. In this article, we will provide an overview of the extent to which the existing prehabilitation literature incorporates behavioral science, as well as studies that have explored patient's attitudes toward prehabilitation. We will go on to describe and critique ongoing trials in a variety of contexts within oncology prehabilitation and discuss how current scientific knowledge may be enhanced from a behavioral science perspective. We will also consider the role of “surgery schools” and detail practical recommendations that can be embedded in existing or emerging clinical settings. (shrink)

This interview with N. Katherine Hayles, one of the foremost theorists of the posthuman, explores the concerns that led to her seminal book How We Became Posthuman, the key arguments expounded in that book, and the changes in technology and culture in the ten years since its publication. The discussion ranges across the relationships between literature and science; the trans-disciplinary project of developing a methodology appropriate to their intersection; the history of cybernetics in its cultural and political context ; (...) the changed role for psychoanalysis in the technoscientific age; and the altering forms of mediated ‘embodiment’ in the posthuman context. (shrink)

During the eukaryotic cell cycle, chromosomes undergo large structural transitions and spatial rearrangements that are associated with the major cell functions of genome replication, transcription and chromosome condensation to metaphase chromosomes. Eukaryotic cells have evolved cell cycle dependent processes that modulate histone:DNA interactions in chromosomes. These are; (i) acetylations of lysines; (ii) phosphorylations of serines and threonines and (iii) ubiquitinations of lysines. All of these reversible modifications are contained in the well‐defined very basic N‐ and C‐ terminal domains of histones. (...) Acetylations and phosphorylations markedly affect the charge densities of these domains whereas ubiquitination adds a bulky globular protein, ubiquitin, to lysines in the C‐terminal tails of H2A and H2B. Histone acetylations are strictly associated with genome replication and transcription; histone H1 and H3 phosphorylations correlate with the process of chromosome condensation. The subunits of histone H1 kinase have now been shown to be cyclins and the p34CDC2 kinase product of the cell cycle control gene CDC2. It is probable that all of the processes that control chromosome structure:function relationships are also involved in the control of the cell cycle. (shrink)

The poetry and journalistic essays of Katherine Tillman often appeared in publications sponsored by the American Methodist church. Collected together for the first time, her works speak to the struggles and triumphs of African-American women.

Background The phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice. Research aim To explore the (...) concept of moral distress in nursing both empirically and conceptually. Methodology Feminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis. Ethical considerations The study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom. Findings The empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas. Discussion We suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress. Conclusion The empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’. (shrink)

Feminist analyses of gender concepts must avoid the inclusion problem, the fault of marginalizing or excluding some prima facie women. Sally Haslanger’s ‘ameliorative’ analysis of gender concepts seeks to do so by defining woman by reference to subordination. I argue that Haslanger’s analysis problematically marginalizes trans women, thereby failing to avoid the inclusion problem. I propose an improved ameliorative analysis that ensures the inclusion of trans women. This analysis yields ‘twin’ target concepts of woman, one concerning gender as class and (...) the other concerning gender as identity, both of which I hold to be equally necessary for feminist aims. (shrink)

Katherine Hawley investigates what trustworthiness means in our lives. We become untrustworthy when we break promises, miss deadlines, or give unreliable information. But we can't be sure about what we can commit to. Hawley examines the social obstacles to trustworthiness, and explores how we can steer between overcommitment and undercommitment.

Aims: The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress. Background: Moral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon. Design: Systematic literature (...) review and narrative synthesis (November 2015–March 2016). Data sources: Ovid MEDLINE® In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO® 1967–Present, CINAHL® Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education Abstracts. Review methods: Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis. Results: In all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity. Conclusion: We suggest the combination of (1) the experience of a moral event, (2) the experience of ‘psychological distress’ and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress. (shrink)

Katherine Hawley explores and compares three theories of persistence -- endurance, perdurance, and stage theories - investigating the ways in which they attempt to account for the world around us. Having provided valuable clarification of its two main rivals, she concludes by advocating stage theory.

The author draws on the policy analysis literature to delineate the linkage between conceptualization of risk and the formulation and proposed solution of risk-related policy problems. Two concepts of risk are identified: a concept of risk as a physically given attribute of hazardous technologies and a concept of risk as a socially constructed attribute. The argument is advanced that the social construction of risk provides a firm, theoretical basis for the design of policy. The discussion links the perception, manage ment, (...) and communication of risk to the more fundamental issue of the nature and role of science and technology. (shrink)

Austerity, by its very nature, imposes constraints by limiting the options for action available to us because certain courses of action are too costly or insufficiently cost effective. In the context of healthcare, the constraints imposed by austerity come in various forms; ranging from the availability of certain treatments being reduced or withdrawn completely, to reductions in staffing that mean healthcare professionals must ration the time they make available to each patient. As austerity has taken hold, across the United Kingdom (...) and Europe, it is important to consider the wider effects of the constraints that it imposes in healthcare. Within this paper, we focus specifically on one theorised effect—moral distress. We differentiate between avoidable and unavoidable ethical challenges within healthcare and argue that austerity creates additional avoidable ethical problems that exacerbate clinicians’ moral distress. We suggest that moral resilience is a suitable response to clinician moral distress caused by unavoidable ethical challenges but additional responses are required to address those that are created due to austerity. We encourage clinicians to engage in critical resilience and activism to address problems created by austerity and we highlight the responsibility of institutions to support healthcare professionals in such challenging times. (shrink)

Social groups, including racial and gender groups and teams and committees, seem to play an important role in our world. This article examines key metaphysical questions regarding groups. I examine answers to the question ‘Do groups exist?’ I argue that worries about puzzles of composition, motivations to accept methodological individualism, and a rejection of Racialism support a negative answer to the question. An affirmative answer is supported by arguments that groups are efficacious, indispensible to our best theories, and accepted given (...) common sense. Then, I turn to an examination of the features of social groups. I argue that social groups can be divided into two sorts. Groups of Type 1 are organized social groups like courts and clubs. Groups of Type 2 are groups like Blacks, women, and lesbians. While groups of both sorts have some features in common, they also have marked differences in features. Finally, I turn to views of the nature of social groups. I argue that the difference in features provides evidence that social groups do not have a uniform nature. Teams and committees are structured wholes, while race and gender groups are social kinds. (shrink)

Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need (...) to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Wilhelm Griesinger: Psychiatry between Philosophy and PraxisKatherine Arens (bio)AbstractThis essay discusses Wilhelm Griesinger’s seminal work on mental illness, Mental Pathology and Therapeutics (1867, trans. 1882), in the context of transcendental idealism, as an outgrowth of the work of Kant, Herbart, and Hegel. Griesinger drew on an adaptation of Hegel’s dialectical model of history and science to offer both a new way to interpret mental illness as a product of (...) an individual’s long-term interactions with both nature and culture and a new norm for therapeutic practice based on the patient’s role in his community and history.Mental Pathology and Therapeutics rests on Griesinger’s adaptation of the Hegelian dialectic to the context of pragmatic science, first by adopting its model of the mind, then by describing the etiology of mental disease and a taxonomy of its forms. Griesinger’s work thus stands in a largely unacknowledged tradition alive as late as Sigmund Freud and Jacques Lacan.KeywordsGriesinger, history of psychiatry/psychology, idealism, Hegel, dialecticIn the nineteenth century, Wilhelm Griesinger (1817–68) emerged as a leader in a range of fields: modern-day psychiatric clinical practice, neuropathology, and diagnostics of mental diseases. 1 Griesinger was a theoretician, a clinician, a textbook author, and the founding editor of major professional organs in his field during the political and social ferment in the German-speaking world that allowed new, more socially responsible institutional practices to be considered by intellectual communities. As a consequence of 1849 German civil reforms, theory and practice became mutually enlightening, actually allowing Griesinger to implement his theories into concrete institutional reforms in the German mental health system.Wilhelm Griesinger’s education and career were in many ways typical for his generation. He enrolled at the University of Tübingen in 1834 as a medical student; there, he became politically active (as a member of a forbidden fraternity), and, like many of his contemporaries, became familiar with Hegelian philosophy. After holding several private positions, he was appointed an associate professor (ausserordentlicher Professor) for pathology, “materia medica” and history of medicine at Tübingen in 1847. In 1848, he was called to Kiel; in 1850, to Egypt. Tübingen reappointed him as a full professor for clinical medicine and head of the university clinic in 1854. By 1860, he had moved to Zurich in a professorship for the medical clinic, where, starting in 1863, he was a key person in the planning of a new clinic for mental diseases—the Burghölzli, where Jung later worked. By 1865, he went to Berlin, as director of the Charité (mental institution), among other positions, and he wrote extensively about reform in asylum practice until his premature death in 1868.To a degree, the eminence of this career is contradicted today by his reputation. Contemporary wisdom describes Griesinger as a synthesizer [End Page 147] rather than an innovator, a man who mixed medical psychology with psychology and psychiatric practice, allowing neurology to take a major role in the treatment of mental disease. 2 In one version, Griesinger simply pulled the clinic and the laboratory together, and so bridged Romanticism (i.e., speculative natural philosophy) and materialism (i.e., empirical science) while failing to effect crucial modern reforms. 3 In other descriptions, Griesinger is identified as an activist (Doerner 1981), a key player in the debates between the Hegelian left and right about the reformulation of public institutions (cf. Verwey 1985), 4 or a typical (but effective) member of the intellectual elite of his age. 5 None of these options explains the attractive or threatening aspects of his clinical practice, or suggests why a psychiatrist of his rank could have been so thoroughly refuted after his death. 6The discussion which follows will try to remedy this lack by setting Griesinger’s approach to mental illness in the context of a transformation of a model from philosophy into medical practice. Griesinger’s scientific context strongly combined philosophical theorizing and empirical practice, a synthesis that later generations tended to denigrate as a “speculative” approach to a branch of medicine that required a more empirical foundation. Drawing on an adaptation of Hegel’s dialectical model of history and... (shrink)

Learn to be responsible with Grover and your Sesame Street friends! Young readers will discover how to be a good helper to both themselves and those around them. Now in Spanish!

By placing the title question alongside five comparative questions and offering answers to the whole set as given by seven imaginary respondents, this paper analyzes the question's deceptiveness and the inconsistency of its implied claims. Apart from ambiguities of situation, history, and agency, the question's demand for a choice between "your child" and "nonhuman animals" obscures a field of other values regarding species, family ties, and the wrongness-in-itself of the experiments envisioned. This paper argues that while a "No" answer to (...) the title question does not, as intended by the questioner, support the experimental status quo, even a "Yes" answer does not reflect a choice between one's own child and animals. (shrink)

Stereotypes sometimes lead us to make poor judgements of other people, but they also have the potential to facilitate quick, efficient, and accurate judgements. How can we discern whether any individual act of stereotyping will have the positive or negative effect? How Stereotypes Deceive Us addresses this question. It identifies various factors that determine whether or not the application of a stereotype to an individual in a specific context will facilitate or impede correct judgements and perceptions of the individual. It (...) challenges the thought that stereotyping only and always impedes correct judgement when the stereotypes that are applied are inaccurate, failing to reflect social realities. It argues instead that stereotypes that reflect social realities can lead to misperceptions and misjudgements, and that inaccurate but egalitarian social attitudes can therefore facilitate correct judgements and accurate perceptions. The arguments presented in this book have important implications for those who might engage in stereotyping and those who are at risk of being stereotyped. They have implications for those who work in healthcare and those who have mental health conditions. How Stereotypes Deceive Us provides a new conceptual framework-evaluative dispositionalism-that captures the epistemic faults of stereotypes and stereotyping, providing conceptual resources that can be used to improve our own thinking by avoiding the pitfalls of stereotyping, and to challenge other people's stereotyping where it is likely to lead to misperception and misjudgement. (shrink)

There has been increasing debate in recent years about the conceptualization of moral distress. Broadly speaking, two groups of scholars have emerged: those who agree with Jameton’s ‘narrow definition’ that focuses on constraint and those who argue that Jameton’s definition is insufficient and needs to be broadened. Using feminist empirical bioethics, we interviewed critical care nurses in the United Kingdom about their experiences and conceptualizations of moral distress. We provide our broader definition of moral distress and examples of data that (...) both challenge and support our conceptualization. We pre‐empt and overcome three key challenges that could be levelled at our account and argue that there are good reasons to adopt our broader definition of moral distress when exploring prevalence of, and management strategies for, moral distress. (shrink)

Du Châtelet’s 1740 text Foundations of Physics tackles three of the major foundational issues facing natural philosophy in the early eighteenth century: the problem of bodies, the problem of force, and the question of appropriate methodology. This paper offers an introduction to Du Châtelet’s philosophy of science, as expressed in her Foundations of Physics, primarily through the lens of the problem of bodies.

Fetal alcohol spectrum disorder is a multifaceted disability, characterized not only by brain- and body-based challenges, but also high rates of environmental adversity, lifelong difficulties with daily living, and distinct sociocultural considerations. FASD is one of the most common neurodevelopmental disabilities in the Western world and associated with significant social and economic costs. It is important to understand the complexities of FASD and the ways in which FASD requires unique consideration in research, practice, and policy. In this article, we discuss (...) our perspectives on factors that distinguish FASD from other disabilities in terms of complexity, co-occurrence, and magnitude. We provide an overview of select literature related to FASD as a socially rooted disability with intergenerational impacts and multiple layers of stigma. These social issues are intertwined with notable experiences of adversity across the lifespan and high rates of co-occurring health concerns for individuals with FASD, all of which present unique challenges for individuals, caregivers, families, service providers, and policy makers. Understanding these factors is the first step in developing and implementing specialized initiatives in support of positive outcomes for individuals with FASD and their families. Future directions are proposed for advancing research, practice, and policy, and responding to the unique complexities of FASD. (shrink)

Highlights feminist rhetorical practices that disrupt and surpass boundaries of time and space.

There are moments when things suddenly seem strange - objects in the world lose their meaning, we feel like strangers to ourselves, or human existence itself strikes us as bizarre and unintelligible. Through a detailed philosophical investigation of Heidegger's concept of uncanniness (Unheimlichkeit), Katherine Withy explores what such experiences reveal about us. She argues that while others (such as Freud, in his seminal psychoanalytic essay, 'The Uncanny') take uncanniness to be an affective quality of strangeness or eeriness, Heidegger uses (...) the concept to go beyond feeling uncanny to reach the ground of this feeling in our being uncanny. -/- "Heidegger on Being Uncanny" answers those who wonder whether human existence is fundamentally strange to itself by showing that we can be what we are only if we do not fully understand what it is to be us. This fundamental finitude in our self-understanding is our uncanniness. In this first dedicated interpretation of Heidegger's uncanniness, Withy tracks this concept from his early analyses of angst through his later interpretations of the choral ode from Sophocles's Antigone. Her interpretation uncovers a novel and robust continuity in Heidegger's thought and in his vision of the human being as uncanny, and it points the way toward what it is to live well as an uncanny human being. (shrink)

Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need (...) to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent. (shrink)

I outline a number of parallels between trust and distrust, emphasising the significance of situations in which both trust and distrust would be an imposition upon the (dis)trustee. I develop an account of both trust and distrust in terms of commitment, and argue that this enables us to understand the nature of trustworthiness. Note that this article is available open access on the journal website.

Although the principle of fair subject selection is a widely recognized requirement of ethical clinical research, it often yields conflicting imperatives, thus raising major ethical dilemmas regarding participant selection. In this paper, we diagnose the source of this problem, arguing that the principle of fair subject selection is best understood as a bundle of four distinct sub-principles, each with normative force and each yielding distinct imperatives: (1) fair inclusion; (2) fair burden sharing; (3) fair opportunity; and (4) fair distribution of (...) third-party risks. We first map out these distinct sub-principles, and then identify the ways in which they yield conflicting imperatives for the design of inclusion and exclusion criteria, and the recruitment of participants. We then offer guidance for how decision makers should navigate these conflicting imperatives to ensure that participants are selected fairly. (shrink)

Can human beings be free and responsible if there is an all-powerful God? Anselm of Canterbury offers viable answers to questions which have plagued religious people for at least two thousand years. Katherin Rogers examines Anselm's reconciliation of human free will and divine omnipotence in the context of current philosophical debates.

Responsibility means we do what we are supposed to do, such as cleaning up after ourselves. Readers discover how to be a good helper alongside their friends from Sesame Street.