Towards untying colonial knots in Canadian health systems: A net metaphor for settler-colonialism.

Forceful imposition of settler-colonial laws and institutions violate Indigenous rights to self-determination, with profound impacts on health and wellness. As a team of Indigenous and non-Indigenous health leaders working in what's known colonially as "British Columbia," our collective work advances the rights and health of Indigenous Peoples (First Nations, Métis, and Inuit) by dismantling Indigenous-specific racism and White supremacy. We envision settler-colonialism as a net composed of hundreds of thousands of "colonial knots" that entangle Indigenous Peoples and prevent sovereignty and self-determination. The net also depicts Indigenous resistance, and the way forward of "untying colonial knots" patiently and persistently every day. We unpack this metaphor of the settler-colonial net and the artwork that inspired it. Our aim is to offer one more tool to Canadian health leaders who are bringing their hands, hearts, and minds to the complex and messy work of arresting White supremacy, Indigenous-specific racism, and settler-colonial harm.

On the use and abuse of metaphors in assessment.

This paper is motivated by a desire to advance assessment in the health professions through encouraging the judicious and productive use of metaphors. Through five specific examples (pixels, driving lesson/test, jury deliberations, signal processing, and assessment as a toolbox), we interrogate how metaphors are being used in assessment to consider what value they add to understanding and implementation of assessment practices. By unpacking these metaphors in action, we probe each metaphor's rationale and function, the gains each metaphor makes, and explore the unintended meanings they may carry. In summarizing common uses of metaphors, we elucidate how there may be both advantages and/or disadvantages. Metaphors can play important roles in simplifying, complexifying, communicating, translating, encouraging reflection, and convincing. They may be powerfully rhetorical, leading to intended consequences, actions, and other pragmatic outcomes. Although metaphors can be extremely helpful, they do not constitute thorough critique, justified evidence or argumentation. We argue that although metaphors have utility, they must be carefully considered if they are to serve assessment needs in intended ways. We should pay attention to how metaphors may be misinterpreted, what they ignore or unintentionally signal, and perhaps mitigate against this with anticipated corrections or nuanced qualifications. Failure to do so may lead to implementing practices that miss underlying and relevant complexities for assessment science and practice. Using metaphors requires careful attention with respect to their role, contributions, benefits and limitations. We highlight the value that comes from critiquing metaphors, and demonstrate the care required to ensure their continued utility.

Comparative structure of similarities and differences between tree and cognitive model of Cognitive Behavioral Theory / Estrutura comparativa de semelhanças e diferenças entre árvore e modelo cognitivo da Teoria Cognitivo-Comportamental

To contribute to studies in Psychology through a systematic and methodological analysis of the comparison between a tree and the cognitive model of the cognitive behavioral theory, establishing similarities and differences between the comparative domains. Method It is a qualitative, exploratory, documentary research, based on the Conceptual Metaphor, the Cognitive-Behavioral Theory, and on the Methodology of Teaching with Analogies. It starts from the hypothesis of the existence of a conceptual metaphor in which "the cognitive model is structured like a tree", transposing characteristics between both. It verifies, classifies, analyzes the comparison by means of analogical reasoning and the filling of comparative charts between vehicle and target. Results The results point to the complexity and potential of comparison if treated systematically and methodologically. Conclusion The research results corroborate the hypothesis that originated it.

Este artigo buscou analisar as percepções de pais e professores a respeito da trajetória escolar de crianças adotadas. Para isto, entrevistamos professores do Ensino Fundamental (3º ao 7º ano) e pais adotivos, investigando como compreendem a existência de possíveis sucessos e dificuldades escolares nas crianças adotadas, e se há relação entre adoção e atuação escolar. Método A pesquisa é qualitativa, exploratória, documental, fundamentada na Metáfora Conceptual, na Teoria Cognitivo-Comportamental e na Metodologia de Ensino com Analogias e parte da hipótese da existência de uma metáfora conceptual em que "o modelo cognitivo se estrutura como uma árvore", transpondo características entre ambos. Verifica-se, classifica-se e analisa-se a comparação por meio de raciocínio analógico e do preenchimento de quadros comparativos entre veículo e alvo. Resultados Os resultados apontam a complexidade e o potencial da comparação, caso seja tratada sistemática e metodologicamente. Conclusão A hipótese de pesquisa é corroborada.

Nursing Care Experiences With Syrian Refugees in Southern Turkey: A Metaphor Analysis.

BACKGROUND: Healthcare professionals' "cultural prejudices" toward individuals' cultural beliefs, attitudes, and perceptions affect the care they provide. Their awareness of their bias is closely associated with the quality of healthcare provided. PURPOSE: This study was designed to assess nurses' perceptions regarding providing care to Syrian refugee patients using metaphors and to evaluate their views based on these metaphors. METHODS: The participants in this qualitative study consisted of 80 nurses who worked in Level 1 and Level 2 health institutions. Data were collected using an interview form prepared by the researchers. The form included descriptive characteristics of the nurses and two expressions used to determine the nurses' opinions on providing care for Syrian refugee patients. The nurses were given an incomplete sentence, which was "Providing care for a Syrian refugee patient…because…," and were asked to complete the blanks. The data were analyzed using the content analysis method. RESULTS: On the basis of "providing care for Syrian refugee patients," four categories of metaphors were determined: occupational awareness, health promotion, a difficult process/resistance, and providing service in vain. The participants generated 50 metaphors, with "humanity," "a baby/little child," and "a barrier" as the three most used metaphors, belonging to the "occupational awareness" and "a difficult process/resistance" categories, respectively. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The metaphors of nurses regarding giving care to Syrian refugee patients were mostly concentrated in the categories of "occupational awareness" and "a difficult process/resistance." Metaphors generated by the nurses offer a powerful research tool to reveal, understand, and explain nurses' personal perceptions and to develop and support nursing care accordingly. In addition, the subject of transcultural nursing should be discussed more extensively in nursing education programs. Understanding the social context of refugees is very important during the nursing care process.

The language of less-lethal weapons.

It has been over 1 year since we observed the policing of the George Floyd protests in the United States [R. R. Hardeman, E. M. Medina, R. W. Boyd, N. Engl. J. Med. 383, 197-199 (2020)]. Multiple injury reports emerged in medical journals, and the scientific community called for law enforcement to discontinue the use of less-lethal weapons [E. A. Kaske et al., N. Engl. J. Med. 384, 774-775 (2021) and K. A. Olson et al., N. Engl. J. Med. 383, 1081-1083 (2020)]. Despite progress in research, policy change has not followed a similar pace. Although the reasoning for this discrepancy is multifactorial, failure to use appropriate language may be one contributing factor to the challenges faced in updating policies and practices. Here, we detail how language has the potential to influence thinking and decision-making, we discuss how the language of less-lethal weapons minimizes harm, and we provide a framework for naming conventions that acknowledges harm.

Framing action to reduce health inequalities: what is argued for through use of the 'upstream-downstream' metaphor?

BACKGROUND: Public health insights struggle to compete with dominant ideas which frame health inequalities as a problem of individual behaviour. There is consequently a need to critically reflect upon and question the effectiveness of different strategies for framing and communicating key insights. Taking the example of the 'upstream-downstream' metaphor, this literature review contributes to a necessary first step by asking what exactly is being argued for through its use. METHODS: An iterative search strategy was used to identify peer-reviewed articles which could contribute to the review question. A discourse analysis framework informed data extraction and synthesis of 24 articles. Articles were subsequently categorized into groups which reflected the different uses of the metaphor identified. RESULTS: All authors used the metaphor to promote a particular causal understanding of health inequalities, leading some to recommend policies and programmes, and others to focus on implementation processes. This seemingly simple metaphor has evolved beyond differentiating 'upstream' from 'downstream' determinants, to communicate an ambitious politically engaged agenda for change. CONCLUSIONS: The metaphor is not without its critics and in light of the complexity of the arguments encapsulated in its use, work is needed to establish if it can, and does, resonate as intended with wider audiences.

Miscibilidade em abordagens combinadas à prática de formação de professores(as) de educação física / Miscibilidad en enfoques combinados hacia la práctica de formación de profesores(as) de educación física / Miscibility in blended approaches to pete practice

Resumo Neste artigo, discutimos descobertas de um autoestudo colaborativo que realizamos sobre a adoção de uma abordagem combinada (ou seja, composta por componentes online e presenciais) para um curso de formação de professores(as) de Educação Física. Os dados consistiram em diários reflexivos e conversas gravadas. Examinamos assunções sobre estrutura, conteúdo e pedagogias de abordagens "combinadas" usando a metáfora da miscibilidade, na qual os líquidos se misturam para formar uma solução homogênea. O curso de formação de professores(as) não foi conceituado ou fomentado de uma forma que o tornasse miscível (ou seja, era imiscível), na medida em que os componentes presencial e online eram vistos como modalidades separadas. Isso significava que havia oportunidades perdidas de oferecer experiências formativas em uma modalidade para estruturar as experiências na outra. Após a pandemia, será importante considerar os pontos fortes dos formatos presencial e online para que alunos(as) experimentem as maneiras como um pode beneficiar o outro.

Resumen En este artículo, discutimos los hallazgos de un self-study colaborativo que hemos realizado sobre la adopción de enfoque combinado (es decir, compuesto por componentes online y presenciales) para un curso de formación de profesores/as de Educación Física. Los datos consistieron en diarios reflexivos y conversaciones grabadas. Examinamos asunciones sobre estructura, contenido y pedagogías de enfoques "combinados" utilizando la metáfora de la miscibilidad, donde los líquidos se mezclan para formar una solución homogénea. El curso de formación de profesores/as no fue conceptualizado ni fomentado de manera a volverlo miscible (es decir, era inmiscible), ya que los componentes presencial y online eran vistos como modalidades separadas. Esto significó que se perdieron oportunidades de ofrecer experiencias formativas en una modalidad para estructurar experiencias en la otra. Después de la pandemia, será importante considerar los puntos fuertes de los formatos presencial y online para que los alumnos/as puedan experimentar formas de que uno pueda beneficiar al otro.

Abstract In this paper, we discuss findings from a collaborative self-study we conducted on enacting a blended approach (i.e. consisting of online and in-person components) to a Physical Education Teacher Education (PETE) course. Data consisted of reflective journals and recorded conversations. We examine assumptions about the structure, content, and pedagogies of "blended" approaches using the metaphor of miscibility, where liquids mix to form a homogeneous solution. The blended PETE course was not conceptualized or enacted in a way that made it miscible (i.e. it was immiscible), in that the in-person and online components were viewed as separate entities. This meant there were missed opportunities to offer formative experiences from one format to shape experiences in the other. Following the pandemic it will be important to consider the strengths of both in-person and online formats so that students experience the ways one can benefit the other.

Picking the right metaphors for addressing microbial systems: economic theory helps understanding biological complexity.

Any descriptive language is necessarily metaphoric and interpretative. Two somewhat overlapping-but not identical-languages have been thoroughly employed in the last decade to address the issue of regulatory complexity in biological systems: the terminology of network theory and the jargon of electric circuitry. These approaches have found many formal equivalences between the layout of extant genetic circuits and the architecture of man-made counterparts. However, these languages still fail to describe accurately key features of biological objects, in particular the diversity of signal-transfer molecules and the diffusion that is inherent to any biochemical system. Furthermore, current formalisms associated with networks and circuits can hardly face the problem of multi-scale regulatory complexity-from single molecules to entire ecosystems. We argue that the language of economic theory might be instrumental not only to portray accurately many features of regulatory networks, but also to unveil aspects of the biological complexity problem that remain opaque to other types of analyses. The main perspective opened by the economic metaphor when applied to control of microbiological activities is a focus on metabolism, not gene selfishness, as the necessary background to make sense of regulatory phenomena. As an example, we analyse and reinterpret the widespread phenomenon of catabolite repression with the formal frame of the consumer's choice theory.

It is not always a matter of time: Addressing the costs of metaphor and metonymy through a speed-accuracy trade-off study.

One of the most debated topics in figurative language studies is whether the access to non-literal meanings is direct or indirect. Although models that argue for longer processing times for figurative compared to literal meanings have been largely criticized, figurative language is often associated with increased cognitive work. We investigated whether such greater cognitive work is indicative of more time-consuming processes or rather lower availability of figurative meanings, and whether there are differences between figurative types. We used a multi-response Speed-Accuracy Trade-off paradigm, where a meaningfulness judgment task was combined with a response deadline procedure to estimate speed and accuracy independently for metaphorical (Those dancers are butterflies) and metonymic sentences (That student reads Camilleri), compared with literal equivalents. While both metaphors and metonymies showed lower asymptote, that is, they were judged less accurately than literal counterparts, only metonymies were associated with a processing delay. Moreover, the difference in asymptote with respect to the literal condition was greater for metaphor than for metonymy. These findings indicate that the process that derives metaphor and metonymy is more complex than the process that derives literal meanings, even more so for metaphor. The processing delay, however, is present only in the case of metonymies. Taken together, our study offers key findings that reconcile a lively debate on the time course of figurative language comprehension, showing that the cost of non-literal meaning is not always a matter of time, and depends also on the figurative type. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Buckets Inequitably Filled by Our Shared Histories.

The COVID-19 pandemic has disproportionately affected patients of color and illuminates long-standing inequity in health status, health outcomes, and access to health care. Maldistribution of burden of disease, risk exposure, and how vulnerable we are to our lives unraveling is not merely unfortunate, not simply due to a bad turn of the cosmic wheel, but unjust, as illustrated in this digital self-portrait.

Immunitarianism: defence and sacrifice in the politics of Covid-19.

As witnessed over the last year, immunity emerged as one of most highly debated topics in the current Covid-19 pandemic. Countries around the globe have been debating whether herd immunity or lockdown is the best response, as the race continues for the development and rollout of effective vaccines against coronavirus and as the economic costs of implementing strict containment measures are weighed against public health costs. What became evident all the more is that immunity is precisely what bridges between biological life and political life in the current climate, be it in terms of the contentious notion of herd immunity, the geopolitical struggle for vaccines, or the possible emergence of "Covid-elite", i.e. holders of so-called "immunity passports". Immunity, as such, is certainly not only a matter of science and biology alone, but is inherently political in the way that pandemics themselves are often highly politicised. Drawing on the work of Roberto Esposito and other literature from the field of biopolitics and immunology, this paper provides a critical examination of the concept of immunity in light of the recent events, highlighting the intersections between the politics of defence and the politics of sacrifice which animate governments' immunitary responses to the Covid-19 pandemic. The paper ends with a discussion on the forms of solidarity and local initiatives that have been mobilised during the current pandemic and their potential for an affirmative form of biopolitics. Overall, the main aim of this paper is to provide a critical cultural and philosophical analysis of Covid-19 debates and responses and a nuanced account on the biopolitical effects of the current pandemic, highlighting the paradoxical nature of immunity which straddles at once negative practices of defence and sacrifice as well as affirmative forms of community and solidarity beyond state apparatuses.

Driving lesson or driving test? : A metaphor to help faculty separate feedback from assessment.

Although there is consensus in the medical education world that feedback is an important and effective tool to support experiential workplace-based learning, learners tend to avoid the feedback associated with direct observation because they perceive it as a high-stakes evaluation with significant consequences for their future. The perceived dominance of the summative assessment paradigm throughout medical education reduces learners' willingness to seek feedback, and encourages supervisors to mix up feedback with provision of 'objective' grades or pass/fail marks. This eye-opener article argues that the provision and reception of effective feedback by clinical supervisors and their learners is dependent on both parties' awareness of the important distinction between feedback used in coaching towards growth and development (assessment for learning) and reaching a high-stakes judgement on the learner's competence and fitness for practice (assessment of learning). Using driving lessons and the driving test as a metaphor for feedback and assessment helps supervisors and learners to understand this crucial difference and to act upon it. It is the supervisor's responsibility to ensure that supervisor and learner achieve a clear mutual understanding of the purpose of each interaction (i.e. feedback or assessment). To allow supervisors to use the driving lesson-driving test metaphor for this purpose in their interactions with learners, it should be included in faculty development initiatives, along with a discussion of the key importance of separating feedback from assessment, to promote a feedback culture of growth and support programmatic assessment of competence.

Termites of Solidarity in the House of Austerity: Undermining Fiscal Governance in the European Union.

European Union (EU) fiscal governance, especially the European Semester, is an ambitious new governance architecture involving surveillance and discipline, across both Eurozone and non-Eurozone member state policies, in pursuit of fiscal rigor. It is the most recent of several attempts to expand EU powers over member state policy with the goal of austere budgeting, and one that has led to remarkable claims of authority by the EU over member state health policies as detailed as medical school admissions and the role of primary care. It is expected that it would be resisted not just by those who object to an EU role in the organization and delivery of health care but also by those who object to a particular austere approach to health policy. How well is it working? Using two waves of interviews and documentary analysis, and health as a policy case study, the authors document three key techniques that opponents use to undermine the semester's governance architecture: broadening goals, expanding the scope of conflict, and disputing and nuancing indicators. The result is that opponents of a narrow fiscal governance agenda are again successfully undermining the narrow focus of the semester.

Mulheres em cargos de liderança no esporte: rompendo o teto de vidro ou percorrendo o labirinto? / Women in leadership sport positions: breaking through the glass ceiling or walking through the labyrinth? / Mujeres en cargos de liderazgo en el deporte: ¿rompiendo el tejado de vidrio o recorriendo el laberinto?

Resumo A metáfora do teto de vidro é amplamente utilizada para representar os obstáculos invisíveis que impedem mulheres de progredir profissionalmente em altos cargos de liderança na gestão e no esporte. O objetivo deste estudo foi, a partir de uma revisão integrativa, analisar o uso da metáfora do teto de vidro na literatura científica nacional e propor o uso do labirinto como uma metáfora mais complexa e inclusiva. Apesar de ser majoritariamente utilizado em estudos brasileiros, o teto de vidro não representa os diferentes locais de partida e as diversas dificuldades vivenciadas por mulheres ao longo de sua trajetória profissional. A metáfora do labirinto possibilita um olhar mais complexo, considerando os diferentes caminhos percorridos por mulheres a partir de suas identidades de gênero, classe e raça.

Abstract The glass ceiling metaphor is widely disseminated and used to represent the invisible obstacles that prevent women from progressing professionally into high leadership roles in management and sport. The aim of this study was, from an integrative review, to analyze the use of the glass ceiling metaphor in the national scientific literature and to propose the use of the labyrinth as a more complex and inclusive metaphor. Despite being mostly used in Brazilian studies, the glass ceiling does not represent the different starting points and the different difficulties experienced by women throughout their professional trajectory. The labyrinth metaphor allows for a more complex look, considering the different paths taken by women based on their gender, class and race identities.

Resumen La metáfora del tejado de vidrio es ampliamente utilizada para representar los obstáculos invisibles que impiden a las mujeres progresar en el ámbito profesional y acceder a altos cargos de liderazgo en la gestión y en el deporte. El objetivo de este estudio fue, a partir de una revisión, analizar el uso de la metáfora del tejado de vidrio en la literatura científica nacional y proponer el uso del laberinto como una metáfora más compleja e inclusiva. A pesar de ser mayoritariamente utilizado en estudios brasileños, el tejado de vidrio no representa los diferentes locales de partida y las diversas dificultades enfrentadas por mujeres a lo largo de su trayectoria profesional. La metáfora del laberinto posibilita una mirada más compleja, considerando los diferentes caminos recorridos por mujeres a partir de sus identidades de género, clase y raza.

An Aide Memoire for a Balancing Act? Critiquing The 'Balance Sheet' Approach to Best Interests Decision-Making.

The balance sheet is commonly used as a deliberative approach to decide best interests in Court of Protection cases in England and Wales, since Thorpe LJ in Re A (Male Sterilisation) described the balance sheet as a tool to enable judges and best interests decision-makers to quantify, compare, and calculate the different options at play. Recent judgments have critically reflected on the substance and practical function of the balance sheet approach, highlighting the practical stakes of its implicit conceptual assumptions and normative commitments. Using parallel debates in proportionality, we show that the balance sheet imports problematic assumptions of commensurability and aggregation, which can both overdetermine the outcome of best interests decisions and obfuscate the actual process of judicial deliberation. This means that the decision-making of judges and best interests assessors more generally could fail to properly reflect the nature of values at stake, as well as the skills of practical judgment needed to compare such values with sensitivity and nuance. The article argues that critical reflection of the balance sheet makes vital space for a more contextualised, substantive mode of deliberation which emphasises skills of qualitative evaluation towards enhancing conditions of articulation around the range of values involved in best interests decision-making.

Invisible Enemies: Coronavirus and Other Hidden Threats.

To say that coronavirus is highly visible is a massive understatement in terms of its omnipresence in our lives and media coverage concerning it, yet also clearly untrue in terms of the virus itself. COVID-19 is our invisible enemy, changing our lives radically without ever revealing itself directly. In this paper I explore its invisibility and how it relates to and exposes other invisible enemies we are and have been fighting, in many cases without even realizing. First, I analyse the virus itself and how its stealthy nature has transformed our lives. Second, I describe how the invisible epidemic of social media sharing of fake news about the virus worsens the situation further. Third, I explore how the virus has revealed to us what really matters in our lives and has forced us to re-evaluate our priorities. Fourth, I go on to explore the underlying structural weaknesses and disparities in society that have been exposed by the virus but previously remained unconsidered for so long that they too have become camouflaged, even if their effects are all too apparent; like the virus, neoliberal capitalism is an invisible enemy that has made prisoners of us all. I conclude by suggesting that the coronavirus pandemic represents a hidden opportunity to overcome perhaps the biggest invisible enemy of all: the moral distance that separates us from others. Only by rendering the rest of humanity morally visible to ourselves can we overcome capitalism and stop treating other people as invisible enemies.