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Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb.

Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition.

In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition. The other authors on this paper were Ginette A.

Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow.

Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear. To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types.

Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a kamagra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs.

€œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says. Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

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Triage is Propecia cheapest price a key principle in the effective management kamagra gold 100 of major incidents and is the process by which patients are prioritised on the basis of their clinical acuity. However, work published over the kamagra gold 100 last decade has demonstrated that existing methods of triage perform poorly when trying to identify patients in need of life-saving interventions. As a result, a review of major incident triage was initiated by NHS England with the remit to determine the optimum way in which to triage patients of all ages in a major incident for the UK. This article describes the output from this review, kamagra gold 100 the changes being undertaken to UK major incident triage and the introduction of the new NHS Major Incident Triage Tool (MITT) from the Spring of 2023.Triage is a key principle in the effective management of major incidents and is the process by which patients are prioritised on the basis of their clinical acuity.

It is the first clinical priority to be undertaken at a major incident, ahead of any patient treatment, and is typically kamagra gold 100 performed with a rapid physiological assessment.In countries using the Major Incident Medical Management and Support principles (eg, the UK, Australia and South Africa), a two-staged approach to triage is undertaken.1 Primary triage is performed using the Triage Sieve, which provides an initial rapid assessment of physiology at the scene. Since 2013, the modified National Ambulance Service Medical Directors (NASMeD) Sieve has been used in the UK.2 The NASMeD Sieve is then followed by a more detailed assessment, using the Triage Sort, in a more permissive environment usually removed from the immediate incident scene (eg, in a casualty clearing station) (online supplemental figure 1).Supplemental materialThe rationale for this two-stage approach is to allow assessment of a large number of patients rapidly using the more simplified tool, the Sieve, which requires neither clinical expertise nor additional medical equipment (eg for the measurement of Blood Pressure). Following this, the triage decision can be refined using the kamagra gold 100 more detailed assessment with the Triage Sort (including Blood Pressure measurement and the Glasgow Coma Scale) and incorporating senior clinician decision-making. For the assessment of children under 12 years, an age-specific adaptation of the Triage Sieve (the Paediatric Triage Tape) is advocated as the primary triage method of choice.1Additional triage methods are used elsewhere in the world, including the Amberg-Schwandorf Algorithm (ASAV) in Germany, the Careflight tool in some parts of Australia, and in the USA, both the Simple Triage and Rapid Treatment (START) and Sort Assess Life-Saving Intervention and Treatment (SALT) triage tools are used.3 While both START and Careflight are purely objective physiological triage tools, the ASAV and SALT differ in that they include a subjective triage assessment.Work published over the last decade has demonstrated that existing triage tools perform poorly when identifying patients in need of life-saving intervention and may also be associated with increased mortality.4 5 Based on emerging evidence, a review of major incident triage (including an appraisal of all existing methods) was initiated by the National Strategic Incident Director for NHS England Emergency Preparedness, Resilience and Response.

A Task and Finish (T&F) group was created, including stakeholders and representation from NHS England, kamagra gold 100 the National Ambulance Resilience Unit, Defence Medical Services and the Advanced Life Support Group. This was a comparable process to that undertaken in the USA by Lerner et al which led to the development and introduction of the SALT triage method.6 The remit of the group was to determine the optimum way to triage patients of all ages kamagra gold 100 in a major incident in the UK.This review has resulted in the development of the NHS MITT (Figure 1), which having been announced in October 2022, will be introduced into UK practice from April 2023. In this article we discuss the changes made to the process of triage and the rationale behind these changes.The NHS Major Incident Triage Tool (MITT)." data-icon-position data-hide-link-title="0">Figure 1 The NHS Major Incident Triage Tool (MITT).FormatThe layout and format of the MITT was developed in consultation with the Behavioural Science and Insights Unit from the UK Health Security Agency with several options field-tested in August 2021 during two simulated major incidents (one a rail crash scenario and the other a marauding terrorist attack) with 50 casualties and two teams of six front-line ambulance staff with a variety of clinical experience. The style selected has the advantage of simplicity in layout and flow allowing rapid and consistent application of the tool by those who may be unfamiliar with it.Physiological thresholdsThe physiological parameters within the MITT differ to those used in both the Triage Sieve and NASMeD Sieve and incorporate the pulse and respiratory rate thresholds from the Modified Physiological Triage Tool, MPTT-24.4 The rationale for changing these thresholds came from a large body of evidence demonstrating that the thresholds within both former tools did not reliably identify patients in need of life-saving intervention and were theoretically associated with both increased mortality and unacceptably high levels of undertriage (incorrectly classifying a patient as not kamagra gold 100 needing a life-saving intervention).The new thresholds (Heart Rate >100 and Respiratory Rate <12 or ≥ 24) were determined in a study using logistic regression methodology and were found to be the optimum parameters with which to identify adult trauma patients in need of life-saving intervention.7 Furthermore, the inclusion of the new physiological thresholds is consistent with the approach taken in the NHS Clinical Guidelines for Major Incidents and the latest iteration of the Defence Medical Services Battlefield Casualty Drills Sieve.8The Survivor Reception CentreThe Survivor Reception Centre (SRC) has historically been used as a term for an area where the uninjured would be taken during a major incident.

Both the SRC and kamagra gold 100 an assessment of whether the patient is injured have been removed from the MITT, as concern was raised that occult injuries may declare themselves within the SRC, where the medical resources are likely to be limited. Furthermore, the MITT is designed as a rapid primary triage assessment, ideally taking less than 30 s, so it was felt it was not appropriate to define whether an individual is injured or not at this stage. As a result, all living individuals involved in a major incident should be categorised as minimum Priority Three, allowing for them to be reassessed and discharged from medical care if and when appropriate.Secondary triageWith evidence demonstrating that the secondary triage tool, the Triage Sort, performs poorly when compared kamagra gold 100 with the MPTT-24 at identifying patients in need of life-saving intervention,5 its use has been deprioritised while further research is undertaken to determine an improved method of secondary triage. In the interim, the consensus is to repeat the triage process using the MITT and when resources allow, follow the local major trauma triage tool with decision support from senior kamagra gold 100 clinicians.What about the children?.

Where previously the Paediatric Triage Tape1 (online supplemental figure 2) was advocated as the primary triage method for those aged under 12 years, following a review of existing published evidence, the MITT uses the same physiological thresholds in both adult and paediatric patients. This approach is borne out of a recent comparative kamagra gold 100 analysis of paediatric MITTs demonstrating that both the existing Paediatric Triage Tape and JumpSTART performed poorly when identifying paediatric patients in need of life-saving intervention. Within the same comparative analysis, the adult MPTT-24 demonstrated improved performance with reduced rates of undertriage.9 The Sheffield Paediatric Triage Tool (online supplemental figure 3), a specific paediatric adaptation of the MPTT-24, demonstrated the best predictive performance, but owing to its complexity, was deemed to be not feasible for use in the field as a primary triage tool.9Additionally, the MITT incorporates two specific paediatric elements. The consideration kamagra gold 100 of rescue breaths and the automatic categorisation of those under 2 years as Priority One.

The inclusion of rescue breaths kamagra gold 100 in paediatric life-support algorithms is common and is an attempt to reverse hypoxia which may lead to cardiac arrest. While the Paediatric Triage Tape did not include rescue breaths, the JumpSTART method did. In a large paediatric Delphi study, consensus opinion was that rescue breaths should be included within triage guidance, but only for mechanisms which were likely to result in hypoxia, such as submersion, immersion or smoke inhalation.10 Paediatric kamagra gold 100 patients who remain apnoeic following five rescue breaths are categorised as dead.Automatically categorising paediatric patients aged under 2 years as Priority One originates from a review of the Trauma Audit and Research Network (TARN) database, which demonstrated an increased mortality and need for life-saving intervention in this age group (online supplemental figure 4).11 The nature of the TARN database and its inclusion criteria have been previously described elsewhere and are included within online supplemental figure 5.9 While cases of non-accidental injury will certainly influence these data, it was felt that this was a clinically important and pragmatic step.This age group will be at variable developmental milestones (mobility and verbal), thereby making accurate assessment difficult. Furthermore, assessing young children is likely to be emotive, especially for those with limited paediatric experience.

These factors are likely to be exaggerated in the context of a major kamagra gold 100 incident. This automatic categorisation as Priority One was felt necessary to reduce cognitive burden of kamagra gold 100 those involved in triage at the incident scene. While the introduction of this step may result in a theoretical increase in overtriage, the likelihood of significant numbers of paediatric patients under the age of 2 years being involved in a major incident is deemed to be low and therefore was felt by the T&F group to be a tolerable risk.SummaryThe new NHS MITT will be introduced into UK practice as a unified replacement to the NASMeD Sieve and Triage Sort in the Spring of 2023. It differs from the previous NASMeD Triage Sieve in a number of ways, notably kamagra gold 100 by having modified physiological parameters and by being designed for use across the entire age range, including both adults and children.

Major incident triage should be rapid, reliable and reproducible, irrespective of the provider performing kamagra gold 100 it. The introduction of the MITT into practice fulfils these principles, and provides not only an evidence-based approach to major incident triage, but also a more simplified approach by adopting a single approach across all ages.Ethics statementsPatient consent for publicationNot applicable.Ethics approvalNot applicable.AcknowledgmentsThe authors thank the rest of the Emergency Preparedness, Resilience and Response (EPRR) Task and Finish Group for their efforts in helping to deliver the MITT. Robert Bentley, Celia Kendrick, Justine Lee, Nabeela Malik, Bimal Mehta, Mark Sewell and kamagra gold 100 Alison Walker. The authors also thank Holly Carter and Louise Davidson from the Behavioural Science and Insights Unit at the UK Health Security Agency..

Triage is a key principle in the effective management of major incidents and is the process by which http://www.949toner.com/propecia-cheapest-price patients are prioritised on the basis of their cheap kamagra 100mg clinical acuity. However, work published over the last decade has demonstrated that existing methods of triage perform poorly when trying to identify patients in need of life-saving interventions cheap kamagra 100mg. As a result, a review of major incident triage was initiated by NHS England with the remit to determine the optimum way in which to triage patients of all ages in a major incident for the UK. This article describes the output from this cheap kamagra 100mg review, the changes being undertaken to UK major incident triage and the introduction of the new NHS Major Incident Triage Tool (MITT) from the Spring of 2023.Triage is a key principle in the effective management of major incidents and is the process by which patients are prioritised on the basis of their clinical acuity. It is the first clinical priority to be undertaken at a major incident, ahead cheap kamagra 100mg of any patient treatment, and is typically performed with a rapid physiological assessment.In countries using the Major Incident Medical Management and Support principles (eg, the UK, Australia and South Africa), a two-staged approach to triage is undertaken.1 Primary triage is performed using the Triage Sieve, which provides an initial rapid assessment of physiology at the scene.

Since 2013, the modified National Ambulance Service Medical Directors (NASMeD) Sieve has been used in the UK.2 The NASMeD Sieve is then followed by a more detailed assessment, using the Triage Sort, in a more permissive environment usually removed from the immediate incident scene (eg, in a casualty clearing station) (online supplemental figure 1).Supplemental materialThe rationale for this two-stage approach is to allow assessment of a large number of patients rapidly using the more simplified tool, the Sieve, which requires neither clinical expertise nor additional medical equipment (eg for the measurement of Blood Pressure). Following this, the triage decision can be refined cheap kamagra 100mg using the more detailed assessment with the Triage Sort (including Blood Pressure measurement and the Glasgow Coma Scale) and incorporating senior clinician decision-making. For the assessment of children under 12 years, an age-specific adaptation of the Triage Sieve (the Paediatric Triage Tape) is advocated as the primary triage method of choice.1Additional triage methods are used elsewhere in the world, including the Amberg-Schwandorf Algorithm (ASAV) in Germany, the Careflight tool in some parts of Australia, and in the USA, both the Simple Triage and Rapid Treatment (START) and Sort Assess Life-Saving Intervention and Treatment (SALT) triage tools are used.3 While both START and Careflight are purely objective physiological triage tools, the ASAV and SALT differ in that they include a subjective triage assessment.Work published over the last decade has demonstrated that existing triage tools perform poorly when identifying patients in need of life-saving intervention and may also be associated with increased mortality.4 5 Based on emerging evidence, a review of major incident triage (including an appraisal of all existing methods) was initiated by the National Strategic Incident Director for NHS England Emergency Preparedness, Resilience and Response. A Task cheap kamagra 100mg and Finish (T&F) group was created, including stakeholders and representation from NHS England, the National Ambulance Resilience Unit, Defence Medical Services and the Advanced Life Support Group. This was a comparable process to that undertaken in the USA by Lerner et al which led to the development and introduction of the SALT triage method.6 The remit of the group was to determine the optimum way to triage patients cheap kamagra 100mg of all ages in a major incident in the UK.This review has resulted in the development of the NHS MITT (Figure 1), which having been announced in October 2022, will be introduced into UK practice from April 2023.

In this article we discuss the changes made to the process of triage and the rationale behind these changes.The NHS Major Incident Triage Tool (MITT)." data-icon-position data-hide-link-title="0">Figure 1 The NHS Major Incident Triage Tool (MITT).FormatThe layout and format of the MITT was developed in consultation with the Behavioural Science and Insights Unit from the UK Health Security Agency with several options field-tested in August 2021 during two simulated major incidents (one a rail crash scenario and the other a marauding terrorist attack) with 50 casualties and two teams of six front-line ambulance staff with a variety of clinical experience. The style selected has the advantage of simplicity in layout and flow allowing rapid and consistent application of the tool by those who may be unfamiliar with it.Physiological thresholdsThe physiological parameters within the MITT differ to those used in both the Triage Sieve and NASMeD Sieve and incorporate the pulse and respiratory rate thresholds from the Modified Physiological Triage Tool, MPTT-24.4 The rationale for changing these thresholds came from a large body of evidence demonstrating that the thresholds within both former tools did not reliably identify patients in need of life-saving intervention and were theoretically associated with both increased mortality and unacceptably high levels cheap kamagra 100mg of undertriage (incorrectly classifying a patient as not needing a life-saving intervention).The new thresholds (Heart Rate >100 and Respiratory Rate <12 or ≥ 24) were determined in a study using logistic regression methodology and were found to be the optimum parameters with which to identify adult trauma patients in need of life-saving intervention.7 Furthermore, the inclusion of the new physiological thresholds is consistent with the approach taken in the NHS Clinical Guidelines for Major Incidents and the latest iteration of the Defence Medical Services Battlefield Casualty Drills Sieve.8The Survivor Reception CentreThe Survivor Reception Centre (SRC) has historically been used as a term for an area where the uninjured would be taken during a major incident. Both the SRC and cheap kamagra 100mg an assessment of whether the patient is injured have been removed from the MITT, as concern was raised that occult injuries may declare themselves within the SRC, where the medical resources are likely to be limited. Furthermore, the MITT is designed as a rapid primary triage assessment, ideally taking less than 30 s, so it was felt it was not appropriate to define whether an individual is injured or not at this stage. As a result, all living individuals involved in a major incident should be categorised as minimum Priority Three, allowing for them to be reassessed and discharged from medical care if and when appropriate.Secondary triageWith evidence demonstrating that the secondary triage tool, the Triage Sort, performs poorly cheap kamagra 100mg when compared with the MPTT-24 at identifying patients in need of life-saving intervention,5 its use has been deprioritised while further research is undertaken to determine an improved method of secondary triage.

In the interim, the consensus is to repeat the triage process using the MITT and when resources allow, follow the local major trauma triage tool with decision support from senior clinicians.What about the children? cheap kamagra 100mg. Where previously the Paediatric Triage Tape1 (online supplemental figure 2) was advocated as the primary triage method for those aged under 12 years, following a review of existing published evidence, the MITT uses the same physiological thresholds in both adult and paediatric patients. This approach is borne out of a recent comparative analysis of paediatric MITTs cheap kamagra 100mg demonstrating that both the existing Paediatric Triage Tape and JumpSTART performed poorly when identifying paediatric patients in need of life-saving intervention. Within the same comparative analysis, the adult MPTT-24 demonstrated improved performance with reduced rates of undertriage.9 The Sheffield Paediatric Triage Tool (online supplemental figure 3), a specific paediatric adaptation of the MPTT-24, demonstrated the best predictive performance, but owing to its complexity, was deemed to be not feasible for use in the field as a primary triage tool.9Additionally, the MITT incorporates two specific paediatric elements. The consideration of rescue breaths and the automatic categorisation of those under 2 years cheap kamagra 100mg as Priority One.

The inclusion cheap kamagra 100mg of rescue breaths in paediatric life-support algorithms is common and is an attempt to reverse hypoxia which may lead to cardiac arrest. While the Paediatric Triage Tape did not include rescue breaths, the JumpSTART method did. In a large paediatric Delphi study, consensus opinion was that rescue breaths should be included within triage guidance, but only for mechanisms which were likely to result in hypoxia, such as submersion, immersion or smoke inhalation.10 Paediatric patients who remain apnoeic following five rescue breaths are categorised as dead.Automatically categorising paediatric patients aged under 2 years as Priority One originates from a review of the Trauma Audit and Research Network (TARN) database, which demonstrated an increased mortality and need for life-saving intervention in this age group (online supplemental figure 4).11 The nature of the TARN database and its inclusion criteria have been previously described elsewhere and are included within online supplemental figure 5.9 While cases of non-accidental injury will certainly influence these data, it cheap kamagra 100mg was felt that this was a clinically important and pragmatic step.This age group will be at variable developmental milestones (mobility and verbal), thereby making accurate assessment difficult. Furthermore, assessing young children is likely to be emotive, especially for those with limited paediatric experience. These factors are likely to be exaggerated in cheap kamagra 100mg the context of a major incident.

This automatic categorisation as Priority One was felt necessary to reduce cognitive burden of those involved cheap kamagra 100mg in triage at the incident scene. While the introduction of this step may result in a theoretical increase in overtriage, the likelihood of significant numbers of paediatric patients under the age of 2 years being involved in a major incident is deemed to be low and therefore was felt by the T&F group to be a tolerable risk.SummaryThe new NHS MITT will be introduced into UK practice as a unified replacement to the NASMeD Sieve and Triage Sort in the Spring of 2023. It differs from the previous NASMeD Triage Sieve in a number of ways, cheap kamagra 100mg notably by having modified physiological parameters and by being designed for use across the entire age range, including both adults and children. Major incident triage should be rapid, reliable and reproducible, irrespective of the provider performing it cheap kamagra 100mg. The introduction of the MITT into practice fulfils these principles, and provides not only an evidence-based approach to major incident triage, but also a more simplified approach by adopting a single approach across all ages.Ethics statementsPatient consent for publicationNot applicable.Ethics approvalNot applicable.AcknowledgmentsThe authors thank the rest of the Emergency Preparedness, Resilience and Response (EPRR) Task and Finish Group for their efforts in helping to deliver the MITT.

Robert Bentley, Celia Kendrick, Justine Lee, Nabeela Malik, Bimal Mehta, Mark Sewell and Alison cheap kamagra 100mg Walker. The authors also thank Holly Carter and Louise Davidson from the Behavioural Science and Insights Unit at the UK Health Security Agency..

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Since the 1970’s, the age of https://www.cabriotravel.nl/naamloos-herbruikbaar-blok/ puberty buy generic kamagra online has gotten younger. While the changes are gradual, they add up. From 1970 to 2013, the onset of buy generic kamagra online puberty has decreased in age by 0.24 years per decade and, 50 years later, kids as young as 6 years old are starting to develop into adults.

A study published in the journal Child Development found that “stressful family relationships” impacted early maturation in girls. Other research has shown that child abuse may also play a role. Some data buy generic kamagra online has even shown that stress during pregnancy may lead girls to develop at a younger age.

All of this has left researchers wondering what will happen in the future. It’s already a stressful time for kids with the kamagra, school violence and an increasingly polarized society. Will all this stress force our kids to grow buy generic kamagra online up even younger?.

A Combination of Factors It’s a complicated and nuanced situation, says Megan Gunnar, a child psychologist and professor at the University of Minnesota. The research is mixed and it’s important to note that shifts in the onset of puberty are slight. While certain kinds of stress seem to cause the early onset of puberty, buy generic kamagra online there are likely other forces at work.

Obesity and weight gain in younger girls has also been an important driver of development. €œWeight gain has a big impact on when puberty starts,” says Gunnar.Often the causes are gray, not black and white. It’s not buy generic kamagra online one thing.

It’s several factors working together to motivate minuscule changes. That seems to be what’s happening here, says Gunnar. Genetics, race and endocrine-disrupting chemicals found in foods and personal care products can also cause buy generic kamagra online early puberty.

And these things are difficult to study. Researchers would have to control factors like diet to fully understand the true impact of stress on development. €œNature doesn’t give us buy generic kamagra online clean buckets.

When we’re stressed, we eat comfort foods and when we eat comfort foods, it can cause weight gain,” she says. What’s Happening in the Brain?. What causes buy generic kamagra online the change?.

How can a child’s development shift because of stress or obesity?. According to Elizabeth Shirtcliff, a psychology professor at the University of Oregon, several factors are at play. Psychosocial stress impacts the brain’s limbic system, which is responsible buy generic kamagra online for emotions.

The limbic system then communicates with the hypothalamus, and this is where much of the pubertal changes take place because it’s also the site of the gonadotropin-releasing hormone pulse generator (GNRH).During childhood, your brain actively inhibits GNRH from releasing pubertal hormones like estrogen and testosterone, allowing kids to experience childhood without hormones in the mix, says Shirtcliff. €œInhibitory neurotransmitters like GABA shut puberty down until GNRH begins to release pulses of hormones like estrogen and testosterone, allowing the body to begin developing. Stress from things like abuse allow pulses of sex hormones to eek out and when this happens too buy generic kamagra online often, the system goes gangbusters and a child starts developing early,” says Shirtcliff.

Shirtcliff says that many of the stress hormones that are released when children are experiencing psychosocial stress can also mimic sex hormones. This means that once puberty begins, it ends up happening much faster than it would under normal circumstances. €œInstead of it buy generic kamagra online being this slow, long process, it goes much quicker because development in a stress context causes hormones to come on very fast,” says Shirtcliff.

Hormonal changes occur in both boys and girls, but in boys there isn’t a cyclical pattern like in girls (because of menstruation), says Shirtcliff. €œWhen boys go through puberty it comes in fits and starts, and we’re less likely to know when it’s going to happen,” she says.But we do know that stress in both boys and girls is having an impact on pathways in the brain responsible for development. Shirtcliff says that stress causes a “suite of biological changes” that can lead to buy generic kamagra online early puberty.

Leptin, for example, which is related to obesity, is also a “stress reactive hormone.” All of this means that everything is working together to shift development. €œIt’s not just obesity and it’s not just psychosocial stress, these things go hand in hand in impacting early maturation,” says Shirtcliff..

Since the 1970’s, the age of cheap kamagra 100mg puberty has gotten younger. While the changes are gradual, they add up. From 1970 to 2013, the cheap kamagra 100mg onset of puberty has decreased in age by 0.24 years per decade and, 50 years later, kids as young as 6 years old are starting to develop into adults. A study published in the journal Child Development found that “stressful family relationships” impacted early maturation in girls. Other research has shown that child abuse may also play a role.

Some data has even shown that stress during pregnancy cheap kamagra 100mg may lead girls to develop at a younger age. All of this has left researchers wondering what will happen in the future. It’s already a stressful time for kids with the kamagra, school violence and an increasingly polarized society. Will all this cheap kamagra 100mg stress force our kids to grow up even younger?. A Combination of Factors It’s a complicated and nuanced situation, says Megan Gunnar, a child psychologist and professor at the University of Minnesota.

The research is mixed and it’s important to note that shifts in the onset of puberty are slight. While certain kinds of stress seem to cause the cheap kamagra 100mg early onset of puberty, there are likely other forces at work. Obesity and weight gain in younger girls has also been an important driver of development. €œWeight gain has a big impact on when puberty starts,” says Gunnar.Often the causes are gray, not black and white. It’s not cheap kamagra 100mg one thing.

It’s several factors working together to motivate minuscule changes. That seems to be what’s happening here, says Gunnar. Genetics, race and endocrine-disrupting chemicals found cheap kamagra 100mg in foods and personal care products can also cause early puberty. And these things are difficult to study. Researchers would have to control factors like diet to fully understand the true impact of stress on development.

€œNature doesn’t cheap kamagra 100mg give us clean buckets. When we’re stressed, we eat comfort foods and when we eat comfort foods, it can cause weight gain,” she says. What’s Happening in the Brain?. What causes cheap kamagra 100mg the change?. How can a child’s development shift because of stress or obesity?.

According to Elizabeth Shirtcliff, a psychology professor at the University of Oregon, several factors are at play. Psychosocial stress impacts the brain’s cheap kamagra 100mg limbic system, which is responsible for emotions. The limbic system then communicates with the hypothalamus, and this is where much of the pubertal changes take place because it’s also the site of the gonadotropin-releasing hormone pulse generator (GNRH).During childhood, your brain actively inhibits GNRH from releasing pubertal hormones like estrogen and testosterone, allowing kids to experience childhood without hormones in the mix, says Shirtcliff. €œInhibitory neurotransmitters like GABA shut puberty down until GNRH begins to release pulses of hormones like estrogen and testosterone, allowing the body to begin developing. Stress from things like abuse allow pulses of sex hormones to eek out cheap kamagra 100mg and when this happens too often, the system goes gangbusters and a child starts developing early,” says Shirtcliff.

Shirtcliff says that many of the stress hormones that are released when children are experiencing psychosocial stress can also mimic sex hormones. This means that once puberty begins, it ends up happening much faster than it would under normal circumstances. €œInstead of it being this slow, long process, it goes much quicker because development in a stress cheap kamagra 100mg context causes hormones to come on very fast,” says Shirtcliff. Hormonal changes occur in both boys and girls, but in boys there isn’t a cyclical pattern like in girls (because of menstruation), says Shirtcliff. €œWhen boys go through puberty it comes in fits and starts, and we’re less likely to know when it’s going to happen,” she says.But we do know that stress in both boys and girls is having an impact on pathways in the brain responsible for development.

Shirtcliff says cheap kamagra 100mg that stress causes a “suite of biological changes” that can lead to early puberty. Leptin, for example, which is related to obesity, is also a “stress reactive hormone.” All of this means that everything is working together to shift development. €œIt’s not just obesity and it’s not just psychosocial stress, these things go hand in hand in impacting early maturation,” says Shirtcliff..

Kamagra legal in uk

IntroductionThe subject of care kamagra legal in uk is gaining importance within the medical humanities, but go now it also remains elusive. Hence, this paper aims to unpack theoretical notions of care in a way that integrates the elusiveness rather than trying to avoid it. It also responds to a recent article by Julia Kristeva et al, in which they claim kamagra legal in uk that care holds humanity (Kristeva et al. 2018).When in need of theoretical elaboration or re-development, medical humanities scholars have sometimes evoked Greek or Roman myths, such as those of Narcissus, Hephaestus or Leto (Cilione, Marinozzi, and Gazzaniga 2019. Pannese 2011.

Schott 2017) kamagra legal in uk. Similarly, this article evokes the Roman myth of Cura to unpack theoretical understandings of care. In this myth, known from the writings of the first century mythographer Hyginus, humanity is created from clay by a personification of care. It has proven useful to thinkers as diverse as Martin Heidegger, Arthur Kleinman kamagra legal in uk (Kleinman and van der Geest 2009) and Julia Kristeva (Kristeva (2012), Kristeva et al. 2018).

While utilisation by Heidegger 1927, 196–200 ‘challenges the myth of self-sufficiency and individual atomization that that has shaped much of modern Western philosophy’ (Froese 2005, 16), both Kleinman and Kristeva explore the tension between universalised knowledge and the singularity of individual patients and intimate care (Engebretsen, Fraas Henrichsen, and Ødemark 2020).While none of these scholars engage with Hyginus’ Fabulae directly, I use the text as an ‘engine’ in a four-step endeavour. This endeavour follows Brandy Schillace’s kamagra legal in uk description of the medical humanities as ‘a field that at its core considers the human story behind and within medicine, its history, its cultural valence and its influence on practice’ Schillace (2017, 139).First, a ‘human story’ entails agency, the things that humans do in their lives. While the ‘appeal’ from Kristeva et al uses a case from intercultural psychoanalysis, the authors have previously researched a variety of professional healthcare practices (Engebretsen 2016. Engebretsen, Sandset, and kamagra legal in uk Ødemark 2017. Hetrick et al.

2017). However, it is crucial to note that Cura (in Hyginus’ text) will ‘hold’ humanity quamdiu vixerit (for as long as he shall kamagra legal in uk live). Such a life-long temporality does not dovetail with the temporary, regulated and systematised relations of healthcare organisations. Hyginus’ text has, I argue, a much stronger affinity to the temporality of parental care. Hence, I begin the endeavour by acknowledging that I am a scholar, and the father of a boy with little linguistic function.1 Although my parental care for my son entails a multitude of meanings and instances, I begin with two tales from my parental care in 2020:Sometimes, if he does not understand what kamagra legal in uk is going on, or if his actions feel unintelligible to others who are present, I take him in my arms.

In that way, we are at least together in a situation when both of us otherwise would have been on our own. Suddenly, it feels as if I am not only holding or embracing him away from an abyss. I am also holding him—or, perhaps, shielding him—in the face of many, many abysses to come.In rough-and-tumble play, I often lift him up with my arms kamagra legal in uk straight—holding him while he straightens his body, and ‘is an airplane’. Although this play is exhausting, particularly since I live with cerebral palsy, this is nevertheless an activity where we can be close to one another. When I hold him up like this, or suddenly ‘crash’ him safely down kamagra legal in uk next to me on the bed, we are skin to skin, but not exactly like I used to be with his older siblings, and I suddenly have the impression that it also differs from how most fathers do this with their children.

I cannot know if our way is exclusively ours, but while I hold him, that is how it feels.Second, a human story ‘behind and within medicine’—or, for that matter, behind and within any social field—consists of underlying notions and involved cultural categories. Hence, this article aims to unpack theoretical notions of care with reference to the thinkers mentioned above. Throughout, I try to unpack how different aspects of care ‘follow’ each other kamagra legal in uk in an analytical ‘path’ or trajectory, as if in a story (Kristeva et al. 2018).Third, the investigation of the human story of care must become an investigation of ‘history’ and ‘cultural valence’. In order to think historically, the analytical ‘engine’ includes Hyginus’ text, and 18th and 19th century uses of Cura and related motifs.Fourth, I follow Schillace’s advice to examine ‘influence on practice’.

In addition to the practice of parental care, the exploration ends with a discussion of medical humanities as practice kamagra legal in uk. When medical humanities scholars ’consider’ the human story of care, they bring together different perspectives and forms of knowledge. In this case, however both the intertextual analyses and the autotheoretical work indicate that those complexities might overpower our theoretical perspectives. Hence, I conclude with kamagra legal in uk a call for epistemological and analytical modesty.MethodAlthough the abovementioned scholars have used the myth of Cura for clearly theoretical purposes, several of them explore this also as carers in a personal sense. Julia Kristeva writes her work on care as the mother of a man with severe disabilities Kristeva (2013, 219–221), Arthur Kleinman and Geest (2009, 159–163) begin their rethinking with a rich narrative of his caring for his wife who lives with Alzheimer’s disease.

In line with their work, this article combines textual interpretation with autotheoretical work.Often used kamagra legal in uk in connection with genre-bending memoir The Argonauts by Maggie Nelson (2015), the term ‘autotheory’ designates a literary form involving ‘the combination of autobiography and critical theory’ (Pearl 2018, 200). In this article, however, I rely on the work of the Canadian artist, curator, writer and interdisciplinary researcher Fournier (2019), who has unpacked autotheory with particular reference to illness and embodiment. Fournier describes autotheory as a specific form of academic practice:In autotheory as a conceptual and performative feminist practice, artists, writers, and critics use the first person, or related practices of self-imaging (Jones, Self/Image 134), to process, perform, enact, iterate, and wrestle with the hegemonic discourses of ‘theory’ and philosophy, extending the feminist practice of theorizing from one’s subject positioning as a way of engendering insights into questions related to aesthetics, politics, ethics, and social and cultural theory. In autotheory, kamagra legal in uk one’s embodied experiences become the material through which one theorizes, and, in a similar way, theory becomes the discourse through which one’s lived experience is refracted (658).In Fournier’s definition, theory functions as ‘hegemonic discourses’, and as discourses through which one’s lived experience is refracted. Contrary to this emphasis on language—as well as their emphasis on language elsewhere (Heidegger 1927Heidegger 1937.

Kleinman 1995. Kristeva 2019)—neither Kristeva nor Kleinman or kamagra legal in uk Heidegger focus on Hyginus’ text. In contrast to this body of research, this article emphasizes the interpretative potential of the original text. In addition to grammatical analysis, I utilize the well-known concept of intertextuality, as introduced by Kristeva (1980). However, I use it in a less structuralist sense than in her early formulations in Desire in Language kamagra legal in uk.

Instead, I approach Hyginus’ text in line with her approach in ‘Nos Deux’ or a short (hi)story of intertextuality (Kristeva 2002).For me, intertextuality is mostly a way of making history go down in us. We, two kamagra legal in uk texts, two destinies, two psyches. It is a way if introducing history to structuralism and its orphan, lonely texts and readings. […] the etymological meaning of ‘semeion’ is a distinctive mark, a trace, an engraved or written sign, that makes us think of the Freudian ‘psychical’ marks, called drives, rhythmical articulations of embodied impulses and psychical movements. In this sense, the meaning of the socio-historical aspect of intertextuality, as already developed by Bakhtin and Barthes, kamagra legal in uk acquires a new significance.

Within each sociolect or ideology, (both well-established sign-systems) there will always be a breach of subjectivity carrying out a hidden matrix of pre-symbolic forces able to make history move on through all its short and singular stories. (2002. 8-9)First, this means that I study Hyginus’ text not as a ‘lonely text’, but as kamagra legal in uk part of a historical trajectory. The ‘singular stories’ are used to disturb the orderly (structural) notions of both textual and philosophical analysis.Second, I interpret Hyginus’ text—as well as other utilisations of the myth—with focus on traces. Or, more specifically, to find ‘distinctive marks’ relevant to the same material as in authotheretical work.

€˜embodied impulses and kamagra legal in uk psychical movements’. This, however, does not mean that the texts are reduced to a canvas for an engraved sign. In methodological term, the aim is to allow the two destinies—the textual trajectory of the Cura motif, and the personal trajectory that becomes so intimate when I hold my son in my arms—to shed light on kamagra legal in uk one another.Third, the interaction between these two methodological approaches will hopefully allow history—what Schillace calls the ‘human story’—to move in two diachronic ways. I aim to emphasise the differences between the different utilisations of the myth. Finally, I also aim to locate breaches in the ‘well-established sign systems’ we call theories of care, to get a glimpse of something yet hidden.Humanity as creation, care as fundamental conditionIn a narrative sense, Hyginus tells three stories.

A story of the creation of humanity followed by a story of a quarrel between deities kamagra legal in uk and finally, a verdict on the ontological role of care in human life. The first story in Hyginus’ fable begins thus:Cura cum quendam fluvium transiret, vidit cretosum lutum. Sustulit cogitabunda et coepit fingere hominem.When Cura was crossing a certain river, she saw some clayey mud. She took kamagra legal in uk it up thoughtfully and began to fashion a man.Before interpreting this first story, we must first acknowledge that the fable is an alteration or addition in a philological sense. While Fabulae is almost exclusively filled with Greek myths, the Cura fable’s position at the end of the collection suggests, ‘that this particularly Roman tale was simply added to the end of the existing narrative portion’ (Smith and Trzaskoma 2007, xlix).

Moreover, philological research consistently argues that fable CCXX ‘hinges on Latin wordplay’ (Smith and Trzaskoma 2007, xlviii).More specifically, Hyginus, in the Cura fable, alters a prevailing myth in late antiquity, one that he has even told earlier in the pages of Fabulae. That of how the titan Prometheus fashioned man kamagra legal in uk from clay. In fable CXLII (‘Pandora’), Hyginus states explicitly that Prometheus lapeti filius primus homines ex luto finxit (Prometheus, son of Iapetus, first fashioned men from clay).Most Greek and Roman sources place the Prometheus plasticator motif within a three-stage narrative. First, Prometheus shapes the human from clay, and kamagra legal in uk then Athena gives the creature inner life. Finally, sometimes after Prometheus has given humankind fire against the orders of Jove, Jove intervenes and sentences Prometheus to eternal punishment in the Caucasus.To understand the human story—to which both this motif and Hyginus’ text belong—comparison is needed.

First, we must note that the neutral or slightly idyllic depictions in Hyginus and Ovid (respectively) differ from earlier and less optimistic renderings in Republican times. The poet kamagra legal in uk Propertius, for instance, in his Libri Elegiarum from the first-century BC, laments and elaborates on how Prometheus was careless in his creating. Here, the adverbial clause ille parum caute casts Prometheus as a figure of titanic heedlessness:ille parum caute pectoris egit opus.corpora disponens mentem non vidit in arto:The making of man’s reason he performed with too little care.Arranging our bodies, he overlooked the mind in his handiwork (Goold 1990, 232).Carelessness, the counterpart to the notion of care, is involved in the Prometheus plasticator motif throughout antiquity. The adverbial clause ille parum caute does not derive from the same verb as Cura, but rather from the verb caveo (to take precautions, to be aware of something). Nevertheless, Prometheus’ lack of kamagra legal in uk care underlines how Hyginus’ text is an inversion these earlier texts.

Instead of being created in a careless way, humanity is created by care.To be fair, a singular text never exhausts the potential of the history to which it belongs. Specific understandings—in this case. Theoretical notions of care—are only a part of a kamagra legal in uk wide array of potentials. The Prometheus Plasticator motif foreshadows 20th and 21st century theories of care, and 18th and 19th century depictions of Prometheus as a figure of romantic transgression. In Goethe’s poem Promethevs (written 1774, published 1789), Prometheus becomes a figure of independence and defiance—as expressed, for instance, in the final stanza:Hier sitz' kamagra legal in uk ich, forme Menschen / Nach meinem Bilde, / Ein Geschlecht, das mir gleich sei, / Zu leiden, zu weinen, / Zu genießen und zu freuen sich, / Und dein nicht zu achten, / Wie ich!.

(Goethe 1998, 44–46)Here sit I, forming mortals /In my image. / A race resembling me, / To suffer, to weep, / To enjoy, to be glad, / And thee to scorn, /As I!. (Bowring 2015, kamagra legal in uk 182)Typical of Goethe’s Sturm und Drang period, his Prometheus Plasticator is a figure of creativity, and embodies ‘ideals of freedom and rebellion’ (Raggio 1958, 44). Goethe’s poem emphasised the ‘autonomous existence’ of mankind (Dougherty 2006, 95), thereby constituting an ‘emancipatory gesture’ (Edgar 2002, 161). Hyginus’ text inverts both classical and romantic evokings of the myth by inserting dependency rather than autonomy and expansion.

To shed further light on this inversion, we must first unpack the name of the personification that Hyginus instals in the Prometheus kamagra legal in uk Plasticator motif. Cura.The name Cura is derived from the verb curo. The Oxford Latin Dictionary defines the verb thus:To watch over, look after, care for.To tend to, to do what is necessary to.To administer remedies, to treat (a sick person, wound, disease, etc).To have charge of. (absol.) to be in command.To devote oneself to, to cultivate (a person).To undertake, to see to (a task or a responsibility).To regard with anxiety or kamagra legal in uk interest, worry or care about, heed.As we can see, the first three senses of this verb invert the Prometheus motif we found in Propertius. To instal the personification of curo in the motif is to instal carefulness, attentiveness and responsibility in a motif usually filled with lack of care.

The third sense also injects kamagra legal in uk an aspect that is totally absent in classical anthropogenies. That of human frailty. It also relates to aspects of human lives that are particularly relevant to understanding care, illness, disease and disability.The fifth and sixth senses of the word similarly invert the romantic depictions of Prometheus motif. The anthropogenic act is no longer about rebellion and expansion, but devotion and responsibility kamagra legal in uk. The seventh sense finally reverses the political impulse of the Sturm und Drang—the desire for increased individual freedom and self-expansion in every imaginable way—into worrying and heeding.In addition to these intertextual relations, it is also fruitful to note the verbs that connect humanity to the three deities.

While Cura’s creating is described with the verb fingo (in Hyginus. €˜fingere’), Jove’s and Tellus’ acts of giving are described by kamagra legal in uk do (in Hyginus. €˜dedisti’). While the former verb is a very tactile verb, a matter of touch and contact, do signifies separation—to deliver or give something, to separate it from something in order to unite it with something else. An initial understanding of care emerges kamagra legal in uk from these textual relations.

Care is fundamental (by belonging to the anthropogony), antithetical (by being the antithesis of carelessness and neglect) and intimate (by establishing relation through touch).Care imaginationsWhen modern scholars use Hyginus’ text, one word of the first sentence is often overlooked. Cogitabunda (thoughtful) kamagra legal in uk. Although an adjective in the purely grammatical sense, this is the only word with an adverbial function in Hyginus’ text. Hence, it is the lone term specifying how actions and interactions take place. While Greco-Roman deities often act from rage (as in the conflict between the titans and Olympian deities) or desire (as in the story of Zeus and Leda), Cura acts thoughtfully or with thought.As we kamagra legal in uk can see, the adverb cogitabunda is attached to the picking up of the clay, not primarily to the act of creation.

Sustulit cogitabunda et coepit fingere hominem. Moreover, the temporal clause ‘and begun to’ (et coepit) also locates this thought as prior to the creation of humanity. To understand care as thoughtful, then, is about understanding kamagra legal in uk thoughts and imaginaries ‘involved’ in care, and it includes thoughts and imaginaries that ‘pre-exist’, ‘frame’ or ‘underpin’ care and care work.It is useful to explore how the meaning of cogitabunda is preserved and unveiled in the work of the German philosopher, poet and literary critic Johann Gottfried Herder (1744–1803). In his poem ‘Das Kind der Sorge’ (1787), Herder follows Hyginus very closely (Bernays 1869, 158-163). This poem was widely read, and it provided the basis for Goethe’s use of the Cura motif in Faust II (1832).

Finally, Heidegger also comments on the poem and cites it in extenso when he develops his notion of Sorge as the fundamental human condition (Dye 2009, 207–218)., Kristeva (2001), kamagra legal in uk too, refers several times to Herder, and even refers directly to this poem (25–26). The first stanza describes the moment of creation thus:Einst saß am murmelnden StromeDie Sorge nieder und sann:Da bildet im Traum der GedankenIhr Finger ein leimernes Bild (von Herder 1889, 75).Once by a murmuring riverSorrow sat down, and there,In a vision, thought to form with the touchA wavering figure (Groth 2016, 31).von Herder positions the moment of creation as a radically imaginative act in at least three ways. First, the gaze is far more manifest in von Herder’s text than in Hyginus’. While Hyginus’ Cura shapes a human (hominen) directly, von Herder’s ‘Sorge’ shapes kamagra legal in uk an image (Bild). This dovetails well with important insights from care research.

In relations of care, kamagra legal in uk the cared-for becomes visible to the carer(s), thereby also becoming a valued imago. Conversely, the carer(s) become visible in the imagination of the cared-for—even in a Western culture that often obscures or silences interpersonal interdependence.Second, cogitabunda in Hyginus is also intertextually connected von Herder’s adverbial clause im Traum der Gedanken. This phrase, roughly translatable as ‘in the dream of thoughts’, roots humanity in a singular image (or dream) that consist of or belong to several different thoughts or ways of thinking. This tension between individuality and multitude dovetails with research on the knowledge complexities involved in care.Third, the word ‘Traum’ (dream) in kamagra legal in uk Traum der Gedanken does not denote unreality, fantasy or illusion. For von Herder, dreams are not the opposite of reality, but thoughts beyond or above manifest reality (Wirklichkeit überhöhenden Gedankens).

A dream of thoughts, then, is an experience or interpretation wherein the understanding of a phenomenon moves beyond how the phenomenon presently is, to what it should or could be. Just as kamagra legal in uk Hyginus’ cogitabunda can, if we interpret in intertextual connection with von Herder’s Traum der Gedanken, also refract my experiences of holding my son in my arms. This is true of the experiences of performing actions that seem strange or unintelligible to those around us, but particularly true of the feeling of doing this in a way that is uniquely ours. The combination of these feelings—where the socially estranged ways of caring is fundamentally ours and integral to my parenting—engenders or entails a striving ‘upwards’. This striving is not limited to the idealisation that so often takes place in parenting, but is also a utopian, imaginative glimpse of a world wherein the both of us truly belong.In other words, the Cura motif foreshadows the ‘horizontal’ complexities kamagra legal in uk involved in care (multiple cultural imaginaries, multiple forms of knowledge).

It also foreshadows ‘vertical’ complexities, through which care imaginations include both underlying categories and überhöhende dimensions. These overarching or utopical dimensions, that both stem from and go beyond the localised, singular imaginations of care, is known by many names in kamagra legal in uk and beyond the medical humanities. Examples include ’underlying values’, ‘ethical content of particular practices’, ‘transformative learning’ and many others (Ayala 2019, 269. Pettersen 2008, 188. Winthrop 2003).Cogitabunda, can mean to be thoughtful and to kamagra legal in uk be ‘full of thoughts’.

The adverbial clause im Traum der Gedanken by von Herder (1888, 533), similarly, also signifies something unclear or disorganised. In his poetotological treatise Über Bild, Dictung und Fabel (1888, 533), von Herder juxtaposes this state with being in Leidenschaft (in passion), in Verrückung (in madness) or nicht auf seiner Hut (off guard). There is complexity and kamagra legal in uk openness—perhaps even fantasy or at least exploration—in this. When I hold my son in my arms connecting different realms of thought. As in ruff-and-tumble-play, these realms are also at play as I think.The quarrel of the deities.

Culture, nature and careAfter the kamagra legal in uk first narrative, the second deals with a quarrel between the deities Cura, Jove and Tellus. Once humanity has been given inner life, the focus in Hyginus’ texts shifts from creating to name-giving:Cum vellet Cura nomen suum imponere, Iovis prohibuit suumque nomen ei dandum esse dixit. Dum de nomine kamagra legal in uk Cura et lovis disceptarent, surrexit et Tellus suumque nomen ei imponi debere dicebat, quandoquidem corpus suum praebuisset.When Cura wanted to give it her name, Jove forbade, and said that his name should be given it. But while they were disputing about the name, Tellus arose and said that it should have her name, since she had given her own body.To name something after something else (and, perhaps particularly, after someone else) places the object within a certain taxonomy. Major deities such as Jove and Tellus are both rulers and personifications of different ontological realms or ‘elements’.

Hyginus’ Cura is not known from other Roman kamagra legal in uk sources. Instead, Cura is a ‘deification of abstract ideas’, a common feature of Roman culture (Axtell 1907). Hence, it becomes clear that the quarrel deals with ontological ideas, more specifically with the ontology of humanity. Each deity proposes a ‘location’ kamagra legal in uk in classical ontology.The philosopher John T. Hamilton has used the myth of Cura to explore how any understanding of security presupposes both care and carefulness.

He underlines how this ‘locating’ somehow names humanity after something that is neither identical nor particularly resembling humanity:The controversy over the creature’s name strives to resolve the issue of the figure’s proper being, without the aid of physical resemblance, without the talent for self-reflection. In my view, the debate kamagra legal in uk over the name revolves on whether humanity is essentially atemporal (Telluric matter or Iovian spirit) or instead fundamentally temporal and constituted by time and history (Hamilton 2013, 71).It is worth noting that the deities are not offering or suggesting certain framings of human life. Hyginus’ text—in particular, the fact that Jove forbade any name other than his own—indicates conflicts between perspectives and disciplines. The imaginative richness involved in care, indicated by Hyginus cogitabunda or by the plural in kamagra legal in uk von Herder’s Traum der Gedanken, is a plurality where incommensurabilities remain. In my view, the myth of Cura points towards three possible but incommensurable ways of studying, describing and interpreting care (corresponding to Jove, Tellus and Cura, respectively):As a cultural or semantic phenomenon, elucidated in terms of meaning or more or less idealised notions.As a biological phenomenon, elucidated in medical, psychological or other health-related terms.As a relational phenomenon, elucidated in terms of care work (professional or not).Although it is necessary to understand care in all these ways, it is nevertheless impossible to fully merge them or produce those understandings simultaneously.

Hence, it is necessary to add a more epistemologically oriented aspect of care. Care is fundamentally imaginative and kamagra legal in uk context-dependent, and stands in-between otherwise incommensurable interpretative domains.Saturn’s verdict. The continuous presence of careIn the third narrative in Hyginus, the quarrel is somehow resolved when the deities choose Saturn as their judge. Sadly, this part of the text is fragmented. There is kamagra legal in uk agreement, however, that Saturn’s verdict clarifies that Jove will receive human souls, while Tellus will receive the body post mortem:Tu Iovis quoniam spiritum dedisti, <…>.

Corpus recipito. Cura quoniam prima eum finxit, quamdiu vixerit, cura eum possideat. Sed quoniam de nomine eius controversia est, homo vocetur quoniam kamagra legal in uk ex humo videtur esse factusJove, since you gave him spirit, let [Tellus] receive his body. Since Cura fashioned him from the start, let Cura possess him for as long as he lives. But since there is controversy about his name, let him be called homo, since he seems to be made from humus.Let us begin by pointing out kamagra legal in uk that Saturn’s verdict exposes yet another way in which Hyginus’ text alters the Prometheus plasticator motif.

In most classical renderings, Prometheus is a trickster, and a transgressor from whom humanity is eventually separated. After discovering his transgressions, the Olympian deities chain Prometheus to a mountain in the Caucasus, and humanity lives on without him. The relation between humanity and kamagra legal in uk its creator is therefore temporary. Hyginus, in contrast, makes it clear that humanity will remain under the guardianship of Cura quamdiu vixerit ‘for as long as he shall live’.The significance of this difference becomes clearer if we compare Hyginus’ text to Ovid’s use of the Prometheus plasticator motif in Metamorphoses. After describing the original moment when cheap kamagra pills Prometheus created Humanity, Ovid goes on to describe the human condition:quam satus Iapeto mixtam pluvialibus undis / finxit in effigiem moderantum cuncta deorum, / pronaque cum spectent animalia cetera terram, / os homini sublime dedit caelumque videre(Ovid 1997, 47)so that his new creation, upright man, / was made in image of commanding gods?.

/ On earth the brute creation bends its gaze, / but man was given kamagra legal in uk a lofty countenance / and was commanded to behold the skies. / and with an upright face may view the stars (Melville and Kenney 2009, 76).As we can see, Ovid’s Prometheus creates a strong and vital human being. Humanity seems not dependent on care or assistance, but ‘made in image of commanding gods’. In Ovid, human life is essentially an independent life which resembles kamagra legal in uk the lives of gods (in effigiem moderantum cuncta deorum). It is common—and tempting—to imagine care relations as exceptions in human lives.

In care research, for instance, one often reserves care needs for vulnerable groups, thereby contrasting them with some kind kamagra legal in uk of original, non-vulnerable state. In life-course research, similarly, care leaves life as people move into adolescence and adulthood, only to re-enter it in the special cases of disability, serious illness or old age. Hyginus’ text, in contrast, opens up for a rethinking of care as a fundamental, continuous part of human lives.This is essentially an ontological argument. Although we often reserve the term for human beings who have unusual needs—for instance, children or people with disabilities—care is, in fact, much more kamagra legal in uk pervasive.Noting the etymology of the verb curo—denoting what we call caring and worrying—Hyginus’ text also points towards an understanding of care as protection. The notion of care becomes meaningful in and of itself, and in relation to its counterparts, such as conflict, violence and neglect.

If the so-called ‘normal’ human life—in Ovid’s words. Lives lived kamagra legal in uk ‘in the image of commanding gods’—is met by a radical lack of care, it would have little freedom and in fact be over in a matter of days.Hyginus’ text points towards an understanding wherein care reigns, organises or facilitates human lives. Cura somehow ‘holds’ humanity in this life, indicating that Jove’s and Tellus’ receiving somehow lies outside that life (after death). For the medical humanities, this understanding of care suggests ways to think about both medical and cultural knowledge as forms of afterlife. Biological knowledge, for instance, kamagra legal in uk is a form of knowledge that has been aggregated outside and beyond individual lives.

Through clinical generalisations, anatomical knowledge, systematic literature reviews and more. Cultural knowledge, conversely, is deeply historical and contextual—thereby kamagra legal in uk inevitably also a testament to how both historical and contextual relations stretch far beyond individual lives.These ambiguities lead to a further understanding of care. Care is not only a fundamental precondition—whose impact depends on context and interpretation—care is indeed a fundamental and omnipresent condition, that continuously engenders and relies on interpretative processes.Care as holding-togetherWhen I hold my son I ruff-and-tumble play, I am also holding together forms of knowledge. I connect many different forms of knowledge—my intimate experiences with him, my research experience from disability studies, the bits of knowledge I have received from medical and educational professionals and many others—with one another. Moreover, the knowledge I produce—from the actual holding, from being skin to skin kamagra legal in uk and from sensing if he cannot understand others—is used in knowledge translation.

I use it to stretch the understandings of medical professionals beyond uncertain prognoses. I also use it to connect the knowledge of the preschool teachers—a knowledge which mainly deals with so-called ordinary children—with the lives of extraordinary children such as my son.In Hyginus’ text, too, Cura holds together what otherwise would have been separate. Had it not been for Cura’s holding, and kamagra legal in uk Saturn’s verdict, humanity would have belonged to either Jove or Tellus. A recent ‘appeal to the medical humanities’ uses the potential of this narrative. In it, Kristeva et al.

(2018) use the myth of Cura to explore how humanity ‘belongs to different ontological domains’ held together by care:Saturn, the God of time, settles the matter through an act of naming and by dividing and temporalising the possession of kamagra legal in uk the various parts that comprise man. Jove is offered man’s soul and Tellus his body, after man’s death, while Cura will possess the creation in its lifetime since she made it. […] Thus, human life as a composite assembly of spiritual (Jove) and material elements (Tellus) is held together by Cura’s temporal care (55).In their unpacking, kamagra legal in uk Cura’s holding of humanity becomes a holding-together of two forms of knowledge. Biomedical knowledge of bios and sociocultural knowledge of zoe. Faced with situations of care—situations that neither biomedical science nor cultural studies of health can understand sufficiently—the understanding of care becomes a point of intersection between otherwise separate landscapes.This holding-together is visible in a variety of care practices.

In the kamagra legal in uk case of evidence-based care, for instance, temporal doing at a certain point in time and history (professional work) holds together atemporal knowledge of effects (evidence) and atemporal norms (professional ethics). The temporal care work may seem like a mere ‘application’ of these atemporal knowledges. However, recent studies argue that both evidence and norms exist as such if and only if they are interwoven with embodied practices. While ‘evidence in clinical decision making is relentlessly situated and kamagra legal in uk contextual’ (Wieringa et al. 2017, 964), so can the normative aspects only be sufficiently understood as ‘embodied process’, located at ‘the action level’ (Doane and Varcoe 2008).Jove, Tellus and Cura personify ontological orders (ways of being), and epistemological orders (ways of knowing).

If we then revisit the epistemological aspect of care, a further understanding emerges. Care is a relational matter—in the lived lives of care receivers, as well as in the work of care professionals—and it is crucial in holding together different social agents and different knowledge domains.Care as withholdingWhen I ‘play airplane’ with my son—or hold him close to me in situations where others do not understand him or vice versa—one might say kamagra legal in uk that I know what I am doing. On the other hand, this holding challenges several parts of my knowledge of this world. It challenges my images of what it is to be a father, since the play differs from how kamagra legal in uk most fathers do this with their children. More importantly, perhaps, the knowledge produced when I hold my son in my arms in the face of many, many abysses to come differs from much of my academic and medical knowledge, including that which is inherent in his diagnoses and prognoses.This withholding might seem, contrary to the straightforward clarity of Hyginus’ text.

However, a more detailed examination can refract these interpretations. It is particularly worth noting that the relation between Cura and the human being—that is, the fundamental ontological condition in this kamagra legal in uk life—is described with a specific verbal clause with the verb possideo. Cura eum possideat (Cura shall hold him).The Oxford Latin Dictionary defines possideo thusly:To have (land) in one’s control, occupy (as a tenant, etc). (absol.) to hold land.(in general) to hold as property, b. To take (property) into one’s keeping, appropriate.(of a sovereign, army, etc) to have control of (a country, position, etc) […] to assume or exercise control over (persons).To take or have in its power, dominate, overwhelm, possess.To kamagra legal in uk fill or take up (a space) with one’s bulk.To take up wholly (a person’s time).

To absorb the thoughts and energies of someone.Possideo denotes not a general sense of holding, or a more general sense of contact or connection, but an exclusive holding—similar to the English verb to possess. Cura, then, is not only holding a humanity that belongs to both Jove and Tellus, but she is also withholding this humanity from them. This becomes even clearer if we emphasise kamagra legal in uk that possideo is a transitive verb. At least to some extent, the clauses quamdiu vixerit, Cura eum possideat entail a micro-narrative. Although ‘created from,’ or consisting of biological matter, and being kamagra legal in uk characterised by the presence of ‘soul’ or some measure of cognition, humanity is fundamentally ‘controlled’ by care in this life.

The separating into meaning (spirit) and biology (bodily remains) takes place outside this life. Cura’s holding, then, allows us to understand the holding-together of medicine and culture, and a withholding from both these domains.The ‘hermeneutic story’ (Kristeva 2002, 10) of Hyginus’ possideat—wherein care holds humanity at the expense of both culture and biomedicine—contradicts epistemological optimism. Hyginus text kamagra legal in uk allows us to glimpse intimate care knowledge that connects cultural and biomedical knowledge, and that holds human life away from generalised knowledge. When Cura withholds humanity from generalised cultural knowledge (Jove) and generalised biochemical knowledge (Tellus) and care produces knowing—often described as insight, sharing and holding-together—and un-knowing.These difficulties indicate the need for an additional understanding of care. Care must be understood as a practice that holds together multiple parties and multiple forms of knowledge.

However, it must also be understood as a practice—or kamagra legal in uk if you will. A form of human relation—that withholds something from knowledge.I shall hold him for as long as I shall liveThe ‘human story’ of care relations (eum possideat) will necessarily entail a human story of singular actions that to some extent can only be described in first-person singular. Eum possideam (I shall hold him). To explore this individual eum possideam, I kamagra legal in uk try to ‘theorise from my subject position’ (Fournier 2019, 658). When activating my own intimate experiences, it became clear that interpretations of my eum possideam quamdiu vixerit can refract—or even fracture—theoretical notions of care.To connect intimate experiences of holding—be it in bodily care, in adverse social situations or in rough-and-tumble play—with cultural and political theory is clearly a daunting task.

Although this still seems unclear to me, I can at least outline four aspects of the refraction. First, I do hold together cultural and biomedical kamagra legal in uk knowledge. When my son is in my arms, multiple cultural imaginaries are involved. My understanding of kamagra legal in uk his life (and of mine) is dependent on my language and my cultural frames, and I am consistently aware of a clinical gaze. My son’s life—and, thereby, also my own life and my care work—are viewed or observed by medical professionals, psychologists, special needs educators and preschool teachers.Second, the holding is troublesome.

In a narrower sense, I note that his needs lead me to hold and even carry him in ways that most parents only do with substantially younger children. Combined with my own embodied condition, there emerges a bodily kamagra legal in uk trouble, an element of exhaustion, uncertain walking and muscular pain. Regarding my cultural knowledge, it becomes clear that my own imaginaries entail expectations and understandings that somehow seem incompatible with his life. In this social context—parenting in Norway, located in middle-class families—childhood is simultaneously about ‘findings one’s own voice’ (autonomy) and about ‘following the path’ (social reproduction). To claim that autonomy outside language is possible, or that a person in his situation may reproduce his kamagra legal in uk parents, seems equally futile.Regarding biomedical knowledge, I take care of my 4-year-old (as I do all three of my children) within a biomedical framework.

Most Norwegian children are screened regularly for somatic problems, and to measure linguistic, cognitive and psychosocial development. While this knowledge has thus far granted me a certain comfort in parenting my two oldest children—confirming, as it were, that all is well—that has, obviously, not been the case with my youngest son. Hence, his life is also framed kamagra legal in uk by medical knowledge in a more direct way. He receives a range of health-related services, a provision that also positions my parental care within the same frame.Third, there is an uncertain future involved in this. This is of course always true of any intersubjective kamagra legal in uk relation in general and of care relations in particular.

The future is open, and it can entail painful events. However, his situation exposes uncertainty in a more radical way. Culturally, it exposes how I see my other children—as having quite stable chances for social reproduction—partly thanks to kamagra legal in uk how I see him. Through a fatherly lens of rather unclear hopes and worries. Medically, the tests of my youngest son continuously yield inconclusive results.

This has kamagra legal in uk replaced my former sense of parental comfort with gnawing anxiety over his future. Moreover, the complexities of his living leaves me, as a caregiver, with the unpredictability of his diagnostic results, rather than with stable prognoses.Fourth, these intimate situations entail a particular life-course temporality, which differs from the temporality of professional care, as well from the temporality in Hyginus’ text. In the case of professional careers, their work is regulated to certain hours (of paid work), and to certain phases of life. Most professional carers will retire, and many will pursue other forms of work at some point in time kamagra legal in uk. In Cura’s case, her care work is also time limited.

The temporality of the deity’s kamagra legal in uk existence is sufficient to encompass the temporality of humanity. In both cases, the life course temporality of the carer is sufficient for the imagined care work.In my parental care work, however, the temporality is insufficient rather than sufficient. In all likelihood, I will somehow care for my son for as long as I am alive. Moreover, this lifelong work will likely be insufficient in at least kamagra legal in uk two ways related to the temporality of my life. My own ageing will likely reduce my ability to perform the care work, and I will likely die before my son, leaving him without parental care.

Hence, the temporality of my care cannot be formulated as eum possideam quamdiu vixerit (I shall hold him for as long as he shall live), but as eum possideam quamdiu vixero (I shall hold him for as long as I shall live).This rudimentary autotheoretical investigation brings to light three forms of withholding. First, the nature of the holding (eum possideam) withholds care from the epistemological domains that the kamagra legal in uk medical humanities traditionally investigate. Second, the temporality involved in parental care (quamdiu vixero) withholds something from the temporality of professional care. Third, something is also withheld from the ‘parental temporality.’. The need care depends on his life (quamidiu vixerit), not on kamagra legal in uk mine.

Several forms of knowledge, and several forms of embodied holding, are involved without being fully commensurable. Since I cannot resolve these enigmatic forms of withholding, the theoretical understandings remain breached, implicitly pointing towards not-yet-explicable or kamagra legal in uk not-yet-nameable understandings.Withholding and ambiguityMy holding of my son in my arms come with several temptations. One of them—in particular, as I am holding him, or, perhaps, shielding him—is to think that I hold some kind of vast, privileged knowledge. While this is of course true to some extent, there are more powerful movements at play. On the one hand, the complexities in the situation forces me out of the internal comfort that characterises the centre of any ontological or epistemological ‘domain’ kamagra legal in uk.

On the other hand, I am also forced to admit another thing. That I can hold him, but it remains unclear—to some extent—if I can know him. I cannot know kamagra legal in uk if our way is exclusively ours.Similarly, intertextual analysis locates breaches in specific ‘sign-systems’, and in larger ‘social and historical material’ (Kristeva 2002, 9–10). Hence, the specific inquiries presented in this article relate to more general ways of inquiry. When we use those notions, we connect different academic investigations, and different academic disciplines, theoretical traditions and research methodologies.

In Julia Kristeva’s kamagra legal in uk words, these relations are ‘temporal connections’ and ‘points of contact‘ (2002:8) and points of ‘distortion, ambiguity and contradiction’ (2002:11).The understanding of care as holding-together connects very well with the rise in interdisciplinarity within the medical humanities. The three deities Jove, Tellus and Cura are brought together in dispute, and Saturn’s verdict foreshadows how different ontological domains are held together in human life.Studying an interaction between form of knowledge—in their case. The interaction between medical imagining and patient creativity—Stahl and Stahl use the insufficiencies of medical knowledge in an argument kamagra legal in uk for multiple perspectives:Although in contemporary Western society, many tend to believe the hard science provide the truest or most accurate interpretation of the natural world, it cannot exhaust the meaning of the body. If we believe we are more than the sum of our parts, then we ought to allow for multiple and even varied interpretations of our bodies (Stahl and Stahl 2016, 159).Interpreting care as connectedness and holding-together, medical humanities scholars aim to hold together medical and cultural knowledge in new, explorative and enriching ways, and they often succeed.Such interpretations also speak to an even more radical ambition, that of academic convergence, sometimes referred to as transdisciplinary research. Such appeals are often embedded in a considerable epistemological ambition.

Pointing out the insufficiencies of ‘illustrative’ or ‘additive’ work in the medical humanities, Kristeva et al kamagra legal in uk. (2018) express a particularly radical version of this ambition:[W]e do not consider the humanities as a critical and potentially liberating perspective that can be applied to medicine as an object in need of repairment. Medical humanities should not be construed as a humanistic perspective on medicine. They should rather be seen as a cross-disciplinary and cross-cultural space for a bidirectional critical interrogation of both biomedicine (simplistic reductions of life to biology) and the humanities kamagra legal in uk (simplistic reductions of suffering and health injustice to cultural relativism). On the one hand, this implies breaking with the culture–nature dichotomy and considering both the humanities and medicine as biocultural practices.

On the other hand, it also implies understanding that boundary work requires boundaries, and that incommensurability between various partial disciplinary perspectives can—and will—emerge (56).The ambition at stake here listens to the holding-together outlined above. Whereas more ‘additive’ ways of connecting knowledge are valuable—for instance, when humanities-based research kamagra legal in uk ‘fill the gaps’ of ‘pure’ medical research in order to facilitate evidence-based care—this is not what Hyginus’ text indicates. Just as the relation between Jove and Tellus is symmetric and mutual (they are equally necessary for the creation of humanity and will ‘hold’ remain with equal sovereignty after this life), so is the relation between Cura and the two other deities. Jove and Tellus are separated from humanity in this life, and Cura kamagra legal in uk is equally separated from humanity after this life. This fable cannot be intertextually connected with asymmetrical or additive relations between knowledge fields, but it is connected with a ‘space for bidirectional critical interrogation’.It is perhaps less clear how care as un-knowing speaks to larger trends in the medical humanities.

It is therefore necessary to ask. How can understandings of care that emphasise withholding and un-knowing, including autotheoretical investigations that increase kamagra legal in uk uncertainty, ambiguity and painful affects, inform knowledge production?. To outline a provisional response to this question, it is useful to return to Hyginus’ text once again. The description of Cura’s relation to humanity—Cura quoniam prima eum finxit, quamdiu vixerit, cura eum possideat (Since Cura fashioned him from the start, let Cura hold him for as long as he shall live)—should also be read with attention to grammar. While the conjunction kamagra legal in uk quoniam (since) introduces a causal clause in the indicative mood (finxit), followed by an adverbial clause in the indicative (vixerit), the resulting clause is in the subjunctive (possideat).

Interestingly, this subjunctive inflection is the only use of the subjunctive mood in Hyginus’ text.This use of the subjunctive mood—sometimes called ‘independent’ usage—can have a variety of purposes. Although the usage in fable CCXX is iussive—in the sense that makes a permanent judgement—it is worth noting that the subjunctive mood is often associated with potentiality in classical Latin. Other common areas of usage include ‘questions in which the speaker kamagra legal in uk or writer expresses doubt or disbelief by “thinking aloud” (deliberative), wishes that cannot or may not be fulfilled (optative), and the potentiality that something may happen or might have happened (potential)’ (Palma 2012, 377). Moreover, it is worth noting that possideat is in present tense. Since the subjunctive mood lacks a kamagra legal in uk future tense in Latin, the active present tense can also denote future actions.

Hyginus’ text, then, points towards knowing and un-knowing, and towards openness to potentiality and some degree of uncertainty.When held together, withholding and uncertainty give a clear implication for the medical humanities as a form of academic practice. The epistemological ambitiousness in medical humanities should be supplemented with what one might call epistemological modesty. Such modesty is rooted in the specifics of care, and in kamagra legal in uk the relation between complexity and synthesis. What is at stake in care research—if we take the abovementioned complexities into account—is a ‘bidirectional space’, and an ever-expanding and exponentially multidimensional space. When medical humanities emerged, it was only a question of time before the field began to involve other humanities and social sciences disciplines than those involved in the initial phase.

Similarly, the growth of critical medical humanities steadily increases the engagements with all kinds of critical kamagra legal in uk research frontiers, in the social sciences as well as in the humanities. At least in an area such as studies of care—where the intimacy is so acutely palpable—it will become increasingly clear that the medical humanities will remain ‘outnumbered’ or ‘overpowered’ by the analytical complexities the field itself brings forth.Some scholars in the critical humanities have argued that scholars should ‘embrace’ this kind of overpowering (Viney, Callard, and Woods 2015, 2–7). However, Hyginus’ text complicates the relation between care practices (Cura), culture (Jove) and biomedicine (Tellus) regardless of such embraces. Although care holds humanity at the expense of kamagra legal in uk the other forms of knowing, his holding neither implies any disregard for humanities-based nor medical knowledge. Rather, the unpacking presented in this article demonstrates how care brings forth an epistemological modesty.

Only an epistemologically modest way of kamagra legal in uk doing medical humanities can address the intimate and enigmatic qualities of care.Discussion. Scholarly and analytical contributionWhile the textual and autotheoretical analyses presented in this paper followed the suggestion from Kristeva et al—to we question ‘the cultural distinction between the objectivity of (medical) science and the subjectivity of culture’ (2018:55)—it nevertheless ended in an emphasis on intimate withholding. This withholding—be it epistemological, theoretical or inherent in the intimate experience of holding or embracing my son away from an abyss—is relevant to the medical humanities in general. However, it is also a contribution to four more specific tendencies in the available literature.First, the unpacking contributes to feminist care kamagra legal in uk research. Beginning with the canonical work on ‘a different voice’ by Gilligan (1982), feminist care research has increasingly emphasised the knowledge multitude involved in care.

More recent research also shows a multitude of empirical delineations. While some scholars reserve kamagra legal in uk the term for face-to-face interaction, or for situations characterised by asymmetrical dependency, others do not. The investigation in this article brings forth additional multitude by combining academic disciplines that rarely interact—care research, linguistic analysis of Latin texts, romanticism studies and autotheoretical analysis work—and implies many possibilities for further research.Second, the autotheoretical interpretations can contribute to the research field sometimes known as ethics of care. Following such works as the book Learning from my Daughter by Kittay Kittay (2019, xx), where she proposes that the relation of parental care provides ‘the only universal and morally significant property that all humans possess’, I aim to shed light on how care work engenders ethical thinking. My holding of my son in my arms—as well as the withholding that both this holding and Hyginus’ kamagra legal in uk text entail—is as political and ethical as it is personal and embodied.Third, this paper also relates to a more critical strain of ethics of care.

Pettersen (2008) work, for instance, demonstrates how the ethics of care ’subverts the public/private dimension altogether’, thereby allowing for a broader range of criticism (45). Moreover, Fletcher and Piemonte (2017) shed light on kamagra legal in uk how healthcare practices constitute a ’quiet subversion’ of neoliberal cultural structures. Arguably, both intimate withholding and epistemological overwhelming shows the power involved in such subversions.Fourth, I hope to contribute to the strand of research—in care research as well as in disability studies—that relate to the work of Julia Kristeva. On the one hand, the rethinking presented in this paper dovetails with her perspectives on how intimate aspects of care destabilise the larger frameworks, cultural structures that are nevertheless sustained by those actions of care. The autotheoretical exploration towards the emblematic formulation eum possideam quamdiu vixero (I shall hold him for as long as I shall live) might also respond fruitfully to Kristeva’s account of how her “living with kamagra legal in uk […] the neurological difficulties of my son David” (2013, 220) lead her to explore maternity as I want that you be (2013, 229).

On the other hand, I also try to challenge what I see as an epistemological and political optimism in Kristeva’s work.Data availability statementNo data are available. Since this is an autoethnographic investigation, primary data will not be available.Ethics statementsPatient consent for publicationNot required.Ethics approvalThe ethical aspects have been reviewed by the research management at the Work Research Institute. See also footnote 1.AcknowledgmentsI would like to thank Eivind Engebretsen and John Ødemark for their encouragements, and the anonymous reviewers kamagra legal in uk for their helpful suggestions.Notes1. Patient and public involvement statement. Although there is no public involvement in the writing of this paper, the autotheoretical approach does of course involve my son.

This approach hinders full anonymisation, just like his way of living in this world hinders informed consent in the kamagra legal in uk traditional sense. The approach also excludes the potential for full anonymisation. The consent is therefore, in consultation with his mother, given by me as his legal guardian..

IntroductionThe subject cheap kamagra 100mg of care is gaining importance within the medical kamagra tablets price humanities, but it also remains elusive. Hence, this paper aims to unpack theoretical notions of care in a way that integrates the elusiveness rather than trying to avoid it. It also responds to a recent article by Julia Kristeva et al, in which they claim that care holds cheap kamagra 100mg humanity (Kristeva et al. 2018).When in need of theoretical elaboration or re-development, medical humanities scholars have sometimes evoked Greek or Roman myths, such as those of Narcissus, Hephaestus or Leto (Cilione, Marinozzi, and Gazzaniga 2019. Pannese 2011.

Schott 2017) cheap kamagra 100mg. Similarly, this article evokes the Roman myth of Cura to unpack theoretical understandings of care. In this myth, known from the writings of the first century mythographer Hyginus, humanity is created from clay by a personification of care. It has proven useful to thinkers as diverse as Martin Heidegger, Arthur Kleinman (Kleinman and van der Geest 2009) and Julia Kristeva (Kristeva (2012), Kristeva et cheap kamagra 100mg al. 2018).

While utilisation by Heidegger 1927, 196–200 ‘challenges the myth of self-sufficiency and individual atomization that that has shaped much of modern Western philosophy’ (Froese 2005, 16), both Kleinman and Kristeva explore the tension between universalised knowledge and the singularity of individual patients and intimate care (Engebretsen, Fraas Henrichsen, and Ødemark 2020).While none of these scholars engage with Hyginus’ Fabulae directly, I use the text as an ‘engine’ in a four-step endeavour. This endeavour follows Brandy Schillace’s description of the medical humanities as ‘a field that cheap kamagra 100mg at its core considers the human story behind and within medicine, its history, its cultural valence and its influence on practice’ Schillace (2017, 139).First, a ‘human story’ entails agency, the things that humans do in their lives. While the ‘appeal’ from Kristeva et al uses a case from intercultural psychoanalysis, the authors have previously researched a variety of professional healthcare practices (Engebretsen 2016. Engebretsen, Sandset, cheap kamagra 100mg and Ødemark 2017. Hetrick et al.

2017). However, it is crucial to note that Cura (in Hyginus’ text) will ‘hold’ humanity quamdiu vixerit (for as long cheap kamagra 100mg as he shall live). Such a life-long temporality does not dovetail with the temporary, regulated and systematised relations of healthcare organisations. Hyginus’ text has, I argue, a much stronger affinity to the temporality of parental care. Hence, I begin the endeavour by acknowledging that I am a scholar, and the father of a boy with little linguistic function.1 Although my parental care for my son entails a multitude of meanings and instances, I begin with two tales from my parental cheap kamagra 100mg care in 2020:Sometimes, if he does not understand what is going on, or if his actions feel unintelligible to others who are present, I take him in my arms.

In that way, we are at least together in a situation when both of us otherwise would have been on our own. Suddenly, it feels as if I am not only holding or embracing him away from an abyss. I am also holding him—or, perhaps, shielding him—in cheap kamagra 100mg the face of many, many abysses to come.In rough-and-tumble play, I often lift him up with my arms straight—holding him while he straightens his body, and ‘is an airplane’. Although this play is exhausting, particularly since I live with cerebral palsy, this is nevertheless an activity where we can be close to one another. When I hold him up like this, or suddenly ‘crash’ him safely down next to me on the bed, we are skin to skin, but not exactly like I used to be with his older siblings, and I suddenly have the impression cheap kamagra 100mg that it also differs from how most fathers do this with their children.

I cannot know if our way is exclusively ours, but while I hold him, that is how it feels.Second, a human story ‘behind and within medicine’—or, for that matter, behind and within any social field—consists of underlying notions and involved cultural categories. Hence, this article aims to unpack theoretical notions of care with reference to the thinkers mentioned above. Throughout, I try to unpack how different aspects of care ‘follow’ each other in an analytical ‘path’ or trajectory, as if in cheap kamagra 100mg a story (Kristeva et al. 2018).Third, the investigation of the human story of care must become an investigation of ‘history’ and ‘cultural valence’. In order to think historically, the analytical ‘engine’ includes Hyginus’ text, and 18th and 19th century uses of Cura and related motifs.Fourth, I follow Schillace’s advice to examine ‘influence on practice’.

In addition to the practice of parental care, the exploration ends cheap kamagra 100mg with a discussion of medical humanities as practice. When medical humanities scholars ’consider’ the human story of care, they bring together different perspectives and forms of knowledge. In this case, however both the intertextual analyses and the autotheoretical work indicate that those complexities might overpower our theoretical perspectives. Hence, I conclude with a call for epistemological and analytical modesty.MethodAlthough the abovementioned scholars have used the myth of Cura for clearly theoretical purposes, several of them explore this also as cheap kamagra 100mg carers in a personal sense. Julia Kristeva writes her work on care as the mother of a man with severe disabilities Kristeva (2013, 219–221), Arthur Kleinman and Geest (2009, 159–163) begin their rethinking with a rich narrative of his caring for his wife who lives with Alzheimer’s disease.

In line with their work, this article combines textual interpretation with autotheoretical work.Often used in connection with genre-bending memoir The Argonauts by Maggie Nelson (2015), the term ‘autotheory’ designates a literary form involving ‘the combination of autobiography and critical theory’ (Pearl 2018, cheap kamagra 100mg 200). In this article, however, I rely on the work of the Canadian artist, curator, writer and interdisciplinary researcher Fournier (2019), who has unpacked autotheory with particular reference to illness and embodiment. Fournier describes autotheory as a specific form of academic practice:In autotheory as a conceptual and performative feminist practice, artists, writers, and critics use the first person, or related practices of self-imaging (Jones, Self/Image 134), to process, perform, enact, iterate, and wrestle with the hegemonic discourses of ‘theory’ and philosophy, extending the feminist practice of theorizing from one’s subject positioning as a way of engendering insights into questions related to aesthetics, politics, ethics, and social and cultural theory. In autotheory, one’s embodied experiences become the material cheap kamagra 100mg through which one theorizes, and, in a similar way, theory becomes the discourse through which one’s lived experience is refracted (658).In Fournier’s definition, theory functions as ‘hegemonic discourses’, and as discourses through which one’s lived experience is refracted. Contrary to this emphasis on language—as well as their emphasis on language elsewhere (Heidegger 1927Heidegger 1937.

Kleinman 1995. Kristeva 2019)—neither Kristeva nor Kleinman or Heidegger cheap kamagra 100mg focus on Hyginus’ text. In contrast to this body of research, this article emphasizes the interpretative potential of the original text. In addition to grammatical analysis, I utilize the well-known concept of intertextuality, as introduced by Kristeva (1980). However, I use it in a less structuralist sense than cheap kamagra 100mg in her early formulations in Desire in Language.

Instead, I approach Hyginus’ text in line with her approach in ‘Nos Deux’ or a short (hi)story of intertextuality (Kristeva 2002).For me, intertextuality is mostly a way of making history go down in us. We, two texts, two destinies, two psyches cheap kamagra 100mg. It is a way if introducing history to structuralism and its orphan, lonely texts and readings. […] the etymological meaning of ‘semeion’ is a distinctive mark, a trace, an engraved or written sign, that makes us think of the Freudian ‘psychical’ marks, called drives, rhythmical articulations of embodied impulses and psychical movements. In this sense, the meaning of the cheap kamagra 100mg socio-historical aspect of intertextuality, as already developed by Bakhtin and Barthes, acquires a new significance.

Within each sociolect or ideology, (both well-established sign-systems) there will always be a breach of subjectivity carrying out a hidden matrix of pre-symbolic forces able to make history move on through all its short and singular stories. (2002. 8-9)First, this cheap kamagra 100mg means that I study Hyginus’ text not as a ‘lonely text’, but as part of a historical trajectory. The ‘singular stories’ are used to disturb the orderly (structural) notions of both textual and philosophical analysis.Second, I interpret Hyginus’ text—as well as other utilisations of the myth—with focus on traces. Or, more specifically, to find ‘distinctive marks’ relevant to the same material as in authotheretical work.

€˜embodied impulses and cheap kamagra 100mg psychical movements’. This, however, does not mean that the texts are reduced to a canvas for an engraved sign. In methodological term, the aim is to allow the two destinies—the textual trajectory of the Cura motif, and the personal trajectory that becomes so intimate when I hold my son in my arms—to shed light on one another.Third, the interaction between these two methodological cheap kamagra 100mg approaches will hopefully allow history—what Schillace calls the ‘human story’—to move in two diachronic ways. I aim to emphasise the differences between the different utilisations of the myth. Finally, I also aim to locate breaches in the ‘well-established sign systems’ we call theories of care, to get a glimpse of something yet hidden.Humanity as creation, care as fundamental conditionIn a narrative sense, Hyginus tells three stories.

A story of the creation of humanity followed by a story of a quarrel between deities and finally, a cheap kamagra 100mg verdict on the ontological role of care in human life. The first story in Hyginus’ fable begins thus:Cura cum quendam fluvium transiret, vidit cretosum lutum. Sustulit cogitabunda et coepit fingere hominem.When Cura was crossing a certain river, she saw some clayey mud. She took it up thoughtfully and began to fashion a man.Before interpreting this cheap kamagra 100mg first story, we must first acknowledge that the fable is an alteration or addition in a philological sense. While Fabulae is almost exclusively filled with Greek myths, the Cura fable’s position at the end of the collection suggests, ‘that this particularly Roman tale was simply added to the end of the existing narrative portion’ (Smith and Trzaskoma 2007, xlix).

Moreover, philological research consistently argues that fable CCXX ‘hinges on Latin wordplay’ (Smith and Trzaskoma 2007, xlviii).More specifically, Hyginus, in the Cura fable, alters a prevailing myth in late antiquity, one that he has even told earlier in the pages of Fabulae. That of how cheap kamagra 100mg the titan Prometheus fashioned man from clay. In fable CXLII (‘Pandora’), Hyginus states explicitly that Prometheus lapeti filius primus homines ex luto finxit (Prometheus, son of Iapetus, first fashioned men from clay).Most Greek and Roman sources place the Prometheus plasticator motif within a three-stage narrative. First, Prometheus shapes the human from clay, and then Athena gives the creature cheap kamagra 100mg inner life. Finally, sometimes after Prometheus has given humankind fire against the orders of Jove, Jove intervenes and sentences Prometheus to eternal punishment in the Caucasus.To understand the human story—to which both this motif and Hyginus’ text belong—comparison is needed.

First, we must note that the neutral or slightly idyllic depictions in Hyginus and Ovid (respectively) differ from earlier and less optimistic renderings in Republican times. The poet Propertius, for instance, in his Libri Elegiarum from the first-century BC, laments and elaborates on how Prometheus was careless in his creating cheap kamagra 100mg. Here, the adverbial clause ille parum caute casts Prometheus as a figure of titanic heedlessness:ille parum caute pectoris egit opus.corpora disponens mentem non vidit in arto:The making of man’s reason he performed with too little care.Arranging our bodies, he overlooked the mind in his handiwork (Goold 1990, 232).Carelessness, the counterpart to the notion of care, is involved in the Prometheus plasticator motif throughout antiquity. The adverbial clause ille parum caute does not derive from the same verb as Cura, but rather from the verb caveo (to take precautions, to be aware of something). Nevertheless, Prometheus’ cheap kamagra 100mg lack of care underlines how Hyginus’ text is an inversion these earlier texts.

Instead of being created in a careless way, humanity is created by care.To be fair, a singular text never exhausts the potential of the history to which it belongs. Specific understandings—in this case. Theoretical notions of care—are only a part of cheap kamagra 100mg a wide array of potentials. The Prometheus Plasticator motif foreshadows 20th and 21st century theories of care, and 18th and 19th century depictions of Prometheus as a figure of romantic transgression. In Goethe’s poem Promethevs (written 1774, published 1789), Prometheus becomes a figure of independence and defiance—as expressed, for instance, in the final stanza:Hier sitz' ich, forme Menschen / Nach meinem Bilde, / Ein Geschlecht, das mir gleich cheap kamagra 100mg sei, / Zu leiden, zu weinen, / Zu genießen und zu freuen sich, / Und dein nicht zu achten, / Wie ich!.

(Goethe 1998, 44–46)Here sit I, forming mortals /In my image. / A race resembling me, / To suffer, to weep, / To enjoy, to be glad, / And thee to scorn, /As I!. (Bowring 2015, 182)Typical of Goethe’s Sturm und Drang period, his Prometheus Plasticator is a cheap kamagra 100mg figure of creativity, and embodies ‘ideals of freedom and rebellion’ (Raggio 1958, 44). Goethe’s poem emphasised the ‘autonomous existence’ of mankind (Dougherty 2006, 95), thereby constituting an ‘emancipatory gesture’ (Edgar 2002, 161). Hyginus’ text inverts both classical and romantic evokings of the myth by inserting dependency rather than autonomy and expansion.

To shed further light on this inversion, we must first unpack the name of the personification that Hyginus instals in cheap kamagra 100mg the Prometheus Plasticator motif. Cura.The name Cura is derived from the verb curo. The Oxford Latin Dictionary defines the verb thus:To watch over, look after, care for.To tend to, to do what is necessary to.To administer remedies, to treat (a sick person, wound, disease, etc).To have charge of. (absol.) to be in command.To devote oneself to, to cultivate (a person).To undertake, to see to (a task or a responsibility).To regard with anxiety or interest, worry or care about, heed.As we can see, the first three senses of this verb invert the Prometheus motif we found in cheap kamagra 100mg Propertius. To instal the personification of curo in the motif is to instal carefulness, attentiveness and responsibility in a motif usually filled with lack of care.

The third sense also injects an aspect that is totally absent in cheap kamagra 100mg classical anthropogenies. That of human frailty. It also relates to aspects of human lives that are particularly relevant to understanding care, illness, disease and disability.The fifth and sixth senses of the word similarly invert the romantic depictions of Prometheus motif. The anthropogenic act is cheap kamagra 100mg no longer about rebellion and expansion, but devotion and responsibility. The seventh sense finally reverses the political impulse of the Sturm und Drang—the desire for increased individual freedom and self-expansion in every imaginable way—into worrying and heeding.In addition to these intertextual relations, it is also fruitful to note the verbs that connect humanity to the three deities.

While Cura’s creating is described with the verb fingo (in Hyginus. €˜fingere’), Jove’s and Tellus’ acts of giving are described by do (in cheap kamagra 100mg Hyginus. €˜dedisti’). While the former verb is a very tactile verb, a matter of touch and contact, do signifies separation—to deliver or give something, to separate it from something in order to unite it with something else. An initial understanding cheap kamagra 100mg of care emerges from these textual relations.

Care is fundamental (by belonging to the anthropogony), antithetical (by being the antithesis of carelessness and neglect) and intimate (by establishing relation through touch).Care imaginationsWhen modern scholars use Hyginus’ text, one word of the first sentence is often overlooked. Cogitabunda (thoughtful) cheap kamagra 100mg. Although an adjective in the purely grammatical sense, this is the only word with an adverbial function in Hyginus’ text. Hence, it is the lone term specifying how actions and interactions take place. While Greco-Roman deities often act from rage (as cheap kamagra 100mg in the conflict between the titans and Olympian deities) or desire (as in the story of Zeus and Leda), Cura acts thoughtfully or with thought.As we can see, the adverb cogitabunda is attached to the picking up of the clay, not primarily to the act of creation.

Sustulit cogitabunda et coepit fingere hominem. Moreover, the temporal clause ‘and begun to’ (et coepit) also locates this thought as prior to the creation of humanity. To understand care as thoughtful, then, is cheap kamagra 100mg about understanding thoughts and imaginaries ‘involved’ in care, and it includes thoughts and imaginaries that ‘pre-exist’, ‘frame’ or ‘underpin’ care and care work.It is useful to explore how the meaning of cogitabunda is preserved and unveiled in the work of the German philosopher, poet and literary critic Johann Gottfried Herder (1744–1803). In his poem ‘Das Kind der Sorge’ (1787), Herder follows Hyginus very closely (Bernays 1869, 158-163). This poem was widely read, and it provided the basis for Goethe’s use of the Cura motif in Faust II (1832).

Finally, Heidegger also comments on the poem and cites it in cheap kamagra 100mg extenso when he develops his notion of Sorge as the fundamental human condition (Dye 2009, 207–218)., Kristeva (2001), too, refers several times to Herder, and even refers directly to this poem (25–26). The first stanza describes the moment of creation thus:Einst saß am murmelnden StromeDie Sorge nieder und sann:Da bildet im Traum der GedankenIhr Finger ein leimernes Bild (von Herder 1889, 75).Once by a murmuring riverSorrow sat down, and there,In a vision, thought to form with the touchA wavering figure (Groth 2016, 31).von Herder positions the moment of creation as a radically imaginative act in at least three ways. First, the gaze is far more manifest in von Herder’s text than in Hyginus’. While Hyginus’ Cura shapes a human (hominen) directly, von Herder’s ‘Sorge’ shapes an image (Bild) cheap kamagra 100mg. This dovetails well with important insights from care research.

In relations of care, the cared-for becomes visible to the carer(s), thereby also becoming a valued cheap kamagra 100mg imago. Conversely, the carer(s) become visible in the imagination of the cared-for—even in a Western culture that often obscures or silences interpersonal interdependence.Second, cogitabunda in Hyginus is also intertextually connected von Herder’s adverbial clause im Traum der Gedanken. This phrase, roughly translatable as ‘in the dream of thoughts’, roots humanity in a singular image (or dream) that consist of or belong to several different thoughts or ways of thinking. This tension between individuality and multitude dovetails with research on the knowledge cheap kamagra 100mg complexities involved in care.Third, the word ‘Traum’ (dream) in Traum der Gedanken does not denote unreality, fantasy or illusion. For von Herder, dreams are not the opposite of reality, but thoughts beyond or above manifest reality (Wirklichkeit überhöhenden Gedankens).

A dream of thoughts, then, is an experience or interpretation wherein the understanding of a phenomenon moves beyond how the phenomenon presently is, to what it should or could be. Just as Hyginus’ cogitabunda can, if we interpret in cheap kamagra 100mg intertextual connection with von Herder’s Traum der Gedanken, also refract my experiences of holding my son in my arms. This is true of the experiences of performing actions that seem strange or unintelligible to those around us, but particularly true of the feeling of doing this in a way that is uniquely ours. The combination of these feelings—where the socially estranged ways of caring is fundamentally ours and integral to my parenting—engenders or entails a striving ‘upwards’. This striving is not limited to the idealisation that so often takes cheap kamagra 100mg place in parenting, but is also a utopian, imaginative glimpse of a world wherein the both of us truly belong.In other words, the Cura motif foreshadows the ‘horizontal’ complexities involved in care (multiple cultural imaginaries, multiple forms of knowledge).

It also foreshadows ‘vertical’ complexities, through which care imaginations include both underlying categories and überhöhende dimensions. These overarching or utopical dimensions, cheap kamagra 100mg that both stem from and go beyond the localised, singular imaginations of care, is known by many names in and beyond the medical humanities. Examples include ’underlying values’, ‘ethical content of particular practices’, ‘transformative learning’ and many others (Ayala 2019, 269. Pettersen 2008, 188. Winthrop 2003).Cogitabunda, can mean cheap kamagra 100mg to be thoughtful and to be ‘full of thoughts’.

The adverbial clause im Traum der Gedanken by von Herder (1888, 533), similarly, also signifies something unclear or disorganised. In his poetotological treatise Über Bild, Dictung und Fabel (1888, 533), von Herder juxtaposes this state with being in Leidenschaft (in passion), in Verrückung (in madness) or nicht auf seiner Hut (off guard). There is cheap kamagra 100mg complexity and openness—perhaps even fantasy or at least exploration—in this. When I hold my son in my arms connecting different realms of thought. As in ruff-and-tumble-play, these realms are also at play as I think.The quarrel of the deities.

Culture, nature cheap kamagra 100mg and careAfter the first narrative, the second deals with a quarrel between the deities Cura, Jove and Tellus. Once humanity has been given inner life, the focus in Hyginus’ texts shifts from creating to name-giving:Cum vellet Cura nomen suum imponere, Iovis prohibuit suumque nomen ei dandum esse dixit. Dum de nomine Cura et lovis disceptarent, surrexit et Tellus suumque nomen ei imponi debere dicebat, quandoquidem corpus suum praebuisset.When Cura wanted to give it her name, Jove forbade, and cheap kamagra 100mg said that his name should be given it. But while they were disputing about the name, Tellus arose and said that it should have her name, since she had given her own body.To name something after something else (and, perhaps particularly, after someone else) places the object within a certain taxonomy. Major deities such as Jove and Tellus are both rulers and personifications of different ontological realms or ‘elements’.

Hyginus’ Cura is not cheap kamagra 100mg known from other Roman sources. Instead, Cura is a ‘deification of abstract ideas’, a common feature of Roman culture (Axtell 1907). Hence, it becomes clear that the quarrel deals with ontological ideas, more specifically with the ontology of humanity. Each deity proposes a ‘location’ in classical cheap kamagra 100mg ontology.The philosopher John T. Hamilton has used the myth of Cura to explore how any understanding of security presupposes both care and carefulness.

He underlines how this ‘locating’ somehow names humanity after something that is neither identical nor particularly resembling humanity:The controversy over the creature’s name strives to resolve the issue of the figure’s proper being, without the aid of physical resemblance, without the talent for self-reflection. In my view, the debate over the name revolves on whether humanity is essentially atemporal (Telluric matter or Iovian spirit) or instead fundamentally temporal and constituted by time and history (Hamilton 2013, 71).It is worth noting that the deities are not offering or suggesting certain framings of human life cheap kamagra 100mg. Hyginus’ text—in particular, the fact that Jove forbade any name other than his own—indicates conflicts between perspectives and disciplines. The imaginative richness involved in care, cheap kamagra 100mg indicated by Hyginus cogitabunda or by the plural in von Herder’s Traum der Gedanken, is a plurality where incommensurabilities remain. In my view, the myth of Cura points towards three possible but incommensurable ways of studying, describing and interpreting care (corresponding to Jove, Tellus and Cura, respectively):As a cultural or semantic phenomenon, elucidated in terms of meaning or more or less idealised notions.As a biological phenomenon, elucidated in medical, psychological or other health-related terms.As a relational phenomenon, elucidated in terms of care work (professional or not).Although it is necessary to understand care in all these ways, it is nevertheless impossible to fully merge them or produce those understandings simultaneously.

Hence, it is necessary to add a more epistemologically oriented aspect of care. Care is fundamentally imaginative and context-dependent, and stands in-between cheap kamagra 100mg otherwise incommensurable interpretative domains.Saturn’s verdict. The continuous presence of careIn the third narrative in Hyginus, the quarrel is somehow resolved when the deities choose Saturn as their judge. Sadly, this part of the text is fragmented. There is agreement, however, that Saturn’s verdict clarifies that Jove will receive human souls, while Tellus will receive the body cheap kamagra 100mg post mortem:Tu Iovis quoniam spiritum dedisti, <…>.

Corpus recipito. Cura quoniam prima eum finxit, quamdiu vixerit, cura eum possideat. Sed quoniam de nomine eius controversia est, homo vocetur quoniam ex humo videtur cheap kamagra 100mg esse factusJove, since you gave him spirit, let [Tellus] receive his body. Since Cura fashioned him from the start, let Cura possess him for as long as he lives. But since there is controversy about his name, let him be called homo, since he seems to be made from humus.Let us begin by pointing out that Saturn’s verdict exposes yet another way in which Hyginus’ text cheap kamagra 100mg alters the Prometheus plasticator motif.

In most classical renderings, Prometheus is a trickster, and a transgressor from whom humanity is eventually separated. After discovering his transgressions, the Olympian deities chain Prometheus to a mountain in the Caucasus, and humanity lives on without him. The relation between cheap kamagra 100mg humanity and its creator is therefore temporary. Hyginus, in contrast, makes it clear that humanity will remain under the guardianship of Cura quamdiu vixerit ‘for as long as he shall live’.The significance of this difference becomes clearer if we compare Hyginus’ text to Ovid’s use of the Prometheus plasticator motif in Metamorphoses. After describing the original moment when Prometheus created Humanity, Ovid goes on to describe the human condition:quam satus Iapeto mixtam pluvialibus undis / finxit in effigiem moderantum cuncta deorum, / pronaque cum spectent animalia cetera terram, / os homini sublime dedit caelumque videre(Ovid 1997, 47)so that his new creation, upright man, / was made in image of commanding gods?.

/ On earth the brute creation bends its gaze, / but man was given a lofty countenance / cheap kamagra 100mg and was commanded to behold the skies. / and with an upright face may view the stars (Melville and Kenney 2009, 76).As we can see, Ovid’s Prometheus creates a strong and vital human being. Humanity seems not dependent on care or assistance, but ‘made in image of commanding gods’. In Ovid, cheap kamagra 100mg human life is essentially an independent life which resembles the lives of gods (in effigiem moderantum cuncta deorum). It is common—and tempting—to imagine care relations as exceptions in human lives.

In care research, for instance, one often reserves care needs for vulnerable groups, thereby contrasting them with some kind of original, non-vulnerable state cheap kamagra 100mg. In life-course research, similarly, care leaves life as people move into adolescence and adulthood, only to re-enter it in the special cases of disability, serious illness or old age. Hyginus’ text, in contrast, opens up for a rethinking of care as a fundamental, continuous part of human lives.This is essentially an ontological argument. Although we often reserve the term for human beings who have unusual needs—for instance, children or people with disabilities—care is, in fact, much more pervasive.Noting the etymology of the verb curo—denoting what we call caring cheap kamagra 100mg and worrying—Hyginus’ text also points towards an understanding of care as protection. The notion of care becomes meaningful in and of itself, and in relation to its counterparts, such as conflict, violence and neglect.

If the so-called ‘normal’ human life—in Ovid’s words. Lives lived ‘in the image of cheap kamagra 100mg commanding gods’—is met by a radical lack of care, it would have little freedom and in fact be over in a matter of days.Hyginus’ text points towards an understanding wherein care reigns, organises or facilitates human lives. Cura somehow ‘holds’ humanity in this life, indicating that Jove’s and Tellus’ receiving somehow lies outside that life (after death). For the medical humanities, this understanding of care suggests ways to think about both medical and cultural knowledge as forms of afterlife. Biological knowledge, for instance, is a form of knowledge that has been aggregated cheap kamagra 100mg outside and beyond individual lives.

Through clinical generalisations, anatomical knowledge, systematic literature reviews and more. Cultural knowledge, conversely, is deeply historical and contextual—thereby inevitably also a testament to how both historical and cheap kamagra 100mg contextual relations stretch far beyond individual lives.These ambiguities lead to a further understanding of care. Care is not only a fundamental precondition—whose impact depends on context and interpretation—care is indeed a fundamental and omnipresent condition, that continuously engenders and relies on interpretative processes.Care as holding-togetherWhen I hold my son I ruff-and-tumble play, I am also holding together forms of knowledge. I connect many different forms of knowledge—my intimate experiences with him, my research experience from disability studies, the bits of knowledge I have received from medical and educational professionals and many others—with one another. Moreover, the knowledge I produce—from the actual holding, from being cheap kamagra 100mg skin to skin and from sensing if he cannot understand others—is used in knowledge translation.

I use it to stretch the understandings of medical professionals beyond uncertain prognoses. I also use it to connect the knowledge of the preschool teachers—a knowledge which mainly deals with so-called ordinary children—with the lives of extraordinary children such as my son.In Hyginus’ text, too, Cura holds together what otherwise would have been separate. Had it not been for Cura’s holding, and Saturn’s verdict, humanity would have belonged to either Jove or Tellus cheap kamagra 100mg. A recent ‘appeal to the medical humanities’ uses the potential of this narrative. In it, Kristeva et al.

(2018) use the myth of Cura to explore how humanity ‘belongs to different ontological domains’ held together by care:Saturn, the God of time, settles the matter through an act of naming and by dividing and temporalising cheap kamagra 100mg the possession of the various parts that comprise man. Jove is offered man’s soul and Tellus his body, after man’s death, while Cura will possess the creation in its lifetime since she made it. […] Thus, human life as a composite assembly of spiritual (Jove) and material cheap kamagra 100mg elements (Tellus) is held together by Cura’s temporal care (55).In their unpacking, Cura’s holding of humanity becomes a holding-together of two forms of knowledge. Biomedical knowledge of bios and sociocultural knowledge of zoe. Faced with situations of care—situations that neither biomedical science nor cultural studies of health can understand sufficiently—the understanding of care becomes a point of intersection between otherwise separate landscapes.This holding-together is visible in a variety of care practices.

In the case of evidence-based care, for instance, temporal doing at a certain point in time and history (professional work) holds together atemporal knowledge of effects (evidence) cheap kamagra 100mg and atemporal norms (professional ethics). The temporal care work may seem like a mere ‘application’ of these atemporal knowledges. However, recent studies argue that both evidence and norms exist as such if and only if they are interwoven with embodied practices. While ‘evidence in clinical cheap kamagra 100mg decision making is relentlessly situated and contextual’ (Wieringa et al. 2017, 964), so can the normative aspects only be sufficiently understood as ‘embodied process’, located at ‘the action level’ (Doane and Varcoe 2008).Jove, Tellus and Cura personify ontological orders (ways of being), and epistemological orders (ways of knowing).

If we then revisit the epistemological aspect of care, a further understanding emerges. Care is a relational matter—in the lived lives of care receivers, as well as in the work of care professionals—and it is crucial in holding together different social agents and different knowledge domains.Care as withholdingWhen I cheap kamagra 100mg ‘play airplane’ with my son—or hold him close to me in situations where others do not understand him or vice versa—one might say that I know what I am doing. On the other hand, this holding challenges several parts of my knowledge of this world. It challenges my images of what cheap kamagra 100mg it is to be a father, since the play differs from how most fathers do this with their children. More importantly, perhaps, the knowledge produced when I hold my son in my arms in the face of many, many abysses to come differs from much of my academic and medical knowledge, including that which is inherent in his diagnoses and prognoses.This withholding might seem, contrary to the straightforward clarity of Hyginus’ text.

However, a more detailed examination can refract these interpretations. It is particularly worth noting that the relation between Cura and the human being—that is, the fundamental ontological condition cheap kamagra 100mg in this life—is described with a specific verbal clause with the verb possideo. Cura eum possideat (Cura shall hold him).The Oxford Latin Dictionary defines possideo thusly:To have (land) in one’s control, occupy (as a tenant, etc). (absol.) to hold land.(in general) to hold as property, b. To take (property) into one’s keeping, appropriate.(of a sovereign, army, etc) to have control of (a country, position, etc) […] to assume or exercise control over (persons).To take or have in its power, dominate, overwhelm, possess.To fill or take cheap kamagra 100mg up (a space) with one’s bulk.To take up wholly (a person’s time).

To absorb the thoughts and energies of someone.Possideo denotes not a general sense of holding, or a more general sense of contact or connection, but an exclusive holding—similar to the English verb to possess. Cura, then, is not only holding a humanity that belongs to both Jove and Tellus, but she is also withholding this humanity from them. This becomes even clearer if cheap kamagra 100mg we emphasise that possideo is a transitive verb. At least to some extent, the clauses quamdiu vixerit, Cura eum possideat entail a micro-narrative. Although ‘created from,’ or consisting of biological matter, and being characterised by the presence of ‘soul’ or some measure of cognition, humanity is fundamentally ‘controlled’ by cheap kamagra 100mg care in this life.

The separating into meaning (spirit) and biology (bodily remains) takes place outside this life. Cura’s holding, then, allows us to understand the holding-together of medicine and culture, and a withholding from both these domains.The ‘hermeneutic story’ (Kristeva 2002, 10) of Hyginus’ possideat—wherein care holds humanity at the expense of both culture and biomedicine—contradicts epistemological optimism. Hyginus text allows us to glimpse intimate care knowledge that connects cultural and biomedical knowledge, and that holds human life away cheap kamagra 100mg from generalised knowledge. When Cura withholds humanity from generalised cultural knowledge (Jove) and generalised biochemical knowledge (Tellus) and care produces knowing—often described as insight, sharing and holding-together—and un-knowing.These difficulties indicate the need for an additional understanding of care. Care must be understood as a practice that holds together multiple parties and multiple forms of knowledge.

However, it must also be cheap kamagra 100mg understood as a practice—or if you will. A form of human relation—that withholds something from knowledge.I shall hold him for as long as I shall liveThe ‘human story’ of care relations (eum possideat) will necessarily entail a human story of singular actions that to some extent can only be described in first-person singular. Eum possideam (I shall hold him). To explore this individual eum possideam, I try to ‘theorise from cheap kamagra 100mg my subject position’ (Fournier 2019, 658). When activating my own intimate experiences, it became clear that interpretations of my eum possideam quamdiu vixerit can refract—or even fracture—theoretical notions of care.To connect intimate experiences of holding—be it in bodily care, in adverse social situations or in rough-and-tumble play—with cultural and political theory is clearly a daunting task.

Although this still seems unclear to me, I can at least outline four aspects of the refraction. First, I cheap kamagra 100mg do hold together cultural and biomedical knowledge. When my son is in my arms, multiple cultural imaginaries are involved. My understanding of his life (and of mine) is dependent on my language and my cultural frames, and I am consistently aware of a clinical gaze cheap kamagra 100mg. My son’s life—and, thereby, also my own life and my care work—are viewed or observed by medical professionals, psychologists, special needs educators and preschool teachers.Second, the holding is troublesome.

In a narrower sense, I note that his needs lead me to hold and even carry him in ways that most parents only do with substantially younger children. Combined with my own embodied condition, there emerges a bodily trouble, an element cheap kamagra 100mg of exhaustion, uncertain walking and muscular pain. Regarding my cultural knowledge, it becomes clear that my own imaginaries entail expectations and understandings that somehow seem incompatible with his life. In this social context—parenting in Norway, located in middle-class families—childhood is simultaneously about ‘findings one’s own voice’ (autonomy) and about ‘following the path’ (social reproduction). To claim that autonomy outside language is possible, or that a person in his situation may reproduce cheap kamagra 100mg his parents, seems equally futile.Regarding biomedical knowledge, I take care of my 4-year-old (as I do all three of my children) within a biomedical framework.

Most Norwegian children are screened regularly for somatic problems, and to measure linguistic, cognitive and psychosocial development. While this knowledge has thus far granted me a certain comfort in parenting my two oldest children—confirming, as it were, that all is well—that has, obviously, not been the case with my youngest son. Hence, his life is also framed by medical cheap kamagra 100mg knowledge in a more direct way. He receives a range of health-related services, a provision that also positions my parental care within the same frame.Third, there is an uncertain future involved in this. This is of course always true cheap kamagra 100mg of any intersubjective relation in general and of care relations in particular.

The future is open, and it can entail painful events. However, his situation exposes uncertainty in a more radical way. Culturally, it exposes how I see my other children—as having quite stable chances for social reproduction—partly thanks to how I cheap kamagra 100mg see him. Through a fatherly lens of rather unclear hopes and worries. Medically, the tests of my youngest son continuously yield inconclusive results.

This has replaced my former sense of cheap kamagra 100mg parental comfort with gnawing anxiety over his future. Moreover, the complexities of his living leaves me, as a caregiver, with the unpredictability of his diagnostic results, rather than with stable prognoses.Fourth, these intimate situations entail a particular life-course temporality, which differs from the temporality of professional care, as well from the temporality in Hyginus’ text. In the case of professional careers, their work is regulated to certain hours (of paid work), and to certain phases of life. Most professional carers will retire, and many will pursue other forms cheap kamagra 100mg of work at some point in time. In Cura’s case, her care work is also time limited.

The temporality of the deity’s existence is sufficient to cheap kamagra 100mg encompass the temporality of humanity. In both cases, the life course temporality of the carer is sufficient for the imagined care work.In my parental care work, however, the temporality is insufficient rather than sufficient. In all likelihood, I will somehow care for my son for as long as I am alive. Moreover, this lifelong work will likely be insufficient in at cheap kamagra 100mg least two ways related to the temporality of my life. My own ageing will likely reduce my ability to perform the care work, and I will likely die before my son, leaving him without parental care.

Hence, the temporality of my care cannot be formulated as eum possideam quamdiu vixerit (I shall hold him for as long as he shall live), but as eum possideam quamdiu vixero (I shall hold him for as long as I shall live).This rudimentary autotheoretical investigation brings to light three forms of withholding. First, the nature of the holding (eum possideam) withholds care from cheap kamagra 100mg the epistemological domains that the medical humanities traditionally investigate. Second, the temporality involved in parental care (quamdiu vixero) withholds something from the temporality of professional care. Third, something is also withheld from the ‘parental temporality.’. The need care depends on cheap kamagra 100mg his life (quamidiu vixerit), not on mine.

Several forms of knowledge, and several forms of embodied holding, are involved without being fully commensurable. Since I cannot resolve these enigmatic forms of withholding, the theoretical understandings remain breached, implicitly pointing towards not-yet-explicable or not-yet-nameable understandings.Withholding cheap kamagra 100mg and ambiguityMy holding of my son in my arms come with several temptations. One of them—in particular, as I am holding him, or, perhaps, shielding him—is to think that I hold some kind of vast, privileged knowledge. While this is of course true to some extent, there are more powerful movements at play. On the one hand, the complexities cheap kamagra 100mg in the situation forces me out of the internal comfort that characterises the centre of any ontological or epistemological ‘domain’.

On the other hand, I am also forced to admit another thing. That I can hold him, but it remains unclear—to some extent—if I can know him. I cannot know if our way is exclusively ours.Similarly, intertextual analysis locates breaches in specific ‘sign-systems’, and in larger ‘social and historical material’ cheap kamagra 100mg (Kristeva 2002, 9–10). Hence, the specific inquiries presented in this article relate to more general ways of inquiry. When we use those notions, we connect different academic investigations, and different academic disciplines, theoretical traditions and research methodologies.

In Julia Kristeva’s words, these relations are ‘temporal connections’ and ‘points of contact‘ (2002:8) and points of ‘distortion, ambiguity and contradiction’ (2002:11).The understanding of care as holding-together connects very well with the rise in interdisciplinarity within the medical cheap kamagra 100mg humanities. The three deities Jove, Tellus and Cura are brought together in dispute, and Saturn’s verdict foreshadows how different ontological domains are held together in human life.Studying an interaction between form of knowledge—in their case. The interaction between medical imagining and patient creativity—Stahl and Stahl cheap kamagra 100mg use the insufficiencies of medical knowledge in an argument for multiple perspectives:Although in contemporary Western society, many tend to believe the hard science provide the truest or most accurate interpretation of the natural world, it cannot exhaust the meaning of the body. If we believe we are more than the sum of our parts, then we ought to allow for multiple and even varied interpretations of our bodies (Stahl and Stahl 2016, 159).Interpreting care as connectedness and holding-together, medical humanities scholars aim to hold together medical and cultural knowledge in new, explorative and enriching ways, and they often succeed.Such interpretations also speak to an even more radical ambition, that of academic convergence, sometimes referred to as transdisciplinary research. Such appeals are often embedded in a considerable epistemological ambition.

Pointing out the insufficiencies of ‘illustrative’ or ‘additive’ work in the cheap kamagra 100mg medical humanities, Kristeva et al. (2018) express a particularly radical version of this ambition:[W]e do not consider the humanities as a critical and potentially liberating perspective that can be applied to medicine as an object in need of repairment. Medical humanities should not be construed as a humanistic perspective on medicine. They should rather be seen as a cross-disciplinary and cross-cultural space for cheap kamagra 100mg a bidirectional critical interrogation of both biomedicine (simplistic reductions of life to biology) and the humanities (simplistic reductions of suffering and health injustice to cultural relativism). On the one hand, this implies breaking with the culture–nature dichotomy and considering both the humanities and medicine as biocultural practices.

On the other hand, it also implies understanding that boundary work requires boundaries, and that incommensurability between various partial disciplinary perspectives can—and will—emerge (56).The ambition at stake here listens to the holding-together outlined above. Whereas more cheap kamagra 100mg ‘additive’ ways of connecting knowledge are valuable—for instance, when humanities-based research ‘fill the gaps’ of ‘pure’ medical research in order to facilitate evidence-based care—this is not what Hyginus’ text indicates. Just as the relation between Jove and Tellus is symmetric and mutual (they are equally necessary for the creation of humanity and will ‘hold’ remain with equal sovereignty after this life), so is the relation between Cura and the two other deities. Jove and Tellus are separated from humanity in this life, and Cura is equally separated from humanity after this cheap kamagra 100mg life. This fable cannot be intertextually connected with asymmetrical or additive relations between knowledge fields, but it is connected with a ‘space for bidirectional critical interrogation’.It is perhaps less clear how care as un-knowing speaks to larger trends in the medical humanities.

It is therefore necessary to ask. How can understandings of care that emphasise withholding and un-knowing, including autotheoretical investigations that increase uncertainty, ambiguity and painful affects, cheap kamagra 100mg inform knowledge production?. To outline a provisional response to this question, it is useful to return to Hyginus’ text once again. The description of Cura’s relation to humanity—Cura quoniam prima eum finxit, quamdiu vixerit, cura eum possideat (Since Cura fashioned him from the start, let Cura hold him for as long as he shall live)—should also be read with attention to grammar. While the conjunction quoniam (since) introduces a cheap kamagra 100mg causal clause in the indicative mood (finxit), followed by an adverbial clause in the indicative (vixerit), the resulting clause is in the subjunctive (possideat).

Interestingly, this subjunctive inflection is the only use of the subjunctive mood in Hyginus’ text.This use of the subjunctive mood—sometimes called ‘independent’ usage—can have a variety of purposes. Although the usage in fable CCXX is iussive—in the sense that makes a permanent judgement—it is worth noting that the subjunctive mood is often associated with potentiality in classical Latin. Other common areas of usage include ‘questions in which the speaker or writer expresses doubt or disbelief by “thinking aloud” (deliberative), wishes cheap kamagra 100mg that cannot or may not be fulfilled (optative), and the potentiality that something may happen or might have happened (potential)’ (Palma 2012, 377). Moreover, it is worth noting that possideat is in present tense. Since the subjunctive mood lacks a future tense in Latin, the active cheap kamagra 100mg present tense can also denote future actions.

Hyginus’ text, then, points towards knowing and un-knowing, and towards openness to potentiality and some degree of uncertainty.When held together, withholding and uncertainty give a clear implication for the medical humanities as a form of academic practice. The epistemological ambitiousness in medical humanities should be supplemented with what one might call epistemological modesty. Such modesty is rooted in the specifics of care, and in cheap kamagra 100mg the relation between complexity and synthesis. What is at stake in care research—if we take the abovementioned complexities into account—is a ‘bidirectional space’, and an ever-expanding and exponentially multidimensional space. When medical humanities emerged, it was only a question of time before the field began to involve other humanities and social sciences disciplines than those involved in the initial phase.

Similarly, the growth of critical medical humanities steadily increases cheap kamagra 100mg the engagements with all kinds of critical research frontiers, in the social sciences as well as in the humanities. At least in an area such as studies of care—where the intimacy is so acutely palpable—it will become increasingly clear that the medical humanities will remain ‘outnumbered’ or ‘overpowered’ by the analytical complexities the field itself brings forth.Some scholars in the critical humanities have argued that scholars should ‘embrace’ this kind of overpowering (Viney, Callard, and Woods 2015, 2–7). However, Hyginus’ text complicates the relation between care practices (Cura), culture (Jove) and biomedicine (Tellus) regardless of such embraces. Although care holds humanity at the expense of the other forms cheap kamagra 100mg of knowing, his holding neither implies any disregard for humanities-based nor medical knowledge. Rather, the unpacking presented in this article demonstrates how care brings forth an epistemological modesty.

Only an cheap kamagra 100mg epistemologically modest way of doing medical humanities can address the intimate and enigmatic qualities of care.Discussion. Scholarly and analytical contributionWhile the textual and autotheoretical analyses presented in this paper followed the suggestion from Kristeva et al—to we question ‘the cultural distinction between the objectivity of (medical) science and the subjectivity of culture’ (2018:55)—it nevertheless ended in an emphasis on intimate withholding. This withholding—be it epistemological, theoretical or inherent in the intimate experience of holding or embracing my son away from an abyss—is relevant to the medical humanities in general. However, it is also a contribution to four more specific tendencies in the available literature.First, the unpacking contributes to feminist care cheap kamagra 100mg research. Beginning with the canonical work on ‘a different voice’ by Gilligan (1982), feminist care research has increasingly emphasised the knowledge multitude involved in care.

More recent research also shows a multitude of empirical delineations. While some scholars reserve the term for face-to-face interaction, or for situations cheap kamagra 100mg characterised by asymmetrical dependency, others do not. The investigation in this article brings forth additional multitude by combining academic disciplines that rarely interact—care research, linguistic analysis of Latin texts, romanticism studies and autotheoretical analysis work—and implies many possibilities for further research.Second, the autotheoretical interpretations can contribute to the research field sometimes known as ethics of care. Following such works as the book Learning from my Daughter by Kittay Kittay (2019, xx), where she proposes that the relation of parental care provides ‘the only universal and morally significant property that all humans possess’, I aim to shed light on how care work engenders ethical thinking. My holding cheap kamagra 100mg of my son in my arms—as well as the withholding that both this holding and Hyginus’ text entail—is as political and ethical as it is personal and embodied.Third, this paper also relates to a more critical strain of ethics of care.

Pettersen (2008) work, for instance, demonstrates how the ethics of care ’subverts the public/private dimension altogether’, thereby allowing for a broader range of criticism (45). Moreover, Fletcher and Piemonte (2017) shed light on how healthcare practices cheap kamagra 100mg constitute a ’quiet subversion’ of neoliberal cultural structures. Arguably, both intimate withholding and epistemological overwhelming shows the power involved in such subversions.Fourth, I hope to contribute to the strand of research—in care research as well as in disability studies—that relate to the work of Julia Kristeva. On the one hand, the rethinking presented in this paper dovetails with her perspectives on how intimate aspects of care destabilise the larger frameworks, cultural structures that are nevertheless sustained by those actions of care. The autotheoretical exploration towards the emblematic formulation eum possideam quamdiu vixero (I shall hold him for as long as I shall live) might also respond fruitfully to Kristeva’s account of how her “living with […] the neurological difficulties of my son David” (2013, 220) lead her to explore maternity as I want that you be (2013, 229) cheap kamagra 100mg.

On the other hand, I also try to challenge what I see as an epistemological and political optimism in Kristeva’s work.Data availability statementNo data are available. Since this is an autoethnographic investigation, primary data will not be available.Ethics statementsPatient consent for publicationNot required.Ethics approvalThe ethical aspects have been reviewed by the research management at the Work Research Institute. See also footnote 1.AcknowledgmentsI would like to thank Eivind Engebretsen and John Ødemark for cheap kamagra 100mg their encouragements, and the anonymous reviewers for their helpful suggestions.Notes1. Patient and public involvement statement. Although there is no public involvement in the writing of this paper, the autotheoretical approach does of course involve my son.

This approach hinders full anonymisation, just like his way of living in this world hinders informed consent in cheap kamagra 100mg the traditional sense. The approach also excludes the potential for full anonymisation. The consent is therefore, in consultation with his mother, given by me as his legal guardian..

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You’re reading the web edition of STAT Health cheap kamagra 100mg Tech, our guide to how tech is transforming the life sciences. Sign up to get this newsletter delivered in your inbox every Tuesday and Thursday.Can wearables detect pregnancy earlier than tests?. Wearables that take cheap kamagra 100mg users’ temperatures could detect pregnancies even before traditional tests, new research from the University of California, San Diego suggests. The small study examined data from 30 women who became pregnant while wearing Oura rings, consumer wearables designed to track temperature and other biometrics. Researchers found that temperature shifts can serve as a passive pregnancy notification that can signal pregnancy about nine days before a positive test.“If women know that they’re pregnant sooner, they can make choices about their life that they might not know to make otherwise,” co-author Benjamin Smarr, a professor in UCSD’s bioengineering and data science departments, told STAT.

Earlier detection could become all the more critical if cheap kamagra 100mg Roe v. Wade is overturned, experts said. Katie has the full story. Advertisement Verily’s latest Parkinson’s workWearables could also be a boon for researchers and clinicians working with patients with Parkinson’s disease cheap kamagra 100mg. If they can accurately detect symptoms, wearables could enable more precise drug dosing, bolster monitoring, and help enroll a broader subset of people in clinical trials for novel treatments.

Building on previous research showing sensors can be used to quantify symptoms, Verily published a paper evaluating a new smartwatch-based virtual exam for Parkinson’s patients.advertisement In the study, 370 participants were guided through weekly exams consisting of various motor tasks carried out while wearing the Verily Study Watch, which also let users input when they took their medication. The researchers say the results across more than 22,600 cheap kamagra 100mg exams point to impressive engagement. In the first week, 80% of participants had completed at least one exam. In week 52, 40% did at least one exam. Moreover, the researchers were able to develop reliable digital measures for symptoms cheap kamagra 100mg like upper-extremity bradykinesia and rest tremor.

In short. People will use the exam and it can yield useful data, but as with much early work, more study is necessary before it’s widely deployed.Avoiding Amazon?. Between its forays into providing primary care and cheap kamagra 100mg delivering prescriptions, Amazon‘s designs on health care are well established. But some large health care organizations may balk at handing over their data to Amazon’s cloud arm, AWS. A new Forrester report highlighting best practices for health care in the cloud notes that while Amazon is unlikely to be the kind of disruptor in health care that it was in retail, decision makers still ought to to carefully assess whether Amazon is a friend or a foe.

€œChoose the cheap kamagra 100mg path you’ll take. Avoiding AWS or partnering with it,” the authors write. €œSmaller [health care organizations] choose AWS for its convenience and presence in the healthcare space. Larger HCO networks may choose to avoid AWS completely and use Azure or Google Cloud Platform or even build a private cloud platform.”Deals and newsHomeward, the rural health care startup launched in March by Livongo veteran Jennifer Schneider, inked a deal to put cheap kamagra 100mg its “mobile care units” at Rite Aid locations, beginning with select stores in Michigan. The hope is that pharmacists will help point Medicare-eligible customers to Homeward for wellness visits and certain screenings.Cognoa announced it’s partnering with University of Missouri ECHO Autism Communities Research Team on a real-world evidence study of its FDA-cleared software that aids the diagnosis of autism.

The goal is to evaluate the effectiveness of the tool as part of a primary care diagnostic path. Many children with autism face significant delays in diagnosis, hindering early interventions that improve long-term outcomes.Blue Note Therapeutics will make attune, its software that treats cancer-related anxiety and depression, available through OncoHealth’s virtual cancer care platform cheap kamagra 100mg. Attune has not been cleared by FDA and is currently available under a kamagra policy.Personnel fileWoebot Health, which develops chatbots for treating mental health conditions, appointed Moses Ike as chief financial officer. Ike previously served as VP and head of M&A and corporate development at Paradigm Corporation and director of venture investments and corporate development for Blue Shield of California. With the new M&A expertise, one could ask what Woebot might be getting ready to buy…Care collaboration tech company Bamboo cheap kamagra 100mg Health — the new entity combining Appriss and Patient Ping — named Guy Mansueto its chief marketing officer.

Mansueto was most recently chief marketing officer at medical equipment supplier PartsSource.What we’re readingHow the health and human services department is staving off hackers, PoliticoTelehealth, primary care and urgent care centers still plague hospital margins, Healthcare FinanceCompanies can’t make CAR-T cells for cancer treatment quickly enough. Here’s what they’re doing about it, STATA study finds that telemedicine and in-person evaluation had similar diagnosis rates for genetic conditions among pediatric patients, Pediatrics.