'I Do It All Alone': The Burdens and Benefits of Being Diagnosed With, and Treated for, Colorectal Cancer During the Covid-19 Pandemic.

INTRODUCTION: The Covid-19 pandemic dramatically altered the way cancer care services were accessed and delivered, including for colorectal cancer (CRC). In the United Kingdom, patients were discouraged from presenting in primary care, many consultations took place remotely, investigative procedures and screening programmes were temporarily suspended, and fewer operations and treatments were delivered. People had to face the practical consequences of having cancer during a pandemic and navigate never before seen pathways, often alone. We examined the experience of being diagnosed and treated for CRC during the pandemic, and the implications of this on people's cancer journeys. METHODS: Semi-structured interviews were undertaken with people diagnosed with CRC during the Covid-19 pandemic (January 2020-May 2021), in the North East of England. An iterative topic guide was used during interviews, which took place remotely (telephone or Zoom), were audio recorded, pseudo-anonymised and transcribed. Initial transcripts were independently coded by two researchers, and a code 'bank' developed for application across transcripts. Development of themes and overarching analytical constructs was undertaken collaboratively by the research team. RESULTS: Interviews were conducted with 19 participants, analysed and four key themes identified: (1) The relative threats of Covid-19 and Cancer were not comparable, with cancer seen as posing a far greater risk than Covid-19; (2) Remote consultations were problematic, affecting patients' abilities to build rapport and trust with clinicians, assess nonverbal communication, and feel able to disclose, comprehend and retain information; (3) Stoma follow-up care was seen to be lacking, with long wait times for stoma reversal experienced by some; Finally, (4) Being alone during consultations negatively impacted some peoples' abilities to absorb information, and left them without the support of loved ones at an emotionally vulnerable time. However, some participants preferred being alone at certain points in their pathways, including receiving a diagnosis, and most frequently when receiving in-patient treatment. CONCLUSION: Being alone brought unexpected benefits, absolving people from undertaking emotions work for others, and instead focus on their recovery, however, remote consultations negatively impacted patients' experiences. This study highlights the complex benefits and burdens of pandemic-located cancer journeys, including how these shifted at different points across cancer pathways. PATIENT OR PUBLIC CONTRIBUTION: Lorraine Angell, a cancer survivor, has been central to this study from idea conception, contributing to: development of study focus and design; securing funding; production of patient-facing materials; development of interview topic guides; analysis and interpretation of data; and drafting of key findings and manuscripts.

The mental health of migrants living in limbo: A mixed-methods systematic review with meta-analysis.

The number of forcibly displaced people has more than doubled over the past decade. Many people fleeing are left in limbo without a secure pathway to citizenship or residency. This mixed-methods systematic review reports the prevalence of mental disorders in migrants living in limbo, the association between limbo and mental illness, and the experiences of these migrants in high income countries. We searched electronic databases for quantitative and qualitative studies published after January 1, 2010, on mental illness in precarious migrants living in HICs and performed a meta-analysis of prevalence rates. Fifty-eight articles met inclusion criteria. The meta-analysis yielded prevalence rates of 43.0 % for anxiety disorders (95 % CI 29.0-57.0), 49.5 % for depression (40.9-58.0) and 40.8 % for posttraumatic stress disorder (30.7-50.9). Having an insecure status was associated with higher rates of mental illness in most studies comparing migrants in limbo to those with secure status. Six themes emerged from the qualitative synthesis: the threat of deportation, uncertainty, social exclusion, stigmatization, social connection and religion. Clinicians should take an ecosocial approach to care that attends to stressors and symptoms. Furthermore, policymakers can mitigate the development of mental disorders among migrants by adopting policies that ensure rapid pathways to protected status.

Borders and liminality in the right to health of migrants in transit: The case of Colchane in Chile and Necoclí in Colombia.

The absence of the right to health of migrants in transit has evolved into a significant global health concern, particularly in the border regions thus, this study aims to improve knowledge in this area by exploring the effects of the spatio-temporal liminal characteristics at borders in the achievement of the right to health of migrants in transit moving across two of the most transited and dangerous borders in Latin America: Colchane (Chile-Bolivia) and the Darién Gap (Colombia-Panamá). Through a qualitative descriptive multi-case study, we implemented 50 semi-structured interviews (n = 30 in Chile and n = 20 in the Darién/Necoclí) involving national, regional, and local stakeholders. The findings highlight that the fulfilment of the right to health of migrants in transit is hindered by liminal dynamics at the borders. These dynamics include closure of borders, (in)securities, uncertainty and waiting, lack of economic resources, lack of protection to all, liminal politics, and humanitarian interventions. These findings surface how the borders' liminality exacerbates the segregation of migrants in transit by placing them in a temporospatial limbo that undermines their right to health. Our study concludes that not just the politics but also the everyday practices, relationships and social infrastructure at borders impedes the enjoyment of the right to health of distressed migrants in transit. The short-term humanitarian response; illicit dynamics at borders; migratory regulations; and border and cross-border political structures are some of the most significant determinants of health at these borderlands.

The Religious Nature of the Psyche, Semiotic Mediation, and the Evanescence of Identity in Liminality.

von Fircks' (Integrative Psychological and Behavioral Science 1-20, 2003) essay on the experience of meditation is rich in stimuli and insights. This paper aims at extrapolating and developing a germinal element from it: Semiotic mediation constitutes the core of the religious nature of the human psyche. It represents both the drive for transformation in the transcendence of the relational process and the search for stability and fixedness in the immanence of the experience of the present moment. The religiosity of the mind can be considered the expression of a transcendent function of semiosis in the very act of looking at an elsewhere in the present moment. The semiotic mediation of the religious psyche seeks meaning in the very act of creating it.

Jointly enclosed in-between: the collective meaning of liminality in refugees' and other migrants' mental health care.

People on the move are increasingly immobilised between and within state borders, having left 'there' but not allowed to be fully 'here'. This paper presents a nuanced examination of this state of enforced in--betweenness, exploring how refugees and other migrants negotiate collective existence through, despite, and alongside liminality. Drawing on ethnographic data collected at a Swiss Red Cross psychotraumatology centre, the study identifies factors that impede and facilitate the formation of collective identities, with temporal and spatial liminality emerging as the most central collective experience for refugees and other migrants. The findings illustrate how therapists reinforce these bonds by fostering an idealised sense of therapeutic communitas that promotes unity in adversity. However, the paper refrains from reducing the collective significance of liminality to a mere act of defiance. Instead, it critically reflects on how refugees and other migrants forge collective connections within politically and legally imposed disconnection. It accounts for the paradox of refugees and other migrants making collective lives in liminality while confronting the always-imminent possibility of this very liminality dismantling their lives.

Viktor von Weizsäcker's Notion of Pathic: Affective Liminality, Modalization of Experience and Illness.

The work presents and discusses Viktor von Weizsäcker's notion of pathic. This concept developed over the course of thirty years represents the culmination of his theoretical thought. The pathic (das Pathische) is closely related to the meaning of 'pathological' and to the meaning of 'suffering'. Yet the pathic does not designate neither a condition of mere illness nor a condition of passivity. Pathic can be considered as the essential nature of the becoming in contrast with the ontic existence. The pathic assumes the changing form of five modal expressions ('will', 'can', 'may', 'shall' and 'must'). The pathic refers the way through which the liminal relationship of the living being with the world and its becoming is expressed. Life is a modal tension between the coming into the world and the coming out of it, so the pathic is the mutable subjective form of this tension. The pathic is the core notion at basis of the foundation of a new medical anthropology where the intersubjective doctor-patient relationship is of the most importance.

Feet in Hell, Spirit in Heaven: Spiritual Transformation of Chinese Travelers on the Camino de Santiago.

The study aims to understand the precursors, catalysts, and dimensions of the spiritual transformation of Chinese travelers on the Camino de Santiago, a pilgrimage-tourist route in Spain. This research has adopted the theoretical framework of spiritual transformation by Pargament and his colleagues in collecting the transformative experience of Chinese Camino travelers reported in 139 blogs and stories. Thematic analysis is employed in analyzing the data. The study results show that Chinese travelers underwent spiritually transformative experiences, as observed in the changes in their relationship to themselves, others, nature, and the transcendent. These four dimensions are interconnected and experienced as something integrated with Chinese cultural and spiritual traditions. This study also explores the transculturality of spiritual experience, the important role of embodied engagement, and the critical and essential qualities of liminality in the transformative process on the Camino de Santiago.

Accompaniment and Bearing Witness: The Path Through Liminal Spaces in Healthcare.

Clinician-healers bear witness to suffering and accompany patients and families through the liminal spaces of an illness experience. Bearing witness to a patient's suffering is a form of attunement toward the ill or hospitalized person. Non-action, or wu wei, becomes illustrative of the empathy that develops as clinicians bear witness to the suffering of patients and families. This empathic response highlights the clinician's moral obligation to accompany their patients. Accompaniment is a form of "co-action" which orients the clinician to a mutual relationship with patients and families. Co-action incites new meaning-making within the liminal spaces and holds the potential to change the clinician's identity as practitioner and healer.

A Theoretically Informed Critical Review of Research Applying the Concept of Liminality to Understand Experiences with Cancer: Implications for a New Oncological Agenda in Health Psychology.

Liminality was described more than 20 years ago as a major category explaining how cancer is experienced. Since then, it has been widely used in the field of oncology research, particularly by those using qualitative methods to study patient experience. This body of work has great potential to illuminate the subjective dimensions of life and death with cancer. However, the review also reveals a tendency for sporadic and opportunistic applications of the concept of liminality. Rather than being developed in a systematic way, liminality theory is being recurrently 're-discovered' in relatively isolated studies, mostly within the realm of qualitative studies of 'patient experience'. This limits the capacity of this approach to influence oncological theory and practice. In providing a theoretically informed critical review of liminality literature in the field of oncology, this paper proposes ways of systematizing liminality research in line with a processual ontology. In so doing, it argues for a closer engagement with the source theory and data, and with more recent liminality theory, and it sketches the broad epistemological consequences and applications.

Liminality and insecurity: A qualitative study of young adults' vulnerabilities during the first twelve months of COVID-19 in Australia.

COVID-19 has disrupted the normative social order, particularly for young adults. Their deteriorating mental health over 2020 has been associated with the economic and social conditions during the COVID-19 lockdowns. We conducted 19 semi-structured interviews with young adults aged 8 and 29 most of whom lived in Victoria, Australia. The interviews explored participants' experiences and responses to COVID-19, covering areas such as disrupted everyday practices and future plans, impacts on their physical and mental health, and interactions with community and services. Young adults were concerned about loss of social connectedness, their mental health and the complex interplay of issues such as employment, income, education and housing. They developed routines to protect their physical and mental health while in lockdown and some made the most of new opportunities. However, the pandemic may have had a profound effect by disrupting some young adults' plans for the future, thus contributing to a sense of ontological insecurity.

Politics in Transitional Spaces: Direct and Indirect Political Participation.

This paper seeks to build on Carriere's (2022) work on the complex, pervasive, and dialogical nature of politics and extend this treatment to examine the politics of the transitional, liminal, and "in-between spaces." In particular, we analyze the theatrical nature of politics by examining how roads and streets become a "dynamic stage" (Valsiner, 2004, p. 2) where private and public policies enter into dynamic dialogical relationships. We distinguish between direct, direct but distanced, and indirect peripheral political participation and explore how roads and streets enable redundant and dramatic communicative processes that feed into the internalization/externalization meaning-making processes (Valsiner, 2014). Finally, we analyze the process of the emergence of roads and streets as a result of complex interactions between public policies, ordinances, and values. We extend this exploration to an illustrative case in Oahu, Hawai'i to demonstrate how streets become constructed and organized to provide affective guidance. We conclude by arguing that the absence of political messages or overt political actions does not mean the absence of politics - power dynamics are still at play in the liminal and transitional zones of human living.

Liminal design: A conceptual framework and three-step approach for developing technology that delivers transcendence and deeper experiences.

As ubiquitous technology is increasingly mediating our relationships with the world and others, we argue that the sublime is struggling to find room in product design primarily aimed at commercial and transactional goals such as speed and efficiency. We suggest a new category of products to promote deeper and more meaningful experiences, specifically those offering liminality, transcendence, and personal transformation. This paper introduces a conceptual framework and three-step design approach looking at narrative participation in design through abstractions to promote, hold and deepen more complex emotions. We explore implications from a theoretical point of view and suggest product examples for how the model might be applied in practice.

The University Couloir: Exploring Physical and Intellectual Connectivity.

Connectivity in both its tangible and intangible forms is a fundamental feature of all aspects of university life though often overlooked in much of the relevant literature. Using the metaphor of the couloir, this paper will examine features of university design and organisation which contribute to this connectivity, in its various senses, across the institution. A typology of connectivity features is proposed, setting efficiency of movement against possibilities for social interaction, with another axis contrasting open/public against closed/private spaces. Universities, which everywhere have both public and private dimensions, seem to have features that occupy a central place in this typology, highlighting the multifaceted nature of connectivity in university life. The significance of connectivity should inform a range of institutional policies affecting space design and use as well as methods in teaching and learning.

Sex Workers' Everyday Security in the Netherlands and the Impact of COVID-19.

Introduction: The COVID-19 pandemic has laid bare and exacerbates the existing insecurities of sex workers. This paper asks: What are sex workers' everyday experiences of (in)security? And: How has the COVID-19 pandemic influenced these? Methods: We engage with these questions through collaborative research based on semi-structured interviews carried out in 2019 and 2020 with sex workers in The Hague, the Netherlands. Results: Revealing a stark mismatch between the insecurities that sex workers' experience and the concerns enshrined in regulation, our analysis shows that sex workers' everyday insecurities involve diverse concerns regarding their occupational safety and health, highlighting that work insecurity is more multi-faceted than sexually transmitted infections (STIs). Widespread employment and income insecurities for sex workers are exacerbated for transwomen and male sex workers. Their legal liminality is enabled not only by the opaque legal status of sex work in the Netherlands, but also by the gendering of official regulation. The COVID-19 pandemic made visible how the sexual and gender norms that informally govern sex workers' working conditions intersect with hierarchies of citizenship, complicating access to COVID-19 support, particularly for migrant sex workers. Conclusions: Sex work regulation in the Netherlands leaves workers in a limbo-not without obligations and surveillance, yet, without the full guarantee of their labour rights. Policy Implications: To effectively address sex workers' insecurities, a shift in regulation from its current biopolitical focus to a labour approach is necessary. Besides, public policy and civil society actors alike need to address the sex industry's harmful social regulation through hierarchies of gender, sexuality and race.

Understanding the subjective experiences of memory concern and MCI diagnosis: A scoping review.

INTRODUCTION: Many older people experience memory concerns; a minority receive a diagnosis of Mild Cognitive Impairment (MCI) or Subjective Cognitive decline (SCD). There are concerns that medicalisation of MCI and memory concern may fail to acknowledge subjective experiences. AIM: We explore the meaning individuals give to their memory concerns, with or without a diagnosis of MCI and SCD. METHOD: We scoped literature exploring subjective experiences of memory concern, with or without a diagnosis of MCI or SCD. We searched CINAHL, PsycINFO and MEDLINE in March 2020, and updated in Sept 2021.We used (Arksey & O'Malley, 2005) framework to guide our scoping review method and thematic analysis to analyse our findings. RESULTS: We screened 12,033 search results reviewing the full texts of 92 papers. We included 24 papers, including a total of 453 participants, the majority of whom were female, from White ethnic majority populations (or from studies where ethnicity was not identified) with high levels of education. In 15 out of 24 studies, 272 participants were diagnosed with MCI. We identified two themes; Making a diagnosis personal and Remembering not to forget. We found that subjective experiences include normative comparison with others of the same age and responses including fear, relief, and acceptance, but culminating in uncertainty. CONCLUSION: Drawing upon sociology, we highlight the subjective experiences of living with memory concerns, SCD and an MCI diagnosis. We identify a gap between the intended purpose of diagnostic labels to bring understanding and certainty and the lived experiences of those ascribed them.

Latinx immigrant experiences with chronic illness management in Central Texas: reframing agency and liminality through nepantla.

Immigrant rights have become increasingly contentious and partisan issues in the United States, and especially within the U.S. healthcare system. It is particularly essential to pay attention to Latinx immigrants-the largest immigrant and uninsured population in the United States. Latinx immigrants face many structural and legal challenges that may impact their biomedical healthcare access and treatment, creating a state of liminality or in-betweenness, especially when managing a chronic illness such as diabetes, hypertension, or arthritis. Using qualitative methods at a free healthcare clinic in Central Texas, the study reveals how the chronic illness narrative becomes inextricable from the immigrant narrative for this particular group, and how a unique 'dual-liminality' emerges from living with both an immigrant status and chronic condition. This study also introduces how Gloria Anzaldúa's theory of nepantla can be used to push existing understandings of migrant liminality in medical anthropology by reframing the experiences of U.S. Latinx immigrants with chronic illness as ones of opportunity. Nepantla functions as a novel theoretical lens to better understand how Latinx immigrants may regain agency in their chronic illness management and promote social change by helping others in similar situations.

Kin or Research Material? Exploring IVF Couples' Perceptions about the Human Embryo and Implications for Disposition Decisions in Norway.

In vitro fertilization (IVF) involves making embryos outside of the human body, which has spurred debate about the status of the embryo, embryo research and donation. We explore couples' perceptions about embryos and their thoughts and acceptability about various disposition decisions in Norway. Based on an ethnographic study including interviews and observations in an IVF clinic, we show that couples do not perceive their pre-implantation IVF embryos to be human lives; rather, they consider successful implantation the start of life. We suggest that this response indicates a change in the perception of the human embryo or the fertilised egg from incipient life-a viewpoint that was dominant in the discussions of embryo research in the 1980s and 1990s. We also show how this view of the pre-implantation embryo elucidates why donating embryos to research appears acceptable but donating to other infertile couples seems rather difficult. Before transfer to a woman's uterus, the embryo exists in a liminality; it is not yet human life but a living cell with potential for both research and pregnancy. When an embryo is implanted and pregnancy is confirmed, human life activates; the embryo becomes potential kin, influencing couples' struggles with donating embryos to other couples.

Enabling Spaces; Rethinking Materiality and the Invitational Character of Institutional Environments.

This article explores how physical surroundings may be integrated as a supportive measure in social work efforts. Drawing on ecological psychology and the concept of liminality, the article presents a case study of Kofoed's School (KS), a social institution in Copenhagen, Denmark. In recent years, KS has undergone a major renovation, opening up previously sheltered workshops to the public. By creating liminal spaces of possibility, where students can take up "both/and" positions allowing for a multitude of ways to participate, students are experiencing increased support and inclusion, which contributes to a growing feeling of citizenship and well-being. Drawing on participant observations and interviews with students, staff members, as well as customers at the school's shops, we explore how the architectural layout may facilitate students' flexible and fluid movements between more or less sheltered positions and further discuss how this flexibility may become supportive for their personal development and well-being. We propose to think of such spaces of possibility as enabling spaces, where inclusive architecture contributes to the creation of new possibilities for participation for people in marginalized life positions. This, we suggest, holds a great potential for social work efforts for people experiencing complex social vulnerability.