Review of:Richard F. Gombrich. What the Buddha Thought. London: Equinox Pub., 2009. xv + 240 pp. 95.00(cloth),ISBN978−1−84553−612−1;95.00 (cloth), ISBN 978-1-84553-612-1; 24.95 (paper), ISBN 978-1-84553-614-5

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‘Paying Attention’ in a Digital Economy: Reflections on the Role of Analysis and Judgement Within Contemporary Discourses of Mindfulness and Comparisons with Classical Buddhist Accounts of Sati

This chapter examines the question of the role of intellectual analysis and ethical judgement in ancient Indian Buddhist accounts of sati and contemporary discourses about ‘mindfulness’. Attention is paid to the role of paññ? (Sanskrit: prajñ?: ‘wisdom’ or ‘analytical insight’) and ethical reflection in the cultivation of sati in mainstream Abhidharma and early Mah?y?na philosophical discussions in India, noting the existence of a subordinate strand of Buddhist thought which focuses upon the non-conceptuality of final awakening (bodhi) and the quiescence of mind. Modern discourses of mindfulness are examined in relation to detraditionalization, the global spread of capitalism and widespread adoption of new information technologies. It is argued that analysis of the exponential growth in popularity of ‘mindfulness’ techniques must be linked to an exploration of the modern history of attention, more specifically, the possibility that the use of fast-paced, digital, multimedia technologies is facilitating a demand for fragmented or dispersed attention. It is argued that the fault line between divergent contemporary accounts of mindfulness can be seen most clearly over the issue of the role of ethical judgements and mental ratiocination within mindfulness practice. The two most extreme versions on this spectrum see mindfulness on the one hand as a secular mental technology for calming the mind and reducing stress and discomfort, and on the other as a deeply ethical and experiential realization of the geopolitics of human experience. These, it is suggested, constitute an emerging discursive split in accounts of mindfulness reflective of divergent responses to the social, economic, political and technological changes occurring in relation to the global spread of neoliberal forms of capitalism

Taking reincarnation seriously: Critical discussion of some central ideas from John Hick

Reincarnation has not been entirely neglected in the philosophy of religion but it has not always been taken seriously or carefully discussed in relation to its role in believers’ lives. John Hick is exceptional insofar as he gave sustained attention to the belief, at least as it features in the philosophies of Vedānta and Buddhism. While acknowledging the value of Hick’s recognition of the variety of reincarnation beliefs, this article critically engages with certain aspects of his approach. It argues that Hick’s search for a ‘criterion’ of reincarnation is misguided, and that his distinction between ‘factual’ and ‘mythic’ forms of the doctrine is over-simplifying

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme