The main objective of this research was to propose a framework centred on the dynamic capabilities approach, and to be applied in the context of family businesses’ adaption to their changing business environment. Data were gathered through interviews with ten FBs operating in Western Australia. Based on the findings, the clusters of activities, sensing, seizing, and transforming emerged as key factors for firms’ adaptation, and were reinforced by firms’ open culture, signature processes, idiosyncratic knowledge, and valuable, rare, inimitable and non-substitutable attributes. Thus, the usefulness of the proposed framework was confirmed. Implications and future research opportunities are presented. Past and current research documents the significance of family businesses (FBs) for different economies  are FBs leveraging to remain competitive in such environment?According to Gedajlovic et al. , examiniRQ2: How is the DCA manifested in the context of the participating FBs?The focus of this research on adaptability provided strong justification and emphasis on the importance of instrumental ways through which FBs build adaptive capabilities and resilience. Chirico and Salvato  postulatSome studies have suggested the nexus between family firm members and the development of adaptive instruments for firms to adapt and become more resilient. For example, McDonald and Marshall  explaineOther mechanisms have been suggested to have important implications for FBs’ competitiveness, and therefore play a key strategic role in allowing them to become more adaptive and resilient. In fact, Lee and Marshall  found thBy extending this body of knowledge, this study was conducted with family firms operating in Western Australia, and has made several important contribution to the extant FB literature. Fundamentally, it helped narrow several knowledge gaps presented in previous studies  does the FB exploit to address the changing environment in which they operate?According to Marshall et al. , data saIn order to maximise consistency and transparency, the interview data were transcribed and cross-checked by members of the research team. The data were analysed employing qualitative content analysis (QCA), which Schreier , p. 1 deConsequently, QCA has precise characteristics. First, as a method QCA emphasises context and subject, as well as similarities and differences between categories or codes  as many as 400. Based on the Australian Bureau of Statistics’ ABS  definitiThe content analysis undertaken Table  helped sIn five cases, participants’ comments suggested that the need for adaptive measures had been triggered by changes in the market, particularly through greater consumer demand Table . For exaWe’re also doing a baby food line… you utilise all of those vegetables and fruits. They all come out as purees that you can turn into baby food… in the food service options, I sort of became aware of a bit of a raw deal that aged care facilities get in Australia. So I made it a bit of a mission that I wanted to do something about that…Establishing networks with other producer associations to begin exports, or to help the FB develop its baby food project was also an essential element differentiating this firm: “Although I’m in the avocado industry, I actually know people in lots of industries, across the board…” This finding found support in the contemporary literature, with Zheng et al. , positinWhat’s important is that team element, and realising that everyone has different strengths and weaknesses, but as a group we’re quite strong because we back each other.” The firm’s open culture, together with idiosyncratic knowledge of the operational side of the industry, as well as knowledge of significant stakeholders, signature processes, home-grown capabilities and VRIN attributes, clearly represented sources of competitive advantage.Jennie’s case also illustrated that, if properly operationalised, different demands, needs and wants in firms’ business environment could be turned into unique commercial opportunities. Notably, in line with Chirico and Nordqvist , Jennie’The cases of Tim, Sam, Marie and John also demonstrated similar characteristics. For example, having experienced currency fluctuations that had affected the FB’s earlier exporting endeavours, Tim underlined the importance of sensing and seizing Teece . After fWe grow about twice as much product as what we need per week, because every week we’re selling products somewhere. Business is quite different, [so] you’ve got to make sure that you have enough product to supply everybody you know…The next form for value adding corn would be partially cooking.”Sensing and transforming also became evident when the participant commented on a proposed trip to Germany to observe new fresh produce growing techniques, and when he anticipated future trends in consumer demands: “Partly aligned with Tim’s case, Sam’s firm was experiencing the rapidly changing fresh produce consumer environment. After buying over the firm, which had gone through receivership, Sam had worked to increase the FB’s involvement in international exports. At the same time, he focused on decreasing wholesales to domestic supermarkets, thereby adding vital value to its food production. Sam explained that the firm now sold as much domestically as internationally, which represented a notable development, given that prior to this change 75% of Sam’s production was sold domestically.We wore the agricultural risk… the economic risk, all the commercial risk as well… and I just didn’t see the point.” While increasing exports also had risks, including those associated with currency fluctuations, the firm had accumulated industry knowledge and expertise to implement key strategies:Through this experience, Sam learned the importance of becoming less dependent on large supermarkets: “We’re probably a little bit unique, we sell everything at a fixed price to all our customers, domestic and exports, so we wear the agricultural risk but our customers wear the currency risk. And that’s across all markets…everyone buys in Aussie dollars.We did spend a lot of time getting the cold chain right and that’s probably the key part of our business. It does come at a cost though, between electricity and equipment costs…but it’s definitely been worth it.” Innovating and differentiating from competitors was also demonstrated in the firm’s commitment to use more environmentally-friendly energy sources: “70–80% of all our energy needs come from wind [-generated energy].” Sam’s experience illustrated the importance of process innovation, or the introduction of new—or considerably improved—production, administrative, or supply chain processes  were also experiencing an increase in demand for their products, and had perceived the potential for value adding through their product offerings, which again illustrates an alignment with seizing and transforming Teece . Marie aThe significance of adding value to food production and strong relationships with end consumers also became evident in John’s case. The participant recognised that his firm set itself apart from many other farming operations, in that from the outset, it employed direct marketing for its products and developed unique packaging for its meats. The FB’s long history in the industry, acquiring market knowledge, skills and critical insights helped the firm to respond to consumer trends, thereby sensing and seizing opportunities. For instance, the firm employed the strategy of only producing organic beef, a product with significant appeal for niche and lucrative markets.Transformation was also revealed in the firm’s evolution, from selling domestically, to entering exports markets. In fact, the participant acknowledged making significant strides in this part of the business, starting in Singapore, and planning to continue exports to the Middle East. The focus on niche markets was also reflected in the firm’s involvement with local high-end clients, including a luxury hotel in Perth, and selling to people with whom John’s firm had established solid business relationships:Generally the guys that we deal with, we’ve dealt with them for a long time. They know the product, they appreciate that they may pay a bit more for it, they recognise what it is, and they’re happy to work with us.This finding was associated with network embeddedness  identified the continuous transformation of her business during more than 120 years of existence, from being first a grocery store, then entering the fresh seafood sector to become a major supplier and wholesaler, and finally a logistics company. The knowledge and expertise accumulated over such a long time and through several family generations facilitated such transformation. For instance, Ely reflected on the significant recognition and numerous awards obtained, as well as on the company’s strengths, which constituted a strong foundation for its performance and sustained competitive advantage:We can get products to customers wherever they may be…we process every day fresh fish and we’ll supply it with all our orders to restaurants, hotels and whoever it may be… We are known in the industry for providing high service. We have people taking telephone orders, so chefs, after they finish in the restaurants at night, before they close they can call us up to ten pm and place an order for next-day delivery.Logistically… we have branches up north… our competitors don’t have that, so they can’t access the markets, [or] ships they don’t supply…”The above comments illustrated strong relationships with all the elements interconnecting DCs and the DCA, including the firm’s organisational heritage, its (open) culture to change, home-grown capabilities, idiosyncratic knowledge and VRIN attributes. As with Marie, Ely’s case also highlighted the importance of the human component, or direct communication and highly personalised service with its clients, which also constituted a source of competitive advantage. “Seizing” was clearly reflected in the careful and systematic service provision, and was further complemented by reliable and unrivalled delivery options (Ely): “The firm’s provision of high quality and personalised logistic services is partly aligned with Rothaermel and Hess’s  researchThe cases of Dan and Rose illustrated two FBs with previous exporting experience that were now adapting to a new business reality in different ways. While traditionally focusing on the state of Western Australia, Rose’s firm had made significant investments in recent years to adapt and have a stronger presence in other Australian markets:…with most of the population of Australia on the east coast…for us and our product, which has a short shelf life, it’s a difficult supply chain to manage…that’s why we have a factory on the east coast, and we’re currently going through a process of establishing a bigger factory on the east coast, just so that we can get close to the market.Additionally, in order to remain competitive against other larger manufacturers of meat products, Rose recognised that the firm strongly communicated and met with their international meat providers, often travelling internationally. The firm also accessed large quantities of data to gain more explicit knowledge of what consumers were buying. This learning process was particularly useful when developing new products, including new meat flavouring , or products with salt and fat reduction.Throughout his more than 40 years of experience in the stone fruit industry, Dan had noticed the continuous transformation of the stone fruit sector. Indeed, due to increasing labour costs and the increasingly high value of the Australian dollar, both fruit canning and exporting had experienced strong decline. Now near retirement age, and using his extensive knowledge of the region and state, the participant and his brother made a decision to diversify into tourism, acquiring a bus to provide tours to and outside the region. At the same time, during and after the harvesting season, the firm continued to add value to his stone fruit production by selling onsite, taking advantage of the orchard’s unique location next to a main road.It’s a never-ending evolution of product enhancements that we’re seeing… over the last three to five years we’ve all had to start to comply with proper codes… So I’ve seen a real shift in compliance…”Being the second family generation, and operating in Western Australia’s north, hours away from Perth, Rob’s firm had accumulated valuable knowledge and expertise in the area of installation of glass materials . However, as suggested in Table As a result, the firm’s management was compelled to learn and apply its knowledge as well as expertise to take on the challenge of compliance. Moreover, management were keen to invest in order to see and experience first-hand new products or designs. In this regard, Rob acknowledged that the firm played a leading role in its region:…up to a about a decade ago nobody did [engage in research], but we started to travel to some of the industry events over in Germany and China and certainly saw what was happening around the globe and realised there was an opportunity to expand…Again, the importance of sensing, seizing, and transforming was revealed in Rob’s case. By making crucial changes, notably, being up-to-date with compliance requirements, or investing in gathering key strategic knowledge, the firm differentiated itself from other, and, arguably, built its competitive advantage.Our connections across the coffee network have been growing, sourcing from other suppliers, and the different ways that they do business.” This strategic advantage became essential in competitively managing the logistics of importing coffee, saving crucial time and enabling the firm to navigate through complex regulations and paper work requirements in the country of origin.Finally, having owned an import business for less than a decade, Nick’s case demonstrates associations with signature processes , accumulating, operationalising and maximising (seizing) valuable resources, alongside reinventing or extending their repertoire of resources (transforming) is crucial. From a practical perspective, one key implication is that, no matter how successful the business is, FB entrepreneurs must be prepared for continuous transformation and change. While there is evidence that some FBs may be prone to being static entities and therefore unwilling to change  and suggested in Fig. While the study provides useful insights, it also has various limitations. First, although the majority of the sampled FBs had existed for two or more generations, amassed a wealth of knowledge and expertise, and were leaders in their industries and region, that only ten participated limits the generalisability of the study. Second, the study also lacks a component of diversity across different industries, with a predominance of FBs operating in the food growing, supplier, and manufacturing sectors. Third, despite operating in other Australian states as well as internationally, all FBs are currently based in Western Australia. Future research could address these limitations by gathering the perspectives of FBs in other Australian states, increasing the number of participants, and widen the research scope to include firms operating in other sectors/industries, thus, providing opportunities for comparative analyses.Similarly, future research could consider a cross-country perspective, combining Australian FBs with those of other nations to produce comparisons. These propositions for future research could illuminate practitioners and academics to the nuanced and innovative ways in which FBs operating in different locations and industries are building their DCs and adapting. Finally, researchers could consider adopting, confirming/disconfirming, refining or further developing this study’s proposed framework. Given the limited adoption of the DCA to study FBs identified in the literature (Jones et al.


Do all teeth show the same wear traces when processing the same diet, or do the wear traces of the same diet differ between species, maybe due to differences in tooth morphology or chewing physiology? Questions like this one can be tested using appropriate biological and statistical methods. Without such tests, claiming that a certain proxy of tooth wear represents a “taxon‐free” signal remains a hypothesis. It additionally hints, in the bolded part, at the possibility that some phylogeny‐related traits influence the way a food leaves wear traces on teeth. And this is the real bone of contention: that the same food might lead to different wear patterns in different species.In a recent study, Fraser, Haupt, and Barr  demonstrHowever, Fraser et al.  did not As a response to Fraser et al. , DeSantiWith respect to tooth wear, DeSantis et al.  do not c


As a trained and licensed doctor, society expects you to consistently provide the best care based on sound judgment of comprehensive patient histories and thorough clinical examinations, while respecting patient autonomy by encouraging shared treatment decision making. A prerequisite for the latter is that the patient receives sufficient unbiased information regarding alternative interventions, including no therapy, and their likely prognoses.However, many times in medicine, the pertinent information is convoluted or nonexistent. In these circumstances, healthcare providers choose different strategies on how to advise the patient or the public. If any RCTs are deemed methodologically weak or fail to focus on a weighty outcome, should a particular intervention be postponed or denied or should the logic proposed by William Osler , or by A… most cases of infective endocarditis are due to everyday life bacteraemia.”  is a rare and complex disease associated with high morbidity and mortality and characterized by a multifactorial etiopathogenesis. Causative microorganisms are identified by blood culture or by polymerase chain reaction (PCR) and are in decreasing order, staphylococci, streptococci, enterococci, and HACEK organisms. Streptococci used to be the most common microorganism until about a decade ago, which is a reflection of changes of underlying causal factors for contracting I.E.  over 17 years .Lastly, be also reminded when we provide any recommendations to our students and patients of the quote by a famous French writer and philosopher, “


In 2016, three researchers published a report where they concluded that systematic reviews from my institution, the Norwegian Knowledge Centre for the Health Services, are of little use for health policy decision-making. Based on their reading of the conclusion section in 14 reports, they argue that our systematic reviews are not useful due to their lack of clear and conclusive findings. I have reviewed the same documents and I beg to differ. Unfortunately, the description of their methodological approach is both sparse and difficult to grasp, making it very hard to understand how they arrived at their conclusions.The online version of this article (10.1186/s12961-018-0386-x) contains supplementary material, which is available to authorized users. The Norwegian Knowledge Centre, like many other organisations around the world, produces systematic reviews to support evidence-informed decisions in the health services and in health policy. At the Centre  we prepare systematic reviews for a range of commissioners, including government bodies, professional groups, and patient organisations. Systematic reviews are generally regarded as more reliable than single studies because they provide a more comprehensive representation of the available evidence . In our Health Research Policy and Systems, Malterud, Bjelland and Elvbakken conclude that the systematic reviews prepared by my institution are inappropriate for health policy decision-making nlyone of these 14 SRs from 2012 ) concluded that extensive and high quality documentation had been identified. While the report identified a range of effective interventions, the language of caution again appeared . Another related SR, dealing with interventions regarding nutrition, physical activity, obesity and sexual health in children and adolescents (06-2012), reported that substantial documentation allowed the authors to draw some conclusions. Nevertheless, they expressed some reservations about the broad scope of the documentation, which meant that the recommended interventions were at a rather general level. For the remaining 12 SRs, the authors’ conclusions are characterized in every case by an overarching caution”.They based their analysis on the conclusions from a “Leaving aside the argument that demonstrating uncertainty may be useful in itself, how did Malterud et al.  go aboutDrawing on perspectives from the rhetorics of health and medicine, we assessed the persuasive power of the conclusions mediated by the language used, especially with regard to terms indicating positions of certainty or reluctance. This process was conducted by systematic negotiation between the authors in pursuit of consensus”.“I finished the methods not entirely sure I know how you carried out the study, it’s unclear and lacking in detail about the ‘how we did it’ information. The casual reader who will glance through the methods will be even more confused” he results are associated with uncertainty as they are based on the efficacy data of a sub-population analysis from only one clinical trial” [Malterud et al.  seem to l trial” .did not include a systematic investigation of uptake and policy consequences”, and I would certainly agree that proof of the usefulness of systematic reviews lies in their actual use. Rather than discarding them, I would propose to develop methods to increase and improve their use in decision-making processes, e.g. through better formats for conveying results to policy-makers [Like Malterud et al., I “y-makers .Therefore, transparent methods are necessary in the evaluation of the usefulness of systematic reviews, as well as of new approaches to improve their usefulness.Additional file 1:Conclusion sections from the 14 included systematic reviews. (DOCX 34 kb)


Smartphones have become crucial in people's everyday lives, including in the medical field. However, as people become close to their smartphones, this leads easily to overuse. Overuse leads to fatigue due to lack of sleep, depressive symptoms, and social relationship failure, and in the case of adolescents, it hinders academic achievement. Self-control solutions are needed, and effective tools can be developed through behavioral analysis. Therefore, the aim of this study was to investigate the determinants of users' intentions to use m-Health for smartphone overuse interventions. A research model was based on TAM and UTAUT, which were modified to be applied to the case of smartphone overuse. The studied population consisted of 400 randomly selected smartphone users aged from 19 to 60 years in South Korea. Structural equation modeling was conducted between variables to test the hypotheses using a 95% confidence interval. Perceived ease of use had a very strong direct positive association with perceived usefulness, and perceived usefulness had a very strong direct positive association with behavioral intention to use. Resistance to change had a direct positive association with behavioral intention to use and, lastly, social norm had a very strong direct positive association with behavioral intention to use. The findings that perceived ease of use influenced perceived usefulness, that perceived usefulness influenced behavioral intention to use, and social norm influenced behavioral intention to use were in accordance with prior related research. Other results that were not consistent with previous research imply that these are unique behavioral findings regarding smartphone overuse. This research identifies the critical factors that need to be considered when implementing systems or solutions in the future for tackling the issue of smartphone overuse. Smartphones have become crucial in our everyday lives, and they affect all sectors from business, to communication, and even to medicine. However, as people become close to their smartphones, they are easily led to engaging in overuse without even acknowledging it. Unfortunately, excessive use sometimes leads to disorders, such as fatigue due to lack of sleep , depressIn our previous research, we proposed the Smartphone Overdependence Management System (SOMS), which is a management system, and solution for overdependence on smartphones . The SOMThe neurophysiological impacts of the devices themselves are also important to consider. There have been several studies that show the biological effects of various waveforms emanating from mobile devices, which cause activation of the sympathetic nervous system (SNS) through oxidative stress and other defined mechanisms , 13. WheThe SOMS is currently in the stage of being implemented in a practical way in order to facilitate the remote monitoring of smartphone overuse by users. Most importantly, for successful intervention, factors affecting the user acceptance of such a system or solution must be evaluated beforehand. Specific services can then be developed or modified as effective solutions that best suit the needs of the user. The Technology Acceptance Model (TAM) and Unified Theory of Acceptance and Use of Technology (UTAUT) model have been frequently used to analyze the factors for acceptance, which will be specifically explained in the study design section in the methods.The definition of smartphone overuse in this article includes all addictive activities, such as excessive use of the internet, playing games, logging on to messenger services, or accessing virtual communities to the extent that the person neglects positive areas of life, which is similar to the definition of Billieux et al. . AlthougTherefore, the aim of this study was to investigate the determinants of the users' intention to use m-Health for smartphone overuse interventions. The research results are expected to identify not only the critical factors to consider when implementing the SOMS, but also to provide successful mainstream guidelines for future systems or solutions that tackle the issue of smartphone overuse, for example, apps that are being released that have screen-time monitors.The research model of this paper was fundamentally based on the TAM and UTAUT models. The TAM is a widely accepted and influential model that predicts users' perceptions or acceptance of information system use –20. The Although this research was based on the TAM and UTAUT, we modified these models by converging, excluding, or including some important variables that were identified as appropriate in the case of smartphone overuse intervention by smartphone apps, as shown in Figure The TAM basically proposes two main factors that determine the users' behavioral intention to use (BIU), which are its perceived usefulness (PU), and perceived ease of use (PEoU). It was also acknowledged by the researchers that, at times, PU acts as a mediator between PEoU and BIU; thus, this was taken into account.In this model, perceived security (PS) was added, since personal security issues in network services have been a threat to many services including in the field of healthcare, which obtains sensitive private information. Altogether, PU, PEoU, and PS comprise the tool characteristics (which represent the technology).Other factors, such as resistance to change (RC) and social norm (SN), were added, with each representing the subjects' characteristics (representative of the users) and environmental characteristics. The research hypotheses were tested in relation to the model proposed above and they are shown in Table The studied population consisted of 400 randomly selected smartphone users aged from 19 to 60 years who were from a social survey institution panel , which was to be extrapolated to the smartphone users of South Korea. Those who had provided written informed consent prior to the survey were accepted. Participants were briefly informed about the SOMS before the survey (shown in the first page of our survey). Participants who were not adults were excluded because of the possibility that they would not understand the research. A brief but sufficient explanation was given about the research before the survey. Participants older than 60 years of age were excluded because they are not accustomed to smartphones.N = 37,454,121). For reliability within the 95% confidence interval, the appropriate recommended sample size was 385. Considering the possibility of missing values, we recruited 15 more people, adding up to a total of 400.The size of the sample population was selected based on the following criteria. According to the July 2017 statistics, ~9 out of 10 adults use smartphones (population n = 200) were selected based on the condition that they had the experience of using similar smartphone usage monitoring/measuring app(s). The other half (n = 200) were selected based on the condition that they did not have any experience of using any similar smartphone usage monitoring/measuring app(s). These groups were evenly selected to prevent a bias of friendliness toward smartphone apps.Only participants who used smartphones for at least 1 h a day were selected. Among them, half , approved the study.In this research, the acceptance (or BIU) of a smartphone overuse monitoring app among smartphone users was the dependent latent variable. The term “smartphone overuse monitoring system” was defined at the beginning of the questionnaire. All questions, except for those that required short-answer questions or socio-demographic information, captured responses through a five-point scale. This five-point Likert scale ranged from “strong negative,” “negative,” “neutral,” “strong,” to “strong positive.” Five survey items were measured for each of the PEoU, PU, PS, RC, SN, and BIU latent variables based on prior TAM- and UTAUT-related research –24, but The PEoU items included “Do you think it will take long to learn the smartphone overuse monitoring system?” (PEoU1), “Do you think that it will be easy to use such a system?” (PEoU2), “Do you think that smartphone overuse treatment will become easier due to this system?” (PEoU3), “Do you think that learning how to use this system will be easy?” (PEoU4), and “Do you think that this system will be hard to use?” .The PU items included “How useful do you think this system will be when learning to control the use of smartphones?” (PU1), “Do you think that doctors and patients will become closer during overuse treatment due to this system?” (PU2), “Do you think that by using this system, needless overuse consulting sessions will decrease?” (PU3), “Do you think that by using this system, the quality of service regarding smartphone overuse treatment will improve?” (PU4), and “Do you think that this system will contribute to reducing misdiagnosis of actual smartphone usage time?” (PU5).The PS items included “Do you think it is safe to transfer your personal smartphone usage information via this system?” PS1), “Do you think that this system has sufficient security to transmit personal information?” (PS2), “Would you feel safe when transmitting personal information via this system?” (PS3), “Do you think that using smartphones is a reliable way to transmit personal information?” (PS4), and “Would you feel uncomfortable when transmitting smartphone usage information via this system?”  , “Do you find this system, which may change the current method of diagnosing smartphone overuse, repulsive?” (RC2), “Do you find this system, which could bring some change to your way of life, repulsive?” (RC3), “Are you willing to accept this ICT applied system?” , and “Are you willing to accept this system, which is expected to change the current method of diagnosing smartphone overuse?” (RC5).The SN items included “Do you think your family or friends will agree with you using this system?” (SN1), “Do you think your friends or coworkers will think positively about you using this system?” (SN2), “Do you think that doctors will be positive about this system?” (SN3), “How negatively do you think your family or friends will think about you using this system?” (SN4), and “How negatively do you think your friends or coworkers will think about you using this system?” (SN5).Lastly, the BIU items included “If you were to use a smartphone overuse prevention or treatment service, would you consider using this system?” (BIU1), “If the opportunity arises, would you recommend this system?” (BIU2), “If the opportunity arises for you to use this system, would you use it?” (BIU3), “If this system was implemented as an actual service, what are the chances that you will use it?” (BIU4), and “If this system was implemented as an actual service, would you be willing to pay the right amount of fees to use this system's service?” (BIU5).Descriptive statistical analysis was conducted to summarize the overall socio-demographic results. Then, correlation analysis was performed to measure the magnitude of the associations between the independent latent variables and the dependent latent variable for each hypothesis . Structural equation modeling (SEM) was also conducted to test each hypothesis. All statistical analyses were performed using SAS 9.3 with a 95% confidence interval. All values were rounded up to the second decimal place.n = 200) and 50% were women (n = 200). Forty percent were 19 to 29 years old (n = 160), 40% were 30 to 39 years old (n = 160), and 20% were over 40 (n = 80). The most used app was SNS, with a percentage of 48.75 (n = 195).The socio-demographic results are shown in Table n = 128). Most respondents were at least graduate school students  and the most common occupation was white-collar . The most common monthly salary group was 3.7 thousand dollars or more per month . Regarding the perceived socio-economic-status, middle class was the most common .A plurality of respondents lived in Seoul , except for PEoU (0.65); however, this was adequate based on past findings (SD), Cronbach's alpha, factor loading, construct reliability, and average variance extracted of all the constructs.Based on the Kaiser-Meyer-Olkin test, confirmatory factor analysis was not acceptable for some theoretical constructs; therefore, they were excluded. Only acceptable theoretical constructs were chosen, which are shown in Table findings . Table 3The correlation analysis between all the theoretical constructs is shown in Table 2/df) was 2.895 (≤ 3.00 recommended), the goodness-of-fit index (GFI) was 0.884 (≥ 0.90 recommended), the adjusted GFI index (AGFI) was 0.851 (≥ 0.90 recommended), the non-normed fit index (NNFI) was 0.865 (≥ 0.90 recommended), the comparative fit index was 0.906 (≥ 0.90 recommended), and the root mean square residual was 0.063 (≤ 0.08 recommended). Although the values of the GFI, AGFI, and NNFI were slightly lower than recommended, it was concluded that all fit indices were acceptable and supported a reasonable fit assumption.The measurement models' fit indices, including the acceptable thresholds, are shown in Table The results of the SEM are presented in this section. All constructs were in accordance with the results shown in Table Although examined in other fields , the result that Perceived Ease of Use is a significant determinant of Perceived Usefulness is consistent with the findings of numerous previous research studies , 26–28. In addition, the current study's results that show that Perceived Usefulness is a strong and significant determinant of Behavioral Intention to Use are consistent with related research. Deng et al.  found thThe most interesting new finding concerned the relationship between Perceived Ease of Use and Behavioral Intention to Use. The important point here was that, although this research is congruent with other research reporting that Perceived Ease of Use is a significant determinant of Behavioral Intention to Use , 30, theThe results indicating that Perceived Security had no significant influence on Behavioral Intention to Use contradict some previous research. Cimperman et al.  emphasizAnother interesting point is that Resistance to Change had a positive significant effect on Behavioral Intention to Use, which is not consistent with prior research. In terms of smartphone apps vs. electronic medical records, William  found thSocial Norm had a significant effect on Behavioral Intention to Use, which is consistent with prior findings in related fields , 23, 24.The objective of this study was to investigate the factors influencing the users' intention to use a smartphone overuse monitoring app for smartphone overuse prevention and treatment interventions. The findings regarding Perceived Ease of Use influencing Perceived Usefulness, Perceived Usefulness influencing Behavioral Intention to Use, and Social Norm influencing Behavioral Intention to Use were in accordance with previous related research.The core findings regarding the negative influence of Perceived Ease of Use on Behavioral Intention to Use, Perceived Security's non-significant influence on Behavioral Intention to Use, and Resistance to Change's positive influence on Behavioral Intention to Use were in contrast to some meaningful related research. These can be considered to be unique findings related to the smartphone overuse monitoring app intervention, which opens some discussion that requires future research.One limitation of this research is that the population did not include adolescents, who are known to be heavy smartphone users who are particularly susceptible to overusing these devices. Another shortcoming is that the neurophysiological impacts of the devices themselves were not adequately controlled.Future research is being planned that actually applies the findings of this study and implements the SOMS to investigate health-related outcomes. Future research should also include further investigation of the difference in perception between genders regarding the acceptance of the app, since the possibility of a difference has been suggested in previous research .The research results not only identify the critical factors to consider when implementing the SOMS, they are also expected to provide successful mainstream guidelines for future systems or solutions that tackle the issue of smartphone overuse with apps. For example, there are now many apps that are being released that have screen-time monitors. This is a practically useful aspect, especially when considering Apple's CEO Tim Cook's recent quote that even he uses his smartphone too much. Most importantly, our unique points are envisioned to provide intensive insights for broadening knowledge about technology acceptance in the field of e-addictology .S-JL designed the study and manuscript. MC collected data and conducted statistical analysis. MR participated in study. D-JK and IC co-corresponded and drove the research project.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The “neural correlates of consciousness” (NCC) is a familiar topic in neuroscience, overlapping with research on the brain’s “default mode network.” Task-based studies of NCC by their nature recruit one part of the cortical network to study another, and are therefore both limited and compromised in what they can reveal about consciousness itself. The form of consciousness explored in such research, we term the human default consciousness (DCs), our everyday waking consciousness. In contrast, studies of anesthesia, coma, deep sleep, or some extreme pathological states such as epilepsy, reveal very different cortical activity; all of which states are essentially involuntary, and generally regarded as “unconscious.” An exception to involuntary disruption of consciousness is Buddhist jhāna meditation, whose implicit aim is to intentionally withdraw from the default consciousness, to an inward-directed state of stillness referred to as jhāna consciousness, as a basis to develop insight. The default consciousness is sensorily-based, where information about, and our experience of, the outer world is evaluated against personal and organic needs and forms the basis of our ongoing self-experience. This view conforms both to Buddhist models, and to the emerging work on active inference and minimization of free energy in determining the network balance of the human default consciousness. This paper is a preliminary report on the first detailed EEG study of jhāna meditation, with findings radically different to studies of more familiar, less focused forms of meditation. While remaining highly alert and “present” in their subjective experience, a high proportion of subjects display “spindle” activity in their EEG, superficially similar to sleep spindles of stage 2 nREM sleep, while more-experienced subjects display high voltage slow-waves reminiscent, but significantly different, to the slow waves of deeper stage 4 nREM sleep, or even high-voltage delta coma. Some others show brief posterior spike-wave bursts, again similar, but with significant differences, to absence epilepsy. Some subjects also develop the ability to consciously evoke clonic seizure-like activity at will, under full control. We suggest that the remarkable nature of these observations reflects a profound disruption of the human DCs when the personal element is progressively withdrawn. It also conforms to the emerging work within neuroscience on active inference, interoceptive inference and selfhood Applied attention, or initial thought ( = •vicāra)Sustained attention or thought ( = •pīti)Energized interest, or “joy” ( = •sukha)Happiness, contentment or bliss ( = •ekaggatācitta)One-pointedness of mind ( = Second rūpa jhāna factors•pīti)Energized interest, or “joy” ( = •sukha)Happiness, contentment or bliss ( = •ekaggatācitta)One-pointedness of mind ( = Third rūpa jhāna factors•sukha)Happiness, contentment or bliss ( = •ekaggatācitta)One-pointedness of mind ( = Fourth rūpa jhāna factors•ekaggatācitta)One-pointedness of mind ( = •upekkha)Equanimity which underpins all four jhānas. The factor pīti is strongly emphasized in the Yogāvacara, which lists five levels of intensity ranging from fine bodily vibration or prickling of the hairs on the head and body, to, at its most intense, bodily shaking and even jumping in the air  any bodily disturbance into an increasingly still mental state “held” by attention to the nimitta. For some meditators the nimitta is experienced visually as light, for others as touching something intangible with the mind, or by others as listening to silence (Visuddhimagga); these differing experiences reflecting the traces of a meditator’s habitual preference for one or other sense modality in their DCs. Once pīti is tranquilized and incorporated, the third rūpa jhāna can develop, and is described in 5th-century texts as being “completely conscious” (Vimuttimagga), or with “full awareness like that of a man on a razor’s edge” (Visuddhimagga). Interestingly, avoiding the words conscious or aware, subjects of this study prefer, “presence”, or “vivid presence” for their subjective experience.Whilst the task of the first rūpa jhāna is to develop a degree of mastery of attention, the task of the second rūpa jhāna is to master nāma-rūpa, or name and form in Buddhist terms), which becomes less cognitively and sensorily determined, and less dependent on liking or disliking; such that in the fourth rūpa jhāna even dependence on the “reward” of pleasure or satisfaction ends, replaced by deep stillness and finely poised balance and equanimity. The nature of the subject-object experience is of considerable interest to neuroscience, and will be taken up later in this paper.Practice of the second, third and fourth rūpa jhānas is also regarded as a progressive exploration and refinement of the subject-object relationship , and not all are overly concerned to develop mastery of the subtleties between the different jhānas, while leading busy day-to-day lives. In fact none of our subjects would claim complete mastery of jhāna, not surprising given that such mastery is regarded as a rare achievement in Buddhism, described in the 5th century Accordingly, in this paper we choose not to rely primarily on subjective views as to which jhāna meditators feel they are experiencing, but focus rather on the themes of EEG activity that emerge across this broad group of meditators as they attempt to develop ever-deeper stages of meditation. In effect, the material constitutes a series of case studies describing paroxysmal electrophysiological changes in the EEG; i.e., spindles, infraslow waves, spike-wave bursts, and clonic seizure-like activity, never previously observed in other researched forms of meditation. The Results section will explore these features in detail in both sensor space and source space. Since the common factor underlying these themes is the practice of jhāna meditation, we hold in mind a hypothesis that these effects may be related to the nature of jhāna, in particular to the underlying goal of jhāna meditation to withdraw the personal component from our default sensory consciousness. We therefore take a cross-discipline approach to explore this hypothesis by comparing the EEG evidence to detailed Buddhist understandings of the characteristics of the different rūpa jhānas in the “Discussion” section.Epochs of these paroxysmal features were observed in every subject to a greater or lesser degree, and we explore the neural correlates of each of these themes in both sensor space and source space . We adopt a common protocol for all meditators, using verbal cues to first record a few minutes of resting state eyes-closed and eyes-open EEG, followed by meditators attempting to progressively develop the jhānas, for a total recording time of 35–40 min. For some meditators this protocol is much quicker than their everyday practice, with corresponding disadvantages, but is adopted for consistency. Subjects practice seated on the ground, usually on a cushion, with the body unsupported, erect and composed. The observer/researcher notes events such as shifts in posture, a cough, external noise, or anything likely to cause an artifact.This is a within-group study, where the control group is, in effect, the wealth of other EEG studies of meditation and the NCC. Twenty-nine experienced meditators  from a total pool of around 400 in the United Kingdom, Ireland and the United States, all experienced in samatha meditation as taught by the Samatha Trust, a UK registered charitable organization, were recorded during 2014–2018, some also re-recorded after 1–3 year intervals. Years’ experience of samatha meditation range from 4 to 40+ years, with most individuals maintaining a daily practice of 30–60 min, with more intensive 7–10 days “retreats” every 1–3 years. Twenty-four of the subjects are of graduate or postgraduate-levels of education, and more than half hold, or have held, senior professional roles in health-care or education. Four have spent temporary periods from 1 to 10 months as ordained Buddhist monks in Thailand. As noted earlier, while all subjects are very experienced in samatha meditation, experience of jhāna varies considerably.Given that recordings show features superficially similar to unconscious states, we stress that subjects are fully conscious throughout, with no signs of loss of muscle tone or sleepiness in posture. Subjects respond quickly to verbal cues; and finally show no signs of sleep inertia or disorientation. In fact, meditators describe feeling more alert and present during and after practice. Following a recording subjects recollect their practice while the researcher monitors the recording in parallel.Recordings were made using 24-bit Mitsar DC amplifiers, either the 31-channel Mitsar 202, or the 21-channel wireless SmartBCI amplifier . The former having a sampling rate of 500/s and upper frequency limit of 150 Hz, used with Easycaps and sintered Ag/AgCl electrodes; the latter a sampling rate of 250/s and upper frequency limit 70 Hz, used with MCScaps and sintered Ag/AgCl electrodes. In using DC amplifiers, choosing the best cap/gel combination is critical to minimize drift and maintain stable low impedances at the electrode-skin interface. Having tested many combinations, we agree with Electrodes were placed according to the international 10–20 system, with a monopolar linked-ears reference. Software analysis was carried out using WinEEG, implementing the Infomax algorithm as used in EEGLAB  to compuEpoch length introduces a smoothing effect of its own irrespective of the pass-band, such that epochs of 4, 8, 16, 32, and 64 s smooth frequencies below 0.25, 0.125, 0.063, 0.031, and 0.016 Hz respectively. To capture ISW activity, we use epochs of 16 or 32 s depending on the length of segment analyzed; for spindles we use 4 s; and for the very brief spike-wave bursts we use the shortest WinEEG epoch of 1 s; all with 50% overlap Hanning windows.With atypical EEG phenomena, the question of what is artifact and what is cortical is very important, with the risk of discarding important cortical activity if some unusual feature is too quickly labeled “artifact.” Accordingly, the experimental design aims, as far as possible, to prevent artifacts arising in the first place. In an early pilot study, movement and eye artifacts were a concern, the former caused mainly by movement of electrode connector wires if a subject moves during recording. For the 31-electrode system the most effective solution has been to gather electrode wires into an “umbilical cord” sheathed in earthed carbon-fiber material between headcap and amplifier; whereas the 21-channel system is already resilient to movement artifacts due to short connections to the wireless amplifier mounted directly on the headcap. Combined with subjects experienced in meditation, used to holding still postures for long periods, as well as the observer/researcher noting posture changes or signs of muscle tension, very few segments were excluded. The only situation where movement remains a problem is when recording the deliberate arousal of high intensity clonic epileptiform states, where the task of separating movement artifact from cortical activity is a work in progress.For eye artifacts, visual inspection can recognize most types, and we have chosen not to use automated software-removal algorithms to avoid confusion with atypical frontal delta and ISW activity seen in this form of meditation. Visual inspection confirms that the bulk of the frontal activity is quite different to eye-blink artifacts, or lateral eye tracking; for example, if it does occur it is far slower than eye blinks, and is mostly not restricted to frontal EEG sites. However, some cases remain where localized frontal activity may be affected by eye-tracking; these we exclude from detailed ISW source analysis, focusing instead on those cases where ISWs develop sustained high intensities and clear rhythmicity, across multiple electrode sites. In a few cases, some meditators display eye-flutter due to over-concentration, and since spike-wave activity is sometimes also observed, this flutter may be related to eyelid myoclonia  seen in On any remaining occasions where doubt remains about artifacts, those sections are excluded, and all EEG activity analyzed in this paper comes from uninterrupted sections to avoid problems of interpolation. The fact that recognizable themes and patterns of cortical sources are found in recordings carried out over several years, using two different amplifiers, with some subjects re-recorded after intervals of 1–3 years, adds to our confidence that we are dealing with patterns of cortical activity inexplicable by artifacts or flawed methodology. very high,  high,  weak/moderate).(1)Spindles: 25 subjects (31 recordings) show spindle activity of varying strength. By spindles we refer to “wave-packet” bursts similar to those found in stage-2 nREM sleep, rather than more continuous EEG activity. The 27 recordings marked “high” or “very high” in (2)Infraslow waves (ISWs): 21 subjects (26 recordings) show varying levels of ISW activity. Those marked “very high” in intensity and rhythmicity and extensive across the head, develop as long trains of well-defined near-sinusoidal ISWs dominating the EEG, and constitute the data for feature characteristics and analysis in source space that follows. Such powerful and clearly defined ISW activity is well-suited for cortical source reconstruction. Two other subjects, 14 and 19, also show very strong and well-defined ISWs, but of a quite different nature; isolated, with long silences between, and affecting only frontal and temporal sites; we suspect a different underlying mechanism for these, and reserve their analysis to a future paper.(3)Spike-wave bursts: 8 subjects (11 independent records) show clearly defined and occipital spike-wave bursts.The presence of persistent and strong ISWs and spindles invites comparison to nREM sleep, anesthesia and coma, while the occurrence of spike-waves is reminiscent of absence epilepsy. In this section each theme is taken in turn with the findings considered as a whole in the final Discussion.Sleep spindles in the sigma band (9–16 Hz) are well-researched in polysomnography .Although the sample size is not large, the spindle frequency bar charts in source space for the two cohorts of meditation experience appear different. The curves of best fit in p < 0.1) suggesting spindle density lowers slightly with longer experience. Spindle duration is also significantly greater (∼7x) in meditation than in sleep (p < 0.1).Spindle density, duration and amplitude in sensor space compared to sleep are shown in Underlying cortical sources were computed for the 18 recordings showing spindles with the highest density and clarity of form , using eIn sleep studies, slow waves (SWs) are considered to reflect bistability of cortical neurons undergoing slow oscillation (<1 Hz) between two distinct states, and are discriminated from paroxysmal discharges by their symmetrical and rhythmic shape. Meditation slow waves are also rhythmic, quite different to paroxysmal discharges, with frequencies well below 1 Hz distinguishing them from 1.0 to 4.0 Hz delta activity, in fact sufficiently lower to justify the label infraslow waves (ISWs). The top panel in When respiration has been measured, visual inspection suggests a close relationship between ISW and respiration frequencies; e.g., subject 5, 2017, middle panel p < 0.1.The left-hand bars in The strongest examples of ISWs noted in Although for most meditators the sites of activity remain fairly constant during a recording , transit times vary considerably. In this case, the ISW in Meditation ISWs are not random, exhibiting rhythmic patterns of powerful excitation–inhibition, as in As with spindle analysis, cortical sources were computed using eLoreta for the strongest ICs accounting for at least 50% of the signals’ variance for each sample, then normalized to 50%, and summarized in We have two examples of particularly strong ISW activity that suggest an underlying rhythm even slower than the mean 0.125 Hz ISW frequency noted above . Such veThe lower part of pīti, the third jhāna factor mentioned in the Introduction. The upper panel of Spike-waves are regarded as the signature of absence epilepsy , and refAs far as this author is aware, there are no reported examples of harmonic structure in epileptic spike waves, which makes their observation in meditation all the more intriguing. Another major difference is the range of frequencies from 3.42 to 7.81 Hz for meditation spike waves, significantly different to the 3–4 Hz range in absence epilepsy  shown inpīti. This typically develops in a natural way during samatha meditation, and we believe is evidenced by the high-energy ISWs we observe for some meditators. In the Yogāvacara tradition, however, specific techniques involving breath control are used to deliberately evoke such states for meditators with a special interest. The rationale is to become familiar with the ability to evoke higher energy states, and to then tranquilize that energy back into deeper absorption. To an observer, the subject typically displays clonic features similar to epilepsy, but without discomfort and able to evoke or leave the state at will. As noted in Section “Attachment,” the transition from the first rūpa jhāna to the second and higher jhānas requires a meditator to become familiar with bodily energization Example A is from an experienced practitioner. The first sign of increasing energization is the development of occipital spike waves, followed immediately by a ∼½ sec global ictal burst, a second burst 3 s later, another ∼7 s later, followed by the main body of the “seizure” 15 s later. Physically, the meditator shows mild clonic jerks or bodily vibration, mainly along a vertical bodily axis. The expanded view below the top panel shows the occipital spike waves, with a related and near-sinusoidal rhythm at the right temporal site T6, reaching remarkable p-p values ∼3000 μV. To the right are the two strongest independent components (ICs) from an eLoreta analysis for the main 26-s event, highlighted yellow. Activity is highly localized at Brodmann B37, MTG (MNI coordinates xyz 60 -60 -5), with spike-wave frequency 5.62 Hz, with the temporal activity at the harmonic, 11.23 Hz.Example B is more complex with stronger clonic activity. The EEG again shows brief global ictal bursts at onset, shown in the expanded view below together with respiration. Although these bursts coincide with the end of out-breaths, the regular breathing rhythm is not disturbed until the development of the paroxysmal effects are well-underway, and we do not believe hypercapnia/hypocapnia plays a role as it might in sleep disturbances. Occipital spike waves then develop progressively rather than precede the “seizure” as in example A. Probably because of the complex mix of activity in this example, including very strong ISW bursts as well as occipital spike waves and complex activity extending into the gamma band, a source analysis proved inconclusive, returning a range of small sources rather than any one or two dominant sources. Strong ISWs, as in this example, feature regularly in the more clonic examples of this activity, and we believe perform a containment function for the disturbance.We have approached this series of case studies by focusing on specific paroxysmal EEG activity, not seen before, where the common factor is the practice of Buddhist jhāna meditation by subjects ranging from those with relatively early experience, to some with substantial experience. The detailed analysis of each of the observed themes in EEG activity will now be considered against the hypothesis that they relate to the nature of jhāna meditation, in a cross-discipline approach.While meditation spindles have similar amplitudes to those in sleep, all other parameters are significantly different . Most stSpindling is also found in situations of conflicted attention , as wellby all subjects in order to access the higher jhānas. These are the development of access concentration and the first rūpa jhāna, representing growing success in resisting habitual attention processes of naming (inevitably related to language), recognition and discrimination .All these modalities share a common theme of disruption to attention, either by driver distraction, chemically induced anesthesia, or the approach to sleep; or in the case of jhāna meditation the shift of attention away from our default sensory consciousness (DCs) as described in Section “Attention.” This strongly suggests that meditation spindles represent disruption to the cortical networks sustaining attention in the DCs, but in a manner significantly different to disruption in sleep or anesthesia, which involve loss of consciousness. Also, given that spindling is by far the most common theme among our subjects (25 out of 27), we conclude that spindling is related to the early stages of developing jhāna that have to be negotiated vitakka to the dorsal stream, and the aspect of attention vicāra, which is much more feeling- and salience-based, to the ventral stream. In addition to these two streams, we might also expect changes to networks supporting memory and spatial and temporal orientation, integral parts of our DCs experience of self. The spindle ROIs in source space summarized in Since it is generally acknowledged that spindles represent thalamo-cortical interactions , we concvittaka and vicāra, are worked on together in the first rūpa jhāna. An older and less well-known model (Vimuttimagga) describes five jhānas where vitakka is mastered in the first jhāna, vicāra in the second, with the third, fourth and fifth being the same as our second, third and fourth. In future recordings we may test this five-jhāna model. Even so, it may be relevant that in the underlying data supporting vitakka in disrupting the dorsal stream, and the theta peak to the deeper activity of vicāra in disrupting the ventral stream. In one of many resonances to work on active inference and predictive hierarchical processing in the brain, vitakka, and the second to the ventral stream and the feeling-based salience aspects of vicāra.In our study we find no preference across subjects for either the dorsal or ventral paths in the balance of cortical sources, which may relate to this form of practice following a model of four rūpa jhānas (see Attention) where the two aspects of attention, All the forms of attentional disruption described above have some relation to the alpha band. Meditation produces spindle activity from the lower alpha band down into the theta band; anesthesia also lowers the alpha frequency; conflicted attention spindles remain within the alpha band/, as do slow sleep spindles; whereas fast sleep spindles extend just above the alpha band. Meditation ISWs are significantly slower and higher amplitude than those in stage-4 nREM sleep , or evenIn source space  we find pīti, heralding approach to the second rūpa jhāna, and subsequent development of the third and fourth jhānas. In this interpretation, those meditators in and ISW activity would be developing experience of the first and second rūpa jhānas, while those subjects showing strong ISWs with either no or weak spindle activity would be consolidating their experience of the second rūpa jhāna, and those where powerful ISW activity dominates would be developing the second, third and fourth rūpa jhānas, culminating in the near absence of alpha activity and fully developed ISW activity near the vertex.The mean amplitude 417 ± 69 μV p-p for the strong examples of meditation ISWs is very significantly higher than other modalities, but in some cases can reach astonishing levels > 2000 μV p-p, unprecedented as far as we are aware anywhere in the literature, for any modality, and representing a power ratio of four orders of magnitude increase from the resting state. We believe that such high amplitude ISWs reflect a deeper separation from the DCs than that characterized by spindling, corresponding in Buddhist understandings of jhāna to the increased energization described by the jhāna factor piti is always accompanied by heightened bodily sensitivity (see Attachment), and in some cases meditators report “waves of piti” moving across the head, which may relate to the slow traveling nature of these ISWs noted in the Section “Results.”The experience of strong Whilst epileptic spike-wave bursts were formerly described as “generalized” rather than focal, often frontal, recent work such as pīti) inherent to jhāna meditation beyond a threshold into instability. What is intriguing is that these phenomena do not appear to overly disturb a meditator’s tranquility.The increased functional connectivity during epileptic discharges noted above is believed to reflect high levels of excitation and synchronization in one or more cortico-thalamic feedback loops, due to pathological conditions, locking the network(s) into fixed 3–4 Hz oscillation. In meditation, however, intentional rather than pathological, we suggest that meditation spike waves re-flect a different form of destabilization of the thalamo-cortical feedback loops when the personal element is withdrawn. And, further, because of the dominance of the occipital hub, that it is the “I/Eye” occipital-thalamic loop that is disrupted. The intentionally evoked “seizure-like” activity, including spike waves, presumably reflects the ability of some meditators to push the energization  front-back axis of the DCs, and suggests involvement of the ascending reticular activating system (ARAS), with its known involvement in arousal, attention and consciousness , strongly connected to the thalamus and projecting directly to the spinal cord, and the highly connected medial parietal associative cortex, believed to be widely involved in high-level processing tasks, with dense links to the underlying cingulate, thalamus and brain stem. We might also include the role of the anterior cingulate cortex in predictive coding discussed in iousness , and agaiousness . It is kiousness , and disiousness , but theVimuttimagga, which quality continues into the fourth rūpa jhāna. We believe the fully developed near-vertex hub of powerful ISWs reflects jhāna consciousness with DCs lower frequency activity now virtually absent .The sense of rocesses  where thWhilst the scale factor for the DCs is suggested to be the ∼10 Hz alpha rhythm, that for SWs in sleep or coma is determined by haemodynamic pressure , where tMeditation spike-waves show harmonic spectral structure, unlike those in epileptic or pathological states, and we have suggested that their appearance relates to withdrawal of the personal “I” component from the occipito-thalamic network. We further suggest that this disruption triggers the thalamus into harmonic activity in an attempt to stimulate scaled network activity similar to that of the DCs; the implication being that harmonic or fractal structure is an integral part of thalamo-cortical network connectivity, and that the δ, 𝜃, α, β structure of the DCs is but one example, that we presume is optimal for sensory consciousness and minimization of free energy.The results and preceding discussion speak to a close relationship between the different aspects of consciousness that reflect departures from our default consciousness, and their neurophysiological correlates, in the light of understandings of the ancient practice of jhāna meditation. Furthermore, these correlates highlight the key role of attention and concomitant changes in neurophysiological excitability. This is entirely consistent with modern-day formulations of hierarchal inference in the brain; particularly in terms of internal attention states, interoceptive inference and the relationship between consciousness and sleep. The common theme is a physiological modulation of cortical excitability and ensuing neuronal dynamics that under the free-energy principle and Bayesian brain hypotheses play the role of precision weighting . In briesamādhi or yoga that describe a deeply integrated mind-body experience. It is as though all the previously widely distributed networks, each consuming portions of available energy, are gathered together into a simple focus revealing a previously unrecognized and remarkable reservoir of available energy.The importance of these brain states is to enable minimization of free energy via the minimization of the statistical construct called complexity in the active inference literature. In essence, this simply means that redundant connections can be removed from the brain’s hierarchical generative models; thereby enabling the brain to generalize its models or explanations for exchange with the world – when re-engaged by sensory input. On this view, one could regard this form of meditation as aspiring to that simple but serene state where all that is redundant, distracting or unnecessarily complex can be dissolved. In practice, we find that the progressive and extensive simplification of network activity as a subject develops jhāna, leads to highly focused activity near the vertex, suggesting extensive connectivity down through the brain stem into the body, reflecting the subjective experience of embodied presence, and the meditational terms responsiveness of the brain’s cortical networks to willed intensions of subjects during this form of meditation, which we presume results from the temporary experience of greatly reduced complexity noted above, and is no doubt also related to plasticity.We believe that the capacity to manage and contain such high-energy states is the result of the detailed development of attention, often over many years, coupled with the deliberate use of non-normal lengths of breath as noted in the Introduction. Indeed, we wonder whether some of the basic features of this attentional development might be adapted for epilepsy sufferers with the goal of reducing frequency of seizures. The study also demonstrates an equally remarkable This study was carried out in accordance with the recommendations of the Trustees of The Samatha Trust [regd UK Charity No. 266367 (1974)] who oversee the teaching of the form of meditation described in this study, with written informed consent from all subjects. All subjects gave written informed consent in accordance with the Declaration of Helsinki. The protocol was approved by the Trustees of The Samatha Trust.The author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


In the last decade, knowledge workers have seen tremendous change in ways of working and living, driven by proliferating mobile communication technologies, the rise of dual-income couples, shifting expectations of ideal motherhood and involved fatherhood, and the rise of flexible working arrangements. Drawing on 54 interviews with Australian knowledge workers in the information technology sector, we argue that the interface between work and life is now blurred and boundaryless for knowledge workers. By this, we mean that knowledge workers are empowered and enslaved by mobile devices that bring work into the home, and family into the workplace. Knowledge workers take advantage of flexible working to craft unique, personal arrangements to suit their work, family, personal and community pursuits. They choose where and when to work, often interweaving the work domain and the home–family domain multiple times per day. Teleworkers, for example, attain rapid boundary transitions rending the work–home boundary, thus making their experience of the work–life interface boundaryless. Ways of working and living have changed dramatically in post-industrial economies in the last decade. First, proliferating information and communication technologies (ICT), often mobile, are connecting people, but also intensifying work beyond traditional offices and working hours , 2018. SKnowledge work is dominating in post-industrial economies. Knowledge work involves manipulating and transmitting ideas, rather than goods. In particular, knowledge workers use ICT to exchange meaning. Knowledge processes are unconstrained, occurring in any location and at any time , but theConsidering rapid technological change, demographic change, societal change and the rise of knowledge work, we propose a new appreciation of the boundaryless work–life interface for flexible knowledge workers. Despite intense work and non-work activities, we contend flexible knowledge workers do not emphasize the distinction between work and non-work. Rather, they work at any place and time, but also manage to achieve harmonious balance in their lives. Existing work–life theories do not present the work–life experiences of flexible knowledge workers accurately. Hence, we describe a richer conceptualisation of the work–life interface for this group and discuss implications for human resources (HR) policies and management methods in the digital economy.Work–life theories can be classified into three streams: (1) negative side of the work–life interface, stemming from role strain theory, (2) positive side of work–life interface, stemming from role accumulation theory, and (3) blurred boundaries between work and non-work, stemming from boundary and border theory.Role strain theory, which originated from As research on work–family conflict matured, In this research, we use “work–life” as opposed to “work–family” or “work–home” to acknowledge non-work roles  . AlongsiBoundary theory focuses on the meanings people assign to work and life  and the Knowledge work tends to involve a high degree of both flexibility and permeability, facilitating role blurring or, increasingly, a state of “boundarylessness” . Unlike Border theory is devoted only to work and family domains. Work–family balance is the outcome of interest, defined as “satisfaction and good functioning at work and at home, with a minimum of role conflict” , p. 751.In this study, our goal is to illuminate the poorly understood boundaryless nature of knowledge workers’ work–life interface. Existing work–life theories do not adequately and accurately account for knowledge workers’ work and non-work experiences. Therefore, we seek a deeper understanding of how flexible knowledge workers perceive and navigate their life domains, and to discover various contextual and socio-cognitive factors that influence their perceptions and decisions. Therefore, a qualitative design is particularly apposite for our research. We interpretively explored three questions: (1) How do flexible knowledge workers perceive, think about, and experience the interface between their work and non-work domains? (2) How do flexible knowledge workers perceive and manage role boundaries between their work and non-work domains? (3) What contextual and socio-cognitive factors account for flexible knowledge workers’ differing perceptions and decisions when managing their work–life interface? In sum, we qualitatively explored the perceptions and decisions of flexible knowledge workers with the understanding that these have implications for their individual, work and family functioning .To answer our research questions, we conducted an exploratory case study, using an embedded single-case design  to examiThe research site was the Australian affiliate of a multi-national technology company (referred to as “Tech”). Tech had around 130,000 employees worldwide at the time of the study, with around 2,100 employees in Australia. Access to employees at the research site was negotiated with the HR director. Before we approached Tech, we sought ethics approval from the University of New England’s Human Research Ethics Committee. The HR director allowed us to gather data in two ways. First, semi-structured interviews were the principal source of information about participants’ thoughts, feelings and perceptions about work–life balance and how they arranged their working and personal lives. Confidentiality was protected by a written informed consent agreement with each participant. Second, we gathered policy documents, people directory entries and corporate broadcast emails from Tech’s intranet, and we downloaded Tech’s statutory reports to government agencies, as triangulation sources. In addition, the principal researcher wrote field notes after each interview to document researcher responses and states, using ongoing reflective commentary  to captuThe lead researcher conducted all interviews to maintain a consistent data collection approach. He conducted pilot interviews with five participants drawn from Sales, Human Resources and Research & Development departments at Tech. Pilot participants used FWAs in different ways: three were teleworkers, one was part-time, and one was full-time, about to begin parental leave. The purpose of the pilot interviews was to test the interview template (see Appendix 1) against the research questions, across different jobs and different demographic attributes, and to enhance dependability by following a consistent procedure, per guidelines of We developed the interview template for the pilot interviews from a study of the literature, focusing on satisfying the research questions. Prior to the pilot interviews, we reviewed the interview template with academic colleagues, to enhance objectivity and confirmability . Sample Following the pilot interviews, the interview template was revised with supplementary questions. For teleworkers, we found it useful to ask: Do you ever work very early or very late? Is this your choice or has your manager directed you? How do you blend work tasks and home or childcare tasks, when working from home? For part-time participants, we asked: To what extent do you work on a non-working day? Is this your choice or has your manager directed you? We also found it useful to ask all participants about availability: When do you make yourself strictly unavailable? Do you ever disconnect? These questions explored richer detail about participants’ methods of forming and dismantling boundaries, and their perceptions of organizational norms and their personal responses to such expectations.We gathered relevant documents from Tech’s intranet, including people directory entries for all participants, copies of published policies, and corporate broadcast emails from business leaders or Tech HR team. We also gathered Tech’s statutory reports to the Workplace Gender Equality Agency.To identify participants accessing FWAs, Tech’s HR team provided reports listing Tech employees with part-time hours, with flexible or remote working arrangements, and with completed leaves of absence . We used non-probability purposive and snowball sampling techniques . We usedOverall, we interviewed 54 participants at Tech . ParticiSaturation for part-time participants was achieved after 12 of 24 interviews. After the twelfth interview, we heard repeated themes of work expanding into non-work time and efforts to juggle work and family. Saturation for teleworker participants was achieved after 15 of 30 interviews. After the fifteenth interview, we heard repeated themes of blending work and home/family during the work day and being available outside of conventional working hours. Turning to sabbatical participants, it was not possible to establish whether saturation was reached. Only five interviews were conducted, because employees going on sabbaticals are rare at Tech.All recorded interviews were transcribed into text files (one participant did not consent to audio recording). We provided the text files to participants for verification, if they had made this request before interview, to enhance credibility and authenticity of the study . During We use the technique of thematic qualitative text analysis  to examiWe began data analysis with a primarily deductive approach, in order to examine participant perceptions in light of role strain theory, role accumulation theory, boundary theory and border theory. We developed thematic categories , displayIn the second cycle of coding, we retrieved all segments within a category, then used an inductive method, in alignment with our research questions, to formulate sub-categories from the data. For example, when investigating ‘Crossing boundaries’ and ‘Work conflict at home/family’ for part-time participants, we coded for the health status of dependent children, the nature of the day (working or non-working), the clock time , and the organizational hierarchical status  of the co-workers making contact.To enhance credibility, preliminary themes and findings were shared with academic colleagues and discussed at length, to challenge the analysis, using the peer debriefing method . The purDuring data collection and analysis, the lead researcher was an employee of Tech. Insider status afforded privileged access to the research site and to gatekeepers within the organization. Insider status also provided an extensive network of acquaintances and co-workers as key participants of the case study. Furthermore, tacit and intrinsic knowledge of Tech’s organizational culture was useful to establish shared cultural membership with participants. Using this knowledge, the lead researcher established trust and rapport with participants, enhancing each participant’s sense of freedom to voice their stories. Conversely, the researcher’s insider status raised fears and risks for some participants. Specifically, some participants were concerned that their stories, employment history or family arrangements were unique, which allowed others to identify them. Some feared their reputation might be damaged or feared their private opinions about co-workers might damage relationships. We addressed these fears by emphasizing arrangements for confidential treatment of interviews, anonymity and provision of pseudonyms.SD = 7.49 years). Mean organizational tenure was 10.12 years (SD = 6.55 years). The number of individual contributors was 41; the number of front-line managers was seven and the number of middle managers was six. Five participants were single, six participants had a partner and no dependents, and 43 participants had a partner and dependent children. Dual-earner couples made up 75.93% of the sample.The sample consisted of 54 flexible knowledge workers. The sample was 62.96% female and 37.04% male. Mean age of participants was 43.24 years .Ronald: I’m present [for work] if I need to, if I get a phone call from school and my wife is at work, and one of the kids needs to be picked up because they’re not feeling well, it has allowed me that flexibility … for me to go and pick them up. Katrina focused on her children during part of the day. When she missed a work telephone call, she quickly returned it, demonstrating high permeability and high integration.Whereas segmentation was the norm decades ago , now int.Katrina: I’ll answer it, if I really can’t answer it I will let it go to voicemail and then I’ll call them back, 10 min later when, when I can. But generally speaking I will just, a child in one hand and I’m on the phone to them. Anastasia illustrated how she interwove between work and family during core working hours, but then extended the working day into the evening.When working at home, some or all of the week, or participating in global projects collaborating across time zones, participants found they needed to work earlier or later than core working hours. Yet, during the day, they used time for home–family tasks. By doing this, participants enacted home devotion and simultaneously work devotion .Anastasia: Ok, well, the girls have got something on at assembly today. I’m just going to go. So I block out my diary and I go to the assembly and enjoy it and I am present for them and then I come home and log back on. Now I might have to work a few extra hours that night after they go to bed. You do it. You just juggle it. Some days I don’t even work my core hours. Thomas took an active role as an involved father, in the late afternoon, but worked intensely during early mornings and late at night.Likewise, .Thomas: One of the things that I’ve always been very careful about is to not let the work–life balance get out of kilter. Given that I’ve got two young kids, what works for me exceptionally well is the fact that because I’ve got a global job where I’m on the phone from, most days, from 06:00 till 08:00 or 09:00 in the morning, and then I’m on the phone again from 20:00 at night through till 22:00 or 23:00, means that I essentially don’t do any work in the early afternoons, which is 15:00 in the afternoon through until about 20:00 at night, so when the kids get home from school. Thomas specifically mentioned leveraging FWAs to manage his work–life balance, to fit his expectations. Because flexible knowledge workers have more freedom to choose working arrangements to suit home–family arrangements, we argue they use the technique of crafting their work–life interface to suit their requirements. We found work–life conflict was present in a small way, but not regarded as excessive by participants. The autonomy afforded by FWAs gave participants control over work and home–family, thus they were able to meet demands from all domains under conditions of apparent work–life balance.We argue there is reduced work–life conflict in this state of boundarylessness. Anastasia and Thomas demonstrate. We contend that individuals make work–life balance decisions across their life-space, including all their roles . Their decisions vary over the life course, as they move across generations and work and home demands shift in priority. Events such as marriage, divorce, childbirth, promotion or relocation shift perceptions about home–family demands and work demands. Choices about whether to use FWAs are not solely governed by perceptions at work, and penalties and benefits from flex-work, but are also governed by perceptions at home, and associated penalties and benefits.Participants did not take a pure work-oriented view of the world. They did not simply regard themselves as employees, above all else, as Ethan explained how he perceived Tech’s organizational culture and the demands of his intense workload as a middle manager.Organizational expectations played a significant role in shaping participant perceptions about boundaries. We observed that managers hardly ever requested extended work hours from participants. Instead, individuals worked where and when they perceived it was necessary, either to complete their workload , or, to collaborate with co-workers in distant time zones. Ethan: And the company doesn’t set it as an expectation. They don’t expect me to sit, or the hundreds of other people that sit on their sofas at night, doing email for the day. It’s not expected, right. But it’s not discouraged. […] It’s a self-driven, there’s no expectation, other than your personal drive to be on top of or in front of or caught up on, or, but it’s, you’re never in front of, right. You’re always […] You’re never in front, yeah. So it’s just about keeping head above water in some respects, right.Lauren explained her views about the mistaken freedom of working from home, and the requirement to be constantly available, enforced by her manager’s behavior. Organizational norms were powerful in shaping acceptable and unacceptable behaviors for participants..Lauren: No, because if you do that, there will be him [Lauren’s manager] asking, where are you? You should always be available. So there was no hiding. There was absolutely no hiding. So even though that people say that you work from home and you’ve got all this freedom, it’s nothing like that. On the contrary, in fact. Because you felt like you had to be constantly by your computer so you can answer your chat right away, or your phone right away. Because if there was a delay there’s always that worry at the back of your head, oh, do they think I’m not working? Lauren’s remarks, participants were not truly free to decide working hours independently. Constant availability for work has become a proxy for organizational commitment. Virtual displays of employee engagement are now paramount. Individuals work within a matrix of co-worker relationships at work, and kin relationships at home. Each of these relationships constitutes border-keeper expectations, so knowledge workers must craft a careful path between competing expectations. Megan paid more attention to work than family. She worked while on vacation (an extreme example in our study), to avoid out-of-control work situations.So, fuzzy boundarylessness has a dark side. Participants framed use of ICT to craft reputations of high availability as a personal choice. Yet, participants were responding to strongly held behavioral norms in organizational culture. There was little resistance to working outside conventional hours—it seemed so ‘normal’. But, per .Megan: No. I’ll even take meetings while I’m on leave too. And I’ve always told my team, you rather bug me while I’m on holiday and don’t let something escalate out of control, because even though I’m on holiday, I can still manage it. Our article exposes the true nature of the work–life interface for flexible knowledge workers. In the two decades since boundary theory and border theory were first proposed, the rise of ICT has drastically altered the work–life interface. Work can now be completed at any time and in any location, meaning that domains are more likely to be blended and boundaries barely exist (as we have argued above). This implies boundary theory and border theory should now be reappraised in the context of knowledge work. Due to the difficulty in grasping the concept of boundarylessness, work–life researchers have tended to classify work and non-work domains into bounded categories . While fResearchers also need to elaborate the concept of work–home conflict. Though role strain theory predicts conflict, in this study participants were less likely to regard their working lives and home lives as a source of conflict. The introduction of mobile communication technologies and the intersection with flexible working imply that conflict is differently comprehended by flexible knowledge workers. Work devotion may be more salient for individuals, but the level of work devotion does not necessarily imply greater control across the work–life interface. Individuals often prioritize work demands over home demands, suggesting that individuals have less control. This problem is exacerbated for teleworkers, where in theory it is possible for the individual to ignore work demands in favor of home demands. This does not happen: individuals make work a higher priority, most of the time, with limited exceptions for family time or personal time at specific moments of the working day.There are four important implications for HR, as flexible knowledge workers navigate the boundaryless work–life interface. First, HR must shape a positive organizational culture that supports flexible work, advocating benefits of FWAs with leaders. HR should challenge organizational practices equating organizational commitment with face-time. Giving knowledge workers flexibility in terms of where and when to work has been shown to alleviate work–family conflict . FurtherSecond, HR managers must provide meaningful, universal access to FWAs. HR should introduce these policies in organizations that have none, and, in organizations where FWAs are restricted, HR should rewrite policies to include all job families and management levels.Third, HR must establish procedures making managers, not employees, accountable for tailoring suitable FWAs. Shifting focus to managerial accountability forces managers to be more engaged in making flexible working successful for both employee and supervisor. It would also ensure managers are committed to team success and flex-worker success, rather than leaving employees to muddle through and make it work individually.Finally, HR must work with information technology (IT) leaders to ensure appropriate balance between technology provisioning, and work and home demands. ICTs are a double-edged sword: on the one hand, empowering employees and enabling work; on the other hand, forcing employees to be constantly connected and constantly available. HR and IT should define appropriate expectations about technology usage by employees. Managers should avoid unwittingly setting an expectation of 24/7 availability, by for example, answering emails late at night. HR should provide pragmatic guidelines: if employees have to collaborate across time zones, it is necessary to work early or late, but employees should feel they have time to disconnect and recover. The appropriate flexible work policy framework, situated in a flex-positive organizational culture, with leader, HR and IT role modeling and resourcing, sets the organization up for success.There are several limitations to this study. The cross-sectional research method did not allow investigation of the construction of the work–life interface over time. From a sampling perspective, the study did not deliberately include full-time co-workers. Given the nature of flexible work, full-time employees were the largest group within Tech, so their perceptions and behaviors influence organizational perceptions of those who work flexibly. The study did not account for the influence of cultural background such as national culture or ethnic background. Furthermore, the study did not account for generational influences on flexible working perceptions. It is reasonable to assume younger employees may have different expectations about work–life balance and how they might construct the work–life interface. Positive response bias is a particular concern when using semi-structured interviews. Though steps were taken to avoid this kind of bias, further triangulation of the findings could help to improve authenticity.There are interesting future directions for research involving flexible knowledge workers and their work–life interface. First, researchers should compare and contrast full-time workers with flexible workers who vary hours, schedule or location of work in future studies. Second, seeing that manager support was essential to positive flexible working perceptions, it would be worthwhile to investigate the specific role of managers and supervisors. Some sample questions include: How do effective managers support subordinates and what do less effective managers do or not do?Another direction for future research is to look more closely at the host location of the supervisor compared to the subordinate. If supervisor and subordinate are in the same office location, then there is more opportunity for interaction, but it also carries an expectation that the employee will be present in the office, unless they have an agreement with the manager for remote or flexible working. If the supervisor is in a different office location, then face-to-face supervision is not possible and expectations might be different. Furthermore, the employee might be forced to work outside conventional hours in order to have discussions with the direct supervisor who may be on the other side of the world.Conceptual definitions of flexible working are also problematic. The precise definition of flexibility, and the intensity and duration of flexible working are important factors in studying the work–life interface. Conceptual definitions are not consistent in the literature so future studies could work toward a consistent and widely accepted definition. Also, given that teleworking appears to have fewer negative consequences compared to working reduced (part-time) hours, future studies should look at the mechanisms that drive these varying outcomes across different cohorts and types of FWAs.Finally, future research should investigate other industries and other countries, to expand research and scholarship about flexible working into new sectors. It is simple for an IT firm to offer flexible working to knowledge workers, because knowledge work is portable—other types of industries such as retail, manufacturing and healthcare would have to offer FWAs to selective occupational groups. Comparative research between industries presents novel opportunities for theory building and analysis.In the last decade, work and life have been transformed by technology, fragmenting time. Now, knowledge workers can work anywhere, at any time. This brings unprecedented empowerment—yet, simultaneously, enslavement. Existing boundaries are no longer salient for flexible knowledge workers. They perceive their work–life interface as fuzzy and boundaryless. Knowledge workers use ICTs combined with FWAs to craft their ideal lives. In bringing attention to fuzzy boundarylessness, we hope to guide HR practitioners, and leaders, to develop new HR approaches for flexible knowledge workers. We encourage future studies to examine the fuzzy boundaryless nature of the work–life interface and explore the different ways flexible knowledge workers navigate work and home, family and life.This study was carried out in accordance with the recommendations of the Human Research Ethics Committee of the University of New England, with written informed consent of all subjects.JF conceptualized the boundaryless work–life interface and collected the qualitative data. XC analyzed the literature and came out with the overall structure. Both authors made a substantial, direct and intellectual contribution to the work.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.