Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

On page 1 of his classic text, Millsap states, “Measurement invariance is built on the notion that a measuring device should function the same way across varied conditions, so long as those varied conditions are irrelevant [emphasis added] to the attribute being measured.” By construction, measurement invariance techniques require not only detecting varied conditions but also ruling out that these conditions inform our understanding of measured domains. In fact, measurement invariance techniques possess great utility when theory and research inform their (...) application to specific, varied conditions that, if not detected, introduce measurement biases, and, thus, depress measurement validity. Yet, we see emerging bodies of work where scholars have “put the cart before the horse” when it comes to measurement invariance, and they apply these techniques to varied conditions that, in fact, may reflect domain-relevant information. These bodies of work highlight a larger problem in measurement that likely cuts across many areas of scholarship. In one such area, youth mental health, researchers commonly encounter a set of conditions that nullify the use of measurement invariance, namely discrepancies between survey reports completed by multiple informants, such as parents, teachers, and youth themselves. In this paper, we provide an overview of conceptual, methodological, and measurement factors that should prevent researchers from applying measurement invariance techniques to detect informant discrepancies. Along the way, we cite evidence from the last 15 years indicating that informant discrepancies reflect domain-relevant information. We also apply this evidence to recent uses of measurement invariance techniques in youth mental health. Based on prior evidence, we highlight the implications of applying these techniques to multi-informant data, when the informant discrepancies observed within these data might reflect domain-relevant information. We close by calling for a moratorium on applying measurement invariance techniques to detect informant discrepancies in youth mental health assessments. In doing so, we describe how the state of the science would need to fundamentally “flip” to justify applying these techniques to detect informant discrepancies in this area of work. (shrink)

RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

ObjectiveHead and neck cancer treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: the prevalence, level, and course of body image concerns; correlates of upon cancer diagnosis body image concerns; predictors of immediate post-treatment body image concerns; and association between body image concerns (...) and levels of anxiety, depression, suicidal ideation, support, and alcohol and drug misuse.MethodsTwo hundred and twenty-three, newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model.ResultsSixty-eight percent of patients with HNC presented some level of body image concerns. Body image concerns at baseline and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment, 89% presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism.ConclusionThis longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions. (shrink)

Es, en la dimensión cultural del poder, donde los españoles americanos y los españoles europeos, en Hispanoamérica y en España, han perdido la más importante de todas las batallas culturales: la batalla por el relato histórico. H3an sido las potencias que tradicionalmente se enfrentaron con 333España e Hispanoamérica las que han escrito —e impuesto el relato— la historia de la conquista española de América y la historia de la relación entre España e Hispanoamérica durante el mal llamado período colonial. La (...) leyenda negra, la falsa historia de la conquista española de América, ha sido la más importante herramienta utilizada por Holanda, Gran Bretaña, Francia y Los Estados Unidos en la guerra cultural que llevaron a cabo contra España. Esa guerra cultural fue, aunque por motivos distintos continuada, paradójicamente, luego por la Unión Soviética, Cuba y Venezuela. (shrink)

Different types of consent are used to obtain human biospecimens for future research. This variation has resulted in confusion regarding what research is permitted, inadvertent constraints on future research, and research proceeding without consent. The National Institutes of Health Clinical Center's Department of Bioethics held a workshop to consider the ethical acceptability of addressing these concerns by using broad consent for future research on stored biospecimens. Multiple bioethics scholars, who have written on these issues, discussed the reasons for consent, the (...) range of consent strategies, and gaps in our understanding, and concluded with a proposal for broad initial consent coupled with oversight and, when feasible, ongoing provision of information to donors. This article describes areas of agreement and areas that need more research and dialogue. Given recent proposed changes to the Common Rule, and new guidance regarding storing and sharing data and samples, this is an important and tim.. (shrink)

Individuals with autistic spectrum disorder (ASD) display diverse deficits in social, cognitive and behavioral functioning. To date, there has been mixed findings on the profile of executive function deficits for high-functioning adults (IQ >70) with ASD. A conceptual distinction is commonly made between “cold” and “hot” executive functions. Cold executive functions refer to mechanistic higher-order cognitive operations (e.g., working memory), whereas hot executive functions entail cognitive abilities supported by emotional awareness and social perception (e.g., social cognition). This study aimed to (...) determine the independence of deficits in hot and cold executive functions for high-functioning adults with ASD. Forty-two adults with ASD (64% male, aged 18-66 years) and 40 age and gender matched controls were administered The Awareness of Social Inference Test (TASIT; emotion recognition and social inference), Letter Number Sequencing (working memory) and Hayling Sentence Completion Test (response initiation and suppression). Between-group analyses identified that the ASD group performed significantly worse than matched controls on all measures of cold and hot executive functions (d =.54-1.5). Hierarchical multiple regression analyses revealed that the ASD sample performed more poorly on emotion recognition and social inference tasks than matched controls after controlling for cold executive functions and employment status. The findings also indicated that the ability to recognise emotions and make social inferences was supported by working memory and response initiation and suppression processes. Overall, this study supports the distinction between hot and cold executive function impairments for adults with ASD. Moreover, it advances understanding of higher-order impairments underlying social interaction difficulties for this population which, in turn, may assist with diagnosis and inform intervention programs. (shrink)

Ubico indicios de mitos nacionales analizando obras narrativas (de Borges y algunos otros autores), y dichos acerca de Borges, centrándome en cómo se verifica, en la narrativa de Borges, (y también en sus intervenciones públicas y en lo que se dice sobre su figura) la irrupción del peronismo. Propongo un cambio de escala: sin intentar interpretar los grandes momentos constitutivos entendiéndolos como mitos de origen, intento constituir series, de características cuasi-míticas, a partir de poner en relación a breves sintagmas que (...) se reiteran en distintas unidades narrativas. Elementos transversales, que van de un relato a otro. Sintagmas que se analizan tomando al conjunto de la obra de Borges como paradigma, y no sólo relatos aislados. En primer término, exploro ciertas constantes en algunos relatos del período 1945-54. Luego me detengo en una serie de versiones contemporáneas sobre un Borges ciego a quien un joven peronista ayuda a cruzar la calle. En tercer lugar. el tema de la aparición de relatos oníricos, literariamente enunciados, sobre personas con garra de pájaro, vinculándolos a los dilemas morales de la élite intelectual en los tiempos del primer peronismo. En tanto estos conjuntos tienen mucho en común con los mitos al ser reelaboraciones sucesivas de un elemento narrativo, podrían ser abordadas con métodos de análisis míticos propios de la antropología estructural. No obstante, el material utilizado tiene diferencias con las mitologías clásicas: a) tiene versiones orales, pero también escritas; b) hechos ficcionales, pero también históricos; c) admiten un orden cronológico verificable. Por lo tanto, arriesgo aquí una exploración metodológica y teórica más bien experimental, aunque deudora de Lévi-Strauss. Concluyo que en estos dos conjuntos se verifica el funcionamiento un sistema ideológico, que es el de la formación nacional argentina, con sus tensiones y crisis. (shrink)

«Fortaleza» y «debilidad» son dos adjetivos que se han utilizado prolijamente en la literatura científica sobre institucionalismo para describir la permanencia o, por el contrario, la porosidad y maleabilidad de las reglas y principios rectores en los que están atrincheradas las instituciones que sobreviven en equilibrio y, por tanto, no son alteradas unilateralmente.

In this article I argue that textual evidence from David Hume's A Treatise of Human Nature does not support J. Baird Callicott's professedly Humean yet holistic environmental ethic, which understands the community (e.g., the biotic community) as a ‘metaorganismic’ entity ‘over and above’ its individual members. Based on Hume's reductionist account of the mind and his assimilation of the metaphysical nature of the mind to that of the community, I also argue that a Humean account of the community should be (...) likewise reductionist. My conclusion is that Callicott's anti-reductionist holism is at least foreign to, and at worst incompatible with, Hume's philosophy. (shrink)

The realism grounding St. Thomas Aquinas’s pre-modern natural science defends the reception of similitudes of the forms of things known by abstraction. Modern natural science challenges this abstractio- nist account by recasting «form» in the leading role of principle of intelligibility—instead of forms, modern science discovers laws. Thomistic realism is prima facie incompatible with this account. Following Charles De Koninck, this essay outlines a rapprochement between the epistemology of pre-modern, Thomistic natural science and its modern successor. I argue that natural (...) forms are noetic limits towards which physical laws tend, and our grasp of this tendency uses a mode of knowledge comparable to what St. Thomas termed universal in repraesentando. (shrink)

Discutamos el principio de la acción mínima (PMA) y su conexión con el axioma tomista operari sequitur esse. El PMA se llama uno de los principios más profundos de la naturaleza. Después de una exposición breve del principio, pasemos a investigar esto en tres etapas aporéticas. La primera etapa involucra una pregunta de prioridad: ¿el PMA—es una causa o un efecto? En la segunda etapa analizamos la conexión entre un comportamiento global y los individuos a escala local: ¿es el PMA (...) una característica verdadera debido a lo que es cierto acerca de las naturalezas de las sustancias? En la etapa final, relacionamos el PMA al axioma tomista operari sequitur esse. La idea clave es que las formas de los objetos físicos no son simplemente determinaciones intrínsecas sino que también establecen de manera extrínseca varias relaciones. Las formas de los individuos son, a través de estas relaciones esenciales, extrínsecas y determinables, partes formales de un todo cósmico. Esto concuerda con la idea tomista de que la forma del universo—el tipo natural del mundo—es su misma unidad de orden. (shrink)

En esta obra se analizan las ideas estéticas más relevantes de tres filósofos contemporáneos, H. Marcuse, M. Merleau-Ponty y H-G. Gadamer, articuladas en torno a la productiva interrelación arte y filosofía y, todavía más concretamente, en torno a la preocupación por el tipo de razón y la búsqueda racional de la libertad que predomina en el ámbito artístico.

Este trabajo, hasta hoy inédito. fue leído en inglés durante el Coloquio Wittgenstein realizado en la Pontificia Universidad Católica del Perú en julio de 1989 con la participación de la autora. Cora Diamond, Juan Bautista Ferro, Peter Geach, Mario Montalbetti y Jorge Secada. La versión original que se publica ahora acompañada de mi traducción al castellano incorpora algunos agregados y correcciones que la profesoraAnscombe hizo en el manuscrito durante y después de la lectura del trabajo. Los únicos cambios que he (...) introducido yo en el texto inglés son unas mínimas alteraciones y correcciones gráficas y una corrección ortográfica evidente.Las menciones a términos del original inglés que he incluido en el texto en castellanovan entre corchetes angulares. Salvo las notas, éstas son las únicasinterpolaciones que he hecho en el cuerpo del artículo. (shrink)

Don Carlos de Sigüenza y sor Juana Inés de la Cruz no solo se encuentran en la encrucijada del paso de la edad media a la moderna, y del viejo al nuevo mundo, sino de la vieja a la nueva vía de reflexión y de la vieja a la nueva ciencia. Es lo que se intenta mostrar en estas páginas.

El objetivo de este trabajo es recuperar la tesis de Schmitt en la que afirma que el derecho no se agota en las normas, sino que implica un orden concreto. Ello se debe a que dicha tesis permite ampliar la capacidad descriptiva y explicativa de la teoría jurídica. Especialmente, permite ir más allá del conocimiento técnico que requiere el trabajo cotidiano de los abogados y jueces, para dar cuenta de la génesis y dinámica de los sistema jurídicos. Entre otras cosas (...) permite reconstruir el proceso que hizo posible la autonomía de los sistemas jurídicos propios de las sociedades modernas. Sin embargo, al mismo tiempo, se crítica la creencia de Schmitt respecto a que conceptualizar la relación entre el orden concreto y las normas jurídicas también permite resolver el problema de la validez de estas últimas. En oposición a ello, se defiende la tesis respecto a que es necesario apelar a un principio universal de justicia. Tesis que se defiende con un argumento que el propio Schmitt utiliza para sostener [otra tesis, según la cual] la restricción del carácter violento de los conflictos sociales, aquello que hace de éstos una práctica estrictamente política, es el reconocimiento del mundo humano como un pluriverso. (shrink)

Este trabajo presenta una propuesta para la investigación y la enseñanza de la parasitología. La Metodología de los Programas de Investigación Científica está basada en la metodología de Imre Lakatos. El “núcleo tenaz” del programa en parasitología es “las características de comportamiento alimenticio de los hospedadores explica y predice la fauna de endoparásitos que ellos albergan “. Las hipótesis auxiliares del cinturón protector son: i) hipótesis de los ciclos biológicos y ii) hipótesis del desarrollo de comunidades de parásitos. Las pre-condiciones (...) iniciales necesarias para el establecimiento de la relación parásitohospedador son: a) existencia del parásito potencial, b) existencia del hospedador potencial y c) existencia del biotopo potencial. Se discute el papel de las anomalías y se sugieren modificaciones al tratamiento hecho por Lakatos. Creemos que las anomalías no deben archivarse y acumularse hasta que la comunidad científica comience a dudar y cuestionar el núcleo tenaz. Es mejor que el científico resuelva cada anomalía a medida que se le van presentando, pudiedo resultar en el futuro en caminos insospechables para el trabajo teórico y empírico, y de esta manera aumentar el poder predictivo y explicativo del programa. En definitiva esto estará aumentando el “contenido experimental” del programa.This paper presents a theoretical methodological proposal for research and teaching in parasitology. The Methodology of Scientific Research Program, , presented here is based on I. Lakatos’ methodology. The “hard core” in parasitology is: the characteristics of the trophic behavior of hosts explain and forecast the parasitic fauna which they harbour. The following hypotheses form the hard core’s safety belt of the auxiliary hypotheses: 1. the hypothesis of the biological cycles; 2. the hypothesis of parasite community development. The necessary initial physical pre-conditions for the establishment of a host-parasite relation are: a.- the existence of a potential parasite; b- the existence of a potential host, and c - the existence of a potential biotope. The role of anomalies in the development of any MSRP is discussed and a modification of Lakatos’ treatment is suggested. We believe that anomalies should not be set aside until they accumulate to the point where the scientific community begins to doubt their basic hard core. It is better for the scientist to resolve each controversial event as soon as it emerges since these events, may, in the future, give rise to unsuspected paths of theoretical and empiricalwork, or even improve and widen the predictive and explicative power of the MSRP itself. This, in brief, would deepen the “experimental content” of the program. (shrink)