With a focus on appearance and racialised perceptions of skin colour, this paper discusses the differences between being and feeling acceptable, pretty or ugly and the possibility of such displacement (from being to feeling or vice versa), as a way to understand what beauty does in people’s lives. The paper explores the fragility of beauty in relation to the visibility of the body in specific racialised contexts. It investigates the claim that beauty can be considered a feeling that emphasises processes (...) (what beauty does) rather than contents (what beauty is). Drawing from life stories with Mexican women, I examine their concerns about visibility, temporality and appearance as expressions of racist practices and ideas, within a context where the racial project of mestizaje (racial mixture) is in operation. Beauty matters as it makes evident the pervasiveness of racism in the everyday. The lived experience of beauty, in its displacement and fragility, as a feeling and as resource, can also point to some of the strategies to resist, cope and get on. (shrink)

In this article I argue the need for a reflexive use of photographic images in research, mainly in the publication and dissemination phase and specifically when the topic investigated relates to issues of visibility, in this case racism and understandings of beauty. This analysis draws on my work on contemporary practices of racism in Mexico, where personal photographs were used as research tools in life-story interviews, creating a sense of shared intimacy. Inspired by Barthes' refusal in Camera Lucida (2000) to (...) reproduce a photograph of his mother, in this article I focus on the dynamics between seeing and looking and suggest that `looking emotionally' at both participants' accounts and their photographic images, is a way to address the complexities of the gaze and discuss the specificity of different `ways of looking'. The notion of `looking emotionally' refers to an engagement, of researchers and audiences of research, with participants' lived emotional experiences that explicitly confronts the historical and social legacies of the visible. Here, photographs are understood not only as illustrative platforms from where experiences are organized, but also as `traps' that both inform and ensnare (Gell, 1999). As such, the argument aims to problematize the intimate relationship between gaze and photographic image in a context where racism is constrained to the visible, both in its reproduction and also in its pressing ongoing critique. (shrink)

El propósito del artículo es explicar el genocidio de la Unión Patriótica en clave de la economía nacional y su ubicación estratégica a partir de una aproximación teórica desde algunos elementos propuestos por Antonio Negri y Michael Hardt. Como conclusión se destaca que el genocidio de la up fue consecuencia de su poderío local, que ponía en riesgo la continuidad de las clases políticas dominantes en razón de sus propuestas como colectivo político. Así mismo, este hecho produjo que a raíz (...) de su origen se construyera sobre ellos un relato negativo de enemigos de la sociedad civil. Por último, las propuestas de memoria que se identificaron son consecuencia de la conquista y de la lucha social por parte de las víctimas. (shrink)

Abstract“The Book of Secrets in the Results of Ideas”, usually called “The Book of Secrets” is a codex containing drawings and descriptions of thirty-one artifacts attributed to the engineer Alī Ibn Khalaf al-Murādī, who lived in Andalusia in southern Spain at the beginning of the 11th century. This manuscript is one of the first written testimonies that describe medieval mechanisms with complex precision. The aim of this work is to reconstruct and study from a historical and technological point of view (...) two of the ancient artifacts contained in the “Book of Secrets”, the “Fortress Demolisher” and the “Magic Well”. The “Fortress Demolisher” is a war machine designed to demolish the upper part of the walls or towers and consists of a battering ram mounted on a platform that can be raised several meters above the ground using a scissor mechanism. The “Magic Well” is a mechanism with several pulleys whose purpose is to raise water several meters from the bottom of a well by collecting a small portion of rope. To reconstruct the two artifacts, a digital model and a detailed study of the geometry and operation of the mechanisms, were first carried out. 3D printing, using the Fused Deposition Modelling technology, made the physical reproduction. The digitization and physical reproduction by 3D printing of the mechanisms represent an update of the traditional ways of transmitting knowledge. The use of these new technologies makes the knowledge more accessible, understandable and attractive. (shrink)

À partir d’une analyse de la matérialité linguistique, cet article explore les processus de subjectivation et d’identification qui constituent le(s) sujet(s) des différentes pratiques urbaines, par rapport à l’espace de la rue et dans le cadre de disputes visant à l’affirmation d’identités socialement légitimées. Le corpus constitué pour ma recherche est de nature hétérogène, aussi bien dans sa matérialité symbolique que du point de vue de son inscription institutionnelle et de sa circulation sociale.

“Artemisa” supone una oportunidad excelente para acercarse al tema de la maternidad desde un punto de vista problemático, alejado de la idealización que, frecuentemente, observamos en tantos textos literarios. En este artículo, trataremos de ver cómo y por qué se fragua en el cuento una visión insoportable del hecho de ser madre, así como una imagen monstruosa del hijo cuya pulsión de vida termina desgastando y debilitando el cuerpo de la mujer a través del amamantamiento forzoso. Por otro lado, reflexionaremos (...) en torno al papel subordinado de Luisa y su interiorización tanto del poder patriarcal como del rol de objeto y no sujeto de deseo. Las principales herramientas metodológicas de nuestro trabajo se desarrollarán desde una perspectiva de género. (shrink)

Background: Serious games have shown positive results in increasing motivation, adherence to treatment and strengthening the therapeutic alliance in multiple psychiatric disorders. In particular, patients with impulse control disorders and other disorders in which the patient suffers from inhibitory control deficits have been shown to benefit from serious games.Aim: The aim of this study was to describe the characteristics and to evaluate the usability of a new serious videogame, e-Estesia. This serious videogame was designed to improve emotion regulation in patients (...) with gambling disorder. Preliminary results from a pilot sample are also reported.Method: A pilot sample of 26 patients undergoing treatment for GD was recruited. Participants used e-Estesia on a tablet, which was connected to a thoracic band that sent heart rate and heart rate variability data to the videogame platform in order to provide biofeedback. The System Usability Scale was completed by patients to determine the usability of e-Estesia.Results and Discussion: e-Estesia performed comparatively well for all the explored groups. Around 84.6% of the patients endorsed that it was easy to use. Female patients with GD presented higher HRV during the use of the serious videogame compared to men. (shrink)

Jelson Roberto de Oliveira, autor de “Compreender Hans Jonas”, é graduado em Filosofia pela Universidade Federal do Paraná, com especialização em Sociologia Política e mestrado em História da Filosofia Moderna e Contemporânea pela mesma universidade. Atualmente é professor da pós-graduação em Filosofia na PUC-PR, e coordenador do GT Hans Jonas, da Anpof, que reúne vários pesquisadores de nível nacional na área. Ética para a civilização tecnológica e A solidão como virtude moral em Nietzsche são alguns dos diversos títulos que compõem (...) o acervo de obras do autor. (shrink)

We investigate the emergence of iconicity, specifically a bouba-kiki effect in miniature artificial languages under different functional constraints: when the languages are reproduced and when they are used communicatively. We ran transmission chains of participant dyads who played an interactive communicative game and individual participants who played a matched learning game. An analysis of the languages over six generations in an iterated learning experiment revealed that in the Communication condition, but not in the Reproduction condition, words for spiky shapes tend (...) to be rated by naive judges as more spiky than the words for round shapes. This suggests that iconicity may not only be the outcome of innovations introduced by individuals, but, crucially, the result of interlocutor negotiation of new communicative conventions. We interpret our results as an illustration of cultural evolution by random mutation and selection. (shrink)

BackgroundComorbidity between diabetes mellitus and depression is highly prevalent. The risk of depression in a person with diabetes is approximately twice that of a person without this disease. Depression has a major impact on patient well-being and control of diabetes. However, despite the availability of effective and specific therapeutic interventions for the treatment of depression in people with diabetes, 50% of patients do not receive psychological treatment due to insufficient and difficult accessibility to psychological therapies in health systems. The use (...) of information and communication technologies has therefore been proposed as a useful tool for the delivery of psychological interventions, but it continues to be a field in which scientific evidence is recent and controversial. This systematic review aims to update the available information on the efficacy of psychological interventions delivered through ICTs to improve depressive symptomatology in patients with diabetes.MethodsA systematic review of the literature was performed following the PRISMA guidelines and using MEDLINE, Embase, PubMed, Web of Science, PsycINFO, Scopus, and Cochrane Library databases to search for randomized clinical trials of eHealth treatments for patients with diabetes and comorbid depression from 1995 through 2020. In addition, studies related to follow-up appointments were identified. Inclusion criteria were as follows: randomized clinical trials ; patients with type 1 and type 2 diabetes; adult population over 18 years of age; presence of depressive symptomatology assessed with standardized instruments; treatments for depression based on established psychotherapeutic techniques and principles; delivered through eHealth technologies. We did not limit severity of depressive symptomatology, delivery setting or comparison group. Two coauthors independently reviewed the publications identified for inclusion and extracted data from the included studies. A third reviewer was involved to discuss discrepancies found. The PEDro scale was used to assess the quality of the RCTs. No meta-analysis of the results was performed. The protocol used for this review is available in PROSPERO.ResultsThe initial search identified 427 relevant scientific publications. After removing duplicates and ineligible citations, a total of 201 articles were analyzed in full text. Ten articles met the criteria of this review and were included, obtaining very good scientific quality after evaluation with the PEDro scale. The main results show that the eHealth psychological intervention for depression in patients with diabetes showed beneficial effects both at the end of treatment and in the short and long term for the improvement of depressive symptomatology. The methodology used was very heterogeneous. However, all studies were based on cognitive-behavioral tools and used standardized assessment instruments to evaluate depressive symptomatology or diagnosis of MDD. Glycemic control was assessed by glycosylated hemoglobin, but no benefits were found in improving glycemic control. Only four studies included psychoeducational content on diabetes and depression, but none used tools to improve or enhance adherence to medical prescriptions or diabetes self-care.ConclusionsICT-based psychological interventions for the treatment of depression in people with diabetes appear to be effective in reducing depressive symptomatology but do not appear to provide significant results with regard to glycemic control. Nonetheless, the scientific evidence reported to date is still very limited and the methodology very diverse. In addition, no studies have implemented these systems in routine clinical practice, and no studies are available on the economic analysis of these interventions. Future research should focus on studying and including new tools to ensure improvements in diabetes outcomes and not only on psychological well-being in order to advance knowledge about these treatments. Economic evaluations should also be undertaken to analyze whether these treatment programs implemented using eHealth technologies are cost-effective. (shrink)

Desde una perspectiva transnacional y comparada, que incorpora la experiencia del exilio, este trabajo analiza las tensiones identitarias que afectaron a la juventud militante de la izquierda revolucionaria española y argentina durante los años setenta. A través de las relaciones familiares y de género, estudia las formas públicas y privadas del compromiso y la transgresión. Aborda cómo la politización de lo privado marcó a hombres y mujeres dentro de un proceso global contestatario, heredero del 68, para destacar las contradicciones que (...) afloraron entre la teoría y la práctica, el deseo y la realidad, que llevaron a los jóvenes militantes a asumir un régimen emocional en constante debate entre el ser y el deber ser. (shrink)

Mass-marketing frauds are on the increase. Given the amount of monies lost and the psychological impact of MMFs there is an urgent need to develop new and effective methods to prevent more of these crimes. This paper reports the early planning of automated methods our interdisciplinary team are developing to prevent and detect MMF. Importantly, the paper presents the ethical and social constraints involved in such a model and suggests concerns others might also consider when developing automated systems.

El presente trabajo investigativo hace referencia al papel central que ejercen las mujeres en la sociedad; y en particular, se abordará a la mujer candidata. En este contexto, hay que señalar que el Ecuador como cualquier otro país tiene su propia forma de gobernar, derivada de su historia política, económica y cultural. Este trabajo principalmente hace una prospección bibliográfica que da cuenta de las tendencias, fortalezas y desafíos que enfrentan las mujeres candidatas; y, el papel del dinero como elemento clave (...) de la política y las elecciones. La lectura de este trabajo se vuelve enriquecedora para quien quiera acercarse al estudio de la cultura política y participativa de las mujeres, lo cual permitirá a su vez, que este artículo esté mucho más cercano a la realidad ecuatoriana. (shrink)

En este texto se hace una introducción y una breve presentación de las distintas contribuciones al dossier. Específicamente, en el texto se precisan los distintos sentidos y perspectivas en los que se han planteado reflexiones filosóficas sobre los distintos aspectos de la educación en América Latina, se muestran algunas líneas temáticas de las reflexiones, se relacionan esas reflexiones con algunos de los planteamientos de la filosofía latinoamericana, se justifica la importancia de continuar y fomentar el trabajo filosófico en este amplio (...) terreno de reflexión filosófica, y se plantean algunos retos para las futuras reflexiones. Finalmente, se presentan y comentan los artículos que forman parte del dossier. (shrink)

El presente artículo hace referencia al papel central que ejercen los medios de comunicación en la sociedad. En este contexto, es preciso que aquellos ofrezcan una percepción adecuada y apegada a la realidad, lo cual involucra el abordaje de la discapacidad y los derechos de las personas que se encuentran en esa condición. Este trabajo principalmente hace una prospección bibliográfica que da cuenta de las tendencias, fortalezas y desafíos de los contenidos de los medios de comunicación. La lectura de este (...) trabajo se vuelve enriquecedora para quien quiera acercarse al estudio de la discapacidad y de los medios de comunicación como cuestión de derechos humanos, lo cual permitirá a su vez, que este artículo esté mucho más cercano a la realidad ecuatoriana. (shrink)

Este texto introduce un dosier dedicado a reflexionar sobre las relaciones entre el compromiso y la transgresión en la España contemporánea y actual, desde un enfoque de género. Con aportaciones provenientes de la Historia, la Literatura, la Comunicación, la Sociología y la Filosofía, pretende problematizar las jerarquías que suelen establecerse sobre ideales y experiencias desarrollados por mujeres y hombres en ámbitos progresistas o contraculturales. Además, muestra que la trasgresión surge en contextos de activismo intelectual, político, social o feminista al subvertir (...) el orden de género y promover avances en la igualdad, pero no está libre de tensiones y paradojas. (shrink)

The centromere is a specialized chromosomal structure that dictates kinetochore assembly and, thus, is essential for accurate chromosome segregation. Centromere identity is determined epigenetically by the presence of a centromere‐specific histone H3 variant, CENP‐A, that replaces canonical H3 in centromeric chromatin. Here, we discuss recent work by Roulland et al. that identifies structural elements of the nucleosome as essential determinants of centromere function. In particular, CENP‐A nucleosomes have flexible DNA ends due to the short αN helix of CENP‐A. The higher (...) flexibility of the DNA ends of centromeric nucleosomes impairs binding of linker histones H1, while it facilitates binding of other essential centromeric proteins, such as CENP‐C, and is required for mitotic fidelity. This work extends previous observations indicating that the differential structural properties of CENP‐A nucleosomes are on the basis of its contribution to centromere identity and function. Here, we discuss the implications of this work and the questions arising from it. (shrink)

One of the most debated questions in psychology and cognitive science is the nature and the functioning of the mental processes involved in deductive reasoning. However, all existing theories refer to a specific deductive domain, like syllogistic, propositional or relational reasoning.Our goal is to unify the main types of deductive reasoning into a single set of basic procedures. In particular, we bring together the microtheories developed from a mental models perspective in a single theory, for which we provide a formal (...) foundation. We validate the theory through a computational model (UNICORE) which allows fine‐grained predictions of subjects' performance in different reasoning domains.The performance of the model is tested against the performance of experimental subjects—as reported in the relevant literature—in the three areas of syllogistic, relational and propositional reasoning. The computational model proves to be a satisfactory artificial subject, reproducing both correct and erroneous performance of the human subjects. Moreover, we introduce a developmental trend in the program, in order to simulate the performance of subjects of different ages, ranging from children (3–6) to adolescents (8–12) to adults (>21). The simulation model performs similarly to the subjects of different ages.Our conclusion is that the validity of the mental model approach is confirmed for the deductive reasoning domain, and that it is possible to devise a unique mechanism able to deal with the specific subareas. The proposed computational model (UNICORE) represents such a unifying structure. (shrink)

In this pioneering new book, Sandra Harding and Robert Figueroa bring together an important collection of original essays by leading philosophers exploring an extensive range of diversity issues for the philosophy of science and technology. The essays gathered in this volume extend current philosophical discussion of science and technology beyond the standard feminist and gender analyses that have flourished over the past two decades, by bringing a thorough and truly diverse set of cultural, racial, and ethical concerns to bear (...) on questioning in these areas. Science and Other Cultures charts important new directions in ongoing discussions of science and technology, and makes a significant contribution to both scholarly and teaching resources available in the field. (shrink)

The US neutrino community gathered at the Workshop on the Intermediate Neutrino Program at Brookhaven National Laboratory February 4-6, 2015 to explore opportunities in neutrino physics over the next five to ten years. Scientists from particle, astroparticle and nuclear physics participated in the workshop. The workshop examined promising opportunities for neutrino physics in the intermediate term, including possible new small to mid-scale experiments, US contributions to large experiments, upgrades to existing experiments, R&D plans and theory. The workshop was organized into (...) two sets of parallel working group sessions, divided by physics topics and technology. Physics working groups covered topics on Sterile Neutrinos, Neutrino Mixing, Neutrino Interactions, Neutrino Properties and Astrophysical Neutrinos. Technology sessions were organized into Theory, Short-Baseline Accelerator Neutrinos, Reactor Neutrinos, Detector R&D and Source, Cyclotron and Meson Decay at Rest sessions.This report summarizes discussion and conclusions from the workshop. (shrink)

Over one-third of the white working class in America vote for Republicans. Some scholars argue that these voters support Republican economic policies, while others argue that these voters’ preferences on cultural and moral issues override their economic preferences. We draw on in-depth interviews with 120 white working-class voters to defend a broadly “economic” interpretation: for this segment of voters, moral and cultural appeals have an economic dimension, because these voters believe certain moral behaviors will help them prosper economically. Even the (...) very word “conservative” is understood as referencing not respect for tradition generally, but avoidance of debt and excessive consumption specifically. For many respondents, the need to focus on morality and personal responsibility as a means of prospering economically—what we call “walking the line”—accords with the rhetoric they associate with Republicans. Deindustrialization may have heightened the appeal of this rhetoric. (shrink)

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

The way Leibniz applied his philosophy to mathematics has been the subject of longstanding debates. A key piece of evidence is his letter to Masson on bodies. We offer an interpretation of this often misunderstood text, dealing with the status of infinite divisibility in nature, rather than in mathematics. In line with this distinction, we offer a reading of the fictionality of infinitesimals. The letter has been claimed to support a reading of infinitesimals according to which they are logical fictions, (...) contradictory in their definition, and thus absolutely impossible. The advocates of such a reading have lumped infinitesimals with infinite wholes, which are rejected by Leibniz as contradicting the part–whole principle. Far from supporting this reading, the letter is arguably consistent with the view that infinitesimals, as inassignable quantities, are mentis fictiones, i.e., (well-founded) fictions usable in mathematics, but possibly contrary to the Leibnizian principle of the harmony of things and not necessarily idealizing anything in rerum natura. Unlike infinite wholes, infinitesimals—as well as imaginary roots and other well-founded fictions—may involve accidental (as opposed to absolute) impossibilities, in accordance with the Leibnizian theories of knowledge and modality. (shrink)

Newborn bloodspot screening programs are some of the longest running population screening programs internationally. Debate continues regarding the need for parents to give consent to having their child screened. Little attention has been paid to how meanings of consent-related terminology vary among stakeholders and the implications of this for practice. We undertook semi-structured interviews with parents, healthcare professionals and policy decision makers in two Canadian provinces. Conceptions of consent-related terms revolved around seven factors within two broad domains, decision-making and information (...) attainment. Decision-making comprised: parent decision authority; voluntariness; parent engagement with decision-making; and the process of enacting choice. Information ascertainment comprised: professional responsibilities ; parent responsibilities; and the need for discussion and understanding prior to a decision. Our findings indicate that consent-related terms are variously understood, with substantive implications for practice. We suggest that consent procedures should be explained descriptively, regardless of approach, so there are clear indications of what is expected of parents and healthcare professionals. Support systems are required both to meet the educational needs of parents and families and to support healthcare professionals in delivering information in a manner in keeping with parent needs. (shrink)

Cognitive Science, Volume 46, Issue 6, June 2022.

Since its inception in September 2010, the Network for Public Health Law has responded to hundreds of public health legal technical assistance claims from around the country. Based on a review of these data, a series of major trends in public health practice and the law are analyzed, including issues concerning: the Affordable Care Act, tobacco control, emergency legal preparedness, health information privacy, food policy, vaccination, drug overdose prevention, sports injury law, public health accreditation, and maternal breastfeeding. These and other (...) emerging themes in public health law demonstrate the essential role of law and practice in advancing the public's health. (shrink)

Public health law research reveals significant complexities underlying the use of law as an effective tool to improve health outcomes across populations. The challenges of applying public health law in practice are no easier. Attorneys, public health officials, and diverse partners in the public and private sectors collaborate on the front lines to forge pathways to advance population health through law. Meeting this objective amidst competing interests requires strong practice skills to shift through sensitive and sometimes urgent calls for action (...) to address known threats to the health of individuals and the community. It also necessitates objective, timely information and national and regional legal support. (shrink)

The text is part of the investigative concerns from the authors with regard to the dialogue between literature and science teaching. It starts from several theoretical approaches around the general didactics, university or superior didactics, science’s didactics and for last, literature’s didactics. This is largely due to our search which is focused in articulate the university didactics with science and literature’s didactics, meanwhile, we pretend to answer to the questions ¿How are the specific didactics of science and literature going to (...) contribute to the university didactics and how is the last one going to contribute to these specific didactics? ¿Is it the dialogue between science and literature possible? The paper has been made in middle education, in Educative Institution José Miguel de Restrepo y Puerta, from Copacabana and also in university education, in the academic unities of Dietetics and Nutrition School, Agricultural Sciences and Medicine, from the University of Antioquia. Finally, the partial results indicate: i) the necessity of general Didactics as a discipline focused on teaching and learning processes to ask itself for its internal problems and establish relations with specific didactics. (shrink)

In this paper we deal with two types of reasoning: induction, and deduction First, we present a unified computational model of deductive reasoning through models, where deduction occurs in five phases: Construction, Integration, Conclusion, Falsification, and Response. Second, we make an attempt, to analyze induction through the same phases. Our aim is an explorative evaluation of the mental processes possibly shared by deductive and inductive reasoning.

In 1959, Neal Miller made the bold claim that the Stimulus–Response, Behaviorist models of that era were describing the way in which stimuli lead to the entry of contents into consciousness. Today, researchers have begun to investigate the link between external stimuli and involuntary entry, using paradigms such as the reflexive imagery task, the focus of our review. The RIT has revealed that stimuli can elicit insuppressible entry of high-level cognitions. Knowledge of the boundary conditions of the RIT effect illuminates (...) the limitations of involuntary processes and the role of consciousness in the regulation of behavior. We review the boundary conditions of this paradigm as well as its systematic effects. Systematic effects are unlikely to be due to experimental demand. While reviewing each effect, we consider its theoretical implications. In addition, throughout our review, we discuss future directions for the study of insuppressible entry using the RIT. Last, we discuss a theoretical development that stems from the RIT and illuminates how involuntary entry and encapsulation, though at times disadvantageous for the actor, are essential for adaptive action selection during the course of ontogeny. (shrink)

ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not reporting and (2) not obtaining consent.MethodsSurvey of primary trial reports, published 2014–2019, identified using an electronic search filter for pragmatic trials implemented in MEDLINE, and registered in ClinicalTrials.gov.ResultsAmong 1988 trials, 132 (6.6%) did not include a statement about participant consent, 1691 (85.0%) reported consent had been obtained, 139 (7.0%) reported a (...) waiver and 26 (1.3%) reported consent for one aspect (eg, data collection) but a waiver for another (eg, intervention). Of the 165 trials reporting a waiver, 76 (46.1%) provided a justification. Few (53, 2.9%) explicitly reported use of alternative approaches to consent. In multivariable logistic regression analyses, lower journal impact factor (p=0.001) and cluster randomisation (p<0.0001) were significantly associated with not reporting on consent, while trial recency, cluster randomisation, higher-income country settings, health services research and explicit labelling as pragmatic were significantly associated with not obtaining consent (all p<0.0001).DiscussionNot obtaining consent seems to be increasing and is associated with the use of cluster randomisation and pragmatic aims, but neither cluster randomisation nor pragmatism are currently accepted justifications for waivers of consent. Rather than considering either standard written informed consent or waivers of consent, researchers and research ethics committees could consider alternative consent approaches that may facilitate the conduct of pragmatic trials while preserving patient autonomy and the public’s trust in research. (shrink)

The shortage of organs for transplantation by its nature prompts ethical dilemmas. For example, although there is an imperative to save human life and reduce suffering by maximising the supply of vital organs, there is an equally important obligation to ensure that the process by which we increase the supply respects the rights of all stakeholders. In a relatively unexamined practice in the USA, organs are procured from unrepresented decedents without their express consent. Unrepresented decedents have no known healthcare wishes (...) or advance care planning document; they also lack a surrogate. The Revised Uniform Anatomical Gift Act of 2006 sends a mixed message about the procurement of organs from this patient population and there are hospitals that authorise donation. In addition, in adopting the RUAGA, some states included provisions that clearly allow organ procurement from unrepresented decedents. An important unanswered question is whether this practice meets the canons of ethical permissibility. The current Brief Report presents two principled approaches to the topic as a way of highlighting some of the complexities involved. Concluding remarks offer suggestions for future research and discussion. (shrink)