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)

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)

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)

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)

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)

A finales de septiembre de 2019, se publica Folie, langage, littèrature que se suma a la anterior colección de textos inéditos de Foucault en torno a la literatura que en 2013 aparecía bajo el título de La gran extranjera. Este nuevo volumen presenta textos inéditos donde los editores, nos dice Judith Revel, han seleccionado textos que vienen a incomodar la lectura canónica del Foucault interesado por la literatura. Y, efectivamente, la selección es especialmente interesante para los estudiosos de su obra (...) porque sitúa su ruptura con un concepto escapista de la literatura en torno a 1967. Particularmente llamativo es el texto «L’extralinguistique et la littérature», donde Foucault propone un análisis de los distintos modos en que lo extralingüístico, como afuera de la obra, se relaciona con ella y viceversa. A partir de esta propuesta, nuestro objetivo es analizar una política de la forma literaria que en Foucault se propone desde una materialidad negativa, a la vez que performativa. (shrink)

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)

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)

Comprender las tecnologías de la comunicación a la luz de las redes con que se comunican y entran en cooperación las personas ha sido una constante en autores que no han disociado su visión acerca del significado de las tecnologías respecto a los nuevos movimientos sociales. Este artículo sostiene que las TIC no son sólo una red a la que se suman los individuos, sino que actúan como tecnologías sociales cuyo perfeccionamiento depende tanto de la diversidad de sus funciones (socio-políticas, (...) cognitivas, etc.) como de la flexibilidad con que se adapten a nuestra diversidad funcional (ciclos de la vida, motricidad, umbrales de percepción, etc.). Prueba de ello son desafíos tecnológicos como el diseño de dispositivos llevables, las redes de área personal, las interfaces de usuario de alta usabilidad, los sistemas de cuidado en el hogar, etc. Este artículo explora dichas tesis en relación con el entorno educativo. (shrink)

Una crítica a los contraejemplos tipo-Frankfurt, presentada por David Widerker y conocida como la "Defensa-W", ha persistido a través de los años como uno de los retos más difíciles que estos han de enfrentar. En este texto defiendo los contraejemplos tipo-Frankfurt de este ataque de Widerker presentando un dilema en el que su premisa fundamental, el Principio de expectativas alternativas, se ve envuelta: o bien la plausibilidad de este principio depende de la máxima kantiana "deber" implica "poder", lo cual haría (...) que el principio mismo, y con él todo el argumento de Widerker, sea redundante y prescindible; o bien no se basa en esta máxima, pero entonces no hay ninguna razón de fuerza por la cual se pudiera defender que este principio debe ser aceptado como válido. A critique presented by David Widerker on Frankfurt-counterexamples and known as the "W-defense" has persisted for years and has been considered one of the most difficult challenges these counterexamples have to face. This paper aims to defend Frankfurt counterexamples against Widerker's attack. For doing this, the paper presents a dilemma addressed to the main premise of Widerker's attack: The Principle of Alternative Expectations. The dilemma states: either this principle rests on the Kant's maxim, "ought" implies "can", and then this makes redundant and unnecessary the principle and Widerker's whole argument; or the principle does not rest on such maxim and then there is no good reason to accept it as valid. (shrink)

. All personal that belong to a company, has to be consider into their daily agenda theoptimization of the inventory, in matter of create a cost reduction into the organization, an finallyincrement the productivity.The inventory is the element that gives “live” to the companies, in the moment to be manufacturedinto a product, through the works stations, is the case, that the excess of inventory will force thecompany not invert into development, research, training, technology, etc., and this situation willaffect competiveness, and (...) take the risk of be out of the market.The clients pay for a good, with a competitiveness price, excellent quality, and complete all thespecification that they request, plus has to be deliver on time; our responsibility is do wherever ittakes to guaranty the mayor percentage of efficiency in all our process and complete the goal ofsatisfy our clients.Keywords. Competitiveness, cost, inventory management, productivity.Resumen. Todo el personal estratégico, administrativo y operativo perteneciente a una empresa,debe considerar dentro de su agenda diaria la optimización de la gestión de los inventarios,permitiendo con ello un impacto en la reducción los costos de la organización, que se traducirá en unincremento de la productividad.El inventario es el elemento que permite dar vida a las empresas, al momento de ser transformada enun producto, a través de todas las estaciones de trabajo dando paso a paso un valor agregado, sinembargo el exceso de los inventarios ocasiona que la organización no pueda en incurrir en gastos quepermitan el desarrollo y crecimiento, como son las áreas de investigación y desarrollo, capacitación yadiestramiento, tecnología, mercadotecnia, etc., trayendo en consecuencia perder el nivel decompetitividad, y con ello correr el riesgo de quedar desplazado por la competencia.Los clientes pagan por producto que presente un precio competitivo; de la más alta calidad; quecumpla con todas y cada una de sus especificaciones; que sea entregado en tiempo y forma; esnuestra responsabilidad como estrategas, administradores y operadores de los inventarios, elgarantizar el mayor porcentaje de eficiencia en los procesos productivos y administrativos, demanera de lograr el fin último de toda empresa tiene, satisfacer a sus clientes.Palabras claves. Administración de inventarios, competitividad, costos, productividad. (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)