The majority of antimicrobials that are produced are administered to animals, particularly food animals. While the overall impact of antimicrobial use in animals on antimicrobial resistance in humans and the environment is unclear, it undeniably has a role. Yet, some degree of antimicrobial use in animals is necessary for animal health and welfare purposes. Balancing the benefits and risks of antimicrobial use in animals is challenging because of the complexity of the problem and limitations in available data. However, a range (...) of measures can be implemented to reduce, refine and optimize antimicrobial use in animals, with a goal of minimizing the impact on human and environmental health while maintaining necessary therapeutic use in animals. A pandemic instrument can provide the necessary foundation for the whole-of-society and whole-of government One Health approach that is required to strengthen surveillance, communication, collaboration, and action. (shrink)

The debate over the propriety of cognitive enhancement evokes both enthusiasm and worry. To gain further insight into the reasons that people may have for endorsing or eschewing pharmacological enhancement, we used empirical tools to explore public attitudes towards PE of twelve cognitive, affective, and social domains. Participants from Canada and the United States were recruited using Mechanical Turk and were randomly assigned to read one vignette that described an individual who uses a pill to enhance a single domain. After (...) reading the vignette, participants were asked how comfortable they were with the individual using the enhancement. People were significantly more comfortable when they read about enhancement of certain CAS domains than others. We found a modest negative correlation between comfort level and the degree to which the PE was perceived as changing core features of the person. We also found a modest correlation between comfort level and the degree to which the PE was perceived as improving success in life. Finally, using a sequential mixed method technique, we found that participants who felt uncomfortable about PE use overwhelmingly focused on a lack of need and, to a lesser degree, expressed concerns about safety; those who felt comfortable about PE use most frequently mentioned the safety of the pill and its ability to provide a positive outcome. The data provide novel insights into public enthusiasms and concerns over the use of PE. (shrink)

Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat psychiatric conditions. For depression therapy, PEIs include both approved treatment modalities, such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS), and experimental neurotechnologies, such as deep brain stimulation (DBS) and adaptive brain implants (ABIs). We present results from a survey-based experiment in which members of four relevant stakeholder groups (psychiatrists, patients with depression, caregivers of adults with depression, and the general public) assessed whether treatment with one of (...) four PEIs (ECT, rTMS, DBS, or ABIs) was better or worse than living with treatment-resistant depression (TRD) and then provided a narrative explanation for their assessment. Overall, the prevalence of many narrative themes differed substantially by stakeholder group—with psychiatrists typically offering different reasons for their assessment than non-clinicians—but much less so by PEI modality. A large majority of all participants viewed their assigned PEI as better than living with TRD, with their reasons being a mix of positive views about the treatment and negative views about TRD. The minority of all participants who viewed their assigned PEI as worse than living with TRD tended to express negative affect toward it as well as emphasize its riskiness, negative side effects, and, to a lesser extent, its invasiveness. The richness of these narrative explanations enabled us to put in context and add depth to key patterns seen in recent survey-based research on PEIs. (shrink)

The ambiguity regarding whether a given intervention is perceived as enhancement or as therapy might contribute to the angst that the public expresses with respect to endorsement of enhancement. We set out to develop empirical data that explored this. We used Amazon Mechanical Turk to recruit participants from Canada and the United States. Each individual was randomly assigned to read one vignette describing the use of a pill to enhance one of 12 cognitive, affective or social domains. The vignettes described (...) a situation in which an individual was using a pill to enhance the relevant domain under one of two possible enhancement conditions, one perceived as enhancing above the norm, what most people recognize as a clear case of enhancement, whereas the other perceived as enhancing towards the norm, with the individual using the enhancement having a modest, but subclinical deficit. Participants were asked how comfortable they were with the individual using the enhancement and about the impact the enhancement might have had in the individuals’ success in life. We found that irrespective of the domain to be enhanced, participants felt significantly more comfortable with ETN than with EAN, and they regarded the enhancement intervention as contributing to greater success in life with ETN rather than EAN. These data demonstrate that the therapy enhancement distinction is morally salient to the public, and that this distinction contributes to the angst that people feel when considering the propriety of CAS enhancement. (shrink)

In recent years, discussion around memory modification interventions has gained attention. However, discussion around the use of memory interventions in the criminal justice system has been mostly absent. In this paper we start by highlighting the importance memory has for human well-being and personal identity, as well as its role within the criminal forensic setting; in particular, for claiming and accepting legal responsibility, for moral learning, and for retribution. We provide examples of memory interventions that are currently available for medical (...) purposes, but that in the future could be used in the forensic setting to modify criminal offenders’ memories. In this section we contrast the cases of dampening and enhancing memories of criminal offenders. We then present from a pragmatic approach some pressing ethical issues associated with these types of memory interventions. The paper ends up highlighting how these pragmatic considerations can help establish ethically justified criteria regarding the possibility of interventions aimed at modifying criminal offenders’ memories. (shrink)

The reporting of clinical trial data is necessary not only for doctors to determine treatment efficacy, but also to explore new questions without unnecessarily repeating trials, and to protect patients and the public from dangers when data are withheld. This issue is particularly salient in those trials involving invasive neurosurgical interventions, such as deep brain stimulation (DBS), for ‘treatment refractory’ psychiatric disorders. Using the federal database ClinicalTrials.gov, it was discovered that out of the completed or unknown‐status trials related to psychiatric (...) DBS up to November 2018, only two had submitted results to ClinicalTrials.gov. These results suggest that, despite federal requirements to report clinical trial data, reporting on psychiatric DBS trials is problematically minimal. It is argued that a human rights approach to this problem establishes a legal and ethical foundation for the need to report clinical trial results in this area. (shrink)

Los fenómenos urbanos son objeto de complejos modelos cuantitativos que persiguen explicar la emergencia de futuras tendencias. De similar manera, la intuición opera en algunos visionarios, cuya propiedad de percibir lo que esta por venir, los acerca a la realidad de un modo distinto. Este es el caso de Víctor Jara, cuya canción “Las Casitas del Barrio Alto” es objeto de estudio a través de un análisis crítico del discurso. En el trabajo se aprecia que Víctor Jara tiene la capacidad (...) de anticipar el futuro con esta canción, enunciando las características de lo que seria el porvenir urbano de Chile post dictatorial. (shrink)

Neurosurgery for psychiatric disorders, also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws and to (...) set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law, what types of regulations are required, and how to approach international harmonization given the potential migration of researchers and patients. (shrink)

To be made aware of bioethical issues related to their disciplines, undergraduate students in biology and pharmaceutical sciences at the University of Basel are required to enroll in the bioethics course called “Introduction to Bioethics”. This article describes the chances and challenges faced when teaching a large number of undergraduate biology and pharmaceutical sciences students. Attention is drawn to the relevance and specific ethical issues that biology and pharmaceutical sciences students may be confronted with and to how these could be (...) integrated into ethics curricula. Results from a survey addressing the knowledge and opinion of students taking the course in spring semester 2012, 2013, and 2014 are presented and discussed. Finally, we describe the lessons learned and how we have improved the course based on students’ feedback throughout the following years. (shrink)

Depression is a widespread concern in the United States. Neuromodulation treatments are becoming more common but there is emerging concern for racial disparities in neuromodulation treatment utilization. This study focuses on Transcranial Magnetic Stimulation (TMS), a treatment for depression, and the structural and attitudinal barriers that racialized individuals face in accessing it. In January 2023 participants from the Twin Cities, Minnesota engaged in focus groups, coupled with an educational video intervention. Individuals self identified as non-white who had no previous TMS (...) exposure but had tried at least one treatment for their depression. Results revealed that the intervention did not notably change knowledge or stigma about TMS, but attitudes surrounding traveling for treatment changed. Notably, barriers like affordability, frequency of treatment, and lack of knowledge persist. Participants expressed a desire for more information, personal connection, and a tailored educational approach. The study suggests a need for multifaceted strategies to reduce disparities, focusing on education, community-based resources, and policy interventions. Immediate actions that can be taken include the creation of a TMS education program focused on patient engagement and awareness about TMS. (shrink)

Despite increasing popularity and intensive worldwide use, few studies have assessed the validity and factorial structure of the Heartland Forgiveness Scale. However, scientific literature showed that the original factorial structure of the HFS was not fully replicated and—in addition—the Italian translation is still lacking. To fill this gap, this study aims to extend evidence about the original HFS factorial validity by analyzing the Italian version. The final sample was composed of 523 randomly enrolled participants [139 males, 384 females ] aged (...) from 18 to 82 years who completed the Italian version of the HFS. The confirmatory factor analysis showed good fit indices for the original hierarchical factor solution and a significant decrease in model fit was found for all of the competing models. Also, the Italian version of the HFS revealed good reliability and very good psychometrical properties. Findings suggest that the Italian version of the HFS can be considered a reliable and good psychometrically based instrument for the assessment of dispositional forgiveness of the Self, Other, and Situation. (shrink)

What happens at the end of a clinical trial for an investigational neural implant? It may be surprising to learn how difficult it is to answer this question. While new trials are initiated with increasing regularity, relatively little consensus exists on how best to conduct them, and even less on how to ethically end them. The landscape of recent neural implant trials demonstrates wide variability of what happens to research participants after an neural implant trial ends. Some former research participants (...) continue to receive support for their devices (e.g., battery and component replacements, software updates, etc.). Others, when safe, have their neural implants removed through surgical explantation. Still others continue to live with a deactivated neural implant embedded in their body. In the United States, there are no uniform requirements to provide services, of any kind, after an neural implant study ends, and other nations are similarly facing this challenge. The existence of a post-trial gap in an expanding neural implant research ecosystem invites obvious questions: What is owed to neural implant research participants post-trial, and why has providing it been so difficult to accomplish in practice? To take a step forward on this difficult issue, we assembled one group of stakeholders – researchers funded for neuroethics grants by the National Institutes of Health – to explore possible starting points on one topic: ethical guidance for post-trial care of research participants in neural implant trials. Based on shared concerns discussed in the expert workshop the current paper is a call to action. It reports the key areas of convergence from the meeting and highlights important next steps towards developing much needed guidance. (shrink)

Introduction As deep brain stimulation (DBS) has shifted to being used earlier during Parkinson’s disease (PD), data is lacking regarding patient specific attitudes, preferences, and factors which may influence the timing of and decision to proceed with DBS in the United States. This study aims to identify and compare attitudes and preferences regarding the earlier use of DBS in Parkinson’s patients who have and have not undergone DBS. Methods We developed an online survey concerning attitudes about DBS and its timing (...) in PD. The survey was distributed nationally in the United States via the Michael J. Fox Foundation Trial Finder, the American Parkinson Disease Association flyers, and as a link on the Parkinson Alliance website. Differences in responses between PD DBS and non-DBS patients were assessed. Results A total of 445 patients with PD met eligibility criteria for the survey of which 160 self-identified as having undergone DBS. Fifty-five percent (n = 124) of non-DBS patients believed that DBS for PD should only be considered after all medication options have been tried. Patients favoring early DBS had fewer concerns regarding the surgery than those favoring later DBS. Conclusion Our findings highlight a variety of important considerations and concerns patients have regarding DBS and its timing. These viewpoints are important aspects of shared decision-making, as they help to identify patients’ preferences, values, and goals, which should enable providers to better navigate, with their patients, the decision path for therapeutic options to consider. (shrink)

The current study assessed the extent to which the use of referential prosody varies with communicative demand. Speaker–listener dyads completed a referential communication task during which speakers attempted to indicate one of two color swatches (one bright, one dark) to listeners. Speakers' bright sentences were reliably higher pitched than dark sentences for ambiguous (e.g., bright red versus dark red) but not unambiguous (e.g., bright red versus dark purple) trials, suggesting that speakers produced meaningful acoustic cues to brightness when the accompanying (...) linguistic content was underspecified (e.g., “Can you get the red one?”). Listening partners reliably chose the correct corresponding swatch for ambiguous trials when lexical information was insufficient to identify the target, suggesting that listeners recruited prosody to resolve lexical ambiguity. Prosody can thus be conceptualized as a type of vocal gesture that can be recruited to resolve referential ambiguity when there is communicative demand to do so. (shrink)

Gilbert et al. argue that discussions of self-related changes in patients undergoing DBS are overblown. They show that there is little evidence that these changes occur frequently and make recommendations for further research. We point out that their framing of the issue, their methodology, and their recommendations do not attend to other important questions about these changes.

The potential to collect brain data more directly, with higher resolution, and in greater amounts has heightened worries about mental and brain privacy. In order to manage the risks to individuals posed by these privacy challenges, some have suggested codifying new privacy rights, including a right to “mental privacy.” In this paper, we consider these arguments and conclude that while neurotechnologies do raise significant privacy concerns, such concerns are—at least for now—no different from those raised by other well-understood data collection (...) technologies, such as gene sequencing tools and online surveillance. To better understand the privacy stakes of brain data, we suggest the use of a conceptual framework from information ethics, Helen Nissenbaum’s “contextual integrity” theory. To illustrate the importance of context, we examine neurotechnologies and the information flows they produce in three familiar contexts—healthcare and medical research, criminal justice, and consumer marketing. We argue that by emphasizing what is distinct about brain privacy issues, rather than what they share with other data privacy concerns, risks weakening broader efforts to enact more robust privacy law and policy. (shrink)

Although language has long been regarded as a primarily arbitrary system, sound symbolism, or non-arbitrary correspondences between the sound of a word and its meaning, also exists in natural language. Previous research suggests that listeners are sensitive to sound symbolism. However, little is known about the specificity of these mappings. This study investigated whether sound symbolic properties correspond to specific meanings, or whether these properties generalize across semantic dimensions. In three experiments, native English-speaking adults heard sound symbolic foreign words for (...) dimensional adjective pairs and for each foreign word, selected a translation among English antonyms that either matched or mismatched with the correct meaning dimension. Listeners agreed more reliably on the English translation for matched relative to mismatched dimensions, though reliable cross-dimensional mappings did occur. These findings suggest that although sound symbolic properties generalize to meanings that may share overlapping semantic features, sound symbolic mappings offer semantic specificity. (shrink)

En el libro 4 de la _Política_ de Aristóteles encontramos una forma de constitución recta que se da cuando los _mésoi_, los ciudadanos de recursos moderados, son, no solo numerosos, sino mayoritarios. Los ciudadanos medios garantizan el gobierno de la ley y de la razón, fundamentan la amistad entre ciudadanos y la estabilidad del régimen. Nos planteamos en este ensayo qué relación tiene esta forma constitucional con la politia, entendida como mezcla de democracia y oligarquía; con la democracia, como gobierno (...) de la mayoría; y con la _aríste politeía_, basada en la virtud de sus ciudadanos. (shrink)

Deep brain stimulation (DBS) uses electrodes implanted in the brain to modulate dysregulated brain activity related to a variety of neurological and psychiatric conditions. A number of people who use DBS have reported changes that affect their sense of self. In the neuroethics literature, there has been significant debate over the exact nature of these changes. More recently, there have been suggestions that this debate is overblown and detracts from clinically-relevant ways of understanding these effects of DBS. In this paper, (...) we offer an alternative approach to understanding the effects of DBS on the self, drawing on John Sadler’s work on self-illness ambiguity. We argue that self-illness ambiguity is a complex concept, with at least three different aspects, and that each of the three aspects we identify also characterizes one kind of DBS-related change. Our analysis also suggests ways of helping patients to adjust to life as a DBS user. (shrink)

El presente estudio se centra en la correlación que existe entre las variables de estereotipos de género y estereotipos emocionales en docentes (actitudes, creencias) analizando factores dentro del ámbito educativo, como segundo agente de socialización.101 docentes de ambos sexos, completaron dos cuestionarios. Uno centrado en actitudes sexistas e igualdad de género, CAIG y el otro, de inteligencia emocional, TMMS-24. Se observó correlación significativa entre los docentes con actitudes sexistas o estereotipadas de género con aquellos con estereotipos emocionales. Concretamente en lo (...) religioso, público y de sexualidad y libertad personal. En el resto, sin diferencias significativas, ni correlación entre las variables. (shrink)

En sus lecciones de los años treinta, Heidegger se centra en el pensamiento de Nietzsche dado que considera que en él se ha consumado el nihilismo de la metafísica a través de la inversión de sus principios en su doble inicio platónico y cartesiano. Pero el “nihilismo impropio” de la metafísica entendido como el “olvido del ser”, es motivado a su vez por el “nihilismo propio” o “abandono del ser”. Consecuentemente Heidegger propone la “superación-sobretorsión” de la metafísica en el sentido (...) de una “torsión” del olvido del ser, camino que lo llevará a la búsqueda de un pensamiento no metafísico entendido como el “recuerdo interiorizante en la metafísica” primeramente, y seguidamente en el sentido de un pensamiento rememorante. Seguidamente la presente propuesta se detiene en la temática del “último Dios” en el horizonte de la temporalidad, donde Heidegger lo anuncia como “el último” pero en el sentido del más originario, pensado desde la dimensión del “tiempo auténtico” tetradimensional, donde lo advenidero no es lo meramente futuro, sino lo predeterminado por “lo sido”. Así se comprende la humanidad de los advenideros, un pueblo de creadores que son “los vigías del silencio del pasaje del último Dios”. (shrink)

En el presente trabajo nos proponemos reflexionar acerca de las posibilidades, límites y desafíos que se presentan en la práctica docente cuando jóvenes de sectores subalternos emprenden la tarea de escribir sus propias historias. Estas reflexiones surgen a partir de una experiencia pedagógica desarrollada en el marco del Programa Pueblos Originarios y Escuelas Rurales de la UNCuyo. Consideramos que la fragmentación y la discontinuidad es un rasgo de la memoria colectiva de los sectores subalternos, sin embargo, en ocasiones encuentra espacios (...) para expresarse y tensionar la historia oficial. En esa dirección, en esta ocasión, decidimos convertir nuestros espacios curriculares en ámbitos de reflexión personal y colectiva donde los y las subalternos (parafraseando a la filósofa india Gayatri Spivak) “pudieron hablar”, para luego plasmar sus historias en fanzines. (shrink)

Resumen Las opiniones que aparecen en la página web TripAdvisor, como muestra relevante de la promoción del Turismo 2.0, se convierten, dadas las características de este discurso, en macroactos de habla directivos en los que convergen actos de distinta naturaleza. Si bien se presentan como opiniones, trascienden los límites de la mera información para convertirse en actos directivos, ya que el opinante se ve implicado en la construcción de una especie de guía de ayuda a otros viajeros. Por tanto, el (...) objetivo de este trabajo es categorizar los distintos tipos de las denominadas por la página web TripAdvisor “opiniones” como sugerencias, consejos, recomendaciones y advertencias, y analizar las estrategias de atenuación a las que se recurre en su formulación al servicio de distintas actividades de imagen. Los resultados muestran una tendencia que nos lleva a proponer la distinción entre estos tipos de actos directivos sobre la base de: la recurrencia a estrategias de atenuación, factores como el poder o la voluntad del opinante, el coste-beneficio para el destinatario, así como las propias calificaciones de las opiniones – en las categorías “excelente”, “muy bueno”, “normal”, “malo” y “pésimo”– establecidas por la propia página web. Tener en cuenta todas estas variables nos ha permitido constatar la existencia de un continuo de los actos de habla que se corresponden con diferentes grados de estrategias de atenuación, también en función de las categorías de evaluación y de los mecanismos utilizados para producir el acto. (shrink)

Evaluating the Knowledge and Practice of Limitation of Therapeutic Effort in Health Workers at a Health Care Institution for Cancer Patients in Medellín, 2018Avaliação do conhecimento e da prática da limitação de esforço terapêutico em equipe de atendimento de uma instituição prestadora de serviços de saúde para pacientes oncológicos de Medellín, 2018Limitation of therapeutic effort is any action that involves suspending or not initiating medical treatment or therapeutic measures in patients who will not receive any clinical benefit. In Latin America, (...) some research has proven a lack of familiarization and disagreement with the subject and its practices. The present study tried to objectify the knowledge of LTE of healthcare personnel at an institute in Medellín using a self-administered survey that allowed conducting a cross-sectional descriptive study with non-probabilistic sampling. Within the results, 56.5 % of respondents understood the concept of LTE, and 90 % applied it actively. However, there were discrepancies regarding the core concepts of the definition and practice.Para citar este artículo / To reference this article / Para citar este artigoVallejo LI, Palacio AM, Marulanda V, Restrepo A, Yepes LA, Valencia NL, Cruz MA. Evaluación del conocimiento y práctica de la limitación del esfuerzo terapéutico en personal asistencial de una institución prestadora de servicios de salud para pacientes oncológicos de Medellín, 2018. 2020;24:177-87. DOI: https://doi.org/10.5294/pebi.2020.24.2.5Recibido: 19/07/2019Aceptado: 08/08/2020Publicado: 27/11/2020. (shrink)

El presente artículo se ocupa de las postura de Aristóteles y Diodoro Crono en torno a la necesidad lógica. Allí se muestra que Aristóteles rechaza la necesidad lógica, mediante la negación de la aplicación universal del principio de bivalencia, para preservar el valor de la deliberación. En segundo lugar se muestra que Diodoro cae en un fatalismo al sostener, mediante sus nociones modales, que hay tipos de eventos lógicamente contingentes, aunque todos los sucesos particulares del mundo son necesarios.

En este artículo recorro algunas de las páginas de la obra kantiana que introducen la problemática de los otros seres racionales, me centro para ello en Historia universal de la naturaleza y Teoría del cielo, la Fundamentación de la metafísica de las costumbres y la Antropología en sentido pragmático. Mi propuesta es que la hipótesis de la existencia de otras formas de racionalidad, que en algunos textos Kant sitúa en otros planetas, nos proporciona una perspectiva necesaria para poder dar alguna (...) respuesta a la cuestión ¿qué es el ser humano? Si bien Kant aborda en textos muy relevantes la forma de tener por verdad la existencia de tales seres, lo realmente importante es el ser capaces de asumir esa perspectiva para reflexionar en torno a nuestra racionalidad. (shrink)

Advancements in novel neurotechnologies, such as brain computer interfaces and neuromodulatory devices such as deep brain stimulators, will have profound implications for society and human rights. While these technologies are improving the diagnosis and treatment of mental and neurological diseases, they can also alter individual agency and estrange those using neurotechnologies from their sense of self, challenging basic notions of what it means to be human. As an international coalition of interdisciplinary scholars and practitioners, we examine these challenges and make (...) recommendations to mitigate negative consequences that could arise from the unregulated development or application of novel neurotechnologies. We explore potential ethical challenges in four key areas: identity and agency, privacy, bias, and enhancement. To address them, we propose democratic and inclusive summits to establish globally-coordinated ethical and societal guidelines for neurotechnology development and application, new measures, including “Neurorights,” for data privacy, security, and consent to empower neurotechnology users’ control over their data, new methods of identifying and preventing bias, and the adoption of public guidelines for safe and equitable distribution of neurotechnological devices. (shrink)

Este artículo analiza la obra de dos beguinas del s. XIII pertenecientes a la denominada teología vernácula. Se propone caracterizar las obras de Matilde de Magdeburgo,La luz que fluye de la divinidad, y de Margarita Porete, El espejo de las almas simples, a fin de determinar las notas más distintivas de las autoras. En ambos trabajos el amor es central, a la vez que está íntimamente vinculado con el conocimiento. Aun así, la lectura de los textos y su detenido examen (...) permite proponer que la obra de Matilde está principalmente relacionada con la literatura del amor cortés mientras que la de Margarita, a la vez que incluye estos elementos, está más enraizada en la mística de la nada, que será luego ampliamente conocida en la tradición por el trabajo de Meister Eckhart. Por esta razón, el lugar otorgado a los sentidos y la corporalidad adquiere mayor relevancia en la obra de Matilde, mientras que en Margarita la experiencia amorosa unitiva es puramente espiritual. Estos matices en las caracterizaciones de la unión con la divinidad deben ser leídos en su contexto histórico, dado que durante el s. XIII y el siguiente se desarrolló una polémica sobre el carácter afectivo o intelectual de la unión mística. Estas diferentes maneras de entender el amor que encontramos en los trabajos de estas autoras medievales representan otro modo de abordar la idea y la función del eros, que desde Platón en adelante ha sido uno de los temas centrales de la reflexión filosófica. (shrink)