Introduction: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design: Data were analysed, codified and (...) triangulated using qualitative ethnographic content analysis. Participants and research context: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. Ethical considerations: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen. (shrink)

Contemporary healthcare practice has been progressively more regulated to increase efficiency, service user safety and practice quality. However, ethical issues in clinical practice that have not been implemented into regulations are undervalued by policymakers and healthcare institutions Considering the issues found by other authors, the use of a simple tool for policymakers to consider recurrent ethical issues could reduce those issues in a policy-driven clinical practice. The lack of tools to support structured ethical assessment of clinical policies was the main (...) reason to create the Clinical Policy Ethics Assessment Tool, but we realised of its possible advantages: limiting ethical dilemmas posed by policies, ensuring ethical practice by the use of policies and developing a consistent process for policymakers, institutions and healthcare professionals. Nonetheless, even if a tool can be implemented and it supports the creation of policies that reduce ethical issues, if the healthcare professionals are not aware of them they will not be implemented and the issues will continue. (shrink)

Contemporary healthcare practice has been progressively more regulated to increase efficiency, service user safety and practice quality. However, ethical issues in clinical practice that have not been implemented into regulations are undervalued by policymakers and healthcare institutions Considering the issues found by other authors, the use of a simple tool for policymakers to consider recurrent ethical issues could reduce those issues in a policy-driven clinical practice. The lack of tools to support structured ethical assessment of clinical policies was the main (...) reason to create the Clinical Policy Ethics Assessment Tool, but we realised of its possible advantages: limiting ethical dilemmas posed by policies, ensuring ethical practice by the use of policies and developing a consistent process for policymakers, institutions and healthcare professionals. Nonetheless, even if a tool can be implemented and it supports the creation of policies that reduce ethical issues, if the healthcare professionals are not aware of them they will not be implemented and the issues will continue. (shrink)

Introduction: Clinical policies control several aspects of clinical practice, including individual treatment and care, resource management and healthcare professionals’ etiquette. This article presents Clinical Policy Ethics Assessment Tool, an ethical assessment tool for clinical policies that could be used not only by clinical ethics committees but also by policy committees or other relevant groups. Aim: The aim of this study was to find or create a tool to identify ethical issues and/or confirm ethical validity in nursing practice policies, protocols and (...) guidelines. Methodology: The development of Clinical Policy Ethics Assessment Tool involved first a literature review, followed by modification of the Research Protocol Ethics Assessment Tool, which was created to identify research protocols’ ethical issues, and finally, a trial of Clinical Policy Ethics Assessment Tool to ensure its reliability and validity. Ethical consideration: The policies analysed trialling Clinical Policy Ethics Assessment Tool were in the public domain and did not contain any confidential information. Despite that, Clinical Policy Ethics Assessment Tool also had the approval of a research ethics committee. Results: Research Protocol Ethics Assessment Tool was chosen as the template for a Clinical Policy Ethics Assessment Tool, to which several modifications were added to adapt it to work within a nursing practice context. Clinical Policy Ethics Assessment Tool was tested twice, which resulted in a general test–retest reliability coefficient = 0.86, r = 0.84, α1 = 0.817, α2 = 0.824 and interclass correlation coefficient = 0.874. Discussion: Contemporary nursing practice in a developed country is often ruled by clinical policies. The use of Clinical Policy Ethics Assessment Tool could confirm the ethical validity of those clinical practice policies, impacting on nurses’ education, values and quality of care. Conclusion: Clinical Policy Ethics Assessment Tool has the potential to detect ethical issues and facilitate the correction and improvement of clinical policies and guidelines in a structured way. This is especially so as it has shown reliability in detecting issues in clinical policies involving human participants and in encouraging policymakers to consider common ethical dilemmas in nursing practice. (shrink)

El texto es una reseña de El lenguaje político de la república. Aproximación a una historia comparada de la prensa y la opinión pública en la América española, 1767-1830, de Gilberto Loaiza Cano. Medellín: Universidad Nacional de Colombia, 2020. 234p.

IntroductionRheumatologists are the primary healthcare professionals responsible for patients with rheumatic diseases and should acquire medical ethical competencies, such as the informed consent process. The objective clinical structured examination is a valuable tool for assessing clinical competencies. We report the performance of 90 rheumatologist trainees participating in a station designed to evaluate the ICP during the 2018 and 2019 national accreditations.MethodsThe station was validated and represented a medical encounter in which the rheumatologist informed a patient with systemic lupus erythematosus with (...) clinically active nephritis about renal biopsy. A trained patient–actor and an evaluator were instructed to assess ICP skills in obtaining formal informed consent, delivering bad news and overall communication with patients. The evaluator used a tailored checklist and form.ResultsCandidate performance varied with ICP content and was superior for potential benefit information but significantly reduced for potential complications and biopsy description. Only 17.8% of the candidates mentioned the legal perspective of ICP. Death was omitted by the majority of the candidates ; after the patient–actor challenged candidates, only 57.1% of them gave a clear and positive answer. Evaluators frequently rated candidate communications skills as superior, but ≥1 negative aspect was identified in 69% of the candidates.ConclusionsEthical competencies are mandatory for professional rheumatologists. It seems necessary to include an ethics competency framework in the curriculum throughout the rheumatology residency. (shrink)

El autor toma las ideas fundamentales que los liberales han legado al mundo contemporáneo: la libertad y la propiedad fueron sus valores predilectos y su vigencia permanece hasta la actualidad. Empeñados en construir un Estado proclive a la libertad y la propiedad, los liberales idearon la soberanía, la separación de poderes y la posibilidad de que alguna vez hubiera Estados regidos por Constituciones. Hoy esas ideas constituyen los pilares de nuestra organización política.

This is the first study that directly links Krausism to the Spanish avant-garde. To this end, the book is presented in chronological order in efforts to highlight how Krausism evolved and affected the culture of Spain. Those changes occurred in the fields of education, politics, philosophy, literature, and arts, to name a few.

Las cuestiones éticas vuelven a ocupar un lugar central en la preocupacioes del hombre contemporáneo. Se trata de la eclosión de una sensibilidad renovada que lleva a enfocar todos los asuntos humanos y sociales desde el punto de vista moral.

This article presents a case that former President of the United States Donald Trump was a tyrant-like leader in the mold of the tyrant in Plato’s Republic. While he does not perfectly embody the tyrant as presented in the Republic, he captures its core feature. Like the tyrant, Trump is driven by unregulated desires that reflect what Plato describes as an extreme freedom that underlies and threatens democratic regimes. Extreme freedom is manifested in Trump’s disregard for social and legal norms, (...) which mirrors the lawlessness of the tyrant. The people, in turn, interpret that posture as a mark of authenticity. Understanding Trump’s appeal in the United States helps alert friends of democracy to the possible rise of tyrant-like figures. In closing, and as a way of remedying the harm done by the tyrannical soul, the article recommends that society help temper tyrant-like passions in the people through a rededication to civic equality. (shrink)

In the last few years, biologists and computer scientists have claimed that the introduction of data science techniques in molecular biology has changed the characteristics and the aims of typical outputs (i.e. models) of such a discipline. In this paper we will critically examine this claim. First, we identify the received view on models and their aims in molecular biology. Models in molecular biology are mechanistic and explanatory. Next, we identify the scope and aims of data science (machine learning in (...) particular). These lie mainly in the creation of predictive models which performances increase as data set increases. Next, we will identify a tradeoff between predictive and explanatory performances by comparing the features of mechanistic and predictive models. Finally, we show how this a priori analysis of machine learning and mechanistic research applies to actual biological practice. This will be done by analyzing the publications of a consortium—The Cancer Genome Atlas—which stands at the forefront in integrating data science and molecular biology. The result will be that biologists have to deal with the tradeoff between explaining and predicting that we have identified, and hence the explanatory force of the ‘new’ biology is substantially diminished if compared to the ‘old’ biology. However, this aspect also emphasizes the existence of other research goals which make predictive force independent from explanation. (shrink)

The aim of this article is to theorize how materials can play an active, constitutive, and causally effective role in the production and sustenance of cultural forms and meanings. It does so through an empirical exploration of the Museum of Modern Art of New York (MoMA). The article describes the museum as an “objectification machine” that endeavors to transform and to stabilize artworks as meaningful “objects” that can be exhibited, classified, and circulated. The article explains how the extent to which (...) the museum succeeds in this process of stabilization ultimately depends on the material properties of artworks and, more specially, on whether these behave as “docile” or “unruly” objects. Drawing on different empirical examples, the article explores how docile and unruly objects shape organizational dynamics within the museum and, through them, the wider processes of institutional and cultural reproduction. The article uses this empirical example to highlight the importance of developing a new “material sensibility” that restores heuristic dignity to the material within cultural sociology. (shrink)

In the last few years, biologists and computer scientists have claimed that the introduction of data science techniques in molecular biology has changed the characteristics and the aims of typical outputs (i.e. models) of such a discipline. In this paper we will critically examine this claim. First, we identify the received view on models and their aims in molecular biology. Models in molecular biology are mechanistic and explanatory. Next, we identify the scope and aims of data science (machine learning in (...) particular). These lie mainly in the creation of predictive models which performances increase as data set increases. Next, we will identify a tradeoff between predictive and explanatory performances by comparing the features of mechanistic and predictive models. Finally, we show how this a priori analysis of machine learning and mechanistic research applies to actual biological practice. This will be done by analyzing the publications of a consortium—The Cancer Genome Atlas—which stands at the forefront in integrating data science and molecular biology. The result will be that biologists have to deal with the tradeoff between explaining and predicting that we have identified, and hence the explanatory force of the ‘new’ biology is substantially diminished if compared to the ‘old’ biology. However, this aspect also emphasizes the existence of other research goals which make predictive force independent from explanation. (shrink)

Deep learning is a kind of machine learning which happens in a certain type of artificial neural networks called deep networks. Artificial deep networks, which exhibit many similarities with biological ones, have consistently shown human-like performance in many intelligent tasks. This poses the question whether this performance is caused by such similarities. After reviewing the structure and learning processes of artificial and biological neural networks, we outline two important reasons for the success of deep learning, namely the extraction of successively (...) higher level features and the multiple layer structure, which are closely related to each other. Then some indications about the framing of this heated debate are given. After that, an assessment of the value of artificial deep networks as models of the human brain is given from the similarity perspective of model representation. Finally, a new version of computational functionalism is proposed which addresses the specificity of deep neural computation better than classic, program based computational functionalism. (shrink)

The “hijacking” and “drug instrumentalization” models of psychoactive drug use predict opposite outcomes in terms of adaptive behavior and fitness benefits. Which is the range of applicability of each model? To answer this question, we need more data than those reported by studies focusing on medical, psychiatric, and legal problems in addicted users. An evolutionary analysis requires a much wider focus.

How can dispute records shed light on the study of dispute settlement processes and their social and political underpinnings? This volume addresses this question by investigating the interplay between record-making, disputing process, and the social and political contexts of conflicts. The authors make use of exceptionally rich charter materials from the Iberian Peninsula, Italy, and Scandinavia, including different types of texts directly and indirectly related to conflicts, in order to contribute to a comparative survey of early medieval dispute records and (...) to a better understanding of the interplay between judicial and other less formal modes of conflict resolution. Contributors are Isabel Alfonso, José M. Andrade, François Bougard, Warren C. Brown, Wendy Davies, Julio Escalona, Kim Esmark, Adam J. Kosto, Juan José Larrea, André Evangelista Marques, Josep M. Salrach, Igor Santos Salazar, and Francesca Tinti. (shrink)

La filosofía helenística es producto de un curso impartido en la Facultad de Filosofía y Letras de la UNAM por Alfonso Reyes, quien a su gran formación filosófica unía extraordinaria sapiencia del mundo griego. El libro se divide en tres partes que comprenden desde la filosofía alejandrina hasta el periodo ético y religioso de los griegos, con lo que se completa el cuadro de la filosofía helenística.

Background: Patients at the end-of-life and their families experience a strong emotional impact. The wellbeing of the patient at the end-of-life and their family caregiver are related. Aim: to explore the elements related with the emotional wellbeing of patients with and without cognitive impairment at the end-of-life and that of their primary family caregivers. Design: Cross- sectional study. Participants: data was collected from 202 patients at the end of life with different diagnosis (COPD, cancer and frail elderly) as well as (...) from their respective 202 primary family caregivers. Results: Structural equation models indicated that the emotional state of the patients was best predicted by their functional independence and the burden of their family caregivers. At the same time, the emotional state of the primary family caregiver was predicted by their burden and not by the cognitive state or the functional independence of the patient. Nevertheless, the burden of the family caregiver, which is the only variable predicting both the emotional state of the patient and that of the caregiver, was directly related with the functional independence of the patient and indirectly with the patient’s cognitive state. Conclusions: The burden of the family caregiver stands out as a key factor in the reduction of the emotional distress of patients at the end-of-life –whether or not they present significant cognitive impairment- and that of their family caregivers. (shrink)