À partir d’une approche anthropologique des prises en charge médicales de la tuberculose et du paludisme, ainsi que des conceptions et usages de la prévention dans des milieux urbains d’Afrique de l’Ouest , ce texte interroge la nature du métier de soignant. Après nous être penchés sur les spécificités de ce type d’étude anthropologique en milieu médical, nous nous attachons à décrypter les processus d’occultations des singularités du malade qui caractérisent les messages et discours de prévention. Dans les structures de (...) santé, sont étudiées les négociations des normes de diagnostic et de traitement à l’œuvre ; les attitudes des soignants qui oscillent entre sur- et sous-estimations des risques sanitaires ; et le hiatus entre la demande et les besoins réels de formations continues. Enfin, nous nous penchons sur la rencontre entre les soignants et les malades qui peut se trouver transformée par les spécificités de la maladie et de son traitement. On constate alors que les fondements de la professionnalisation tendent à disparaître au profit d’un mode de régulation du rapport au malade, au collègue et plus largement au savoir médical qui témoigne de l’émergence d’une culture soignante qui est, de fait, une culture organisationnelle. Elle se caractérise à la fois par la délégation des tâches à des non-professionnels, la production et la résolution des conflits mettant en évidence des réseaux clientélistes ainsi que par une routinisation des gestes.Drawing on an anthropological approach of tuberculosis and malaria care in West African cities , and on an analysis of prevention modes, this paper examines the characteristics of medical work. We first examined the conditions of an anthropological field study in health care centres. The concealment of both patients’ singularities and populations’ specificities targeted in the prevention messages were then studied. The negotiation of diagnosis and treatment standards, and the under- and over-estimations of nosocomial risks were also analysed. We also focused on the gap between demands and actual needs for training, and on the relationships between health care providers and patients, which can be modified by the specificities of the disease. We noticed a decay of professionalization, a kind of regulation of relationships between health care workers and patients, and among medical staff, which expresses an emerging medical culture, which is also an organizational culture. Its main features are the delegation of tasks to non-professionals workers, a strategy of conflict management based on clientelism, and the development of routine action. (shrink)

BackgroundClinical trials should be as inclusive as possible to facilitate equitable access to research and better reflect the population towards which any intervention is aimed. Informed by the UK’s National Institute for Health and Care Research (NIHR) Innovations in Clinical Trial Design and Delivery for the Under-served (INCLUDE) guidance, we audited oncology trials conducted by the Clinical Trials and Statistics Unit at The Institute of Cancer Research, London (ICR-CTSU) to identify whether essential documents were overtly excluding any groups and whether (...) sufficient data were collected to assess diversity of trial participants from groups suggested by INCLUDE as under-served by research in the UK.MethodsThirty cancer clinical trials managed by ICR-CTSU and approved between 2011–2021 were audited. The first ethics approved version of each trial’s protocol, patient information sheet, and patient completed questionnaire, together with the first case report forms (CRFs) version were reviewed. A range of items aligned with the INCLUDE under-served groups were assessed, including age, sex and gender, socio-economic and health factors. The scope did not cover trial processes in participating hospitals.ResultsData relating to participants’ age, ethnic group and health status were well collected and no upper age limit was specified in any trials’ eligibility criteria. 23/30 (77%) information sheets used at least one gendered term to address patients. Most CRFs did not specify whether they were collecting sex or gender and only included male or female categories. The median reading age for information sheets was 15–16 years (IQR: 14–15 – 16–17). Socio-economic factors were not routinely collected and not commonly mentioned in trial protocols.ConclusionsNo systemic issues were identified in protocols which would explicitly prevent any under-served group from participating. Areas for improvement include reducing use of gendered words and improving readability of patient information. The challenge of fully assessing adequate inclusion of under-served populations remains, as socio-economic factors are not routinely collected because they fall beyond the data generally required for protocol-specified trial endpoint assessments. This audit has highlighted the need to agree and standardise demographic data collection to permit adequate monitoring of the under-served groups identified by the NIHR. (shrink)

Background: COVID-19 has taken many lives worldwide and due to this, millions of persons are in grief. When the grief process lasts longer than 6 months, the person is in risk of developing Complicated Grief Disorder. The CGD is related to serious health consequences. To reduce the probability of developing CGD a preventive intervention could be applied. In developing countries like Mexico, the psychological services are scarce, self-applied interventions could provide support to solve this problem and reduce the health impact (...) even after the pandemic has already finished.Aims: To design and implement a self-applied intervention composed of 12 modules focused on the decrease of the risk of developing CGD, and increasing the life quality, and as a secondary objective to reduce the symptomatology of anxiety, depression, and increase of sleep quality. The Intervention Duelo COVID follows the principles of User Experience and is designed according to the needs and desires of a sample of the objective participants, to increase the adherence to the self-applied intervention, considered one of the main weaknesses of online interventions.Methods: A Randomized Controlled Trial will be conducted from the 22nd of December of 2020 to the first of June 2021. The participants will be assigned to an intervention with elements of Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Mindfulness and Positive Psychology. The control group will be a wait-list condition, that will receive the intervention 1.5–2 months after the pre-measurement were taken. The Power Size Calculation conducted through G*Power indicated the need for a total of 42 participants, which will be divided by 21 participants in each group. The platform will be delivered through responsive design assuring with this that the intervention will adapt to the screen size of cellphones, tablets, and computers.Ethics and Dissemination: The study counts with the approval of the Research Ethics Committee of the Autonomous University of Ciudad Juárez, México, and it is registered in Clinical Trials. The article is sent and registered in clinical trials before the recruitment started. The results will be reported in future conferences, scientific publications, and media. (shrink)

In the Netherlands fertility doctors increasingly formulate protocols, which oblige patients to quit their unhealthy lifestyle before they are admitted to IVF procedures. We argue that moral arguments could justify parenting protocols that concern all future parents. In the first part we argue that want-to-be parents have moral responsibilities towards their future children to prevent them from harm by diminishing or eliminating risk factors before as well as during the pregnancy. This is because of the future children's potential to become (...) of a certain type, more specifically: a person that will be the want-to-be parents' child. Want-to-be parents intend to become pregnant and therefore have an additional moral reason to diminish the risks. Also, people who become pregnant unintentionally have the responsibility to prevent their children from harm, unless they become pregnant due to contraception failure. All people not wanting to become pregnant should use contraception methods carefully.In the second part of this paper we translate the want-to-be parents' responsibilities into practice. We distinguish four determinants of risk factors: modifiability, chance, severity and effort. We examine some evidence-based risk factors based on these variables and deduce levels of responsibility.In conclusion, formulating informal requirements for want-to-be parents is morally required and therefore also for want-to-be parents in need of medical assistance. The protocols developed by fertility doctors in the Netherlands could be seen as the precursor for a general, informal Parenting Protocol that could be developed on the basis of an extended and thoroughly debated risk-responsibility analysis. (shrink)

In the Netherlands fertility doctors increasingly formulate protocols, which oblige patients to quit their unhealthy lifestyle before they are admitted to IVF procedures. We argue that moral arguments could justify parenting protocols that concern all future parents. In the first part we argue that want‐to‐be parents have moral responsibilities towards their future children to prevent them from harm by diminishing or eliminating risk factors before as well as during the pregnancy. This is because of the future children's potential to become (...) of a certain type, more specifically: a person that will be the want‐to‐be parents' child. Want‐to‐be parents intend to become pregnant and therefore have an additional moral reason to diminish the risks. Also, people who become pregnant unintentionally have the responsibility to prevent their children from harm, unless they become pregnant due to contraception failure. All people not wanting to become pregnant should use contraception methods carefully.In the second part of this paper we translate the want‐to‐be parents' responsibilities into practice. We distinguish four determinants of risk factors: modifiability, chance, severity and effort. We examine some evidence‐based risk factors based on these variables and deduce levels of responsibility.In conclusion, formulating informal requirements for want‐to‐be parents is morally required and therefore also for want‐to‐be parents in need of medical assistance. The protocols developed by fertility doctors in the Netherlands could be seen as the precursor for a general, informal Parenting Protocol that could be developed on the basis of an extended and thoroughly debated risk‐responsibility analysis. (shrink)

In the Netherlands fertility doctors increasingly formulate protocols, which oblige patients to quit their unhealthy lifestyle before they are admitted to IVF procedures. We argue that moral arguments could justify parenting protocols that concern all future parents. In the first part we argue that want‐to‐be parents have moral responsibilities towards their future children to prevent them from harm by diminishing or eliminating risk factors before as well as during the pregnancy. This is because of the future children's potential to become (...) of a certain type, more specifically: a person that will be the want‐to‐be parents' child. Want‐to‐be parents intend to become pregnant and therefore have an additional moral reason to diminish the risks. Also, people who become pregnant unintentionally have the responsibility to prevent their children from harm, unless they become pregnant due to contraception failure. All people not wanting to become pregnant should use contraception methods carefully.In the second part of this paper we translate the want‐to‐be parents' responsibilities into practice. We distinguish four determinants of risk factors: modifiability, chance, severity and effort. We examine some evidence‐based risk factors based on these variables and deduce levels of responsibility.In conclusion, formulating informal requirements for want‐to‐be parents is morally required and therefore also for want‐to‐be parents in need of medical assistance. The protocols developed by fertility doctors in the Netherlands could be seen as the precursor for a general, informal Parenting Protocol that could be developed on the basis of an extended and thoroughly debated risk‐responsibility analysis. (shrink)

Se realizó una investigación cualitativa, durante noviembre de 2013 a noviembre de 2015 con el objetivo de mostrar un protocolo de salud como tecnología social para la promoción y prevención de las manifestaciones oftalmológicas en pacientes con VIH/sida. Se utilizaron métodos teóricos y empíricos los cuales permitieron conocer antecedentes del problema a investigar, realizar acciones y caracterizar el fenómeno en estudio. El protocolo constituye una tecnología social, debido a que está compuesto por normas y procedimientos para la conducción de un (...) proceso social no relacionado con la esfera productiva. El diseño de esta tecnología social propicia un adecuado diagnóstico, tratamiento y seguimiento de las enfermedades oculares en pacientes con VIH/sida, sustentado en la teoría del conocimiento. A qualitative investigation was carried out during November 2013 to November 2015 with the objective of developing a protocol as social technology for the promotion and prevention of ophthalmologic manifestations in patients with HIV/AIDS. Theoretical and empirical methods that allowed knowing the antecedents of the problem under investigation, to carry out actions and to characterize the studied phenomenon, were used. The protocol constitutes a social technology, because it is composed by norms and procedures for the conduction of a social process that is not related with the productive area. The design of this social technology favors an adequate diagnosis, treatment and follow-up of eye conditions in patients with HIV/ AIDS, based on the theory of knowledge. (shrink)

Reviews of research and development collaborations with indigenous communities have exhibited numerous challenges related to researcher–community interactions. Based on many accounts of indiscretions, indigenous communities have begun generating conduct guidelines for researchers. However, the effectiveness of their chosen communication methods, guaranteeing appropriate behavior of the researchers, has not been established. This research contributes to an ongoing debate around appropriate ethical conduct of researchers in situ. The aim of this study was to investigate the interpretation accuracy of interaction guidelines produced in (...) the form of sketches by a Malaysian indigenous community. We provided eight interaction sketches to 57 students, in three continents, for interpretation and expression of their intended behavior. We found that most were unable to accurately interpret the sketches and describe intended behavioral responses. A major concern remains with the tendency to fall back on prior practices of “good” behavior, with minimal guidance on contextual practices. In an attempt to provide greater direction, we explored a speech bubble exercise with further 15 students. Our findings directly contribute to current efforts in formulating researcher–community interaction practices that should form the basis of ethical research in situ. (shrink)

In 2004, the first ever multi‐sited clinical trials studied the prospect of HIV biomedical prevention (referred to as pre‐exposure prophylaxis—‘PrEP’). The trials were implemented at several international sites, but many officially closed down before they completed. At most sites, both scientists and community AIDS advocates raised concerns over the ethics and scientific rationales of the trial. Focusing on the Nigerian trial site, we detail the controversy that emerged among mostly Nigerian research scientists who scrutinized the research design and (...) class='Hi'>protocol. While some of the disputes, especially those pertaining to community engagement mechanisms, were ultimately resolved in international fora and implemented in later PrEP trials, concerns over science rationales and assumptions were never addressed. We argue that scientific rationales should be treated as ethical concerns and suggest that such concerns should be deliberated at host sites before the trial protocol is finalized. (shrink)

Diplomatic relations carried out between the states are fulfilled under the protocol ruled out by the actors within the international system, which prevents any possible problems that might affect the course of bilateral relations from coming out. However, work and actions in the public arena are carried out under the protocol rules, some of which are in written form, and some of which are based on traditions used for a long period of time. Conducting the mentioned work and (...) actions under the protocol rules not only creates a discipline prevailing work environment, but also encourages employees to perform their duties in a more relaxed, peaceful, happier and more productive manner. Therefore, it is an absolute necessity to act with the attitudes and behaviors under the protocol rules both in the fulfillment of diplomatic relations and in the fulfillment of public activities. But as the protocol rules are not known well enough in Turkey, the necessity mentioned above is not obeyed. This case leads to occurance of significant defects during the implemention of services provided by public institutions in Turkey and the implementation of diplomatic relations. As a matter of fact; when examining the proceduces concerning public work and functions, and diplomatic relations in detail; one can obviously see that numerous problems are encountered which result from not implementing or mis-implementing protocol rules. This study aims to prove that more importance must be given to education on protocol rules in Turkey. (shrink)

BackgroundMental illness among Malaysian children is gradually reaching a fundamentally alarming point as it persistently shows increasing trend. The existing literature on the etiologies of children’s mental illness, highlights the most common cause to be ineffective or impaired parenting. Thus, efforts to combat mental illness in children should focus on improving the quality of parenting. Documented interventional studies focusing on this issue, particularly in Malaysia, are scarce and commonly report poor treatment outcomes stemming from inconvenient face-to-face instructions. Consequently, proposing an (...) accessible online and digital-assisted parenting program is expected to reach a larger number of parents, as it can overcome substantial barriers. Hence, this study aims to develop a universal digital-assisted preventive parenting intervention called DaPI, that aims to enhance mental health of children in Malaysia.MethodsA total of 200 parents of children aged 10–14 years will be recruited and randomized into two groups either intervention or waitlist-control based on a 1:1 ratio for a duration of 8 weeks. Those in the intervention group will receive eight sessions of the DaPI program that focus mainly on parenting and children’s mental health. The primary outcome of this study will essentially focus on the changes in parent-reported parenting behavior and parental self-efficacy. The secondary outcome will be changes in children’s mental health. Assessments will be arranged pre- and post-intervention as well as at the 1-month follow-up. Analyses will be conducted using a paired t-test and multivariate analysis of covariance.DiscussionThe expected outcome will be the establishment of DaPI in promoting children’s mental health by targeting changes in parenting behavior and parental self-efficacy in Malaysia. Findings from this study will be beneficial for policymakers to invest in parenting programs that could provide support to parents in enhancing their child’s overall development.Clinical trial registration[www.irct.ir], identifier [IRCT20211129053207N1]. (shrink)

Geoffrey Rose's ‘prevention paradox’ occurs when a population-based preventative health measure that brings large benefits to the community – such as compulsory seatbelts, a ‘fat tax’, or mass immunisation – offers little to each participating individual. Although the prevention paradox is not obviously a paradox in the sense in which philosophers understand the term, it does raise important normative questions. In particular, should we implement population-based preventative health measures when the typical individual is not expected to gain from (...) them? After canvassing other attempts to address the paradox, I argue that what is significant about the prevention paradox is that it involves intra-personal trade-offs; the costs and benefits of the choice to implement or not implement a preventative health measure fall on the same individuals. The intra-personal nature of these trade-offs has two implications. First, the solutions to the paradox proposed by other authors are deficient. Second, the policy choice to not implement some preventative health measures can be normatively justified. (shrink)

For much of 2021, allocating the scarce supply of Covid‐19 vaccines was the world's most pressing bioethical challenge, and similar challenges may recur for novel therapies and future vaccines. In the United States, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) identified three fundamental ethical principles to guide the process: maximize benefits, promote justice, and mitigate health inequities. We argue that critical components of the recommended protocol were internally inconsistent with these principles. Specifically, (...) the ACIP violated its principles by recommending overly broad health care worker priority in phase 1a, using being at least seventy‐five years of age as the only criterion to identify individuals at high risk of death from Covid‐19 during phase 1b, failing to recommend place‐based vaccine distribution, and implicitly endorsing first‐come, first‐served allocation. More rigorous empirical work and the development of a complete ethical framework that recognizes trade‐offs between principles may have prevented these mistakes and saved lives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:SENECA FALLS INHERITANCE: DISENTANGLING WOMEN, LEGISLATION AND VIOLENCE IN MONFREDO'S HISTORICAL CRIME FICTION Rosemary Erickson Johnsen National Coalition ofIndependent Scholars That men were not prevented by courts or clergy from mistreating their wives meant that, to society's institutions, women had no value. A man could be jailed, even hanged, for stealing another man's horse, but not even reproached for beating his wife. (Miriam Grace Monfredo, Through a Gold Eagle) (...) Miriam Grace Monfredo's feminist genre fiction, her "historymystery " series featuring nineteenth-century librarian Glynis Tryon, offers an opportunity to find a way ofreading literary texts that is not only feminist, but also Girardian. Girard's work provides two clear ways to construct feminist readings directly, without the mediation of overtly feminist theory. First ofthese is Girard's respect for the "quasi-theoretical" potential of literary texts, especially some of those which attend to apparently trivial matters. In Deceit, Desire and the Novel, Girard argues that (male) novelists offer insights unavailable elsewhere, including those scientific fields that claim to know more than everyone else. In its valuing of questions about snobbism, for example, Deceit, Desire and the Novel offers a woman-friendly model. The (male) novelist's question about snobbism is "too frivolous" for (men of) science, but Girard argues that "in his probe of snobbism the novelist is asking himself in his own way just what Rosemary Erickson Johnsen59 might be the hidden springs that make the social mechanism tick" (220). While I regret the fact that Girard's examples and language often ignore women, I believe his conviction that attention to matters socially coded as superficial and frivolous can produce great insight is one feminist critics can appreciate. The second Girardian tool feminists can rely upon is the method of reading texts of persecution described in The Scapegoat. Girard suggests how we might read texts ofpersecution written by naive persecutors in ways that identify with the persecuted and gather the information unintentionally supplied by the authors: "I call those persecutors naive who are still convinced that they are right and who are not so mistrustful as to cover up or censor the fundamental characteristics of their persecution. Such characteristics are either clearly apparent in the text and are directly revealing or they remain hidden and reveal indirectly" (8). Monfredo's crime novels, set in the mid-nineteenth century and focusing on such disenfranchised groups of citizens as women, slaves, Native Americans, and free African-Americans, depend for their verisimilitude on her ability to read historical sources and literary predecessors in just such a way. Accuracy requires that Monfredo's works be categorized as feminist historical crime novels, however awkward such a lengthy description may be. Her novels observe the principles not only of both genres—historical fiction and detective fiction—but also the political position offeminism, and they meet these multiple demands with considerable skill. Furthermore, resolution in crime fiction depends upon the law; working within that tradition, Monfredo is called upon to seek solutions within the system, to look for justice as the result ofa proper functioning ofthe legal and social systems. Information gathered, whether by the official representatives ofthe law or by amateurs, is turned over to the authorities. While her novels clearly respect that tradition, they also point out some limits to the judicial system's ability to contain violence. Girard's model ofits functioning, as described in Violence and the Sacred, depends upon an equality that whole segments of the society Monfredo is depicting do not in fact enjoy: "The judicial authority is beholden to no one. It is thus at the disposal ofeveryone" (23). Ifwomen cannot own property, enter into contracts or sit on juries, in what sense is the law at their disposal? Monfredo's exploration ofthis question takes its place alongside Girard's explanation of the legal system's proper functioning; ifhis theory reveals how it works when all are enfranchised, her fiction suggests some ofthe consequences that result from the existence of disenfranchised subjects. 60'Seneca Falls Inheritance' Our Seneca Falls Inheritance In her first book, Seneca Falls Inheritance (1992), Monfredo offers a theory for the reduction of violence against women: provide women with complete legal equality. The... (shrink)

Regulations designed to prevent global inequalities in the use of genetic resources apply to both commercial and non-commercial research. Conflating the two may have unintended consequences for collaboration between the Global North and biodiverse countries in the Global South, which may promote global injustice rather than mitigate it.

The Internet was conceptualized as a technology that would be capable of bringing about a better future, but recent literature in science and technology studies and adjacent fields provides numerous examples of how this pervasive sociotechnical system has been shaped and used to dystopic ends. This article examines different future imaginaries present in Future Internet Architecture projects funded by the National Science Foundation from 2006 to 2016, whose goal was to incorporate social values while building new protocols to replace Transmission (...) Control Protocol and Internet Protocol to transfer and route information across the ever-expanding Internet. I examine the findings from two of the NSF’s FIA projects—Mobility First and eXpressive Internet Architecture—to understand the projects’ trajectories and values directives through their funding cycle and their projections into the future. I discuss how project documentation and participant articulations fall into the following three distinct themes about past experience and speculation: understanding the public, negotiating resources, and carrying project values into the future. I conclude that if the future Internet is to promote positive sociotechnical relationships, its architects must recognize that complex social and political decisions pervade each step of technical work and do more to honor this fact. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Managing the Transition from Patient-Centered Care to ProtocolDavid SlakterI learned that I would need a kidney transplant in the summer of 2015. This was not a complete surprise to me, as I had been subjected to a number of tests and invasive procedures to investigate nephritis since I was a child. I had heard similar stories of clinicians performing repeated tests on my father for similar reasons without any (...) conclusions. Following my recommendation for transplant and consultation with genomics specialists, the cause of my kidney failure was determined to be Alport syndrome. What made Alport syndrome so difficult to diagnose in my case was that the associated mutation is a rare, autosomal-dominant one that has only recently been associated with the condition.After reviewing the data on survival rates for transitioning to dialysis versus a transplant, my family and I then considered the success rates for living versus cadaver donors, and the success rates at various transplant centers. The current data favor the long-term outcomes of transplant over dialysis and living over cadaver donors. Since we had decided to focus on searching for a live donor, my nephrologist recommended contacting Renewal, an organization that specializes in connecting those in need of a kidney transplant with live donors and providing support for donors to make the donation process less burdensome.On Renewal’s recommendation, my family and friends reached out across their social networks to search for potential donors. Many of those tested for compatibility were eliminated on basic matching criteria, others due to previously undiagnosed medical problems. Finally, the wife of a childhood friend came forward as an eligible donor and was also an incredibly close match on the antigens tested for kidney transplants.Having a living donor who was also a friend made the transplant experience somewhat less intimidating than it might have been. It meant the transformation of an existing relationship with someone already close to me, with fewer open questions about what may have motivated them to be so generous than if the donor had been someone I did not know. It also meant our families could be together in the waiting room, and that we shared in each other’s recoveries.Life post-transplant has been a significant improvement from what it was like immediately beforehand. Before my transplant, I regularly weighed food and consulted nutrition charts to gauge how much potassium I was consuming. To prevent too much potassium from building up in my bloodstream, I had to take sodium polystyrene [End Page 111] regularly. As one might guess from the name, it tastes much like burnt Styrofoam, and I could only ingest it with copious amounts of fruit-flavored syrup (strawberry covered up the awful flavor the best). There are other potassium binders on the market now, so fewer people with kidney failure will likely need to engage in such gustatory experimentation.I was also able to engage in more activities than what was possible even years before my transplant. I had long experienced difficulty with aerobic exercises, but assumed the reason was merely being out of shape. Though I have always walked regularly, even the one-mile walk from my office to my apartment had become a chore by the end. Within a few months after my transplant, I was riding a bicycle all over NYC, from Harlem to Brooklyn and back regularly, and hiking trails in nearby state parks. I began sessions with a personal trainer and attained a level of fitness I had not reached since I played soccer as a child.The transition from personalized care to one more driven by protocol has been a surprising and challenging aspect of the transplant process. While my previous experience with medical treatment has been individual meetings with physicians, my post-transplant care is managed by a team of nephrologists and other specialists in transplant care. My initial transplant nephrologist was automatically assigned to me. Because the standard of care for transplant patients is often driven by protocol, my assigned nephrologist recommended a biopsy on my transplanted kidney due to results in my recent lab tests. When pressed on the necessity of a biopsy in my case versus... (shrink)

Based on my study of the Rhodes Must Fall movement, I develop a rejectionist perspective by identifying the understanding and mobilization of epistemic disobedience as the core premise of such a perspective. Embedded in this contextual perspective, epistemic disobedience refers to the decolonization of the self and a fight against colonial legacies. I argue that, rather than viewing a rejectionist perspective as a threat, it should be integrated into the moral learning of contemporary institutions and businesses. This approach is (...) important in ensuring colonial legacies and biases do not create further racism or unequal situations for marginalized groups. The implication for critical management studies is that scholars from this camp should be more sensitive to issues of black consciousness and implement an authentic pragmatic ideal to promote black culture and historiographies in universities and curricula. It also highlights a need for the field of business ethics to apply more sensitive theory of marginalized stakeholders in order to prevent any escalation of violence by multinational corporations in the name of shareholder value creation and profit-maximization. (shrink)

Concussions are traumatic brain injuries that can result from a blow to the head or a jolt to the body. Athletes in many sports are exposed to concussion risks. There is a growing concern in sport and society about sport-related concussions (SRC) and an increasing awareness of the importance of proper diagnosis, treatment, and prevention. A traditional, reactive approach emphasizes sound protocols in cases of suspected SRC. A proactive approach involves identifying various causes of SRC and implementing preventive measures. (...) For example, to reduce SRC prevalence in Canadian youth ice hockey, a ban on body checking has been introduced. When a preventive SRC measure implies a change in the main rules of a sport, it impacts its nature and alters how it is played. This can lead to tensions between SRC prevention and sporting concerns. By employing an extended consequentialist framework that includes normative analyses of the values of sport, I will examine the possibilities and limitations of preventive SRC measures in terms of constitutive rule changes. More specifically, I will propose a consequentialist framework to determine the conditions under which athlete exposure to SRC risks in a given sport can be considered unacceptable, acceptable, and even valuable. (shrink)

The prevalence of cognitive impairment in hemodialysis patients is extremely high. Despite the well-documented benefits of interventions on cognitive function, there is a widespread call for effective strategies that will show the long-term consequences in patients undergoing dialysis. The aim of this research protocol was to investigate the effect of cognitive training combined with physical exercise on cognitive function, physical performance, and frailty indicators in the HD population. We will conduct a randomized controlled intervention trial to examine the effects (...) of a combined non-pharmacological intervention in the form of intradialytic physical exercise and intradialytic cognitive training on cognitive function, indicators of frailty, and physical performance measures in HD patients. The group of patients receiving the study intervention will be compared to the control group receiving standard HD care. The duration of the intervention will be 12 weeks. We will use sensitive instruments to assess cognitive functions. The primary outcome of the study at 12 weeks will be performance on the Alertness subtest of the computerized Test of Attentional Performance. Secondary study outcomes are: Performance in other domains of cognitive function, physical fitness, and assessment of frailty. Study outcomes will be assessed at baseline, immediately after the 12-week intervention, and 6 months after the end of the study without specific further intervention. This study will be among the first to test the synergistic effects of a uniquely designed physical exercise and cognitive training intervention on functional status in HD patients. We believe our results will contribute to dementia prevention research by demonstrating the long-term efficacy of our combined intervention.Clinical Trial Registration:ClinicalTrials.Gov, NCT05150444. (shrink)

Persons who are dangerous and legally responsible, but who have not yet committed any currently recognised criminal offence, fall within the gap left between the domains of criminal justice and civil commitment. Many jurisdictions operate legal regimes that permit the detention of such persons in order to prevent the occurrence of anticipated criminal harms. These regimes often either fail to respect the principle of proportionality or contradictorily treat a dangerous offender as both legally responsible and not responsible at the (...) same time. In response to these problems, a number of preventive detention models have been proposed. Retributivist models seek to prevent the occurrence of anticipated criminal harms by requiring blame on the dangerous person’s part in order to warrant detention. However, these models are ill-equipped to deal with the problem of coextensiveness; i.e., they struggle to comprehensively reconcile proportionality in punitive sentencing with the period over which dangerous persons remain dangerous and during which one might therefore want them to be incapacitated. In order to achieve comprehensive incapacitation of dangerous persons for the duration of their dangerousness, retributivist models are forced to abandon their fidelity to proportionality in punitive sentencing, thereby losing themselves in the process. Accordingly, if the practice of preventive detention can be justified at all, such justification will not be of a retributivist character. (shrink)

Many preventive intervention studies with adolescents address high-risk behaviors such as drug and alcohol use, and unprotected sex. Randomized controlled trials (RCT) are the gold standard methodology used to test the effectiveness of these behavioral interventions. Interventions outside the rigidly described protocol are prohibited. However, there are ethical challenges to implementing inflexible intervention protocols, especially when the target population is young, experiences many stressful events, and lives in a resource-poor environment. Teens who are at high risk for substance use (...) or sexual risk behaviors tend to be at risk for other problems such as exposure to violence, sexual and physical abuse, depression, and homelessness. How should investigators deal with the psychological and social needs of teenagers in prevention programs in an ethically appropriate way and at the same time preserve the validity of RCT results? We have identified program characteristics, participant characteristics, interaction with parents, and problems with adolescents not in the study as sources of ethical dilemmas in RCT with at-risk adolescents. As a result of our experience, we recommend that every behavioral intervention study develop an ethics protocol, which should include rules for providing help to participants, has contact information for experts to provide guidance, and an emergency procedure for dealing with life threatening situations. In addition, studies should have a resource manual, train research staff in these ethical issues, and work with a data safety and monitoring board or ethics committee. (shrink)

Most model checking techniques for security protocols make a number of simplifying assumptions on the protocol and/or on its execution environment that greatly complicate or even prevent their applicability in some important cases. For instance, most techniques assume that communication between honest principals is controlled by a Dolev-Yao intruder, i.e. a malicious agent capable to overhear, divert, and fake messages. Yet we might be interested in establishing the security of a protocol that relies on a less unsecure channel (...) (e.g. a confidential channel provided by some other protocol sitting lower in the protocol stack). In this paper we propose a general model for security protocols based on the set-rewriting formalism that, coupled with the use of LTL, allows for the specification of assumptions on principals and communication channels as well as of complex security properties that are normally not handled by state-of-the-art security protocol analysers. By using our approach we have been able to formalise all the assumptions required by the ASW protocol for optimistic fair exchange and some of its key security properties. Besides the previously reported attacks on the protocol, we report a new attack on a patched version of the protocol. (shrink)

Imagine you fly home from vacation with your one-and-a-half-year-old son who is traveling for free as a “lap child.” In the airport parking lot, you put him into his forward-facing car seat, where he sits much more contentedly than he did in the rear-facing one that was mandatory until his first birthday. After he falls asleep on the way home, you transfer him to his crib without waking him, lowering the side rail so you can lift him in more easily. (...) -/- Many parts of this idyllic parenting picture are deemed unacceptably risky according to recent child safety proposals. While these proposals all aim to improve child safety, their possible impact is unclear because there has been little discussion of the absolute risk and risk reduction involved in each. And while precise figures are lacking, rough estimates indicate that the magnitudes are quite small. I will argue that this risk and benefit data raises important questions about the proposals, including whether parents might reasonably believe that the small absolute risk reduction offered by the proposed changes does not justify the attendant burdens. This possibility—termed the “prevention paradox” in other contexts—highlights ethical and theoretical challenges in this area of public health. (shrink)

Background People who are at elevated risk of suicide stand to benefit from internet-based interventions; however, research in this area is likely impacted by a range of ethical and practical challenges. The aim of this study was to examine the ethical issues and practical barriers associated with clinical studies of internet-based interventions for suicide prevention. Method This was a mixed-methods study involving two phases. First, a systematic search was conducted to identify studies evaluating internet-based interventions for people at risk (...) of suicide, and information pertaining to safety protocols and exclusion criteria was extracted. Second, investigators on the included studies were invited to complete an online survey comprising open-ended and forced-choice responses. Quantitative and qualitative methods were used to analyse the data. Results The literature search identified 18 eligible studies, of which three excluded participants based on severity of suicide risk. Half of the 15 suicide researchers who participated in the survey had experienced problems obtaining ethics approval, and none had encountered adverse events attributed to their intervention. Survey respondents noted the difficulty of managing risk in online environments and the limitations associated with implementing safety protocols, although some also reported increased confidence resulting from the ethical review process. Respondents recommended researchers pursue a collaborative relationship with their research ethics committees. Conclusion There is a balance to be achieved between the need to minimise the risk of adverse events whilst also ensuring interventions are being validated on populations who may be most likely to use and benefit from them. Further research is required to obtain the views of research ethics committees and research participants on these issues. Dialogue between researchers and ethics committees is necessary to address the need to ensure safety while also advancing the timely development of effective interventions in this critical area. (shrink)

The return of genetic research results after death in the pediatric setting comes with unique complexities. Researchers must determine which results and through which processes results are returned. This paper discusses the experience over 15 years in pediatric cancer genetics research of returning research results after the death of a child and proposes a preventive ethics approach to protocol development in order to improve the quality of return of results in pediatric genomic settings.

BackgroundThe ethical concerns associated with HIV prevention and treatment research have been widely explored in South Africa over the past 3 decades. However, HIV cure research is relatively new to the region and significant ethical and social challenges are anticipated. There has been no published empirical enquiry in Africa into key informant perspectives on HIV cure research. Consequently, this study was conducted to gain preliminary data from South African HIV clinicians, researchers and activists.MethodsIn-depth interviews were conducted on a purposive (...) sample of fourteen key informants in South Africa. Audiotaped interviews were transcribed verbatim with concurrent thematic analysis. The perspectives of HIV clinicians, researchers and activists were captured. Analyst triangulation occurred as the data were analysed by three authors independently.ResultsThe rapid evolution of HIV cure research agendas was prominent with participants expressing some concern that the global North was driving the cure agenda. Participants described a symbiotic relationship between cure, treatment and prevention research necessitating collaboration. Assessing and managing knowledge and expectations around HIV cure research emerged as a central theme related to challenges to constructing ‘cure’ - how patients understand the idea of cure is important in explaining the complexity of cure research especially in the South African context where understanding of science is often challenging. Managing expectations and avoiding curative misconception will have implications for consent processes. Unique strategies in cure research could include treatment interruption, which has the potential to create therapeutic and ethical conflict and will be perceived as a significant risk. Ethical challenges in cure research will impact on informed consent and community engagement.ConclusionsIt was encouraging to note the desire for synergy amongst researchers and clinicians working in the fields of prevention, treatment and cure. Translation of complex HIV cure science into lay language is critical. Moving forward, RECs must be adequately constituted with scientific expertise and community representation when reviewing cure protocols. It is hoped that knowledge and resource sharing in the context of collaboration between research scientists working in cure and those working in treatment and prevention will accelerate progress towards cure. (shrink)

Suicide is a public health problem which will require an integrated cross-sector approach to help reduce prevalence rates. One strategy is to include the legal system in a more integrated way with suicide prevention efforts. Caine explored a public health approach to suicide prevention, depicting risk factors across the socio-ecological model. The purpose of this paper is to examine laws that impact suicide prevention at the individual, relational, community, and societal levels. These levels are fluid, and some (...) interventions will fall between two, such as a community-level approach to training that enhances provider-patient relationships. At the individual level, we will review laws to improve screening requirements across systems. At the relational level, we note interventions with couples having conflict, such as protection orders and access to attorney consultations, which have been known to be injury prevention mechanisms. At the community level, we discuss legislation that recommends suicide prevention efforts for key individuals working as frontline providers in the medical and educational systems. At the societal level, we explore public awareness campaigns that target stigma reduction for those suffering from mental health burden and enhance linkage to care. The article closes with the discussion that laws are good, but their implementation is essential. (shrink)

Over the past century, the rise and fall of economic policy orders has been shaped by a paradox, as intellectual and institutional stability have repeatedly caused market instability and crisis. To highlight such dynamics, this volume offers a theory of economic ideas in political time. The author counters paradigmatic and institutionalist views of ideas as enabling self-reinforcing path dependencies, offering an alternative social psychological argument that ideas which initially reduce uncertainty can subsequently fuel misplaced certainty and crises. Historically, the (...) book then traces the development and decline of the progressive, Keynesian, and neoliberal orders, arguing that each order's principled foundations were gradually displaced by macroeconomic models that obscured new causes of the Great Depression, Great Stagflation, and Global Financial Crisis. Finally, in policy terms, Widmaier stresses the costs of intellectual autonomy, as efforts to 'prevent the last crisis' have repeatedly obscured new causes of crises. (shrink)

Einstellung effects designate the phenomenon where established routines can prevent people from finding other, possibly more efficient solutions. Here we investigate the mechanism behi...

The Brazilian Federal Senate created a Parliamentary Inquiry Commission (CPI) to investigate the Bolsonaro government's irregularities in the management of the COVID-19 pandemic. One of the cases that drew attention was the research conducted by Prevent Senior, a private health insurance company, on the early treatment of COVID-19. The article analyzes the scientific validity of the research and the ethical problems related to its implementation. It is based on analysis of Prevent Senior's report of the clinical study, the Brazilian and (...) USA clinical trial registries, the Senate's CPI report, and on the information reported by the media. This case of scientific fraud and political-ideological bias exemplifies how Prevent Senior, using a questionable protocol to enhance its reputation and gain government support, was instrumental in building the “early treatment” narrative for COVID-19, and shows how it served as a basis for a government public policy that promoted the use of ineffective drugs. (shrink)

Introduction: Falls are the leading cause of fatal and nonfatal injuries among older adults. Studies showed that older adults can reduce the risk of falls after participation in an unexpected perturbation-based balance training, a relatively novel approach that challenged reactive balance control. This study aims to investigate the effect of the practice schedule on reactive balance function and its transfer to proactive balance function. Our primary hypothesis is that improvements in reactive balance control following block PBBT will be not inferior (...) to the improvements following random PBBT.Methods and Analysis: This is a double-blind randomized controlled trial. Fifty community-dwelling older adults will be recruited and randomly allocated to a random PBBT group or a block PBBT group. The random PBBT group will receive eight training sessions over 4 weeks that include unexpected machine-induced perturbations of balance during hands-free treadmill walking. The block PBBT group will be trained by the same perturbation treadmill system, but only one direction will be trained in each training session, and the direction of the external perturbations will be announced. Both PBBT groups will receive a similar perturbation intensity during training, the same training period, and the same concurrent cognitive tasks during training. The generalization and transfer of learning effects will be measured by assessing the reactive and proactive balance control during standing and walking before and after 1 month of PBBT, for example, step and multiple steps and fall thresholds, Berg balance test, and fear of falls. The dependent variable will be rank transformed prior to conducting the analysis of covariance to allow for nonparametric analysis.Discussion: This research will explore which of the balance retraining paradigms is more effective to improve reactive balance and proactive balance control in older adults over 1 month. The research will address key issues concerning balance retraining: older adults’ neuromotor capacities to optimize training responses and their applicability to real-life challenges.Clinical Trial Registration: Helsinki research ethics approval has been received. (shrink)

A prevailing issue in clinical research is the duty clinicians have to treat or prevent the progression of disease during a study that they are conducting. While all clinical researchers have a duty of care for the patients who participate in clinical research, intervening at the onset or progression of disease may skew results and have a negative impact on the scientific validity of a study. Extreme examples of failures to intervene can be found in the Tuskegee syphilis study and (...) in an attempt to determine if cervical smears were an accurate predictor of cancer, which was uncovered by the Cartwright Inquiry. However, the issue arises in all research where delay in intervention can cause harm. A current study in Singapore is investigating the significance of an ‘ultra-high risk’ state that may constitute the prodromal phase of psychosis. This project called ‘The Longitudinal Youth at Risk Study’ is potentially contentious because it is recruiting young people who are identified as being ‘at risk’ of developing psychosis. In this paper, the decision to offer treatment to all participants as well as a fast track for those who are assessed to have developed serious mental illness into treatment is discussed. It is argued that this approach is ethically justified because of the duty of care that is owed to research participants, and suggests that the principle of equipoise may be used to guide intervention decisions in other clinical research protocols. (shrink)

Good sleep is essential for health but there is no consensus on how to define and measure people’s understanding of good sleep. To date, people’s perceptions of a good night’s sleep have been, almost exclusively, conceptualized under the lens of sleep quality, which refers to objective characteristics of good sleep, such as such as ease and time needed to fall asleep, hours of sleep, and physical symptoms during sleep and upon awakening. A related, yet different construct, sleep satisfaction, refers (...) to perceived positive affect about one’s sleep experience and has, to date, received little attention. This research focuses on sleep satisfaction, rather than sleep quality, and aims to develop a self-report measure to assess sleep satisfaction in an English adult population. As the measure will be developed in Suffolk, England, and its primary intended users are Suffolk community members, it is labelled the Suffolk Sleep Index. The SuSI will draw from principles of community-based participatory research, following a seven-phase developmental process comprising literature review, interviews with Suffolk community members, synthesis of literature review and interview findings, pre-testing, pilot-testing, scale evaluation, and refinement. The present research will also investigate indices related to sleep satisfaction, including the community’s general health status, lifestyle factors and socio-economic status. The research will add to the limited, yet emerging body of research on perceived sleep satisfaction and its measurement. To our knowledge, a valid and reliable sleep satisfaction self-report measure has not been developed in the United Kingdom previously. (shrink)

In this paper we argue that the responsibility for systematic community-based preventive medicine should not be made part of the role of the general practitioner (GP). Preventive medicine cannot be shown to be more effective than curative or supportive medicine. Therefore, the allocation of the large amount of general practice staff time and resources required for systematic preventive medicine should not come at the expense of the care of the sick and the suffering. The traditional healing role of the GP (...) requires a cooperative patient-centred approach, whereas systematic preventive medicine is driven by rigid pre-set protocols and is intrinsically paternalistic. Trying to merge the two approaches is detrimental to the doctor-patient relationship. Furthermore, a number of potential pitfalls are identified that may be encountered in the implementation of preventive medicine programmes in general practice: interference with the course of the consultation; inadequate explanation and consent; distortion of practice priorities as reflected in quality indicators; temptation to record inaccurate data; conflict of interests where the doctor is rewarded for performance; patient blaming; exacerbation of the health gap. We suggest that a more justifiable strategy would be for GPs to identify patients at high risk and offer them specific preventive advice when the opportunity presents itself and at a time when the patient is likely to be most amenable to cooperate. Opportunistic health promotion offers higher expectations of benefit, as well as a more equitable allocation of the risks associated with preventive medicine, than a systematic community-based approach. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 61.2 (2000) 189-202 [Access article in PDF] Spinoza in Denmark and the Fall of Struensee, 1770-1772 John Christian Laursen * Baruch (Benedict) de Spinoza was the arch-heretic of the late seventeenth and eighteenth centuries. He was denounced in half a dozen languages from the time he began to publish until at least the 1780s, when Lessing's allegiance to Spinoza became the heart (...) of a literary scandal. 1 In time-honored fashion, some of these denunciations led to the burning of books and the imprisonment or banning of authors. The most spectacular case, however, led to the trial of a prime minister, the cutting off of his right hand and of his head, and the drawing and quartering of his body in full public ceremony. The year was 1772, the prime minister was Johann Friedrich Struensee, and the country was Denmark.Late eighteenth-century Denmark was not known for barbarities of the type represented by Struensee's execution. Previously disgraced prime ministers had merely been imprisoned, and other political enemies of the ruling powers had [End Page 189] merely been exiled. 2 Why such harshness with Struensee? What was at stake in the fall of Struensee?The answers to these questions are complex, but an important element of those answers lies in Struensee's public image, which made it seem both necessary and justifiable to treat him with such harshness. In turn, public opinion about Struensee was closely tied to the reputation of Spinoza. This essay will show that charges of Spinozism were part of the campaign that poisoned public opinion against Struensee. This was an unusually clear case of a theological and philosophical debate having direct political effects.Before getting to the role of Spinozism and anti-Spinozism in eighteenth-century Denmark, let us fill in important points of the story. The charge against Struensee was lèse majesté, for plotting the death of the King and for usurping power in violation of the constitution. Behind these charges was a further element which encouraged outrage: sleeping with Queen Caroline Matilda. That much was true, as both the Queen, a sister of George III of England, and Struensee admitted, each in order to save the other. The King knew about it all along but did not care. He did not care because he had become a libertine, going out to whorehouses most nights with rowdy friends, and he figured that what was good for the gander was good for the goose. He was also schizophrenic and easily manipulable by those around him, so that Struensee and the Queen encountered no disapproval from him until he fell under other people's influence. After Struensee and the Queen were taken into custody, the King was forced to divorce the Queen and she was sent to live in a Hannoverian castle in Celle because her brother did not want the embarrassment of having her back in England. She died there a few years later. 3It is an irony that we owe our knowledge of the state of public opinion in Denmark in this period to Struensee. Until shortly before the fatal events mentioned above, the Danish press had been subject to censorship that might have prevented the expression of many of the subsequent attacks on Struensee. But in September 1770 Struensee persuaded the king to declare freedom of the press in all his realms (consisting of the kingdoms of Denmark and Norway, the Duchies of Slesvig and Holsten [Schleswig and Holstein in German], Greenland, Iceland, the Faroes, and colonies in India, Africa, and the Caribbean). 4 It is not widely [End Page 190] known that Denmark was the first country to declare unlimited freedom of the press as official public policy. For much of the century England and the Netherlands had effective freedom of the press, but it had never been declared official policy. The next to do so was rebellious Virginia, in the Virginia Declaration of Rights (1776), followed by other colonies and then the Bill of Rights of the new... (shrink)

In their recent paper‘Undue inducement: a case study in CAPRISA 008’, Mngadi et al conclude that a participant in an HIV prevention study who deliberately concealed her pregnancy was not ‘unduly induced’ to participate by the offer of an experimental product. This paper argues that while the authors’ conclusion is sound, the framing of this case study is consistent with the preoccupation in research ethics with the concept of undue inducement, coupled with a highly risk-averse attitude to pregnancy. We (...) suggest that the critical research ethics question raised by Mngadi et al ’s case study is not ‘undue inducement’, but the exclusion of pregnant women from research studies where the risks are acceptable to the potential participant, and benefits likely. We also suggest that current regulatory paradigms regarding pregnancy are both overly paternalistic and value the fetus over the mother. In order to ensure timely provision of new HIV prevention agents, we argue that there is a need for expeditious testing of proven effective agents in pregnancy, with due consideration given to situations where preliminary efficacy data exist but fall short of licensure standards. This requires a paradigm shift from researchers, funders, regulators and ethical review bodies towards practices that critically examine the legitimacy of the exclusion of pregnant women on a study-by-study basis. (shrink)

Since 2000, research within positive psychology has exploded, as reflected in dozens of meta-analyses of different interventions and targeted processes, including strength spotting, positive affect, meaning in life, mindfulness, gratitude, hope, and passion. Frequently, researchers treat positive psychology processes of change as distinct from each other and unrelated to processes in clinical psychology. This paper presents a comprehensive framework for positive psychology processes that crosses theoretical orientation, links coherently to clinical psychology and its more dominantly “negative” processes, and supports practitioners (...) in their efforts to personalize positive psychological interventions. We argue that a multi-dimensional and multi-level extended evolutionary approach can organize effective processes of change in psychosocial interventions, by focusing interventions on context-appropriate variation, selection, and retention of processes, arranged in terms of key biopsychosocial dimensions across psychological, biophysiological, and sociocultural levels of analysis. We review widely studied positive psychology constructs and programs and show how this evolutionary approach can readily accommodate them and provide a common language and framework for improving human and community flourishing. We conclude that Interventions should start with the person, not the protocol. (shrink)