IntroductionTranscranial magnetic stimulation is a consolidated procedure for the treatment of depression, with several meta-analyses demonstrating its efficacy. Theta-burst stimulation is a modification of TMS with similar efficacy and shorter session duration. The geriatric population has many comorbidities and a high prevalence of depression, but few clinical trials are conducted specifically for this age group. TBS could be an option in this population, offering the advantages of few side effects and no pharmacological interactions. Therefore, our aim is to investigate the (...) efficacy of TBS in geriatric depression.Clinical trial registration[https://clinicaltrials.gov/ct2/], identifier [NCT04842929]. (shrink)

São várias as críticas que Leo Strauss e os seus discípulos dirigem contra São Tomás, sujo ensinamento jusnaturalista abertamente desconsideram. Acusam-no de conceber o direito natural em termos maximanente universalistas, com o resultado de que todos os códigos de leis que se pretendam justos terão de convergir no seu desenho fundamental, o que nitidamente incomoda os straussianos. Partindo dessa crítica, o presente texto analisa qual a relação estabelecida na Suma teológica entre o direito natural e o ius gentium, esse corpo (...) básico de institutos jurídicos tido precisamente por comum aos vários povos. (shrink)

Interactive technology assessment (iTA) provides an answer to the ethical problem of normative bias in evaluation research. This normative bias develops when relevant perspectives on the evaluand (the thing being evaluated) are neglected. In iTA this bias is overcome by incorporating different perspectives into the assessment. As a consequence, justification of decisions based on the assessment is provided by stakeholders having achieved agreement. In this article, agreement is identified with wide reflective equilibrium to show that it indeed has the potential (...) of justifying decisions. We work out several conditions for this agreement to be achievable and just. (shrink)

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is the (...) contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization. (shrink)

This study examined whether it was possible to classify Australian public sector employees as either whistleblowers or non-reporting observers using personal and situational variables. The personal variables were demography (gender, public sector tenure, organisational tenure and age), work attitudes (job satisfaction, trust in management, whistleblowing propensity) and employee behaviour (organisational citizenship behaviour). The situational variables were perceived personal victimisation, fear of reprisals and perceived wrongdoing seriousness. These variables were used as predictors in a series of binary logistic regressions. It was (...) possible to identify whistleblowers on the basis of individual initiative, whistleblowing propensity (individual and organisational), fear of reprisals, perceived wrongdoing seriousness and perceived personal victimisation. It was concluded that whistleblowers are not markedly dissimilar to non-reporting observers. Based on the two most influential variables (perceived personal victimisation and perceived wrongdoing seriousness), the average Australian public sector whistleblower is most likely to be an ordinary employee making a good faith attempt to stop what they perceived to be a serious wrongdoing that was initially identified through personal victimisation. (shrink)

The mid-twentieth century marks a frontier in the development of social production: the scale of human transformative activity has come to approximate that of natural processes. As a result, a certain bilateral relationship has begun to manifest itself more and more clearly: The state of the environment depends on the scale of production and level of technology, while the growth rate of social production has come to depend on the state of the environment.

I. Einleitung: Prinzipien einer konstruktivistischen Rekonstruktion des Aufbaus von Wissenschaften. Die Stelle der Protophysik der Zeit in einem solchen Aufbau der Physik. Skizze der Ziele und der Struktur von Janichs Protophysik der Zeit und der wichtigsten immanenten Kriterien ihrer Beurteilung. II. Referat und immanente Kritik seiner grundlegenden Definition . III. Ein konstruktivistischer Vorschlag zur Verbesserung von und zu einem akzeptablen Realisationsverfahren für sie. Eigentümlichkeiten dieses Realisationsverfahrens lassen bereits erwarten, daß Janichs 'Eindeutigkeitsbeweis' einen Fehler haben muß. IV. Skizze des Weges von (...) bis zu den Forderungen für Uhren und dem angeblichen Eindeutigkeitsbeweis für diese. Untersuchung und Widerlegung dieses Beweises, mit dessen Haltbarkeit das ganze Unternehmen Janichs steht und fällt. (shrink)

This article is an attempt to clarify a confusion in the brain death literature between logical sufficiency/necessity and natural sufficiency/necessity. We focus on arguments that draw conclusions regarding empirical matters of fact from conceptual or ontological definitions. Specifically, we critically analyze arguments by Tom Tomlinson and Michael B. Green and Daniel Wikler. which, respectively, confuse logical and natural sufficiency and logical and natural necessity. Our own conclusion is that it is especially important in discussing the brain death issue to observe (...) the distinction between logical and natural sufficiency/necessity in a strict fashion. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

In this article, we report findings from a qualitative study that explored how the relatives of intensive care unit patients experienced the nurses’ role and relationship with them in the end-of-life decision-making processes. In all, 27 relatives of 21 deceased patients were interviewed about their experiences in this challenging ethical issue. The findings reveal that despite bedside experiences of care, compassion and comfort, the nurses were perceived as vague and evasive in their communication, and the relatives missed a long-term perspective (...) in the dialogue. Few experienced that nurses participated in meetings with doctors and relatives. The ethical consequences imply increased loneliness and uncertainty, and the experience that the relatives themselves have the responsibility of obtaining information and understanding their role in the decision-making process. The relatives therefore felt that the nurses could have been more involved in the process. (shrink)

The aim of this study was to analyze the association between physical activity and eating habits during the COVID-19 pandemic among Brazilian adults. A sample of 1,929 participants answered an online survey, however 1,874 were included in the analysis. The impact of the COVID-19 pandemic on eating habits was assessed inquiring about participants' intake of fruits, vegetables, fried foods, and sweets during the pandemic. Physical activity was assessed by asking participants about their weekly frequency, intensity and number of minutes/hours engaging (...) in structured physical activities per week. Participants were then stratified into categories based on moderate-to-vigorous intensity and into active or inactive. Increased sweets consumption was the most commonly reported change to eating habits, followed by an increase in the consumption of vegetables, fruits, and fried foods. Physical activity practice was related to lower consumption of fried foods and sweets. A cluster analysis revealed subjects with higher the level of physical activity was more likely to follow a healthy diet. Thus, physical activity was positively associated with healthier eating habits. Health authorities must recommend regular physical as a strategy to improve overall health during the COVID-19 pandemic. Future studies should address the physical activity interventions to improve health status during a pandemic. (shrink)

In response to widespread concern about illegal drug use and the associated risk of the spread of HIV/AIDS, a study was undertaken to examine whether it was, in principle, feasible to conduct a trial providing heroin to dependent users in a controlled manner. Such a trial involves real ethical issues which are examined in this paper. The general issues examined are: should a trial be an experiment or an exercise in public policy?; acts and omissions; countermobilization; termination of a trial, (...) and payment for drugs and for a trial. The specific issues examined are: selection of trial participants; privacy; issues for staff working on a trial; coupling the trial with other treatment, and issues for researchers. A number of alternative approaches to the various ethical issues are presented and discussed. (shrink)

Este artigo recorda os principais aspectos e motivações da Expedição Langsdorff, missão de reconhecimento do interior do Brasil iniciada em 1821, composta pelo cônsul russo barão Langsdorff, o pintor alemão Moritz Rugendas, Aimé-Adrien Taunay, Nicolas-Antoine Taunay, o polígrafo Hercules Florence e o especialista em mapas Néster G. Rubtsov. Busca diferenças entre esta expedição e iniciativas outras, a título de exemplo, as dos bandeirantes e jesuítas, bem como a expedição indigenista de Rondon, e propõe o aprofundamento das investiga­ções. Apresenta atributos resgatados (...) pela poesia brasileira contemporânea e elementos cons­titutivos da identidade cultural brasileira presentes na Expedição Langsdorff, os quais os auto­res sugerem ser relevantes para pesquisadores do tema e para a inserção do Brasil no contexto internacional político, diplomático e econômico nos tempos hodiernos. (shrink)

Background: The high disease burden of Africa, the emergence of new diseases and efforts to address the 10/90 gap have led to an unprecedented increase in health research activities in Africa. Consequently, there is an increase in the volume and complexity of protocols that ethics review committees in Africa have to review. Methods: With a grant from the Bill and Melinda Gates Foundation, the African Malaria Network Trust (AMANET) undertook a survey of 31 ethics review committees (ERCs) across sub-Saharan Africa (...) as an initial step to a comprehensive capacity-strengthening programme. The number of members per committee ranged from 3 to 21, with an average of 11. Members of 10 institutional committees were all from the institution where the committees were based, raising prima facie questions as to whether independence and objectivity could be guaranteed in the review work of such committees. Results: The majority of the committees (92%) cited scientific design of clinical trials as the area needing the most attention in terms of training, followed by determination of risks and benefits and monitoring of research. The survey showed that 38% of the ERC members did not receive any form of training. In the light of the increasing complexity and numbers of health research studies being conducted in Africa, this deficit requires immediate attention. Outcome: The survey identified areas of weakness in the operations of ERCs in Africa. Consequently, AMANET is addressing the identified needs and weaknesses through a 4-year capacity-building project. (shrink)