BackgroundFor many decades, the debate on children’s competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children’s competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally children of 11.2 (...) years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children’s competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives.DiscussionAlthough assessment of children’s competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad.SummaryPrevious research outcomes showed that children’s medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents, for children from the age of 12 until they reach majority. For children between 10 and 12 years of age, and in case of children older than 12 years in special research populations of mentally compromised patients, we suggest a case-by-case assessment of children’s competence to consent. Since such a dual consent procedure is fundamentally different from a procedure of parental permission and child assent, and would imply a considerable shift regarding some current legislations, practical implications are elaborated. (shrink)

The current times call for reforms in educational processes. The Covid-19 pandemic had an unforeseen impact on the educational system in all countries. This need for change requires new pedagogies and new methods for teaching and learning. Understanding the need for change is essential for the formulation of adaptive proposals, as well as for the generation of training activities to complement the teaching curriculum. New educational practices lead to a vision of educational quality, with new approaches that allow the continuous (...) integration of knowledge and permanent interaction with the student. This paper presents an analysis of the new teaching methodologies in times of confinement due to the pandemic caused by Covid-19. Keywords: Teaching methodologies, educational system, learning process. References [1]É. Tremblay-Wragg, C. Raby, L. Ménard y I. Plante, «El uso de estrategias didácticas diversificadas por cuatro profesores universitarios: ¿qué contribución a la motivación de aprendizaje de sus alumnos?,» Docencia en educación superior, vol. 26, nº 21, 2021. [2]L. Czerniewicz, R. Mogliacci, S. Walji, A. Cliff, B. Swinnerton y N. Morris, «Enseñanza y aprendizaje académico en el nexo: desagregación, mercantilización y digitalización en la educación superior,» Teaching in Higher Education, vol. 26, nº 2021, p. 16, 2021. [3]S. Dogan y A. Adam, «Aumentar el efecto del desarrollo profesional en la instrucción efectiva a través de comunidades profesionales,» Docentes y docencia: teoría y práctica, vol. 26, nº 3-4, pp. 326-349, 2020. [4]I. M. Torres Salas, «La enseñanza tradicional de las ciencias versus las nuevas tendencias educativas,» Educare, vol. 14, nº 1, pp. 131-142, 2010. [5]B. Fabio, J. Antonio Palomino y J. González Henríquez, «Evaluación y contraste de los métodos de enseñanza tradicional y lúdico,» Revista de Educación física y deportes, vol. 13, nº 94, pp. 29-36, 2008. [6]Y. Benítez y C. Mora, «Enseñanza tradicional vs aprendizaje activo,» Revista Cubana de Física, vol. 27, nº 2A, pp. 175-179, 2010. [7]P. Morales Bueno y V. Landa Fitzgerald, «Aprendizaje basado en problemas,» Theoria, vol. 13, nº 1, pp. 145-157, 2004. [8]R. Gil-Galván, I. Martín-Espinosa y F. Gil-Galván, «University student perceptions of competences acquired through problem-based learning,» Educación XXI, vol. 24, nº 1, pp. 271-295, 2020. [9]E. Ortiz Cermeño, «El aprendizaje basado en problemas,» Perfiles Educativos, vol. 41, nº 164, pp. 208-213, 2019. [10]E. Araos-Baeriswyl, C. Moll-Manzur, Á. Paredes y J. Landeros, «Aprendizaje invertido: un enfoque pedagógico en tiempos de pandemia,» Rev. Atención Primaria, vol. 53, nº 1, p. 117, 2021. [11]V. León-Carrascosa, M. Belando-Montoro y S. Sánchez-Serrano, «Design and validation of a questionnaire to evaluate the service-learning methodology,» Rev.Estudios sobre educación, vol. 39, nº 1, pp. 247-266, 2020. [12]J. Collado-Ruano, M. Ojeda, M. Malo y D. Amino, «Educación, arte e interculturalidad: El cine documental como lenguaje comunicativo y tecnología innovadora para el aprendizaje de la metodología I + D + I,» Rev. Texto livre, vol. 13, nº 3, pp. 376-393, 2020. [13]P. M. Bueno y V. Landa Fitzgerald, «Aprendizaje basado en problemas,» Theoria, vol. 13, nº 1, pp. 145-157, 2004. [14]J. A. Martí, M. Heydrich, M. Rojas y A. Hernández, «Aprendizaje basado en proyectos: Una experiencia de innovación docente,» Universidad EAFIT, vol. 46, nº 158, pp. 11-21, 2010. [15]L. Rojas y N. M. Jaimes, «Canvas LMS y el trabajo colaborativo como metodología de aprendizaje en entornos virtuales,» de Congreso Ibérico de Sistemas y Tecnologías de la Información, CISTI, Bogotá, Colombia, 2020. [16]B. Bordel y P. Mareca, «Results and Trends in educational MOOCs in the engineering area with MIRIADAX platform. A case study,» de 15th Iberian Conference on Information Systems and Technologies, CISTI 2020; Seville; Sevilla, España, 2020. [17]K. Vermeir y G. Kelchtermans, «Innovative practice as interpretative negotiation.A case-study on the kamishibai in Kindergarten.,» Teachers and Teaching: Theory and Practice, vol. 26, nº 3-4, pp. 248-263, 2020. [18]B. Tucker, «The Flipped Classroom: Online instruction at home frees class time for learning,» Education Next, vol. 1, nº 1, pp. 82-84, 2012. [19]M. V. Ledo, N. R. Michelena, N. N. Cao, I. d. R. M. Suárez y M. N. Vialart Vidal, « Aula invertida, nueva estrategia didáctica,» Educación Médica Superior, vol. 30, nº 3, pp. 678-688, 2016. [20]Metodologías activas por medio de las TIC, [Online]. Available: https://www.campuseducacion.com/blog/recursos/articulos-campuseducacion metodologias-activas-por-medio-de-las-tic/?cn-reloaded=1. [Last access: February 14, 2021]. (shrink)

The nonvisual self-touch rubber hand paradigm elicits the compelling illusion that one is touching one’s own hand even though the two hands are not in contact. In four experiments, we investigated spatial limits of distance and alignment on the nonvisual self-touch illusion and the well-known visual rubber hand illusion. Common procedures and common assessment methods were used. Subjective experience of the illusion was assessed by agreement ratings for statements on a questionnaire and time of illusion onset. The nonvisual self-touch illusion (...) was diminished though never abolished by distance and alignment manipulations, whereas the visual rubber hand illusion was more robust against these manipulations. We assessed proprioceptive drift, and implications of a double dissociation between subjective experience of the illusion and proprioceptive drift are discussed. (shrink)

Inattentional blindness studies have shown that an unexpected object may go unnoticed if it does not share the property specified in the task instructions. Our aim was to demonstrate that observers develop an attentional set for a property not specified in the task instructions if it allows easier performance of the primary task. Three experiments were conducted using a dynamic selective-looking paradigm. Stimuli comprised four black squares and four white diamonds, so that shape and colour varied together. Task instructions specified (...) shape but observers developed an attentional set for colour, because we made the black–white discrimination easier than the square–diamond discrimination. None of the observers instructed to count bounces by squares reported an unexpected white square, whereas two-thirds of observers instructed to count bounces by diamonds did report the white square. When attentional set departs from task instructions, you may fail to see what you were told to look for. (shrink)

Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothesize that 1) lack of equipoise at enrolment among parents may reduce recruitment; 2) lack of equipoise during participation may reduce retention in patients assigned to a less favoured treatment-strategy. Methods We compared preferences of (...) parents/patients at enrolment, documented by a questionnaire, with preferences developed during follow-up by an interview-study to investigate equipoise of child-participants and parents in the BeSt-for-Kids-study. This trial in new-onset Juvenile Idiopathic Arthritis-patients consists of three strategies. One strategy comprises initial treatment with a biological disease-modifying-antirheumatic-drug, currently not standard-of-care. Semi-structured interviews were conducted with 23 parents and 7 patients, median 11 months after enrolment. Results Initially most parents and children were not in equipoise. Parents/patients who refused participation, regularly declined due to specific preferences. Many participating families preferred the biological-first-strategy. They participated to have a chance for this initial treatment, and would even consider stopping trial-participation when not randomized for it. Their conviction of superiority of the biological-first strategy was based on knowledge from internet and close relations. According to four parents, the physician-investigator preferred the biological-first-strategy, but the majority stated that she had no preferred strategy. In phase 2, preferences tended to change to the treatment actually received. Conclusions Lack of equipoise during enrolment did not reduce study recruitment, mainly due to the fact that preferred treatment was only available within the study. Still, when developing a trial it is important to evaluate whether the physicians’ research question is in line with preferences of the patient-group. By exploring so-called ‘informed patient-group’-equipoise, successful recruitment may be enhanced and bias avoided. In our study, lack of equipoise during trial-participation did not reduce retention in those assigned to a less favoured option. We observed a change for preference towards treatment actually received, possibly explained by comparable outcomes in all three arms. (shrink)

Open peer commentary on the target article “How and Why the Brain Lays the Foundations for a Conscious Self” by Martin V. Butz. Excerpt: Avoiding the term “representation” would make the article much more consistent with a radical constructivist way of thinking. It would also open up unexpected opportunities for realizing the potential of some of its most interesting ideas, such as the connection between anticipatory drive and attention (§31).

Public policy issues around access to networked information are explored and examined. Long viewed as the quintessential public good, information has evolved into a critically important market commodity in little more than a generation. New technologies and a political climate in which the meaning of universal access to information is no longer commonly understood and in which its importance is no longer taken for granted pose significant challenges for American society. Libraries, as information commons, offer the means of meeting those (...) challenges. Historical, economical, and professional factors that shape the conflict are described and discussed. (shrink)

Current UK legislation is impacting upon the feasibility and cost-effectiveness of medical record-based research aimed at benefiting the NHS and the public heath. Whereas previous commentators have focused on the Data Protection Act 1998, the Health and Social Care Act 2001 is the key legislation for public health researchers wishing to access medical records without written consent. The Act requires researchers to apply to the Patient Information Advisory Group for permission to access medical records without written permission. We present a (...) case study of the work required to obtain the necessary permissions from PIAG in order to conduct a large scale public health research project. In our experience it took eight months to receive permission to access basic identifying information on individuals registered at general practices, and a decision on whether we could access clinical information in medical records without consent took 18 months. Such delays pose near insurmountable difficulties to grant funded research, and in our case £560 000 of public and charitable money was spent on research staff while a large part of their work was prohibited until the third year of a three year grant. We conclude by arguing that many of the current problems could be avoided by returning PIAG’s responsibilities to research ethics committees, and by allowing “opt-out” consent for many public health research projects. (shrink)

We introduce and study a natural extension of Marcus external contextual grammars. This mathematically simple mechanism which generates a proper subclass of simple matrix languages, known to be mildly context-sensitive ones, is still mildly context-sensitive. Furthermore, we get an infinite hierarchy of mildly context-sensitive families of languages. Then we attempt to fill a gap regarding the linguistic relevance of these mechanisms which consists in defining a tree structure on the strings generated by many-dimensional external contextual grammars, and investigate some related (...) issues. Several open problems are finally discussed. (shrink)

Dispositions are essential to our understanding of the world. Dispositions: A Debate is an extended dialogue between three distinguished philosophers - D.M. Armstrong, C.B. Martin and U.T. Place - on the many problems associated with dispositions, which reveals their own distinctive accounts of the nature of dispositions. These are then linked to other issues such as the nature of mind, matter, universals, existence, laws of nature and causation.

While outcomes for children with T-cell acute lymphoblastic leukemia have improved dramatically, survival rates for patients with relapsed/refractory disease remain dismal. Prior studies indicate that glucocorticoid resistance is more common than resistance to other chemotherapies at relapse. In addition, failure to clear peripheral blasts during a prednisone prophase correlates with an elevated risk of relapse in newly diagnosed patients. Here we show that intrinsic GC resistance is present at diagnosis in early thymic precursor T-ALLs as well as in a subset (...) of non-ETP T-ALLs. GC-resistant non-ETP T-ALLs are characterized by strong induction of JAK/STAT signaling in response to interleukin-7 stimulation. Removing IL7 or inhibiting JAK/STAT signaling sensitizes these T-ALLs, and a subset of ETP T-ALLs, to GCs. The combination of the GC dexamethasone and the JAK1/2 inhibitor ruxolitinib altered the balance between pro- and anti-apoptotic factors in samples with IL7-dependent GC resistance, but not in samples with IL7-independent GC resistance. Together, these data suggest that the addition of ruxolitinib or other inhibitors of IL7 receptor/JAK/STAT signaling may enhance the efficacy of GCs in a biologically defined subset of T-ALL.Leukemia advance online publication, 30 May 2017; doi:10.1038/leu.2017.136. (shrink)

Current UK legislation is impacting upon the feasibility and cost-effectiveness of medical record-based research aimed at benefiting the NHS and the public heath. Whereas previous commentators have focused on the Data Protection Act 1998, the Health and Social Care Act 2001 is the key legislation for public health researchers wishing to access medical records without written consent. The Act requires researchers to apply to the Patient Information Advisory Group for permission to access medical records without written permission. We present a (...) case study of the work required to obtain the necessary permissions from PIAG in order to conduct a large scale public health research project. In our experience it took eight months to receive permission to access basic identifying information on individuals registered at general practices, and a decision on whether we could access clinical information in medical records without consent took 18 months. Such delays pose near insurmountable difficulties to grant funded research, and in our case £560 000 of public and charitable money was spent on research staff while a large part of their work was prohibited until the third year of a three year grant. We conclude by arguing that many of the current problems could be avoided by returning PIAG’s responsibilities to research ethics committees, and by allowing “opt-out” consent for many public health research projects. (shrink)

The rubber hand paradigm is used to create the illusion of self-touch, by having the participant administer stimulation to a prosthetic hand while the Examiner, with an identical stimulus , administers stimulation to the participant’s hand. With synchronous stimulation, participants experience the compelling illusion that they are touching their own hand. In the current study, the robustness of this illusion was assessed using incongruent stimuli. The participant used the index finger of the right hand to administer stimulation to a prosthetic (...) hand while the Examiner used a paintbrush to administer stimulation to the participant’s left hand. The results indicate that this violation of tactile expectations does not diminish the illusion of self-touch. Participants experienced the illusion despite the use of incongruent stimuli, both when vision was precluded and when visual feedback provided clear evidence of the tactile mismatch. (shrink)

A simple experimental paradigm creates the powerful illusion that one is touching one’s own hand even when the two hands are separated by 15 cm. The participant uses her right hand to administer stimulation to a prosthetic hand while the Examiner provides identical stimulation to the participant’s receptive left hand. Change in felt position of the receptive hand toward the prosthetic hand has previously led to the interpretation that the participant experiences self-touch at the location of the prosthetic hand, and (...) experiences a sense of ownership of the prosthetic hand. Our results argue against this interpretation. We assessed change in felt position of the participant’s receptive hand but we also assessed change in felt position of the participant’s administering hand. Change in felt position of the administering hand was significantly greater than change in felt position of the receptive hand. Implications for theories of ownership are discussed. (shrink)

Empirical research has increasingly turned its attention to distributed cognition. Acts of remembering are embedded in a social, interactional context; cognitive labor is divided between a rememberer and external sources. The present article examines the benefits and costs associated with distributed, collaborative, conversational remembering. Further, we examine the consequences of joint acts of remembering on subsequent individual acts of remembering. Here, we focus on influences on memory through social contagion and socially shared retrieval-induced forgetting. Extending beyond a single social interaction, (...) we consider work that tracks the propagation of socially shared retrieval-induced forgetting throughout larger networks made up of several agents. Although much work has focused on how distributing cognition can augment memory, this is not the primary lesson we draw from the conversational remembering literature. Rather, mnemonic convergence between communicators is a boon to sociality. It allows the formation and maintenance of mnemonic communities, rather than expanding capacity or accuracy of memory per se. (shrink)

This paper describes the change of emphasis that occurred in the teaching of ethics to small groups of clinical students. Although the original focus of the course was on the analysis of ethical dilemmas associated with individual patients known to the students, it soon became evident that there were, for the students themselves, more fundamental ethical dilemmas in their new role as clinical students. These included worries about how to respond when patients asked questions which their consultants had previously deceived (...) them about, worries about inflicting pain on patients, as with intravenous cannulation, and the role of the medical student in the clinical team. We emphasise the need to explore student experiences as part of the process of ethics teaching. (shrink)

Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. An empirical ethical approach, combining (1) a narrative review of (primarily) qualitative studies on parents' and physicians' experiences of the pediatric (...) oncology research practice, and (2) comparison of these experiences with existing theoretical ethical concepts about (pediatric) research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice. Analysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician (doctor vs. scientist). True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the existence of a therapeutic misconception between them and parents. Due to the integration of research and care, their different ethical perspectives become intertwined in the daily practice of pediatric oncology. Increasing awareness of what this means for the communication between parents and physicians is essential. Future research should focus on efforts that overcome the problems that the synchronicity of research and care evokes. (shrink)

For decades, the discussion on children’s competence to consent to medical issues has concentrated around normative concerns, with little progress in clinical practices. Decision-making competence is an important condition in the informed consent model. In pediatrics, clinicians need to strike a proper balance in order to both protect children’s interests when they are not fully able to do so themselves and to respect their autonomy when they are. Children’s competence to consent, however, is currently not assessed in a standardized way. (...) Moreover, the correlation between competence to give informed consent and age in children has never been systematically investigated, nor do we know which factors exactly contribute to children’s competence. (shrink)

Originally published in 1988, M. C. Dillon's classic study of Merleau-Ponty is now available in a revised second edition containing a new preface and a new ...

Human moral judgement may have evolved to maximize the individual's welfare given parochial culturally constructed moral systems. If so, then moral condemnation should be more severe when transgressions are recent and local, and should be sensitive to the pronouncements of authority figures (who are often arbiters of moral norms), as the fitness pay-offs of moral disapproval will primarily derive from the ramifications of condemning actions that occur within the immediate social arena. Correspondingly, moral transgressions should be viewed as less objectionable (...) if they occur in other places or times, or if local authorities deem them acceptable. These predictions contrast markedly with those derived from prevailing non-evolutionary perspectives on moral judgement. Both classes of theories predict purportedly species-typical patterns, yet to our knowledge, no study to date has investigated moral judgement across a diverse set of societies, including a range of small-scale communities that differ substantially from large highly urbanized nations. We tested these predictions in five small-scale societies and two large-scale societies, finding substantial evidence of moral parochialism and contextual contingency in adults' moral judgements. Results reveal an overarching pattern in which moral condemnation reflects a concern with immediate local considerations, a pattern consistent with a variety of evolutionary accounts of moral judgement. (shrink)

Introducing Philosophy: A Text with Integrated Readings, Tenth Edition is a thorough introduction to the core problems of philosophy, including explanations and background by the authors along with generous excerpts from the philosophers under discussion. Organized topically, the chapters present alternative perspectives-including analytic, continental, feminist, and non-Western viewpoints-alongside the historical works of major philosophers. The text provides the course materials that allow instructors and students to focus on a variety of philosophical problems and perspectives. Spanning 2,500 years, the selections range (...) from the oldest known fragments to cutting-edge contemporary essays. (shrink)