The literature on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises concerns that these technologies may affect personality, mood, and behavior. We conducted semi-structured interviews with researchers (n = 23) involved in developing next-generation DBS systems, exploring their perspectives on ethics and policy topics including whether DBS/aDBS can cause such changes. The majority of researchers reported being aware of personality, mood, or behavioral (PMB) changes in recipients of DBS/aDBS. Researchers offered varying estimates of the frequency of PMB changes. A (...) smaller majority reported changes in personality specifically. Some expressed reservations about the scientific status of the term ‘personality,’ while others used it freely. Most researchers discussed negative PMB changes, but a majority said that DBS/aDBS can also result in positive changes. Several researchers viewed positive PMB changes as part of the therapeutic goal in psychiatric applications of DBS/aDBS. Finally, several discussed potential causes of PMB changes other than the device itself. (shrink)

Langerhans cells (LCs), residing in the epidermis, are able to induce potent immunogenic responses and also to mediate immune tolerance. We propose that tolerogenic and immunogenic responses of LCs are directed by signaling from the epidermis and involve counter‐acting gene circuits that are coupled to a core maturation gene module. We base our analysis on recent genetic and genomic findings facilitating the understanding of the molecular mechanisms controlling these divergent immune functions. Comparing gene regulatory network (GRN) analyses of various types (...) of dendritic cells (DCs) including LCs we integrate signaling‐dependent (TGFβ, EpCAM, β‐Catenin) and transcription factor (IRF4, IRF1, NFκB) regulated gene circuits that appear to orchestrate the distinctive LC functional states. Our model proposes, that while epidermal signaling in the steady‐state promotes LC tolerogenic function, the disruption of cell‐cell contacts coupled with inflammatory signaling induces LC immunogenic programing. The conceptual framework emphasizes the sensing of discrete epidermal and inflammatory cues by resident LCs in dictating their genomic programing and cell state dynamics. (shrink)

Drawing on sixteenth-century Protestant discourse on marriage and sexuality, this essay examines the anxieties permeating Spenser’s two poetical celebrations of his courtship and wedding with Elizabeth Boyle. Though the Reformers’ departure from Rome included an embrace of clerical marriage and an advocacy for the virtues of companionate marriage, revulsion at the sinfulness of sex remained. Through the sonnets of the Amoretti and the stanzas of the Epithalamion, an idea of mutual love is disrupted by a Protestant-tinged sense of innate and (...) pervasive depravity. Special attention is given to sonnets #58 and #84, and to the Epithalamion passages on Maia and Alcema. (shrink)

In the last decades, proportionality has become increasingly influential in human rights adjudication. Even in the United States, a country with its own tradition of constitutional review, proporti...

Introduction: Resilience is a multidimensional and dynamic construct associated with positive growth and the capacity to transform stressful and negative factors into opportunities of personal development and self-improvement when faced with difficult experiences. The resilience process of each individual integrates multiple analysis levels, which range from genetic-environmental interactions to a complex process of adaptation between the individual and his/her family, friends, co-workers, society, and culture.Objective: To determine whether resilience improves in students of occupational therapy when exposed for the first time (...) to practice placement education.Methodology: Quasi-experimental, prospective, observational, multi-center study with a sample composed of students from the Degree of Occupational Therapy of the public universities of Málaga and Castilla-La Mancha. Two weeks prior to the beginning of the practice education period, the participants completed a questionnaire that included sociodemographic data and the area of their internships. They were also given the Spanish version of the Connor-Davidson's resilience scale. All these instruments were also completed 1 week after the end of the clinical practice.Results: There were statistically significant differences between the variables that make up resilience and the different internship areas. On the other hand, there was a significant improvement of global resilience after the clinical practice period, in both women and men, when the internship area was not considered.Conclusions: The results show that resilient students are more optimistic and work to improve a situation beyond doing simply what is expected of them, knowing how to control their feelings. This is beneficial for students in practice education, since, during these, they face difficult situations that require a resilient pattern, which helps reduce stress and the burnout syndrome. (shrink)

David Estlund and Massimo Renzo argue that, given the right background conditions, combatants are obligated to obey orders to fight in unjust wars, a thesis they put forward even as they recognize that this involves committing serious moral wrongs. Their views, then, fall between traditionalism and revisionism in the theory of just war. We argue that both Estlund and Renzo fail to adequately distinguish between binding and nonbinding serious morally wrong orders, that their views are incompatible with their assumed fact‐relative (...) understanding of morality, and that they fail to establish that combatants are obligated to obey orders to fight in unjust wars. We conclude that just as untenable as these two middle‐ground positions is the traditionalist view. (shrink)

The study of Attention Deficit Hyperactivity Disorder addresses variables related to three core symptoms: inattention, hyperactivity, and impulsivity. However, it has been suggested that in recent years emotional difficulties and subsequent social challenges have not received sufficient attention. This study had two objectives: 1) to compare the performance of participants (age range: 8-14 years) on facial emotion recognition tasks using the Affect Recognition subtest of the Children Neuropsychological Battery II; and 2) to assess the perceptions of family members in relation (...) to variables associated with emotional problems, difficulty in regulating emotions, and anger management using the Spanish Assessment System for Children and Adolescents. Assessments were conducted before and after applying an emotion regulation intervention designed for this study. Following the intervention, there was a significant decrease in scores associated with emotional regulation, and an improvement in the identification of affect on facial recognition tasks. The results suggest that despite Attention Deficit Hyperactivity Disorder children and adolescents having social and emotional deficits secondary to the core symptom triad, emotional regulation in this group can be improved by the application of socio-emotional intervention programs. (shrink)

Propósito: la adecuación del esfuerzo terapéutico es una decisión clínica basada en la evidencia que pretende evitar la futilidad médica. Se han señalado diferentes factores que pueden influir en esta toma de decisiones los cuales se relacionan con el paciente, el profesional médico que toma de las decisiones, barreras del sistema, cultura y economía, entre otros. El presente estudio pretende identificar aquellos factores que influyen en los médicos especialistas que laboran en la institución referente del cáncer en Colombia, a fin (...) de planear acciones que mejoren el abordaje de la toma de decisiones con respecto a la adecuación del esfuerzo terapéutico en pacientes con cáncer. Metodología: diseño cualitativo basado en 13 entrevistas en profundidad a médicos especialistas del Instituto Nacional de Cancerología de Colombia. Resultados: participaron 3 mujeres y 10 hombres, con un promedio de edad de 36 años, 7 pertenecientes a la especialidad de oncología de adultos, 2 a oncohematología pediátrica, 1 a cuidados intensivos de adultos y 3 a cuidados intensivos pediátricos. Los factores hallados se agruparon en cuatro categorías: 1) conocimiento, 2) aspectos relacionados con la toma de decisiones, 3) quién decide, 4) tipo de decisión que se toma; a su vez, estas categorías se agruparon en temas que hacen alusión a los factores que influyen en la toma de decisiones de los especialistas para adecuar los esfuerzos terapéuticos. Conclusión: la adecuación de los esfuerzos terapéuticos es importante para evitar procedimientos médicos fútiles que prolonguen el sufrimiento. Se evidenciaron algunos factores que influyen en la toma de decisiones de los especialistas: falta de preparación de los profesionales de salud en el tema de toma de decisiones al final de la vida, uso reducido de escalas que permitan mejorar la información del pronóstico y desconocimiento sobre voluntades anticipadas; estos son algunos de aquellos factores que deben fortalecerse para generar acciones que mejoren el abordaje de esta temática. (shrink)

Introduction Currently, The nature and scope of Clinical Ethics Protocols in Madrid are not well understood.Objectives The main objective is to describe the features of ‘guideline/recommendation’ type CEPs that have been or are being developed by existing Clinical Ethics Committees in Madrid. Secondary objectives include characterisation of those CECs that have been the most prolific in reference to CEP creation and implementation and identification of any trends in future CEP development.Methods We collected CEPs produced and in process by CECs accredited (...) in the public hospitals in Madrid, Spain, from 1996 to 2008.Results CECs developed 30 CEPs, with 10 more in process. The most common topic is refusal of treatment . If CEPs addressing terminal illness, Do-Not-Resuscitate orders and advance directives are placed into a separate ‘ethical problems at the end of life’ category, this CEP subject emerges as the most common . There is a relationship between the age of the CEC and the development of CEPs . CECs now seem to be more likely to engage in CEP development.Conclusions The CECs in Madrid, Spain, have developed a significant number of CEPs and there is a trend towards continued development. The most frequent topics are ethical problems at the end of life and refusal of treatment by the patient. (shrink)

Membership in voluntary organizations is associated with individual and social benefits. Due to the negative consequences of the global pandemic on older people, and the governmental challenges posed by population aging, voluntary membership is of great importance to society. To effectively promote volunteering among older people, it is necessary to understand the determinants of voluntary membership. This study analyses the influence of individual values—secular/traditional and survival/self-expression–on voluntary membership among European adults. Specifically, it examines which values orient two age groups, as (...) well as men and women toward a certain type of association. The sample of 31,985 comprises 60% of adults aged 50–64 and 40% aged 65–79; of which 56% are women and 44% men. The empirical estimation considers different levels of data aggregation: individual, national and welfare system, therefore multilevel analysis is used as an analytical strategy. Individual-level variables from the Integrated Values Survey and national-level variables from the World Bank and Eurostat are used. The results indicate that traditional and self-expression values promote membership in voluntary organizations in general more than secular and survival values. However, there are differences according to the type of organization. Furthermore, values are found to moderate the effect of age and gender on voluntary membership. (shrink)

Desde hace tiempo el docente se ha visto supeditado no solo a un aprendizaje ad hoc de las competencias digitales sino a prepararse para desarrollar competencias en sus alumnos en las diferentes modalidades: presencial, on line, hibrido. En este capitulo se exponen algunos retos para el docente, así como la relación del conectivismo como forma de aprendizaje. Se expondrán la auto percepción de los alumnos de varios cursos sobre el saber hacer del docente en las clases virtuales. Como principales conclusiones, (...) se hace necesario mayor manejo por parte del docente en competencia digital, así como el manejo de estrategias para dinamizar las sesiones. (shrink)

Studies of individuals under conditions of confinement or severe social and physical restrictions have consistently shown deleterious mental health effects but also high levels of adaptability when dealing with such conditions. Considering the role of physical activity and sport in psychological adaptation, this paper describes a longitudinal study to explore to what extent the imposed restrictions due to the outbreak of SARS-CoV-2 may have affected athletes’ mental health outcomes and how far the process of adaptation to confinement conditions is differentially (...) affected depending on whether the sports activity was practiced individually or in a group, and outdoors, indoors, or both. Two hundred and seventy-four athletes were assessed over 7 weeks using the GHQ-28 and an ad hoc survey exploring the practice of physical activity. A mixed-model fixed effects ANCOVA was used to analyze the effects of time, place, and company in which the sport was practiced, with an index of the amount of physical activity expended as a covariate. Results show a significant effect of time in three out of four of the GHQ-28 subscales, in all cases showing a consistent adaptation to conditions over time. Results also show that playing sport indoors, outdoors, or both, and practicing alone vs. with others differentially affect the somatic symptoms exhibited during confinement: Athletes who practiced sport with others showed higher levels of somatic symptoms at the beginning of the set of data but a quicker rate of adaptation. Differences arising from practicing sport alone or with others were more pronounced in the case of indoor sports, which could be related to the fact that physical activity that can be practiced during confinement is more similar to that practiced indoors alone. Implications relating to what sport psychologists and other health professionals may offer to athletes in stressful situations are discussed. (shrink)

In this conceptual article, we argue that defining corporate social responsibility and corporate social irresponsibility as opposite constructs produces a lack of clarity between responsible and irresponsible acts. Furthermore, we contend that the treatment of the CSR and CSI concepts as opposites de-emphasizes the value of CSI as a stand-alone construct. Thus, we reorient the CSI discussion to include multiple aspects that current conceptualizations have not adequately accommodated. We provide an in-depth exploration of how researchers define CSI and both identify (...) and analyze three important gray zones between CSR and CSI: the role of harm and benefit, the role of the actor and intentionality, and the role of rectification. We offer these gray zones as factors contributing to the present lack of conceptual clarity of the term CSI, as a concept in its own right, leading to difficulties that researchers and managers experience in categorizing CSI acts as distinct from CSR. (shrink)

The expansion of research on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises important neuroethics and policy questions related to data sharing. However, there has been little empirical research on the perspectives of experts developing these technologies. We conducted semi-structured, open-ended interviews with aDBS researchers regarding their data sharing practices and their perspectives on ethical and policy issues related to sharing. Researchers expressed support for and a commitment to sharing, with most saying that they were either sharing their data (...) or would share in the future and that doing so was important for advancing the field. However, those who are sharing reported a variety of sharing partners, suggesting heterogeneity in sharing practices and lack of the broad sharing that would reflect principles of open science. Researchers described several concerns and barriers related to sharing, including privacy and confidentiality, the usability of shared data by others, ownership and control of data (including potential commercialization), and limited resources for sharing. They also suggested potential solutions to these challenges, including additional safeguards to address privacy issues, standardization and transparency in analysis to address issues of data usability, professional norms and heightened cooperation to address issues of ownership and control, and streamlining of data transmission to address resource limitations. Researchers also offered a range of views on the sensitivity of neural activity data (NAD) and data related to mental health in the context of sharing. These findings are an important input to deliberations by researchers, policymakers, neuroethicists, and other stakeholders as they navigate ethics and policy questions related to aDBS research. (shrink)

Children and adolescents are not indifferent to the dramatic impact of the COVID-19 pandemic, and the need to be forced to live in confinement. The change in life to which they have been abruptly subjected forces us to understand the state of their mental health in order to adequately address both their present and future needs. The present study was carried out with the intention of studying the consequences of confinement on anxiety, sleep routines and executive functioning of 1,028 children (...) and adolescents, aged from 6 to 18 years, residing in Spain to; assess if there are differences regarding these consequences in terms of sex and age; how anxiety affects executive functioning in males and females; and to examine the possible correlations between the measured variables. For this purpose, an online questionnaire containing five sections was designed: the first section gathers information on sociodemographic and health data, while the following sections gather information from different standardized scales which measure anxiety, sleep and executive functions, whose items were adapted in order to be completed by parents, and/or legal guardians. The statistical analyzes carried out highlights significant differences in executive functioning between males and females. In turn, in regards to age, greater difficulties were detected in anxiety in the 9 to 12 age group and greater sleep disturbances between 13 and 18 year olds. On the other hand, significant differences were found in intra-sexual executive functioning depending on whether they presented greater or lesser anxiety, with executive functioning being more tendentiously maladjusted in males than in females, revealing a significantly relevant effect size. Positive correlations are obtained between state anxiety and sleep and executive functioning alterations. Finally, through Path Analysis, it is verified that state anxiety is the variable with the greatest weight within the model that would explain the alteration in the executive functioning of the present sample. (shrink)

This methodological article provides a Mixed Method approach to analyze how the Teaching Personal and Social Responsibility (TPSR) Model is feasible to enhance student’s autonomy. The objective is to detect how teachers’ behavior-oriented patterns shift in response to continuing professional development to reinforce TPSR strategies. We compared the application of TPSR by three teachers who had previously attended a training course for this model, with that of an expert in the model. A total of 44 sessions of primary and secondary (...) school semesters in various subjects, taught by all four teachers and comprising 120 students. A mixed-method approach followed in the study involved: a) the Observational System of Teaching Oriented Responsibility (OSTOR), which revealed how the teachers’ behavior patterns shifted over their interventions, and b) the Tool for Assessing Responsibility-Based Education (TARE 2.0.), which focused on perceived behaviors by teachers and student behaviors. Data analysis was conducted for a) the T-pattern detection technique, b) polar coordinate analysis to obtain detailed sequences of instruction, and c) descriptive and correlational analysis from the TARE. The mixed-method analysis of data confirms how the TPSR improved the teaching behaviors of the three teachers in training compared with the expert teacher. (shrink)

Attention-deficit hyperactivity disorder is one of the most common neurodevelopmental disorders in children and adolescents. People who have this disorder are characterized by presenting difficulties in the processes of sustained attention, being very active, and having poor control of their impulses. Despite the high prevalence of this disorder and the existence of various tests used for its diagnosis, few data are available regarding the usefulness and diagnostic validity of these tools. Given the difficulties that these subjects present in executive functions, (...) the aim of this study was to evaluate whether the Neuropsychological Assessment of Executive Functions battery for Children allows to establish specific profiles of executive performance for people with attention-deficit hyperactivity disorder. The sample was made up of 197 participants of both sexes, aged between 6 and 12 years age. A nonexperimental design was followed, using a comparative descriptive study method. The results indicated that the scales of phonological fluency, color path, rings, and interference are the most associated with the diagnosis of ADHD, providing data on inhibition, mental flexibility, sustained and selective attention, planning, verbal fluency, and working memory, among others. The practical implication of these results is in line with providing support in the clinical diagnosis that is carried out in children’s mental health units. In addition, the ENFEN tool can be valued as a suitable psychometric instrument in the psychoeducational field, helping professionals in a school environment to be more aware of the areas of cognitive development in which a student diagnosed with ADHD will have more difficulties and, in doing so, providing more adjusted and effective psychopedagogical measures when it comes to supporting students in their adaptation to the school environment. (shrink)

Drawing on sixteenth-century Protestant discourse on marriage and sexuality, this essay examines the anxieties permeating Spenser’s two poetical celebrations of his courtship and wedding with Elizabeth Boyle. Though the Reformers’ departure from Rome included an embrace of clerical marriage and an advocacy for the virtues of companionate marriage, revulsion at the sinfulness of sex remained. Through the sonnets of the Amoretti and the stanzas of the Epithalamion, an idea of mutual love is disrupted by a Protestant-tinged sense of innate and (...) pervasive depravity. Special attention is given to sonnets #58 and #84, and to the Epithalamion passages on Maia and Alcema. (shrink)

We propose a mathematical model for a class of predator–prey systems more complex than the usual one, involving a commensalism effect consisting in an influence of the predator on the sustainability of the prey. This effect induces interesting new features, including bi-stability. The question of the possibility of reaching a certain attractor starting from initial conditions with a small population of predators, which presents an interest from the vewpoint of the onset of the predator in evolution, is addressed. We propose (...) two possibilities: the classical one involving adapted conditions in the far past and a new one using biodiversity, specifically the presence of another predator which operates as a starter, being displaced in the sequel. (shrink)

In the framework of population dynamics, we start from the logistic equation describing the evolution of one species with limited food supply. A split device allows us to consider the population as two sub-populations x and y evolving analogously. The dynamical system has a one-parameter family of equilibria which is structurally unstable. Then small perturbations of the system (describing functional or ethological differentiations between the sub-species) lead in general to a new system involving a fast and a slow dynamics with (...) a finite number of equilibria. In simple situations where the differentiation is clearly either an advantage or an inconvenience for one of the subspecies, the stable equilibrium amounts to extinction of the disadvantaged subspecies (elementary Darwinism). Oppositely more complex differentiations (involving both advantages and inconveniences) often lead to stable equilibria with well-defined non zero proportions of the sub-populations (preservation of the biodiversity). Other examples are concerned with symbiosis-like differentiations, leading to preservation, whereas the opposite case (mutual nuisances) has an unstable equilibrium and lead to extinction of one or the other subspecies according to the initial conditions. The case of a scission into three subspecies is more rich in consequences. In certain cases, predator-prey relations lead to auto-organization phenomena with stable diversity-preserving diversity. Cases of instability are also possible, leading to orbits tending towards a poly-cycle.This implies some kind of pseudo-extinction: this amounts to “pseudo-periodic-like” orbits with “pseudo-periods” larger and larger, tending to infinity; each pseudo-period contains parts where one of the sub-populations practically vanish. Other non-linear perturbations lead to stable orbits. (shrink)

Do doctors fix patients? Or do they heal them? For all of modern medicine’s many successes, discontent with the quality of patient care has combined with a host of new developments, from aging populations to the resurgence of infectious diseases, which challenge medicine’s overreliance on narrowly mechanistic and technical methods of explanation and intervention, or “fixing’ patients. The need for a better balance, for more humane “healing” rationales and practices that attend to the social and environmental aspects of health and (...) illness and the experiencing person, is more urgent than ever. Yet, in public health and bioethics, the fields best positioned to offer countervailing values and orientations, the dominant approaches largely extend and reinforce the reductionism and individualism of biomedicine. The collected essays in To Fix or To Heal do more than document the persistence of reductionist approaches and the attendant extension of medicalization to more and more aspects of our lives. The contributors also shed valuable light on why reductionism has persisted and why more holistic models, incorporating social and environmental factors, have gained so little traction. The contributors examine the moral appeal of reductionism, the larger rationalist dream of technological mastery, the growing valuation of health, and the enshrining of individual responsibility as the seemingly non-coercive means of intervention and control. This paradigm-challenging volume advances new lines of criticism of our dominant medical regime, even while proposing ways of bringing medical practice, bioethics, and public health more closely into line with their original goals. Precisely because of the centrality of the biomedical approach to our society, the contributors argue, challenging the reductionist model and its ever-widening effects is perhaps the best way to press for a much-needed renewal of our ethical and political discourse. (shrink)

Many digital technologies, designed and controlled by intensive data-driven corporate platforms, have become ubiquitous for many of our daily activities. This has raised political and ethical concerns over how they might be threatening our personal autonomy. However, not much philosophical attention has been paid to the specific role that their hyper-designed (sensorimotor) interfaces play in this regard. In this paper, we aim to offer a novel framework that can ground personal autonomy on sensorimotor interaction and, from there, directly address how (...) technological design affects personal autonomy. To do this, we will draw from enactive sensorimotor approaches to cognition, focusing on the central notion of habits, understood as sensorimotor schemes that, in networked relations, give rise to sensorimotor agency. Starting from sensorimotor agency as a basis for more complex forms of personal autonomy, our approach gives us grounds to analyse our relationship with technology (in general) and to distinguish between autonomy-enhancing and autonomy-diminishing technologies. We argue that, by favouring/obstructing the enactment of certain (networks of) habits over others, technologies can directly act upon our personal autonomy, locally and globally. With this in mind, we then discuss how current digital technologies are often being designed to be autonomy-diminishing (as is the case of “dark patterns” in design), and sketch some ideas on how to build more autonomy-enhancing digital technologies. (shrink)

The concept of transformative experience (TE) has been widely explored by several disciplines from philosophy to neurobiology, and in different domains, from the spiritual to the educational one. This attitude has engendered heterogeneous models to explain this phenomenon. However, a consistent and clear understanding of this construct remains elusive. The aim of this work is to provide an initial comprehensive interdisciplinary, cross-domain, up-to-date, and integrated overview on the concept of TEs. Firstly, all the models and theories on TEs were reviewed (...) to extract and analyze TEs’ main components emerging from different disciplines. Then, this preliminary analysis was integrated with an in-depth examination of redundancies and particularities across domains and disciplines, to provide an integrated theoretical framework of TEs and a preliminary interdisciplinary operational definition of TEs. This examination, in turn, can help organize current research and theories, thus providing suggestions for operationalizing TEs as well as encouraging new interdisciplinary research endeavors. (shrink)

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Biomedical Informatics: We Are What We Publish", written by Peter L. Elkin, Steven H. Brown, and Graham Wright. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Elkin et al. paper. In subsequent issues the discussion can continue through letters to the editor.