In prevention and health promotion interventions, screening methods and risk profile assessments are often used as tools for establishing the interventions’ effectiveness, for the selection and determination of the health status of participants. The role these instruments fulfil in the creation of effectiveness and the effects these instruments have themselves remain unexplored. In this paper, we have analysed the role screening methods and risk profile assessments fulfil as part of prevention and health promotion programmes in the selection, enrolment and participation (...) of participants. Our analysis showed, that screening methods and health risk assessments create effects as they objectify health risks and/or the health status of individuals, i.e., they select the individuals ‘at risk’ and indicate the lifestyle modifications these people are required to make in order to improve their health. Yet, these instruments also reduce the group of participants thereby decreasing the possible effect of interventions, as they provide the legitimisation for people to make choices to whether they enrol or not and what lifestyle changes they incorporate into their lives. In other words, they present a space of interaction, in which agency is distributed across the practice nurses, the participants and the instruments. Decisions were not just made upon the projection of the outcomes of these instruments; decisions that were made by both the patients and practice nurses were the resultant of their opinions on these outcomes that were formed in interaction with the instruments. (shrink)

The transition towards sustainable and just food systems is ongoing, illustrated by an increasing number of initiatives that try to address unsustainable practices and social injustices. Insights are needed into what a just transition entails in order to critically engage with plural and potentially conflicting justice conceptualisations. Researchers play an active role in food system transitions, but it is unclear which conceptualisations and principles of justice they enact when writing about food system initiatives. To fill this gap this paper investigates: (...) Which conceptualisations of justice emerge from the literature related to food system initiatives and which principles of justice do authors use? We developed an initial framework for which we drew on political philosophy literature. We then undertook an extensive review of the food system transitions literature using this framework and were able to identify a range of recognition, distributive, and procedural justice conceptualisations and associated principles of justice. Recognised as subjects of justice were those with a particular role in the food system, people who are marginalised, Indigenous communities, those with experiences of negative consequences of the food system, future generations, and nonhumans. The identified conceptualisations and the developed framework can be used by those involved in food system initiatives to reflect on how they conceptualise justice. We challenge them to be more explicit about who they do and do not recognise as subjects of justice and which principles of justice they use. Such clarity is needed to reflexively enact a just transition towards sustainable and just food systems. (shrink)

The aim of the article is threefold: to argue and motivate that unnecessary surgery is a worldwide phenomenon, that it exposes patients to unwarranted risks and that patients should actively participate in decision-making and take a shared responsibility to protect their interests. There is a firm belief that the enterprise of medicine is something of value – both intrinsically because being healthy is good and instrumentally since being healthy allows us to do what we wish to, to attain happiness and (...) to live valuable lives. However, this can only hold if treatment is justified in terms of accepted evidence-based criteria. Imperative for all forms of treatment, including costly and invasive investigations, this is particularly true for surgical interventions because no surgery is without risk. Surgery performed outside of the norms of accepted indications constitutes a grave form of assault. Medicine is a noble cause if we stick to the rules and help each other to do so. As professionals, our most fundamental regulation is by ourselves. (shrink)

Guido de Ruggiero (1888-1948) was perhaps the greatest Italian intellectual historian in the twentieth century. He was a fierce champion of liberalism, an ardent opponent of Fascism, an insightful critic and interpreter of his contemporaries, and a formidable philosopher in his own right. Idealism & Experience: The Philosophy of Guido de Ruggiero comprises eight new critical essays, as well as English translations of five of de Ruggiero's most important shorter writings, which chart the development of his thought between 1914 and (...) 1946. Taken together, these essays reveal the range, richness and philosophical sophistication of de Ruggiero's ideas, enabling Anglophone readers to appreciate their enduring relevance in our own troubled times. (shrink)

Ethics support services like Moral Case Deliberation intend to support healthcare professionals in ethically difficult situations. To assess outcomes of MCD, the Euro-MCD Instrument has been developed. Field studies to test this instrument are needed and have been conducted, examining important outcomes before MCD participation and experienced outcomes. The current study aimed to describe how participants’ perceive the importance of MCD outcomes after MCD; compare these perceptions with those before MCD participation; and test the factor structure of these outcomes. Swedish, (...) Norwegian and Dutch healthcare professionals rated the importance of outcomes in the Euro-MCD Instrument after four and eight MCDs. Ratings were compared with those before MCD participation using paired and independent samples t-tests. The factor structure was tested using exploratory factor analyses. After 4 and 8 MCDs, 443 respectively 247 respondents completed the instrument. More than 69% rated all MCD outcomes as ‘quite’ or ‘very’ important, especially outcomes from Enhanced Collaboration, Improved Moral Reflexivity and Improved Moral Attitude. Significant differences for 16 outcomes regarding ratings before and after MCD participation were not considered meaningful. Factor analyses suggested three categories, which seemingly resemble the domains Improved Moral Reflexivity, Enhanced Collaboration and a combination of Improved Moral Attitude and Enhanced Emotional Support. After participation in MCDs, respondents confirmed the importance of outcomes in the Euro-MCD Instrument. The question on perceived importance and the categorization of outcomes need reconsideration. The revised instrument will be presented elsewhere, based on all field studies and theoretical reflections. (shrink)

In order to study early human development while avoiding the burdens associated with human embryo research, scientists are redirecting their efforts towards so-called human embryo-like structures (hELS). hELS are created from clusters of human pluripotent stem cells and seem capable of mimicking early human development with increasing accuracy. Notwithstanding, hELS research finds itself at the intersection of historically controversial fields, and the expectation that it might be received as similarly sensitive is prompting proactive law reform in many jurisdictions, including the (...) Netherlands. However, studies on the public perception of hELS research remain scarce. To help guide policymakers and fill this gap in the literature, we conducted an explorative qualitative study aimed at mapping the range of perspectives in the Netherlands on the creation and research use of hELS. This article reports on a subset of our findings, namely those pertaining to (the degrees of and requirements for) confidence in research with hELS and its regulation. Despite commonly found disparities in confidence on emerging biotechnologies, we also found wide consensus regarding the requirements for having (more) confidence in hELS research. We conclude by reflecting on how these findings could be relevant to researchers and (Dutch) policymakers when interpreted within the context of their limitations. (shrink)

BackgroundPreprint usage is growing rapidly in the life sciences; however, questions remain on the relative quality of preprints when compared to published articles. An objective dimension of quality that is readily measurable is completeness of reporting, as transparency can improve the reader’s ability to independently interpret data and reproduce findings.MethodsIn this observational study, we initially compared independent samples of articles published in bioRxiv and in PubMed-indexed journals in 2016 using a quality of reporting questionnaire. After that, we performed paired comparisons (...) between preprints from bioRxiv to their own peer-reviewed versions in journals.ResultsPeer-reviewed articles had, on average, higher quality of reporting than preprints, although the difference was small, with absolute differences of 5.0% [95% CI 1.4, 8.6] and 4.7% [95% CI 2.4, 7.0] of reported items in the independent samples and paired sample comparison, respectively. There were larger differences favoring peer-reviewed articles in subjective ratings of how clearly titles and abstracts presented the main findings and how easy it was to locate relevant reporting information. Changes in reporting from preprints to peer-reviewed versions did not correlate with the impact factor of the publication venue or with the time lag from bioRxiv to journal publication.ConclusionsOur results suggest that, on average, publication in a peer-reviewed journal is associated with improvement in quality of reporting. They also show that quality of reporting in preprints in the life sciences is within a similar range as that of peer-reviewed articles, albeit slightly lower on average, supporting the idea that preprints should be considered valid scientific contributions. (shrink)

Our goal was to explore self‐care practices among men who have sex with men in the context of Mpox in Brazil. This study used qualitative research methods, including interviews and thematic analysis, to collect and analyze data from male participants across the Brazilian territory. The narratives unveil men's perspectives on self‐care, risk reduction, and health beliefs during the Mpox pandemic. Our findings highlight a multifaceted approach to self‐care among men, encompassing hygiene, physical contact management, mask usage, skin lesion vigilance, and (...) adherence to official guidelines. Men's attitudes toward sexual behaviors emphasize the importance of reducing sexual partners, practicing safe sex, and combating misinformation through accurate information dissemination. The development of these behaviors and self‐care practices can be facilitated by nurses guided by Dorothea Orem's Self‐Care Theory, supported by patient‐centered care, with strategies to address and confront the stigma associated with the disease and provide emotional support. Thus, the study underscores the pivotal role of self‐care in mitigating infection risks, especially in the context of emerging infectious diseases. It acknowledges the impact of socio‐cultural factors and healthcare policies on men's preventive measures. However, it also recognizes limitations, such as potential bias due to stigma concerns and a nonrepresentative sample. Ultimately, the research advocates for tailored education, promotion of gender equity, and healthcare empowerment to effectively manage health risks in such contexts. (shrink)

Cell line immortalisation is a growing component of African genomics research and biobanking. However, little is known about the factors influencing consent to cell line creation and immortalisation in African research settings. We contribute to addressing this gap by exploring three questions in a sample of Xhosa participants recruited for a South African psychiatric genomics study: First, what proportion of participants consented to cell line storage? Second, what were predictors of this consent? Third, what questions were raised by participants during (...) this consent process? 760 Xhose people with schizophrenia and 760 controls were matched to sex, age, level of education and recruitment region. We used descriptive statistics to determine the proportion of participants who consented to cell line creation and immortalization. Logistic regression methods were used to examine the predictors of consent. Reflections from study recruiters were elicited and discussed to identify key questions raised by participants about consent. Approximately 40% of participants consented to cell line storage. The recruiter who sought consent was a strong predictor of participant’s consent. Participants recruited from the South African Eastern Cape, and older participants, were more likely to consent; both these groups were more likely to hold traditional Xhosa values. Neither illness nor education were significant predictors of consent. Key questions raised by participants included two broad themes: clarification of what cell immortalisation means, and issues around individual and community benefit. These findings provide guidance on the proportion of participants likely to consent to cell line immortalisation in genomics research in Africa, and reinforce the important and influential role that study recruiters play during seeking of this consent. Our results reinforce the cultural and contextual factors underpinning consent choices, particularly around sharing and reciprocity. Finally, these results provide support for the growing literature challenging the stigmatizing perception that people with severe mental illness are overly vulnerable as a target group for heath research and specifically genomics studies. (shrink)

The geometric system of deduction called N-Graphs was introduced by de Oliveira in 2001. The proofs in this system are represented by means of digraphs and, while its derivations are mostly based on Gentzen's sequent calculus, the system gets its inspiration from geometrically based systems, such as the Kneales' tables of development, Statman's proofs-as-graphs, Buss' logical flow graphs, and Girard's proof-nets. Given that all these geometric systems appeal to the classical symmetry between premises and conclusions, providing an intuitionistic version of (...) any of these is an interesting exercise in extending the range of applicability of the geometric system in question. In this article we produce an intuitionistic version of N-Graphs, based on Maehara's LJ' system, as described by Takeuti. Recall that LJ' has multiple conclusions in all but the essential intuitionistic rules, e.g., implication right and negation right. We show soundness and completeness of our intuitionistic N-Graphs with respect to LJ'. We also discuss how we expect to extend this work to a version of N-Graphs corresponding to the intuitionistic logic system FIL (Full Intuitionistic Logic) of de Paiva and Pereira and sketch future developments. (shrink)

Concepts that include the participation and empowerment of workers are becoming increasingly important nowadays. In many of these concepts, the formal responsibility is delegated to teams. Does this imply that the normative responsibility for the actions of teams is also delegated? In this article we will reflect on the difference between holding a person accountable and bearing responsibility. A framework is elaborated in order to analyse the accountability and responsibility of teams. In this framework, the emergence of a collective mind, (...) and the organisational factors that influence the extent to which teams have the possibility of acting in a responsible way play an important role. It shows that teams can bear responsibilities that could never be carried by a group of individuals. The framework is used to analyse two sample cases with self-managing teams in production facilities. The authors discuss the implications for the theory and practice of self-managing teams and the allocation of responsibility between individuals, teams and the organisation. (shrink)

Context. The identification of the sources that reionized the Universe and their specific contribution to this process are key missing pieces of our knowledge of the early Universe. Faint star-forming galaxies may be the main contributors to the ionizing photon budget during the epoch of reionization, but their escaping photons cannot be detected directly due to inter-galactic medium opacity. Hence, it is essential to characterize the properties of faint galaxies with significant Lyman continuum photon leakage up to z 4 to (...) define indirect indicators allowing analogues to be found at the highest redshift. Aims. Long gamma-ray bursts explode typically in star-forming regions of faint, star-forming galaxies. Through LGRB afterglow spectroscopy it is possible to detect directly LyC photons. Our aim is to use LGRBs as tools to study LyC leakage from faint, star-forming galaxies at high redshift. Methods. Here we present the observations of LyC emission in the afterglow spectra of GRB 191004B at z = 3:5055, together with those of the other two previously known LyC-emitting LGRB, to determine their LyC escape fraction and compare their properties. Results. From the afterglow spectrum of GRB 191004B we determine a neutral hydrogen column density at the LGRB redshift of og =17:2 0:15, and negligible extinction. The only metal absorption lines detected are C iv and Si iv. In contrast to GRB 050908 and GRB 060607A, the host galaxy of GRB 191004B displays significant Ly emission. From its Ly emission and the non-detection of Balmer emission lines we constrain its star-formation rate to 1 SFR 4:7 M yr. 1. We fit the Ly emission with a shell model and find parameters values consistent with the observed ones. The absolute LyC escape fractions we find for GRB 191004B, GRB 050908 and GRB 060607A are of 0:35+0:10.0:11, 0:08+0:05.0:04 and :20+0:05.0:05, respectively. We compare the LyC escape fraction of LGRBs to the values of other LyC emitters found from the literature, showing that LGRB afterglows can be powerful tools to study LyC escape for faint high-redshift star-forming galaxies. Indeed we could push LyC leakage studies to much higher absolute magnitudes. The host galaxies of the three LGRB presented here have all M1600 >.19:5 mag, with the GRB 060607A host at M1600 >.16 mag. LGRB hosts may therefore be particularly suitable for exploring the ionizing escape fraction in galaxies that are too faint or distant for conventional techniques. Furthermore the time investment is very small compared to galaxy studies. (shrink)

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)

BackgroundClinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies (...) and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process.MethodsThe revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.ResultsThe Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.ConclusionsThe Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD. (shrink)

This chapter contains sections titled: Types of Knowledge in Technology A Neglected Topic Empirical Studies Philosophical Explorations References and Further Reading.

Whereas most current theories on emotions posit a central position to goals, direct tests of associations between emotions and goals have been sparse. We investigated such relations by comparing ratings of value importance and frequency of emotional experiences in daily life. The results confirmed our general expectation that associations would be found between values and emotions related to corresponding goals. We argue that data like these are fundamental to further development of emotion theory.

We present the idea of searching for X-rays as a signature of the mechanism inducing the spontaneous collapse of the wave function. Such a signal is predicted by the continuous spontaneous localization theories, which are solving the “measurement problem” by modifying the Schrödinger equation. We will show some encouraging preliminary results and discuss future plans and strategy.