Background: In Hospital Emergency Department and Emergency Medical Services professionals experience situations in which they face difficulties or barriers to know patient’s advance directives and implement them. Objectives: To analyse the barriers, facilitators, and ethical conflicts perceived by health professionals derived from the management of advance directives in emergency services. Research design, participants, and context: This is a qualitative phenomenological study conducted with purposive sampling including a population of nursing and medical professionals linked to Hospital Emergency Department and Emergency Medical (...) Services. Three focus groups were formed, totalling 24 participants. We performed an inductive-type thematic discourse analysis. Ethical considerations: This study was approved by ethical committees of Ethical Commitee of Clínic Hospital (Barcelona) and Comittee of Emergency Medical Services (Barcelona). The participants received information about the purpose of the study. Patients’ anonymity and willingness to participate in the study were guaranteed. Findings: There were four types of barriers that hindered the proper management of patients’ advance directives in Hospital Emergency Department and Emergency Medical Services: personal and professional, family members, organisational and structural, and those derived from the health system. These barriers caused ethical conflicts and hindered professionals’ decision-making. Discussion: These results are in line with those of previous studies and indicate that factors such as gender, professional category, and years of experience, in addition to professionals’ beliefs and the opinions of colleagues and family members, can also influence the professionals’ final decisions. Conclusion: The different strategies described in this study can contribute to the development of health policies and action protocols to help reduce both the barriers that hinder the correct management and implementation of advance directives and the ethical conflicts generated. (shrink)

BackgroundImplementing the routine consultation of patient advance directives in hospital emergency departments and emergency medical services has become essential, given that advance directives constitute the frame of reference for care personalisation and respect for patients’ values and preferences related to healthcare. The aim of this study was to assess the levels and relationship of knowledge and attitudes of nursing and medical professionals towards advance directives in hospital emergency departments and emergency medical services, and to determine the correlated and predictor variables (...) of favourable attitudes towards advance directives.MethodsObservational, descriptive, and cross-sectional study. The study was conducted in the emergency department of a second-level hospital and in the emergency medical service. Data collection was performed from January 2019 to February 2020. The STROBE guidelines were followed for the preparation of the study.ResultsA total of 173 healthcare professionals responded to the questionnaire. Among them, 91.3% considered that they were not sufficiently informed about advance directives, and 74% acknowledged not having incorporated them into their usual practice. Multinomial analysis indicated a statistically significant relationship between the variable emergency medical service and having more favourable attitudes towards consulting the advance directives in their practical application (OR 2.49 [95% CI 1.06–5.88]; p = 0.037) and compliance in complex scenarios (OR 3.65 [95% CI 1.58 − 8.41]; p = 0.002). Working the afternoon and night shift was a predictor variable for obtaining a higher score with respect to attitudes in complex scenarios.ConclusionThere is an association between the level of knowledge that nursing and medical professionals have about advance directives and the scores obtained on the attitude scales at the time of practical implementation and in complex scenarios. This shows that the more knowledge professionals have, the more likely they are to consult patients' advance directives and to respect their wishes and preferences for care and/or treatment. (shrink)

The present study aims to apply a program based on Hellison’s Teaching Personal and Social Responsibility Model (TPSR), traditionally used in Physical Education, to other educational subjects and examine the assessment of the teachers who carried it out during the 2018-2019 school year. The program was applied over eight months of one academic year and during at least 60% of the weekly class hours. Initially, 586 students participated, 429 being experimental subjects with 30 teachers, of whom 16 participated in the (...) interviews carried out, all of them being Secondary Education teachers. We used qualitative methodology through content analysis carried out with ATLAS.ti 7.1.3. The instruments used to collect information were semi-structured recorded group interviews. The conclusion is that the Personal and Social Responsibility Model can be applied to all subjects in the curriculum and is adaptable to any content and type of student body. As a basis for future research, we suggest the application of the model by all teachers involved in the same school year and the participation of students’ families. (shrink)

El siguiente texto se circunscribe en el ámbito de la filosofía de la religión; tiene como objeto central analizar la alienación del hombre dentro del fenómeno religioso (particularmente en las religiones monoteístas) y cómo esta origina intolerancia social en las sociedad contemporáneas entre hombres que no comparten las mismas creencias; esta postura ha causado momentos de violencia extrema a lo largo de la historia humana y otra tanta en la actualidad como el conflicto en el Medio Oriente – Judíos y (...) Musulmanes. Para tal empresa tomaremos como referencia la crítica a la religión expuesta por el pensador alemán del siglo XIX Ludwig Feuerbach en su obra principal: La esencia del cristianismo (Das Wesen des Christentums), complementándolo con otros críticos religiosos (Voltaire, Kirsch, Freud, etc.). Por último, expondremos el ateísmo humanista de Feuerbach como alternativa para la superación de la intolerancia social. (shrink)

Behavioral interventions have shown promising neuroprotective effects, but the cascade of molecular, brain and behavioral changes involved in these benefits remains poorly understood. Projecte Moviment is a 12-week multi-domain, single-blind, proof-of-concept randomized controlled trial examining the cognitive effect and underlying mechanisms of an aerobic exercise, computerized cognitive training and a combined groups compared to a waitlist control group. Adherence was > 80% for 82/109 participants recruited. In this study we report intervention-related changes in plasma biomarkers and structural-MRI and how they (...) related to changes in physical activity and individual variables and their potential role as mediators in the cognitive changes. Our results show that although there were no significant changes in molecular biomarker concentrations in any intervention group, changes in ICAM-1 and SDF1-α were negatively associated with changes in physical activity outcomes in AE and COMB groups. Brain volume changes were found in the CCT showing a significant increase in precuneus volume. Sex moderated the brain volume change in the AE and COMB groups, suggesting that men may benefit more than women. Changes in molecular biomarkers and brain volumes did not significantly mediate the cognitive-related benefits found previously for any group. This study shows crucial initial molecular and brain volume changes related to lifestyle interventions at early stages and highlights the value of examining activity parameters, individual difference characteristics and using a multi-level analysis approach to address these questions. (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)

Physical activity, body composition and sedentary behavior may affect the health of children. Therefore, this study examined the effect of an educational hybrid physical education program on physical fitness, body composition and sedentary and PA times in adolescents. A 9-month group-randomized controlled trial was conducted in 150 participants allocated into the control group and experimental group. Cardiorespiratory fitness, speed, strength, agility, flexibility and body mass index were assessed through previously validated field tests. Sedentary time, PA at school and afterschool were (...) evaluated with the Youth Activity Profile-Spain questionnaire. Significant differences were observed concerning to the CG in APA-weekend, speed-agility and agility. Regarding the intervention, cardiorespiratory fitness, speed-agility, strength, flexibility, agility, PA in school, APA-weekday, APA-weekend, APA-week, and sedentary time increased significantly in the EG. The use of a hybrid program based on teaching personal and social responsibility and gamification strategies produced enhancements in cardiorespiratory fitness, agility, speed, APA-weekdays and APA-weekends, reducing the sedentary time. (shrink)

This paper offers an historical introduction to Pere Alberch's evolutionary thought and his contributions to Evo-Devo, based on his unique approach to experimental teratology. We will take as our point of reference the teratogenic experiments developed by Alberch and Emily A. Gale during the 1980s, aimed at producing monstrous variants of frogs and salamanders. We will analyze his interpretation of the results of these experiments within the framework of the emergence of evolutionary developmental biology (or “Evo-Devo”). The aim is (...) understand how Alberch interpreted teratological anomalies as highly revealing objects of study for understanding the development of organic form, not only in an ontogenetic sense—throughout embryonic development—but also phylogenetically—throughout the evolution of species. Alberch's interpretation of monsters reflects the influence of a long tradition of non-Darwinian evolutionary thought, which began in the nineteenth century and was continued in the twentieth century by people such as Richard Goldschmidt, Conrad H. Waddington, and Stephen Jay Gould. They all proposed various non-gradualist models of evolution, in which embryonic development played a central role. Following this tradition, Alberch argued that, in order to attain a correct understanding of the role of embryological development in evolution, it was necessary to renounce the gradualist paradigm associated with the Darwinian interpretation of evolution, which understood nature as a continuum. According to Alberch, the study of monstrous abnormalities was of great value in understanding how certain epigenetic restrictions in development could give rise to discontinuities and directionality in morphological transformations throughout evolution. (shrink)

Los críticos con el liberalismo igualitarista suelen sostener que la virtud cívica es un elemento indispensable para la realización y mantenimiento de bienes sociales como la justicia social o distributiva. Acostumbran a argumentar también que el liberalismo igualitarista desatiende la importancia de la virtud cívica y que, por tanto, los fines liberal igualitaristas o bien resultan inalcanzables, o bien no pueden ser mantenidos. En este trabajo se parte de la premisa de que, efectivamente, la virtud cívica es un instrumento indispensable (...) para la realización y mantenimiento de bienes sociales como la justicia distributiva. Pero se argumenta que el liberalismo igualitarista no tiene ningún problema en reconocer este hecho de modo que las críticas hacia el mismo en este sentido andan desencaminadas. El Estado liberal igualitarista debe promover todas aquellas virtudes cívicas que sean necesarias para alcanzar y/o estabilizar la justicia de la sociedad con el único límite que fija el respeto a la prioridad de lo correcto sobre lo bueno. A lo largo del trabajo se exponen los conceptos rawlsianos de pluralismo razonable, consenso entrecruzado entre doctrinas comprehensivas razonables y de neutralidad del Estado, y se trata de aclarar cuál es el papel de la virtud cívica dentro de ese entramado teórico. (shrink)

El presente artículo se basa en la teoría de la creatividad artística de Jon Elster para tratar de ofrecer un esbozo de definición del concepto de arte, así como las bases para una teoría del valor artístico. Se sostiene que una obra de arte es una creación humana realizada con la intención de provocar una experiencia estética, así como que el principal valor de una obra de arte radica en su capacidad para producir emociones estéticas y no estéticas. Dicha concepción (...) pone en dificultades a algunas importantes formas de arte contemporáneo, como el arte conceptual. (shrink)

Urban Digital Twins (UDTs) have become the new buzzword for researchers, planners, policymakers, and industry experts when it comes to designing, planning, and managing sustainable and efficient cities. It encapsulates the last iteration of the technocratic and ultra-efficient, post-modernist vision of smart cities. However, while more applications branded as UDTs appear around the world, its conceptualization remains ambiguous. Beyond being technically prescriptive about what UDTs are, this article focuses on their aspects of interaction and operationalization in connection to people in (...) cities, and how enhanced by metaverse ideas they can deepen societal divides by offering divergent urban experiences based on different stakeholder preferences. Therefore, firstly this article repositions the term UDTs by comparing existing concrete and located applications that have a focus on interaction and participation, including some that may be closer to the concept of UDT than is commonly assumed. Based on the components found separately in the different studied cases, it is possible to hypothesize about possible future, more advanced realizations of UDTs. This enables us to contrast their positive and negative societal impacts. While the development of new immersive interactive digital worlds can improve planning using collective knowledge for more inclusive and diverse cities, they pose significant risks not only the common ones regarding privacy, transparency, or fairness, but also social fragmentation based on urban digital multiplicities. The potential benefits and challenges of integrating this multiplicity of UDTs into participatory urban governance emphasize the need for human-centric approaches to promote socio-technical frameworks able to mitigate risks as social division. (shrink)

John Locke's philosophy was deeply affected by medicine of his times. It was specially influenced by the medical thought and practice of Thomas Sydenham. Locke was a personal friend of Sydenham, expressed an avid interest in his work and shared his views and methods. The influence of Sydenham's medicine can be seen in the following areas of Locke's philosophy: his “plain historical method”; the emphasis on observation and sensory experience instead of seeking the essence of things; the rejection of hypotheses (...) and principles; the refusal of research into final causes and inner mechanisms; the ideal of irrefutable evidence and skepticism on the possibilities of certainty in science. The science which for Locke held the highest paradigmatic value in his theory of knowledge was precisely medicine. To a great extent, Locke's Essay on Human Understanding can be understood as an attempt to justify, substantiate, and promote Sydenham's medical method. This method, generalized, was then proposed as an instrument for the elaboration of all natural sciences. (shrink)

Academic entrepreneurship and the formation of spin-offs from educational institutions have been consolidated as essential elements to promote innovation and stimulate economic growth worldwide. However, the evolution of these initiatives shows marked differences between developed countries and emerging economies, such as Colombia. This study focuses on analyzing how research in this area has progressed, identifying the key factors that determine the success of spin-offs and suggesting a framework for action for Colombia in comparison with international dynamics. The findings reveal a (...) shift in research attention from prioritizing the creation of spin-offs to a greater focus on their long-term performance and sustainability. At the international level, the relevance of technology transfer, strategic alliances between universities and industry and the efficient management of technological resources are highlighted. On the other hand, in the Colombian context, research tends to focus on institutional aspects, cultural factors and support regulations, underestimating the analysis of the performance of spin-offs after their creation. This paper aims to contribute to the formulation of policies and strategies that promote not only the emergence but also the sustainability of academic spin-offs in Colombia, seeking to align their practices with international standards in order to maximize their impact on the economic and social development of the country. (shrink)

Tocqueville, como todos los grandes clásicos, es inagotable. A man for all seasons, como lo prueba su reciente éxito en China y Japón, dos países y dos sistemas políticos tan alejados de la historia europea y del modelo democrático que él describió que le hubiera parecido sorprendente que le utilizaran como referencia. Ser un clásico inagotable con solo dos obras de obligada lectura es un logro del que pocos pueden vanagloriarse. Quizá Hobbes, quizá John Locke, dos de los autores que (...) menciona Lucien Jaume en el primer artículo de este monográfico que presentamos en la revista Araucaria. (shrink)

El artículo se propone examinar la tensión entre la lengua castellana y la gramática en la novela El cuervo blanco, escrita por el controvertido escritor colombiano Fernando Vallejo, hoy radicado en México. Se trata de un texto híbrido que explora el pensamiento y la biografía del célebre filólogo Rufino José Cuervo. El libro indaga en sus papeles, cartas y libros; documentos en donde recoge sus conversaciones filosófico-filológicas con lingüistas europeos a propósito de las modalidades y formas idiomáticas que adquiere el (...) castellano en Colombia y Latinoamérica. La característica de este libro es su forma de narración, ya que más que darle primacía a los acontecimientos se preocupa de los tropos, giros, citas y efectos gramaticales que construyen la lógica de los documentos relacionados con la lengua de Estado. A nivel metafórico, Rufino José Cuervo es presentado como un “pájaro negro de alma blanca que tiene el don de la palabra”, es decir un “Cuervo blanco”, cuyo color es un índice de su excepcionalidad, nombre con el que lo identifica en una de sus cartas el lingüista alemán August Friedrich Pott, pero que el narrador convierte en el título de este curioso libro. (shrink)

In “Pre-Conventions. A Fragment of the Background”, Celano argues that there are ways of acting that can be called “conventions” which are, literally, normative facts. There are a number of interesting claims in Celano’s paper about the nature of these conventions, and showing that they amount to normative facts is only part of his strategy for establishing their significance. But given that the question of whether there are normative facts deserves a treatment of its own, the paper inquires whether Celano’s (...) account of normative facts is plausible. It then makes three claims. First, it claims that Celano’s account of normative facts is in need of clarification. Amongst other reasons, there is no proper characterisation of either the concept of fact or of the concept of norm. Second, the paper claims that, under a relatively acceptable way of understanding facts and norms, Celano’s argument in favour of normative facts needs to be completed. But if the argument is completed by appealing to the general philosophical outlook which Celano seems inclined to employ, the argument reaches a point where it becomes unstable. This does not, of course, mean that the project should be abandoned. An argument within the same line of thought may be available. But the prospect seems uninviting. So, thirdly, the paper proposes a sketch of an alternative, Kantian-like conception of normative facts based on an argument put forward by Christine Korsgaard. (shrink)

Aprovechando la circunstancia de que en 2001 se ha cumplido el tricentenario de la Universidad de Yale y el centenario de Instituto Rockefeller para Investigación Médica (Universidad Rockefeller), se resume la historia de estas dos instituciones, insertándola en el contexto de la historia de la ciencia, medicina e instituciones de enseñanza superior en Estados Unidos, al igual que en el de los distintos modos de promover la investigación científica.

La deconstrucción es la apertura al porvenir, hacia el otro como porvenir absoluto. Sin embargo, ese otro se encuentra ante nosotros y tras nosotros, es un pasado por venir, un pasado que nunca ha sido presente. De este modo, la obra de Derrida puede ser leída como la preocupación constante por esa memoria del porvenir, por la herencia y el duelo, por la apertura al acontecimiento. En este sentido, la memoria en Derrida no puede comprenderse como «reunión en el pensamiento», (...) como «Versammlung» y, por tanto, supone quizás una distancia radical en la obra de Derrida con respecto al pensamiento heideggeriano. (shrink)

Condicionada por el modo económico de cada formación social, la pintura ha participado -y no en menor medida- de la adaptación; sus imágenes rectoras han dado cuerpo y forma a los engranajes ideológicos, y su valor funcional se ha reconducido a la mera relación fetichista; de esta manera, en el instante en que hay pintura, deja de haberla propiamente. Por otro lado, el arte tiene por condición autonomía y libertad, y en el artista no es decisiva la conciencia armónica, puesto (...) que carece de libertad, puesto que está en dialéctica con la realidad social, éste interviene en su transformación. El presente artículo intenta dar cuenta cómo la vida y la obra de John Singer Sargent remiten a dicha naturaleza antinómica, que nos hace recordar la idea y la realidad, de la propia libertad. Palabras clave: fetichismo, transformación, arte, artista, naturaleza. (shrink)

La tesis de Søren Kierkegaard, Sobre el concepto de ironía en constantereferencia a Sócrates, contiene una interesante crítica de la pura ironía endos sentidos: a) la pura ironía es una postura incoherente y por tantoirrealizable; b) la búsqueda de la pura ironía es moralmente débil,psicológicamente destructiva y culmina en el límite de las costumbres. Eneste ensayo intento primero clarificar el pensamiento de Kierkegaard de lapura ironía como “negatividad infinita y absoluta”. Luego planteo unacrítica enfática de la pura ironía. Finalmente considero (...) una distinciónteológica en la crítica de Kierkegaard. Argumento que esta característicade la exposición kierkegaardiana puede y debe distinguirse de la críticaética de la pura ironía. Mi objetivo final en este ensayo es revelar laplausibilidad de la crítica de Kierkeggard a la pura ironía. (shrink)

El propósito de este artículo es mostrar la ambigüedad que caracteriza a la definición de los afectos que Spinoza presenta al principio del libro III de su Ética en lo que respecta a la locución adverbial et simul que aparece en ella. El problema que aquí se plantea es aclarar hasta qué punto y en qué sentido Spinoza podría considerar que hay afectos del cuerpo o afectos del alma puramente. Este estudio pretende añadir argumentos, basados en las consideraciones que hace (...) Spinoza sobre el placer y el dolor, que respalden la hipótesis de la existencia de afectos del cuerpo, pero haciendo compatible dicha tesis con el enfoque monista de Spinoza. (shrink)