The social brain paradigm does more than help us reveal the social and world realities beyond the conspiracy of mythologies that gives us Einstein as a grammatical illusion and his brain as a sacred relic. The social brain has implications for how we understand the brain in health and illness. The objective of this chapter is to explore the implications of social brain research and theory for the mental health professions. There is already a growing literature on the social brain (...) and psychiatry. While this literature is an important rationale for our work, our approach is distinguished by a more strongly social science foundation for understanding the social brain. In Chap. 10.1007/978-3-030-32918-1_5, we saw how by building on the current body of knowledge about the social brain, we arrive at a new concept of the self and a new unit of socialization. Here we explore the implications of this re-envisioning of the social brain paradigm developed in Chap. 10.1007/978-3-030-32918-1_5 for clinical practice in psychiatry and prevention of mental illness. (shrink)

BackgroundClinical trials should be as inclusive as possible to facilitate equitable access to research and better reflect the population towards which any intervention is aimed. Informed by the UK’s National Institute for Health and Care Research (NIHR) Innovations in Clinical Trial Design and Delivery for the Under-served (INCLUDE) guidance, we audited oncology trials conducted by the Clinical Trials and Statistics Unit at The Institute of Cancer Research, London (ICR-CTSU) to identify whether essential documents were overtly excluding any groups and whether (...) sufficient data were collected to assess diversity of trial participants from groups suggested by INCLUDE as under-served by research in the UK.MethodsThirty cancer clinical trials managed by ICR-CTSU and approved between 2011–2021 were audited. The first ethics approved version of each trial’s protocol, patient information sheet, and patient completed questionnaire, together with the first case report forms (CRFs) version were reviewed. A range of items aligned with the INCLUDE under-served groups were assessed, including age, sex and gender, socio-economic and health factors. The scope did not cover trial processes in participating hospitals.ResultsData relating to participants’ age, ethnic group and health status were well collected and no upper age limit was specified in any trials’ eligibility criteria. 23/30 (77%) information sheets used at least one gendered term to address patients. Most CRFs did not specify whether they were collecting sex or gender and only included male or female categories. The median reading age for information sheets was 15–16 years (IQR: 14–15 – 16–17). Socio-economic factors were not routinely collected and not commonly mentioned in trial protocols.ConclusionsNo systemic issues were identified in protocols which would explicitly prevent any under-served group from participating. Areas for improvement include reducing use of gendered words and improving readability of patient information. The challenge of fully assessing adequate inclusion of under-served populations remains, as socio-economic factors are not routinely collected because they fall beyond the data generally required for protocol-specified trial endpoint assessments. This audit has highlighted the need to agree and standardise demographic data collection to permit adequate monitoring of the under-served groups identified by the NIHR. (shrink)

À partir d’une approche anthropologique des prises en charge médicales de la tuberculose et du paludisme, ainsi que des conceptions et usages de la prévention dans des milieux urbains d’Afrique de l’Ouest , ce texte interroge la nature du métier de soignant. Après nous être penchés sur les spécificités de ce type d’étude anthropologique en milieu médical, nous nous attachons à décrypter les processus d’occultations des singularités du malade qui caractérisent les messages et discours de prévention. Dans les structures de (...) santé, sont étudiées les négociations des normes de diagnostic et de traitement à l’œuvre ; les attitudes des soignants qui oscillent entre sur- et sous-estimations des risques sanitaires ; et le hiatus entre la demande et les besoins réels de formations continues. Enfin, nous nous penchons sur la rencontre entre les soignants et les malades qui peut se trouver transformée par les spécificités de la maladie et de son traitement. On constate alors que les fondements de la professionnalisation tendent à disparaître au profit d’un mode de régulation du rapport au malade, au collègue et plus largement au savoir médical qui témoigne de l’émergence d’une culture soignante qui est, de fait, une culture organisationnelle. Elle se caractérise à la fois par la délégation des tâches à des non-professionnels, la production et la résolution des conflits mettant en évidence des réseaux clientélistes ainsi que par une routinisation des gestes.Drawing on an anthropological approach of tuberculosis and malaria care in West African cities , and on an analysis of prevention modes, this paper examines the characteristics of medical work. We first examined the conditions of an anthropological field study in health care centres. The concealment of both patients’ singularities and populations’ specificities targeted in the prevention messages were then studied. The negotiation of diagnosis and treatment standards, and the under- and over-estimations of nosocomial risks were also analysed. We also focused on the gap between demands and actual needs for training, and on the relationships between health care providers and patients, which can be modified by the specificities of the disease. We noticed a decay of professionalization, a kind of regulation of relationships between health care workers and patients, and among medical staff, which expresses an emerging medical culture, which is also an organizational culture. Its main features are the delegation of tasks to non-professionals workers, a strategy of conflict management based on clientelism, and the development of routine action. (shrink)

Importance: Wrong-level spine surgery (WLSS), a medical error in which a surgeon operates at an unintended vertebral level, is considered a “never event.” However, it continues to be a problem in spine surgery today despite the implementation of preventive measures such as the Universal Protocol. The consequences of this event are severe for both the afflicted patient and the treating physician and may result not only in physical harm but also in costly medicolegal proceedings.Observations: While WLSS incidence varies with (...) the patient population and practice setting, large studies generally report rates below 1%. Given the ubiquity of spine surgery, this remains a concerning number. Risk factors for WLSS can be categorized into three domains: patient factors, imaging issues, and technical issues. Awareness of risk factors allows surgeons to plan for difficulties in level localization. Many techniques for preventing WLSS have been developed, including invasive preoperative marking strategies. Intraoperative radiography or fluoroscopy is necessary but not sufficient for WLSS prevention, in that many errors occur after imaging. The evidence for prevention methods remains of low quality, necessitating future prospective comparison studies.Conclusions and relevance: Consensus has been reached in professional societies: All spine surgeons should implement WLSS prevention protocols. We assess the reported techniques for safer surgery and emphasize one crucial time-out element: the time-out for level localization (TOLL). Addressing WLSS as a problem specific to spine surgery, we show that by using specially tailored prevention strategies, such measures will allow WLSS to become a true never event. (shrink)

Mike accidentally knocked against a bottle. Seeing that the bottle was about to fall, Jack was just about to catch it when Peter accidentally knocked against him, making Jack unable to catch it. Jack did not grab the bottle, and it fell to the ground and spilled. In double-prevention cases like these, philosophers and nonphilosophers alike tend to judge that Mike knocking into the bottle caused the beer to spill and that Peter knocking into Jack did not cause (...) the beer to spill. This difference in causal judgment is a difficult puzzle for counterfactual theories of causal judgment; if each event had not happened, the outcome would not have, yet there is a difference in people’s causal judgments. In four experiments and three supplemental experiments, we confirm this difference in causal judgments. We also show that differences in people’s counterfactual thinking can explain this difference in their causal judgments and that recent counterfactual models of causal judgment can account for these patterns. We discuss these results in relation to work on counterfactual thinking and causal modeling. (shrink)

Casuistry has been suggested as the optimal methodology to analyze modern bioethical dilemmas and this methodology can used to develop a Jewish ethic towards preventive care. A number of Biblical precepts are clearly life and health promoting. These include the law forbidding the putting of others at risk, mandating constructing a parapet around one's roof to prevent individuals from falling and the law forbidding the placing of a stumbling block in front of a blind person. The Talmud is full of (...) specific public measures to protect people's health, again interpreted quite broadly to include not only specific health hazards, but also pollution by foul smells, and excessive noise. These edicts emphasizes the role of man as a guardian of their body, which has been given to them in stewardship by the Lord. Man is thus commanded to be vigilant in preventing damage, in the form of ill health to one's body. When a physician is confronted with a sick patient, Jewish tradition places an impressive array of immediate demands upon the prospective provider of services. However with respect to societal decision making, Jewish law expects the “elders” of the community to set priorities that go beyond the immediate heart-rending demands of the suffering individual and to allocate resources in a rational and responsible manner. (shrink)

BackgroundFor research on sensitive topics like HIV, it is critical to understand the capacity of adolescents to provide informed consent, as parental consent has been identified as the greatest barrier to adolescent participation in biomedical research. In many countries including low-and middle-income countries, where 90% of adolescents live, adolescents can consent to sexual and reproductive healthcare but require parent/guardian permission to participate in research before age 18 – leading to adolescent underrepresentation and systematic exclusion from biomedical and behavioral studies. Among (...) adults, research has identified effective biomedical HIV prevention tools such as pre-exposure prophylaxis (PrEP) that have successfully decreased HIV transmission. Youth in East and Southern Africa have the highest HIV incidence in the world, yet less than 1% of biomedical HIV prevention trials include minor adolescents. Thus, developmentally tailored HIV prevention and care research for adolescents and young adults is urgently needed.MethodsImproving understanding of Capacity to consent to sensitive biomedical Research among adolescents in Rakai Uganda (ICARE) will leverage The Rakai Community Cohort Study (RCCS) to test adolescent capacity to consent to biomedical research, identify differences in developmental decision-making, characterize eligibility for, beliefs about and interest in oral and injectable pre-exposure prophylaxis (PrEP), and construct a digital toolkit for including adolescents in biomedical research. The RCCS presents a unique opportunity to compare cognitive capacity to consent for biomedical research among adolescents with and without prior research experience at three developmental stages – early (10–14 years), middle (15–17 years), and late (18–19 years) – with the cognitive capacity of their parents/guardians.DiscussionLimited data are available on adolescents’ actual capacity to consent, particularly in low-and middle-income countries and low resource, high HIV prevalence settings. Findings will contribute to addressing a major barrier to research participation through an examination of the capacity of adolescents to comprehend risks, benefits, and the other elements of informed consent and, therefore, to provide informed consent to biomedical research. ICARE has the potential to offer guidance for ethical boards seeking to harmonize adolescent treatment and prevention with research procedures, thus addressing a major barrier to adolescent research participation. (shrink)

Background: COVID-19 has taken many lives worldwide and due to this, millions of persons are in grief. When the grief process lasts longer than 6 months, the person is in risk of developing Complicated Grief Disorder. The CGD is related to serious health consequences. To reduce the probability of developing CGD a preventive intervention could be applied. In developing countries like Mexico, the psychological services are scarce, self-applied interventions could provide support to solve this problem and reduce the health impact (...) even after the pandemic has already finished.Aims: To design and implement a self-applied intervention composed of 12 modules focused on the decrease of the risk of developing CGD, and increasing the life quality, and as a secondary objective to reduce the symptomatology of anxiety, depression, and increase of sleep quality. The Intervention Duelo COVID follows the principles of User Experience and is designed according to the needs and desires of a sample of the objective participants, to increase the adherence to the self-applied intervention, considered one of the main weaknesses of online interventions.Methods: A Randomized Controlled Trial will be conducted from the 22nd of December of 2020 to the first of June 2021. The participants will be assigned to an intervention with elements of Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Mindfulness and Positive Psychology. The control group will be a wait-list condition, that will receive the intervention 1.5–2 months after the pre-measurement were taken. The Power Size Calculation conducted through G*Power indicated the need for a total of 42 participants, which will be divided by 21 participants in each group. The platform will be delivered through responsive design assuring with this that the intervention will adapt to the screen size of cellphones, tablets, and computers.Ethics and Dissemination: The study counts with the approval of the Research Ethics Committee of the Autonomous University of Ciudad Juárez, México, and it is registered in Clinical Trials. The article is sent and registered in clinical trials before the recruitment started. The results will be reported in future conferences, scientific publications, and media. (shrink)

For research on sensitive topics like HIV, it is critical to understand the capacity of adolescents to provide informed consent, as parental consent has been identified as the greatest barrier to adolescent participation in biomedical research. In many countries including low-and middle-income countries, where 90% of adolescents live, adolescents can consent to sexual and reproductive healthcare but require parent/guardian permission to participate in research before age 18 – leading to adolescent underrepresentation and systematic exclusion from biomedical and behavioral studies. Among (...) adults, research has identified effective biomedical HIV prevention tools such as pre-exposure prophylaxis (PrEP) that have successfully decreased HIV transmission. Youth in East and Southern Africa have the highest HIV incidence in the world, yet less than 1% of biomedical HIV prevention trials include minor adolescents. Thus, developmentally tailored HIV prevention and care research for adolescents and young adults is urgently needed. Improving understanding of Capacity to consent to sensitive biomedical Research among adolescents in Rakai Uganda (ICARE) will leverage The Rakai Community Cohort Study (RCCS) to test adolescent capacity to consent to biomedical research, identify differences in developmental decision-making, characterize eligibility for, beliefs about and interest in oral and injectable pre-exposure prophylaxis (PrEP), and construct a digital toolkit for including adolescents in biomedical research. The RCCS presents a unique opportunity to compare cognitive capacity to consent for biomedical research among adolescents with and without prior research experience at three developmental stages – early (10–14 years), middle (15–17 years), and late (18–19 years) – with the cognitive capacity of their parents/guardians. Limited data are available on adolescents’ actual capacity to consent, particularly in low-and middle-income countries and low resource, high HIV prevalence settings. Findings will contribute to addressing a major barrier to research participation through an examination of the capacity of adolescents to comprehend risks, benefits, and the other elements of informed consent and, therefore, to provide informed consent to biomedical research. ICARE has the potential to offer guidance for ethical boards seeking to harmonize adolescent treatment and prevention with research procedures, thus addressing a major barrier to adolescent research participation. (shrink)

In this article, an intervention aimed at improving quality of care to prevent seclusion in psychiatry by focusing on the first five minutes at admission is analyzed from a care ethics perspective. Two cases are presented from an evaluation study in a psychiatric hospital. In both cases, the nurses follow the intervention protocol, but the outcome is different. In the first case, the patient ends up in the seclusion room. In the second case, this does not happen. Analyzing the (...) cases from a care ethics perspective, we conclude that applying the intervention in the right way implies more than following the steps laid down in the protocol. It requires a new way of thinking and acting, resulting in new relationships between nurses and patients. Care ethics theory can help clarify what good care is actually about and keep in mind what is needed to apply the intervention. Thus, care ethics theory can be highly practical and helpful in changing and improving healthcare practice. (shrink)

In 2004, the first ever multi‐sited clinical trials studied the prospect of HIV biomedical prevention (referred to as pre‐exposure prophylaxis—‘PrEP’). The trials were implemented at several international sites, but many officially closed down before they completed. At most sites, both scientists and community AIDS advocates raised concerns over the ethics and scientific rationales of the trial. Focusing on the Nigerian trial site, we detail the controversy that emerged among mostly Nigerian research scientists who scrutinized the research design and (...) class='Hi'>protocol. While some of the disputes, especially those pertaining to community engagement mechanisms, were ultimately resolved in international fora and implemented in later PrEP trials, concerns over science rationales and assumptions were never addressed. We argue that scientific rationales should be treated as ethical concerns and suggest that such concerns should be deliberated at host sites before the trial protocol is finalized. (shrink)

Concussions are traumatic brain injuries that can result from a blow to the head or a jolt to the body. Athletes in many sports are exposed to concussion risks. There is a growing concern in sport and society about sport-related concussions (SRC) and an increasing awareness of the importance of proper diagnosis, treatment, and prevention. A traditional, reactive approach emphasizes sound protocols in cases of suspected SRC. A proactive approach involves identifying various causes of SRC and implementing preventive measures. (...) For example, to reduce SRC prevalence in Canadian youth ice hockey, a ban on body checking has been introduced. When a preventive SRC measure implies a change in the main rules of a sport, it impacts its nature and alters how it is played. This can lead to tensions between SRC prevention and sporting concerns. By employing an extended consequentialist framework that includes normative analyses of the values of sport, I will examine the possibilities and limitations of preventive SRC measures in terms of constitutive rule changes. More specifically, I will propose a consequentialist framework to determine the conditions under which athlete exposure to SRC risks in a given sport can be considered unacceptable, acceptable, and even valuable. (shrink)

Artificial-intelligence systems are rapidly reproducing colonial extractivism by harvesting Indigenous linguistic, biometric, geospatial, and ecological data without consent, compensation, or accountability. Biotechnology offers a blueprint for curbing such practices: the Convention on Biological Diversity and its Nagoya Protocol obligate users of genetic resources to obtain Prior Informed Consent, negotiate Mutually Agreed Terms, and share benefits fairly. No comparable framework restrains the digital appropriation that underpins many AI products. Consequently, corporations and states monetize Indigenous knowledge systems under the banners of (...) “open data” and “scientific neutrality,” eroding rights affirmed in the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). In response to this rising risk of AI extractivism, we make the case for a binding, sui generis ABS protocol for AI data governance. First, through a series of case studies we demonstrate that AI extraction mirrors the colonial and biopiracy controversies that originally triggered Access‑and‑Benefit‑Sharing (ABS) rules in biotechnology. Second, we translate those rules into a digital register by braiding two Indigenous data‑governance frameworks—OCAP® (Ownership, Control, Access, Possession) and the CARE Principles (Collective Benefit, Authority to Control, Responsibility, Ethics)—inside the ABS triad of consent, terms, and benefit‑sharing. The resulting model grounds technical safeguards in relational accountability and Indigenous legal orders. Such an instrument would compel transparent negotiations with Indigenous rights‑holders, assign enforceable authority over data across the AI lifecycle, and require equitable redistribution of the economic value generated by models trained on Indigenous data. Embedding ABS principles into AI governance offers a decolonial pathway that centers Indigenous epistemologies, promotes ethical foresight, and transforms AI from a vehicle of digital colonialism into a space for algorithmic justice. (shrink)

Geoffrey Rose's ‘prevention paradox’ occurs when a population-based preventative health measure that brings large benefits to the community – such as compulsory seatbelts, a ‘fat tax’, or mass immunisation – offers little to each participating individual. Although the prevention paradox is not obviously a paradox in the sense in which philosophers understand the term, it does raise important normative questions. In particular, should we implement population-based preventative health measures when the typical individual is not expected to gain from (...) them? After canvassing other attempts to address the paradox, I argue that what is significant about the prevention paradox is that it involves intra-personal trade-offs; the costs and benefits of the choice to implement or not implement a preventative health measure fall on the same individuals. The intra-personal nature of these trade-offs has two implications. First, the solutions to the paradox proposed by other authors are deficient. Second, the policy choice to not implement some preventative health measures can be normatively justified. (shrink)

A wealth of research shows that youth suicidal ideation, attempts, and death by suicide is a growing public health concern in the United States. Rates of suicidal ideation and attempts for children ages 10–14 differ from those of adolescents, yet research on suicide risk for this distinct group is sparse. Experiencing symptoms of psychological disorders increases suicide risk for children. Children exposed to violence at home and school and those who experience social isolation are also at greater risk for suicide. (...) Conversely, having strong, supportive relationships with family and peers mitigates a child’s suicide risk. Given that children spend most of their time in schools, advocates have concentrated their efforts for suicide risk assessment, prevention, and intervention for children in school settings. Universal screening practices can help identify children at risk for suicide in schools. School-based clinicians have also designed and implemented numerous suicide prevention programs for the entire student body, as well as interventions for those students specifically at risk for suicide. However, most programs are designed for adolescents ages 14 and older. Additional research is needed to determine whether these programs, or other socio-emotional learning protocols, effectively reduce suicide risk for young children. (shrink)

Mechanism design is concerned with settings where a policymaker (or social planner) faces the problem of aggregating the announced preferences of multiple agents into a collective (or social) system-wide decision. One of the most important ways for aggregating preference that has been used in multiagent systems is election. In an election, the aim is to select the candidate who reflects the common will of society. Despite the importance of this subject, in some situations the result of the election does not (...) respect the purpose of those who execute it, and the election leads to dissatisfaction of a large amount of people and in some cases causes polarization in societies. To analyze these situations, we introduce a new notion called social disappointment, and we show which voting rules can prevent it in elections. In addition, we propose a new protocol to prevent social disappointment in elections. A version of the impossibility theorem is proved regarding social disappointment in elections, showing that there is no voting rule for four or more candidates that simultaneously satisfies avoiding social disappointment and Condorcet winner criteria. We give conditions under which our new protocol always selects the Condorcet winner under the assumption of single-peakness. We empirically compare our protocol with eight well-known other voting protocols and observe that our protocol is capable of preventing social disappointment and is more robust against manipulations. (shrink)

With healthcare systems worldwide committing to reduce their greenhouse gas emissions, policymakers must navigate how to reconcile emissions reduction with the delivery of high-quality care. Two main distributive ideals have emerged to guide a just transition to decarbonized healthcare: subsistence emissions and prevention. The subsistence view holds that healthcare emissions that are necessary to meet a threshold of “enough health” are permissible, while emissions exceeding this threshold should be mitigated. The prevention approach, in contrast, prioritizes the most efficient (...) uses of limited emissions through emphasizing measures to prevent the onset of illness and to promote healthy living. Although both frameworks aim to reconcile pursuing the goals of healthcare with reducing the sector’s carbon footprint, their approaches to that end appear to conflict. Subsistence emissions tend to prioritize those below the threshold of enough health, whereas prevention focuses on maintaining health in the already relatively well off. As subsistence emissions offers a compelling strategy for decarbonizing healthcare fairly, the question arises: can it accommodate prevention? This paper argues that these two perspectives can be reconciled by detailing how a subsistence emissions approach can also endorse emissions for measures that prevent individuals from falling below a health threshold. (shrink)

Persons who are dangerous and legally responsible, but who have not yet committed any currently recognised criminal offence, fall within the gap left between the domains of criminal justice and civil commitment. Many jurisdictions operate legal regimes that permit the detention of such persons in order to prevent the occurrence of anticipated criminal harms. These regimes often either fail to respect the principle of proportionality or contradictorily treat a dangerous offender as both legally responsible and not responsible at the (...) same time. In response to these problems, a number of preventive detention models have been proposed. Retributivist models seek to prevent the occurrence of anticipated criminal harms by requiring blame on the dangerous person’s part in order to warrant detention. However, these models are ill-equipped to deal with the problem of coextensiveness; i.e., they struggle to comprehensively reconcile proportionality in punitive sentencing with the period over which dangerous persons remain dangerous and during which one might therefore want them to be incapacitated. In order to achieve comprehensive incapacitation of dangerous persons for the duration of their dangerousness, retributivist models are forced to abandon their fidelity to proportionality in punitive sentencing, thereby losing themselves in the process. Accordingly, if the practice of preventive detention can be justified at all, such justification will not be of a retributivist character. (shrink)

Imagine you fly home from vacation with your one-and-a-half-year-old son who is traveling for free as a “lap child.” In the airport parking lot, you put him into his forward-facing car seat, where he sits much more contentedly than he did in the rear-facing one that was mandatory until his first birthday. After he falls asleep on the way home, you transfer him to his crib without waking him, lowering the side rail so you can lift him in more easily. (...) -/- Many parts of this idyllic parenting picture are deemed unacceptably risky according to recent child safety proposals. While these proposals all aim to improve child safety, their possible impact is unclear because there has been little discussion of the absolute risk and risk reduction involved in each. And while precise figures are lacking, rough estimates indicate that the magnitudes are quite small. I will argue that this risk and benefit data raises important questions about the proposals, including whether parents might reasonably believe that the small absolute risk reduction offered by the proposed changes does not justify the attendant burdens. This possibility—termed the “prevention paradox” in other contexts—highlights ethical and theoretical challenges in this area of public health. (shrink)

In the Netherlands fertility doctors increasingly formulate protocols, which oblige patients to quit their unhealthy lifestyle before they are admitted to IVF procedures. We argue that moral arguments could justify parenting protocols that concern all future parents. In the first part we argue that want-to-be parents have moral responsibilities towards their future children to prevent them from harm by diminishing or eliminating risk factors before as well as during the pregnancy. This is because of the future children's potential to become (...) of a certain type, more specifically: a person that will be the want-to-be parents' child. Want-to-be parents intend to become pregnant and therefore have an additional moral reason to diminish the risks. Also, people who become pregnant unintentionally have the responsibility to prevent their children from harm, unless they become pregnant due to contraception failure. All people not wanting to become pregnant should use contraception methods carefully.In the second part of this paper we translate the want-to-be parents' responsibilities into practice. We distinguish four determinants of risk factors: modifiability, chance, severity and effort. We examine some evidence-based risk factors based on these variables and deduce levels of responsibility.In conclusion, formulating informal requirements for want-to-be parents is morally required and therefore also for want-to-be parents in need of medical assistance. The protocols developed by fertility doctors in the Netherlands could be seen as the precursor for a general, informal Parenting Protocol that could be developed on the basis of an extended and thoroughly debated risk-responsibility analysis. (shrink)

Many preventive intervention studies with adolescents address high-risk behaviors such as drug and alcohol use, and unprotected sex. Randomized controlled trials (RCT) are the gold standard methodology used to test the effectiveness of these behavioral interventions. Interventions outside the rigidly described protocol are prohibited. However, there are ethical challenges to implementing inflexible intervention protocols, especially when the target population is young, experiences many stressful events, and lives in a resource-poor environment. Teens who are at high risk for substance use (...) or sexual risk behaviors tend to be at risk for other problems such as exposure to violence, sexual and physical abuse, depression, and homelessness. How should investigators deal with the psychological and social needs of teenagers in prevention programs in an ethically appropriate way and at the same time preserve the validity of RCT results? We have identified program characteristics, participant characteristics, interaction with parents, and problems with adolescents not in the study as sources of ethical dilemmas in RCT with at-risk adolescents. As a result of our experience, we recommend that every behavioral intervention study develop an ethics protocol, which should include rules for providing help to participants, has contact information for experts to provide guidance, and an emergency procedure for dealing with life threatening situations. In addition, studies should have a resource manual, train research staff in these ethical issues, and work with a data safety and monitoring board or ethics committee. (shrink)

Hand, Foot, and Mouth Disease (HFMD) continues to pose a public health concern in school-aged children, yet parental understanding and compliance with health measures remain erratic. This study assessed the level of parental awareness and health protocol practices regarding HFMD and examined the relationship between these variables among caregivers of Grade 1 to 3 pupils in a public elementary school in Aklan, Philippines. A quantitative correlational research design was employed. Data were gathered from 166 randomly selected parents and caregivers (...) using a validated, researcherdeveloped survey composed of 16 true/false items on awareness and 16 Likert-scale items on protocol adherence. Descriptive statistics and Spearman’s rho correlation were analyzed using SPSS version 21. Results showed that overall awareness was moderate (M=10.67, SD=2.02), with lowest scores in etiology (54.97%) and transmission (60.84%) and highest in pathophysiology (80.87%). Health protocol practice was also moderate (M=2.96, SD=0.87), with variable adherence across promotion, treatment, and rehabilitation behaviors. A weak but statistically significant positive correlation was found between awareness and practice (r=0.220, p=0.004). These findings indicate that while awareness contributes to better adherence, knowledge alone does not guarantee consistent compliance with preventive measures. Strengthening targeted health education and implementing behavior-focused interventions are recommended to enhance prevention efforts. The study supports the integration of school-based hygiene programs and community-driven health campaigns to reduce HFMD transmission in early childhood settings. (shrink)

BackgroundThe ethical concerns associated with HIV prevention and treatment research have been widely explored in South Africa over the past 3 decades. However, HIV cure research is relatively new to the region and significant ethical and social challenges are anticipated. There has been no published empirical enquiry in Africa into key informant perspectives on HIV cure research. Consequently, this study was conducted to gain preliminary data from South African HIV clinicians, researchers and activists.MethodsIn-depth interviews were conducted on a purposive (...) sample of fourteen key informants in South Africa. Audiotaped interviews were transcribed verbatim with concurrent thematic analysis. The perspectives of HIV clinicians, researchers and activists were captured. Analyst triangulation occurred as the data were analysed by three authors independently.ResultsThe rapid evolution of HIV cure research agendas was prominent with participants expressing some concern that the global North was driving the cure agenda. Participants described a symbiotic relationship between cure, treatment and prevention research necessitating collaboration. Assessing and managing knowledge and expectations around HIV cure research emerged as a central theme related to challenges to constructing ‘cure’ - how patients understand the idea of cure is important in explaining the complexity of cure research especially in the South African context where understanding of science is often challenging. Managing expectations and avoiding curative misconception will have implications for consent processes. Unique strategies in cure research could include treatment interruption, which has the potential to create therapeutic and ethical conflict and will be perceived as a significant risk. Ethical challenges in cure research will impact on informed consent and community engagement.ConclusionsIt was encouraging to note the desire for synergy amongst researchers and clinicians working in the fields of prevention, treatment and cure. Translation of complex HIV cure science into lay language is critical. Moving forward, RECs must be adequately constituted with scientific expertise and community representation when reviewing cure protocols. It is hoped that knowledge and resource sharing in the context of collaboration between research scientists working in cure and those working in treatment and prevention will accelerate progress towards cure. (shrink)

Background People who are at elevated risk of suicide stand to benefit from internet-based interventions; however, research in this area is likely impacted by a range of ethical and practical challenges. The aim of this study was to examine the ethical issues and practical barriers associated with clinical studies of internet-based interventions for suicide prevention. Method This was a mixed-methods study involving two phases. First, a systematic search was conducted to identify studies evaluating internet-based interventions for people at risk (...) of suicide, and information pertaining to safety protocols and exclusion criteria was extracted. Second, investigators on the included studies were invited to complete an online survey comprising open-ended and forced-choice responses. Quantitative and qualitative methods were used to analyse the data. Results The literature search identified 18 eligible studies, of which three excluded participants based on severity of suicide risk. Half of the 15 suicide researchers who participated in the survey had experienced problems obtaining ethics approval, and none had encountered adverse events attributed to their intervention. Survey respondents noted the difficulty of managing risk in online environments and the limitations associated with implementing safety protocols, although some also reported increased confidence resulting from the ethical review process. Respondents recommended researchers pursue a collaborative relationship with their research ethics committees. Conclusion There is a balance to be achieved between the need to minimise the risk of adverse events whilst also ensuring interventions are being validated on populations who may be most likely to use and benefit from them. Further research is required to obtain the views of research ethics committees and research participants on these issues. Dialogue between researchers and ethics committees is necessary to address the need to ensure safety while also advancing the timely development of effective interventions in this critical area. (shrink)

Se realizó una investigación cualitativa, durante noviembre de 2013 a noviembre de 2015 con el objetivo de mostrar un protocolo de salud como tecnología social para la promoción y prevención de las manifestaciones oftalmológicas en pacientes con VIH/sida. Se utilizaron métodos teóricos y empíricos los cuales permitieron conocer antecedentes del problema a investigar, realizar acciones y caracterizar el fenómeno en estudio. El protocolo constituye una tecnología social, debido a que está compuesto por normas y procedimientos para la conducción de un (...) proceso social no relacionado con la esfera productiva. El diseño de esta tecnología social propicia un adecuado diagnóstico, tratamiento y seguimiento de las enfermedades oculares en pacientes con VIH/sida, sustentado en la teoría del conocimiento. A qualitative investigation was carried out during November 2013 to November 2015 with the objective of developing a protocol as social technology for the promotion and prevention of ophthalmologic manifestations in patients with HIV/AIDS. Theoretical and empirical methods that allowed knowing the antecedents of the problem under investigation, to carry out actions and to characterize the studied phenomenon, were used. The protocol constitutes a social technology, because it is composed by norms and procedures for the conduction of a social process that is not related with the productive area. The design of this social technology favors an adequate diagnosis, treatment and follow-up of eye conditions in patients with HIV/ AIDS, based on the theory of knowledge. (shrink)

The Brazilian Federal Senate created a Parliamentary Inquiry Commission (CPI) to investigate the Bolsonaro government's irregularities in the management of the COVID-19 pandemic. One of the cases that drew attention was the research conducted by Prevent Senior, a private health insurance company, on the early treatment of COVID-19. The article analyzes the scientific validity of the research and the ethical problems related to its implementation. It is based on analysis of Prevent Senior's report of the clinical study, the Brazilian and (...) USA clinical trial registries, the Senate's CPI report, and on the information reported by the media. This case of scientific fraud and political-ideological bias exemplifies how Prevent Senior, using a questionable protocol to enhance its reputation and gain government support, was instrumental in building the “early treatment” narrative for COVID-19, and shows how it served as a basis for a government public policy that promoted the use of ineffective drugs. (shrink)

In their recent paper‘Undue inducement: a case study in CAPRISA 008’, Mngadi et al conclude that a participant in an HIV prevention study who deliberately concealed her pregnancy was not ‘unduly induced’ to participate by the offer of an experimental product. This paper argues that while the authors’ conclusion is sound, the framing of this case study is consistent with the preoccupation in research ethics with the concept of undue inducement, coupled with a highly risk-averse attitude to pregnancy. We (...) suggest that the critical research ethics question raised by Mngadi et al ’s case study is not ‘undue inducement’, but the exclusion of pregnant women from research studies where the risks are acceptable to the potential participant, and benefits likely. We also suggest that current regulatory paradigms regarding pregnancy are both overly paternalistic and value the fetus over the mother. In order to ensure timely provision of new HIV prevention agents, we argue that there is a need for expeditious testing of proven effective agents in pregnancy, with due consideration given to situations where preliminary efficacy data exist but fall short of licensure standards. This requires a paradigm shift from researchers, funders, regulators and ethical review bodies towards practices that critically examine the legitimacy of the exclusion of pregnant women on a study-by-study basis. (shrink)

A prevailing issue in clinical research is the duty clinicians have to treat or prevent the progression of disease during a study that they are conducting. While all clinical researchers have a duty of care for the patients who participate in clinical research, intervening at the onset or progression of disease may skew results and have a negative impact on the scientific validity of a study. Extreme examples of failures to intervene can be found in the Tuskegee syphilis study and (...) in an attempt to determine if cervical smears were an accurate predictor of cancer, which was uncovered by the Cartwright Inquiry. However, the issue arises in all research where delay in intervention can cause harm. A current study in Singapore is investigating the significance of an ‘ultra-high risk’ state that may constitute the prodromal phase of psychosis. This project called ‘The Longitudinal Youth at Risk Study’ is potentially contentious because it is recruiting young people who are identified as being ‘at risk’ of developing psychosis. In this paper, the decision to offer treatment to all participants as well as a fast track for those who are assessed to have developed serious mental illness into treatment is discussed. It is argued that this approach is ethically justified because of the duty of care that is owed to research participants, and suggests that the principle of equipoise may be used to guide intervention decisions in other clinical research protocols. (shrink)

The return of genetic research results after death in the pediatric setting comes with unique complexities. Researchers must determine which results and through which processes results are returned. This paper discusses the experience over 15 years in pediatric cancer genetics research of returning research results after the death of a child and proposes a preventive ethics approach to protocol development in order to improve the quality of return of results in pediatric genomic settings.

In this paper we argue that the responsibility for systematic community-based preventive medicine should not be made part of the role of the general practitioner (GP). Preventive medicine cannot be shown to be more effective than curative or supportive medicine. Therefore, the allocation of the large amount of general practice staff time and resources required for systematic preventive medicine should not come at the expense of the care of the sick and the suffering. The traditional healing role of the GP (...) requires a cooperative patient-centred approach, whereas systematic preventive medicine is driven by rigid pre-set protocols and is intrinsically paternalistic. Trying to merge the two approaches is detrimental to the doctor-patient relationship. Furthermore, a number of potential pitfalls are identified that may be encountered in the implementation of preventive medicine programmes in general practice: interference with the course of the consultation; inadequate explanation and consent; distortion of practice priorities as reflected in quality indicators; temptation to record inaccurate data; conflict of interests where the doctor is rewarded for performance; patient blaming; exacerbation of the health gap. We suggest that a more justifiable strategy would be for GPs to identify patients at high risk and offer them specific preventive advice when the opportunity presents itself and at a time when the patient is likely to be most amenable to cooperate. Opportunistic health promotion offers higher expectations of benefit, as well as a more equitable allocation of the risks associated with preventive medicine, than a systematic community-based approach. (shrink)

Suicide is a public health problem which will require an integrated cross-sector approach to help reduce prevalence rates. One strategy is to include the legal system in a more integrated way with suicide prevention efforts. Caine explored a public health approach to suicide prevention, depicting risk factors across the socio-ecological model. The purpose of this paper is to examine laws that impact suicide prevention at the individual, relational, community, and societal levels. These levels are fluid, and some (...) interventions will fall between two, such as a community-level approach to training that enhances provider-patient relationships. At the individual level, we will review laws to improve screening requirements across systems. At the relational level, we note interventions with couples having conflict, such as protection orders and access to attorney consultations, which have been known to be injury prevention mechanisms. At the community level, we discuss legislation that recommends suicide prevention efforts for key individuals working as frontline providers in the medical and educational systems. At the societal level, we explore public awareness campaigns that target stigma reduction for those suffering from mental health burden and enhance linkage to care. The article closes with the discussion that laws are good, but their implementation is essential. (shrink)

BackgroundMental illness among Malaysian children is gradually reaching a fundamentally alarming point as it persistently shows increasing trend. The existing literature on the etiologies of children’s mental illness, highlights the most common cause to be ineffective or impaired parenting. Thus, efforts to combat mental illness in children should focus on improving the quality of parenting. Documented interventional studies focusing on this issue, particularly in Malaysia, are scarce and commonly report poor treatment outcomes stemming from inconvenient face-to-face instructions. Consequently, proposing an (...) accessible online and digital-assisted parenting program is expected to reach a larger number of parents, as it can overcome substantial barriers. Hence, this study aims to develop a universal digital-assisted preventive parenting intervention called DaPI, that aims to enhance mental health of children in Malaysia.MethodsA total of 200 parents of children aged 10–14 years will be recruited and randomized into two groups either intervention or waitlist-control based on a 1:1 ratio for a duration of 8 weeks. Those in the intervention group will receive eight sessions of the DaPI program that focus mainly on parenting and children’s mental health. The primary outcome of this study will essentially focus on the changes in parent-reported parenting behavior and parental self-efficacy. The secondary outcome will be changes in children’s mental health. Assessments will be arranged pre- and post-intervention as well as at the 1-month follow-up. Analyses will be conducted using a paired t-test and multivariate analysis of covariance.DiscussionThe expected outcome will be the establishment of DaPI in promoting children’s mental health by targeting changes in parenting behavior and parental self-efficacy in Malaysia. Findings from this study will be beneficial for policymakers to invest in parenting programs that could provide support to parents in enhancing their child’s overall development.Clinical trial registration[www.irct.ir], identifier [IRCT20211129053207N1]. (shrink)

In this paper, we examine the potential integration of artificial intelligence (AI) into capital punishment through lethal autonomous mechanisms (LAMs), an extension of developments in lethal autonomous weapons (LAWs). While most philosophical and ethical research on autonomous weapons systems focuses on warfare and policing, their potential role in capital executions remains unexplored. Through anticipatory analysis of LAMs’ integration into what we term the “death row network,” we show how retentionists might leverage these technologies to counter key abolitionist critiques. We analyze (...) how LAMs could undermine two abolitionist arguments: the harm to corrections personnel and the medicalization of execution protocols. However, we argue that while LAMs resolve these specific challenges, they simultaneously generate new ethical concerns. First, LAMs will not eliminate the moral and psychological burden on corrections personnel entirely but rather redistribute it to networks of AI developers, software engineers, and technology professionals who become implicated in state-sanctioned killings through their work. Similarly, LAMs address the medicalization concern, yet they merely shift ethical scrutiny from the medical sector to the technology corporations developing LAMs and their industrial partners. Second, LAMs’ elimination of human presence undermines the exercise of benevolence through sustained interpersonal engagement, from sharing final conversations to offering comfort during an inmate’s last moments. This human connection, which preserves dignity even within a dehumanizing process, cannot be replicated by automated systems and is a further argument against their adoption. (shrink)

Most model checking techniques for security protocols make a number of simplifying assumptions on the protocol and/or on its execution environment that greatly complicate or even prevent their applicability in some important cases. For instance, most techniques assume that communication between honest principals is controlled by a Dolev-Yao intruder, i.e. a malicious agent capable to overhear, divert, and fake messages. Yet we might be interested in establishing the security of a protocol that relies on a less unsecure channel (...) (e.g. a confidential channel provided by some other protocol sitting lower in the protocol stack). In this paper we propose a general model for security protocols based on the set-rewriting formalism that, coupled with the use of LTL, allows for the specification of assumptions on principals and communication channels as well as of complex security properties that are normally not handled by state-of-the-art security protocol analysers. By using our approach we have been able to formalise all the assumptions required by the ASW protocol for optimistic fair exchange and some of its key security properties. Besides the previously reported attacks on the protocol, we report a new attack on a patched version of the protocol. (shrink)

Diplomatic relations carried out between the states are fulfilled under the protocol ruled out by the actors within the international system, which prevents any possible problems that might affect the course of bilateral relations from coming out. However, work and actions in the public arena are carried out under the protocol rules, some of which are in written form, and some of which are based on traditions used for a long period of time. Conducting the mentioned work and (...) actions under the protocol rules not only creates a discipline prevailing work environment, but also encourages employees to perform their duties in a more relaxed, peaceful, happier and more productive manner. Therefore, it is an absolute necessity to act with the attitudes and behaviors under the protocol rules both in the fulfillment of diplomatic relations and in the fulfillment of public activities. But as the protocol rules are not known well enough in Turkey, the necessity mentioned above is not obeyed. This case leads to occurance of significant defects during the implemention of services provided by public institutions in Turkey and the implementation of diplomatic relations. As a matter of fact; when examining the proceduces concerning public work and functions, and diplomatic relations in detail; one can obviously see that numerous problems are encountered which result from not implementing or mis-implementing protocol rules. This study aims to prove that more importance must be given to education on protocol rules in Turkey. (shrink)

With the great increase in litigation, insurance costs, and consumer prices, both managers and businesses should take a proactive position in avoiding liability. Legal liability may attach when a duty has been breached; many actions falling into this category are also considered unethical. Since much of business liability is caused by a breach of a duty by a business to either an individual, another business, or to society, this article asserts that the practice of liability prevention is a practical (...) business application of ethics. In today's highly litigious environment, it is appropriate for the concept of general liability prevention to be included in corporate codes of ethics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:SENECA FALLS INHERITANCE: DISENTANGLING WOMEN, LEGISLATION AND VIOLENCE IN MONFREDO'S HISTORICAL CRIME FICTION Rosemary Erickson Johnsen National Coalition ofIndependent Scholars That men were not prevented by courts or clergy from mistreating their wives meant that, to society's institutions, women had no value. A man could be jailed, even hanged, for stealing another man's horse, but not even reproached for beating his wife. (Miriam Grace Monfredo, Through a Gold Eagle) (...) Miriam Grace Monfredo's feminist genre fiction, her "historymystery " series featuring nineteenth-century librarian Glynis Tryon, offers an opportunity to find a way ofreading literary texts that is not only feminist, but also Girardian. Girard's work provides two clear ways to construct feminist readings directly, without the mediation of overtly feminist theory. First ofthese is Girard's respect for the "quasi-theoretical" potential of literary texts, especially some of those which attend to apparently trivial matters. In Deceit, Desire and the Novel, Girard argues that (male) novelists offer insights unavailable elsewhere, including those scientific fields that claim to know more than everyone else. In its valuing of questions about snobbism, for example, Deceit, Desire and the Novel offers a woman-friendly model. The (male) novelist's question about snobbism is "too frivolous" for (men of) science, but Girard argues that "in his probe of snobbism the novelist is asking himself in his own way just what Rosemary Erickson Johnsen59 might be the hidden springs that make the social mechanism tick" (220). While I regret the fact that Girard's examples and language often ignore women, I believe his conviction that attention to matters socially coded as superficial and frivolous can produce great insight is one feminist critics can appreciate. The second Girardian tool feminists can rely upon is the method of reading texts of persecution described in The Scapegoat. Girard suggests how we might read texts ofpersecution written by naive persecutors in ways that identify with the persecuted and gather the information unintentionally supplied by the authors: "I call those persecutors naive who are still convinced that they are right and who are not so mistrustful as to cover up or censor the fundamental characteristics of their persecution. Such characteristics are either clearly apparent in the text and are directly revealing or they remain hidden and reveal indirectly" (8). Monfredo's crime novels, set in the mid-nineteenth century and focusing on such disenfranchised groups of citizens as women, slaves, Native Americans, and free African-Americans, depend for their verisimilitude on her ability to read historical sources and literary predecessors in just such a way. Accuracy requires that Monfredo's works be categorized as feminist historical crime novels, however awkward such a lengthy description may be. Her novels observe the principles not only of both genres—historical fiction and detective fiction—but also the political position offeminism, and they meet these multiple demands with considerable skill. Furthermore, resolution in crime fiction depends upon the law; working within that tradition, Monfredo is called upon to seek solutions within the system, to look for justice as the result ofa proper functioning ofthe legal and social systems. Information gathered, whether by the official representatives ofthe law or by amateurs, is turned over to the authorities. While her novels clearly respect that tradition, they also point out some limits to the judicial system's ability to contain violence. Girard's model ofits functioning, as described in Violence and the Sacred, depends upon an equality that whole segments of the society Monfredo is depicting do not in fact enjoy: "The judicial authority is beholden to no one. It is thus at the disposal ofeveryone" (23). Ifwomen cannot own property, enter into contracts or sit on juries, in what sense is the law at their disposal? Monfredo's exploration ofthis question takes its place alongside Girard's explanation of the legal system's proper functioning; ifhis theory reveals how it works when all are enfranchised, her fiction suggests some ofthe consequences that result from the existence of disenfranchised subjects. 60'Seneca Falls Inheritance' Our Seneca Falls Inheritance In her first book, Seneca Falls Inheritance (1992), Monfredo offers a theory for the reduction of violence against women: provide women with complete legal equality. The... (shrink)

Regulations designed to prevent global inequalities in the use of genetic resources apply to both commercial and non-commercial research. Conflating the two may have unintended consequences for collaboration between the Global North and biodiverse countries in the Global South, which may promote global injustice rather than mitigate it.

Reviews of research and development collaborations with indigenous communities have exhibited numerous challenges related to researcher–community interactions. Based on many accounts of indiscretions, indigenous communities have begun generating conduct guidelines for researchers. However, the effectiveness of their chosen communication methods, guaranteeing appropriate behavior of the researchers, has not been established. This research contributes to an ongoing debate around appropriate ethical conduct of researchers in situ. The aim of this study was to investigate the interpretation accuracy of interaction guidelines produced in (...) the form of sketches by a Malaysian indigenous community. We provided eight interaction sketches to 57 students, in three continents, for interpretation and expression of their intended behavior. We found that most were unable to accurately interpret the sketches and describe intended behavioral responses. A major concern remains with the tendency to fall back on prior practices of “good” behavior, with minimal guidance on contextual practices. In an attempt to provide greater direction, we explored a speech bubble exercise with further 15 students. Our findings directly contribute to current efforts in formulating researcher–community interaction practices that should form the basis of ethical research in situ. (shrink)