Ethical challenges during critical phases of the COVID-19 pandemic: An interpretive synthesis.

BACKGROUND: During the most critical phases of COVID-19 pandemic, dramatic situations were experienced in hospitals and care centers that nurses could hardly verbalize. Especially relevant were deep challenges related to terminal illness, situations of extreme sacrifice, as well as reflections on protective measures mixed with beliefs. We intend to analyze which problems had the greatest impact on professionals. AIM: The aim is to explore the ultimate basis for action when making decisions and the orientation of their behavior in the face of moral conflicts. METHOD: The methodological strategy is an interpretive synthesis. Narrative review of academic articles that analyzed ethical dilemmas during the pandemic was carried out by searching five databases (Pubmed, Scopus, Psycinfo, CINHAL, and WOS) between January 2020 and December 2022. Finally, 43 articles were selected. ETHICAL CONSIDERATIONS: Ethical requirements were respected in all study phases. RESULTS: The reading and review of the 43 articles initiated the first phase of inductive coding which resulted in 14 initial sub-themes. Based on this structure, a second phase of coding was carried out, giving rise to six categories or emerging themes. To facilitate the process of identifying the central category, the authors agreed to carry out a phase of synthesis, grouping the six themes into three meta-themes: the identification and acceptance of human vulnerability; the discovery of positive paradigms in traumatic situations in society; the prevalence of the common good over the particular interest, as the core structure of any society. CONCLUSION: The study has shown the need to consider healthcare benevolence as a new dimension of health care upon global vulnerability. Responsibility is required to ensure the well-being of a global society, prioritizing the common good over particular interests and building solutions on solid moral structures. A new ethical landscape is essential, starting with a humanistic curricular training of all healthcare professionals.

Contemplative Meditation and Neuroscience: Prospects for Mental Health.

Numerous studies show that personal spirituality developed through prayer positively influences mental health. Phenomenological and neuroscientific studies of mindfulness, an Eastern meditative prayer form, reveal significant health benefits now yielding important insights useful for guiding treatment of psychological disorders. By contrast, and despite its practice for millennia, Christian meditation is largely unrepresented in studies of clinical efficacy. Resemblances between mindfulness and disciplinary acts in Christian meditation taken from the ancient Greek practice of askesis suggest that Christian meditation will prove similarly beneficial; furthermore, psychological and neuroscientific studies suggest that its retention of a dialogical and transcendent praxis will additionally benefit social and existential psychotherapy. This paper thus argues that study of contemplative meditation for its therapeutic potential is warranted.

Self-Deception in Terminal Patients: Belief System at Stake.

A substantial minority of patients with terminal illness hold unrealistically hopeful beliefs about the severity of their disease or the nature of its treatment, considering therapy as curative rather than palliative. We propose that this attitude may be understood as self-deception, following the current psychological theories about this topic. In this article we suggest that the reason these patients deceive themselves is to preserve their belief systems. According to some philosophical accounts, the human belief system (HBS) is constituted as a web with a few stable central nodes - deep-seated beliefs - intimately related with the self. We hypothesize that the mind may possess defensive mechanisms, mostly non-conscious, that reject certain sensory inputs (e.g., a fatal diagnosis) that may undermine deep-seated beliefs. This interpretation is in line with the theory of cognitive dissonance. Following this reasoning, we also propose that HBS-related self-deception would entail a lower cognitive load than that associated with confronting the truth: whereas the latter would engage a myriad of high cognitive functions to re-configure crucial aspects of the self, including the setting of plans, goals, or even a behavioral output, the former would be mostly non-conscious. Overall, we believe that our research supports the hypothesis that in cases of terminal illness, (self-)deceiving requires less effort than accepting the truth.

Homeostasis y rppresentaciones intelectuales: ua aproximación a la conducta mooral desde la teoría de la emoción de antonio damasio / Homeostasis nd iintellectualrepresentations: an approach to moral behavior based on antonio damasio's theory of emotions / Homostase e reprresntações intelectuais: uma aproximação ao comporrtamento moral a partir da teoria da emoção de antonio damasio

Antonio Damasio elabora una teoría de la mente humana y de la conducta moral a partir de su hipótesis sobre la evolución de los mecanismos de autorregulación biológicos. En ella, a la capacidad para representar relaciones organismo-mundo se le confiere un importante papel en los cambios organizacionales (y, en último término, normativos) que emergen de los sistemas con un sistema nervioso central. Concretamente, en nuestro artículo analizamos, en primer lugar, la tesis acerca de la doble homeostasis biológicamental que caracteriza a los agentes racionales. Desde su perspectiva, la conciencia es producto y manifestación de complejos procesos del procesamiento de representaciones, los cuales favorecen la regulación no consciente. Además, para entender los procesos conscientes también es clave, según Damasio, conocer cómo la evolución de tales mecanismos está asociada con el desarrollo de áreas neuronales próximas al córtex emocional, especialmente, el giro cingulado. Los argumentos que Damasio utiliza para vincular los procesos representacionales con la particular preocupación humana por los sentimientos de los otros (un fenómeno que identifica en el origen de las normas éticas y, en último término, de lo que denomina homeostasis social) es la segunda cuestión que evaluamos.

Antonio Damasio has developeda theory of the human mind and moral conduct based on his hypothesis regarding the evolution of biological self-regulation mechanisms. In it, he affords the ability to represent organism-world relationships an important role in the organizational changes (and, ultimately, in normative or regulatory changes) that emerge from systems with a central nervous system. Specifically, in this article, the authors first analyze the theory of biology-mind dual homeostasis that characterizes rational agents. From that perspective, consciousness is the product and manifestation of complex procedures for processing representations, which favor nonconscious regulation. Moreover, to understand conscious processes Damasio also says it is crucial to know how the evolution of these mechanisms is associated with the development of neural areas near the emotional cortex, especially the cingulate gyrus. The arguments Damasio uses to link representational processes with particular human concern for the feelings of others (a phenomenon that identifies the origin of ethical standards and, ultimately, of what he calls social homeostasis) is the second question the authors evaluate.

Antonio Damasio elabora uma teoria da mente humana e do comportamento moral a partir de suas hipóteses sobre a evolução dos mecanismos de autorregulação biológicos. Nela, à capacidade para representar relações organismo-mundo é conferido um papel importante nas mudanças organizacionais (e, em última análise, normativas) que emergem dos sistemas com um sistema nervoso central. Concretamente, neste artigo, analisa-se, em primeiro lugar, a tese acerca da dupla homeostase biológica-mental que caracteriza os agentes racionais. De acordo com sua perspectiva, a consciência é produto e manifestação de complexos processos do processamento de representações, os quais favorecem a regulação não consciente. Além disso, para entender os processos conscientes, também é chave, segundo Damasio, conhecer como a evolução desses mecanismos está associada com o desenvolvimento de áreas neuronais próximas do córtex emocional, especialmente, do giro cingulado. Os argumentos que Damasio utiliza para vincular os processos representacionais com a particular preocupação humana pelos sentimentos dos outros (um fenômeno que identifica na origem das normas éticas e no que denomina homeostase social) é a segunda questão avaliada.

Acidosis metabólica y topiramato. Utilidad de la fórmula de Winters / Metabolic acidosis and topiramate. Use of Winters’ formula

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Proyección y líiites de la neuroteología en el ensamiento de aldous huxley: laa interdisciplinariedad a prueba en estudios existenciales / Projection and limits of neurotheology in the test of aldous haxley

En este artículo perfilo el área de la "neuroteología", estableciendo sus límites metodológicos, proponiendo una clasificación temática y analizando su proyección actual. Para ello, y utilizando el esquema inicial dado por Aldous Huxley, identifico tres grupos de objetivos posibles, los orientados al "operacionismo práctico", al "operacionismo trascendental" y al "operacionismo místico". Brindo además ejemplos de investigaciones en curso en cada uno de ellos así como los nuevos debates que de éstas emergen. En definitiva, destaco el renovado interés de la ciencia experimental por lo religioso; ofrezco un mejor marco desde donde poder reflexionar sobre el lugar y el peso de tales estudios en neuroética, y examino los obstáculos específicos que acompañan a este tipo de proyectos interdisciplinares.

The area of "neurotheology" is outlined in this article. In doing so, the author identifies its methodological limits, proposes a thematic classification and analyzes its present scope. Using the scheme proposed initially by Aldous Huxley, three groups of possible objectives are identified: those focused on "practical operationalism", "transcendental operationlism" and "mystic operationalism". Examples of ongoing research into each of these groups of possible objectives are provided, with some discussion of the new debates they have sparked. The renewed interest in religion on the part of experimental science is underscored and a better framework for reflecting on the place and weight of such studies in neuroethics is provided, together with a look at the particular obstacles that accompany interdisciplinary projects of this type.

Neste artigo eu exponho a área da "neuroteología", fixando os seus limites metodológicos, propondo uma classificação temática e analisando a sua projeção de hoje em dia. Mediante o esquema de Aldous Huxley, identifico três grupos de objetivos possíveis: enfocados na "operabilidade prática", "operabilidade transcendental" e "operabilidade mística". Além disso, apresento exemplos de pesquisas em cada grupo, assim como os novos debates que propiciam. Em síntese, sobressai o renovado interesse da ciência experimental pelo religioso. Também proporciono um quadro desde onde reflexionar melhor sobre o lugar e o valor destes estudos na neuroética e analiso os obstáculos específicos que acompanham esta classe de projetos interdisciplinares.

Feasibility of shortening respiratory isolation with a single sputum nucleic acid amplification test.

RATIONALE: Serial smear analysis to guide respiratory isolation (RI) of patients with suspected tuberculosis (TB), the majority of whom will be found not to have TB, leads to expensive and unnecessary isolation, and may potentially result in decreased vigilance of subjects with respiratory compromise. OBJECTIVES: To compare the performance of a single first-sputum, Mycobacterium tuberculosis-specific nucleic acid amplification (NAA) test with three sputum smears for assessing the need for RI. METHODS: Prospective evaluation of 493 patients with suspected TB (74% HIV positive) admitted to RI in a major county hospital in the United States, who had at least three sputum smears and material available from the first sample for additional NAA testing. MEASUREMENTS AND MAIN RESULTS: Accuracy of the first sputum NAA result and serial smears for identifying patients with potentially infectious TB who truly require RI was determined. Forty-six patients (9.3%) had TB confirmed by culture. First-sputum NAA test detected all patients with TB who had a positive smear (n = 35), even when the first of the three specimens was smear negative. In addition, when compared with serial smears, the first-sputum NAA had a higher sensitivity (0.87; 95% confidence interval [CI], 0.74-0.95) and specificity (1.0) in the detection of subjects with positive M. tuberculosis cultures (smear sensitivity, 0.76; 95% CI, 0.61-0.87; and specificity, 0.96; 95% CI, 0.94-0.98). CONCLUSIONS: A single first-sputum NAA testing can rapidly and accurately identify the subset of patients with suspected TB who require RI according to serial sputum smears. Its potential use to shorten RI time does not preclude the need to obtain subsequent specimens for culture.