Condiciones para preservar e valor moral del consentimiento informado en medicina

El consentimiento informado (CI) en medicina corre el riesgo de quedar reducido a un formalismo legal sin valor moral; esto puede suceder por dos cosas: 1) como consecuencia de que el paciente no comprenda con suficiencia el concepto de autonomía y 2) debido a la disminución de la autonomía práctica del paciente por efecto de la autoridad del personal médico o de las instituciones de salud. Este artículo tiene como fin mostrar bajo qué condiciones se puede evitar la reducción del CI a un formalismo legal desprovisto de valor moral. Para servir a este propósito, se considera el concepto de autonomía relacional como eje articulador que pone en relación al paciente con su comunidad moral y con el médico, lo que impulsa al personal de la salud a proporcionar las condiciones para tal fin. Así, se afirma que la valía moral del CI puede conservarse, primero, a partir de una concepción relacional de la autonomía y, segundo, mediante la aplicación, por parte del médico y de la institución, de un protocolo que disminuya la posibilidad de choque entre la autonomía y la autoridad.

Charlie Cook's favourite book.

Érase una vez un niño llamado Charlie Cook, que sentado en un cómodo sillón leía su libro favorito, con historias de piratas, de caballeros y dragones, de fantasmas, de niñas rubias, de reyes y reinas.

The gruffalo's child.

El gruffalo dice a su pequeño que no debe nunca entrar en el bosque porque puede encontrar al malvado ratón gigante y le explica cómo es. Cuando el padre se duerme,el hijo del gruffalo hace caso omiso de la advertencia y con su muñeca de palo bajo el brazo entra en el bosque. Sigue en la nieve los rastros de la serpiente, la lechuza y el zorro. Finalmente encuentra a un pequeño ratón que con un inteligente truco hace creer al pequeño que el malvado ratón gigante existe y la criatura vuelve para dormir en los brazos de su padre. La historia está narrada en verso y adecuada para niños entre siete y once años.

Monkey puzzle.

Co un texto en rima se cuenta la historia de un mono joven que ha perdido a su mamá, y una mariposa que se ofrece a reunirlos. La mariposa pide al mono que describa a su madre. Sin embargo, no es tan sencillo como parece, y se tarda bastante tiempo antes de que la mariposa lo consiga. La mariposa malinterpreta las descripciones que hace el mono de su mamá y lo lleva a todo tipo de animales, elefante, araña, murciélago, loro, serpiente, rana. Por último después de mucho ensayo y error consigue llevar al monito con su madre, cuando se entera que se parece a él. Al fin y al cabo no todos los bebés se parecen a sus madres, porque ninguno de sus bebés se parecen a ella, son orugas.

The gruffalo.

Una historia en rima de un ratón y un monstruo. El pequeño ratón va a dar un paseo por un peligroso bosque donde se encuentra con un zorro, una serpiente, una lechuza. Para intimidar a sus enemigos, inventa cuentos fantásticos de una criatura llamada Gruffalo que sus comidas favoritas son, asado de zorro, helado de lechuza, sopa de serpiente. Los animales huyen perdiendo el interés por el ratón, pero éste encuentra un verdadero gruffalo.

Room on the broom.

Esta bruja con una larga trenza color zanahoria sobre la que lleva un sombrero alto, y que va sentada en un palo de escoba, acompañada de un gato y un caldero, vuela con el viento. Pero, a veces éste le juega malas pasadas, y golpea con tanta furia que le vuela el sombrero o le saca el lazo de la coleta, también le tira la varita mágica al río o le parte por la mitad la escoba.

The snail and the whale.

Es la historia de un pequeño caracol y de una grande y larga ballena jorobada. El caracol se desliza sobre una roca negra como el hollín desde la que divisa el mar y los barcos en el puerto. Los mira fijamente y suspira por conocer el profundo mar y el ancho mundo, pero cómo podría ella viajar sino enganchada a la cola de la enorme ballena.

The use of innovative financial instruments for financing EU policies and objectives: Implications for EU and national budgets. CEPS Special Report, October 2012

This CEPS Special Report analyses the proposed expansion of innovative financial instruments in the EU Multiannual Financial Framework for the 2014–20 period. It presents the economic rationale, governance principles and criteria that these instruments should follow and compares these with proposals from the European Commission. Based on this assessment, it makes recommendations for the proposed instruments.

The influence of a weakening of the Atlantic meridional overturning circulation on ENSO

The influences of a substantial weakening of the Atlantic meridional overturning circulation (AMOC) on the tropical Pacific climate mean state, the annual cycle, and ENSO variability are studied using five different coupled general circulation models (CGCMs). In the CGCMs, a substantial weakening of the AMOC is induced by adding freshwater flux forcing in the northern North Atlantic. In response, the well-known surface temperature dipole in the low-latitude Atlantic is established, which reorganizes the large-scale tropical atmospheric circulation by increasing the northeasterly trade winds. This leads to a southward shift of the intertropical convergence zone (ITCZ) in the tropical Atlantic and also the eastern tropical Pacific. Because of evaporative fluxes, mixing, and changes in Ekman divergence, a meridional temperature anomaly is generated in the northeastern tropical Pacific, which leads to the development of a meridionally symmetric thermal background state. In four out of five CGCMs this leads to a substantial weakening of the annual cycle in the eastern equatorial Pacific and a subsequent intensification of ENSO variability due to nonlinear interactions. In one of the CGCM simulations, an ENSO intensification occurs as a result of a zonal mean thermocline shoaling. Analysis suggests that the atmospheric circulation changes forced by tropical Atlantic SSTs can easily influence the large-scale atmospheric circulation and hence tropical eastern Pacific climate. Furthermore, it is concluded that the existence of the present-day tropical Pacific cold tongue complex and the annual cycle in the eastern equatorial Pacific are partly controlled by the strength of the AMOC. The results may have important implications for the interpretation of global multidecadal variability and paleo-proxy data.

Gender stereotyping and decision processes: extending and reversing the gender bias in fame judgements

M. R. Banaji and A. G. Greenwald (1995) demonstrated a gender bias in fame judgments—that is, an increase in judged fame due to prior processing that was larger for male than for female names. They suggested that participants shift criteria between judging men and women, using the more liberal criterion for judging men. This "criterion-shift" account appeared problematic for a number of reasons. In this article, 3 experiments are reported that were designed to evaluate the criterion-shift account of the gender bias in the false-fame effect against a distribution-shift account. The results were consistent with the criterion-shift account, and they helped to define more precisely the situations in which people may be ready to shift their response criterion on an item-by-item basis. In addition, the results were incompatible with an interpretation of the criterion shift as an artifact of the experimental situation in the experiments reported by M. R. Banaji and A. G. Greenwald. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Negative correlations between control performance and verbalizable knowledge: indicators for implicit learning in process control tasks?

Negative correlations between task performance in dynamic control tasks and verbalizable knowledge, as assessed by a post-task questionnaire, have been interpreted as dissociations that indicate two antagonistic modes of learning, one being “explicit”, the other “implicit”. This paper views the control tasks as finite-state automata and offers an alternative interpretation of these negative correlations. It is argued that “good controllers” observe fewer different state transitions and, consequently, can answer fewer post-task questions about system transitions than can “bad controllers”. Two experiments demonstrate the validity of the argument by showing the predicted negative relationship between control performance and the number of explored state transitions, and the predicted positive relationship between the number of explored state transitions and questionnaire scores. However, the experiments also elucidate important boundary conditions for the critical effects. We discuss the implications of these findings, and of other problems arising from the process control paradigm, for conclusions about implicit versus explicit learning processes.

The impact of global warming on the tropical Pacific Ocean and El Niño

The El Niño–Southern Oscillation (ENSO) is a naturally occurring fluctuation that originates in the tropical Pacific region and affects ecosystems, agriculture, freshwater supplies, hurricanes and other severe weather events worldwide. Under the influence of global warming, the mean climate of the Pacific region will probably undergo significant changes. The tropical easterly trade winds are expected to weaken; surface ocean temperatures are expected to warm fastest near the equator and more slowly farther away; the equatorial thermocline that marks the transition between the wind-mixed upper ocean and deeper layers is expected to shoal; and the temperature gradients across the thermocline are expected to become steeper. Year-to-year ENSO variability is controlled by a delicate balance of amplifying and damping feedbacks, and one or more of the physical processes that are responsible for determining the characteristics of ENSO will probably be modified by climate change. Therefore, despite considerable progress in our understanding of the impact of climate change on many of the processes that contribute to El Niño variability, it is not yet possible to say whether ENSO activity will be enhanced or damped, or if the frequency of events will change.