Del conductismo normativista a la bioética en la enseñanza de la ética médica

Tomar decisiones acertadas, desde el punto de vista ético-moral en medicina representa un desafío tomando en cuenta que el avance cientifico-tecnológico tiene un efecto dual como establece Horxheimer en la dialáctica de la ilustracion. Por un lado promueve el desarrollo material y por el otro un retroceso en el desarrollo práctico o etico-moral. La racionalidad instrumental que subyace a dicha dialéctica no solo se le considera defectuosa sino que además generadora de una falsa conciencia. Al enfrentarnos a un retroceso en lo ético-moral ¿ cómo lograr formar médicos que puedan encarnar valores éticos, pensamiento crítico, sean investigadores, innovadores, líderes y enfocados en atender las necesidades sociales del pais? El presente trabajo responde a la aplicación de filosofia hermeneútica. Se intenda clarifcar el modelo educativo para formar médicos como profesionales altamente calificados y con conciencia ético-moral. Ciñéndonos a esta metodología la interpretación se desarrolla en 4 capítulos. En capítulo 1 se interpreta la realidad problemática de las escuelas de medicina y el impacto de la corriente Flexneriana que impulsa el desarrollo de la técnica en detrimento de la ética. Se plantea la importancia de superar el modelo tradicional de enseñanza centrada en el profesor a uno con mayor participación del estudiante en que construya su propio aprendizaje y un docente como facilitador. Capítulo 2 es un núcleo de discusión entre paradigmas por tanto se desarrolla un debate teórico entre los paradigmas conductista y constructivista y de qué manera una enseñanza promovedora del aprendizaje autónomo y constructivo, en entornos de aprendizaje positivos propicia la formación de competencias científicas y de valores como la responsabilidad, el autoconocimiento, el razonamiento moral y el juicio ético. Capitulo 3 se desarrolla el núcleo de implicaciones conceptuales del paradigma defendido por tanto se clarifica los aportes del constructivismo a la formación de un médico con pensamiento crítico y habilidades, destrezas y poseedor de las competencias Tuning y qúe elementos de la ética y la bioética requieren ser incluidos En el capítulo 4, se interpreta de qué modo un facilitador de la educación superior, al aplicar metodología constructivista favorece el proceso dialéctico entre el sujeto que cognoce y el objeto de conocimiento mediante la creación de procedimientos coherentes, los cuales propician la elaboración de estructuras de conocimiento de complejidad creciente. Cuando se construye en interacción con otros se da un proceso de socioestructuración que fomenta una determinada intersubjetividad (conciencia ético-moral), lo cual nos indica que el constructivismo favorece un proceso integrador del contexto educativo y una visión de sistema; La formación moral, se fortalece mediante la enseñanza de la ética pura y las éticas aplicadas como la dialógica que permite trascender del yo personal basada en “yo pienso” al “ nosotros argumentamos” y en el reconocimiento del otro ( el paciente ) como interlocutor válido. La práctica interdisciplinar en ambientes positivos, favorece el modelaje de competencias humanísticas. La enseñanza de la ética no es sólo cuestión de aprendizaje constructivo y obligatorio de la ética deontológica y la bioética, sino también un asunto para ser pensado en el contexto educativo como una comunidad moral, en que se debe actuar aplicando diferentes estrategias, durante todo el ciclo educativ

Lesion-symptom mapping corroborates lateralization of verbal and nonverbal memory processes and identifies distributed brain networks responsible for memory dysfunction.

Memory disorders are a common consequence of cerebrovascular accident (CVA). However, uncertainties remain about the exact anatomical correlates of memory impairment and the material-specific lateralization of memory function in the brain. We used lesion-symptom mapping (LSM) in patients with first-time CVA to identify which brain structures are pivotal for verbal and nonverbal memory and to re-examine whether verbal and nonverbal memory functions are lateralized processes in the brain. The cognitive performance of a relatively large cohort of 114 patients in five classic episodic memory tests was analysed with factor analysis. Two factors were extracted that distinguished the verbal and nonverbal components of these memory tests, and their scores were subsequently tested for anatomical correlates by combining univariate and multivariate LSM. LSM analysis revealed for the verbal factor exclusively left-hemispheric insular, subcortical and adjacent white matter regions and for the nonverbal factor exclusively right-hemispheric temporal, occipital, insular, subcortical and adjacent white matter structures. These results corroborate the long-standing hypothesis of a material-specific lateralization of memory function in the brain and confirm a robust association between right temporal lobe lesions and nonverbal memory dysfunction. The right-hemispheric correlates for the nonverbal aspects of episodic memory include not only classic memory structures in the medial temporal lobe but also a more distributed network that includes cortical and subcortical structures also known for implicit memory processes

Capillary-Force-Assisted Optical Tuning of Coupled Plasmons.

An ultrathin (few nanometer) polymer spacer layer is softened by local optical heating and restructured by strong capillary forces, which increase the gap between the plasmonic metal components. This results in a continuous blue-shift of the coupled plasmon from near infrared to visible with a tuning range of >150 nm that can be tightly controlled by adjusting either irradiation time or power.This work was supported by UK EPSRC grants EP/G060649/1, EP/L027151/1, and ERC grant LINASS 320503This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1002/adma.20150329

Re-structuring lentiviral vectors to express genomic RNA via cap-dependent translation

Lentiviral (LV) vectors based on human immunodeficiency virus type I (HIV-1) package two copies of their single-stranded RNA into vector particles. Normally, this RNA genome is reverse transcribed into a double-stranded DNA provirus that integrates into the cell genome, providing permanent gene transfer and long-term expression. Integration-deficient LV vectors have been developed to reduce the frequency of genomic integration and thereby limit their persistence in dividing cells. Here, we describe optimization of a reverse-transcriptase-deficient LV vector, which enables direct translation of LV RNA genomes upon cell entry, for transient expression of vector payloads as mRNA without a DNA intermediate. We have engineered a novel LV genome arrangement in which HIV-1 sequences are removed from the 5′ end, to enable ribosomal entry from the 5′ 7-methylguanylate cap for efficient translation of the vector payload. We have shown that this LV-mediated mRNA delivery platform provides transient transgene expression in vitro and in vivo. This has a potential application in gene and cell therapy scenarios requiring temporary payload expression in cells and tissues that can be targeted with pseudotyped LV vectors

An Engineered IFNγ-Antibody Fusion Protein with Improved Tumor-Homing Properties

Interferon-gamma (IFNγ) is one of the central cytokines produced by the innate and adaptive immune systems. IFNγ directly favors tumor growth control by enhancing the immunogenicity of tumor cells, induces IP-10 secretion facilitating (CXCR3+) immune cell infiltration, and can prime macrophages to an M1-like phenotype inducing proinflammatory cytokine release. We had previously reported that the targeted delivery of IFNγ to neoplastic lesions may be limited by the trapping of IFNγ-based products by cognate receptors found in different organs. Here we describe a novel fusion protein consisting of the L19 antibody, specific to the alternatively spliced extra-domain B of fibronectin (EDB), fused to a variant of IFNγ with reduced affinity to its cognate receptor. The product (named L19-IFNγ KRG) selectively localized to tumors in mice, showed favorable pharmacokinetic profiles in monkeys and regained biological activity upon antigen binding. The fusion protein was investigated in two murine models of cancer, both as monotherapy and in combination with therapeutic modalities which are frequently used for cancer therapy. L19-IFNγ KRG induced tumor growth retardation and increased the intratumoral concentration of T cells and NK cells in combination with anti-PD-1

Glyconanoparticles for colorimetric bioassays

Carbohydrate molecules are involved in many of the cellular processes that are important for life. By combining the specific analyte targeting of carbohydrates with the multivalent structure and change of solution colour as a consequence of plasmonic interactions with the aggregation of metal nanoparticles, glyconanoparticles have been used extensively for the development of bioanalytical assays. The noble metals used to create the nanocore, the methodologies used to assemble the carbohydrates on the nanoparticle surface, the carbohydrate chosen for each specific target, the length of the tether that separates the carbohydrate from the nanocore and the density of carbohydrates on the surface all impact on the structural formation of metal based glyconanoparticles. This tutorial review highlights these key components, which directly impact on the selectivity and sensitivity of the developed bioassay, for the colorimetric detection of lectins, toxins and viruses

Status of the LUX Dark Matter Search

The Large Underground Xenon (LUX) dark matter search experiment is currently being deployed at the Homestake Laboratory in South Dakota. We will highlight the main elements of design which make the experiment a very strong competitor in the field of direct detection, as well as an easily scalable concept. We will also present its potential reach for supersymmetric dark matter detection, within various timeframes ranging from 1 year to 5 years or more.Comment: 4 pages, in proceedings of the SUSY09 conferenc

Scale and intensity of intertidal habitat use by knots Calidris canutus in the Western Wadden Sea in relation to food, friends and foes

In August-October 1988-1992 we studied the distribution and abundance of knots Calidris canutus around Griend in the western Wadden Sea, and the extent to which these can be explained by benthic prey availability and presence of avian predators. Numbers in the nonbreeding season showed monthly averages of 10000 to 25000 birds. Over 100000 knots were recorded on three occasions. Knots feed in large flocks, individual birds usually experiencing 4000 to 15000 flock-mates. The Siberian-breeding/west-African wintering canutus subspecies passed through in late July and early August. Otherwise the Greenlandic/Canadian breeding islandica subspecies was present. Over the period 1964-1992 there were no clear trends in the number of knots, but canutus-knots were particularly abundant in July-August 1991, whereas in 1992 both subspecies were absent. Macoma balthica was the preferred prey of both subspecies. Hydrobia ulvae, Mytilus edulis and Cerastoderma edule were eaten when Macoma was absent close to the surface of the sediment. As Macoma buried deeper from July onwards, canutus faced better average feeding conditions than islandica later in the year. The spatial distribution of knots feeding on the intertidal flats around Griend was best explained by the harvestable biomass of the prevalent prey species in a particular year and season, i.e. Macoma (main prey when their harvestable biomass densities were greater than ca 0.8 g AFDM per m2) and Cerastoderma, and by the avoidance of situations where they run the risk of attack by bird-eating birds. Flocks of knots covered most of the intertidal flats in the western Dutch Wadden Sea in a couple of tidal cycles. This is about 800 km2, much larger than the equivalent area used by knots on their wintering grounds in Mauritania (10-15 km2), a difference that is correlated with prey spectrum, prey availability and predictability.