A critical realist analysis of consent to surgery for children, human nature and dialectic: the pulse of freedom

Consent can only be voluntary, freely given and uncoerced. Can this legal adult standard also apply to children? High-risk surgery is seldom a wanted choice, but compared with the dangers of the untreated problem, surgery can become the least unwanted option. Critical realism helps to reveal explicit and hidden levels of informed and voluntary consent at empirical, actual and real levels, on the four planes of social being and through the four-stage dialectic. Instead of starting with the rational-legal adult patient standard of consent, and assessing how young children fail this, understanding of consent could start at the other end of life. What does innate physical-social-moral-intuitive human nature in the emotional embodied person tell us about the meaning and purpose of consent/refusal for self-preservation, for avoiding suffering and promoting wellbeing? This discussion paper considers examples of life-giving treatment for children, and ethical dilemmas including one of conjoined twins, when only one child could survive separation

Dialectic and informed and voluntary consent: the pulse of freedom

The pulse in the title Dialectic: The Pulse of Freedom (Bhaskar, 2008) suggests a beating heart, and consent is at the heart of freedom. Its absence is at the heart of coercion. From personal to political, marriage to the vote, consent threads through daily interactions. Consent may be respected or not. A mouse click ‘consenting’ to cookies may join thousands of individuals’ clicks used by agencies for advertising or for fixing elections. The agencies may bypass consent when they rely not only on the first uninformed, unthinking click, but also on the half-attentive skimming of messages when readers may scarcely notice how these can alter their beliefs and behaviours. Consent to medical treatment or surgery is a major topic in bioethics, and the topic of our research. Yet we also aim to understand the meaning and purpose of consent more broadly in personal and political contexts. Our paper reviews how critical realism can help to deepen analysis, first of consent and second of why consent matters when it is more than a cerebral or arbitrary choice but expresses powerfully held values. This discussion paper is based on earlier research about parents’ consent to children’s heart surgery (Alderson, 1990) and related current research (Sutcliffe et al., 2019), children’ consent to orthopaedic surgery (Alderson 1993), children’s share in managing diabetes (Alderson et al., 2006; Sutcliffe, 2010) and parents’ decisions about neonatal care (Alderson et al., 2005; Mendizabal, 2017)

Parents' and children's informed and voluntary consent to heart surgery: Protocol

This research is intended to increase understanding of the views and experiences of children aged 6-15 years having heart surgery, their needs, hopes and fears, in order that parents and practitioners may provide children with more research-based information and support. The aim is to contribute to ways of involving children in the decision making process before heart surgery, so that their acceptance or consent, as well as their parents’ consent, are well informed and voluntary. The research will also examine children’s, parents and staff views about the age of consent, and when children become competent to give consent to heart surgery ‘as well as their parents can’

SDRS: a new lossless dimensionality reduction for text corpora

In recent years, most content-based spam filters have been implemented using Machine Learning (ML) approaches by means of token-based representations of textual contents. After introducing multiple performance enhancements, the impact has been virtually irrelevant. Recent studies have introduced synset-based content representations as a reliable way to improve classification, as well as different forms to take advantage of semantic information to address problems, such as dimensionality reduction. These preliminary solutions present some limitations and enforce simplifications that must be gradually redefined in order to obtain significant improvements in spam content filtering. This study addresses the problem of feature reduction by introducing a new semantic-based proposal (SDRS) that avoids losing knowledge (lossless). Synset-features can be semantically grouped by taking advantage of taxonomic relations (mainly hypernyms) provided by BabelNet ontological dictionary (e.g. “Viagra” and “Cialis” can be summarized into the single features “anti-impotence drug”, “drug” or “chemical substance” depending on the generalization of 1, 2 or 3 levels). In order to decide how many levels should be used to generalize each synset of a dataset, our proposal takes advantage of Multi-Objective Evolutionary Algorithms (MOEA) and particularly, of the Non-dominated Sorting Genetic Algorithm (NSGA-II). We have compared the performance achieved by a Naïve Bayes classifier, using both token-based and synset-based dataset representations, with and without executing dimensional reductions. As a result, our lossless semantic reduction strategy was able to find optimal semantic-based feature grouping strategies for the input texts, leading to a better performance of Naïve Bayes classifiers.info:eu-repo/semantics/acceptedVersio

Global emergency remote education in secondary schools during the COVID-19 pandemic: A systematic review

The worldwide shift to emergency remote education in 2020 as a result of the COVID-19 pandemic impacted billions of students and teachers. A range of teaching and learning strategies were employed by schools as a result, despite confusing and sometimes contradictory government guidance, with systemic issues such as equity and access impacting heavily on disadvantaged students. In light of the findings of a recent IPPO evidence snapshot and roundtable event, and in order to gain further insight into how emergency remote education was experienced by secondary school students, parents and educators, a systematic review was conducted that collates and synthesises primary empirical studies across five key research questions focusing on student engagement, online assessment, peer collaboration, parent engagement, and future directions for online learning. Studies were searched for in May 2021 using Web of Science, Scopus, ERIC, Microsoft Academic Graph, ResearchGate and the COVID-19 living map, and were included if they focused on teaching and learning using blended or online approaches in secondary schools during the pandemic, that were published in English. Following quality assessment on scope and methodological rigour, 81 studies were included for narrative synthesis. The research studies were conducted in 38 countries, with 37% of studies from low or lower-middle income countries, and 63% from upper-middle income or high-income countries. Most of the evidence came from students (64%), followed by teachers (53%), with very few studies exploring the perceptions and experiences of parents (6%) or school leaders (5%). Findings reveal that self-regulation and understanding were the most frequently reported indicators of student engagement, with online assessment tools, learning management systems with collaborative tools, live synchronous lessons with peer and teacher interaction, and teacher-made videos considered particularly engaging. Social isolation was the most frequently reported indicator of disengagement, characterised by poor attendance in live lessons, a lack of opportunities to seek help with challenges and difficulties facilitating peer collaboration. Although many articles reported that assessment online was particularly challenging, 21 different types of online assessments strategies were identified, with online quizzes and formative online feedback the most frequently used. Live marking or recorded feedback and assessment were found to be particularly beneficial, as providing feedback during live lessons was sometimes challenging. Peer collaboration was facilitated through peer assessment, inquiry-based group work and experiments, aided by the use of collaborative software and combining multiple applications. Parental involvement and support contributed to student learning, although issues of equity impacted the extent to which they could engage with their children's learning, alongside gaps in family content knowledge and technological skills. Numerous implications for future policy relating to online and blended learning are provided

Time Sensitive Parameters of Immune Reconstitution Measured Between Day 100 and 1 Year Predict Survival After Unrelated Cord Blood Transplant (UCBT): The Dynamic Impact of Dendritic Cells, Tregs, and Thymic Recovery

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Living bioethics, clinical ethics committees and children's consent to heart surgery

This discussion paper considers how seldom recognised theories influence clinical ethics committees. A companion paper examined four major theories in social science: positivism, interpretivism, critical theory and functionalism, which can encourage legalistic ethics theories or practical living bioethics, which aims for theory–practice congruence. This paper develops the legalistic or living bioethics themes by relating the four theories to clinical ethics committee members’ reported aims and practices and approaches towards efficiency, power, intimidation, justice, equality and children’s interests and rights. Different approaches to framing ethical questions are also considered. Being aware of the four theories’ influence can help when seeking to understand and possibly change clinical ethics committee routines. The paper is not a research report but is informed by a recent study in two London paediatric cardiac units. Forty-five practitioners and related experts were interviewed, including eight members of ethics committees, about the work of informing, preparing and supporting families during the extended process of consent to children’s elective heart surgery. The mosaic of multidisciplinary teamwork is reported in a series of papers about each profession, including this one on bioethics and law and clinical ethics committees’ influence on clinical practice. The qualitative social research was funded by the British Heart Foundation, in order that more may be known about the perioperative views and needs of all concerned. Questions included how disputes can be avoided, how high ethical standards and respectful cooperation between staff and families can be encouraged, and how minors’ consent or refusal may be respected, with the support of clinical ethics committees