Ethics Service Research Articles

Genetic Overlap of Acute Myocarditis and Inherited Cardiomyopathy

Background: Acute myocarditis is a complex inflammatory disease increasingly associated with dilated cardiomyopathy (DCM) and arrhythmogenic ventricular cardiomyopathy (ACM), but its underlying genetic basis is unknown. We sought to determine if there is a genetic overlap between myocarditis and inherited forms of cardiomyopathy. Methods: Population-based cohort of 336 consecutive patients with acute myocarditis enrolled in London and Maastricht. All participants underwent targeted DNA-sequencing for well-characterised cardiomyopathy-associated genes with comparison to healthy controls (n=1053). Case ascertainment was assessed against national admission data. Findings: Variants of known or likely pathogenicity were identified in 6% of cases compared to <1% of controls (∆+5%; p=0.0097). In London (n=230; median age 33years; 84% men), which was representative of national myocarditis admissions (median age 32years; 71% men; 66% case ascertainment), 4.8% of cases carried rare truncating variants (tv), particularly within ACM genes (3% cases vs 0% controls; odds ratio 8.2; p=0.001). This was predominantly driven by desmoplakin ( DSP )-tv in patients with normal LVEF and ventricular arrhythmia. In Maastricht (n=106; median age 54years; 61% men), there was enrichment of rare tv in DCM genes, particularly TTN -tv found in 7% (all with LVEF<50%) compared to 1% in controls (OR 3.6; p=0.0116). DCM variants occurred in patients with LV dysfunction (median LVEF 39% vs 60%; p<0.0001). During a median follow-up of 1.9years, all-cause mortality was greatest with a DCM variant (18% vs 4% with no variant; OR 5.0; p=0.004). Interpretation: One in 20 myocarditis cases had a DCM- or ACM-associated genetic variant that would potentially inform clinical management and need for family screening. This was dominated by DSP -tv in those with normal LVEF, and TTN -tv in those with reduced LVEF. Routine genetic testing may be beneficial in acute myocarditis. Funding: British Heart Foundation, Alexander Jansons Foundation, Royal Brompton Hospital, Imperial College London, Wellcome Trust, Medical Research Council and Rosetrees Trust. Declaration of Interest: SKP has received honoraria from Bayer Schering and travel support from Circle 42, outside the submitted work. JSW has received personal fees from Myokardia, outside the submitted work. JSW also has a patent (US 62383189—Methods, systems and apparatus for identifying pathogenic gene variants) issued. DJP has received research support from Siemens and Bayer, and personal fees from Bayer and Chiesi, outside the submitted work. All other authors declare no competing interests. Ethical Approval: All participants in cohorts 1, 2 and 3 provided written informed consent as approved by the 23 National Research Ethics Service [references 09/H0504/104+5 and 09/H0707/69] or Medical Ethical Committee of Maastricht University.

Mental Health, Wellbeing and Technology Use Amongst UK Adolescents: An Exploration of &lt;i&gt;Understanding Society&lt;/i&gt;: The UK Household Longitudinal Study

Background: Most research explores the impact of digital technology, specifically social networking sites, on mental health and wellbeing amongst adolescents. Findings suggest small effects with a possible link amongst girls. This investigates whether levels of mental health and wellbeing impact use of digital technology amongst adolescents. Methods: Data come from waves 1-9 of Understanding Society: The UK Household Longitudinal Study, a longitudinal panel study with a youth panel (10-15 year olds) where household members are interviewed annually. Young people were asked about time spent using social networking sites, and gaming on a console or computer. Measures of mental health and wellbeing were the Strengths and Difficulties Questionnaire and a composite happiness measure. Random effects ordinal logistic models were used to test associations. Findings: Higher levels of happiness and lower levels of poor mental health were associated with lower levels of digital technology use. Slightly larger associations were observed amongst girls for social networking site use and amongst boys for console gaming. There were no gender differences in the association between levels of mental health and wellbeing and time spent playing computer games. Happiness with family was associated with social networking site use for girls while happiness with friends was associated for boys. Internalising behaviours showed associations across all types of digital technology with higher levels of internalising associated with increased time on digital technology. Interpretation: The findings of this study suggest that there is a relationship between existing mental ill health and increased use of digital technology for adolescents. There also appear to be certain aspects of these measures which may be important, particularly internalising behaviours. Future studies should explore the pathways of these relationships to identify characteristics of vulnerable young people and to inform policy and decisions of parents and young people in their use of digital technology. Funding Information: YK was supported by the Economic and Social Research Council (ESRC ES/R008930/1); CB was supported by (ESRC RES-586-47-0001/RES-586-47-0002). Understanding Society is funded through the following ESRC grants: Understanding Society: The UK Longitudinal Household Study (RES-586-47-0001); Understanding Society, the UK Longitudinal Studies Centre (RES-586-47-0002). The ESRC provided funding for the collection of UKHLS data; however they were not involved in the study design, analysis, interpretation of the data or writing up of this paper. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: Parents or guardians provides consent for young people to participate. Young people are then asked for assent for a pen-and-paper questionnaire. The University of Essex Ethics Committee has approved all data collection on Understanding Society main study and innovation panel waves, including asking consent for all data linkages except to health records. Requesting consent for health record linkage was approved at Wave 1 by the National Research Ethics Service (NRES) Oxfordshire REC A (08/H0604/124), at BHPS Wave 18 by the NRES Royal Free Hospital & Medical School (08/H0720/60) and at Wave 4 by NRES Southampton REC A (11/SC/0274). Approval for the collection of biosocial data by trained nurses in Waves 2 and 3 of the main survey was obtained from the National Research Ethics Service (Understanding Society - UK Household Longitudinal Study: A Biosocial Component, Oxfordshire A REC, Reference: 10/H0604/2).

Catholic Health Care Ethics: A Manual for Practitioners ed. by Edward J. Furton

Reviewed by: Catholic Health Care Ethics: A Manual for Practitioners ed. by Edward J. Furton Basil Cole O.P. Catholic Health Care Ethics: A Manual for Practitioners. Third Edition. Edited by Edward J. Furton. Philadelphia: Catholic Bioethics Center, 2020. Pp. xvii + 753. $49.95 (softcover). ISBN 978-0-935372-70-0. This work is not for beginners in the field of medical moral theology or Catholic bioethics. It presumes that one is already working in the medical field and knows some of the tools for appraising difficult moral questions about health. This reviewer can only indicate what he considers some highlights. This third edition contains studies by thirty-seven new authors, in addition to authors of the second edition whose articles were updated (to varying degrees). The volume consists of six parts with a total of thirty-nine chapters, some of which are divided into many subchapters written by different authors. Part I, "Foundational Principles," focuses on fundamental moral theology, with a new chapter on the Ethical and Religious Directives. Part II places new emphasis on "Health Care Ethics Services," and contains many articles on the importance of bioethical committees and consultation services for hospitals and dioceses. Part III addresses beginning-of life issues such as family planning. Part IV turns to end-of-life issues with some very deep reflections on determining death, care of the dying, advance directives, and solutions to controversies surrounding burial of corpses or the fetal remains of those who perished in the womb, whether by deliberate abortion or otherwise. Part V, "Selected Clinical Issues," attempts to unravel difficult problems, such as concerning organ donation and vaccination development based on previously aborted fetuses or human experimentation, and the interplay of patients with those who care for them. Finally, Part VI, titled "Institutional Issues," discusses, among other problems, the hospital care of newborns, collaborative work with other hospitals, conscientious objections, and gender dysphoria. Due to the size and scope of newer problems facing Catholic bioethics and healthcare, not all pertinent difficulties are, or could have been, included in this admittedly ample third edition. [End Page 493] What happened that such a large amount of bioethical thinking was needed in such a short period of time since the second edition, published in 2009? Scientific discoveries and medical cure and care advances remind us that some parts of ethical thinking are not absolute or stable because new dilemmas emerge, although the cardinal and theological virtues remain the same. Saint Thomas Aquinas, as well as common sense, teaches that one's first natural inclination that guides the desire for happiness is to remain and flourish in existence notwithstanding certain limitations such as illness and death (STh I-II, q. 94). This inclination is the basis for all healthcare and one of the first principles of bioethics. Medical decisions are governed by the principle of totality, that a part of the human body can be sacrificed for the survival and well-being of the whole (STh II-II, q. 65, a. 1). But in practice, medical decisions can be morally right or wrong insofar as they uphold or violate other principles of human flourishing. The order, or teleology, of human nature, knowable by reason and confirmed by divine revelation, contains standards, rules, precepts, and commands, not merely ideals, that indicate what kinds of medical behavior violate the moral domain of a person and the fundamental goods of human nature. Some medical interventions are wrong, not because the Church says so (as if they were simply edicts), but because certain natural goods are diminished, impeded, or harmed within the human person, thereby undermining the dignity of the human person as an image of God. While "autonomy," "beneficence," "nonmalfeasance," and "justice to others" are standard value words that today's hospitals apply to good health care for individuals, these notions do not define what is to be done in a clinical situation. The value of autonomy, for example, could lead a patient to desire something such as euthanasia, which violates the autonomy of the Catholic hospital and a doctor's conscience. Some systems of bioethics have added health maximalization, efficiency, and proportionality to the traditional principalism of Tom Beauchamp and...

Clinical Predictors of Encephalitis in UK Adults – A Multi-Centre Prospective Observational Cohort Study

Background: Encephalitis, brain inflammation and swelling, most often caused by an infection or the body’s immune defences, can have devastating consequences, especially if diagnosed late. We looked for clinical predictors of different types of encephalitis to help clinicians consider earlier treatment. Methods: We conducted a multicentre prospective observational cohort study (ENCEPH-UK) of adults (> 16 years) with suspected encephalitis at 31 UK hospitals. We evaluated clinical features and investigated for infectious and autoimmune causes. Findings: 341 patients were enrolled between December 2012 and December 2015 and followed up for 12 months. 233 had encephalitis, of whom 65 (28%) had herpes simplex virus (HSV), 38 (16%) had confirmed or probable autoimmune encephalitis, and 87 (37%) had no cause found. The median time from admission to 1st dose of aciclovir for those with HSV was 14 hours (IQR 5-50); time to 1st dose of immunosuppressant for the autoimmune group was 125 hours (IQR 45-250). Compared to non-HSV encephalitis, patients with HSV more often had fever, lower serum sodium and lacked a rash. Those with probable or confirmed autoimmune encephalitis were more likely to be female, have abnormal movements, normal serum sodium levels and a cerebrospinal fluid white cell count < 20 cells x106/L, but they were less likely to have a febrile illness. Interpretation: Initiation of treatment for autoimmune encephalitis is delayed considerably compared with HSV encephalitis. Clinical features can help identify patients with autoimmune disease and could be used to initiate earlier presumptive therapy. Clinical Trial Registration Details: Funding Information: National Institute for Health Research, UK. Declaration of Interests: None to declare. Ethics Approval Statement: The study protocols were approved by participating sites and the National Research Ethics Service (now part of the Health Research Authority) East Midlands Nottingham 1 committee (reference 11/EM/0442). Written consent for entry into the study was obtained from patients or an accompanying relative.

Effectiveness of First Dose of COVID-19 Vaccines Against Hospital Admissions in Scotland: National Prospective Cohort Study of 5.4 Million People

Background: The BNT162b2 mRNA (Pfizer-BioNTech) and ChAdOx1 (Oxford-AstraZeneca) COVID-19 vaccines have demonstrated high efficacy against infection in phase 3 clinical trials and are now being used in national vaccination programmes in the UK and several other countries. There is an urgent need to study the ‘real-world’ effects of these vaccines. The aim of our study was to estimate the effectiveness of the first dose of these COVID-19 vaccines in preventing hospital admissions.Methods: We conducted a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) database comprising of linked vaccination, primary care, Real-Time Polymerase Chain Reaction (RT-PCR) testing, hospitalisation and mortality records for 5.4 million people in Scotland (covering ~99% of population). A time-dependent Cox model and Poisson regression models were fitted to estimate effectiveness against COVID-19 related hospitalisation (defined as 1- Adjusted Hazard Ratio) following the first dose of vaccine.Findings: The first dose of the BNT162b2 vaccine was associated with a vaccine effect of 85% (95% confidence interval [CI] 76 to 91) for COVID-19 related hospitalisation at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 94% (95% CI 73 to 99). Results of combined vaccine effect for prevention of COVID-19 related hospitalisation were comparable when restricting the analysis to those aged ≥80 years (81%; 95% CI 65 to 90 at 28-34 days post-vaccination).Interpretation: A single dose of the BNT162b2 mRNA and ChAdOx1 vaccines resulted in substantial reductions in the risk of COVID-19 related hospitalisation in Scotland.Funding: UK Research and Innovation (Medical Research Council); Research and Innovation Industrial Strategy Challenge Fund; Health Data Research UK.Conflict of Interest: AS is a member of the Scottish Government Chief Medical Officer’s COVID-19Advisory Group and the New and Emerging Respiratory Virus Threats (NERVTAG) Risk Stratification Subgroup. CRS declares funding from the MRC, NIHR, CSO and New Zealand Ministry for Business, Innovation and Employment and Health Research Council during the conduct of this study. SVK is co-chair of the Scottish Government’s Expert Reference Group on COVID-19 and ethnicity, is a member of the Scientific Advisory Group on Emergencies (SAGE) subgroup on ethnicity and acknowledges funding from a NRS Senior Clinical Fellowship, MRC and CSO. All other authors report no conflicts of interest.Ethical Approval: Approvals were obtained from the National Research Ethics Service Committee, Southeast Scotland 02 (reference number: 12/SS/0201) and Public Benefit and Privacy Panel for Health and Social Care (reference number: 1920-0279).

Assessing Ethical Issues in Tax Agencies in Mongolia

The primary goal of this study is to assess practices and services provided by tax agencies from an ethical standpoint, to research and evaluate the impact of the ethical problems on supporting businesses, to compare the findings with practices in other public administration agencies and to identify areas for improvement. The findings of the study indicate that: 1) Regarding the suitability of tax services for business environment, it currently looks not very supportive for business entities although it does appear to be average or slightly above average; 2) Six indicators of tax service ethics are carefully examined: knowledge and skills of tax staff; their interpersonal skills and ethics; consistency of rules on corruption and bribery within tax agencies; bureaucracy; and relationships among departments and units. When the data are combined and represented at the national level, in UB city and local population, the findings indicate that tax agencies demonstrate indicators of moderate ethical problems when compared to those of other government bodies across the country; 3) As the impact assessment of the above six indicators implies, interpersonal skills and inter-departmental relationship indicators in tax agencies in UB, knowledge and skills, interpersonal skills, and ethics indicators in the case of local tax agencies demonstrate having impact as the regressive equation suggests; 4) When ethics in tax agencies are thoroughly examined in terms of corruption, bribery and bureaucracy and their nationwide, UB city and local population aggregate distribution are presented, no indicators of corruption and bribery affecting the operations and services of tax agencies are observed; however, as regression equation recommends, a bureaucratic impact is detected.

Etika javne službe u lokalnoj samoupravi

Within different ethical approaches, public service ethics belongs to deontological ethics. It encompasses the moral culture of employees, professional integrity, and public service integrity in institutions. Public service ethics is based on the ethical principles of professionals: autonomy, benevolence, taking care not to inflict harm on others, and fair conduct. Professional associations are the guarantors of practising and respecting the ethical principles of professionals. The acceptance of and adherence to ethical principles of professional associations is embodied through self-regulation in the codes of ethics. The codes of ethics are based on ethical principles of professionals: accountability, openness, accessibility, transparency, exemplarity, respect, and politeness.

Participation predictors for leisure-time physical activity intervention in children with cerebral palsy.

To determine the predictors of magnitude of change in response to a participation-focused leisure-time physical activity intervention in children with cerebral palsy (CP) using the ParticiPAte CP protocol. We included 33 children (16 males, 17 females) aged 8 to 12years (mean age=10y, SD=1y 6mo) with CP with pre/postintervention data from a wait-list randomized trial. The hypothesized linear predictors of change in primary outcomes (Canadian Occupational Performance Measure [COPM]-performance and COPM-satisfaction, Belief in Goal Self-Competence Scale (BiGSS), and minutes per day moderate-to-vigorous physical activity [MVPA]) were: age; Gross Motor Function Classification System level; comorbid autism spectrum disorder (ASD); Goal Attainment Scaling T score; Problems in Schools Questionnaire; Physical Activity Climate Questionnaire; Motives for Physical Activities Measure-Revised; and stage of behaviour change. Multivariable models were selected using the Bayesian information criterion. Overcoming barriers to participation, age, and comorbid ASD explained 49% of the variance in change in COPM-performance. Being motivated by interest and/or enjoyment and age explained 32% of the variance in change in COPM-satisfaction. Being motivated by physical activity competence or appearance (extrinsic motivation) explained 24% of the variance in change in BiGSS. Parental autonomy supportiveness, overcoming barriers to participation, appearance motivation, and baseline MVPA explained 59% of the variance in change in MVPA. These findings support a behaviour paradigm for conceptualizing physical activity in children with CP. Children who met their treatment goals showed a greater increase in physical activity participation. Children who were more intrinsically motivated by physical activity at baseline improved more. Being older and having a comorbid diagnosis of autism spectrum disorder were associated with an attenuated effect of the therapy.

The Effectiveness of the First Dose of BNT162b2 Vaccine in Reducing SARS-CoV-2 Infection: Real-World Evidence

Background: BNT162b2 vaccines showed high efficacy against COVID-19 in a randomised controlled phase-III trial. A vaccine effectiveness evaluation in real life settings is urgently needed, especially given the global disease surge. Hence, we assessed the short-term effectiveness of the first dose of BNT162b2-vaccine against SARS-CoV-2 infection. Given the BNT162b2 Phase-III results, we hypothesized that the cumulative incidence of SARS-CoV-2 infection among vaccinees will decline after 12 days following immunization compared to the incidence during the preceding days.Methods: We conducted a retrospective cohort study using data from 2·6 million-member state-mandated health provider in Israel. Study population consisted of all members aged 16 or above years who were vaccinated with BNT162b2-vaccine between December/19/2020 and January/15/2021. We collected information regarding medical history and positive SARS-CoV-2 polymerase chain reaction test from days after first dose to January/17/2021. Daily and cumulative infection rates in days 13-24 were compared to days 1-12 after first dose using Kaplan-Meier survival analysis and generalized linear models.Findings: Data of 503,875 individuals (mean age 59·7 years SD=14·7, 47·8% males) were analysed, of whom 351,897 had 13-24 days of follow-up. The cumulative incidence of SARS-CoV-2 infection was 0·57% (n=2484) during days 1-12 and 0·27% (n=614) in days 13-24. A 51·4% relative risk reduction (RRR) was calculated in weighted-average daily incidence of SARS-CoV-2 infection from 43·41-per-100,000(SE=12·07) in days 1-12 to 21·08-per-100,000(SE=6·16) in days 13-24 following immunization. The decrement in incidence was evident from day 18 after first dose. Similar RRRs were calculated in individuals aged 60 or above (44.5%), younger individuals (50.2%), females (50.0%) and males (52.1%). Findings were similar in sub-populations and patients with various comorbidities.Interpretation: We demonstrated an effectiveness of 51% of BNT162b2 vaccine against SARS-CoV-2 infection 13-24 days after immunization with the first dose. Immunization with the second dose should be continued to attain the anticipated protection.Funding: No external funding was available for this study.Declaration of Interests: We declare no competing interests.Ethics Approval Statement: We obtained ethical approval from Maccabi Healthcare Services Ethics Committee.

Prophetic Ethics: The Basic Value of Public Service Ethics

Dialectics of public service in providing services to the community is always involved in social interactions that do not stop. Very complex interactions involving not only theories related to public service, but also heterogeneous and dynamic human individuals who are involved either directly or indirectly. This research aims to build the concept of prophetic ethics as the basis of the ethical values of public service. This research uses a qualitative descriptive approach in building the concept of prophetic ethics. The main bases of the theory are adopted from the spirit and the prophetic principle of profetic which is classified respectively into the four elements of the establishment, namely humanity, scholarly, pregnancy as well as humanist, emancypatorist, transcendental and Teleological. This ethical concept has an orientation on the highest human spiritual peaks, namely the divine and prophetic consciousness. With such awareness of public service not only give service to society in general, but also as a form of devotion of a servant to the creator. Prophetic ethic recognizes the existence of empirical knowledge and not empirical. From the science was then made a practical formulation in the form of “prophetic law”, which was finally called by the name “prophetic ethics”. Prophetic ethics is an endeavor that the writer undertakes in internalizing a principle and spirit that holds fast to a holistic awareness that is divine and prophetic awareness. Thus the concept of public service is not only to dethrone obligations in providing service but also as a form of devotion of a servant to its creator.

ЕТИЧНІ ЗАСАДИ ДІЯЛЬНОСТІ ШВЕДСЬКОЇ СЛУЖБИ ТЮРЕМ І ПРОБАЦІЇ .

The article addresses to the analysis of the content of ethical norms that underlie the activities of the Swedish Prison and Probation Service. The content of the Code of Ethics of the Swedish Prison and Probation Service is analyzed and also its compliance with the model European Code of Ethics for prison personnel is established and the possibility of its involvement as a model for creating an updated version of the Code of Ethics and Service Conduct of the State Penitentiary Service of Ukraine is determined. The main task of the Swedish Prison and Probation Service is taking care of prisoners and enforcing sanctions, which, in addition to general values, set the most specific requirements for managers and personnel in both prisons and probation. These requirements are based on the moral values that most fully characterize the work of the Service. It is noted that the penitentiary administration`s actions help in reducing the risk of recidivism and thus increase the level of security in prisons and in the community. The necessary actions are based on fundamental values that apply to the entire Swedish government. The Swedish Prison and Probation Service is a government agency responsible for prisons, correctional facilities and probation. Their mission is to work with the police, prosecutors and courts to reduce crime and increase human security. The Swedish Prison and Probation Service is accountable to the government and is the responsibility of the Ministry of Justice. In its daily activities, the Swedish Prison and Probation Service work to persuade its clients not to commit new crimes. Its personnel guarantee humane treatment of clients, as well as honesty towards them and their legal security. Any client serving a sentence must do so safely and must not be able to commit a crime while registered with the Swedish Prison and Probation Service. It has been established that one of the ways to increase safety in the community is to reduce the recurrence rate. To this end, the Swedish Prison and Probation Service conducts motivational interviews, implements treatment and employment programs, and provides clients with the opportunity to attend school. The management of the Service is convinced that convicts and probation clients should be better prepared so that they can live without crimes and drugs when they are released from a closed institution (prison) or from the probation service. Key words: client, personality, professionalism, knowledge, moral values, legal certainty, predictability.

Fostering and promoting professionalism in undergraduate medical students

In recent years professionalism has developed increased attention to provide compassionate and ethical health service for the patients and society. Medical students and future physicians are committed to foster this service as a patient-centered holistic manner to be a part of becoming a doctor. We conducted a questionnaire survey with year 4 MBBS students of AIMST University, Kedah, Malaysia to interpret the perceptions of students on professional knowledge, professional skills, and professional attitude. Statistical analysis was performed using SPSS Statistics version 25.0. Students agreed on their up-to-date knowledge with basic science 41.2%, clinical sciences 41.2%, and clinical Skills 42.4%. Among all three elements (professional knowledge, professional skills, and professional attitude), students’ positive responses were more in different fields of professional attitude. The top five qualities essential for professionalism as chosen by the students are: appropriate behavior (67.1%), fully aware of patient safety (65.9%), teamwork with batchmates (65.9%), and understand hospital setup and clinic setup (65.9% in each). Survey of student’s beliefs on professional requirements would help us to target teaching and assessment so that students develop as professionally responsible doctors.

Ethics in the public services – selected aspects

The article discusses various aspects of the theoretical foundations and genesis of the canon of ethics of the Polish public services. A well-functioning public administration is the foundation of the modern state. Working in the public services entails a great deal of responsibility as administration employees must meet certain special requirements. Society expects that the administration, serving its citizenry, act with the common good in mind, which requires that the officials possess a degree of ethical awareness. Officials responsible for decision-making must adhere to applicable laws, in addition to taking into consideration the public interest and the rights of citizens, which frequently leads to conflicts of interest, in particular on the interface of the administration, economy and politics. The purpose of this paper is to present the role of ethics in the functioning of public administration organs in a modern democratic state adhering to the rule of law. Ethical issues are closely related to the legal and institutional aspects of public administration – and should be analysed as such. The article discusses various theoretical and general aspects of the relations between law, morality and ethics, the role of ethics infrastructure in public administration and the institutional and legal instruments used to prevent pathological behaviours.

Talk Like Me: Supporting Students Who Are African American Using Augmentative and Alternative Communication

Purpose With the changing demographics, speech-language pathologists are increasingly supporting diverse caseloads. Research and discussion within the profession often look at culturally and linguistically diverse populations as a monolith and may provide heightened focus on the complexity of bi/multilingual communicators who require augmentative and alternative communication (AAC); however, an exclusive focus on African Americans who use AAC is limited within the published body of research. This article aims to open discussion around the unique and specific supports needed to provide ethical services for African Americans who require AAC systems. Method A review of published literature across disciplines, including communication disorders, health and medicine, education, and social sciences across the last two decades was synergized with analysis of government and professional organization data sets, and professional reflection based upon clinical experience. Results Speech-language pathologists developing a practice embedded with cultural competence and client advocacy will support not only just the AAC user but also their family as primary communication partners. Analysis of the institutional barriers, and how to mitigate the impact, will lead the clinician to culturally responsive intervention strategies. Conclusions It is imperative to use culturally responsive techniques from the stage of referral through the assessment and into intervention. Clinicians engaging in a culturally responsive practice will help reduce institutional barriers for African Americans using AAC, while also increasing the participation and engagement of both the person who uses AAC and their family communication partners. Evidence-based practices already being implemented for supporting African Americans with communication disorders can be extrapolated to support the specific subgroup who require AAC for functional communication.

Business Methods for Certification of Government Employees in the Russian Federation: Problems and Prospects

This article provides a brief overview of the ongoing changes in the methodology for evaluating and selecting personnel in government agencies of the Russian Federation. The author analyzes the details of ongoing reforms in the current macroeconomic context. The article covers expected consequences of the planned unified approach to certification of civil servants in all state bodies of the Russian Federation using examples of existing business structures that already use the new methods. The author comes to the conclusion that disproportionate powers of managers in any departments and strictly formalized criteria for certification of civil servants, which came from the commercial sphere, will negatively affect the motivation of civil servants, the quality of their work with citizens, and lead to erosion of the civil service ethics. The ongoing reform may potentially result in a loss of public trust to state institutions.

Preventing Cardiomyopathy in DMD: A Randomized Placebo-Controlled Drug Trial.

To determine whether a combination of 2 heart medications would be tolerated and could prevent/delay the onset of cardiomyopathy in boys with Duchenne muscular dystrophy (DMD) compared with placebo. This multicenter, parallel group, 1:1 patient randomized, placebo-controlled study of prophylactic perindopril and bisoprolol recruited boys with DMD aged 5-13 years, with normal ventricular function. Repeat assessments of left ventricular (LV) function, electrocardiogram, and adverse event reporting were performed 6 monthly. The primary outcome was change in ejection fraction between arms after 36 months. The study was approved by the National Research Ethics Service Committee East Midlands-Derby. Eighty-five boys were recruited (76% on steroid therapy) and randomized to combination heart drugs or matched placebo. Group change in left ventricular ejection fraction (LVEF%) at 36 months from baseline was -2.2% ± 6.0% and -2.9% ± 6.1% in active and placebo arms (adjusted mean difference: -2.1, 95% CI -5.2 to 1.1). There was no difference between treatment arms over repeated assessments (analysis of variance) up to 36 months (trial arms p = 0.53); arm-over-time (p = 0.44). Four participants on placebo but none on active therapy were withdrawn due to deteriorations in LV function. Secondary outcomes did not differ between arms either. Thirty-six serious adverse events occurred none due to cardiac events or trial medication. Combination therapy was well tolerated. Consistent with the previous prophylactic perindopril heart study, there was no evidence of group benefit after 36-month treatment. This study provides Class I evidence that combination perindopril-bisoprolol therapy was well tolerated but did not change decline in LVEF significantly in boys with DMD.

Protocol for an implementation study of an evidence-based home cardiac rehabilitation programme for people with heart failure and their caregivers in Scotland (SCOT:REACH-HF)

IntroductionDespite evidence that cardiac rehabilitation (CR) is an essential component of care for people with heart failure, uptake is low. A centre-based format is a known barrier, suggesting that home-based...

Optimising Chemotherapy for Frail and Older Patients With Advanced Gastroesophageal Cancer: The GO2 Phase III Trial

Background: GO2 sought to optimise chemotherapy dosing in older/frail patients with advanced gastroesophageal cancer, and explored baseline geriatric assessment (GA) as a tool for treatment decision-making. Methods: Patients were recruited for whom full-dose combination chemotherapy was considered unsuitable. Two randomisation options were available: CHEMO-INTENSITY compared oxaliplatin/capecitabine at Level A (doses as used in the standard epirubicin/oxaliplatin/capecitabine regimen), B (0·8x A) or C (0·6x A). Non-inferiority of PFS was assessed using boundary HR=1·34, selected by a forum of patients and clinicians. Overall Treatment Utility (OTU), which combines efficacy, toxicity, QL and patient value/acceptability, was scored at nine weeks. Alternatively, if the patient and clinician agreed the indication for chemotherapy was uncertain, they could enter the CHEMO-BSC randomisation, comparing Level C versus best supportive care. Findings: 514 patients entered the CHEMO-INTENSITY randomisation: non-inferior PFS was confirmed for B vs A (HR=1·09 [CI=0·89-1·32]) and C vs A (HR=1·10 [0·90-1·33]). Level C produced less toxicity and better OTU than A or B. No subgroup benefited from higher doses: Level C produced better OTU even in the younger, fitter patients. 45 patients entered the CHEMO-BSC randomisation: overall survival was non-significantly longer with chemotherapy: median 6·1 vs 3·0 months, HR=0·69 [0·32-1·48], p=0·34. In multivariate analysis, baseline frailty, QL and neutrophil:lymphocyte ratio were independently associated with OTU, so can be combined in a model to estimate the probability of better or worse outcome. Interpretation: Reduced-intensity chemotherapy provided non-inferior efficacy with an improved patient experience. Baseline geriatric assessment can help predict the utility of chemotherapy. Trial Registration: [Trial registration: ISRCTN44687907] Funding Statement: Cancer Research UK [CRUK/12/022] Declaration of Interests: Dr. Grabsch reports personal fees from Merck Sharpe Dome, outside the submitted work; all other authors have nothing to declare. Ethics Approval Statement: This study was approved by the UK National Research Ethics Service and overseen by independent Trial Steering and Data Monitoring & Ethics Committees (TSC; IDMC).

Political Ethics by Sheikh Hasina And Khaleda Zia’s Government from 2009 to Present: A Research on Literature Review

The principal motive of this research is to analyze the status of ethical, democratic government and Public Services in Bangladesh. This paper examines the state of democratic governance in various rulers of Bangladesh, especially during Sheikh Hasina and Khaleda Zia’s governmental from 2009 to present. With qualitavie method This paper begins with a conceptual analysis of democratic governance and then identifies several vital problems. This article explains the status of ethical, democratic public services in Bangladesh in terms of some critical elements/elements of democratic governance, including the development of democratic institutions. Furthermore, processes, strengthening electoral and law enforcement systems, improving access to justice through freedom to the division of power, and encouraging citizen participation. Answer promoting tolerance, transparency, promoting democratic values and respect of liberty in public services with good governance and ethics, which are very infrequent in current Bangladesh politics.

Evaluating the Effectiveness of Influenza Vaccine in People With At-Risk Medical Conditions: A Test-Negative Design Case-Control Study for the Seasonal Influenza Vaccine Effectiveness II (SIVE II) Project

Background: Seasonal trivalent inactivated influenza (TIV) vaccine effectiveness (VE) against laboratory confirmed influenza in adults with at-risk medical conditions is not well established. Previous studies have been hampered by small sample sizes to assess VE for each at-risk medical condition recommended for vaccination. Larger better powered studies investigating how influenza VE varied in those with specific risk factors associated with poor influenza outcomes is therefore required. Methods: A test-negative design case-control study of influenza VE was carried out in adults with at-risk medical conditions in Scotland between 2010/11 to 2015/16. We used individual patient-level health administrative data from 223 primary care practices linked with hospital and laboratory data (n=10275 swabs from n=9147 individuals). Generalised additive logistic regression was used to provide adjusted VE estimates between adults (aged >18 years) with laboratory-confirmed influenza compared to those with a negative test for influenza. Findings: Significant positive VE was found for all adults with chronic heart disease (31%; 95% confidence interval [CI]: 10 to 48), diabetes (34%; 95%CI: 12 to 51), impaired immune function (51%; 95%CI: 13 to 72), chronic kidney disease (40%; 95%CI: 17 to 57) and Body Mass Index (BMI) >30 to <40 kg/m2 (62%; 95%CI: 26 to 81). Significant VE was demonstrated for impaired immune function amongst most age groups including younger adults (18-54 years; 68%; 95%CI: 17 to 88) and those aged 85 years and over (42%; 95%CI: 4 to 65). The oldest adults aged 85 years and over had a significant positive VE for chronic respiratory disease (20%; 95%CI: 3 to 34), diabetes (34%; 95%CI: 11 to 51), and impaired immune function (42%; 95%CI: 4 to 65). Non-significant VE was found for those with chronic neurological disease (18%; 95%CI: -16 to 43). Interpretation: The amount of vaccine protection against laboratory-confirmed influenza varied amongst adults with at-risk medical conditions in different age groups. Seasonal influenza vaccination programmes should additionally consider those with BMI >30 to <40 kg/m2. Available alternate vaccines which aim to improve immune response should be considered for at-risk groups with consistently low TIV VE (e.g. neurological disease). Funding Statement: National Institute for Health Research Health Technology Assessment Programme (project number 13/34/14), Health Data Research UK, Asthma UK Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The Privacy Advisory Committee of the Information Services Division, NSS, approved the linkage and the statistical analysis of the anonymised data used in this study. Ethical permission was granted from the National Research Ethics Service Committee, West Midlands - Edgbaston [15/WM/0035].