High degrees of uncertainty and a lack of effective therapeutic treatments have characterized the COVID-19 pandemic and the provision of drug products outside research settings has been controversial. International guidelines for providing patients with experimental interventions to treat infectious diseases outside of clinical trials exist but it is unclear if or how they should apply in settings where clinical trials and research are strongly regulated. We propose the Professional Oversight of Emergency-Use Interventions and Monitoring System as an alternative pathway based (...) on guidance developed for the ethical provision of experimental interventions to treat COVID-19 in Singapore. We support our proposal with justifications that establish moral duties for physicians to record outcomes data and for institutions to establish monitoring systems for reporting information on safety and effectiveness to the relevant authorities. Institutions also have a duty to support generation of evidence for what constitutes good clinical practice and so should ensure the unproven intervention is made the subject of research studies that can contribute to generalizable knowledge as soon as practical and that physicians remain committed to supporting learning health systems. We outline key differences between POEIMS and other pathways for the provision of experimental interventions in public health emergencies. (shrink)

The evolutionary neurological foundations of religious experience are detailed. Human beings have been burying and preparing their dead for the Hereafter for more than 100,000 years. These behaviors and beliefs are related to activation of the amygdala, hippocampus, and temporal lobe, which are responsible for religious, spiritual, and mystical trancelike states, dreaming, astral projection, near‐death and out‐of‐body experiences, and the hallucination of ghosts, demons, angels, and gods. Abraham, Moses, Muhammad, and Jesus Christ, and others who have communed with angels or (...) gods display limbic system hyperactivity, whereas patients report religious hallucinations or out‐of‐body experiences when limbic structures are stimulated or excessively activated. It is postulated that limbic and temporal lobe structures account for the sexual and violent aspects of religious behavior and also serve as a “transmitter to God,” and that the evolution of these structures made spiritual experience possible. (shrink)

Background: Collaboration between physicians and nurses is key to improving patient care. We know very little about collaboration and interdisciplinary practice in African healthcare settings. Research question/aim: The purpose of this study was to explore the ethical challenges of interdisciplinary collaboration in clinical practice and education in Botswana Participants and research context: This qualitative descriptive study was conducted with 39 participants (20 physicians and 19 nurses) who participated in semi-structured interviews at public hospitals purposely selected to represent the three levels (...) of hospitals in Botswana (referral, district, and primary). Ethical considerations: Following Institutional Review Board Approval at the University of Pennsylvania and the Ministry of Health in Botswana, participants’ written informed consent was obtained. Findings: Respondents’ ages ranged from 23 to 60 years, and their duration of work experience ranged from 0.5 to 32 years. Major qualitative themes that emerged from the data centered on the nature of the work environment, values regarding nurse–doctor collaboration, the nature of such collaboration, resources available for supporting collaboration and the smooth flow of work, and participants’ views about how their work experiences could be improved. Discussion: Participants expressed concerns that their work environment compromised their ability to provide high-quality and safe care to their patients. The physician staffing structure was described as consisting of a few specialists at the top, a vacuum in the middle that should be occupied by senior doctors, and junior doctors at the bottom—and not a sufficient number of nursing staff. Conclusion: Collaboration between physicians and nurses is critical to optimizing patients’ health outcomes. This is true not only in the United States but also in developing countries, such as Botswana, where health care professionals reported that their ethical challenges arose from resource shortages, differing professional attitudes, and a stressful work environment. (shrink)

BackgroundAdolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents’ experience of challenges identified by adolescents ages 10–19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania. MethodsAn exploratory descriptive qualitative (...) design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10–19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis.ResultsQualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame.ConclusionLack of adolescents’ involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania. (shrink)

My article is about legal interpretation, but not about the question: how to interpret the law. Rather its aim is to make us consider seriously the question: Why is interpretation central to legal practices? After all not all normative practices assign interpretation such a central role. In this regard the law contrasts with morality. The reason for the contrast has to do with the status of sources in the law. There are no “moral sources” while legal sources are central to (...) the law. Legal interpretation is primarily—I will suggest—the interpretation not of the law, but of its sources. To understand why interpretation is central to legal practices requires understanding the role of sources in the law: the reasons for having them, and hence also the ways in which they should be treated. I will show how reflections about these topics connect with some traditional jurisprudential puzzles, such as the relations between law and morality. Are there gaps in the law? Is the law or its interpretation objective or subjective? (shrink)

Background. Decisions to test, enrol and disclose HIV status are among the ethical challenges that may influence adherence to antiretroviral therapy (ART) and HIV care and treatment in adolescents living with HIV. In the Tanzanian setting, how parental perceptions of ethical issues affect adolescents’ adherence to HIV care and treatment is not well known.Objective. To explore parental perceptions of ethical issues in adolescent HIV care and treatment. Methods. The study employed a descriptive qualitative exploratory design and was conducted at Temeke (...) Regional Referral Hospital in Dar es Salaam Care and Treatment Centre (CTC) in the Outpatient Department (OPD). The study population were parents and non-parent caregivers of HIV-infected adolescents 10 - 19 years of age. A total of 16 persons participated in semi-structured interviews after their consent was obtained. All interviews were audiotaped, transcribed verbatim in Swahili and back-translated into English. An inductive content analysis was used, and standards of qualitative rigour applied. Results. Three qualitative themes emerged: balancing adolescents’ autonomy with parents’ desire to protect their children; parental dilemmas regarding disclosure of adolescents’ HIV status; and parental reasons for delayed disclosure.Conclusion. Participants perceived that parental authority should override adolescents’ autonomy in HIV care and treatment. Disclosure of HIV status to adolescents is a challenge to parents. Delays in disclosure often occur because parents feel guilty and because they have fears of rejection by their adolescent children. (shrink)

This case report illustrates the ethical issues involved in paediatric liver transplantation, especially in terms of assessing recipient suitability and the role of parents as donors. Ms. X was a child with advanced chronic liver disease who undergone an elective living donor liver transplant with her father as the donor. Post-operatively, she was in a critically ill state as a result of acute liver graft failure with resultant multi-organ dysfunction. A re-transplant was done at 36 hours after the first one, (...) this time with her mother as the donor. She responded well to the transplant, however by post-operative day 8, it was evident that she had features of severe brain stem dysfunction and brain death was subsequently certified. The ethical issues that arise from this case, including the need for careful assessment of recipient suitability for a transplant and the specific considerations of using parents as organ donors, are discussed. (shrink)

Here, Greenberg excavates the skeletons of some of our most iconoclastic buildings, spurring on a continued engagement with those intentionally (World Trade Center) and accidentally (Charles DeGaulle Airport Terminal) destroyed that ...

Purpose The purpose of this study is to examine the primary sources and methods of Web-based messaging during the early stages of the coronavirus pandemic. The authors use ethical lens to develop a conceptual framework to inform and reduce conflicts of Web-based messaging associated with COVID-19. Design/methodology/approach This paper provides a comprehensive review of three different ethical schools and identifies the cohesive theme of common good across them. Common good leading to a greater good serves as the overarching ethical construct (...) for Web-based messages that focus on society and not the singular individual, business or political ideology. Findings The findings suggest that the ethical construct of common good focuses on prioritizing the society over the individual and draws upon utilitarian principles focused on consequences, Kantian principles focused on intentions and Aristotelian principles focused on the definition of good. Web-based messaging on COVID-19 originates from diverse public and private sources and ethically can be governed by adherence to achieving the greatest good for society. Pervasive conflicts with COVID-19 messaging can be mitigated by pursuing a more ethical agenda with messages. Originality/value This manuscript provides a conceptual framework, based on ethical principles, to serve as a blueprint for Web-based messaging during a pandemic. This work offers an ethical perspective for communication during a pandemic and it is original in conceptualizing the components of Web-based messaging and decomposing them into the different levels where conflicts can occur. This article can serve as a template for Web-based communication pertaining to future pandemics and other events that benefit from prioritizing the impact on society over the impact on the individual. (shrink)

It has been reported that, on average, most adults recall first memories formed around age 3.5. In general, most first memories are positive. However, whether these first memories tend to be visual or verbal and whether the period for childhood amnesia (CA) is greater for visual or verbal or for positive versus negative memories has not been determined. Because negative, stressful experiences disrupt memory and can injure memory centers such as the hippocampus and amygdala, and since adults who were traumatized (...) or abused during childhood (TA) reportedly suffer memory disturbances, it was hypothesized that those with a history of early trauma might suffer from a lengthier childhood amnesia and form their first recallable memories at a later age as compared to the general population (GP). Because the right hemisphere matures earlier than the language-dominant left hemisphere, and is dominant for visual and emotional memory, as well as the stress reponse, it was hypothesized that first recallable memories would be visual rather than verbal. Lastly, since stress can injure the brain and disrupt memory, it was hypothesized that the traumatized group would demonstrate memory and intellectual disturbances associated with right hemisphere injury as based on WAIS-R, Wechsler Memory Scale, and facial-memory testing. All hypotheses were supported. Positive and visual memories are formed before negative and verbal memories. TA CA offset, on average, is at age 6.1 versus 3.5 for GPs. TA PIQ (performance IQ), short-term visual memory, and facial memory were significantly reduced. (shrink)

In a recent BBS target article, MacNeilage (1998) presents what he claims to be the only theory that can account for the evolution of language. However, major portions of his target article basically repeat and in many respects are identical to the theories of language evolution and development first proposed and detailed by the present commentator.

Background Obtaining informed consent is the practice of respect for persons that gives the right to participants to make autonomous decisions about research participation. The difficult-to-read research informed consent forms (RICFs) hinder comprehension and can expose participants to harm. This study aims to assess the readability of health RICFs for studies approved by the National Health Research Ethics Committee (NatHREC) in Tanzania. Methods We used a retrospective cross-sectional study design. A total of 266 RICFs were sampled from the NatHREC database (...) using stratified and systematic random sampling strategies. The readability of RICFs was assessed using the Flesch Reading Ease (FRE) and Flesch-Kincaid Readability Grade Level (FKRGL) formulas available in Microsoft Word Office and by manual check. Data were collected using the assessment checklist, analyzed, and presented with SPSS and MS Excel software. Results Out of 266 RICFs assessed, 65.4% had the recommended page numbers, 81.6% had longer sentences, and 80.5% were difficult to read, necessitating a person to acquire a US grade 10 (Form Four educational level in Tanzania) to understand the presented information. Pearson’s correlation coefficient with p-values of < 0.001 and 95% confidence level disclosed that sentence lengths in the RICFs had a statistical association with the difficult reading levels obtained. Conclusion Findings from this study showed that most of the RICFs were concise in terms of page numbers and word count but had long and difficult sentences. Researchers should assess the readability of RICFs before submitting them for ethical approval. Research Ethics Committees (RECs) should consider inclusion of RICFs readability measurements in the Ethics Guidelines for Health Research. The study recommends further studies to assess the Kiswahili versions of RICFs to determine if the results obtained in this study apply to Kiswahili texts. Clinical trial number Not applicable. (shrink)

The workplace is characterised by numerous contracts of agreement that an employee and employer must sign to formalise their employment relationship. The informal agreement, known as the psychological contract, is often overlooked, although it is pivotal in determining the engagement of employees in an organisation. This study aimed to probe the perceptions line managers have of the influence of the psychological contract on employee engagement in a South African bank with a particular focus on how the integration of technologies from (...) the Fourth Industrial Revolution may have impacted the workplace in the banking sector. The study was carried out using a qualitative research approach. A purposive random sampling strategy was used to select participants who were interviewed using semi-structured, one-on-one interviews. The data collected were analysed using thematic analysis, and verbatim quotes were used to support emergent themes. The findings of the study revealed that continuous change in the world, exacerbated by the COVID-19 pandemic, influences employee expectations. Thus, organisations must be able to quickly adapt and adjust their talent attraction and retention mechanisms. Talent management, the nature of the business, structure and operations, the nature of the work environment, and emotional needs are the themes that emerged from the study. With the constant change in the world of work, including industry disruptions continually imposed by the 4IR and other factors, employees’ expectations are ever-changing. Thus, organisations must keep adapting to attract and retain talent. This study adds value by addressing various aspects aligned with competitively adjusting to the current and future world of work. (shrink)

BackgroundThe increased risk of developing attention-deficit hyperactivity disorder (ADHD) in extremely preterm infants is well-documented. Better understanding of perinatal risk factors, particularly those that are modifiable, can inform prevention efforts.MethodsWe examined data from the Extremely Low Gestational Age Newborns (ELGAN) Study. Participants were screened for ADHD at age 10 with the Child Symptom Inventory-4 (N = 734) and assessed at age 15 with a structured diagnostic interview (MINI-KID) to evaluate for the diagnosis of ADHD (N = 575). We studied associations (...) of pre-pregnancy maternal body mass index (BMI), pregestational and/or gestational diabetes, maternal smoking during pregnancy (MSDP), and hypertensive disorders of pregnancy (HDP) with 10-year and 15-year ADHD outcomes. Relative risks were calculated using Poisson regression models with robust error variance, adjusted for maternal age, maternal educational status, use of food stamps, public insurance status, marital status at birth, and family history of ADHD. We defined ADHD as a positive screen on the CSI-4 at age 10 and/or meeting DSM-5 criteria at age 15 on the MINI-KID. We evaluated the robustness of the associations to broadening or restricting the definition of ADHD. We limited the analysis to individuals with IQ ≥ 70 to decrease confounding by cognitive functioning. We evaluated interactions between maternal BMI and diabetes status. We assessed for mediation of risk increase by alterations in inflammatory or neurotrophic protein levels in the first week of life.ResultsElevated maternal BMI and maternal diabetes were each associated with a 55–65% increase in risk of ADHD, with evidence of both additive and multiplicative interactions between the two exposures. MSDP and HDP were not associated with the risk of ADHD outcomes. There was some evidence for association of ADHD outcomes with high levels of inflammatory proteins or moderate levels of neurotrophic proteins, but there was no evidence that these mediated the risk associated with maternal BMI or diabetes.ConclusionContrary to previous population-based studies, MSDP and HDP did not predict ADHD outcomes in this extremely preterm cohort, but elevated maternal pre-pregnancy BMI, maternal diabetes, and perinatal inflammatory markers were associated with increased risk of ADHD at age 10 and/or 15, with positive interaction between pre-pregnancy BMI and maternal diabetes. (shrink)