Teaching Ethics: Expanding Ethical Perspectives By Cultivating Moral Imagination

Moral imagination (MI) is described as the ability to challenge operative worldviews in order to discover new ways of framing ethical problems and moral perspective taking. Because operative worldviews can contain implicit bias, MI helps individuals reach beyond their own ways of knowing to seek alternative perspectives and find innovative ways to solve ethical problems. This article describes a graduate level ethics curriculum designed to develop moral imagination in leadership students, and ultimately help them make ethical decisions within the context of their organizations. The article also reports results of a concurrent, evaluative qualitative study designed to gather student reflections as they attempt to learn and apply moral imagination in practice

Altered placental and fetal expression of IGFs and IGF-binding proteins associated with intrauterine growth restriction in fetal sheep during early and mid-pregnancy.

The insulin-like growth factors (IGFs) are postulated to be altered in association with the development of intrauterine growth restriction (IUGR). The present studies examined placental and fetal hepatic mRNA concentration of components of the IGF system at two time points (55 and 90 d gestational age, dGA; Term 147 dGA) in a hyperthermia (HT)-induced sheep model of placental insufficiency-IUGR. Maternal plasma insulin and IGF-I were constant at 55 and 90 dGA and were unaffected by treatment. Umbilical vein insulin concentrations tended to be reduced at 90 dGA following HT exposure. Caruncle IGF-I mRNA was increased at 90 dGA in HT placentae (p \u3c 0.05), while cotyledon concentrations were constant over gestation and unaltered by treatment. In control cotyledons, IGF-II mRNA concentration increased (p \u3c 0.01) and IGFBP-3 decreased between 55 and 90 dGA (p \u3c 0.01). Cotyledon IGF-II and caruncle IGFBP-4 mRNA were elevated at 55 dGA in HT placentae compared with control (p \u3c 0.01 and p \u3c 0.05 respectively). Fetal hepatic IGF-I, IGFBP-2, -3 and -4 concentrations rose over gestation (p \u3c 0.05), but there were no treatment effects. These data suggest that changes in placental IGF expression in early and mid gestation may predispose the pregnancy to placental insufficiency, resulting in inadequate substrate supply to the developing fetus later in gestation

Umbilical uptakes and transplacental concentration ratios of amino acids in severe fetal growth restriction

Background: This study examines the relationship between placental amino acid (AA) transport and fetal AA demand in an ovine fetal growth restriction (FGR) model in which placental underdevelopment induces fetal hypoxemia and hypoglycemia. Methods: Umbilical uptakes of AA, oxygen, glucose, and lactate were measured near term in eight experimental ewes (FGR group) and in eight controls (C group). Results: The FGR group demonstrated significantly reduced umbilical uptakes of oxygen, glucose, lactate, and 11 AAs per kg fetus. The combined uptake of glucose, lactate, and AAs, expressed as nutrient/oxygen quotients, was reduced almost to 1.00 (FGR: 1.05 vs. C: 1.32, P ≤ 0.02). In contrast to a decrease in umbilical glucose concentration, all but one of the AAs that were transported from placenta to fetus demonstrated normal or elevated fetal concentrations, and five of the essential AAs were transported against a significantly higher feto/maternal (F/M) concentration ratio. This ratio peaked at the lowest fetal oxygen levels. Conclusion: We conclude that, in the hypoxic FGR fetus, the reduction in AA uptake is not due to a disproportionally small placental AA transport capacity. It is the consequence of decreased fetal oxidative metabolism and growth rate, which together reduce fetal AA demand. © 2013 International Pediatric Research Foundation, Inc

Evaluation of a two-way SMS messaging strategy to reduce neonatal mortality: rationale, design and methods of the Mobile WACh NEO randomised controlled trial in Kenya

Abstract: Introduction Globally, approximately half of the estimated 6.3 million under-5 deaths occur in the neonatal period (within the first 28 days of life). Kenya ranks among countries with the highest number of neonatal deaths, at 20 per 1000 live births. Improved identification and management of neonates with potentially life-threatening illness is critical to meet the WHO’s target of ≤12 neonatal deaths per 1000 live births by 2035. We developed an interactive (two-way) short messaging service (SMS) communication intervention, Mobile Solutions for Neonatal Health (Mobile women’s and children’s health (WACh) NEO), focused on the perinatal period. Mobile WACh NEO sends automated tailored SMS messages to mothers during pregnancy and up to 6 weeks post partum. Messages employ the Information-Motivation-Behaviour Skills framework to promote (1) maternal implementation of essential newborn care (ENC, including early, exclusive breast feeding, cord care and thermal care), (2) maternal identification of neonatal danger signs and care-seeking, and (3) maternal social support and self-efficacy. Participants can also send SMS to the study nurse, enabling on-demand remote support. Methods and analysis We describe a two-arm unblinded randomised controlled trial of the Mobile WACh NEO intervention. We will enrol 5000 pregnant women in the third trimester of pregnancy at 4 facilities in Kenya and randomise them 1:1 to receive interactive SMS or no SMS (control), and conduct follow-up visits at 2 and 6 weeks post partum. Neonatal mortality will be compared between arms as the primary outcome. Secondary outcomes include care-seeking, practice of ENC and psychosocial health. Exploratory analysis will investigate associations between maternal mental health, practice of ENC, care-seeking and SMS engagement. Ethics and dissemination This study received ethical approval from the University of Washington (STUDY00006395), Women and Infants Hospital (1755292-1) and Kenyatta National Hospital/University of Nairobi (P310/04/2019). All participants will provide written informed consent. Findings will be published in peer-reviewed journals and international conferences

Parents' Online Portrayals of Pediatric Treatment and Research Options

Parents of seriously ill children face difficult decisions when standard therapies are limited or ineffective. In their search for information, they may turn to websites created by other parents facing similar experiences. We conducted a qualitative content analysis of 21 websites created by families with children affected by cancer or genetic disease, two serious conditions with a range of treatment and clinical trial options. Our research questions address how parent authors portray serious pediatric illness, available options, parties to decision making, and sources of influence. In addition, we examine what these sites reveal about family vulnerability to various risks, particularly the risk of misunderstanding the distinction between standard treatment and research and the risk of overestimating the likely benefits of research participation, as well as whether vulnerability varies by type of condition. Our results demonstrate typically favorable views on research, but with inadequate distinctions between research and treatment and a complex set of trade-offs in consideration of research risks and potential benefits. While portraits of vulnerability emerge for both parents and children, so do portraits of strength and resilience. As a result, parents describe frustration with both under- and over-protection from research participation. Our discussion of these findings clarifies the potential for parent-authored websites to inform and influence families considering research and treatment options for their seriously ill children

“That's a good question”: University researchers' views on ownership and retention of human genetic specimens

To explore the views of university-based investigators conducting genetic research with human specimens regarding ownership and retention of specimens, and knowledge of related institutional review board and university policies

Perception of Filipino physicians on the roles and scope of practice of physical therapy in the Philippines: A multi-method quantitative study

Introduction: Physical therapists (PTs) are licensed practitioners who can assess, diagnose, and provide treatment interventions that restore patients to optimal function. While PTs can deliver complete management plans, the practice of physical therapy (PT) in the Philippines follows a referral system where physicians are the first contact of the patient, emphasizing the importance of physician\u27s perception towards the role of PTs and scope of PT service. This study aimed to determine the internal consistency of the Perception on Physical Therapists Questionnaire (PoPTQ), and to use this tool to report the existing perceptions of Filipino physicians on the practice of PT. Method: This study was divided into two phases and utilized a multi-method quantitative research design. For Phase 1 (psychometric), 18 questionnaires administered to Filipino physicians were used to compute Cronbach\u27s α of PoPTQ. A total of 134 questionnaires of the same population were analyzed for Phase 2 (cross-sectional), in which descriptive statistics and cross tab analysis were used to report the respondents\u27 perceptions. Both phases utilized online means of data gathering done via convenience sampling. Results: Phase 1 revealed a Cronbach\u27s α value of 0.528 for all items of PoPTQ. Phase 2 showed that physicians who have attended lectures discussing the roles of PTs or have experience with working with them have a higher referral rate than those with no prior exposure to PTs. Discussion: Filipino physicians believe that PTs can establish strong patient-therapist relationships, treat different patients, and acknowledge the roles of PTs in clinical and research settings. Data suggest that adequate foundational knowledge, positive perceptions, and high awareness of PTs\u27 roles and scope of practice are observed among Filipino physicians. However, there remains a need to increase collaboration opportunities between PTs and physicians in their academic years and programs that focus on the promotion of PT roles and scope of practice