The limits of deontology in dental ethics education

Most current dental ethics curricula use a deontological approach to biomedical and dental ethics that emphasizes adherence to duties and principles as properties that determine whether an act is ethical. But the actual ethical orientation of students is typically unknown. The purpose of the current study was to determine the ethical orientation of dental students in resolving clinical ethical dilemmas. First-year students from one school were invited to participate in an electronic survey that included eight vignettes featuring ethical conflicts common to the health care setting. The Multidimensional Ethics Scale was used to evaluate the students’ ethical judgments of these conflicts. Students rated each vignette along 13 ethically relevant items using a 7-point scale. Nine of the thirteen items were analyzed because they represent the dominant ethical theories, including deontology. One hundred sixteen dental students successfully completed the survey. Of the analyzed items, those associated with deontology had comparatively weak associations with whether students judged the action to be ethical and whether students judged themselves likely to perform the action. Whether an action was judged to be caring had the strongest association with whether the action was judged to be ethical and whether students judged themselves likely to perform the action. These results suggest that adherence to duties or principles has weaker association with students’ ethical judgments and behavior compared to caring, which was found to be more influential in their ethical judgments and behavior. Current dental school curricula with a primary focus on deontology may n

Transforming the ethical behavior of clinicians through pedagogical innovation: sensemaking as a means to promote ethical practice in the face of moral ambiguity

Even though there is evidence to suggest that teaching normative ethical theory has limited influence on the ethical behavior of clinicians, typical pedagogy in clinical ethics continues to focus on adherence to professional duties and the principles of biomedical ethics. A sensemaking approach to ethics training has demonstrated promise as an evidence-based pedagogical method to improve ethical reasoning and response. It has been posited that participation in Project ECHO (Extension for Community Health Outcomes) leads to improved sensemaking by clinicians. This study examined the effect of type of ethics training on ethical response self-efficacy scores. Using a series of univariate analyses of variance, the study found that participants of a Health Care Ethics ECHO, who were trained in sensemaking strategies, scored higher than both clinicians who received traditional training in clinical ethics, and clinicians who participated in a traditional Health Care Ethics ECHO, which incorporated normative theory, but not sensemaking (N=172). Clinicians, who participated in the Health Care Ethics ECHO with sensemaking, perceived their ability to recognize and effectively address ethical conflict in practice as significantly higher than those who participated in a traditional Ethics ECHO that did not include sensemaking strategies (p=0.035, mean difference = 0.888, 95% CI= (0.05, 1.172)). The study produced preliminary evidence to support the claim that incorporating sensemaking into clinical ethics training increases the clinician’s ability to respond ethically in practice.Includes bibliographical references

Case analysis : Ethical issues in predictive genetic testing of minors for adult-onset hereditary conditions

Introduction: Predictive genetic testing for adult-onset conditions in children is an issue that has initiated ethical discussions and polarized views. Case Presentation: A genetic counselor is contacted by a mother requesting predictive genetic testing of her young son for Hereditary Nonpolyposis Colorectal Cancer (HNPCC) due to an extensive family history of the condition. The ethics team subsequently worked to balance professional guidelines and ethical considerations to evaluate whether to comply with the parental request. It was necessary to consider the importance preserving the child's future right to exercise his autonomy in participating in such testing, preserving the confidentiality of the test result, and considering the possibility of potential psychological harm. Conclusion: Determining whether to perform predictive genetic testing in a minor for conditions of adult-onset should be guided by the potential outcomes that indicate that medical benefits obtained will outweigh the risks of testing

Measuring mitochondria-derived reactive oxygen species in cell culture: Challenges and limitations

Context. Post-processing algorithms play a key role in pushing the detection limits of high-contrast imaging (HCI) instruments. State-of-the-art image processing approaches for HCI enable the production of science-ready images relying on unsupervised learning techniques, such as low-rank approximations, for generating a model point spread function (PSF) and subtracting the residual starlight and speckle noise. Aims. In order to maximize the detection rate of HCI instruments and survey campaigns, advanced algorithms with higher sensitivities to faint companions are needed, especially for the speckle-dominated innermost region of the images. Methods. We propose a reformulation of the exoplanet detection task (for ADI sequences) that builds on well-established machine learning techniques to take HCI post-processing from an unsupervised to a supervised learning context. In this new framework, we present algorithmic solutions using two different discriminative models: SODIRF (random forests) and SODINN (neural networks). We test these algorithms on real ADI datasets from VLT/NACO and VLT/SPHERE HCI instruments. We then assess their performances by injecting fake companions and using receiver operating characteristic analysis. This is done in comparison with state-of-the-art ADI algorithms, such as ADI principal component analysis (ADI-PCA). Results. This study shows the improved sensitivity versus specificity trade-off of the proposed supervised detection approach. At the diffraction limit, SODINN improves the true positive rate by a factor ranging from ∼2 to ∼10 (depending on the dataset and angular separation) with respect to ADI-PCA when working at the same false-positive level. Conclusions. The proposed supervised detection framework outperforms state-of-the-art techniques in the task of discriminating planet signal from speckles. In addition, it offers the possibility of re-processing existing HCI databases to maximize their scientific return and potentially improve the demographics of directly imaged exoplanets.VORTE

Predoctoral Interns\u27 Nondisclosure in Supervision

In interviews with 14 counseling center predoctoral interns regarding a significant nondisclosure in supervision, eight interns reported good supervisory relationships and six indicated that they experienced problematic supervisory relationships. Nondisclosures for the interns in good supervisory relationships related to personal reactions to clients, whereas nondisclosures for interns in problematic supervisory relationships related to global dissatisfaction with the supervisory relationship. In both groups, interns mentioned concerns about evaluation and negative feelings as typical reasons for nondisclosure. Additional reasons for nondisclosure for interns in problematic supervision were power dynamics, inhibiting demographic or cultural variables, and the supervisor\u27s theoretical orientation. Both groups described negative effects of nondisclosure on themselves and their relationships with clients. Interns in problematic supervision also reported that nondisclosures had negative effects on the supervisory relationship

Interactions of phenethylamine‐derived psychoactive substances of the 2C‐series with human monoamine oxidases

Psychoactive substances of the 2C‐series (2Cs) are phenethylamine‐derived designer drugs that can induce psychostimulant and hallucinogenic effects. Chemically, the classic 2Cs contain two methoxy groups in positions 2 and 5 of the phenyl ring, whereas substances of the so‐called FLY series contain rigidified methoxy groups integrated in a 2,3,6,7‐tetrahydrobenzo[1,2‐b:4,5‐b’]difuran core. One of the pharmacological features that has not been investigated in detail is the inhibition of monoamine oxidase (MAO). Inhibition of this enzyme can cause elevated monoamine levels that have been associated with adverse events such as agitation, nausea, vomiting, tachycardia, hypertension, or seizures. The aim of this study was to extend the knowledge surrounding the potential of MAO inhibition for 17 test drugs, which consisted of 12 2Cs (2C‐B, 2C‐D, 2C‐E, 2C‐H, 2C‐I, 2C‐N, 2C‐P, 2C‐T‐2, 2C‐T‐7, 2C‐T‐21, bk‐2C‐B, and bk‐2C‐I) and five FLY analogs (2C‐B‐FLY, 2C‐E‐FLY, 2C‐EF‐FLY, 2C‐I‐FLY, and 2C‐T‐7‐FLY). The extent of MAO inhibition was assessed using an established in vitro procedure based on heterologously expressed enzymes and analysis by hydrophilic interaction liquid chromatography–high resolution tandem mass spectrometry. Thirteen test drugs showed inhibition potential for MAO‐A and 11 showed inhibition of MAO‐B. In cases where MAO‐A IC50 values were determined, values ranged from 10 to 125 μM (7 drugs) and from 1.7 to 180 μM for MAO‐B (9 drugs). In the absence of detailed clinical information on most test drugs, it is concluded that a pharmacological contribution of MAO inhibition cannot be excluded and that further studies are warranted

In vitro monoamine oxidase inhibition potential of alpha-methyltryptamine analog new psychoactive substances for assessing possible toxic risks

Tryptamines have emerged as new psychoactive substances (NPS), which are distributed and consumed recreationally without preclinical studies or safety tests. Within the alpha-methylated tryptamines, some of the psychoactive effects of the prototypical alpha-methyltryptamine (AMT) have been described decades ago and a contributing factor of its acute toxicity appears to involve the inhibition of monoamine oxidase (MAO). However, detailed information about analogs is scarce. Therefore, thirteen AMT analogs were investigated for their potential to inhibit MAO. An in vitro assay analyzed using hydrophilic interaction liquid chromatography–high resolution-tandem mass spectrometry was developed and validated. The AMT analogs were incubated with recombinant human MAO-A or B and kynuramine, a non-selective MAO substrate to determine the IC50 values. The known MAO-A inhibitors 5-(2-aminopropyl)indole (5-IT), harmine, harmaline, yohimbine, and the MAO-B inhibitor selegiline were tested for comparison. AMT and all analogs showed MAO-A inhibition properties with IC50 values between 0.049 and 166 μM, whereas four analogs inhibited also MAO-B with IC50 values between 82 and 376 μM. 7-Me-AMT provided the lowest IC50 value against MAO-A comparable to harmine and harmaline and was identified as a competitive MAO-A inhibitor. Furthermore, AMT, 7-Me-AMT, and nine further analogs inhibited MAO activity in human hepatic S9 fraction used as model for the human liver which expresses both isoforms. The obtained results suggested that MAO inhibition induced by alpha-methylated tryptamines might be clinically relevant concerning possible serotonergic and adrenergic effects and interactions with drugs (of abuse) particularly acting as monoamine reuptake inhibitors. However, as in vitro assays have only limited conclusiveness, further studies are needed

In vitro metabolic fate of the synthetic cannabinoid receptor agonists (quinolin-8-yl 4-methyl-3-(morpholine-4-sulfonyl)benzoate [QMMSB]) and (quinolin-8-yl 4-methyl-3-((propan-2-yl)sulfamoyl)benzoate [QMiPSB]) including isozyme mapping and carboxylesterases activity testing

The synthetic cannabinoid receptor agonists (SCRAs) (quinolin-8-yl 4-methyl-3-(morpholine-4-sulfonyl)benzoate [QMMSB]) and (quinolin-8-yl 4-methyl-3-((propan-2-yl)sulfamoyl)benzoate [QMiPSB], also known as SGT-46) are based on the structure of quinolin-8-yl 4-methyl-3-(piperidine-1-sulfonyl)benzoate (QMPSB) that has been identified on seized plant material in 2011. In clinical toxicology, knowledge of the metabolic fate is important for their identification in biosamples. Therefore, the aim of this study was the identification of in vitro Phase I and II metabolites of QMMSB and QMiPSB in pooled human liver S9 fraction (pHLS9) incubations for use as screening targets. In addition, the involvement of human monooxygenases and human carboxylesterases (hCES) was examined. Analyses were performed by liquid chromatography coupled with high-resolution tandem mass spectrometry. Ester hydrolysis was found to be an important step in the Phase I metabolism of both SCRAs, with the carboxylic acid product being found only in negative ionization mode. Monohydroxy and N-dealkyl metabolites of the ester hydrolysis products were detected as well as glucuronides. CYP2C8, CYP2C9, CYP3A4, and CYP3A5 were involved in hydroxylation. Whereas enzymatic ester hydrolysis of QMiPSB was mainly catalyzed by hCES1 isoforms, nonenzymatic ester hydrolysis was also observed. The results suggest that ester hydrolysis products of QMMSB and QMiPSB and their glucuronides are suitable targets for toxicological screenings. The additional use of the negative ionization mode is recommended to increase detectability of analytes. Different cytochrome P450 (CYP) isozymes were involved in the metabolism; thus, the probability of drug–drug interactions due to CYP inhibition can be assessed as low

Phenethylamine-derived new psychoactive substances 2C-E-FLY, 2C-EF-FLY, and 2C-T-7-FLY: Investigations on their metabolic fate including isoenzyme activities and their toxicological detectability in urine screenings

Psychoactive substances of the 2C‐series are phenethylamine‐based designer drugs that can induce psychostimulant and hallucinogenic effects. The so‐called 2C‐FLY series contains rigidified methoxy groups integrated in a 2,3,6,7‐tetrahydrobenzo[1,2‐b:4,5‐b']difuran core. The aim of the presented work was to investigate the in vivo and in vitro metabolic fate including isoenzyme activities and toxicological detectability of the three new psychoactive substances (NPS) 2C‐E‐FLY, 2C‐EF‐FLY, and 2C‐T‐7‐FLY to allow clinical and forensic toxicologists the identification of these novel compounds. Rat urine, after oral administration, and pooled human liver S9 fraction (pS9) incubations were analyzed by liquid chromatography−high‐resolution tandem mass spectrometry (LC−HRMS/MS). By performing activity screenings, the human isoenzymes involved were identified and toxicological detectability in rat urine investigated using standard urine screening approaches (SUSAs) based on gas chromatography (GC)−MS, LC−MSn, and LC−HRMS/MS. In total, 32 metabolites were tentatively identified. Main metabolic steps consisted of hydroxylation and N‐acetylation. Phase I metabolic reactions were catalyzed by CYP2D6, 3A4, and FMO3 and N‐acetylation by NAT1 and NAT2. Methoxyamine was used as a trapping agent for detection of the deaminated metabolite formed by MAO‐A and B. Interindividual differences in the metabolism of the 2C‐FLY drugs could be caused by polymorphisms of enzymes involved or drug–drug interactions. All three SUSAs were shown to be suitable to detect an intake of these NPS but common metabolites of 2C‐E‐FLY and 2C‐EF‐FLY have to be considered during interpretation of analytical findings

Occupational therapy students’ perspectives of ethics in two countries: South Africa and the United States of America

Objectives: Worldwide, health-care students, including occupational therapy students undergo ethics training. Ethics training facilitates students’ critical thinking, objective analysis and clinical reasoning skills to promote impartiality and minimize bias in decision-making. The aim of the study was to explore and describe similarities and differences in occupational therapy students’ perceptions and experiences of an ethical dilemma. Methods: The study employed a descriptive qualitative approach. Eighty occupational therapy students from South Africa and the United States of America (USA) participated in the study as part of an online international ethics module. Data were collected from students’ written analyses of a case study engaging them in an ethics reasoning process and were analyzed thematically. Results: Three themes emerged: Personal views and biases, ethical approaches, and practical alternatives and implications. Both groups of students from South Africa and the USA approached the case in a similar manner using their knowledge of ethics, principles, and approaches. They also applied the steps of an ethics reasoning process to guide their decision-making. All occupational therapy students from both countries highlighted Ethics of Care as an integral basis for their reasoning. Conclusion: There is a need amongst educators to identify, share, and discuss similarities and differences in how health-care practitioners address ethical issues, using the ethics reasoning process as a guide. The international occupational therapy community needs to further the profession’s meta-ethical discourse to guide clinical application within a diverse and globally connected workforce