‘Does My Haltung Look Big In This?”: The Use of Social Pedagogical Theory for the Development of Ethical and Value Led Practice

The aim of this article is to set out how the use of social pedagogical Haltung can support the exploration of values and how this informs and shapes a practitioner’s direct work. Haltung is a German concept that has no direct English translation but means ‘mind set’, ‘ethos’ or ‘attitude’ (Eichsteller, 2010) and relates to an individual’s value base. Mührel’s (2008, cited in Eichsteller, 2010), sets out that a social pedagogical Haltung is based on the two concepts of empathic understanding and regard. This paper argues that the use of a social pedagogical Haltung gives practitioners a philosophical framework to support the reflection of core values and ethics held on a personal level. It also supports an understanding of how these influence practitioners and students when using ‘self’ in relationship based practice. The understanding of Haltung is important but for social pedagogical practice to be undertaken it also has to be demonstrated by actions. The reflective activity Values Alive in Practice, set out in this article, provides a tool for social workers, practitioners and students to critically explore their own values and practice and make more meaningful connections between their Haltung and their behaviours demonstrated in their everyday work. In the UK, values and standards for social work practice are set out by British Association of Social Work and Social Work England. Arguably, these have, at times, been reduced to a checklist for students and practitioners and can lack more in depth and explicit links to practice. The analysis of practice is more likely to focus on the skills and abilities of practitioners rather than the value base that underpins these. Whilst the understanding and key application of core knowledge and skills is essential for competent social work practice (Forrester et al., 2019), this article argues that it must also be supported and shaped by ethical principles. This article seeks to explore how social workers can be supported to adopt value led approaches to complex work within an outcome focussed culture

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference

Large-scale phenotyping of patients with long COVID post-hospitalization reveals mechanistic subtypes of disease

One in ten severe acute respiratory syndrome coronavirus 2 infections result in prolonged symptoms termed long coronavirus disease (COVID), yet disease phenotypes and mechanisms are poorly understood1. Here we profiled 368 plasma proteins in 657 participants ≥3 months following hospitalization. Of these, 426 had at least one long COVID symptom and 233 had fully recovered. Elevated markers of myeloid inflammation and complement activation were associated with long COVID. IL-1R2, MATN2 and COLEC12 were associated with cardiorespiratory symptoms, fatigue and anxiety/depression; MATN2, CSF3 and C1QA were elevated in gastrointestinal symptoms and C1QA was elevated in cognitive impairment. Additional markers of alterations in nerve tissue repair (SPON-1 and NFASC) were elevated in those with cognitive impairment and SCG3, suggestive of brain–gut axis disturbance, was elevated in gastrointestinal symptoms. Severe acute respiratory syndrome coronavirus 2-specific immunoglobulin G (IgG) was persistently elevated in some individuals with long COVID, but virus was not detected in sputum. Analysis of inflammatory markers in nasal fluids showed no association with symptoms. Our study aimed to understand inflammatory processes that underlie long COVID and was not designed for biomarker discovery. Our findings suggest that specific inflammatory pathways related to tissue damage are implicated in subtypes of long COVID, which might be targeted in future therapeutic trials

SARS-CoV-2-specific nasal IgA wanes 9 months after hospitalisation with COVID-19 and is not induced by subsequent vaccination

BACKGROUND: Most studies of immunity to SARS-CoV-2 focus on circulating antibody, giving limited insights into mucosal defences that prevent viral replication and onward transmission. We studied nasal and plasma antibody responses one year after hospitalisation for COVID-19, including a period when SARS-CoV-2 vaccination was introduced. METHODS: In this follow up study, plasma and nasosorption samples were prospectively collected from 446 adults hospitalised for COVID-19 between February 2020 and March 2021 via the ISARIC4C and PHOSP-COVID consortia. IgA and IgG responses to NP and S of ancestral SARS-CoV-2, Delta and Omicron (BA.1) variants were measured by electrochemiluminescence and compared with plasma neutralisation data. FINDINGS: Strong and consistent nasal anti-NP and anti-S IgA responses were demonstrated, which remained elevated for nine months (p < 0.0001). Nasal and plasma anti-S IgG remained elevated for at least 12 months (p < 0.0001) with plasma neutralising titres that were raised against all variants compared to controls (p < 0.0001). Of 323 with complete data, 307 were vaccinated between 6 and 12 months; coinciding with rises in nasal and plasma IgA and IgG anti-S titres for all SARS-CoV-2 variants, although the change in nasal IgA was minimal (1.46-fold change after 10 months, p = 0.011) and the median remained below the positive threshold determined by pre-pandemic controls. Samples 12 months after admission showed no association between nasal IgA and plasma IgG anti-S responses (R = 0.05, p = 0.18), indicating that nasal IgA responses are distinct from those in plasma and minimally boosted by vaccination. INTERPRETATION: The decline in nasal IgA responses 9 months after infection and minimal impact of subsequent vaccination may explain the lack of long-lasting nasal defence against reinfection and the limited effects of vaccination on transmission. These findings highlight the need to develop vaccines that enhance nasal immunity. FUNDING: This study has been supported by ISARIC4C and PHOSP-COVID consortia. ISARIC4C is supported by grants from the National Institute for Health and Care Research and the Medical Research Council. Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research. The PHOSP-COVD study is jointly funded by UK Research and Innovation and National Institute of Health and Care Research. The funders were not involved in the study design, interpretation of data or the writing of this manuscript

A marriage made in hell: early intervention meets child protection

In this article we will argue for the moral legitimacy of support and its difference from intervention and the need to engage with and develop a family support project for the 21st century. We call for a debate on the current settlement between the state and family life and for a recognition that a perfect storm has ensued from the unholy alliance of early intervention and child protection. We will argue for a project that celebrates families’ strengths as well as their vulnerabilities in the context of considerable adversities and (re) locates workers as agents of hope and support. We draw from a diverse set of literatures and disciplines to locate our arguments within a broader project occasioned by the economic crisis and questioning of the verities of neo-liberalism

Ethics in an individualized field of practice – Social pedagogy in the context of the neoliberal organization

Writing from a Danish social pedagogical perspective, the author raises concerns about the difficulty of developing and integrating ethical reflection within the organization in the context of neoliberalism. While ethical reflection in social pedagogy tends to focus on the relationship between practitioner and client, or the relationship between the profession and the general public, this article wishes to focus on how ethical reflection develops in the workplace on an everyday basis. The reason for this focus is that the culture and language of the workplace can have major consequences for how practitioners interpret their roles and how they interpret the official ethical code. Although this article addresses the problem from a Danish context, the author argues that the struggle to develop ethical reflection within the organization is a general concern in most professions in contemporary society. What makes this problem controversial within the Danish social pedagogical context is that the profession has a long tradition of working qualitatively with relationship-based-practices. In the neoliberal organization, mercantile logic undermines the ethical logic of relationship-based practices. This is due to the former’s emphasis on effectivity and the latter’s emphasis on responsibility. This article is a critique of what the author sees as the neoliberal organization’s inability to tackle this conflict of values. Furthermore, this article problematizes the ‘abstract individuality’ that neoliberal organizations produce, highlighting the fact that such individuality is inconsistent with responsibility. Finally, the author argues that, by reinterpreting the concept of reflective practice, the organization may develop a more concrete individuality that is more consistent with responsibility

Ethics in genetic counselling

Difficult ethical issues arise for patients and professionals in medical genetics, and often relate to the patient’s family or their social context. Tackling these issues requires sensitivity to nuances of communication and a commitment to clarity and consistency. It also benefits from an awareness of different approaches to ethical theory. Many of the ethical problems encountered in genetics relate to tensions between the wishes or interests of different people, sometimes even people who do not (yet) exist or exist as embryos, either in an established pregnancy or in vitro. Concern for the long-term welfare of a child or young person, or possible future children, or for other members of the family, may lead to tensions felt by the patient (client) in genetic counselling. Differences in perspective may also arise between the patient and professional when the latter recommends disclosure of information to relatives and the patient finds that too difficult, or when the professional considers the genetic testing of a child, sought by parents, to be inappropriate. The expectations of a patient’s community may also lead to the differences in perspective between patient and counsellor. Recent developments of genetic technology permit genome-wide investigations. These have generated additional and more complex data that amplify and exacerbate some pre-existing ethical problems, including those presented by incidental (additional sought and secondary) findings and the recognition of variants currently of uncertain significance, so that reports of genomic investigations may often be provisional rather than definitive. Experience is being gained with these problems but substantial challenges are likely to persist in the long term