Using a virtue ethics lens to develop a socially accountable community placement programme for medical students

Background: Community-based education (CBE) involves educating the head (cognitive), heart (affective), and the hand (practical) by utilizing tools that enable us to broaden and interrogate our value systems. This article reports on the use of virtue ethics (VE) theory for understanding the principles that create, maintain and sustain a socially accountable community placement programme for undergraduate medical students. Our research questions driving this secondary analysis were; what are the goods which are internal to the successful practice of CBE in medicine, and what are the virtues that are likely to promote and sustain them? Methods: We conducted a secondary theoretically informed thematic analysis of the primary data based on MacIntyre’s virtue ethics theory as the conceptual framework. Results: Virtue ethics is an ethical approach that emphasizes the role of character and virtue in shaping moral behavior; when individuals engage in practices (such as CBE), goods internal to those practices (such as a collaborative attitude) strengthen the practices themselves, but also augment those individuals’ virtues, and that of their community (such as empathy). We identified several goods that are internal to the practice of CBE and accompanying virtues as important for the development, implementation and sustainability of a socially accountable community placement programme. A service-oriented mind-set, a deep understanding of community needs, a transformed mind, and a collaborative approach emerged as goods internal to the practice of a socially accountable CBE. The virtues needed to sustain the identified internal goods included empathy and compassion, connectedness, accountability, engagement [sustained relationship], cooperation, perseverance, and willingness to be an agent of change. Conclusion: This study found that MacIntyre’s virtue ethics theory provided a useful theoretical lens for understanding the principles that create, maintain and sustain CBE practice

Towards measurement of political pressure on central banks in the emerging market economies: the case of the central bank of Egypt

This paper assesses whether the legal independence granted to the Central Bank of Egypt (CBE) under the latest legislation is factual. I followed Fry’s methodology, which assumes that the level of independence of the central bank is determined by fiscal attributes. In an attempt to develop Fry’s method, I used a simple criterion to assess the central bank’s independence, namely, that the central bank is actually independent if it can fulfill its money supply target. Applying this criterion to the CBE and some other CBs in the developed countries and emerging market economies, we find that: (i) the legal independence granted to the CBE under the latest legislation is not factual; although the final objective of monetary policy is to achieve price stability, the CBE failed to fulfill its money supply target and achieve price stability, because it was responsive to political pressure and did not react to fulfill its money supply target; (ii) such political pressure on the CBE is due to fiscal attributes, as measured by domestic credit to the government; (iii) CBs whose independence is factual, according to our criterion, showed a negative relationship between the legal indices, as measured by the GMT index, and the fiscal attributes measured by DCGY. However, the relationship was anomalous when measured by the rate of inflationmonetary policy; central bank independence; fiscal dominance; political pressure

Tax law: rules or principles?

This is the year of simplification of tax legislation and I should like to add my thoughts to the debate. There is nothing new in complaining about the complexity of tax legislation. Every generation does it. To give two examples, the Codification Committee in 1936 looked back longingly to the early days of income tax: ‘... the Statutes of 1842 and 1853 were relatively simple. The growth of legislation since 1907 and its increasing complexity have been in large measure due to the high rates of tax in operation ... The space occupied by the provisions relating to such reliefs and exemptions is now prodigious, and contrasts with the comparative brevity of the earlier code.... Unhappily the actual language in which many of the statutory provisions are framed is so intricate and obscure as to be frankly unintelligible’. In 1955, the Royal Commission said much the same: ‘... the law on the subject of income tax remains voluminous, complicated and obscure.... The history of earlier attempts [to simplify it], however, suggests that the problem may be in fact an intractable one, beyond the reach of recommendations’.

A controlled study of community-based exercise training in patients with moderate COPD.

BackgroundThe effectiveness of clinic-based pulmonary rehabilitation in advanced COPD is well established, but few data exist for less severe patients treated in alternative settings. The purpose of this study was to investigate whether a novel, community-based exercise program (CBE) was feasible and effective for patients with moderate COPD.MethodsNineteen patients with moderate COPD (mean FEV1 62%) and self-reported exercise impairment were randomized to 12-weeks of progressive endurance and strength training at a local health club under the guidance of a certified personal trainer, or to continuation of unsupervised habitual physical activity. Outcomes assessed at baseline and 12 weeks included session compliance, intensity adherence, treadmill endurance time, muscle strength, dyspnea, and health status.ResultsCompliance was 94% and adherence was 83%. Comparisons between CBE and control groups yielded the following mean (SEM) differences in favor of CBE: endurance time 134 (74) seconds versus -59 (49) seconds (P=0.041) and TDI 5.1 (0.8) versus -0.2 (0.5) (P<0.001). The CBE group increased muscle strength (weight lifted) by 11.8 kilograms per subject per week of training (P<0.001). SGRQ was not significantly changed.ConclusionsWe demonstrated the feasibility and effectiveness of a novel community-based exercise program involving health clubs and personal trainers for patients with moderate COPD.Trial registrationClinicalTrials.gov Identifier NCT01985529

Looking Under the Hood of Competency-Based Education: The Relationship Between Competency-Based Education Practices and Students' Learning Skills, Behaviors, and Dispositions

The Nellie Mae Education Foundation (Nellie Mae), in partnership with the American Institutes for Research (AIR), has recently released a comprehensive analysis of competency-based education (CBE), an instructional approach that emphasizes what students learn and master rather than time spent in a classroom. The study, titled "Looking Under the Hood of Competency-Based Education," examines the relationship between various competency-based practices and increased student learning capacity. Additionally, the study highlights the varying degrees of CBE practices in schools that have an existing reputation for implementation."Schools across the country are increasingly seeking ways to provide a competency-based education for students, yet many educators are not sure of where to begin or how they can implement this approach to learning," said Eve Goldberg, Director of Research at the Nellie Mae Education Foundation. "The framework developed by AIR of learning skills, behaviors, and dispositions and the findings on specific practices can help educators strengthen their practices and gives them the tools to continuously improve their practice. We hope educators interested in making this shift will benefit from this analysis.""Looking Under the Hood" analyzes a variety of competency-based practices to examine how schools implement CBE and determine how it relates to students' learning capacities. Some notable findings include:Learning in contexts outside the classroom (for example, internships) positively relates to increasing students' learning capacitiesThe option for students to learn at a comfortable pace (for example, extra time to finish a topic or unit and the opportunity to retake an exam or re-do a final project) has a positive association with self-efficacy and increasing students' motivation to learnThe option for students to receive both instruction and assessment in a variety of formats, including collaborative group projects, helped students' intrinsic motivationEstablishing clear learning targets was positively related to increasing students' learning capacitiesOverall, the study finds that many students' experiences with CBE-aligned practices were positively associated with changes in learning capacities in several areas, most notably in students' intrinsic motivation for classroom work."Competency-based education varies tremendously from school to school and even across classrooms, so it can be hard to determine if it is working," said Erin Haynes, Senior Researcher at the American Institutes for Research. "This study examined specific CBE-aligned practices, giving us a more finely-honed view of how such practices are related to students' capacity to learn. We hope this research will help inform future efforts to implement competency-based methods across districts, schools and classrooms.

Predictors of adherence to clinical breast examination and mammography screening among Malaysian women.

Breast cancer is the most common cancer among Malaysian women and early detection can play an important role in reducing cancer morbidity and mortality. The aim of this cross-sectional study was to determine the rates and factors related to clinical breast examination (CBE) and mammography among 425 female teachers in Selangor, Malaysia. A self-administered questionnaire that included questions on socio-demography, cancer-related knowledge practice and an adapted version of Champion's revised Health Belief Model Scale was employed. The mean age of participants was 37.2±7.16 years. Only 25% of the women ever had a CBE. Of women over the age 40 (n=138), 13.6% reported having had a mammography. The results showed higher susceptibility to breast cancer, higher benefits of doing CBE and regular visits with a physician to be significant predictors for undergoing CBE (p<0.05). In addition, higher a perceived susceptibility to breast cancer and regular undergoing CBE were significant predictors for having a mammography. The findings clearly suggest a need for improving women's awareness on breast cancer screening, its importance and recommended guidelines

Community-based enterprise as an instrument for sustainable development?

Along with the increasing efforts to create a sustainable world, community-based enterprise (CBE) has been increasingly acknowledged as a potential solution. However, despite the increasing implementation of CBE, knowledge about the organizational architecture and performance is still lacking. The paper presents a brief overview of how CBE can be assessed from the perspective of organizational theory

Framework for Analyzing Community-Based Enterprise (CBE): Literature review of organizational architecture and organizational performance

Community-based enterprise (CBE) has increasingly been acknowledged as a potential solution for environmental-poverty problems in developing countries. However, the imprecision of how the CBE is defined and the lack of clarity regarding the organization of CBE have posed a challenge of identifying effective way to successfully implement the CBE model. These facts have become the motivation of conducting research in this topic. The aim of this working paper is to present a literature review regarding the possibility of assessing the CBE from the organizational perspective, namely by looking at organizational architecture and performance issues. Four features of organizational architecture are taken into account, i.e. contextual constraints, organizational goals, collection of resources, and architectural design. As for organizational performance, the focus is on measuring the relative growth of the triple-bottom-line and survivability dimensions. Some next steps are also suggested at the end of the paper

Development of non-antibiotic-resistant, chromosomally based, constitutive and inducible expression systems for aroA-attenuated Salmonella enterica serovar typhimurium

Live-vaccine delivery systems expressing two model antigens from Mycoplasma hyopneumoniae, F2(P97) (Adh) and NrdF, were constructed using Salmonella enterica serovar Typhimurium aroA (STM-1), and immunogenicity in mice was evaluated. Recombinant plasmid-based expression (PBE) and chromosomally based expression (CBE) systems were constructed. The PBE system was formed by cloning both antigen genes into pJLA507 to create an operon downstream of temperature-inducible promoters. Constitutive CBE was achieved using a promoter-trapping technique whereby the promoterless operon was stably integrated into the chromosome of STM-1, and the expression of antigens was assessed. The chromosomal position of the operon was mapped in four clones. Inducible CBE was obtained by using the in vivo-induced sspA promoter and recombining the expression construct into aroD. Dual expression of the antigens was detected in all systems, with PBE producing much larger quantities of both antigens. The stability of antigen expression after in vivo passage was 100% for all CBE strains recovered. PBE and CBE strains were selected for comparison in a vaccination trial. The vaccine strains were delivered orally into mice, and significant systemic immunoglobulin M(IgM) and IgG responses against both antigens were detected among all CBE groups. No significant immune response was detected using PBE strains. Expression of recombinant antigens in S. enterica serovar Typhimurium aroA from chromosomally located strong promoters without the use of antibiotic resistance markers is a reliable and effective method of inducing a significant immune response