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

Redistricting in Illinois

Redistricting in Illinois is a challenging and contentious political game which must be played every ten years. The rules of the game consist of a maze of federal constitutional and legal requirements supplemented by the constitution and laws of the state of Illinois. The national laws provide a legal framework within which Illinois lawmakers must work as they redraw the map for the congressional and state legislative districts to meet the new population count every decade. Within the parameters provided to the state by federal law and court rulings, Illinois is like every other state and must meet the same requirements imposed on every state by the superiority of federal law and the national constitution. However, like most other things in the political sphere, Illinois has its own unique history and political culture and its own way of meeting the challenge. Our constitution, for example, is unique in the provision of the tie breaker system for breaking out of an impasse between the two parties. The very competitive political culture in Illinois, with our two almost equally matched parties, ensures that the decennial redistricting game will be very hard fought and closely matched, often going into the “overtime” provided by the tie breaker provision in the constitution, and often then challenged further in the courts. This paper details some of the major provisions, in both law and politics, for the redistricting process in Illinois and nationally

Epidemiological patterns of hepatitis B virus (HBV) in highly endemic areas

This paper uses meta-analysis of published data and a deterministic mathematical model of hepatitis B virus (HBV) transmission to describe the patterns of HBV infection in high endemicity areas. We describe the association between the prevalence of carriers and a simple measure of the rate of infection, the age at which half the population have been infected (A50), and assess the contribution of horizontal and perinatal transmission to this association. We found that the two main hyper-endemic areas of sub-Saharan Africa and east Asia have similar prevalences of carriers and values of A50, and that there is a negative nonlinear relationship between A50 and the prevalence of carriers in high endemicity areas (Spearman's Rank, P = 0·0086). We quantified the risk of perinatal transmission and the age-dependent rate of infection to allow a comparison between the main hyper-endemic areas. East Asia was found to have higher prevalences of HBeAg positive mothers and a greater risk of perinatal transmission from HBeAg positive mothers than sub-Saharan Africa, though the differences were not statistically significant. However, the two areas have similar magnitudes and age-dependent rates of horizontal transmission. Results of a simple compartmental model suggest that similar rates of horizontal transmission are sufficient to generate the similar patterns between A50 and the prevalences of carriers. Interrupting horizontal transmission by mass immunization is expected to have a significant, nonlinear impact on the rate of acquisition of new carriers

Monitoring the South African National Antiretroviral Treatment Programme, 2003-2007: the IeDEA Southern Africa collaboration.

OBJECTIVES: To introduce the combined South African cohorts of the International epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration as reflecting the South African national antiretroviral treatment (ART) programme; to characterise patients accessing these services; and to describe changes in services and patients from 2003 to 2007. DESIGN AND SETTING: Multi-cohort study of 11 ART programmes in Gauteng, Western Cape, Free State and KwaZulu-Natal. SUBJECTS: Adults and children (<16 years old) who initiated ART with > or =3 antiretroviral drugs before 2008. RESULTS: Most sites were offering free treatment to adults and children in the public sector, ranging from 264 to 17,835 patients per site. Among 45,383 adults and 6,198 children combined, median age (interquartile range) was 35.0 years (29.8-41.4) and 42.5 months (14.7-82.5), respectively. Of adults, 68% were female. The median CD4 cell count was 102 cells/microl (44-164) and was lower among males than females (86, 34-150 v. 110, 50-169, p<0.001). Median CD4% among children was 12% (7-17.7). Between 2003 and 2007, enrolment increased 11-fold in adults and 3-fold in children. Median CD4 count at enrolment increased for all adults (67-111 cells/microl, p<0.001) and for those in stage IV (39-89 cells/microl, p<0.001). Among children <5 years, baseline CD4% increased over time (11.5-16.0%, p<0.001). CONCLUSIONS: IeDEA-SA provides a unique opportunity to report on the national ART programme. The study describes dramatically increased enrolment over time. Late diagnosis and ART initiation, especially of men and children, need attention. Investment in sentinel sites will ensure good individual-level data while freeing most sites to continue with simplified reporting

Honest to God and the South African churches in 2016

The year 2013 was fifty years since the publication of Honest to God, by John A.T. Robinson (1919-1983), who was Bishop of Woolwich at the time. The book became a bestseller. The research question that gave rise to the present article is how relevant and sound its main ideas are for South Africa, in particular, and for his own church in 2016. This paper examines Robinson’s views from three perspectives, namely Christian and secular practical ethics, the recent history of the church, to which the Bishop belonged in England, and the contemporary South African situation, in particular. The paper argues that, five hundred years on, Robinson’s project of developing a Christian response to contemporary secular challenges remains valid in South Africa

Has the phasing out of stavudine in accordance with changes in WHO guidelines led to a decrease in single-drug substitutions in first-line antiretroviral therapy for HIV in sub-Saharan Africa?

This version is the Accepted Manuscript and is published in final edited form as: AIDS. 2017 January 02; 31(1): 147–157. doi:10.1097/QAD.0000000000001307OBJECTIVE: We assessed the relationship between phasing out stavudine in first-line antiretroviral therapy (ART) in accordance with WHO 2010 policy and single-drug substitutions (SDS) (substituting the nucleoside reverse transcriptase inhibitor in first-line ART) in sub-Saharan Africa. DESIGN: Prospective cohort analysis (International epidemiological Databases to Evaluate AIDS-Multiregional) including ART-naive, HIV-infected patients aged at least 16 years, initiating ART between January 2005 and December 2012. Before April 2010 (July 2007 in Zambia) national guidelines called for patients to initiate stavudine-based or zidovudine-based regimen, whereas thereafter tenofovir or zidovudine replaced stavudine in first-line ART. METHODS: We evaluated the frequency of stavudine use and SDS by calendar year 2004-2014. Competing risk regression was used to assess the association between nucleoside reverse transcriptase inhibitor use and SDS in the first 24 months on ART. RESULTS: In all, 33 441 (8.9%; 95% confience interval 8.7-8.9%) SDS occurred among 377 656 patients in the first 24 months on ART, close to 40% of which were amongst patients on stavudine. The decrease in SDS corresponded with the phasing out of stavudine. Competing risks regression models showed that patients on tenofovir were 20-95% less likely to require a SDS than patients on stavudine, whereas patients on zidovudine had a 75-85% decrease in the hazards of SDS when compared to stavudine. CONCLUSION: The decline in SDS in the first 24 months on treatment appears to be associated with phasing out stavudine for zidovudine or tenofovir in first-line ART in our study. Further efforts to decrease the cost of tenofovir and zidovudine for use in this setting is warranted to substitute all patients still receiving stavudine

Anaesthesia and the developing brain

Increasing concern about the effect of anaesthesia on the infant and young child is raised by health care practitioners as well as the public immature neurons exposed to anaesthesia may lead to apoptosis and long-term neurobehavioural deficits in animals. The majority of anaesthetic agents work by influencing GABA or NMDA receptors and may induce animal neuro apoptosis. The search for neuroprotective strategies to reverse or counter act the effect of anaesthesia, so far, has not been very successful. Dexmedetomidine is an α-2 adrenoreceptor and may have neuroprotective effects. The available human studies have failed to prove any long-term neurobehavioural deficiencies caused by anaesthetic exposure. Large international prospective studies are currently on the way that may change the practice of paediatric and obstetric anaesthesiologists in the future

African speculative fiction as Indigenous remembering: Contrasting stories by Jonathan Dotse and Masima Musodza

How to understand what uniquely African contribution speculative fiction created by African authors makes is a vexed question. Drawing on concepts of the geopolitics of knowledge and locus of enunciation, from the South American tradition of decolonial theory, I argue that the term “Indigenous” must be retained to specify works that speak from epistemic locations within Indigenous African cultures. Such fiction does important remembering work by recovering, renewing, and extending Indigenous knowledge traditions and so claiming the right to imagine futures in Indigenous terms. This remembering is obscured if such fiction is examined in terms such as Afrofuturism, which primarily focuses on race, or Africanfuturism, which focuses on geographical location. Indigenous remembering works from a specific Indigenous locus of enunciation and uses this episteme to explain the present and imagine the future. Such remembering must be distinguished from works that reduce Indigenous knowledge and knowers to tokens of their culture, as the “Other” to Eurocentric knowledge and its claim of universality. I illustrate this distinction by discussing two stories, “The writing in the stars” by Jonathan Dotse and “Herbert wants to return home” by Masima Musodza, showing how Musodza’s story is told from within a specific Indigenous framework, the Shona conception of personhood known in Shona as hunhu, whereas Dotse’s tale speaks about Malian astrophysics but from outside it. It is this distinction, a vital colonial difference, that the term Indigenous African speculative fiction aims to capture

From science council to health and medical research organisation 25 years of MRC history

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