Breaking the cycle of malnutrition through sustainable business models: The case of ready-to-use therapeutic foods

The data explained in the relevant report "The State of Food Security and Nutrition in the World. Transforming Food Systems for Affordable Healthy” (FAO, IFAD, UNICEF, WFP and WHO, Rome 2020) reveals that the world is not on track to achieve the SDG 2.1 ("Universal access to safe and nutritious food”) and SDG 2.2 ("End of all forms of malnutrition”), both Zero Hunger of Sustainable Development Goal 2 ("End hunger, achieve food security and improved nutrition and promote sustainable agriculture”) targets by 2030 Agenda for Sustainable Development. If recent trends continue, the number of people affected by hunger would increase further. The combination of moderate and more severe levels of food insecurity raises the estimate to over 25% of the world population, equivalent to a total of about 2 billion people. In addition, the COVID-19 pandemic is intensifying the vulnerabilities and inadequacies of global food systems and of all the activities and processes affecting the production, distribution, and consumption of food so that this circumstance further questions the achievement of the goal Zero Hunger. A very important tool to successfully tackle this serious and long-standing problem is represented by nutraceutical products and in the rehabilitation of severe patients and undernourished children, the "ready-to-use therapeutic foods” (RUTFs) have shown remarkable efficacy. They refer to a number of varieties of ready-to-eat foods, ranging from those prepared from locally available ingredients by village women in their own self-help groups for the malnourished children to those prepared according to specific formulas in worldwide factories. RUTF now almost always refers to the latter and it is a generic term including different types of foodstuff, such as spreads or compressed products with precise amounts of nutrients, mainly derived from powdered milk, peanut, oil, sugar, and micronutrients, providing energy equivalent to WHO requirement. However, the local availability of the necessary ingredients limits the production in geographical areas where their use is required, thus there are currently important efforts in the research for alternative ingredients to overcome this limitation. The purpose of this study is to trace the current scenario in terms of food security and malnutrition in the world, focusing attention on the problems associated with the dissemination of initiatives aimed at addressing such a global challenge. The research was conducted following the tripartition model both in the analysis of the problem and in the proposed answer model, although the business perspective was the privileged one. Encouraging the proper and effective implementation of an economically, socially, and environmentally sustainable local market for RUTFs means creating shared values, acting jointly, and maximizing the results in favour of children and their families who are still fighting for the right to live in dignity. © 2023 Elsevier Inc. All rights reserved.

Optimising students' participation during emergency remote teaching in the Covid-19 pandemic

This study examined issues related to students' participation and online absenteeism among students at Zimbabwe's universities during COVID-19 induced online teaching and learning. More specifically, the study examined some of the ethical issues related to students' participation and assessment during online learning in selected universities in Zimbabwe. The study also examined some of the strategies that can be adopted to optimize students' participation during online learning to make online learning a more honest and interactive endeavour. To fully understand the challenges related to participation and online absenteeism, the study extrapolated the perspectives of students and academic staff who had adopted online learning since the outbreak of the COVID-19 pandemic. The research was a mixed-methods study, employing a descriptive-analytical approach which utilised three main methods of data collection. Firstly, semi-structured questionnaires distributed electronically among participants in the selected universities were used to collect research data. Secondly, follow-up online focus-group discussions (FGDs) were conducted to elicit participants' views on some of the ethical challenges posed by online learning and possible strategies for dealing with the challenges. Finally, follow-up telephone interviews were also conducted with lecturers with the same objective as the FGDs. The study's population consisted of 110 students and 77 academic staff randomly selected from six universities in Zimbabwe. Two of the selected universities were privately owned and four were public universities. The study showed some of the technological and pedagogical issues regarding students' participation and strategies for optimising students' participation during online learning. The study also shared some of the ethical challenges that arose from the adoption of online teaching and assessment systems and the policy, resource and training interventions needed to make online learning more interactive, while at the same time safeguarding academic integrity. The findings of this study, therefore, have implications for universities, learners and academic staff if online learning programmes are to be successful. Firstly, universities for instance, need to ensure that students and academic staff have the prerequisite technological resources to ensure that optimal active learning takes place. Secondly, to address the shortage of resources, universities should ensure that their libraries migrate from physical to digital libraries. Universities should also ensure that both academic staff and students receive the necessary training to access these digital libraries and the services they offer.

Regulatory Aspects on AI and Pharmacovigilance for COVID-19

This chapter looks at current and perspective legislative and regulatory scenario, identifying rules governing the use of Artificial Intelligence in the health sector at European Union level with a focus on the impact of AI on pharmacovigilance activities. After some preliminary considerations on definitory issues, attention will be paid to the challenges posed by AI to pharmaceutical industry in developing medicinal products and monitoring their quality, safety and efficacy. The European strategy addressing the use of AI in pursuing a better health policy will then be outlined, followed by some caveat concerning ethical implications and protection of personal data. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Separation and Discrimination: The Lived Experience of COVID-19 Survivors in Philippine Isolation Centers

Social isolation in times of pandemic can affect the well-being of individuals infected with a contagious disease. This study explores the lived experience of the 12 COVID-19 survivors placed in community-based isolation centers in Cebu City, Philippines and whose cases were mild and asymptomatic. In describing their lived experience, we employed Max van Manen's phenomenology of practice. Results show that the COVID-19 survivors have suffered more from the consequences of separation and discrimination than the disease's physiological effects. Educating the whole community about social responsibility and ethical behavior in dealing with COVID-19 survivors is essential to minimize social stigma and discrimination.

Ethical moments and institutional expertise in UK Government COVID-19 pandemic policy responses: where, when and how is ethical advice sought?

Background:The emergency response to the COVID-19 pandemic has required a rapid acceleration of policy decision making, and raised a wide range of ethical issues worldwide, ranging from vaccine prioritisation, welfare and public health ‘trade-offs', inequalities in policy impacts, and the legitimacy of scientific expertise.Aims and objectives:This paper explores the legacy of the pandemic for future science-advice-policy relationships by investigating how the UK government's engagement with ethical advice is organised institutionally. We provide an analysis of some key ethical moments in the UK Government response to the pandemic, and institutions and national frameworks which exist to provide ethical advice on policy strategies.Methods:We draw on literature review, documentary analysis of scientific advisory group reports, and a stakeholder workshop with government ethics advisors and researchers in England.Findings:We identify how particular types of ethical advice and expertise are sought to support decision making. Contrary to a prominent assumption in the extensive literature on ‘governing by expertise', ethical decisions in times of crisis are highly contingent.Discussion and conclusions:The paper raises an important set of questions for how best to equip policymakers to navigate decisions about values in situations characterised by knowledge deficits, complexity and uncertainty. We conclude that a clearer pathway is needed between advisory institutions and decision makers to ensure ethically-informed debate.

EVALUATING THE ETHICAL AND SOCIETAL IMPACTS OF MODELLING PANDEMIC CRISES: EXPERIENCES FROM A WORKSHOP

This paper describes a hybrid (virtual and online) workshop held as part of the EU STAMINA project that aimed to engage project partners to explore ethics and simulation modelling in the context of pandemic preparedness and response. The purpose of the workshop was to consider how the model's design and use in specific pandemic decision-making contexts could have broader implications for issues like transparency, explainability, representativeness, bias, trust, equality, and social injustices. Its outputs will be used as evidence to produce a series of measures that could help mitigate ethical harms and support the greater possible benefit from the use of the models. These include recommendations for policy, data-gathering, training, potential protocols to support end-user engagement, as well as guidelines for designing and using simulation models for pandemic decision-making. This paper presents the methodological approaches taken when designing the workshop, practical concerns raised, initial insights gained, and considers future steps. © SW 2023.All rights reserved

Attitudes among physicians toward vaccine mandates for emerging infectious disease: the case of the COVID-19 vaccine

Objectives: The outbreak of SARS-CoV-2 resulted in a global pandemic. Vaccine mandates were implemented in several countries, including in Taiwan, and often targeted health-care workers in particular. This study investigated attitudes among Taiwanese physicians toward such policies and how ethical beliefs and logic influenced attitudes. Methods: A total of 16 physicians were recruited by using the snowball method from hospitals in northern Taiwan. Data were collected through semi-structured interviews. Results: Physicians tended not to support mandatory vaccination. Five themes emerged: (1) Individual rights, including violation of autonomy and labor rights;(2) vaccine performance, including safety and efficacy;(3) institutional norms, including the degree of relevancy of the policy-issuing unit and the employment relationship between physicians and institutions;(4) social and workplace stigma resulting from coercive policies in different job categories or departments;and (5) professional ethics of physicians. Conclusions: Autonomy and professional ethics among physicians influence attitudes toward vaccine mandates. Vaccine performance, institutional norms, and stigma also influence attitudes toward vaccine mandates and decision-making. Even with high ethical awareness, the study participants tended not to support vaccine mandates. The government should formulate mandatory vaccination policy means for healthcare workers that can be used by hospitals. Each hospital should assess their unique risks and implement policies that best suit their needs. (Taiwan J Public Health. 2023;42(1):75-87)

Values and ethics in the teaching profession

The emergence of the COVID-19 pandemic has resulted in a crisis that has had not only far-reaching consequences on our health and economy but also on education systems around the world. It has prompted educational institutions to take measures to continue to teach and support students at a distance, as well as to prepare for the long-term impact of the crisis on teaching. As institutions continue to create and implement solutions for distance learning, new ethical issues and challenges arise as major points of consideration. Building ethical frameworks to facilitate learning systems that support both students and educators is becoming a top priority around the world. As we move through the COVID-19 crisis, the values and professional competences of teachers must be critically examined. Serious ethical dilemmas face educational institutions now and in the future. A successful response and adaptation to the ongoing crisis with a focus on ethical concerns will result in institutions of learning that are more robust and resilient, and that will continue to effectively educate future generations of students. This chapter focuses on values and professional competence, the education system during the pandemic, and new ethical challenges after the pandemic. © Springer Nature Switzerland AG 2021. All rights reserved.

Engineering in a Crisis: Observing Students' Perceptions of Macroethical Responsibilities during Pandemics and Natural Disasters

When the ethical responsibilities of engineers are discussed in classrooms, the focus is usually on microethics, which concentrates on individual decision-making, rather than macroethics, that addresses broad societal concerns. Pandemics (e.g., COVID-19) and natural disasters (e.g., hurricanes, derechos) have presented unique opportunities to observe engineering macroethical responsibilities, because unjust social, economic, and environmental systems have been brought to the forefront amidst the responses (e.g., inequitable transportation access). In this paper, we consider pandemics and natural disasters through the lens of engineering macroethics, aiming to understand students' perceptions about the macroethical responsibilities of engineers. In the fall of 2020, we deployed a survey to undergraduate engineering students at two universities (n=424). Students were asked to discuss what they perceived to be the role of engineering professionals in response to the global COVID-19 pandemic and natural disasters. We used a qualitative content analysis to explore the macroethical responsibilities mentioned in students' responses. Many of these responses include considerations of infrastructure resilience, resource distribution, and community equity. Logit models were used to identify which sociodemographic factors were associated with responses that included macroethical responsibilities, revealing engineering major (specifically, civil engineering), employment status, gender identity, and family size, among others as significant factors. The implications from this study include recommendations on curricular content, and identifying which student sociodemographic groups would especially benefit from macroethical content in coursework. © 2023 American Society of Civil Engineers.

Values, indicators and policies. A reflection starting from sustainability issues and the Covid-19 pandemic

The article critically discusses the role of indicators, with particular reference to sustainability issues and the Covid-19 pandemic. The distinction between "cognitive values” and "ethical values” is assumed as fundamental in discussing the relationship between indicators and public policies.L'articolo discute criticamente il ruolo degli indicatori, con particolare riferimento ai temi della sostenibilità e della pandemia da Covid-19. La distinzione tra "valori epistemici” e "valori etici” è assunta come fondamentale nel discutere il rapporto tra indicatori e politiche pubbliche.

Should age matter in COVID-19 triage? A deliberative study

The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and 'anticipatory triage' likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public's moral intuitions. Our study aimed to explore general public views in the UK on the role of age, and related factors like frailty and quality of life, in triage during the COVID-19 pandemic. We held online deliberative workshops with members of the general public (n = 22). Participants were guided through a deliberative process to maximise eliciting informed and considered preferences. Participants generally accepted the need for triage but strongly rejected 'fair innings' and 'life projects' principles as justifications for age-based allocation. They were also wary of the 'maximise life-years' principle, preferring to maximise the number of lives rather than life years saved. Although they did not arrive at a unified recommendation of one principle, a concern for three core principles and values eventually emerged: equality, efficiency and vulnerability. While these remain difficult to fully respect at once, they captured a considered, multifaceted consensus: utilitarian considerations of efficiency should be tempered with a concern for equality and vulnerability. This 'triad' of ethical principles may be a useful structure to guide ethical deliberation as societies negotiate the conflicting ethical demands of triage. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The lived experiences of principals in the northeast United States in supporting the social-emotional wellbeing of their school community during the COVID-19 pandemic

This study investigated the lived experiences of (12) elementary and middle school principals in the Northeast United States throughout the COVID-19 pandemic. In light of the emergency COVID-19 guidelines that have been implemented across schools in the United States, the purpose of this phenomenological study was to understand how principals support the social-emotional wellbeing of their school community and make emergency policy decisions during crisis. Through virtual interviews, elementary and middle school principals shared their unique perspectives around the perceived impact that COVID-19 emergency guidelines had on their schools, actions they took to support their schools' socio-emotionally, and the ways in which they made decisions around emergency policy. The study revealed that leaders and teachers experienced higher levels of stress due to the COVID-19 emergency guidelines, and students had fewer opportunities for social interactions. Principals also had to leverage existing socio-emotional supports and develop innovative methods to promote the socio-emotional wellbeing of their school communities throughout the pandemic. Throughout the crisis, policy decisions were made by leaning on experts, considering safety and operational feasibility, and deliberating community perception. The ways in which principals individually perceived and interpreted emergency guidelines also influenced the decision-making process and implementation. School communities were impacted by emergency guidelines in profound ways and principals recognized the critical importance of supporting their school community socio-emotionally during crisis. Principals prioritized the overall safety of their school communities regardless of the impact on socio-emotional health. Lastly, this study provided recommendations not only for future policy in education, but potential practices that will provide targeted socio-emotional interventions to students and strengthen community connections. Recommendations for future studies are also included to help bring to light the degree COVID-19 emergency guidelines have impacted schools throughout the United States for generations to come. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Ethical considerations for protecting the options of subjects in primary epidemic vaccine trials

Comments on an article by J. T. Monrad (see record 2020-61038-012). Monrad presented several issues about secondary vaccine trials. It lays out the case in which a vaccine has been tested through phases I-III and is being deployed. Subsequently, consideration is being given to conducting 'trials for another vaccine for the pathogen'. Monrad stated: 'In summary, we may say that researchers have strong prima facie reasons not to conduct a secondary vaccine trial.' Monrad discusses several factors meriting careful consideration about the need for developing and testing more than one vaccine: relative efficacy, length of immunity, adverse reactions (reactogenicity), ease of storage and administration, economic and logistical factors. What is not addressed are the ethical duties that exist when there are competing phase III vaccine candidates for COVID- 19. Ethically, a subject is allowed to quit a trial at any time. But how might this work in a vaccine trial with multiple candidates? If someone has received an experimental vaccine, they need to be informed of what to do should they wish to subsequently try an approved vaccine. But will companies and researchers with financial stakes in one vaccine readily disclose other options either initially or mid-trial? If a subject got experimental vaccine, there may be more of a chance of having an adverse immune reaction to an additional vaccine that is approved. So they may not wish to do anything. Thus, as part of all informed consents for phase three trials, participants need to be told that at the time some vaccine is approved, they will be told whether or not they received the test vaccine or the placebo so as to help participants make their decision as to whether to get another approved vaccine or not. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

New development: Ethical dilemmas and emotional labour—what can we learn from the shared Covid-19 crisis?

IMPACTThis article will be of value to public officials and managers who are grappling with the ethical questions arising from public sector work and service delivery. This is especially relevant in the context of Covid-19 where new forms of emotional labour are emerging. Procurement officers and politicians are encouraged to consider the possibilities of unethical behaviour and the consequences.

Moral distress and positive experiences of ICU staff during the COVID-19 pandemic: lessons learned.

BACKGROUND: The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. METHODS: A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. RESULTS: All 178 respondents (response rate: 25-32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to 'team cooperation', 'team solidarity' and 'work ethic'. Lessons learned were mostly related to 'quality of care' and 'professional qualities'. CONCLUSIONS: Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals' dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. TRIAL REGISTRATION: The trial was registered on The Netherlands Trial Register, number NL9177.

Mapping emerging technologies in aged care: results from an in-depth online research.

BACKGROUND: Emerging Technologies (ETs) have recently acquired great relevance in elderly care. The exceptional experience with SARS-CoV-2 pandemic has emphasized the usefulness of ETs in the assistance and remote monitoring of older adults. Technological devices have also contributed to the preservation of social interactions, thus reducing isolation and loneliness. The general purpose of this work is to provide a comprehensive and updated overview of the technologies currently employed in elderly care. This objective was achieved firstly, by mapping and classifying the ETs currently available on the market and, secondly, by assessing the impact of such ETs on elderly care, exploring the ethical values promoted, as well as potential ethical threats. METHODS: An in-depth search was carried out on Google search engine, by using specific keywords (e.g. technology, monitoring techniques, ambient intelligence; elderly, older adults; care and assistance). Three hundred and twenty-eight technologies were originally identified. Then, based on a predetermined set of inclusion-exclusion criteria, two hundreds and twenty-two technologies were selected. RESULTS: A comprehensive database was elaborated, where the two hundred and twenty-two ETs selected were classified as follows: category; developmental stage; companies and/or partners; functions; location of development; time of development; impact on elderly care; target; website. From an in-depth qualitative analysis, some ethically-related contents and themes emerged, namely: questions related to safety, independence and active aging, connectedness, empowerment and dignity, cost and efficiency. Although not reported by developers, a close analysis of website contents highlights that positive values are often associated with potential risks, notably privacy threats, deception, dehumanization of care. CONCLUSIONS: Research findings may ultimately lead to a better understanding of the impact of ETs on elderly people.

Moral Agency Development as a Community-Supported Process: An Analysis of Hospitals' Middle Management Responses to the COVID-19 Crisis.

This paper investigates the process of moral agency development as a community-supported process. Based on a multimethod qualitative inquiry, including diaries, focus groups, and documentary analysis, we analyze the experiences of middle managers in two Norwegian hospitals during the first year of the COVID-19 pandemic. We find that moral agency is developed through a community-embedded value inquiry, emerging in three partially overlapping steps. The first step is marked by moral reflex, an intuitive, value-driven, pre-reflective response to a crisis situation. In the second step, the managers involved the community in value calibration, a collective-ethical sensemaking. In the third step, they took active stances to translate values into actions, with an increased awareness of values and an ability to explain and justify their actions. We label the steps, respectively: value inquiry-in-action, value inquiry-on-action and reflective enactment of value. An analysis of the process reveals two aspects critical for moral agency development: it happens through confrontation with uncertainty, and it is relational, that is, embedded in a community. While uncertainty forces an intuitive moral response, dialogical reflection in the community develops value awareness and relationships of mutual care and support.

Supporting Birthing People and Supporting Doulas: The Impact of the COVID-19 Pandemic on a Community-Based Doula Organization in San Francisco.

Background: Beginning in March 2020, health care systems in the United States restricted the number of support people who could be present during pregnancy-related care to reduce the spread of COVID-19. We aimed to describe how SisterWeb, a community-based doula organization that employs Black, Pacific Islander, and Latinx doulas in San Francisco, California, adapted to the COVID-19 pandemic. Methods: As part of process and outcome evaluations conducted through an academic-community partnership, we interviewed SisterWeb doulas, mentors, and leaders in 2020, 2021, and 2022 (n=26 interviews). We identified preliminary themes using the Rapid Assessment Process and then conducted thematic analysis of data related to COVID-19. Results: SisterWeb leadership remained committed to safeguarding doulas by shifting to virtual support until doulas were onboarded as benefitted employees. Doulas reported hospital policies impacted clients' pregnancy-related care. Initially, doulas adapted to virtual support by connecting with clients more frequently through phone and text. When permitted to meet in person, doulas adjusted to client preference. Finally, as the pandemic impacted doulas' well-being, they turned to mentors for emotional support. Discussion and Health Equity Implications: This analysis contributes to a growing body of literature describing doulas' experiences during the pandemic. By shifting to virtual support, SisterWeb leaders prioritized the health, safety, and financial stability of doulas, who were members of communities disproportionately impacted by COVID-19. Our findings suggest that public health guidance, organizational COVID-19 precautions, and hospital policies hindered SisterWeb's goal of ensuring clients receive equitable medical care. In addition, we found that emotional support for doulas is vital to their work.

Erratum: Conducting clinical research in the era of the COVID-19 pandemic: Challenges and lessons for Speech-Language Pathology and Audiology research.

No abstract available.

Researching with Care - Participatory Health Research with Afghan Women Refugees in Germany During the Covid-19 Pandemic: A Case with Commentaries

This article comprises a short case exemplifying ethical challenges arising for a participatory researcher working with Afghan women refugees during the Covid-19 pandemic in Germany. The researcher is an Iranian-German woman, qualified as a midwife, undertaking doctoral research on refugees' access to reproductive health care. Disclosures about some women's experience of domestic violence are made, which raise ethical issues for the researcher relating to personal-professional boundaries, roles and responsibilities. Two commentaries are given on this case from participatory researchers based in Germany, UK and Austria. Both commentaries highlight the relevance of the ethics of care for participatory research and for this research in particular, which entails very close relationships between the doctoral researcher and the refugee women with whom she is researching. The first commentary analyses the research process in terms of Tronto's five phases of care, while the second illustrates the importance of caring institutions in supporting researchers working on sensitive topics.