Outrunning Burnout in a GI Fellowship Program During the COVID-19 Pandemic.

Many GI training programs have needed to adjust to the serious disruption to the training and education of fellows worldwide due to the COVID-19 pandemic. A silent problem that has arisen within programs is the issue of burnout among their trainees. Burnout is common among gastroenterologists, especially in fellows (Keswani et al. in Gastroenterology 147(1):11-14, 2014. https://doi.org/10.1053/j.gastro.2014.05.023 , Am J Gastroenterol 106(10):1734-1740, 2011. https://doi.org/10.1038/ajg.2011.148 ), with negative consequences to patient care and the safety of the trainees if not effectively dealt with. In this article, the author describes several additional factors potentially contributing to the intensifying burnout of the fellows in their home institution during this pandemic. Moreover, he describes specific practical interventions that the hospital and program have taken in order to address these factors.

Research 101: A process for developing local guidelines for ethical research in heavily researched communities.

BACKGROUND: Marginalized communities often attract more than their share of research. Too often, this research benefits researchers disproportionately and leaves such communities feeling exploited, misrepresented, and exhausted. The Downtown Eastside (DTES) neighborhood of Vancouver, Canada, has been the site of multiple public health epidemics related to injection drug use as well as the site of much community-led resistance and struggle that has led to the development of cutting-edge harm reduction interventions (e.g., North America's first supervised injection facility, Insite) and a strong sense of community organization. This background has made the DTES one of the most heavily researched communities in the world. Amidst ongoing experiences of unethical or disrespectful research engagement in the neighborhood, a collaboration between local academic researchers and community representatives developed to explore how we could work together to encourage more respectful, community-responsive research and discourage exploitative or disrespectful research. METHODS: We developed a series of six weekly workshops called "Research 101." These workshops brought together approximately 13 representatives from peer-based organizations in the DTES with a variety of experiences with research. Research 101 created space for community members themselves to discuss the pitfalls and potential of research in their neighborhood and to express community expectations for more ethical and respectful research. RESULTS: We summarized workshop discussions in a co-authored "Manifesto for Ethical Research in the Downtown Eastside." This document serves as a resource to empower community organizations to develop more equitable partnerships with researchers and help researchers ground their work in the principles of locally developed "community ethics." Manifesto guidelines include increased researcher transparency, community-based ethical review of projects, empowering peer researchers in meaningful roles within a research project, and taking seriously the need for reciprocity in the research exchange. CONCLUSIONS: Research 101 was a process for eliciting and presenting a local vision of "community ethics" in a heavily researched neighborhood to guide researchers and empower community organizations. Our ongoing work involves building consensus for these guidelines within the community and communicating these expectations to researchers and ethics offices at local universities. We also describe how our Research 101 process could be replicated in other heavily researched communities.

Responsibility, planning and risk management: moralizing everyday finance through financial education.

The individualization, privatization and marketization of risk management represent a fundamental dimension of the financialization of everyday life. As individuals are required to engage with financial products and services as the main way of protecting themselves from risks and uncertainties, their economic welfare and security are construed as depending largely on their own financial decisions. Within this setting, the concept of financial literacy and accompanying practices of financial education have emerged as a prominent institutional field handling the formulation and communication of the attributes and dispositions that arguably constitute the proper financial actor. This article analyzes financial education programmes currently conducted by state agencies in Israel, examining the notions and principles they articulate when defining and explaining proper financial conduct. The study indicates that moral themes and categories occupy a salient place in the formulation of the character traits that constitute the desired literate financial actor. Notions of individual responsibility, planning ahead and rational risk management are presented not merely as instrumental resources, but as moral imperatives. Through these notions, the programmes moralize a broad array of everyday practices of personal finance such as saving, investing, borrowing and budget management, thereby connecting the sphere of financial matters to the domain of moral virtues. Offering a representation of particular modes of financial conduct as constitutive components of morally virtuous personhood, these practices imbue the financial field as a whole, especially its current generalized logic of individualized and marketized risk management, with moral meanings, hence contributing to the normalization and depoliticization of the financialization of everyday life.

"But We Want to Work": The Movement of Child Workers in Peru and the Actions for Reducing Child Labor.

The program Edúcame Primero (Educate Me First) is an evidence-based practice for eradicating child labor that has been applied with positive results in Colombia, Peru, and several Central American countries. In this article, we describe the difficulties of implementing the program in two poor areas of Lima (Peru) between 2014 and 2016. Specifically, we discuss three ethical challenges faced during the implementation of the program: (a) the existence of a movement of working children that defends the right of children to work; (b) the polarization of some community-based associations and government institutions on how to deal with the problems of working children; and (c) the use of network indicators in the evaluation of the community's level of cohesion. Taking the Code of Ethics of the General Council of Associations of Psychologists in Spain as a guide, we adopted a consensus approach in planning and research design, combining different criteria of value with the participation of different stakeholders. The implementation of the program in Peru gave preference to developing skills in children over changing attitudes in relation to child protection, although the intervention openly declared its aims when engaging institutions and families. Finally, we address how social network research places special ethical demands on conventional ethical standards. Our experience with this project shows the importance of acting as a bridge between different stakeholders and assessing how all of them benefit from the intervention.

From patient to participant: enhancing the validity and ethics of cancer research through participatory research.

Participatory health research involves a wide spectrum of participation from the population of study. We describe the participatory research processes of a large mixed method study on the psychosocial impact of dragon boating in individuals with breast cancer. In particular, we discuss the involvement of a Community Advisory Group (consisting of five breast cancer patients/survivors) in the development of the research study, data collection and analysis, and dissemination of the study results. We also outline the elements of a research workshop, in which 13 breast cancer patients/survivors were involved in the development of a provincial survey for the study. The purpose of this article is to share our experience of engaging cancer patients/survivors in a participatory research study. We discuss the value-based elements of participatory research (power sharing, voice and respect, reciprocity, and mutual benefit), and provide a case-based example of how these participatory elements were employed to potentially increase the validity of the survey instrument, to enhance the ethics of working with a cancer population, and ultimately contributed to a high survey response rate.

The ethical self-fashioning of physicians and health care systems in culturally appropriate health care.

Diverse advocacy groups have pushed for the recognition of cultural differences in health care as a means to redress inequalities in the U.S., elaborating a form of biocitizenship that draws on evidence of racial and ethnic health disparities to make claims on both the state and health care providers. These efforts led to federal regulations developed by the U.S. Office of Minority Health requiring health care organizations to provide Culturally and Linguistically Appropriate Services. Based on ethnographic research at workshops and conferences, in-depth interviews with cultural competence trainers, and an analysis of postings to a moderated listserv with 2,000 members, we explore cultural competence trainings as a new type of social technology in which health care providers and institutions are urged to engage in ethical self-fashioning to eliminate prejudice and embody the values of cultural relativism. Health care providers are called on to re-orient their practice (such as habits of gaze, touch, and decision-making) and to act on their own subjectivities to develop an orientation toward Others that is "culturally competent." We explore the diverse methods that cultural competence trainings use to foster a health care provider's ability to be self-reflexive, including face-to-face workshops and classes and self-guided on-line modules. We argue that the hybrid formation of culturally appropriate health care is becoming detached from its social justice origins as it becomes rationalized by and more firmly embedded in the operations of the health care marketplace.

Realizing the Potential of Robotics for Aged Care Through Co-Creation.

Socially assistive robots have the potential to improve aged care by providing assistance through social interaction. While some evidence suggests a positive impact of social robots on measures of well-being, the adoption of robotic technology remains slow. One approach to improve technology adoption is involving all stakeholders in the process of technology development using co-creation methods. To capture relevant stake holders' priorities and perceptions on the ethics of robotic companions, we conducted an interactive co-creation workshop at the 2019 Geriatric Services Conference in Vancouver, BC. The participants were presented with different portrayals of robotic companions in popular culture and answered questions about perceptions, expectations, and ethical concerns about the implementation of robotic technology. Our results reveal that the most pressing ethical concerns with robotic technology, such as issues related to privacy, are critical potential barriers to technology adoption. We also found that most participants agree on the types of tasks that robots should help with, such as domestic chores, communication, and medication reminders. Activities that robots should not help with, according to the stakeholders, included bathing, toileting, and managing finances. The perspectives that were captured contribute to a preliminary outline of the areas of importance for geriatric care stake holders in the process of ethical technology design and development.

Perceptions on Diversity in Cardiology: A Survey of Cardiology Fellowship Training Program Directors.

Background The lack of diversity in the cardiovascular physician workforce is thought to be an important driver of racial and sex disparities in cardiac care. Cardiology fellowship program directors play a critical role in shaping the cardiology workforce. Methods and Results To assess program directors' perceptions about diversity and barriers to enhancing diversity, the authors conducted a survey of 513 fellowship program directors or associate directors from 193 unique adult cardiology fellowship training programs. The response rate was 21% of all individuals (110/513) representing 57% of US general adult cardiology training programs (110/193). While 69% of respondents endorsed the belief that diversity is a driver of excellence in health care, only 26% could quote 1 to 2 references to support this statement. Sixty-three percent of respondents agreed that "our program is diverse already so diversity does not need to be increased." Only 6% of respondents listed diversity as a top 3 priority when creating the cardiovascular fellowship rank list. Conclusions These findings suggest that while program directors generally believe that diversity enhances quality, they are less familiar with the literature that supports that contention and they may not share a unified definition of "diversity." This may result in diversity enhancement having a low priority. The authors propose several strategies to engage fellowship training program directors in efforts to diversify cardiology fellowship training programs.

[Educational system and equal opportunities for young people in care: recent studies in the UK]. / Sistema educativo e igualdad de oportunidades entre los jóvenes tutelados: estudios recientes en el Reino Unido.

Publications on research about formal educational itineraries of people who were cared for by the social protection public systems when they were children are scarce, and restricted to a few countries. In recent years, statistics from some European countries have been published, showing that the young people who were cared for are overrepresented in practically all the clusters of people that accumulate indicators of social disadvantage, and it has therefore been argued that they can be considered one of the groups of population with the highest risk for social exclusion. In the present review, the emergence of new data and research results in some European countries--particularly in the United Kingdom, where the fact that less than 5% of this population reaches university studies has been underlined--is tentatively contextualised. Although the extent to which current available data can be extrapolated to other contexts and countries is yet unclear, such results raise important challenges for social intervention and social policies, as well as for psychosocial research, in all countries of the European space.

Resituating the principle of equipoise: justice and access to care in non-ideal conditions.

The principle of equipoise traditionally is grounded in the special obligations of physician-investigators to provide research participants with optimal care. This grounding makes the principle hard to apply in contexts with limited health resources, to research that is not directed by physicians, or to nontherapeutic research. I propose a different version of the principle of equipoise that does not depend upon an appeal to the Hippocratic duties of physicians and that is designed to be applicable within a wider range of research contexts and types, including health services research and research on social interventions. I consider three examples of ethically contentious research trials conducted in three different social settings. I argue that in each case my version of the principle of equipoise provides more plausible and helpful guidance than does the traditional version of the principle.

El mal en Jean Jacques Rousseau: sobre el ser humano y el conocimiento de sí / The evil in Jean Jacques Rousseau: on the human being and the knowledge of himself

Este artículo se ocupa del mal en Rousseau, recurriendo a cuatro imágenes, a saber: la vida social (socie-dad) y el hombre social (homme de l ́homme), en contraste con el estado de naturaleza (état de nature) y el hombre natural (homme naturel). Imágenes de orden lógico, esto es, filosófico argumentativas, que exponen la tensión y el alejamiento del hombre con respecto a su naturaleza. El supuesto indica que este alejamiento se eleva como la imposibilidad del conocimiento pleno de sí; convierte al ser humano en alguien extraño para sí que hipostasia su concepto en las determinaciones de la vida social. El método utilizado se desprende de la filosofía misma de Rousseau. El procedimiento se organiza con la identificación y presen-tación de un supuesto y su desarrollo lógico mediante argumentos que requieren la selección, organización y sistematización de fuentes encaminadas a exponer el supuesto en toda su complejidad

This article deals with evil in Rousseau, resorting to four images, namely. Social life (society) and social man (Homme de l'homme) are in contrast to (contrast with)) the state of nature (état de nature) and the natural man (Homme naturel). Images of logical order, that is, argumentative philosophical, which expose the tension and distance of man from his nature. The assumption indicates that this estrangement rises as the impossibility of full self-knowledge; it turns the human being into someone foreign to himself who hypostasia his concept in the determinations of social life. The method used follows from Rousseau's philosophy. The procedure is organized with the identification and presentation of an assumption and its logical development through arguments that require the selection, organization, and systematization of sources aimed at exposing the assumption in all its complexity.

Resiliencia comunitaria frente a la exclusión social: caso María Cano Carambolas, Medellín / Community resilience facing social exclusion: a case study in Maria Cano Carambolas, Medellin

Este artículo tuvo como propósito crear un espacio de reflexión acerca de las capacidades resilientes de los habitantes del barrio María Cano Carambolas (Medellín-Colombia) a partir de observaciones participantes. El trabajo de campo se documentó mediante diarios de campo y relatos del alumnado de la principal institución educativa. A partir del estudio de las condiciones socio-económicas, políticas y educativas del barrio, analizaremos las habilidades de afrontamiento y las estrategias resilientes comunitarias. Nuestras conclusiones resaltan la alta capacidad de abstracción ante las problemáticas que les rodean y en el caso de los jóvenes, la percepción positiva de logro de objetivos a medio-largo plazo; a pesar de que las dinámicas disfuncionales de sus familias, las políticas públicas insuficientes e ineficaces de un Estado negligente y las propias condiciones del barrio limitan su acceso a oportunidades de futuro

The purpose of this article was to create a reflection space on the resilient capacities of the inhabitants of the María Cano Carambolas neighborhood (Medellín-Colombia) based on participant observations. The field work was documented through field diaries and stories from the students of the main educational institution. From the study of the socio-economic, political and educational conditions of the neighborhood, we will analyze coping skills and community resilient strategies. Our conclusions highlight the high capacity for abstraction in the face of the problems that surround them and in the case of young people, the positive perception of achievement of medium-long-term objectives; despite the fact that the dysfunctional dynamics of their families, the insufficient and ineffective public policies of a negligent state and the very conditions of the neighborhood limit their access to future opportunities

The "total" museum, a tool for social change.

Science museums encourage not only scientific knowledge and methodology, but also people's opinion about scientific issues. This has been the main concern of Barcelona's Museo de Ciência de la Fundación "la Caixa" throughout its twenty years of existence. According to the author of the present article, the goals of "total museology" comply with the new trend some museums have been following. So that this new trend becomes more sound and widespread, it is necessary to create new concepts for museology. The first science museums were natural history and tools and machinery museums, which displayed artifacts in glass cases to visitors. Their mission was also that of preserving collections for the use of scientists. Science museums of today display real phenomena and provide visitors' interaction with them. Whatever the topic it focus, a science museums is "concentrated reality" either of objects or phenomena. This is probably the main distinctive feature of museology and of other forms of scientific communication. For teachers and lecturers, words are the basic element of communication, for books and magazines, the written language. There are no films without images, as there is no radio with sounds. In a museum, there are no restrictions as to the use of stimulation, models, graphic images or new technology, but just as accessories to reality, never as reality itself.

[Latin American science museums and equity]. / Los museos latinoamericanos de cienca y la equidad.

Latin America and the Caribbean form a region of great variations yet marked by cultural resemblances. The origins of the region's countries, of their wealth, and also of their problems are quite similar. Indeed, there are clear points of contact in the most basic aspects, such as each society's worldview. Throughout the region there is a very strong democratizing trend that seeks more just and more educated societies. Science plays a key role in the development as a powerful weapon for tolerance and equity and therefore should be disseminated among the greatest possible number of Latin Americans. Red POP the network for the Popularization of Science and Technology in Latin America and the Caribbean - was created to help reach this goal. Under the auspices of ORCYT-UNESCO, Red POP is an interactive network of centers and programs that work to bring science and technology to the public at large. It fosters exchange, skill-acquisition, and resource use among its members. Based on the network's experience, we explore to what extent science museums favor equity in their home societies.