Moral Features of the Therapeutic Relationship with Adults: Dignity, Trust, Autonomy, Vulnerability, and Resilience.

Using dignity as a foundational value of morality, this article defines trust, autonomy, vulnerability, and resilience in relational terms. A fictional narrative illustrates these attributes as well as solidarity and care, two core tenets of relational ethics. Medicine and rehabilitation are described as moral enterprises with at the core of our professional obligations to patients-namely, duties of care, trustworthiness, and loyalty.

Consent, Refusal, and Waivers in Patient-Centered Dysphagia Care: Using Law, Ethics, and Evidence to Guide Clinical Practice.

Purpose: When patients refuse medical or rehabilitation procedures, waivers of liability have been used to bar future lawsuits. The purpose of this tutorial is to review the myriad issues surrounding consent, refusal, and waivers. The larger goal is to invigorate clinical practice by providing clinicians with knowledge of ethics and law.

Congenital rubella syndrome in child of woman without known risk factors, New Jersey, USA.

We report a case of congenital rubella syndrome in a child born to a vaccinated New Jersey woman who had not traveled internationally. Although rubella and congenital rubella syndrome have been eliminated from the United States, clinicians should remain vigilant and immediately notify public health authorities when either is suspected.

Retrospective cost-effectiveness analysis of treatments for aphasia: an approach using experimental data.

Purpose: Evidence supports the effectiveness of speech-language treatment for individuals with aphasia, yet less is known about the cost-effectiveness of such treatments. The purpose of this study was to examine the incremental cost and cost-effectiveness of aphasia treatment using previously published data.

Method: The authors completed a retrospective cost-effectiveness analysis using experimental data that they extracted from 19 previously published aphasia treatment studies.

Evaluation of a pilot communication skills training intervention for minority cancer patients.

The aim of this study was to pilot test in a minority cancer patient population a communication workshop to improve doctor-patient communication skills. Thirty-two patients participated. Eighteen evaluated a face-to-face workshop, while 14 completed surveys only.

A risk assessment approach to identifying constituents in oilfield produced water for treatment prior to beneficial use.

A risk assessment approach incorporating exposure pathways and calculated risk quotients was applied to identifying constituents requiring treatment prior to beneficial use of oilfield produced water (OPW). In this study, risk quotients are ratios of constituent concentrations in soil or water to guideline concentrations for no adverse effects to receptors. The risk assessment approach is illustrated by an example of an oilfield water produced from non-marine geologic strata of a rift basin in sub-Saharan Africa.

Responsible conduct of research in communication sciences and disorders: faculty and student perceptions.

Purpose: Two Web-based surveys (Surveys I and II) were used to assess perceptions of faculty and students in Communication Sciences and Disorders (CSD) regarding the responsible conduct of research (RCR).

Method: Survey questions addressed 9 RCR domains thought important to the responsible conduct of research: (a) human subjects protections; (b) research involving animals; (c) publication practices and responsible authorship; (d) mentor/trainee responsibilities; (e) collaborative science; (f) peer review; (g) data acquisition, management, sharing, and ownership; (h) conflicts of interest; and (i) research misconduct. Respondents rated each of 37 topics for importance and for sufficiency of instructional coverage.

Research ethics II: Mentoring, collaboration, peer review, and data management and ownership.

Purpose: In this series of articles--Research Ethics I, Research Ethics II, and Research Ethics III--the authors provide a comprehensive review of the 9 core domains for the responsible conduct of research (RCR) as articulated by the Office of Research Integrity. In Research Ethics II, the authors review the RCR domains of mentoring, collaboration, peer review, and data management and ownership.

Method: They relied on authoritative documents, both historical and contemporary, insightful commentary, and empirical research in order to identify current issues and controversies of potential interest to both faculty and students.

Research ethics I: Responsible conduct of research (RCR)--historical and contemporary issues pertaining to human and animal experimentation.

Purpose: In this series of articles--Research Ethics I, Research Ethics II, and Research Ethics III--the authors provide a comprehensive review of the 9 core domains for the responsible conduct of research (RCR) as articulated by the Office of Research Integrity. In Research Ethics I, they present a historical overview of the evolution of RCR in the United States then examine the evolution of human and animal experimentation from the birth of scientific medicine through World War II to the present day.

Method: They relied on authoritative documents, both historical and contemporary, insightful commentary, and empirical research in order to identify current issues and controversies of potential interest to both faculty and students.

Ethical principles associated with the publication of research in ASHA's scholarly journals: importance and adequacy of coverage.

Purpose: The purpose of this 2-part study was to determine the importance of specific topics relating to publication ethics and adequacy of the American Speech-Language-Hearing Association's (ASHA's) policies regarding these topics.

Method: A 56-item Web-based survey was sent to (a) ASHA journal editors, associate editors, and members of the Publications Board (Group 1); (b) authors, reviewers, and members of ASHA's Board of Ethics (Group 2); and (c) a random sample of the ASHA membership, characterized as journal readers (Group 3). The survey contained 4 questions related to ethical principles associated with the publication of research: (a) In regard to scientific integrity in research publications in general, how important is the issue of [topic]? (b) Should ASHA publication policies address this issue? (c) Do ASHA policies address this issue? (d) If yes, how adequately do ASHA policies address this issue? A second study evaluated the contents of ASHA's publication policy documents in regard to their coverage of the survey topics.

Research ethics III: Publication practices and authorship, conflicts of interest, and research misconduct.

Purpose: In this series of articles--Research Ethics I, Research Ethics II, and Research Ethics III--the authors provide a comprehensive review of the 9 core domains for the responsible conduct of research (RCR) as articulated by the Office of Research Integrity.

Method: In Research Ethics III, they review the RCR domains of publication practices and authorship, conflicts of interest, and research misconduct. Whereas the legal definition of research misconduct under federal law pertains mainly to intentional falsification, fabrication, and plagiarism, they discuss a host of research practices that raise ethical concerns.

Averting adverse events in communication skills training: a case series.

Objective: To document cases of adverse or near adverse events in communication skills training (CST) and to identify risk factors and strategies to reduce the likelihood of their occurrence.

Methods: Six physician CST cases meeting criteria for an adverse or near adverse collected from experienced facilitators are analyzed and discussed.

Results: Three types of adverse CST events are described: traumatic personal experiences or losses evoked by training; perception that feedback is not empathic; and where trainees are referred for remedial CST as a risk management strategy.

Developing an "essential functions" rubric: purposes and applications for speech-language-hearing academic programs.

This article describes the purpose and application of an essential functions rubric for prospective and current students engaged in the study of communication sciences and disorders. Adopted in 2007 by the Council on Academic Programs in Communication Sciences and Disorders (CAPCSD), the essential functions rubric identifies core skills and attributes in five areas: communication, motor, intellectual-cognitive, sensory/observational, and behavioral/social. CAPCSD does not intend the rubric to be prescriptive but rather expects that it will be adapted to reflect the unique mission or circumstances of each academic program.

Mechanistic analysis of a dynamin effector.

Dynamin-related proteins (DRPs) can generate forces to remodel membranes. In cells, DRPs require additional proteins [DRP-associated proteins (DAPs)] to conduct their functions. To dissect the mechanistic role of a DAP, we used the yeast mitochondrial division machine as a model, which requires the DRP Dnm1, and two other proteins, Mdv1 and Fis1.

Mitochondrial outer and inner membrane fusion requires a modified carrier protein.

In yeast, three proteins are essential for mitochondrial fusion. Fzo1 and Mgm1 are conserved guanosine triphosphatases that reside in the outer and inner membranes, respectively. At each membrane, these conserved proteins are required for the distinct steps of membrane tethering and lipid mixing.

Condom failure: examining the objective and cultural meanings expressed in interviews with African American adolescents.

The purpose of this study was to explore the meaning and context of self-reported "condom failure" among sexually active African American adolescents. Semistructured interviews regarding methods of protection from pregnancy and sexually transmitted disease (STD) with 124 youth (ages 14-19 years) were content analyzed. The findings suggested three meanings of condom failure.

Using culture-centered qualitative formative research to design broadcast messages for HIV prevention for African American adolescents.

The need for formative research in designing mass media health-education messages is widely accepted; however, distinct methodologies for developing such messages are less well documented. This article describes a culture-centered approach for developing messages to promote sexual risk reduction in urban African American adolescents. The method uses qualitative formative research to identify "competing narratives" that support healthy behavior despite the dominance of messages that favor risk-taking behavior.

Withdrawal (coitus interruptus) as a sexual risk reduction strategy: perspectives from African-American adolescents.

This study examined adolescents' beliefs about the benefits and risks of withdrawal (coitus interruptus) with respect to both pregnancy and sexually transmitted infections (STIs). In the course of qualitative interviews with African-American youth aged 14-19 (n = 124) about sexuality and risk, 24 adolescents spontaneously introduced the subject of withdrawal as a sexual risk reduction strategy. Eighteen percent of the sexually experienced adolescents mentioned their own use of withdrawal as a contraceptive method.

The requirement for perp in postnatal viability and epithelial integrity reflects an intrinsic role in stratified epithelia.

Mice lacking the desmosome protein Perp exhibit blistering in their stratified epithelia and display postnatal lethality. However, it is unclear if these phenotypes are strictly related to Perp function in stratified epithelia, as Perp expression is not restricted to these tissues during embryogenesis, and certain desmosomal blistering diseases such as pemphigus vulgaris and pemphigus foliaceus have non-cell-intrinsic bases. Furthermore, we show here that Perp is expressed in the heart, raising the possibility that defects in heart function could account for lethality in the Perp-deficient mice.

Mice lacking the p53/p63 target gene Perp are resistant to papilloma development.

Perp is a target of the p53 tumor suppressor involved in the DNA damage-induced apoptosis pathway. In addition, Perp is a target of the p53-related transcription factor p63 during skin development, where it participates in cell-cell adhesion mediated through desmosomes. Here we test the role of Perp in tumorigenesis in a two-step skin carcinogenesis model system.

Perp is a p63-regulated gene essential for epithelial integrity.

p63 is a master regulator of stratified epithelial development that is both necessary and sufficient for specifying this multifaceted program. We show here that Perp, a tetraspan membrane protein originally identified as an apoptosis-associated target of the p53 tumor suppressor, is the first direct target of p63 clearly involved in mediating this developmental program in vivo. During embryogenesis, Perp is expressed in an epithelial pattern, and its expression depends on p63.

Morality, ethics, and law: introductory concepts.

The purpose of this article is to differentiate morality, ethics, and law. Morality refers to a set of deeply held, widely shared, and relatively stable values within a community. Ethics as a philosophical enterprise involves the study of values, and the justification for right and good actions, as represented by the classic works of Aristotle (virtue ethics), Kant (duty-based ethics), and Bentham and Mill (utilitarian and consequentialist ethics).

Perp is a mediator of p53-dependent apoptosis in diverse cell types.

The induction of apoptosis by the p53 protein is critical for its activity as a tumor suppressor. Although it is clear that p53 induces apoptosis at least in part by direct transcriptional activation of target genes, the set of p53 target genes that mediate p53 function in apoptosis in vivo remains to be well defined. The Perp (p53 apoptosis effector related to PMP-22) gene is highly expressed in cells undergoing p53-dependent apoptosis as compared to cells undergoing p53-dependent G1 arrest.