This scenario presents a professional challenge due to the inherent complexities of interprofessional collaboration within a resource-constrained medical social work setting in Sub-Saharan Africa. The challenge lies in balancing the immediate needs of a patient with chronic illness requiring ongoing support and education, with the limited availability of specialized services and the need to ensure sustainable patient engagement. Careful judgment is required to navigate these constraints while upholding ethical obligations and promoting patient autonomy. The best approach involves a proactive, patient-centered strategy that leverages existing resources and empowers the patient. This includes establishing clear communication channels with the primary healthcare team, developing a tailored educational plan that addresses the patient’s specific learning needs and cultural context, and identifying community-based support systems. This approach is correct because it aligns with the principles of patient-centered care, emphasizing shared decision-making and promoting self-management. It also adheres to ethical guidelines that mandate providing comprehensive care within the scope of practice and advocating for patient needs. Furthermore, it recognizes the importance of interprofessional collaboration in ensuring continuity of care and optimizing patient outcomes, particularly in settings where specialized services may be scarce. An approach that relies solely on referring the patient to a distant specialist without ensuring adequate preparation or follow-up is professionally unacceptable. This fails to acknowledge the practical realities of access to care in many Sub-Saharan African contexts and neglects the social worker’s role in facilitating care navigation and patient support. It also risks patient disengagement due to logistical barriers and a lack of immediate, accessible education. Another professionally unacceptable approach is to provide generic health information without assessing the patient’s understanding or tailoring the content to their specific condition and literacy level. This can lead to misinformation, patient anxiety, and a failure to achieve desired health outcomes. It overlooks the ethical imperative to provide effective and relevant education. Finally, an approach that focuses exclusively on the immediate medical needs without addressing the psychosocial factors impacting the patient’s ability to manage their chronic illness is incomplete. Social workers have a responsibility to consider the holistic well-being of the patient, including their social determinants of health, which significantly influence their capacity for self-care and adherence to treatment plans. Professionals should employ a decision-making process that begins with a thorough assessment of the patient’s needs, considering their medical, social, and educational requirements. This should be followed by an evaluation of available resources, both within the healthcare facility and the wider community. Collaboration with the interprofessional team is crucial to develop a coordinated care plan. Patient education should be individualized, culturally sensitive, and delivered in a manner that promotes understanding and empowerment. Finally, ongoing monitoring and evaluation of the patient’s progress and the effectiveness of the interventions are essential.

Scenario Analysis: This scenario is professionally challenging because it requires a social worker to navigate the complex intersection of fellowship program requirements, individual applicant circumstances, and the overarching goal of advancing medical social work capacity in Sub-Saharan Africa. Misinterpreting the purpose and eligibility criteria can lead to excluding deserving candidates, undermining the fellowship’s objectives, or admitting individuals who may not be best positioned to benefit from or contribute to the program. Careful judgment is required to ensure fairness, equity, and adherence to the fellowship’s stated mission. Correct Approach Analysis: The best approach involves a thorough understanding of the fellowship’s stated purpose and eligibility criteria as outlined in its official documentation. This means reviewing the fellowship’s mission statement, program goals, and specific requirements for applicants, which are designed to identify individuals who can most effectively contribute to and benefit from the program’s objectives of enhancing medical social work practice in Sub-Saharan Africa. Adherence to these established guidelines ensures that the selection process is objective, transparent, and aligned with the fellowship’s intended impact. The purpose of the fellowship is to build capacity and leadership in medical social work across the region, and eligibility criteria are the gatekeepers to achieving this. Incorrect Approaches Analysis: One incorrect approach would be to prioritize personal connections or informal recommendations over the stated eligibility criteria. This introduces bias and can lead to the selection of candidates who may not possess the necessary qualifications or commitment, thereby compromising the fellowship’s effectiveness and potentially disadvantaging more suitable applicants. This fails to uphold principles of fairness and meritocracy. Another incorrect approach is to focus solely on an applicant’s current role without considering their potential for growth and contribution to the broader goals of the fellowship. While current experience is important, the fellowship aims to develop future leaders and practitioners. Overlooking potential based on a narrow interpretation of current status would be a misstep. A further incorrect approach would be to interpret eligibility too narrowly, excluding candidates who may have transferable skills or experience from related fields that could be highly valuable to medical social work in Sub-Saharan Africa. This can stifle diversity of thought and experience within the fellowship cohort and limit the program’s reach and impact. Professional Reasoning: Professionals should approach this situation by first consulting the official fellowship documentation to gain a clear and accurate understanding of the purpose and eligibility requirements. They should then evaluate each applicant against these criteria objectively, considering both their current qualifications and their potential to contribute to the fellowship’s mission. Any ambiguities in the criteria should be clarified with the fellowship administrators. The decision-making process should be guided by principles of fairness, equity, and the ultimate goal of strengthening medical social work in Sub-Saharan Africa.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate needs of vulnerable individuals with the overarching mandate of a fellowship program to gather data for broader impact. The social worker is caught between the urgency of providing direct support and the ethical obligation to maintain confidentiality and ensure data integrity for research purposes. Careful judgment is required to navigate these competing demands without compromising either the well-being of the participants or the validity of the fellowship’s objectives. Correct Approach Analysis: The best professional practice involves prioritizing the informed consent process and ensuring participants fully understand how their data will be used, including the potential for anonymized sharing for research purposes. This approach requires clear, accessible communication about the fellowship’s goals, the nature of the data being collected, and the safeguards in place to protect their privacy. It acknowledges the participants’ right to self-determination and builds trust, which is fundamental in social work practice, especially when working with potentially marginalized or vulnerable populations. Adherence to ethical principles of autonomy and beneficence, as well as any relevant data protection regulations within Sub-Saharan Africa (e.g., national data protection acts, ethical review board guidelines), is paramount. Incorrect Approaches Analysis: One incorrect approach involves proceeding with data collection without explicitly re-confirming consent for research sharing, assuming prior consent for general support covers this. This fails to uphold the principle of informed consent, as participants may not have fully grasped the implications of their data being used for research beyond their immediate case. It also risks violating data protection regulations that mandate specific consent for research purposes. Another incorrect approach is to withhold data collection entirely due to concerns about confidentiality, thereby hindering the fellowship’s research objectives. While caution is understandable, this approach fails to explore potential solutions for anonymization and ethical data handling, thereby undermining the broader goal of improving social work practices through research. It also potentially deprives the community of the benefits that well-conducted research could bring. A third incorrect approach is to collect data without clearly explaining the research component and obtaining specific consent for its use in anonymized reports. This is a direct breach of ethical guidelines and potentially legal requirements regarding data privacy and research ethics. It erodes trust and can lead to significant harm to participants if their information is misused or inadvertently identified. Professional Reasoning: Professionals should employ a decision-making framework that begins with a thorough understanding of the ethical principles and legal requirements governing their practice and the specific context of the fellowship. This involves proactively identifying potential conflicts between client welfare and research objectives. The process should include open communication with participants, ensuring their autonomy is respected through comprehensive informed consent. When dilemmas arise, seeking guidance from supervisors, ethics committees, or relevant professional bodies is crucial. The ultimate goal is to find solutions that uphold the dignity and rights of individuals while advancing the collective good through ethical research.

The control framework reveals that effective examination orientation is crucial for ensuring that candidates understand the scope, expectations, and ethical considerations of the Comprehensive Sub-Saharan Africa Medical Social Work Fellowship Exit Examination. This scenario is professionally challenging because it requires balancing the need to provide clear guidance with the imperative to maintain the integrity and fairness of the examination process. Misinformation or biased orientation can significantly disadvantage candidates and undermine the credibility of the fellowship. The best approach involves providing a comprehensive overview of the examination’s structure, content domains, assessment methods, and the ethical principles that underpin medical social work practice within the Sub-Saharan African context. This includes clearly outlining the expected professional conduct during the examination, the resources available for preparation, and the criteria for successful completion. This approach is correct because it aligns with the principles of transparency and fairness, ensuring all candidates have equal access to information necessary for preparation. It also reinforces the ethical obligation of the fellowship program to support candidates’ professional development and uphold the standards of the profession. Specifically, it adheres to the implicit ethical guidelines of professional assessment bodies that mandate clear communication and equitable treatment of all candidates. An incorrect approach would be to focus solely on the administrative aspects of the examination, such as timing and logistics, without addressing the substantive content or ethical expectations. This fails to equip candidates with the necessary understanding of what is being assessed and the professional standards they are expected to meet, potentially leading to anxiety and underperformance. Another incorrect approach would be to provide candidates with sample examination questions that are not representative of the actual assessment or that offer an unfair advantage to certain individuals. This violates principles of fairness and academic integrity, potentially compromising the validity of the examination results. Finally, an approach that emphasizes rote memorization of facts without encouraging critical thinking and application of knowledge to complex social work scenarios would be detrimental. This fails to assess the practical skills and ethical reasoning essential for effective medical social work in the specified context. Professionals should employ a decision-making framework that prioritizes clarity, fairness, and ethical integrity. This involves: 1) identifying the core purpose of the examination orientation (to inform and prepare candidates equitably); 2) considering the diverse backgrounds and needs of the candidates; 3) consulting relevant professional standards and fellowship guidelines; 4) developing clear, concise, and accurate informational materials; and 5) providing opportunities for candidates to ask questions and receive clarification.

The evaluation methodology shows that assessing the impact of allied health interventions within a Sub-Saharan African medical social work fellowship requires a nuanced understanding of local contexts, resource limitations, and diverse stakeholder needs. This scenario is professionally challenging because social workers often operate with limited resources, face complex socio-economic determinants of health, and must navigate cultural sensitivities while advocating for vulnerable populations. Careful judgment is required to ensure interventions are not only clinically effective but also culturally appropriate, sustainable, and ethically sound, respecting the autonomy and dignity of service users. The best approach involves a participatory evaluation framework that actively engages community members, healthcare providers, and fellowship participants in defining success metrics and interpreting findings. This method ensures that the evaluation reflects the lived experiences and priorities of those most affected by the interventions. It aligns with ethical principles of respect for persons and beneficence by empowering stakeholders and ensuring that the fellowship’s impact is measured in ways that are meaningful and beneficial to the community. Furthermore, it promotes accountability and transparency, fostering trust between the fellowship program and the communities it serves. An approach that solely relies on quantitative data collected by external evaluators without community input is professionally unacceptable. This fails to capture the qualitative nuances of social work impact, such as improved social cohesion or enhanced coping mechanisms, which are crucial in this context. It also risks imposing external evaluation standards that may not be relevant or culturally sensitive, potentially leading to misinterpretations of success and undermining local ownership of the program’s outcomes. Another professionally unacceptable approach is one that prioritizes the fellowship’s internal objectives above the expressed needs and feedback of the service users and local healthcare partners. This can lead to a disconnect between the fellowship’s perceived success and its actual contribution to community well-being. It neglects the ethical imperative to ensure that interventions are genuinely beneficial and responsive to the specific challenges faced by the target population, potentially leading to the perpetuation of ineffective or even harmful practices. A third professionally unacceptable approach is to conduct an evaluation that is purely retrospective, focusing only on outcomes without considering the process and challenges encountered during the fellowship. This overlooks the valuable learning opportunities inherent in the implementation of allied health interventions in complex settings. It fails to provide actionable insights for future program development or for the ongoing professional growth of the fellows, thereby limiting the long-term impact and sustainability of the fellowship’s efforts. Professionals should employ a decision-making framework that begins with a thorough understanding of the local context and stakeholder landscape. This involves actively seeking input from all relevant parties to define evaluation goals and methodologies. The framework should prioritize ethical considerations, such as informed consent, confidentiality, and cultural sensitivity, throughout the evaluation process. It should also incorporate principles of participatory action research, where evaluation is seen as a tool for empowerment and positive change, rather than simply a measure of accountability. Finally, the framework should emphasize the iterative nature of evaluation, allowing for adaptation and continuous improvement based on ongoing feedback and learning.

This scenario is professionally challenging because it requires balancing the need for consistent and fair assessment of fellows with the potential impact of retake policies on individual career progression and the overall reputation of the fellowship program. The fellowship’s commitment to upholding high standards of medical social work practice, as evidenced by its comprehensive exit examination, necessitates a clear and equitable approach to scoring and retakes. The challenge lies in designing a policy that is both rigorous enough to ensure competence and compassionate enough to support fellows who may face extenuating circumstances. The best professional approach involves a transparent and well-communicated policy that clearly defines the blueprint weighting, scoring thresholds, and retake procedures. This approach prioritizes fairness and predictability for all fellows. The fellowship’s governing body, in consultation with experienced medical social work professionals and educational experts, should establish these guidelines. The blueprint weighting ensures that all critical areas of medical social work practice are assessed proportionally to their importance. A clearly defined passing score, based on demonstrated competency rather than arbitrary cutoffs, is essential. Furthermore, a retake policy that allows for a limited number of attempts, coupled with mandatory remediation or further training between attempts, ensures that fellows have the opportunity to address identified weaknesses without compromising the integrity of the qualification. This aligns with ethical principles of professional development and accountability, ensuring that only competent practitioners are certified. An approach that involves arbitrary adjustments to passing scores based on individual circumstances without a formal appeals process or documented extenuating circumstances is professionally unacceptable. This undermines the principle of fairness and can lead to perceptions of bias, eroding trust in the examination’s validity. Such a practice fails to adhere to the established blueprint weighting and scoring, potentially allowing less competent individuals to pass. Another professionally unacceptable approach is to implement a retake policy that is overly punitive, allowing only one attempt with no provision for remediation or support. This can disproportionately disadvantage fellows who may have experienced unforeseen personal or professional challenges that impacted their performance on a single examination, despite their overall competence. It fails to acknowledge the developmental nature of professional learning and can hinder the entry of capable individuals into the field. A third professionally unacceptable approach is to have an unwritten or inconsistently applied retake policy. This lack of transparency creates uncertainty and anxiety for fellows, making it difficult for them to prepare adequately. It also opens the door to subjective decision-making, which can be perceived as unfair and can damage the fellowship’s reputation. The professional decision-making process for similar situations should involve a systematic review of existing best practices in professional certification and assessment. This includes consulting relevant professional bodies and regulatory guidelines for medical social work in Sub-Saharan Africa. The process should prioritize transparency, fairness, and the upholding of professional standards. A clear, documented policy that is communicated to all fellows well in advance of the examination is paramount. This policy should be reviewed periodically to ensure its continued relevance and effectiveness.

This scenario presents a professional challenge because it requires a medical social worker to navigate the ethical and practical complexities of ensuring accurate and appropriate calibration of a medical device used in a community setting, where direct oversight might be limited. The social worker must balance the patient’s immediate needs with the long-term implications of device malfunction and the regulatory requirements for safe and effective use. Careful judgment is required to determine the most appropriate course of action that upholds patient well-being and adheres to professional standards. The best approach involves proactively seeking expert guidance and ensuring the patient receives appropriate training and support. This includes contacting the medical device manufacturer or a qualified biomedical technician to arrange for the calibration, documenting all communication and actions taken, and providing the patient with clear, understandable instructions on how to operate the device and whom to contact in case of issues. This approach is correct because it prioritizes patient safety by ensuring the device is functioning optimally, adheres to the principle of beneficence by actively addressing a potential risk, and aligns with professional ethical obligations to maintain competence and ensure the safe use of medical equipment. Furthermore, it demonstrates due diligence in seeking external expertise when internal knowledge is insufficient, a key aspect of responsible practice. An incorrect approach would be to assume the device is functioning adequately without verification, perhaps based on the patient’s subjective report of it working. This is professionally unacceptable because it neglects the potential for subtle calibration errors that could lead to inaccurate readings or device failure, thereby compromising patient care and potentially violating the principle of non-maleficence. It also fails to meet the standard of care expected in managing medical equipment. Another incorrect approach would be to advise the patient to attempt to recalibrate the device themselves using online tutorials or informal advice. This is professionally unacceptable as it outsources a critical technical procedure to an untrained individual, increasing the risk of incorrect calibration, device damage, or patient injury. It demonstrates a failure to uphold professional responsibility for ensuring the safe and effective use of medical technology. Finally, an incorrect approach would be to simply document the patient’s concern and wait for a scheduled follow-up appointment without taking immediate steps to address the calibration issue. This is professionally unacceptable because it creates an unnecessary delay in addressing a potentially critical technical problem, leaving the patient at risk of suboptimal treatment or adverse events. It fails to act with the necessary urgency when patient safety is a concern. Professionals should employ a decision-making framework that begins with identifying the core issue (device calibration), assessing the potential risks to the patient, determining the scope of their own expertise, and then proactively seeking the most appropriate resources to resolve the issue. This involves a commitment to continuous learning, ethical practice, and patient advocacy, ensuring that all actions taken are in the best interest of the patient and in compliance with relevant professional guidelines and standards.

Scenario Analysis: This scenario is professionally challenging because it requires a fellow to balance their immediate need for comprehensive preparation with the ethical imperative to respect the time and expertise of their supervisors and mentors. Rushing the process or demanding excessive, unsolicited resources can strain professional relationships and may not yield the most effective learning outcomes. Careful judgment is required to identify resources that are both beneficial and appropriate within the fellowship’s context. Correct Approach Analysis: The best professional practice involves proactively identifying key areas for development based on the fellowship’s stated objectives and the fellow’s self-assessment, then engaging in a structured, collaborative discussion with their supervisor. This approach prioritizes a targeted and efficient preparation strategy, ensuring that the resources sought are relevant and aligned with the fellowship’s goals. It demonstrates initiative and respect for the supervisor’s guidance, fostering a supportive learning environment. This aligns with ethical principles of professional development, which emphasize self-awareness, goal-setting, and seeking appropriate mentorship. Incorrect Approaches Analysis: One incorrect approach involves independently compiling an exhaustive list of every conceivable resource without prior consultation. This can be perceived as a lack of trust in the supervisor’s judgment or an attempt to bypass established guidance. It may lead to the acquisition of irrelevant or redundant materials, wasting both the fellow’s and the institution’s resources. Ethically, it fails to leverage the expertise of mentors who are there to guide the fellow’s development. Another incorrect approach is to solely rely on informal recommendations from peers without verifying their relevance or quality. While peer insights can be valuable, they may not be tailored to the specific requirements of the fellowship or the individual’s learning style. This approach risks superficial preparation and may overlook crucial, formally recognized resources. It also neglects the structured guidance expected from a formal fellowship program. A third incorrect approach is to assume that all necessary preparation resources will be provided by the fellowship without any proactive effort from the fellow. This passive stance can lead to missed opportunities for deeper learning and may indicate a lack of commitment to maximizing the fellowship experience. It fails to acknowledge the shared responsibility in professional development and the importance of a fellow’s active engagement in their own learning journey. Professional Reasoning: Professionals should approach fellowship preparation by first understanding the program’s explicit learning outcomes and expectations. This understanding should then inform a self-assessment of current knowledge and skills. The next critical step is to schedule a meeting with their assigned supervisor or mentor to discuss their self-assessment and collaboratively develop a personalized preparation plan. This plan should outline specific learning objectives, identify relevant resources (including those suggested by the supervisor), and establish a realistic timeline. Regular check-ins with the supervisor are essential to monitor progress and adjust the plan as needed, ensuring that preparation remains focused, effective, and ethically sound.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for patient care with the long-term imperative of preventing the spread of infection and ensuring the quality of services provided. Social workers often operate in resource-constrained environments where adherence to strict safety protocols can be difficult due to limited supplies, staff training, or infrastructure. The ethical imperative to “do no harm” is directly implicated, as is the professional responsibility to advocate for safe and effective care within the existing system. The social worker must navigate potential conflicts between patient comfort, staff workload, and public health mandates. Correct Approach Analysis: The best approach involves a multi-pronged strategy that prioritizes immediate patient safety while simultaneously initiating systemic improvements. This includes diligently following established infection prevention protocols for the specific patient’s condition, such as appropriate hand hygiene, use of personal protective equipment (PPE), and safe disposal of waste. Concurrently, the social worker should document the observed gaps in safety and infection control, report these findings to the relevant supervisory and administrative personnel within the healthcare facility, and advocate for necessary resources or training. This approach is correct because it aligns with the fundamental ethical principles of beneficence and non-maleficence, ensuring the patient receives care without undue risk of infection. It also upholds professional accountability by addressing systemic issues that could compromise the safety of all patients and staff. Regulatory frameworks in Sub-Saharan Africa, while varying by country, generally emphasize the responsibility of healthcare providers to maintain a safe environment and prevent healthcare-associated infections, often guided by national health policies and international best practices promoted by organizations like the World Health Organization. Incorrect Approaches Analysis: One incorrect approach is to solely focus on the immediate patient’s comfort and needs without addressing the underlying infection prevention concerns. This fails to uphold the principle of non-maleficence, as it risks exposing the patient and others to potential pathogens. It also neglects the professional and ethical duty to report and address systemic safety failures, which could lead to broader public health consequences. Another incorrect approach is to bypass established reporting channels and directly implement personal, unverified safety measures without consultation or approval. While well-intentioned, this can lead to inconsistent practices, potential conflicts with existing protocols, and may not be effective or even safe. It undermines the hierarchical structure of healthcare systems designed for coordinated quality control and can create confusion or liability. A third incorrect approach is to ignore the observed safety and infection control issues due to perceived lack of authority or resources. This is ethically unacceptable as it constitutes a failure to act in the face of potential harm. Professionals have a duty to report concerns, even if they cannot directly resolve them, to ensure that those with the authority to act are informed. This inaction can perpetuate unsafe practices and compromise the quality of care for all. Professional Reasoning: Professionals should employ a systematic decision-making process that begins with a thorough assessment of the immediate situation, identifying any risks to patient safety and infection control. This should be followed by adherence to established protocols and, crucially, a commitment to reporting and advocating for improvements. Professionals should understand their role not only in direct patient care but also as agents of change within their institutions. This involves knowing the relevant national health guidelines, institutional policies, and ethical codes of conduct that govern safety and quality. When faced with resource limitations or systemic challenges, the professional’s responsibility is to document, report, and advocate, rather than to compromise on fundamental safety principles.

Scenario Analysis: This scenario is professionally challenging because it requires the social worker to navigate the complex interplay between client confidentiality, the legal mandate to report, and the specific documentation requirements of a fellowship program. The fellowship’s emphasis on rigorous documentation for program evaluation and potential future research introduces a layer of complexity beyond standard clinical record-keeping. Failure to adhere to both ethical principles and regulatory mandates can have serious consequences, including legal repercussions, damage to professional reputation, and compromise of client trust. The need for accurate, timely, and compliant documentation is paramount. Correct Approach Analysis: The best professional practice involves meticulously documenting all client interactions, including the specific details of the disclosure and the social worker’s subsequent actions. This documentation should clearly distinguish between information shared for clinical purposes and information that may be subject to mandatory reporting. Crucially, the social worker must consult the fellowship’s specific guidelines on data handling and reporting, alongside relevant national and local child protection legislation. If the disclosure involves a child at risk of harm, the social worker must follow the established reporting protocols for their jurisdiction, ensuring that the report is made to the appropriate authorities promptly and that this action is accurately recorded in the client’s file and the fellowship’s records, without compromising the client’s privacy beyond what is legally required. This approach prioritizes client well-being, legal compliance, and fellowship requirements. Incorrect Approaches Analysis: Failing to document the disclosure and the subsequent reporting action would be a significant ethical and regulatory failure. It would leave the social worker vulnerable to accusations of negligence and would prevent proper oversight and accountability within the fellowship program. It also hinders any potential future review or research that relies on complete case records. Reporting the disclosure to the authorities without first consulting the fellowship’s specific documentation guidelines and ensuring the information is presented in a manner compliant with both legal and fellowship requirements risks oversharing sensitive information or failing to meet the fellowship’s data collection standards. This could lead to breaches of confidentiality beyond what is necessary or acceptable to the fellowship. Omitting the disclosure from the client’s record and fellowship documentation, even if a report is made, is a serious breach of professional practice. All significant client interactions and professional actions must be recorded. This omission creates an incomplete and potentially misleading record, which can have legal and ethical ramifications and undermines the integrity of the fellowship’s data. Professional Reasoning: Professionals should approach such situations by first identifying all relevant stakeholders and their requirements: the client, the fellowship program, and the relevant legal/regulatory bodies. A systematic process involves: 1) Understanding the ethical duty of confidentiality and its limits. 2) Identifying any mandatory reporting obligations based on the nature of the disclosure and jurisdictional laws. 3) Consulting the specific policies and guidelines of the employing organization or fellowship program regarding documentation and reporting. 4) Documenting all relevant information accurately, contemporaneously, and objectively, distinguishing between clinical notes and information for external reporting. 5) Acting in accordance with legal and ethical obligations, ensuring that any reports are made to the correct authorities in the prescribed manner. 6) Maintaining clear and comprehensive records of all actions taken.