bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding Stakeholder Preference for Contralateral Prophylactic Mastectomy: A Conjoint Analysis
Authors: Shamsunder Meghana G. , Panchal Hina , Pilewskie Melissa , Lee Clara , Razdan Shantanu N. , Matros Evan
Published: August 2021

BACKGROUND:

Despite increasing numbers of women with unilateral breast cancer undergoing CPM, quantitative evidence of all stakeholder preferences regarding CPM is lacking, particularly for healthy volunteers. Conjoint analysis, a marketing tool, can be used to quantify tradeoffs surrounding CPM.

STUDY DESIGN:

The objective of this study was to quantify preferences for aspects of contralateral prophylactic mastectomy (CPM) decision-making process among key stakeholders. Healthy volunteers, women with cancer (WwCa), surgical oncologists, and plastic surgeons were surveyed with the same conjoint simulation exercise. Respondents chose between either single (SM) or double (DM) mastectomy under varying recurrence and complication rates, surveillance, and symmetry conditions. Hierarchical Bayesian models calculated partworth utilities and importance scores.

RESULTS:

Overall, 1,244 respondents participated. The top 3 important factors for all stakeholders were surgical complication rates after DM, type of surgery (SM vs DM) independent of other variables, and 10-year future contralateral cancer risk after SM. HV and surgeons placed greatest importance on high rates of surgical complications after DM. WwCa preferred DM, regardless of complication risk or low rates of a 10-year future cancer episode after SM. Surgical oncologists strongly preferred SM and were more accepting of future cancer risk of 3% or 10% than other stakeholders. Symmetry and need for surveillance were least important factors for all stakeholders.

CONCLUSIONS:

The threshold of acceptability for future cancer episodes and risk tolerance for complications varies by stakeholder, with a profound influence upon WwCA. Current findings suggest room for improved provider and patient alignment through behavioral techniques, such as framing, meanwhile highlighting changes in risk perception after a breast cancer diagnosis.
US Medical Licensing Exam Performance and American Board of Surgery Qualifying and Certifying Examinations
Authors: Stain Steven C. , Matthews Jeffrey B. , Ata Ashar , Adams David B. , Chen Herbert , Potts John R.
Published: August 2021

Background

Program directors use US Medical Licensing Exam (USMLE) scores as criteria for ranking applicants. First-time pass rates of the American Board of Surgery (ABS) Qualifying (QE) and Certifying (CE) Examinations have become important measures of residency program quality. USMLE Step 1 will become pass/fail in 2022.

Study design

American Board of Surgery QE and CE success rates were assessed considering multiple characteristics of highly ranked (top 20) applicants to 22 general surgery programs in 2011. Chi-square, t-test, Wilcoxon Rank sum, linear and logistic regression were used, as appropriate.

Results

The QE and CE first attempt pass rates were 96% (235/244) and 86% (190/221), respectively. QE/CE success was not significantly associated with sex, race, research experience, or publications. Alpha Omega Alpha (AΩA) status was associated with success on the index CE (98% vs 83%; p = 0.008). Step 1 and Step 2 Clinical Knowledge (CK) scores of surgeons who passed QE on their first attempt were higher than scores of those who failed (Step 1: 233 vs 218; p = 0.016); (Step 2CK: 244 vs 228, p = 0.009). For every 10-point increase in Step 1 and 2CK scores, the odds of passing CE on the first attempt increased 1.5 times (95% CI 1.12, 2.0; p = 0.006) and 1.5 times (95% CI 1.11, 2.02, p = 0.008), respectively. For every 10-point increase in Steps 1 and 2CK scores, the odds of passing the QE on the first attempt increased 1.85 times (95% CI 1.11, 3.09; p = 0.018) and 1.86 times (95% CI 1.14, 3.06, p = 0.013), respectively.

Conclusions

USMLE Step 1 and Step 2 CK examination scores correlate with American Board of Surgery QE and CE performance and success. The USMLE decision to transition Step 1 to a pass/fail examination will require program directors to identify other factors that predict ABS performance for ranking applicants.

Visual Abstract
Implementation of a Frailty Assessment and Targeted Care Interventions and Its Association with Reduced Postoperative Complications in Elderly Surgical Patients
Authors: Wilson Spencer , Sutherland Evan , Razak Alina , O’Brien Mollie , Ding Callie , Nguyen Thien , Rosenkranz Pam , Sanchez Sabrina E.
Published: August 2021

Background

Older patients with frailty syndrome have a greater risk of poor postoperative outcomes. In this study, we used a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to implement an assessment tool to identify frail patients and targeted interventions to improve their outcomes.

Study Design

We implemented a 5-question frailty assessment tool for patients 65 years and older admitted to the general and vascular surgery services from January 1, 2018 to December 31, 2019. Identified frail patients received evidence-based clinical orders and nursing care plan interventions tailored to optimize recovery. A RE-AIM framework was used to assess implementation effectiveness through provider and nurse surveys, floor audits, and chart review.

Results

Of 1,158 patients included in this study, 696 (60.1%) were assessed for frailty. Among these, 611 patients (87.8%) scored as frail or intermediately frail. After implementation, there were significant increases in the completion rates of frailty-specific care orders for frail patients, including delirium precautions (52.1% vs 30.7%; p < 0.001), aspiration precautions (50.0% vs 26.9%; p < 0.001), and avoidance of overnight vitals (32.5% vs 0%). Floor audits, however, showed high variability in completion of care plan components by nursing staff. Multivariate analysis showed significant decreases in 30-day complication rates (odds ratio 0.532; p < 0.001) after implementation.

Conclusions

A frailty assessment was able to identify elderly patients for provision of targeted, evidence-based frailty care. Despite limited uptake of the assessment by providers and completion of care plan components by nursing staff, implementation of the assessment and care interventions was associated with substantial decreases in complications among elderly surgical patients.

Visual Abstract
Realisation and testing of novel fully articulated bird-inspired flapping wings for efficient and agile UAVs
Authors: Kumar D. , Goyal T. , Kamle S. , Mohite P.M. , Lau E.M.
Published: August 2021

Large birds have evolved an effective wing anatomy and mechanics, enabling airborne mastery of manoeuvres and endurance. For these very reasons, they are difficult to replicate and study. The aim of the present work is to achieve active wing articulations to mimic natural bird flapping towards efficient and agile Unmanned Aerial Vehicles (UAVs). The proposed design, bio-mimicking the black-headed gull,Larus ridibundus, has three active and independent servo-controlled wing joints at the shoulder, elbow and wrist to achieve complex controls. The construction of the wing is realised through a polymeric skin and carbon fibre–epoxy composite spars and ribs. The wing movements (flapping, span reduction and twisting) envelopes of the full-scale robotic gull (Robogull) are examined using the Digital Image Correlation (DIC) technique and laser displacement sensing. Its aerodynamic performance was evaluated in a wind tunnel at various flapping parameters, wind speeds and angles of attack. It is observed that a flapping amplitude of 45$^\circ$is more favourable than 90$^\circ$for generating higher lift and thrust, while also depending on the presence of span reduction, twist and wind speed. The model performs better at a flying velocity of 4m/s as compared with 8m/s. Both lift and thrust are high at a higher flapping frequency of 2.5Hz. Combined variation of the flapping frequency and stroke ratio should be considered for better aerodynamic performance. The combination of a lower stroke ratio of 0.5 with a flapping frequency of 2.5Hz generates higher lift and thrust than other combinations. Span reduction and wing twist notably and independently enhance lift and thrust, respectively. An increase in the angle-of-attack increases lift but decreases thrust. The model can also generate a significant rolling moment when set at a bank angle of 20$^\circ$and operated with independently controlled flapping amplitudes for the wings (45$^\circ$for the left wing and 90$^\circ$for the right wing). Based on the optimal values for the flapping amplitude (45$^\circ$), flapping frequency (2.5Hz) and flying velocity (4m/s), the Strouhal number (St) of the Robogull model is 0.24, lying in the optimal range ($0.2 < \mathrm{St} < 0.4$) for natural flyers and swimmers.
Lock-in phenomenon of vortex shedding in flows excited with two commensurate frequencies: a theoretical investigation pertaining to combustion instability
Authors: Britto Abraham Benjamin , Mariappan Sathesh
Published: August 2021

An analytical investigation is performed to study the dynamics of vortex shedding behaviour during two commensurate frequency velocity excitations, with an emphasis on the phenomenon of lock-in. We attempt to theoretically study the dynamical features of lock-in under two-frequency excitations and contrast the behaviour with single-frequency excitation. We employ an existing low-order model to characterise the vortex shedding process behind a step/bluff-body. The continuous-time domain model is transformed to a nonlinear dynamical map that relates time instances of successive vortex shedding. Further, these time instances are converted to phase instances, involving which criteria for a generic p : q phase lock-in is obtained. Four parameters are involved: amplitude and frequency of the two excitation components termed as primary and secondary. Bifurcations occurring are investigated using return maps. The inclusion of secondary excitation leads to the existence of two orders of lock-in within a single lock-in boundary. Furthermore, our results indicate that secondary excitation can be used as a control in order to tailor the 1:1 lock-in region formed by the primary excitation. Finally, analytical expressions are obtained to identify lock-in boundaries and their salient geometrical features. Interesting features such as the occurrence of bistability and change in the order of lock-in are observed, which can be explored further with future experiments.
Predictors of adverse birth outcomes among pregnant adolescents in Ashanti Region, Ghana
Authors: Annan Reginald Adjetey , Gyimah Linda Afriyie , Apprey Charles , Asamoah-Boakye Odeafo , Aduku Linda Nana Esi , Azanu Wisdom , Luterodt Herman E. , Edusei Anthony K.
Published: August 2021

Adolescent pregnancy is associated with adverse birth outcomes. However, the determinants of these outcomes are understudied. The present study sought to identify the predictors of adverse birth outcomes among pregnant adolescents in Ghana. In this prospective health centre-based study, 416 pregnant adolescents, aged 13–19 years old, were followed, and 270 birth outcomes were evaluated. We collected data on socio-demographic variables, eating behaviour, household hunger scale (HHS), lived poverty index (LPI) and compliance to antenatal interventions. The prevalence of low birth weight (LBW) and preterm births (PTB) were 15⋅2 and 12⋅5 %, respectively. Pregnant adolescents with no formal education (AOR 9⋅0; P = 0⋅004; 95 % CI 2⋅1, 39⋅8), those who experienced illness (AOR 3⋅0; P = 0⋅011; 95 % CI 1⋅3, 7⋅0), those who experienced hunger (OR 2⋅9; P = 0⋅010; 95 % CI 1⋅3, 6⋅5) and those with high LPI (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅2, 5⋅3) presented increased odds of delivering preterm babies compared with those who have had secondary education, did not experience any illness, were not hungry or having low LPI, respectively. Pregnant adolescents who used insecticide-treated net (ITN) (AOR 0⋅4; P = 0⋅013; 95 % CI 0⋅2, 0⋅9) presented reduced odds LBW children; while those who experienced illness (AOR 2⋅7; P = 0⋅020; 95 % CI 1⋅2, 6⋅0), poorer pregnant adolescents (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅1, 4⋅8) and those who experienced hunger (AOR 3⋅0; P = 0⋅028; 95 % CI 1⋅1, 8⋅1) presented increased odds of LBW children compared with those who used ITN, were not ill, were not poor or did not experience hunger. Adverse birth outcomes were associated with ANC compliance and socioeconomic factors of the pregnant adolescents. Hence, strengthening antenatal uptake and compliance by pregnant adolescents, promoting their livelihood and socioeconomic status, and interventions to prevent teenage pregnancies are strongly recommended.
Managing Complementary Assets to Build Cross-Functional Ambidexterity: The Transformation of Huawei Mobile
Authors: Yan Mengling , Hu Yanni , Dong Xiaoying
Published: August 2021

During technology transitions, incumbents are frequently faced with the ambidextrous challenge of exploiting existing capabilities and exploring new ones. While extant studies focus on radical changes in the product domain, we notice radical changes can happen in both product and market domains. Pioneering studies indicate that cross-functional ambidexterity addresses this challenge at the business-unit level by juxtaposing exploration and exploitation across different functional domains (particularly in product and market domains) and that complementary assets address this challenge at the organizational level. However, how efforts at two levels can be combined to build cross-functional ambidexterity and what roles complementary assets play remain unclear. Therefore, this study conducts an in-depth case study of Huawei Mobile, which managed to achieve superior performance during a technology transition that triggers radical changes in both product and market domains. We find that multi-level synergies contribute to the transition process. Specifically, cross-functional ambidexterity is constructed by prioritizing exploration in the product domain ahead of that in the market domain, and that it generates learning, brand and channel extension, matching, and brand alliance benefits at the business-unit level. Complementary assets help to reduce the uncertainty of exploration and resolve functional conflicts at the organizational level.
Bifurcation structure of coexistence states for a prey–predator model with large population flux by attractive transition
Authors: Kuto Kousuke , Oeda Kazuhiro
Published: August 2021

This paper is concerned with a prey–predator model with population flux by attractive transition. Our previous paper (Oeda and Kuto, 2018, Nonlinear Anal. RWA, 44, 589–615) obtained a bifurcation branch (connected set) of coexistence steady states which connects two semitrivial solutions. In Oeda and Kuto (2018, Nonlinear Anal. RWA, 44, 589–615), we also showed that any positive steady-state approaches a positive solution of either of two limiting systems, and moreover, one of the limiting systems is an equal diffusive competition model. This paper obtains the bifurcation structure of positive solutions to the other limiting system. Moreover, this paper implies that the global bifurcation branch of coexistence states consists of two parts, one of which is a simple curve running in a tubular domain near the set of positive solutions to the equal diffusive competition model, the other of which is a connected set characterized by positive solutions to the other limiting system.
The Mediterranean dietary pattern for optimising health and performance in competitive athletes: a narrative review
Authors: Griffiths Alex , Matu Jamie , Whyte Eleanor , Akin-Nibosun Petros , Clifford Tom , Stevenson Emma , Shannon Oliver Michael
Published: August 2021

Nutrition plays a key role in training for, and competing in, competitive sport, and is essential for reducing risk of injury and illness, recovering and adapting between bouts of activity, and enhancing performance. Consumption of a Mediterranean diet (MedDiet) has been demonstrated to reduce risk of various non-communicable diseases and increase longevity. Following the key principles of a MedDiet could also represent a useful framework for good nutrition in competitive athletes under most circumstances, with potential benefits for health and performance parameters. In this review, we discuss the potential effects of a MedDiet, or individual foods and compounds readily available in this dietary pattern, on oxidative stress and inflammation, injury and illness risk, vascular and cognitive function, and exercise performance in competitive athletes. We also highlight potential modifications which could be made to the MedDiet (whilst otherwise adhering to the key principles of this dietary pattern) in accordance with contemporary sports nutrition practices, to maximise health and performance effects. In addition, we discuss potential directions for future research.
Higher habitual dietary flavonoid intake associates with lower central blood pressure and arterial stiffness in healthy older adults
Authors: Parmenter Benjamin H. , Croft Kevin D. , Cribb Lachlan , Cooke Matthew B. , Bondonno Catherine P. , Lea Ana , McPhee Grace M. , Komanduri Mrudhula , Nolidin Karen , Savage Karen , Pase Matthew P. , Hodgson Jonathan M. , Stough Con , Bondonno Nicola P.
Published: August 2021

Flavonoids have shown anti-hypertensive and anti-atherosclerotic properties: the impact of habitual flavonoid intake on vascular function, central haemodynamics and arterial stiffness may be important. We investigated the relationship between habitual flavonoid consumption and measures of central blood pressure and arterial stiffness. We performed cross-sectional analysis of 381 non-smoking healthy older adults (mean age 66·0 (sd 4·1) years; BMI, 26·4 (sd 4·41) kg/m2; 41 % male) recruited as part of the Australian Research Council Longevity Intervention study. Flavonoid intake (i.e. flavonols, flavones, flavanones, anthocyanins, isoflavones, flavan-3-ol monomers, proanthocyanidins, theaflavins/thearubigins and total consumption) was estimated from FFQ using the US Department of Agriculture food composition databases. Measures of central haemodynamics and arterial stiffness included systolic blood pressure (cSBP), diastolic blood pressure (cDBP), mean arterial pressure (cMAP) and augmentation index (cAIx). After adjusting for demographic and lifestyle confounders, each sd/d higher intake of anthocyanins ((sd 44·3) mg/d) was associated with significantly lower cDBP (−1·56 mmHg, 95 % CI −2·65, −0·48) and cMAP (−1·62 mmHg, 95 % CI −2·82, −0·41). Similarly, each sd/d higher intake of flavanones ((sd 19·5) mg/d) was associated with ~1 % lower cAIx (−0·93 %, 95 % CI −1·77, −0·09). These associations remained signiﬁcant after additional adjustment for (1) a dietary quality score and (2) other major nutrients that may affect blood pressure or arterial stiffness (i.e. Na, K, Ca, Mg, n-3, total protein and fibre). This study suggests a possible benefit of dietary anthocyanin and flavanone intake on central haemodynamics and arterial stiffness; these findings require corroboration in further research.
The Puzzling Persistence of Racial Inequality in Canada
Authors: Banting Keith , Thompson Debra
Published: August 2021

This article examines the failure of Canadian public policy in addressing racial economic inequality directly. Our analysis contends that Canada's key policy regimes were established in the postwar era, when approximately 96 per cent of Canadians were of European descent. As a result, the frameworks, problem definitions and policy tools inherited from that era were never intended to mitigate racial economic inequality. Moreover, this policy inheritance was deeply shaped by liberal universalism, which rejected racial distinctions in law and policy. These norms were carried forward into the more racially diverse Canada of today, where they have steered attention away from the use of racial categories in policy design. As a result, racial inequality was not a central priority during major policy reforms to core policy regimes in recent decades. In theoretical terms, our analysis contributes to Canadian Political Development through a sustained consideration of the intersecting roles of ideational frameworks, path dependency and policy inertia.
Rhinological manifestations of Sjögren's syndrome: a cohort-matched, prospective, cross-sectional, observational study
Authors: Kamel U F , Maddison P J
Published: August 2021

Objective

To assess the prevalence of abnormal rhinological findings in a Sjögren's syndrome population.

Methods

A cohort-matched, prospective, cross-sectional, observational study was conducted. Sixty-seven subjects (30 patients and 37 controls) were enrolled. Rhinological assessment including smell threshold was evaluated using a standardised, validated clinical test as part of a larger study.

Results

Smell thresholds were –4.4 and –5.4 in the Sjögren's syndrome and control groups, respectively (p = 0.001). Hyposmia (threshold values of less than −4.5) was demonstrated in the Sjögren's syndrome group (47 per cent). Smell was negatively correlated with age (p = 0.040). Nasal septal perforation was noted in 3 Sjögren's syndrome patients (10 per cent) and nasal mucosal dryness in 10 patients (33 per cent), but none of the control group were affected.

Conclusion

Hyposmia in Sjögren's syndrome was demonstrated using the Smell Threshold Test. Nasal septal perforation and nasal mucosa dryness were also noted in patients with Sjögren's syndrome. A diagnosis of Sjögren's syndrome should be considered and investigated in smell deprivation and/or nasal septal perforation patients.
Bridgeman Island, Antarctica, ‘burning mount’ or old eroded volcano?
Authors: Williams Karen Louise
Published: August 2021

Deception, Bridgeman and Penguin are the three most recently active volcanic islands in the South Shetland Islands. Since the discovery of the archipelago in 1819, Deception Island has erupted on frequent occasions, most recently in August 1970. A number of nineteenth-century observers reported fumarolic or volcanic activity from Bridgeman Island. No eyewitness accounts of activity from Penguin Island have been found. A chronological list detailing the historic reports from Bridgeman Island was compiled to compare and establish their veracity. This process revealed a consistency of observation from independent observers. An effort has been made to consider if any of these reports of activity may have belonged instead to Penguin Island volcano, 60 km (32 NM) away. A review of the timing of discovery and availability of the first charts of the South Shetlands was also examined to narrow the period when mariners might have mistaken one island for another. Only the three earliest observations of activity from an unnamed volcano, during the short period when no maps were available, may be questioned. A useful chart of the region was published in 1822, and all subsequent observations of activity were from Bridgeman, not Penguin Island.
Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: a parallel-group randomized controlled trial
Authors: Chan Christian S. , Wong Christy Y. F. , Yu Branda Y. M. , Hui Victoria K. Y. , Ho Fiona Y. Y. , Cuijpers Pim
Published: August 2021

Background

Despite its efficacy in treating comorbid insomnia and depression, cognitive behavioral therapy for insomnia (CBT-I) is limited in its accessibility and, in many countries, cultural compatibility. Smartphone-based treatment is a low-cost, convenient alternative modality. This study evaluated a self-help smartphone-based CBT-I in alleviating major depression and insomnia.

Methods

A parallel-group randomized, waitlist-controlled trial was conducted with 320 adults with major depression and insomnia. Participants were randomized to receive either a 6-week CBT-I via a smartphone application,proACT-S, or waitlist condition. The primary outcomes included depression severity, insomnia severity, and sleep quality. The secondary outcomes included anxiety severity, subjective health, and acceptability of treatment. Assessments were administered at baseline, post-intervention (week 6) follow-up, and week 12 follow-up. The waitlist group received treatment after the week 6 follow-up.

Results

Intention to treat analysis was conducted with multilevel modeling. In all but one model, the interaction between treatment condition and time at week 6 follow-up was significant. Compared with the waitlist group, the treatment group had lower levels of depression [Center for Epidemiologic Studies Depression Scale (CES-D): Cohen'sd= 0.86, 95% CI (−10.11 to −5.37)], insomnia [Insomnia Severity Index (ISI): Cohen'sd= 1.00, 95% CI (−5.93 to −3.53)], and anxiety [Hospital Anxiety and Depression Scale – Anxiety subscale (HADS-A): Cohen'sd= 0.83, 95% CI (−3.75 to −1.96)]. They also had better sleep quality [Pittsburgh Sleep Quality Index (PSQI): Cohen'sd= 0.91, 95% CI (−3.34 to −1.83)]. No differences across any measures were found at week 12, after the waitlist control group received the treatment.

Conclusion

proACT-Sis an efficacious sleep-focused self-help treatment for major depression and insomnia.

Trial registration

ClinicalTrials.gov, NCT04228146. Retrospectively registered on 14 January 2020.https://clinicaltrials.gov/ct2/show/NCT04228146
Emergence and Restraint: Indigenous Performances during the COVID-19 Pandemic
Authors: Wilch Clara Margaret
Published: August 2021

During the summer of 2020, I intended to make my second visit to Iqaluit, Nunavut, to speak with people involved in performance and climate science practices, engage in “co-performative witnessing” (methodology after Dwight Conquergood), and work to make my doctoral research useful to communities in Nunavut.1 Needless to say, that didn't happen. However, the limitations imposed by COVID-19 have also been opportunities for all of us in performance studies to renew our understandings of what it is we do. The pandemic has forced me to understand my dissertation project differently and to reassess the complex process of respectfully engaging communities to which I do not personally belong.
Going “Live” Again: Reflections on Zoom, Copresence, & Liveness in a (Post)Pandemic World
Authors: Neuss Carla
Published: August 2021

In April 2020—only weeks after the World Health Organization declared COVID-19 a global pandemic—the New York Times published an article titled “Why Zoom Is Terrible.” Quoting a gustatory simile from Sheryl Brahnam of Missouri State University, the article declared, “In-person communication resembles video conferencing about as much as a real blueberry muffin resembles a packaged blueberry muffin that contains not a single blueberry but artificial flavors, textures and preservatives.”1 It has been a year marked by the absence of “in-person” connection, or in the language of our field, of spatial copresence. The COVID-19 pandemic has fundamentally disrupted our ability to share space. Spatial copresence, it turns out, is what the coronavirus requires to spread. The virus, in this sense, is a phenomenon of the live. While technologies like Zoom have maintained our capacity for temporal copresence, the now ubiquitous status of “Zoom fatigue” points to new ways to consider spatial copresence, and by extension “liveness.”
Changes
Authors: Tiehen Jeanne
Published: August 2021

In March 2020 I came home from a theatre conference with a nagging cough, which I had been fighting for some time. Yet, it deepened and strengthened over the next few days. In the following week, symptoms accumulated and were strange and fluctuating: an experience with which I would become all too well acquainted in my COVID journey. Two weeks later on a second telemedical appointment a doctor heard me describe the coughing and chest burning I felt—where it almost felt like a sunburn—and told me it sounded like I had COVID. The inhaler she prescribed helped, but I originally dismissed her diagnosis. These were the early days when a test could not be found or taken, so I lacked confirmation that my body would verify to me for the months following through more drastic measures. A year later, after ongoing and prolonged symptoms of costochondritis, fluctuating high heart rates, difficulty breathing, and a multitude of costly hospital and specialist visits—including now being a part of the Post/Long COVID clinic in my state—I am changed. My health, like most of our lives this past year, follows a path of uncertainty and unknowns.
“Dancing Alone Together”
Authors: Dickinson Peter
Published: August 2021

My experience of this pandemic began with bureaucracy. I want it to end with dancing.
The Rhodesian Front and the African National Council
Authors: Kirk Tony
Published: August 2021

In most countries ordinary people do not appreciate the sheer guile of their political leaders. Rhodesia is no exception. The dealings between the government and the African National Council confirm it. The government interrupted its dialogue with the ANC by detaining thirtythree senior ANC officials without trial, effectively destroying the cohesion of the only black political organization in the country. To the white voter, who sees no further than the surface of events, the detentions represented a simple exercise of executive power. In fact the government could not act in as sudden and arbitrary a fashion as that. It had to choose the time for its action with care, and to some extent it had to prepare the white electorate to accept what happened without question.
The Black Reaction
Authors: Tambo Oliver
Published: August 2021

Examination of the black reaction to apartheid during the period 1948-1973 is topical and should help us to understand what is now happening in South Africa. The black reaction is not merely to apartheid; it is to the whole social system imposed on the black people of South Africa from the moment the white man landed there in 1652. There has been a reaction over the succeeding centuries which has manifested itself in a variety of ways. For a long time this reaction assumed the form of armed resistance. When that was defeated, it took the form of political opposition.
South Africa in 1998: Trends and Developments During the Next Twenty-Five Years
Authors: Keppel-Jones A. M.
Published: August 2021

Prophecy is one of the simplest ways for an historian to destroy his credit and reputation. Having been persuaded to take this risk, I shall partly cover it with one small insurance policy: I shall set forth what seem to me to be the relevant facts, but not be too dogmatic about the conclusions to be drawn from them.

Where will South Africa stand twenty-five years from now? What will have happened during those years? In theory there are, I think, only four possibilities: (i) that the status quo will remain essentially unchanged; (ii) that radical changes, involving or at least leading to the abolition of all racial discrimination, will come about peacefully, by constitutional means; (iii) that the regime will be overthrown by invading foreign forces; and (iv) that it will be overthrown by revolution within the country, with or without foreign support. As there are strong reasons for believing that none of these alternatives is really possible, some factor seems to have been overlooked. Perhaps it will appear as the four alternatives are examined.
American Economic Assistance to Africa Some Observations
Authors: Gappert Gary
Published: August 2021

Several years ago I testified before the House Foreign Affairs Committee about the insufficiency of American aid to Africa. I urged that foreign aid be increased because, in Africa, our foreign aid still had the opportunity of being genuine economic assistance and not something else. It was understood in my remarks that the genuine nature of economic assistance would become apparent as structural changes in African economies took place.
The Failure of U.S. Southern African Policy
Authors: Seiler John
Published: August 2021

The Nixon Adminsitration’s decision to sign an executive agreement covering U.S. access to Azores military facilities reflects the moral and practical bankruptcy of this Administration’s policy toward the white-governed territories of southern Africa. If there is to be any improvement in the social and political situation of nonwhites in Angola and Mozambique as a quid pro quo for our commitment of development funds and symbolic support, no signs of it appear in the news reports of the agreement. Whether or not any of the development projects are to be in those territories, U.S. support will contribute in a major way to the stabilization of Portuguese political control there.
China's Changing Policies in Africa
Authors: El-Khawas Mohamed A.
Published: August 2021

China's foreign policy toward Africa has been of major concern to the great powers ever since the time that China embarked on an active policy in the African continent. By its action, China presented a direct challenge to Soviet leadership in the Third World, and at the same time put an end to the seclusion the United States had tried to impose on the Communist regime.
Selected Arguments Against United States' Economic Disengagement from South Africa and some Alternative Measures
Authors: Hance William A.
Published: August 2021

There is very wide agreement, with which I fully concur, regarding the abhorrent and unacceptable character of apartheid and regarding the inevitable demise of minority rule in South Africa. There is, however, honest disagreement regarding the best way for Americans and others to assist in effecting change. Differing motives for recommending disengagement may also sometimes confuse the issue. Disengagement can reflect such diverse policies as neutralism, non-cooperation, dissociation, intervention, or withdrawal. It can reflect a desire to induce change by positive steps or an acceptance that little can be done, but that the disengager will at least not be implicated or involved in a detested situation. To some it is the isolation of the disengager that is the goal; others appear to be propounding as-full-as-possible isolation of South Africa.
The Semitic Impact on Black Africa: Arab and Jewish Cultural Influences
Authors: Mazrui Ali A.
Published: August 2021

Contemporary Africa's Triple Heritage of indigenous, Islamic, and Western legacies is just the modern culmination of a much older Triple Heritage —the heritage of indigenous, Semitic, and Greco-Roman influences on Africa. The ancient Semitic strand has now narrowed and focused more firmly on Arab and Islamic influences; the ancient Greco-Roman strand has now expanded to encompass wider European and American intrusions.
Safaris in the Bush of Ghosts: Gamara Laye, Saul Bellow, and Ayi Kwei Armah
Authors: Johnson Lemuel A.
Published: August 2021

The land of Zanj is vast, wrote Suleiman the Merchant. Its plants are all black in colour.

When he gets to heaven, I don't think he'll walk through the pearly gates. He'll swing in on a grape vine. – Pat Buttram, actor, upon the death of Johnny Weismuller, January 1984.

I did not know the time that I entered into a dreadful bush which is called the “Bush of Ghosts” because I was very young to understand the meaning of “bad” or “good”. This “Bush of Ghosts” was so dreadful so that no superior earthly person ever entered it. – Amos Tutuola, My Life in the Bush of Ghosts.
Business as Usual - Transactions Violating Rhodesian Sanctions
Authors: Park Stephen , Lake Anthony
Published: August 2021

Travel to many parts of Africa is a complicated undertaking — visas and shots, tickets … delays. A trip to Southern Rhodesia, however, is a breeze. No visa is required, just one or two innoculations, a passport and a confirmed onward reservation. Air travel reservations? Drop by a Pan American ticket counter anywhere in the United States and in seconds the computer will confirm space for you on an Air Rhodesia flight from Johannesburg, South Africa to the Rhodesian capital of Salisbury. It is all very convenient. The trouble is that when Pan Am, TWA, and perhaps other American carriers help make the going great, they apparently do it illegally.
The Soviet Union and the Nigerian Civil War: A Triumph of Realism
Authors: Stent Angela
Published: August 2021

The “winds of change” had barely swept across Africa when the newly-independent nations felt the chilling gusts of the cold war. Decolonization created a power vacuum in the prevailing bipolar structure and for a time it appeared that the African continent would be one of the areas in which the struggle between capitalism and communism would be resolved. As the center of gravity of the cold war shifted towards the periphery, the USSR became increasingly interested in extending its influence in Africa. This interest was sharpened as Sino-Soviet rivalry intensified. Under Khrushchev, Soviet policy in Africa was expansionist, vigorous and unrealistically optimistic, both in its assessment of African gratitude towards Moscow and in its estimation of the socialist potential of certain regimes. A series of spectacular setbacks in the Congo, Guinea, Ghana, and Mali led Khrushchev's successors to reevaluate their Third World policies and downgrade Africa as an area deserving extensive Russian resources.
“Cent Moutons Font Un Loup”
Authors: Rodegem F.
Published: August 2021

One of the most perplexing features of the welter of events that led to the slaughter of 1972 has to do with the emergence, or the resurgence, of intra-Tutsi rivalries. These were particularly noticeable in the months immediately preceding the holocaust and involved among other things a struggle for power between the so-called Tutsi-Hima and the Tutsi-Banyaruguru. The following passage is excerpted from Father Rodegem’s article “Burundi: La Face Cachée de la Rébellion” (Intermédiaire, 15 June 1973) in which the author emphasizes the historical dimensions of the Hima-Banyaruguru conflict. One may or may not agree with the facts and interpretations presented by the author; however, the article suggests at least one possible explanation for the scale of the massacre: by systematically killing all educated Hutu elements, the Hima elites also destroyed the basis for a potential alliance between Hutu intellectuals and Tutsi-Banyaruguru.

Father Rodegem spent many years in Burundi and is intimately acquainted with the traditional aspects of Rundi culture. He is the author of Sagesse Kirundi (Tervueren: 1961) and “Ainsi Parlait Samandari: Analyse ethnolinguistique d’un phénomène de déviance dans une société à caractère empirique” (Anthropos, Vol. 69, 1974). The latter is a pioneering effort to penetrate the political culture of Burundi through techniques of analysis borrowed from ethnolinguistics.
The Constitution of Burundi
Authors: Morris L.
Published: August 2021

Having been drafted by the Constitutional Committee and ratified by the Supreme Council of the Republic, the following Constitution is hereby proclaimed by the President of the Republic as the constitutional law of the Republic of Burundi.
Angola
Authors: Wheeler Douglas L.
Published: August 2021

I would like to thank the Subcommittee for inviting me to testify before it on the subject of Angola.

In this presentation I shall make six major points. Briefly, and in summary, they are the following: one, the historical record in Angola, both remote and recent, suggests that there are deep roots to the current political fragmentation and conflict in that country and that, even under good conditions, political unity and stable government will be difficult to establish. Two, the Alvor Agreement, signed on January 15, 1975, between Portugal and the three major Angolan nationalist parties is, on paper, a masterful piece of diplomacy and compromise; its provisions should be studied and enforced.
Testimony on South Africa and U.S. Foreign Policy
Authors: Butcher Goler T.
Published: August 2021

Mr. Chairman, I wish to express appreciation for the invitation to appear before the Committee. It is Congress that must take the lead to end what is essentially a “cover-up” of U.S. policy on southern Africa. The Congress must insist on

(1)

a frank statement of the facts on the situation in South Africa,

(2)

an open analysis of U.S. interests in that area,

(3)

progress towards a therapeutic confrontation, discussion, debate, and analysis of what U.S. policy should be,

(4)

change with a view towards developing an honest, sensible and rational U.S. policy—consistent with U.S. interests—towards South Africa.
Gorbachev’s ‘New Thinking’ and the Options for President Bush on Africa
Authors: Rothchild Donald
Published: August 2021

Upon taking office, a new administration has a unique opportunity to set its own goals and priorities. President Bush, although somewhat constrained by his links to the Reagan past as well as by his cold war (i.e., “globalist”) perceptions of the external world and by his self-imposed austerity measures, nonetheless retains a sometimes unrecognized room for maneuver. Taking into account the limitations in public economic resources that he faces, what policy options are open to his administration in its dealing with contemporary Africa?
Burundi: The Killing Fields Revisited
Authors: Lemarchand René
Published: August 2021

(Readers of the Summer 1975 issue of ISSUE — entirely devoted to a discussion of the 1972 killings in Burundi — had the opportunity to take the full measure of the tragedy then visited upon the country, 18 years before the latest outburst of ethnic violence. As René Lemarchand noted at the time, “anyone for whom the name Burundi evokes more than a Lilliputian entity in the heart of Africa must look back to the events of 1972 with a sense of horror and consternation: in a matter of weeks tens of thousands of human beings were systematically slaughtered in what, in retrospect, can only be described as the nearest equivalent offered by Africa of a ‘final solution.’”
Transnational NGO’s: A New Direction for U.S. Policy
Authors: Robinson Pearl T.
Published: August 2021

President Bush has a unique opportunity to link U.S. development assistance with grass roots Pan-Africanism. By broadening the focus of aid policy to include relations among networks of African nongovernmental organizations (NGO’s), the Administration can begin addressing the barriers to African participation in the surge of transnationalism that will undergird economic prosperity in the 21st century. Already, the emerging global pattern is clear: In 1992 the European Community (EC) will become the West’s largest integrated market. The Gulf States, as well as the five Maghreb states of North Africa, recently announced plans for greater political and economic unity. The incorporation of Hong Kong into the People’s Republic of China holds the promise of new modalities for accommodating radically different economic and political systems within the same national boundaries. And the list will continue to grow.
The International Politics of Southern Africa: Change or Continue?
Authors: Shaw Timothy M.
Published: August 2021

Soweto, Rhodesia, and Umtata in 1976 are poignant and pointed symbols of change and continuity in Southern Africa. Regional politics here as in other international subsystems are characterized by the tension between order and continuity on the one hand and opposition and change on the other. This trinity of symbols consists, in part, of a revival of the violence of Sharpeville, earlier diplomacy over Zimbabwe and Afrikanerdom’s continued ambivalence towards the demands of African nationalism. But clearly it also embodies new features, especially the apparent inexhaustibility of black anger, the greater imperative of a settlement, and the unacceptability of “separate freedoms” respectively. Moreover, both the regional and global environments have evolved significantly in the last decade so that apparently similar events in Southern Africa may now have new meanings, implications, and results.
Why We Said no to A.I.D.
Authors: Gervasi Sean , Seidman Ann , Wallerstein Immanuel , Wiley David
Published: August 2021

In 1977, Congress authorized the expenditure of one million dollars for “the preparation of a comprehensive analysis of development needs of southern Africa to enable the Congress to determine what contribution United States foreign assistance can make.” AID was instructed to present specific proposals on how to spend this one million dollars. AID seems to have approached several groups of scholars heretofore critical of U.S. policy in southern Africa on the possibility of serving as “consultants” to draft this analysis. AID in late November approached the four of us as scholars in contact with persons knowledgeable about the region (and not ostensibly because of our links to the Association of Concerned African Scholars) to meet with them to discuss what kind of work ought to be done, could be done, and might be done by us. We agreed to meet with them in December in Washington.
History of Pluralistic Medical Systems: A Sociological Analysis of the Ghanaian Case
Authors: Twumasi Patrick A.
Published: August 2021

This paper addresses itself to the history of pluralistic medical systems in Ghana. Case studies of the systems (traditional and modern-scientific) as evolving traditions with unique premises and techniques will be discussed. Modes of medical institutionalization, recruitment, training, and allocation of resources will be explained. Finally, this paper will attempt to explain the nature of the interrelationship between the two medical orientations in terms of their consequences in health care. The essay will focus on how medical systems are used by consumers and how medical systems are created, maintained, and reformed by professional authorities.
African Attitudes Toward America
Authors: Anise Ladun
Published: August 2021

“What do you think of America?” No visitor to the
United States can escape this question. From the moment he debarks, the foreigner
is confronted by a question that will follow him throughout his stay in the U.S.
At first he seems bewildered. But he soon gathers from the questioner’s tone that
he is expected to respond favorably. “Great! I like it very
much,” he answers. Indeed America is
great, but the perplexed visitor has had no time to make even the most superficial
observation of his own.
Democracy for the Second Republic
Authors: Sklar Richard L.
Published: August 2021

Following the collapse of many civilian and constitutional governments in postcolonial Africa, most political analysts and commentators drew a dismal conclusion. They decided that democratic representation based upon freedom of speech and association would be abandoned in Africa and they proclaimed the onset of an era of authoritarian rule. Some analysts, in the tradition of colonialist thought, asserted that cultural and social conditions in Africa are simply unsuited to the practice of liberal democracy.
African Refugees: Their Impact on Economic Development in Countries of Asylum
Authors: Smythe Mabel M.
Published: August 2021

The basic facts are well known: half the world’s refugees are in African, trying to eke out an existence in some of the world’s poorest countries. Since the numbers –five million is the usual total given for all Africa–change constantly, one cannot be precise about how many there are. African countries have opened their doors and, inevitably, their economies to the refugees; the international community is giving help, chiefly through the United Nations High Commissioner for Refugees. There are obvious reasons for countries of asylum to inflate the figures. Moreover, since more homeless people may arrive tomorrow–or may already have come without making their presence known–the’most honest of officials have incentive to err on the generous side.