bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers to Cancer Care among American Indians and Alaska Natives
Authors: Sawchuk Craig N. , Van Dyke Emily , Omidpanah Adam , Russo Joan E. , Tsosie Ursula , Goldberg Jack , Buchwald Dedra
Published: January 2016

Introduction . Cancer is among the leading causes of death in American Indians and Alaska Natives (AI/ANs), with rates increasing over the last two decades. Barriers in accessing cancer screening and treatment likely contribute to this situation. Methods . We administered structured clinical interviews and conducted descriptive and multiple linear regression analyses of demographic, health, spiritual, and treatment factors associated with self-reported barriers to cancer care among 143 adult AI/AN oncology patients. Results . High levels of satisfaction with cancer care, older age, positive mental health quality of life, and positive physical health quality of life were all significantly associated with lower scores for cancer care barriers, explaining 27% of the total model variance. Conclusion . Addressing barriers to cancer care might help to reduce health disparities among AI/AN oncology patients. Future research should determine whether reducing barriers improves engagement with cancer treatment and overall health outcomes.
Maintaining High Level of Care at Satellite Sickle Cell Clinics
Authors: Hamm Jennifer , Hilliard Lee , Howard Thomas , Lebensburger Jeffrey
Published: January 2016

Traveling to and from university-based clinics is a major health care barrier for children with sickle cell disease in Alabama. To reduce this barrier, the University of Alabama at Birmingham (UAB) developed satellite clinics. This study seeks to determine if these satellite clinics provide a similar level of comprehensive care when compared with the university-based clinic using four surrogate markers: 1) attendance rates, 2) percentage of patients on hydroxyurea, 3) percentage of screening MRIs obtained, and 4) percentage of transcranial dopplers (TCD) completed. A retrospective review of sickle cell visits from June 1, 2012 to May 31, 2013 demonstrated that satellite clinics can provide levels of medical care for children with sickle cell disease similar to those provided by university-based clinics.
Integration of Clinical Pharmacist Services into an Underserved Primary Care Clinic Utilizing an Interprofessional Collaborative Practice Model
Authors: Gentry Chad K. , Parker Robin P. , Ketel Christian , Rosenbloom S. Trent , Crutcher Terri D. , Scott Aaron W. , Starks Jannyse L. , Davidson Heather A. , Pilon Bonita A.
Published: January 2016

This report describes the role of a clinical pharmacist serving onsite in an interprofessional collaborative practice care model at an urban underserved primary care clinic. It also overviews current health care legislative policy as it relates to expanding pharmacists roles as an integrated team member in medically underserved, vulnerable populations.
Utility of Respondent Driven Sampling to Reach Disadvantaged Emerging Adults for Assessment of Substance Use, Weight, and Sexual Behaviors
Authors: Tucker Jalie A. , Simpson Cathy A. , Chandler Susan D. , Borch Casey A. , Davies Susan L. , Kerbawy Shatomi J. S. , Lewis Terri H. , Crawford M. Scott , Cheong JeeWon , Michael Max
Published: January 2016

Emerging adulthood often entails heightened risk-taking with potential life-long consequences, and research on risk behaviors is needed to guide prevention programming, particularly in under-served and difficult to reach populations. This study evaluated the utility of Respondent Driven Sampling (RDS), a peer-driven methodology that corrects limitations of snowball sampling, to reach at-risk African American emerging adults from disadvantaged urban communities. Initial “seed” participants from the target group recruited peers, who then recruited their peers in an iterative process (110 males, 234 females; M age = 18.86 years). Structured field interviews assessed common health risk factors, including substance use, overweight/obesity, and sexual behaviors. Established gender-and age-related associations with risk factors were replicated, and sample risk profiles and prevalence estimates compared favorably with matched samples from representative U.S. national surveys. Findings supported the use of RDS as a sampling method and grassroots platform for research and prevention with community-dwelling risk groups.
Fostering a Commitment to Quality: Best Practices in Safety-net Hospitals
Authors: Hochman Michael , Briggs-Malonson Medell , Wilkes Erin , Bergman Jonathan , Daskivich Lauren Patty , Moin Tannaz , Brook Ilanit , Ryan Gery W. , Brook Robert H. , Mangione Carol M.
Published: January 2016

In 2007, the Martin Luther King, Jr.–Harbor Hospital (MLK-Harbor), which served a large safety-net population in South Los Angeles, closed due to quality challenges. Shortly thereafter, an agreement was made to establish a new hospital, Martin Luther King, Jr. Community Hospital (MLKCH), to serve the unmet needs of the community. To assist the newly appointed MLKCH Board of Directors in building a culture of quality , we conducted a series of interviews with five high-performing hospital systems. In this report, we describe our findings. The hospitals we interviewed achieved a culture of quality by: 1) developing guiding principles that foster quality; 2) hiring and retaining personnel who are stewards of quality; 3) promoting efficient resource utilization; 4) developing a well-organized quality improvement infrastructure; and 5) cultivating integrated, patient-centric care. The institutions highlighted in this report provide important lessons for MLKCH and other safety-net institutions.
Implementing Community Engagement as a Mission at the David Geffen School of Medicine at the University of California, Los Angeles
Authors: Chung Bowen , Brown Arleen F. , Moreno Gerardo , Cuen Pattie , Uy Visith , Vangala Sitaram , Bell Douglas S. , Washington A. Eugene , Norris Keith C. , Mangione Carol M.
Published: January 2016

This manuscript describes the development and implementation of community engagement as a mission at UCLA’s David Geffen School of Medicine (DGSOM) and UCLA Health System, and summarizes survey results documenting existing community-engaged projects and interest between 2010 to 2013.
Psychometric Validation of the Insomnia Severity Index in Adults with Sickle Cell Disease
Authors: Moscou-Jackson Gyasi , Allen Jerilyn , Smith Michael T. , Haywood Carlton
Published: January 2016

Background . The Insomnia Severity Index (ISI) is an instrument to evaluate insomnia symptoms. The psychometric properties have not been established in adults (18 years of age or older) with sickle cell disease (SCD). Objective . Evaluate the reliability and validity of the ISI among adults with SCD. Methods . Analysis included psychometric evaluation with exploratory factor analysis. Results . Our 263 participants had a mean age of 35.6 years and primarily were female (54.8%) with HbSS genotype (69.2%). Almost 41% were classified as clinical insomnia cases (ISI ≥14) using the traditional scoring approach. Two factors, Insomnia Symptoms and Insomnia Impact , emerged during factor analysis. Reliability of both factor-scales was good and each correlated with pain severity and depressive symptomatology ( r = 0.38 to 0.66, p<.01). Conclusion . The ISI demonstrated construct validity and reliability for evaluating insomnia symptomatology among adults with SCD and can be used in research and clinical practice.
Black Americans and Incarceration: A Neglected Public Health Opportunity for HIV Risk Reduction
Authors: Rowell-Cunsolo Tawandra L. , El-Bassel Nabila , Hart Carl L.
Published: January 2016

Black Americans are incarcerated at disproportionate rates, largely due to racial differences in the application of drug laws. Human immunodeficiency virus (HIV) prevalence rates among Black Americans are also disproportionately high. Moreover, availability of and access to HIV prevention services in correctional settings are limited. Recognizing that Blacks are at an elevated risk of contracting HIV, and that incarceration worsens health outcomes, this paper addresses the importance of implementing comprehensive prison-based HIV programs and prevention interventions to improve the health of this vulnerable population. In the absence of a vaccine, prevention interventions can serve as an effective method of systematically addressing HIV-related health disparities. Prevention strategies offered within correctional settings provide a unique opportunity to engage a high-risk population when its members may be receptive to behavior modification.
Estimates of Mental Health Problems in a Vulnerable Population within a Primary Care Setting
Authors: Hudson Darrell L. , Kaphingst Kimberly A. , Croston Merriah A. , Blanchard Melvin S. , Goodman Melody S.
Published: January 2016

We examined the prevalence of mental disorders in a primary care setting affiliated with a large academic medical center. We also examined whether there were racial differences in mental health disorders. Patients were seeking medical care in an outpatient medical clinic; mental health data were available for them via medical records (n=767). Overall, 45% of patients had a diagnosed mental health problem; the most commonly reported form of mental disorder was depression. African Americans (OR= 1.88; CI: 1.21–2.91) were more likely than Whites to have a diagnosed mental health problem. These results suggest a strong mental health treatment need among patients seeking primary care in urban settings. The evidence garnered from this study underscores the need to detect and treat mental health problems systematically within outpatient primary care clinics that serve similarly vulnerable populations.
Reducing Medical School Admissions Disparities in an Era of Legal Restrictions: Adjusting for Applicant Socioeconomic Disadvantage
Authors: Fenton Joshua J. , Fiscella Kevin , Jerant Anthony F. , Sousa Francis , Henderson Mark , Fancher Tonya , Franks Peter
Published: January 2016

A diverse physician workforce is needed to increase access to care for underserved populations, particularly as the Affordable Care Act expands insurance coverage. Yet legal restrictions constrain the extent to which medical schools may use race/ethnicity in admissions decisions. We conducted simulations using academic metrics and socioeconomic data from applicants to a California public medical school from 2011 to 2013. The simulations systematically adjusted medical school applicants’ academic metrics for socioeconomic disadvantage. We found that socioeconomic and under-represented minority disparities in admissions could be eliminated while maintaining academic readiness. Adjusting applicant academic metrics using socioeconomic information on medical school applications may be a race-neutral means of increasing the socioeconomic and racial/ethnic diversity of the physician workforce.
Toward Eliminating Hospice Enrollment Disparities among African Americans: A Qualitative Study
Authors: Dillon Patrick J. , Basu Ambar
Published: January 2016

Over the past decade, scholars and practitioners have called for efforts to reduce disparities in the cost and quality of end-of-life care; a key contributor to these disparities is the underuse of hospice care by African American patients. While previous studies have often relied on interviewing minority individuals who may or may not have been terminally ill, among them only few who were using hospice care services, this essay reports the findings of a grounded theory analysis of interviews with 26 African American hospice patients (n = 10) and lay caregivers (n = 16). Participants identified several barriers to hospice enrollment and reported how they were able to overcome these barriers by reframing/prioritizing cultural values and practices, creating alternative goals for hospice care, and relying on information obtained outside the formal health system. Finally, participants offered suggestions for eliminating barriers and providing salient information about hospice care to other African Americans.
Factors Associated with HIV Discussion and Condom Use with Sexual Partners in an Underserved Community in South Africa
Authors: Conserve Donaldson F. , Middelkoop Keren , King Gary , Bekker Linda-Gail
Published: January 2016

We examined factors associated with discussing HIV and condom use with a sexual partner. Two cross-sectional surveys were conducted in 2004 prior to the implementation of an HIV awareness campaign in a South African community and in 2008 after a three-year education program. Overall, the proportion of individuals who had discussed HIV with a sexual partner increased from 76% in 2004 to 89% in 2008 (p <.001). Among respondents who had sex six months before completing the surveys, condom use significantly increased from 64% in 2004 to 79% in 2008 (p <.05). Respondents who discussed HIV with a sexual partner were more likely to use condoms than respondents who had not discussed HIV with a sexual partner (OR=2.08, 95% CI=1.16, 3.72). These findings indicate the importance of interventions aimed at promoting HIV awareness and discussion of HIV in communities with individuals at risk of acquiring HIV.
Disparities in Primary Care EHR Adoption Rates
Authors: Mack Dominic , Zhang Shun , Douglas Megan , Sow Charles , Strothers Harry , Rust George
Published: January 2016

This study evaluates electronic health record (EHR) adoption by primary care providers in Georgia to assess adoption disparities according to practice size and type, payer mix, and community characteristics. Frequency variances of EHR “Go Live” status were estimated. Odds ratios were calculated by univariate and multivariate logistic regression models. Large practices and community health centers (CHCs) were more likely to Go Live (>80% EHR adoption) than rural health clinics and other underserved settings (53%). A significantly lower proportion (68.9%) of Medicaid predominant providers had achieved Go Live status and had a 47% higher risk of not achieving Go Live status than private insurance predominant practices. Disparities in EHR adoption rates may exacerbate existing disparities in health outcomes of patients served by these practices. Targeted support such as that provided to CHCs would level the playing field for practices now at a disadvantage.
A Community-Based Participatory Research on Smoking Cessation Intervention for Urban Communities
Authors: Wagner Fernando A. , Sheikhattari Payam , Buccheri Jane , Gunning Mary , Bleich Lisa , Schutzman Christine
Published: January 2016

Smoking disproportionally affects minority and underserved populations but only a handful of interventions tailored to these populations have demonstrated effectiveness in real-life situations. We use community-based participatory research (CBPR) to test two interventions delivered by a community-based health care center. Methods . Participants randomly assigned to individual or group-based intervention for smoking cessation (N= 400). Both included cessation counseling and health education, a contingency behavioral program, Nicotine Replacement Therapy, and health care for other comorbidities. Smoking cessation was verified by expired carbon monoxide at the end of the program. Results . No differences were observed between the two treatment modalities (8.9% and 8.6%, respectively). Those with greater attendance had 1.4 times better odds of cessation per additional session. Retention and follow up proved to be challenging with this population.
Hip and Knee Replacement in Safety-net Hospitals: Recognizing the Challenges
Authors: Arlas Nicholas , Jergesen Harry
Published: January 2016

Factors endemic in safety-net hospitals may breed poor outcomes in hip and knee arthroplasty. This review highlights these challenges and discusses strategies to reduce operative risk and promote better surgical outcomes. Sub-optimally managed medical co-morbidities, poverty, and substance abuse are examples of challenges common in safety-net hospital populations and are associated with poor surgical outcomes. Patient management strategies that positively affect surgical outcomes may be nonexistent, underfunded, or underused. Surgical complications frequently lead to reoperations, particularly revision arthroplasty. Revision procedures are costly, in terms of patient morbidity and financial expenditure. Safety-net institutions can ill afford the burden of caring for preventable complications following arthroplasty procedures. Prospective studies are needed to define the status of arthroplasty care and patient outcomes in U.S. safety-net hospitals. Best practices that have been shown in non-safety-net hospitals to improve outcomes may prove beneficial in safety-net hospitals.
Homelessness, HIV, and Incomplete Viral Suppression
Authors: Thakarar Kinna , Morgan Jake R. , Gaeta Jessie M. , Hohl Carole , Drainoni Mari-Lynn
Published: January 2016

Background . The importance of HIV viral suppression is widely known, however few studies have examined the effects of homelessness on HIV viral suppression. Methods . The study included HIV-seropositive patients in a health care for the homeless program (HCH). Electronic medical record data for 138 patients were analyzed to compare demographic characteristics, health characteristics, and utilization by housing status. For the 95 individuals with available HIV viral loads, multivariable logistic analysis was performed to examine factors associated with incomplete viral suppression. Results . The adjusted odds ratio of incomplete HIV viral load suppression was 3.84 times higher in homeless compared with housed (95% CI 1.36–10.36) individuals. Illicit drug use and combined antiretrovirals (cART) were associated with HIV viral suppression. Conclusions . Homelessness predicted incomplete HIV viral suppression. Stable housing may improve viral suppression and access to cART. Drug use was associated with viral suppression, likely because of patient engagement with on-site addiction services.
African American Patients’ Intent to Screen for Colorectal Cancer: Do Cultural Factors, Health Literacy, Knowledge, Age and Gender Matter?
Authors: Brittain Kelly , Christy Shannon M. , Rawl Susan M.
Published: January 2016

African Americans have higher colorectal cancer (CRC) mortality rates compared with all racial/ethnic groups. Research suggests that CRC screening interventions for African Americans target cultural variables. Secondary analysis of data from 817 African-Americans who had not been screened for CRC was conducted to examine: 1) relationships among cultural variables (provider trust, cancer fatalism, health temporal orientation [HTO]), health literacy, and CRC knowledge; 2) age and gender differences; and 3) relationships among cultural variables, health literacy, CRC knowledge, and CRC screening intention. Provider trust, fatalism, HTO, health literacy, and CRC knowledge demonstrated significant relationships among study variables. Stool blood test intention model explained 43% of the variance, with age and gender being significant predictors. Colonoscopy intention model explained 41% of the variance with gender a significant predictor. Results suggest when developing CRC interventions for African Americans, addressing cultural variables is important, but particular attention should be given to age and gender.
Cultural Health Assets of Somali and Oromo Refugees and Immigrants in Minnesota: Findings from a Community-Based Participatory Research Project
Authors: Lightfoot Elizabeth , Blevins Jennifer , Lum Terry , Dube Amano
Published: January 2016

This community-based participatory research study sought to identify the cultural health assets of the Somali and Oromo communities in one Minnesota neighborhood that could be mobilized to develop culturally appropriate health interventions. Community asset mappers conducted 76 interviews with Somali and Oromo refugees in in Minnesota regarding the cultural assets of their community. A community-university data analysis team coded data for major themes. Key cultural health assets of the Somali and Oromo refugee communities revealed in this study include religion and religious beliefs, religious and cultural practices, a strong culture of sharing, interconnectedness, the prominence of oral traditions, traditional healthy eating and healthy lifestyles, traditional foods and medicine, and a strong cultural value placed on health. These cultural health assets can be used as building blocks for culturally relevant health interventions.
Ideological vs. Instrumental Barriers to Accessing Formal Mental Health care in the Developing World: Focus on South-eastern Nigeria
Authors: Ikwuka Ugo , Galbraith Niall , Manktelow Ken , Chen-Wilson Josephine , Oyebode Femi , Muomah Rosemary C. , Igboaka Anuli
Published: January 2016

The striking gaps in formal mental health care in the developing world are largely traceable to Instrumental and Ideological Barriers. Focusing on south-eastern Nigeria, the study aimed to establish the relative weight, significance and determinants of these barriers for prioritised policy interventions. Multistage sampling method was used to select participants (n = 706) to whom questionnaires were administered. Ideological Barriers (cultural and mental health literacy constraints) were more significantly perceived (84.8%) than Instrumental Barriers (systemic and financial impediments) (56.6%). The study demonstrated the primacy of improved knowledge in plugging the gap in conventional mental health care in a region ironically defined more by systemic and material poverty. This is instructive for prioritised policy interventions with an indication that even if facilities and socio-economic status improve, services will likely be underused without greater improvement in people’s conceptualisation of mental illness. It equally underscored the need for cultural competence in mental health service provision.
Engaging Patients and Caregivers to Design Transitional Care Management Services at a Minority Serving Institution
Authors: Ursan Iulia D. , Krishnan Jerry A. , Pickard A. Simon , Calhoun Elizabeth , DiDomenico Robert , Prieto-Centurion Valentin , Sullivan Jamie B. , Valentino Lauren , Williams Mark V. , Joo Min
Published: January 2016

Limited socioeconomic resources contribute to high readmission rates at minority serving institutions (MSIs). A better understanding of patient-level factors and need for patient navigators could inform approaches to enhance care transitions tailored to these vulnerable patient populations. We sought to understand the perspectives of patients and their caregivers about hospital to home transitions from an MSI, as well as their attitudes about patient navigators to facilitate care transitions. We conducted qualitative research using focus groups (FGs)—five disease-specific patient FGs and two caregiver FGs, including 23 patients and 10 caregivers. Findings support the need for additional services to address: (1) gaps in the hospital discharge; (2) socioeconomic resources; (3) access to post-discharge care; (4) patient’s health care seeking behaviors; (5) patient anxiety; (6) self-management education; and (7) social supports for patients and caregivers. While caregivers uniformly expressed interest in patient navigators, support for navigators among patients was more variable.
Adult Cancer Risk Behaviors Associated with Adverse Childhood Experiences in a Low Income Population in the Southeastern United States
Authors: Mouton Charles P. , Hargreaves Margaret K. , Liu Jianguo , Fadeyi Saudat , Blot William J
Published: January 2016

Objectives . Adverse childhood experiences (ACE) can affect health in adulthood. We investigate the relationship between childhood experiences and adult cancer risk and screening behaviors in a racially diverse, low income population. Methods . Nearly 22,000 adults 40 years and older in the Southern Community Cohort Study were administered the ACE questionnaire. We estimated odds ratios (OR) for the prevalence of smoking, alcohol consumption, BMI and five cancer screening methods in relation to the ACE score. Results . Over half reported at least one ACE, with percentages higher for women (61%) than men (53%). Higher ACE scores were related to increased prevalence of smoking (ORs 1.25 (1.05–1.50) to 2.33 (1.96–2.77). Little association was seen between rising ACE score and alcohol consumption or BMI, except for a modest trend in morbid obesity (BMI ≥ 40 kg/m 2 ). Mammography and cervical cancer screening decreased with rising ACE scores, but no trends were seen with prostate or colorectal cancer screening. Conclusions . Adverse childhood experiences are strong predictors of adult cancer risk behaviors, particularly increased likelihood of smoking, and among women, lower mammography and Pap screening rates.
Predictors of Adherence to Post-Polypectomy Surveillance Colonoscopy
Authors: Calderwood Audrey H. , Schroy Paul C. , Kluge Matthew A. , Cabral Howard J. , Burgess James F.
Published: January 2016

Objective . To identify predictors of adherence with surveillance colonoscopy at a safety-net hospital. Methods . We evaluated average-risk patients aged 50–75 with adenomas diagnosed at screening colonoscopy between 1/1/05–12/31/07. The primary outcome was on-time follow-up defined as attendance at surveillance colonoscopy within 5.5 years of screening colonoscopy. Results . Among 881 patients, of whom 38% were English-speaking non-Hispanic Blacks, 38.3% attended on-time surveillance colonoscopy. In unadjusted analyses, ≥3 PCP visits after baseline colonoscopy (OR 3.6 [2.5–5.0]), “adenoma” on the EMR problem list (OR 2.2 [1.6–2.9]), and Charlson Index ≥1 (OR 1.4 [1.0–1.8]) were associated with adherence. “Adenoma” on the EMR problem list remained significant in multivariable analyses (aOR 1.8 [1.3–2.5]). A significant interaction was observed between ethnicity/language and PCP visits (p=.003). Conclusion . Many adenoma-bearing patients fail to attend surveillance colonoscopy in a safety-net setting. Adding “adenomas” to the EMR problem list improved attendance, suggesting that system-level interventions can increase adherence.
The Quest for Good Governance: Learning from Virtuous Circles
Authors: Mungiu-Pippidi Alina
Published: January 2016

Abstract: Once of interest mainly to specialists, the problem of explaining how institutions change is now a primary concern not only of economists, but of the international donor community as well. Many have come to believe that political institutions are decisive in shaping economic institutions and, with them, the course of innovation and investment that leads to a developed society. This is the shift from patrimonialism to ethical universalism, a transformation that most of today’s advanced democracies accomplished through a long historical evolution. But there has been very little research on whether and how this kind of change can be engineered and speeded up by human design. The EU-funded ANTICORRP project that I have been leading aims to help fill this gap. The big challenge is to explain the shift of the governance paradigm from particularism to universalism in the few societies that have managed to accomplish it in the postwar era. Do these success stories offer any lessons about how other societies can make that journey?
What’s Wrong with East-Central Europe?: Liberalism’s Failure to Deliver
Authors: Krastev Ivan
Published: January 2016

Abstract: In argument with James Dawson and Sean Hanley, the author insists that the current state of liberal democracy in Central and Eastern Europe cannot be explained simply by the absence of more value-based democratic politics and the opportunism of liberal elites. In the author’s view, what we see in Central and Eastern Europe is not the crisis of democratization but a genuine crisis of liberal democracy caused by a major economic crisis, publics’ backlash against globalization and some of the core beliefs of liberal cosmopolitanism, and decline of the role of Europe and the European Union in world politics. In this view, the concept of “backsliding” is not helpful in making sense of the current crisis.
The Quest for Good Governance: Georgia’s Break with the Past
Authors: Kupatadze Alexander
Published: January 2016

Abstract: This paper looks at Georgia’s path to reform in 2004–2012. The author argues that the young, ideologically and structurally cohesive elite capitalized on the window of opportunity and implemented “big bang” reform in 2004–2008. As time passed, the new incumbents developed vested interests that became apparent with the reemergence of a state-business nexus reemerged in 2008–2012. During the Saakashvili administration, these interests undermined market competition, and elite networks used state power to control economic and political structures. Even though concerns over particularistic practices have remained, petty bribery has decreased substantially.
China and the “Singapore Model”
Authors: Ortmann Stephan , Thompson Mark R.
Published: January 2016

Following the death of Singapore’s founding leader Lee Kuan Yew in March 2015, China remains obsessed with Singapore, the only country in the region to achieve advanced economic industrialization without undergoing substantial political liberalization. The key “lesson” that China is trying to learn is how to combine authoritarian rule with “good governance” (“meritocratic” one-party rule). The impact of the “Singapore model” on China shows that learning by nondemocratic states is not necessarily a short-term “modular” phenomenon that is largely reactive in character, but can be long-term and highly institutionalized. It has become increasingly clear, however, that China sees what it wants to see in Singapore, making the “lessons” learned more caricature than reality. And China’s recent crackdown on dissenters, squeezing the already limited political space allowed during the post–Tiananmen Square Massacre period, is actually moving the country further away from rather than toward the Singapore model.
The Quest for Good Governance: Taiwan’s Fight Against Corruption
Authors: Goebel Christian
Published: January 2016

Abstract: In Taiwan, the legal definition of what constitutes “corrupt” behavior and legal changes is now clearer than ever. Moreover, since the change in ruling parties, judicial independence has been guaranteed and anti-corruption agencies have been strengthened considerably. Although there is still corruption and that the institutional configuration of Taiwan’s anti-corruption agencies is far from optimum, these are major achievements. The present report explains these achievements by tracing the interplay between agency and institutions at two turning points in Taiwan’s history, democratization and the change in ruling parties, in bringing about Taiwan’s anti-corruption reforms.
The Authoritarian Threat: The Hijacking of “Soft Power”
Authors: Walker Christopher
Published: January 2016

Abstract: In the post–Cold War period, the democracies pursued a strategy of engagement with authoritarian states in the belief that this approach would yield mutual benefits and lead to political reform in the autocracies. Instead, authoritarian regimes have turned the tables on the democracies. Exploiting globalization and the opportunities presented by integration with the West, authoritarian states have set out to undermine the very international institutions that welcomed them by employing a malign mirror image of “soft power.” Through the manipulation of the Internet, the establishment of pseudo–civil society organizations and “zombie” election monitors, as well as sophisticated state-run propaganda outlets, authoritarian trendsetters such as China, Russia, Iran, Saudi Arabia, and Venezuela have hijacked the concept of “soft power.”
The Quest for Good Governance: Uruguay’s Shift from Clientelism
Authors: Buquet Daniel , Piñeiro Rafael
Published: January 2016

Abstract: Uruguay improved its levels of universalism in the last fifteen years. This improvement is due to a prolonged process of transformation in Uruguayan politics from competitive particularism to an open access regime. We claim that the change in the way that parties compete for votes - from clientelistic to programmatic strategy – is the cause of this transformation. In order to provide descriptive evidence of the main features of this governance regime transformation, this paper traces the process of institutional reforms and elite behavioral changes that lead to that outcome, and proposes an analytic framework to explain it.
The Authoritarian Threat: Weaknesses of Autocracy Promotion
Authors: Way Lucan
Published: January 2016

Abstract: As the international balance of power has shifted away from established democracies, autocrats have begun to assert themselves on the world stage. Once the passive targets of democracy promotion, dictators now actively defend their power abroad, often seeking to undermine democracy in the process. Such deliberate efforts to promote authoritarian rule present a potentially serious threat to democracy in the world today. Yet a closer examination of the actual impact of “autocracy promotion” suggests that it so far presents a less serious challenge than is often assumed. The influence of autocracy promotion is limited, above all, by the fact that authoritarian powers tend to be concerned less with promoting authoritarianism as such than with furthering their own countries’ more narrow economic and geopolitical interests. As a result, authoritarian interventions often have contradictory effects and may in some cases even foster greater pluralism .
A Win for Democracy in Sri Lanka
Authors: Devotta Neil
Published: January 2016

If Sri Lanka’s civil war contributed to democratic recession, the defeat of the separatist Liberation Tigers of Tamil Eelam emboldened President Mahinda Rajapaksa to become increasingly authoritarian. In the January 2015 presidential election, however, a multiethnic and ideologically diverse coalition led by Maithripala Sirisena defeated the miscalculating Rajapaksa. Seven months later a similar coalition thwarted Rajapaksa’s attempts to make a comeback as prime minister through parliamentary elections. The ensuing national unity government’s attempts to revive independent institutions, effectuate transitional justice, and rebalance Sri Lanka’s foreign relations will partly determine the degree to which the island regains its once commendable democratic credentials.
Ethiopia: The 100% Election
Authors: Arriola Leonardo R. , Lyons Terrence
Published: January 2016

Abstract: Ethiopia’s 2015 elections confirm that the ruling Ethiopian People’s Revolutionary Democratic Front (EPRDF)—having won 100 percent of parliamentary seats—has chosen to entrench an authoritarian system. We argue that this total election victory was meant as a signal to party cadres that defection is not tolerated. Our analysis of intra-regime dynamics shows how the EPRDF has responded to the death of Meles Zenawi through greater reliance on trusted party stalwarts for high-level posts. We conclude that growing demands from lower-level party cadres threaten to transform the ruling party from a disciplined national organization into a patronage-based alliance of ethnic factions.
On Democratic Backsliding
Authors: Bermeo Nancy
Published: January 2016

Democratic backsliding (meaning the state-led debilitation or elimination of the political institutions sustaining an existing democracy) has changed dramatically since the Cold War. Open-ended coups d’état, executive coups, and blatant election-day vote fraud are declining while promissory coups, executive aggrandizement and strategic electoral manipulation and harassment are increasing. Contemporary forms of backsliding are especially vexing because they are legitimated by the very institutions democracy promoters prioritize but, overall, backsliding today reflects democracy’s advance and not its retreat. The current mix of backsliding is more easily reversible than the past mix and successor dictatorships are shorter-lived and less authoritarian.
Ethiopia: Silencing Dissent
Authors: Mengesha Simegnish Yekoye
Published: January 2016

Abstract: In Ethiopia’s May 2015 parliamentary elections, the long-ruling Ethiopian People’s Revolutionary Democratic Front (EPRDF), together with its allies, claimed a historic victory with 100 percent of the seats. This result is not a surprising as it might seem: Since the 2005 general elections—the most contested in the nation’s history—the party has been using antiterrorism laws and harsh restrictions on media and civil society to silence voices critical of the regime. The regime justifies its repressive measures by telling citizens that the country is in danger of ethnic strife and that maintaining law and order requires a firm approach. Like most autocratic regimes, however, the EPRDF worries that the more informed and connected the people are, the more empowered they will be to hold the government to account.
What’s Wrong with East-Central Europe?: The Fading Mirage of the “Liberal Consensus”
Authors: Dawson James , Hanley Seán
Published: January 2016

Abstract: In 2007 Ivan Krastev argued that EU-enforced ‘liberal consensus’ in East Central Europe was giving way to illiberal, but ultimately benign, populism. Post-accession ‘backsliding’ in Hungary suggests a stronger illiberal challenge. However, we argue, democratic malaise in ECE is better understood as a long-term pattern of ‘illiberal consolidation’ built on an accommodation between technocratic, economistic liberalism and forces of rent-seeking and cultural conservatism. This configuration generates a mirage of liberal-democratic progress and mainstream moderate politics, which obscures engrained elite collusion and limits to cultural change. Bulgarian-style hollowness, rather than Hungarian-style semi-authoritarianism, better exemplifies the potential fate of ECE democracies today.
Paradoxes and Possibilities of “Confucian Freedom”: From Yan Fu (1853–1921) to Mou Zongsan (1909–1995)
Authors: Marchal Kai
Published: January 2016

This essay investigates the reception in China of two major representatives of Classical liberalism, John Stuart Mill and Immanuel Kant. It is shown that the creative appropriation of these two thinkers by Yan Fu 嚴復 (1853–1921) and Mou Zongsan 牟宗三 (1909–1995) needs to be understood as a response to the challenges of global modernity. Finally, I argue that such a cross-cultural dynamic also has major philosophical implications.
Theatrics of Emotion: Self-deception and Self-cultivation in Abhinavagupta’s Aesthetics
Authors: Timalsina Sthaneshwar
Published: January 2016

This essay explores arguments regarding self-deception and self-cultivation, primarily relying on Abhinavagupta’s (eleventh century) philosophy of theatrics. Abhinava’s aesthetic theory has much to say on these issues because performance art requires at least a two-tiered breach of subjectivity and intersubjective introspection, between the audience and the performer and the performer and the character that he is playing. The lead argument questions to what extent the actors are aware of their own personality and how much they merge with the character, followed by an examination of the extent to which the audience breaches its own subjective horizon and enters the imagined subjective domain of the character. Finally, this essay seeks to answer whether this fusion and play of subjectivities is, after all, a wholesome and enlightening experience.
Play, Theater, and Nondualism: A Philosophical Meditation
Authors: Antony Devasia M.
Published: January 2016

The attempt here is to meditate philosophically on the nature, meaning, and significance of the conceptions of play, theater, and nondualism and to articulate further the metaphysical interweaving and symphony of these concepts with particular reference to the domain of social ethics. After a brief analysis of the philosophical notion of nondualism and its description of reality as fundamentally nondualistic, the essay dwells on the possibility of play and theater as the epiphany of the Self and its forms and contends that the pluriform images are the apparent other of the nondual self. Then, moving on to the domain of social ethics, the essay ventures to imagine theatricality as an incarnation of social ethics and attempts to show that nondualism and untouchability are diametrically opposed to each other in both theory and practice. Augmenting this discussion, the essay dwells upon Theyyam, the celebratory divine dance form, and indicates how it takes one to the ethical imaginary by radically subverting the socially exclusionary practice of caste hierarchy.
Brecht’s Materialist Ethics between Confucianism and Mohism
Authors: Wessendorf Markus
Published: January 2016

This essay examines how Brecht’s long-standing engagement with the philosophies of Confucius and Mo Zi helped to shape a materialist perspective that is far more complex than what is suggested by one of his most famous lines: “Food is the first thing. Morals follow on” ( The Threepenny Opera [1928]). The essay’s primary references are two texts by Brecht, which remained fragments and are not (yet) available in English translation: his notes for a play on the Life of Confucius (1940–1941) and an extensive collection of shorter prose texts from the 1930s, first published posthumously in 1965 under the title Me-ti: Buch der Wendungen (Mo-zi: Book of turns).
From Puzzling Pleasures to Moral Practices: Aristotle and Abhinavagupta on the Aesthetics and Ethics of Tragedy
Authors: Ashton Geoff , Tanner Sonja
Published: January 2016

How is it that our enjoyment of tragic theater is enhanced as the pain, fear, and pity it evokes become more intense? Does just the distancing mechanism of ‘make-believe’ and ‘mimesis’ explain why normal, nice people enjoy watching others suffer on stage or on the screen? Aristotle has traditionally been read as explaining away the puzzle of tragic pleasure in terms of a cathartic cleansing of the emotions through witnessing the play of complex feelings inside the spectator when the theatrical narrative is acted out. But such an interpretation of Aristotelian katharsis appears to work by a weakening of the intensity of the emotions, particularly as we relate to imagined others. In contrast, the eleventh-century Kashmir-Shaiva philosopher Abhinavagupta finds the solution of the puzzle within the magic of heart-sharing through aesthetically transformed emotions themselves. The audience of a tragedy no longer needs to be passive, disinterested witnesses who have elided the alterity of others. Ours is an exercise in comparative aesthetics of theater by imagining a debate between Aristotle and Abhinavagupta on the puzzle of the pleasures of a tragedy. Along the way, it challenges standard readings of both thinkers, considers and responds to serious objections to these theories, and offers insights into how the experience of theater provides important resources for moral transformation.
Fixing the White Horse Discourse: Zhuangzi’s Proof of “A White Horse Is not a Horse”
Authors: Ming Thomas , Lai Aaron
Published: January 2016

This article proposes an interpretation of Zhuangzi’s comment, in “Discussion on Making all Things Equal” (“Qiwulun” 齊物論), on the “White Horse Discourse” (“Baimalun” 白馬論) that suggests his awareness of what Western logicians call intuitionist proof. According to logical intuitionism, one cannot rely on the Law of the Excluded Middle, and relatedly the Law of Double Negation, to facilitate formal reasoning. Consequent to this prohibition is an asymmetry in proof: one may indirectly prove his or her denial of a statement p by deriving an absurdity from p , but there is no similar way to prove p from the assumption of not- p . It is argued here that in this intuitionist framework, Zhuangzi’s strategy is in effect a recipe for silencing a debater who challenges the acceptability (可) of the opponent’s beliefs. An account shall also be given of how to reconcile Zhuangzi’s relativism with his dialectical reasoning based on reductio ad absurdum (bei 悖).
Sharing Emotions Through Theater: The Greek Way
Authors: Woodruff Paul
Published: January 2016

Ancient Greek theater aims at a cognitive basis for the sharing of emotions between characters and audience. In this cognitive model, theater yields gains in understanding others, but with no loss of the sense of self.
Being Staged: Unconcealment through Reading and Performance in Marlowe’s Doctor Faustus and Bharata’s Nātyaśāstra
Authors: Chakravorty Swapan
Published: January 2016

In exploring the ethical significance of the performative, if blasphemous, dimensions of the momentous events in Christopher Marlowe’s play Doctor Faustus , this essay deploys insights from an ancient Sanskrit manual on drama, Bharata’s Nātyaśāstra , and its early eleventh-century commentary by Abhinavagupta. Bharata states that the aesthetic ‘essence’ ( rasa ) of theater emerges out of the functioning of vibhāva (the stimulus, the determinant device that produces affect in the audience), anubhāva (the enacted response and bodily expressions of emotion), and vyabhiċāri bhāva (the minor, passing, and mixed bhāvas produced by the major sentiments). Is there a simultaneous bid for the performative as constituting ethical identity ? If so, whose identity are we talking about — the portrayed character’s, the performer’s, or the viewer’s? Such are the questions that link this discussion of Marlowe and Shakespeare with Abhinavagupta’s gloss on the relevant passage in Bharata. Perhaps the early modern English stage had an intuition that was beyond the range of the discursive apparatus of Bharata or Abhinavagupta. It was the intuition that a performed moment of choice was more than fictive. It was constitutive of the ethical selfhood that accounts for Doctor Faustus being still such a disturbing play for viewers.
Parmenides’ and Śaṅkara’s Nondual Being without Not-being
Authors: Robbiano Chiara
Published: January 2016

This essay explores the similarities in the thought of the Greek philosopher Parmenides (fifth century b.c.e .) and that of the Indian philosopher Śaṅkara (eighth to ninth centuries c.e .). Parmenides’ being is compared to the nonduality of Brahman and ātman , as defended by Sankara. The focus is especially on the methods used by both philosophers to help readers know nondual reality. First, they both make a distinction ( krísis/viveka ) between being (real, Self) and not-being (unreal, Non-self); and second, starting from this distinction, they both test, by means of negative dialectic, what, according to common sense, are the fundamental characteristics of reality.
Achieving the Way: Confucian Virtue Politics and the Problem of Dirty Hands
Authors: Kim Sungmoon
Published: January 2016

Confucian virtue politics is premised on two fundamental assumptions. First, a good government founded on the Way is predicated on the political actor’s personal moral virtue, and there is no qualitative difference between the ruler’s virtue and the virtue(s) that people are ultimately to embody. Second, since there is only one single and holistic Way and the political is extended from the ethical, there cannot be two separate political and moral standards, which implies the impossibility of what Michael Walzer calls “the problem of dirty hands.” After examining how early Confucians such as Mencius and Xunzi rationalized the ostensibly problematic actions taken by their ancient moral heroes in politically critical moments, this essay concludes that early Confucians’ absolutist commitment to the Way enabled them to deal with moral dilemmas in politics with great moral flexibilities without invoking dirty hands.