bluuebunny/crossref_metadata_2025 huggingface dataset:
Balancing the Risks and Benefits of Using Emergency Diagnostic Radiocontrast Studies to Diagnose Life-Threatening Illness in Critically Ill Patients: A Decision Analysis
Authors: Ho K. M.
Published: January 2019

Diagnosis of many life-threatening illnesses, including acute pulmonary embolism, aortic dissection, and ischaemic bowel disease, requires confirmatory radiological imaging with radiocontrast. It is well established that radiocontrast can induce acute kidney injury, especially in patients with pre-existing renal impairment. The decision to proceed with a radiological study with radiocontrast to confirm or exclude a life-threatening, but potentially reversible, illness in patients with renal impairment is difficult. Theoretically, a radiocontrast study will be justifiable provided its benefits outweigh its harms. Using published prognostic data of contrast-induced nephropathy (CIN), this decision analysis aimed to assess whether a certain threshold of pre-test probability of a life-threatening illness is needed before a radiocontrast study can be justified for patients with different levels of renal impairment. In critically ill patients presenting with a life-threatening illness with hypotension requiring vasopressors or inotropes, the risk of CIN (defined by an increment in plasma creatinine of 40 μmol/l) and the associated attributable mortality after using 50 to 100 ml of radiocontrast was about 30% and 4%, respectively, for patients with baseline plasma creatinine concentrations <400 μmol/l. The risk of CIN and its associated attributable mortality increased substantially and exceeded 80% and 10%, respectively, if patients also had diabetes mellitus and their baseline plasma creatinine concentrations were >400 μmol/l. In the latter high-risk patients, using a radiocontrast study to diagnose or exclude a life-threatening illness could only be justified if the life-threatening illness was readily treatable and the pre-test probability of having such disease was greater than 15%-20%.
The Introduction of Expired Air Resuscitation into Surf Life Saving Australia
Authors: Ball C. M.
Published: January 2019

Surf Life Saving Australia, which began In the early 1900s, initially adopted the indirect resuscitation methods used by the Royal Life Saving Society. As new indirect methods became available, both organisations adapted their resuscitation techniques and followed international developments closely. In the 1950s, accumulating evidence suggested that direct methods of resuscitation, such as mouth-to-mouth ventilation, might be more efficacious. Subsequently a number of investigations were carried out In Sydney at the Royal Prince Alfred Hospital on anaesthetised and paralysed patients. These experiments were recorded for an ABC documentary and reported at the International Convention on Life Saving Techniques held in Sydney in March 1960. Following the convention, Queensland Surf Life Saving conducted training sessions in cooperation with anaesthetists Roger Bennett and Tess Brophy (later Cramond), at St Andrew's Hospital In Brisbane. Two volunteers were anaesthetised and paralysed on two separate weekends to allow over one hundred people to gain experience in expired-air and bag-mask ventilation. One of the volunteers In these training exercises kindly provided much of the material that led to this paper, providing a first hand account of the experiments and an Invaluable Insight into the cooperation between anaesthetists and volunteer rescue associations.
A Cross-sectional Overview of the First 4,000 Incidents Reported to webAIRS, a De-identified Web-based Anaesthesia Incident Reporting System in Australia and New Zealand
Authors: Gibbs N. M. , Culwick M. , Merry A. F.
Published: January 2019

webAIRS is a web-based de-identified anaesthesia incident reporting system, which was introduced in Australia and New Zealand in September 2009. By July 2016, 4,000 incident reports had been received. The incidents covered a wide range of patient age (<28 days to >90 years), American Society of Anesthesiologists physical status, and body mass index (<18.5 to >50 kg/m2). They occurred across a wide range of anaesthesia techniques and grade of anaesthesia provider, and over a wide range of anaesthetising locations and times of day. In a high proportion the outcome was not benign; about 26% of incidents were associated with patient harm and a further 4% with death. Incidents appeared to be an ever-present risk in anaesthetic practice, with extrapolated estimates exceeding 200 per week across Australia and New Zealand. Independent of outcomes, many anaesthesia incidents were associated with increased use of health resources. The four most common main categories of incident were Respiratory/Airway, Medication, Cardiovascular, and Medical Device/Equipment. Over 50% of incidents were considered preventable. The narratives accompanying each incident provide a rich source of information, which will be analysed in subsequent reports on particular incident types. The summary data in this initial overview are a sober reminder of the prevalence and unpredictability of anaesthesia incidents, and their potential morbidity and mortality. The data justify current efforts to better prevent and manage anaesthesia incidents in Australia and New Zealand, and identify areas in which increased resources or additional initiatives may be required.
Primary Prevention in the Intensive Care Unit: A Prospective Single-Centre Study of the Risk Factors for Invasive Pneumococcal Disease
Authors: Chapman A. R. , Litton E. L.
Published: January 2019

Invasive pneumococcal disease is a significant health burden in Australia, with immunisation recommended for children and at-risk adults. Health benefits of immunisation are clear, but less effective when immunisation rates are low, as in Western Australia. We hypothesised that patients admitted unplanned to the intensive care unit (ICU) would have high eligibility for pneumococcal immunisation, but low rates of recorded vaccine administration. We performed a prospective observational study of 119 emergency admissions to Royal Perth ICU, a 20-bed mixed ICU at a tertiary teaching hospital in Western Australia. Each admission was screened for vaccine eligibility (age and risk factors as per Australian Technical Advisory Group of Immunisation guidelines), with patients’ health records examined and primary care providers contacted after ICU discharge. Risk factors for invasive pneumococcal disease were common, with 52% of the study population having one or more. Fifty-four of 119 admitted patients (45%) were assessed as eligible for immunisation after ICU discharge. ICU survivors represent a high-risk population for which intervention against modifiable targets, such as invasive pneumococcal disease, may reduce both their chronic health burden and future health expenditure. Future efforts should concentrate on assessing the feasibility of a screening program for modifiable factors in ICU survivors, and the logistics of delivering these interventions in a timely manner during their hospital stay.
The Rapid and Accurate Categorisation of Critically Ill Patients (RACE) to Identify Outcomes of Interest for Longitudinal Studies: A Feasibility Study
Authors: Deane A. M. , Hodgson C. L. , Young P. , Little L. , Singh V. , Poole A. , Young M. , Mackle D. , Lange K. , Williams P. , Peake S. L. , Chapman M. J. , Iwashyna T. J.
Published: January 2019

The capacity to measure the impact of an intervention on long-term functional outcomes might be improved if research methodology reflected our clinical approach, which is to individualise goals of care to what is achievable for each patient. The objective of this multicentre inception cohort study was to evaluate the feasibility of rapidly and accurately categorising patients, who were eligible for simulated enrolment into a clinical trial, into unique categories based on premorbid function. Once a patient met eligibility criteria a rapid ‘baseline assessment’ was conducted to categorise patients into one of eight specified groups. A subsequent ‘gold standard’ assessment was made by an independent blinded assessor once patients had recovered sufficiently to allow such an assessment to occur. Accuracy was predefined as agreement in >80% of assessments. One hundred and twenty-two patients received a baseline assessment and 104 (85%) were categorised to a unique category. One hundred and six patients survived to have a gold standard assessment performed, with 100 (94%) assigned to a unique category. Ninety-two patients had both a baseline and gold standard assessment, and these agreed in 65 (71%) patients. It was not feasible to rapidly and accurately categorise patients according to premorbid function.
The Effect of Oral Intake during the Immediate Pre-Colonoscopy Time Period on Volume Depletion in Patients who Receive Sodium Picosulfate
Authors: Labuschagne G. S. , Morris R. W.
Published: January 2019

Sodium picosulfate, used in combination with magnesium oxide and citric acid for bowel cleansing, can result in dehydration. We investigated whether enhanced carbohydrate fluid intake pre-colonoscopy could mitigate this effect. We enrolled 398 elective colonoscopy patients in a prospective, controlled, single-blinded study. The control group (n=194) fasted routinely (minimum seven hours) whilst the treatment group (n=197) drank 1,200 ml carbohydrate solution leading up to admission (up until two hours pre-colonoscopy). On admission a patient survey was completed, and urine specific gravity obtained. Supine blood pressure and pulse rate were measured, and repeated within three minutes of standing. The carbohydrate group had reduced symptoms and signs of dehydration, including thirst (34% versus 65%, P <0.001), dry mouth (45% versus 59%, P=0.008), dizziness (10% versus 20%, P=0.010), lower mean urine specific gravity (1.007 versus 1.017, P <0.001), lower incidence of orthostatic hypotension (2.6% versus 11%, P <0.001), and lower mean erect pulse rate (78 versus 81/minute, P=0.047). The postural change in systolic blood pressure was less in the treatment group (mean −0.4 mmHg, median −1 mmHg [interquartile range, IQR −7 to 7]) than in the control group (mean −4.1 mmHg, median −1 mmHg [IQR −12 to 3], P=0.028). These findings indicate that hydration with carbohydrate solution in patients taking sodium picosulfate has clinical benefit.
What Are We Injecting with Our Drugs?
Authors: Merry A. F. , Gargiulo D. A. , Fry L. E.
Published: January 2019

In preparation for a case, an anaesthetist opened a 20 ml glass vial of propofol and aspirated the propofol into a syringe via a blunt drawing-up needle. Increased resistance was felt with aspiration. On inspection, a shard of glass was found at the tip of the drawing-up needle. The shard was presumed to be from the propofol ampoule, and to have fallen into the solution upon snapping open its glass tip. This illustrative case raises the issue of contamination of drugs by particles introduced during the drawing-up process. It also highlights the possibility that during the drawing-up process, intravenous drugs may become contaminated not just with particles, but with microorganisms on the surface of the particles. In this article, we discuss relevant recent research of the implications of this type of drug contamination. We draw attention to the need for meticulous care in drawing up and administering intravenous drugs during anaesthesia, particularly propofol.
Impact of Thrombelastography in Paediatric Intensive Care
Authors: Carter B. G. , Carland E. , Monagle P. , Horton S. B. , Butt W.
Published: January 2019

We assessed the clinical impact of thrombelastography (TEG®) results (TEG® 5000, Haemonetics Corporation, Braintree, MA, USA) by measuring their ability to cause changes in a theoretical treatment plan and contribute to the understanding of haemostasis. We prospectively included paediatric intensive care unit (PICU) patients who had standard tests of haemostasis and TEG ordered and had an arterial catheter or extracorporeal access port in situ. Blood for standard tests and TEG was taken simultaneously. Independent of patient care, general patient information and results of standard laboratory tests were presented to five clinicians who were asked to document their theoretical treatment plan. Clinicians were then shown TEG results and asked if they caused a change in their plan, if they confirmed initial standard laboratory test results, if they enabled a better understanding of haemostasis and if they provided additional information. Inter-rater agreement between the clinicians was determined. Forty-two TEG results were obtained from 34 patients. Overall, the inclusion of TEG results led to a change in treatment plan in 97 of 207 occasions (47%), confirmed standard laboratory test results in 177 of 204 occasions (87%), enabled a better understanding of haemostasis in 140 of 204 occasions (69%) and provided additional information in 131 of 204 occasions (64%). Variation existed between clinicians, seemingly due to individual differences, with poor inter-rater agreement. We conclude that TEG results led to changes in treatment plans almost half the time, confirmed findings of standard tests and provided a better understanding of haemostasis, but randomised controlled trials are required to determine the role and influence of TEG results on patient outcome.
Outcomes of Telemedicine Intervention in a Regional Intensive Care Unit: A before and after Study
Authors: Panlaqui O. M. , Broadfield E. , Champion R. , Edington J. P. , Kennedy S.
Published: January 2019

Telemedicine consultations in remote intensive care units (ICUs) overseas were found to be effective in reducing mortality and hospital length of stay (LOS). In Australia, there were anecdotal reports of these clinical outcomes. This retrospective before and after study assessed the improvement in patient outcomes with the implementation of a telemedicine program in a regional high dependency unit. Daily virtual consultations were conducted between the rural facility and the intensivists at the regional centre. A total of 525 patients received intensive care support between 2010 and 2015. Hospital and High Dependency Unit mortality showed no evidence of significant differences between the telemedicine group and the baseline (relative risk 1.02, 95% confidence interval [CI] 0.99–1.06, P=0.25 and relative risk 1.00, 95% CI 0.98–1.03, P=0.67 respectively). The hospital LOS was lower in the baseline group by 1.5 days. There was no significant difference in High Dependency Unit LOS. To adjust for the covariates in LOS, log linear regression analysis was performed. The telemedicine intervention, Acute Physiology and Chronic Health Evaluation II scores and inter-hospital transfers were found to contribute significantly to hospital LOS. The most important result of the study was that the proportion of inter-hospital transfers was lower in the telemedicine group (relative risk 0.88, 95% CI 0.80–0.98, P=0.03) compared to baseline. This means that critically ill patients in our regional centre can continue to receive specialist care remotely through tele-ICU consultations thus avoiding the need for patient transport. However, further study is needed to establish the benefits and risks of telemedicine intervention in ICUs in Australia.
The Effects of Antivenom and Verapamil on the Haemodynamic Actions of Chironex Fleckeri (Box Jellyfish) Venom
Authors: Tibballs J. , Williams D. , Sutherland S. K.
Published: January 2019

The efficacy of antivenom and verapamil against Chironex fleckeri (box jellyfish) venom was investigated in monitored mechanically ventilated piglets. Chironex fleckeri tentacle extract alone, a mixture of tentacle extract with antivenom, and verapamil before tentacle extract were administered intravenously to groups of animals. Tentacle extract caused severe systemic hypotension, cardiac dysrrhythmias, pulmonary hypertension, haemolysis and hyper-kalaemia. These effects were prevented by pre-incubation of tentacle extract with antivenom. Verapamil did not prevent any effect of venom, exacerbated cardiovascular collapse and increased mortality. We conclude that antivenom neutralizes the cardiovascular, haemolytic and hyperkalaemic effects of box jellyfish venom. Verapamil does not prevent any of these effects and is contra-indicated for treatment of envenomation.
Trainees’ Attitudes to Research as part of Anaesthetic Training
Authors: Kluger M. T.
Published: January 2019

The formal project has been a requirement for the F.A.N.Z.C.A. diploma for the past few years. A questionnaire was sent to all registrars on a formal program asking questions relating to the formal project, perceived advantages, disadvantages, value of formal research teaching methodology and future career intentions. All years of training were represented.

Forty-nine of the fifty-six (86%) respondents replied to the survey. Of these 15% felt the formal project had no value, 54% found it possibly useful whilst 31% perceived is as very useful. Advantages of the formal project included appreciation of research skills and the ability to critically appraise research. Disadvantages included lack of dedicated time, space and funding and production of poor quality research. A majority (63%) favoured formal teaching of research methods for the F.A.N.Z.C.A. diploma, which ideally should be taught before the Primary (30%) or in the Provisional Fellowship year (36%). Few respondents indicated a willingness to undertake a major commitment to research in the future (4%) but 46% wanted some contact with research and teaching as part of their normal work practice.

A more structured teaching in research methodology, assessment of published work and presentation skills may be more suited to the longterm goals of the majority of clinical anaesthetists.
Epidural Analgesia: Prospective Audit of 1062 Patients
Authors: Burstal R. , Wegener F. , Hayes C. , Lantry G.
Published: January 2019

A prospective survey of one thousand and sixty-two patients receiving epidural analgesia in surgical wards was undertaken over a two-year period. The duration of infusion ranged from one to fourteen days, with a mode of three days. There were 1131 episodes where a local anaesthetic and opioid mixture was used and 160 where opioids were used alone. Local anaesthetic was not used without opioids. 23% of catheters were removed prematurely because of catheter related problems including accidental dislodgement (13%) and skin site inflammation (5.3%). No epidural abscess or haematoma was identified. In 14% of the total number of episodes there was either no demonstrable block or complications occurred requiring a change of solution: 30% of this group were salvaged following intervention by the Acute Pain Service (APS). The incidence of respiratory depression was 0.24%. There was no case of delayed respiratory depression. Epidural analgesia can be used safely in surgical wards provided that regular review of the patients is undertaken. It must be anticipated however, that up to 20% of patients will not receive adequate analgesia for the first 48 hours postoperatively. The failure rate could be halved if accidental dislodgement of epidural catheters could be eliminated.
Pneumothorax and Pneumomediastinum during Colonoscopy
Authors: Webb T.
Published: January 2019

A case of bowel perforation during diagnostic colonoscopy is reported. This resulted in the sudden appearance of massive subcutaneous emphysema of the neck, causing acute upper airway obstruction which necessitated urgent endotracheal intubation. Large bilateral pneumothoraces and pneumomediastinum were also present.
Recurrent Acute Upper Airway Obstruction after Anterior Cervical Fusion
Authors: Penberthy A. , Roberts N.
Published: January 2019

A 67-year-old man presented with cervical myelopathy for which a C3/4 discectomy and anterior fusion was performed. Recurrent episodes of acute upper airway obstruction necessitated laryngoscopy and endotracheal intubation. Drainage of a prevertebral collection of CSF and surgical repair of a dural tear corrected the obstructive symptoms. Management of the difficult airway is discussed.
Cardiac Tamponade in a Postpartum Woman with Lemierre's Syndrome
Authors: McLean A. S. , Tyler K.
Published: January 2019

A 23-year-old primigravida with Lemierre's syndrome developed pericardial tamponade secondary to mediastinal infection and anticoagulant therapy. Intrathoracic echocardiographic diagnosis during a period of cardiac arrest led to urgent pericardiocentesis and successful resuscitation.
The Anaesthetic Management of Autistic Children
Authors: Rainey L. , Van Der Walt J. H.
Published: January 2019

Autistic children are difficult to manage and there are no anaesthesia studies to suggest management strategies. We present five case reports which describe an integrated management program taking into account the special needs of autistic children and their families. We describe a method of early warning and recognition of these patients and the establishment of a database to allow review of our program. We also present a process to minimize the stress and problems inherent in the conventional admission process. Oral ketamine (6 to 7 mg/kg) has proven to be the most reliable preoperative sedative for these patients.
The Effect of Different Bypass Flow Rates and Low-Dose Dopamine on Gut Mucosal Perfusion and Outcome in Cardiac Surgical Patients
Authors: Schneider M. , Valentine S. , Hegde R. M. , Peacock J. , March S. , Dobb G. J.
Published: January 2019

The aim of this double-blind, randomized, placebo-controlled trial was to investigate the effects of different cardiopulmonary bypass flow rates and low-dose dopamine on gastric mucosal pH (pHi) and outcome. We hypothesized that by minimizing gut mucosal hypoperfusion during and after cardiac surgery endotoxin translocation may be prevented, resulting in an improved clinical outcome. Four groups of 25 patients each receiving high or low flows during bypass and low-dose dopamine or saline for 24 hours after induction of anaesthesia were studied. The pHi was measured at six time intervals over 24 hours.

The combination of low-dose dopamine and a low bypass flow rate was associated with a significantly greater frequency and severity of low pHi. This group also demonstrated a significantly lower vascular resistance on admission to the intensive care unit. There may be an association between low pHi and low vascular resistance.
Planning for Older Adult Day Programs in an Arab American Community: Perceptions From Older Adults, Caregivers, and Professional Providers
Authors: Hopp Faith P. , Cassady CM , Ajrouch Kristine J. , Talab Amne M. , Mendez Jennifer
Published: January 2019

Background and Objective: This study explored Arab American stakeholders’ perceptions about potential future adult day programming to inform geriatric service providers about relevant services for culturally diverse older adults. Research Design and Method: Participants ( N = 28) in five focus groups were recruited through a social service provider in Metropolitan Detroit, Michigan. Results were analyzed using thematic analysis. Results: Themes included basic requirements, promoting clear and transparent understanding of adult day programs (ADPs), respecting the person, social engagement and activities, explaining complex ethnic and geographic identities, and implementing diversity. Discussion and Implications: ADP service providers can enhance services by drawing on the life experiences, resilience, and creativity of older Arab Americans. Person-focused policies and programs that draw on the strengths of the diverse local community should be developed and communicated clearly for potential participants, family members, and service providers.
Knowledge, Perceptions, and Patterns of Fish Oil Use in Cardiac Patients
Authors: Hilleman Daniel E. , Teply Robyn , Packard Kathleen A.
Published: January 2019

Background:

Fish oils are the most widely used nonvitamin, nonmineral dietary supplements in the United States. They are not over-the-counter medications and are neither approved nor indicated for treating disease. Patient knowledge and patterns of fish oil use are not well defined.

Objective:

To determine cardiac patients’ knowledge and patterns of fish oil use.

Methods:

One thousand consecutive patients admitted to an in-patient cardiology service (2015-2017) taking fish oil dietary supplements or prescription omega-3 fatty acids were asked to complete an anonymous questionnaire concerning product knowledge and use.

Results:

A total of 711 (71%) patients completed the questionnaire. Primary reasons for use included general health (34%), heart health (28%), arthritis (9%), and lipid disorders (8%). Few patients (14%) were advised to take fish oil products by a health-care provider. Only 2.5% were taking prescription omega-3 fatty acids. Only 26% knew the active ingredient in their fish oil product. Supplements were purchased through a nonpharmacy retail seller by 81% of respondents.

Conclusions:

Most cardiac patients consuming fish oil dietary supplements do so without medical supervision and without knowledge of the active ingredients. As most patients obtain supplements outside of a pharmacy, opportunities to monitor and educate patients remain a major challenge.
Spanish trade unions against labour market reforms: strategic choices and outcomes
Authors: del Rio Loira Pablo , Fenger Menno
Published: January 2019

Trade unions are considered to be key political actors in the formation of welfare states. Their importance for the current fate of welfare states, however, has been disputed within academia. Aiming to contribute to this vast body of literature, this article analyses the participation of Spanish trade unions in labour market reforms since the restitution of democracy in Spain. The article analyses the strategic choices open to trade unions, particularly the choice of calling for mobilisation, and why unions make the choices that they do. Mobilisation in the form of a general strike constitutes unions’ last and most extreme resort for confronting the government. We also explain the context in which such mobilisations are able to prevent retrenchment measures attempted by the government.
Efficacy and Productivity: The Future of School-Based Decision-Making Councils in Kentucky
Authors: Johnson Patsy E. , Logan Joyce
Published: January 2019

This study examines the relationship between efficacy and productivity and stakeholders’ attitudes about the school-based, decision-making council's usefulness as a decision-making body. Efficacy was defined as the power to produce an intended effect. Productivity was defined as yielding perceived results or benefits. Respondents included teachers, principals, and parents serving on the school council and teachers and parents not serving on the councils. Findings indicate that efficacy and productivity of the councils are related to noninstructional issues and not related to issues that might directly affect student achievement.
The Power of Trust: Teams and Collective Action in Self-Managed Schools
Authors: Henkin Alan B. , Dee Jay R.
Published: January 2019

Trust is a significant factor in collective action. This article delineates the concept of trust in collective action in the self-managed school context. A composite case is provided to illustrate the valence of trust as a critical element in effective teamwork. A series of propositions implicit in the case is suggested in order to increase comprehension of the complex phenomenon of trust and suggest alternative directions for future inquiry.
Moving beyond “Good/Bad” Student Accountability Measures: Multiple Perspectives of Accountability
Authors: Capper Colleen A. , Hafner Madeline M. , Keyes Maureen W.
Published: January 2019

This article examines three student accountability measures through two different theoretical perspectives: structural functionalism and feminist post-structuralism. The analysis reveals how educators can use various kinds of student assessments, whether typically categorized as traditional or progressive, in both structural functional or feminist poststructural ways—ways that maintain the status quo or support equity and justice for all students. We claim and show that it is not the assessment itself, per se, that is the issue. Rather, it is how we use them that can determine their effects on students. The purpose of this article is to help practicing administrators and scholars in administrator preparation programs to move beyond an either/or view of differing accountability measures, beyond resignation or criticism of the issue of accountability, and consider new questions about and possibilities for the dialogue.
Balancing the Contradictions between Accountability and Systemic Reform
Authors: Kersaint Gladis , Borman Kathryn M. , Lee Reginald , Boydston Theodore L.
Published: January 2019

This article examines the impacts of the National Science Foundation's Urban Systemic Initiative reforms in four cities: Chicago; El Paso, Texas; Memphis, Tennessee; and Miami, Florida, based on analysis of 47 principal interviews. We analyze the role of school administrators in addressing the demands of both systemic reform in mathematics and science and state, district, and local accountability policies. Specifically, we examine their concepts of their roles and ability to balance contradictions and paradoxes between systemic reform and accountability. Our research demonstrates that principals must overcome many challenges before they are able to affect desired achievement outcomes for all students. Key among the identified challenges is the ability of principals to balance the demands of the reform effort with the press to negotiate multiple policies, especially in the areas of student assessment and school accountability for which they are ultimately responsible.
Social Justice and the Importance of Rebellious, Oppositional Imaginations
Authors: Rapp Dana
Published: January 2019

In this article I hope to add convictional fuel, fodder, and possibility to the fires of those educational administrators and professors of leadership who have dedicated their lives to deeper forms of social justice, as well as to professionals who are beginning to admit that they have been too generous in trusting and conceding power to political and economic elites. I will lay bare the incommensurability between proscribed roles of educational leadership and social justice while, at the same time, discussing unconventional sources for inspiration, broader mediums and languages for naming our work, and the importance of forging alliances with groups outside our institutions. My intention has as much to do with provoking broader social action as it does to contributing to an academic discourse.
An Examination of School Board Presidents’ Perceptions of Their Superintendent's Interpersonal Communication Competence and Board Decision Making
Authors: Petersen George J. , Short Paula M.
Published: January 2019

Using research focused on interpersonal communication theory, this exploratory investigation examined school board presidents’ perceptions of their district superintendent's interpersonal communication competence in his or her role as chief executive officer and advisor to the board of education. Interpersonal communication theory suggests empathy, listening, and versatility are effective and compelling elements of persuasion. Specifically we investigated the attitudes and opinions as well as the covariance between the board of education president and their view of the district superintendent's interpersonal communication competence and its influence on school board voting decisions. Results from the investigation suggest that board decision making is closely related to the attributes of empathy, listening, self-disclosure, the absence of social anxiety, and versatility. Further, a statistically significant relationship was discovered between the overall interpersonal communication competence of the district superintendent and the support of board members on board agenda issues that have immediate consequences on the actual school system.
“Enmeshed in the Work”: The Educative Power of Developing Standards
Authors: Bogotch Ira E.
Published: January 2019

The purpose of this study is to illustrate empirically the educative power associated with developing leadership standards in contrast to the miseducative dispositions associated with both implementation and policy-making. Those leaders “enmeshed in the work” experienced the joys of learning, yet when their task was completed, they foresaw a predictable, if not cynical, future for the standards. Specifically, standards’ development was characterized by a fluidity of local and contextualized meanings. Once written, however, the standards became fixed and distant, to be folded into current practice.
Beyond Dualism, Splits, and Schisms: Social Justice for a Renewal of Vocational–Academic Education
Authors: Mullen Carol A. , Kohan Alan R.
Published: January 2019

To fulfill the democratic dream for American schooling, educators and policymakers need to work together for the same common cause: reforming the academic-vocational dichotomy of schooling that has persisted over the past century. Academic subjects continue to be separated from vocational schooling with the effect of diluting each domain's effectiveness. The Deweyian vision of social justice provides a solution for healing this fundamental dualism that characterizes schooling. Even where integration has been attempted using academic-vocational models, tracking continues in public schools without commitment to whole-school reform design. This article discusses these issues in the context of the history of vocational education and Dewey's perspective of integrated education through the occupations. The authors also illustrate the concepts presented through promising whole-school reform designs for democratizing the public education system. Policy implications are addressed for moving toward a socially just system of schooling.
Homosexuality and School Superintendents: A Brief History
Authors: Blount Jackie M.
Published: January 2019

From the beginning, sexuality has been an important defining consideration in school administration. This article explores the history of the three ways in which sexuality has been a central force in shaping school administration. First, administrative work, in conjunction with teaching, paralleled the roles of men and women respectively in traditional married households. Second, over much of the past century, school administrators have been required to demonstrate notably masculine qualities, including married status, as their existence in a profession of women repeatedly has been questioned. Finally, over the past half century, school administrators also have been pressed to cleanse from the ranks of school workers those persons with nonmainstream sexualities and/or unconventional gender characteristics, which have been regarded as evidence of homosexuality.
Principled, Pragmatic, and Purposive Leadership: Reimagining Educational Leadership through Prophetic Spirituality
Authors: Dantley Michael E.
Published: January 2019

This article reimagines educational leadership using Cornel West's notions of prophetic spirituality. Three categories of leadership—principled, pragmatic, and purposive—are proposed. All three are grounded in the components of West's prophetic spirituality, namely, a deep-seated moralism, an inescapable opportunism, and an aggressive or profound pessimism. The article argues that the transformation of educational leadership necessitates searching for a unique way to alter its construction. Using an African American spiritual frame is suggested as one way to bring about such fundamental change in the field.
Schools as Learning Communities: Unpacking the Concept
Authors: Schussler Deborah L.
Published: January 2019

Because the term “learning community” has been used with increasing frequency to describe schools, this article synthesizes theoretical and empirical research to describe learning community as a construct. The overall purpose is to describe a viable lens through which schools can be viewed in a meaningful manner. First, a summary of the effective schools’ model is used to explain the evolution of learning communities. The construct is then described in terms of three broad dimensions: cognitive, affective, and ideological. A summary with suggestions for future research is provided.
Enabling School Structures: Principal Leadership and Organizational Commitment of Teachers
Authors: Sinden James , Hoy Wayne K. , Sweetland Scott R.
Published: January 2019

School structures need not be rigid, controlling, and coercive; in fact, they can be just the opposite. Enabling school structures are centralized and formalized in ways that promote problem solving, collaboration, flexibility, change, and professional judgment. The current research demonstrates the importance of both collegial leadership of the principal and organizational commitment of the faculty in the development of enabling school structures. Building an enabling structure is likely a key to promoting quality school organizations.
Trauma and Stress in the Principal's Office: Systematic Inquiry as Coping
Authors: Lindle Jane Clark
Published: January 2019

The study of school leaders’ feelings during and about their work suffers from inadequate academic definitions about the depth, character, and legitimacy of those feelings, as well as from limitations on the means of capturing and recording those feelings. This study pushes the definitions of administrators’ stress into the areas of traumatic stress and offers autobiography as a systematic means of investigating and legitimating school leaders’ feelings about their work. Four vignettes drawn from autobiographical inquiry demonstrate the authenticity of this method and the legitimacy of school leaders’ experiences of traumatic stress in their work.
An Analysis of Principals’ Ethical Decision Making Using Rest's Four Component Model of Moral Behavior
Authors: Klinker Joann Franklin , Hackmann Donald G.
Published: January 2019

Secondary school principals confront ethical dilemmas daily. This study examined how MetLife/NASSP Secondary Principals of the Year made ethical decisions conforming to three dispositions from Standard 5 of the ISLLC Standards and if they could identify processes used to reach those decisions through Rest's Four Component Model of Moral Behavior. Using a descriptive design with a mixed methodological approach of survey research and interviews of selected respondents, state principals of the year (N = 64) were surveyed regarding selected dispositions. Quantitative results indicated that the majority of respondents made ethical decisions regarding the three dispositions tested, but analysis as to the justifications used for those decisions was inconclusive. Qualitative analysis of selected respondents indicated that Rest's four components are essential justifications for making ethical decisions. Four themes emerged from the qualitative study: courage, a philosophy of the common good, gut feelings, and difficulty in defining ethics.
Superintendent Recruitment: Effects of School Councils, Job Status, Signing Bonus, and District Wealth
Authors: Winter Paul A. , Millay John D. , Björk Lars G. , Keedy John L.
Published: January 2019

This study examined the effects of four variables on job ratings provided by applicants for simulated superintendent vacancies. The participants were superintendents ( n = 72) and superintendent-certified personnel ( n = 72) reacting to jobs described in simulated position announcements. The participants rated jobs in districts without school councils higher than jobs in districts with school councils. Superintendents rated jobs in districts without school councils higher than did superintendent-certified personnel. Superintendents rated jobs in high-wealth districts with signing bonuses higher than jobs in a high-wealth district with no signing bonus. Implications for recruitment practice and future research are discussed.
Building Bridges, Building Community: Transformational Leadership in a Challenging Urban Context
Authors: Giles Corrie , Johnson Lauri , Brooks Sharon , Jacobson Stephen L.
Published: January 2019

Few empirical studies have been undertaken concerning successful leadership practices within challenging urban schools. Given that much of the school leadership literature relies on principals as the source of evidence for school improvement, this article explores, through multiperspective case study methodology, how one failing urban elementary school has become successful largely as a result of the transformative leadership of the principal. Our findings support more recent school-derived iterations of transformational leadership theory, in which principals stress support, care, trust, participation, facilitation, and the building of consensus. However, our data also draw attention to how this particular successful principal transcends the administrative immediacy of short-term innovation, by paying considerable attention to longer term, socially transformative, and morally grounded principles, rooted in democracy, equity, and social justice.
The Uses of Spirit: Notes on Derrida, Spiritual Politics, and Educational Leadership
Authors: Carlson Dennis
Published: January 2019

This article focuses on a critical reading of two texts by Derrida: Of Spirit: Heidegger and the Question (1989) and Memoirs of the Blind (1993). In these two texts, Derrida explores some of the dominant tropes and metaphors of a language of spirit in two distinctively different, but interrelated, genealogies in the West: one in philosophy and one in religion. Derrida's interest was to show how the same language can be, and has been, made to serve very different purposes. In this article, the author argues that a language of “spirit” can serve as a powerful tool in democratic educational leadership by providing an ethical grounding and a heading for change. At the same time, educational leaders who invoke a language of spirit should do so with a keen sense of the undemocratic uses to which such language has been linked—linkages to systems of racial class, gender, sexual, and other oppression.
Rewriting Narratives and Leadership Vision through a Postmodern Imagination: A Spiritual Imperative to Leading African American Schools
Authors: Dantley Michael E.
Published: January 2019

This article asks educational leaders to imagine schools from a postmodern perspective in order to address the issues specifically germane to black children in public schools. In fact, this article challenges current as well as prospective school leaders to adopt a radical approach to perceiving schools so that the inequities and undemocratic practices in these institutions may be uncovered and dealt with. All of this is initiated through a spirit of resistance and radical reconstruction aimed at creating schools that are more effective in facilitating crucial education for African American and impoverished students.
Identity-Based Othering and Collaborative Leadership: Implications of Contradictory Messages for New Administrators
Authors: Retelle Ellen , Poole Wendy
Published: January 2019

A study of beginning administrators in a school district reveals that they receive contradictory messages about school leadership. Although the school district emphasizes collaborative, facilitative leadership through documents and orientation of new administrators, bureaucratic, political, and identity-based messages reinforce traditional hierarchical structure and the othering of teachers. The contradictions make it difficult for new administrators to develop strong, coherent identities. Those who possess a strong sense of leadership dentity at the beginning of their 1st year as administrators may have a better chance of resisting the pull of traditional leadership models. Although the findings are not generalizable, they raise important contemporary issues in the identity development of new administrators.

This article examines the teacher–administrator relationship, particularly the “we–they” construction that tends to underlie the relationship. The norm of othering tends to exist whether parties perceive the teacher–administrator relationship in their particular settings to be generally positive or adversarial. The focus of this article is how vice principals in one school district, while making the transition from teaching to administration, make sense (or not) of the teacher–administrator relationship.
Changing the Culture of Schools: Professional Community, Organizational Learning, and Trust
Authors: Louis Karen Seashore
Published: January 2019

The theme of this special issue of the Journal of School Leadership involves teachers’ professional learning communities. It is satisfying to see a major journal in educational leadership focus on a problem that was seen only dimly two decades ago. This contribution examines the antecedents and underlying research traditions that have culminated in the strong sense of urgency among scholars and practitioners to shift the focus of school reform away from restructuring and toward reculturing (Miller, 1998). In addition, it cautions against the hope that professional learning communities will become a temporary panacea for what ails the public schools and the even greater tendency to develop in professional learning communities interventions that can be implemented, such as a new reading curriculum.
Redistributed Leadership for Sustainable Professional Learning Communities
Authors: Hargreaves Andy , Fink Dean
Published: January 2019

Distributed leadership in schools is not exclusive to professional learning communities; it is distributed in all schools, for good purposes and for bad, by design and by emergence. In this article, we describe a normative view of distributed leadership that tends to be a leadership of advocacy, and we offer a descriptive perspective that argues that although sustainable leadership is distributed leadership, not all distributed leadership is sustainable leadership. It depends on how the leadership is distributed and for what purposes. Using one of our seven principles of sustainable leadership—breadth—we then show how leadership distribution in professional learning communities is both distinctive and varied.
The Tri-Level Model in Action: Site, District, and State Plans for School Accountability in Increasing Student Success
Authors: Huffman Jane B. , Pankake Anita , Muñoz Ava
Published: January 2019

This article offers information about a district's school improvement efforts to reculture as a professional learning community, which we believe exemplifies the school and district levels of Fullan's (2004b, 2005) tri-level model. We use Fullan's eight elements of sustainability to organize the data gathered in interviews with school and district personnel over a 3-year period. Additionally data from an interview with the state commissioner of education (also, the former superintendent of the district) hint at emerging state-level changes based on changes initiated within the district studied.
Educator Perspectives on Parent Involvement for English-Language Learners: Examining Student Needs and School Programs
Authors: Gates Gordon S. , Smothermon Deborah
Published: January 2019

This qualitative study describes educator perspectives on student development, resource allocation, and parental knowledge for furthering understanding about parent involvement for English-language learners. The critique of schoolcentric parent involvement programs offered in literature is examined and recommendations advanced for focusing parent–educator collaboration on addressing student academic, affective, and physical needs. The study exposes the slippery slope of deficit thinking that confronts educators who step forward to assist in meeting the needs of students and their families, and it provides insights for strengthening the home–school connection that resist division and inhibit blame.