bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards Adopting an Appropriate Dispute Resolution Mechanism to Promote Investments to Enhance Energy Access in Africa
Authors: Idornigie Paul Obo
Published: April 2018

Any development initiative in the energy sector will not only consider the legal framework for attracting such investment but the dispute resolution mechanisms also. Conventionally, the dispute resolution mechanism usually offered is litigation through the courts. However, it has become clear that no foreign investor would like to be restricted to fora like litigation without other alternatives. This chapter examines the role that law plays in the enablement and empowerment of the world’s energy poor with particular focus on Africa; the various dispute resolution mechanisms; and the legal framework for arbitration in Africa states to determine whether the arbitration laws enhance or impede access to energy. The chapter also considers whether arbitration laws and other instruments are stimulants for inward investment into the energy sector and concludes that if arbitration is to serve this purpose the contracts and treaties should be properly negotiated and clauses on arbitration professionally drafted.
Reflexive Authorities
Authors: Zürn Michael
Published: April 2018

In this chapter, authority is developed as key concept for analyzing the global governance system. Max Weber’s foundational treatment is used to capture the paradox involved in the notion of “voluntary subordination.” Building on this foundation, the concept of reflexive authority is elaborated in contrast to two other concepts that have prevailed in international relations so far. The argument is laid out against the background of the global governance context, one in which the authority holders are in many respects weaker than most state actors. Two types of reflexive authority are identified: epistemic and political authority. Finally, the interplay between different authorities in global governance is analyzed to identify the major features of the global governance system. It is—to put it in the shortest possible form—a system of only loosely coupled spheres of authorities that is not coordinated by a meta-authority and lacks a proper separation of powers.
The Right to Life of Armed Forces Personnel during Armed Conflict
Authors: Park Ian
Published: April 2018

The application of the right to life to military personnel has proved to be a controversial topic and has generated emotive litigation. Some would take the view that willingly accepting the possibility of death during armed conflict is an inherent part of serving in the armed forces. Others would contend that, while this may be true, States nonetheless have an obligation to properly train and equip their armed forces. This chapter reviews the litigation in this area and offers a view on when a state has right to life obligations in respect of its armed forces and what these obligations amount to.
Was there a strategy in Gandhi’s approach to fight against the caste system?*
Authors: Kolge Nishikant
Published: April 2018

The chapter argues that despite enormous difficulties that different scholars had faced in assessing Gandhi’s views on the problem of the caste system and untouchability due to inconsistency in his writings, the subject needs to be thoroughly examined by studying his practices too. The first part of the chapter examines Gandhi’s practice on different caste restrictions and some other religious obligations, while the second part of the chapter looks at the community life in Gandhi’s four Ashrams. The third part of the chapter analyses different arguments and justifications presented by different scholars regarding Gandhi’s views on the caste system. On examining these arguments and the justifications offered by different scholars in the light of Gandhi’s practice the chapter argues it is only appropriate to hold Rajmohan Gandhi’s and few other scholars’ view that for strategic reason alone Gandhi emphasizes on the positive aspect of the caste system after coming from South Africa.
Transnational Commercial Surrogacy and the (Un)Making of Kin in India
Authors: Majumdar Anindita
Published: April 2018

Billed as an emerging transnational industry, the commercial surrogacy arrangement is more than mere commerce. It involves the birth of kin and relationships that include cross-cultural dialogues and conflicts between forms of reproduction and birthing. The process of making kin is fraught with different forms of negotiations regarding biology, nurture, pregnancy, and parenthood. This book engages with the idea of emerging forms of families and meanings of kinship in a transnational world through ethnographic research, kinship, gender studies, and science and technology studies. The ethnography draws from a context that is enmeshed in the local–global politics of reproduction, and the engaging and ongoing debate regarding ethics and morality in the sphere of reproductive rights. Drawing from conversations with foreign couples coming to India to hire Indian surrogates through Indian fertility clinics, lawmakers, and clinicians, this book looks at the politics of foreign gay couples seeking families through surrogacy in India, identity giving processes to the babies born to foreign couples, the clinicians understanding of kinship, the networks of commerce and agents, and the ways in which the surrogate and her husband positions itself within the arrangement. The mapping of transnational commercial surrogacy in its processual, dynamic representation—from the choice of the arrangement, to the pregnancy and finally to the birth of the child—is done in broad stages. This book aims to present an important ethnographic picture of a complicated, controversial practice such as commercial surrogacy by focusing on its relevance for kinship and our understanding of interpersonal relationships at large.
‘Strange Meeting’
Authors: Das Chaity
Published: April 2018

The final chapter juxtaposes fiction from Pakistan, Bangladesh, and India. The war crimes tribunal and the post-war histories of Pakistan and Bangladesh raise questions of justice and impunity. The attempt here is to listen to the stories and what they tell us about the possibility of recognizing of each other’s wounds and suffering. While only one work by an Indian author is discussed, it points to the transnational stake in the memories of 1971. While one of the objectives of this work was to take stock of the war literature of Bangladesh, it is clear that any politics that addresses open injuries of history cannot be constructed without recognizing the entangled nature of our pasts—1947 and 1971 to name only two—and the future. This chapter also tries to make a division of chapters on the basis of genre arguing that the method was defined by the material and not the other way round. Works by Tahmima Anam, O.V. Vijayan, Intizar Husain, Yasmin Saikia and others are analysed.
History of Education Policymaking in India, 1947-2016
Authors: Ayyar R.V. Vaidyanatha
Published: April 2018

This book chronicles the history of education policymaking in India. The focus of the book is on the period from 1964 when the landmark Kothari Commission was constituted; however, to put the policy developments in this period into perspective major developments since the Indian Education Commission (1882) have been touched upon. The distinctiveness of the book lies in the rare insights which come from the author’s experience of making policy at the state, national and international levels; it is also the first book on the making of Indian education policy which brings to bear on the narrative comparative and historical perspectives it, which pays attention to the process and politics of policymaking and the larger setting –the political and policy environment- in which policies were made at different points of time, which attempts to subject regulation of education to a systematic analyses the way regulation of utilities or business or environment had been, and integrates judicial policymaking with the making and implementation of education policies. In fact for the period subsequent to 1979, there have been articles- may be a book or two- on some aspects of these developments individually; however, there is no comprehensive narrative that covers developments as a whole and places them against the backdrop of national and global political, economic, and educational developments.
The Early Years of Republic
Authors: Ayyar R.V. Vaidyanatha
Published: April 2018

The chapter is a prologue to the main narrative of the book. It offers an evaluation of Macaulay’s minute which paved the way for introduction of modern education in India, the idea of National System Of Education which dominated Indian thinking on education for over sixty years from the Partition of Bengal (1905) to the Kothari Commission (1964), and the division of responsibility between the Central and Provincial Governments for educational development during British Raj. It offers a succinct account of the key recommendations of the landmark Sarjent Committee on Post-War Educational Development, the Radhakrishnan Commission on University Development, and the Mudaliar Commission on Secondary Education, of the drafting history of the provisions relating to education in the Constitution, the spectacular expansion of access after Independence, the evolution of regulatory policies and institutions like the University Grants Commission (UGC), and of the delicate compromise over language policy.
The Show Goes On
Authors: Ayyar R.V. Vaidyanatha
Published: April 2018

This chapter describes the policy initiatives of the Modi Government such as the appointment of the Hari Guatam and Kaw Committees to review the functioning of the UGC and AICTE respectively and of the work so far on developing a new education policy. It critiques the process adopted for policy development and the salient features of the report of the TSR Committee and MHRD’s discussion draft, the Input Document. It also critiques the far reaching judgment of the Supreme Court mandating a National Eligibility and Education Test (NEET) for admission to undergraduate medical and dental courses of all colleges including minority institutions. It outlines the controversy over teaching German as a third language in Classes VI–VIII of Kendriya Vidyalayas, and the establishment of world class universities. It outlines the measures taken by Modi Government to carry forward the initiatives taken by the UPA Governments to promote skill development.
Political and Economic History of Land-Grabs in India
Authors: Suhail Peer Ghulam Nabi
Published: April 2018

This chapter begins with tracing the roots of colonialism in India, followed by understanding its various structures and processes of resource-grabbing. It argues, that India has largely followed the colonial approach towards land appropriation. After independence, although the Indian state followed a nationalistic path of development, the developmental approach of the state was far from being pro-peasant and/or pro-ecology. In a similar fashion, hydroelectricity projects in Kashmir, developed by NHPC from 1970s, have been displacing thousands of peasants from their lands and houses. Despite this, they are yet to become a major debate in the media, in the policy circles, or in academia in India.
From Land Tenure Changes to Land-Grabs
Authors: Suhail Peer Ghulam Nabi
Published: April 2018

This chapter provides a historical account of land rights and land tenure changes in Kashmir. It also explains land reforms in Kashmir, and how these land reforms look like. It further discusses how these land reforms took place and how the rights of the peasants were affected due to land reforms. The chapter discusses, that while land reforms provided land to the tiller, they did not stop them from getting dispossessed and displaced during the current wave of land-grabbing. It also explains the historical background of Badwan and Khopri, besides presenting the geographical, administrative, and a brief socio-economic sketch of the two villages. The functioning of NHPC in the state, the process of land acquisition, and the arrival of external capital in Gurez has also been explained.
A Description of the Surrounding Environs of Dar-ul Khilafa Shahjahanabad, AND THE INSCRIPTIONS [ON] THE BUILDINGS OF OLD DELHI
Authors: Beg Mirza Sangin
Published: April 2018

Finally, Mirza Sangin Beg tackles a huge assemblage of eclectic human exertions in the environs, centred around areas of trade and commerce, piety, landscaped spaces, cemeteries, and natural surroundings of rivers and hillocks. While structures such as the Jantar Mantar and the Firoz Shah’s lat are alluded to, it is stories about the human agencies that are privileged above these spaces. There are detailed renderings of activities in areas such as Pahar Ganj, Subzi Mandi, and Qadam Sharif, the biannual fair at Hanuman Temple, celebrations of Salono, numerous chhariyan melas, and worship of Goga. A fantastic account of Makhdum Jahanian Jahan Gasht coexists with an intense belief in relics of Prophet Muhammad, Hazrat Ali, and Imam Husain. Mirza Sangin Beg goes beyond the geographical region of Delhi towards north, west, and southwest. He writes of Bu Ali Shah Qalander’s dargah in Panipat and of the English platoon, officers, and gentlemen stationed between Gurgaon and Pataudi. The author has placed a variety of inscriptions and epitaphs from equally diverse structures and graveyards in a fatuous manner. Certain inscriptions seem to satisfy the self-esteem of the builders, some are laudatory while several are informative.
The Mechanism
Authors: Breckenridge Wylie
Published: April 2018

In this chapter a theory is developed of how we use ‘grey’ in ‘The patch looks grey to you’ to refer to the way of looking w. The author proposes that we exploit a general mechanism that we have for referring to ways of occurring by expressing properties. We might refer to a certain way of walking by expressing the property of being proud (perhaps using the adjective ‘proud’). So too, we might refer to a certain way of looking by expressing the property of being grey, and that’s what we do, the author proposes, with ‘grey’ in ‘The patch looks grey to you’.
The Many Property Problem
Authors: Breckenridge Wylie
Published: April 2018

The theory of visual experience that the author has developed in the book is an adverbial theory, as these were characterized in Chapter 1: according to the theory, to have a visual experience with a certain character is to have a visual experience that is occurring in a certain way. There is a well-known problem for adverbial theories, called the ‘many property problem’. In this chapter the author explains what the problem is, and offers a solution to it. Key to the proposed solution is recognizing that when a visual experience occurs in a certain way it simultaneously occurs in many distinct ways, of various degrees of generality, and that some of these ways are more specific determinates of others.
The Romance Verb
Authors: Maiden Martin
Published: April 2018

This book is the first ever comprehensive comparative–historical survey of patterns of alternation in the Romance verb that appear to be autonomously morphological in the sense that, although they can be shown to be persistent through time, they have long ceased to be conditioned by any phonological or functional determinant. Some of these patterns are well known in Romance linguistics, while others have scarcely been noticed. The sheer range of phenomena that participate in them far surpasses what Romance linguists had previously realized. The patterns constitute a kind of abstract leitmotif, which runs through the history of the Romance languages and confers on them a distinctive morphological phsyiognomy. Although intended primarily as a novel contribution to comparative–historical Romance linguistics, the book considers in detail the status of patterns that appear to be, in the terminology of Mark Aronoff, ‘morphomic’: a matter of ‘morphology by itself’, unsupported by determining factors external to the morphological system. Particular attention is paid to the problem of their persistence, self-replication, and reinforcement over time. Why do abstract morphological patterns that quite literally do not make sense display such diachronic robustness? The evidence suggests that speakers, faced with different ways of expressing semantically identical material, seek out distributional templates into which those differences can be deployed. In Romance, the only available templates happen to be morphomic, morphologically accidental effects of old sound changes or defunct functional conditionings. Those patterns are accordingly exploited and reinforced by being made maximally predictable.
The L-pattern and the U-pattern
Authors: Maiden Martin
Published: April 2018

The chapter presents the two types of Romance palatalization that have given rise to patterns of allomorphy. These involve principally the first-person singular present indicative and all the forms of the present subjunctive (the L-pattern); and in some cases the third-person plural present (the U-pattern). The diachronic persistence, replication, and ‘repair’ of this morphomic pattern is illustrated. It is argued that the apparent realignment of the alternant just with present subjunctive in Gallo-Romance is itself morphomic, rather than motivated semantically; that the patterns may retain a measure of phonological conditioning in Italo-Romance and Daco-Romance; and that morphomic patterns may involve asymmetrical distributions in paradigms.
Introduction
Authors: Balkelis Tomas
Published: April 2018

The introduction sets a thematic and historiographical framework for the study of the continuous military violence in Lithuania from 1914 to 1923, its offshoots social disaster, state failure, revolution, mass mobilizations, paramilitarism, and their impact on nation-making and identity formation during the post-World War I period. It posits a general question: what is the relationship between nation-making and war violence? It provides a brief overview of key events and historical developments in the Lithuanian–Polish borderland from the Great War to the end of the Polish–Lithuanian War and explains the roots of the post-war conflict. It also discusses major historiographical debates on the impact of the Russian revolution and the Great War on the post-World War I order in Eastern Europe and different types of violence that were common to the region.
Multidirectional War and Paramilitarism
Authors: Balkelis Tomas
Published: April 2018

This chapter, by following the course of military actions in Lithuania in 1919, explores the emergence of various military and paramilitary groups that engaged in different types of violence. The focus here is on the entanglement of three types of actors: those that performed state-sanctioned violence; those that acted as semi-independent paramilitary agents, and those that engaged in ethnically or socially motivated violence on a local level. The ability of the Lithuanian government to survive the series of military engagements in 1919 enhanced its legitimacy among the local population, and laid the foundation for a modern Lithuanian identity among the masses. Yet the new state and national identity were shaped in a continuous cycle of violence, social strife, mobilization, and militarization of society.
Home Front
Authors: Balkelis Tomas
Published: April 2018

This chapter discusses the militarization of Lithuanian society, most evident in the emergence of a mass paramilitary movement that developed from a small group of the local intelligentsia based in Kaunas. The paramilitary Riflemen Union of Lithuania (šauliai) played a significant military role in helping to contain Lithuania’s foes, providing security inside the country and mobilizing the civilian population for the cause of independence. It also explores several key events that were used as mobilizing moments and helped to create the home front: the putsch of the Polish Military Organization in 1919 and a soldiers’ revolt in 1920 that took place in government-controlled territory.
The Polish–Lithuanian Conflict
Authors: Balkelis Tomas
Published: April 2018

This chapter discusses the Polish–Lithuanian War of 1919–20. The war flared in May 1919 when the first open clash took place between Lithuanian and Polish troops. It gradually escalated and lasted until late November 1920 when, in Kaunas, both sides agreed to stop fighting along the demarcation line established by the League of Nations. Yet there was no final peace agreement signed, only a truce. And low-scale paramilitary violence continued unabated in the “neutral zone” along the demarcation line until as late as May 1923. The chapter argues that the war against Poland provided an opportunity for total mobilization of the whole of Lithuanian society. The fact that, during the entire interwar period, the conflict remained open-ended, ensured that the paramilitary structures and military laws that emerged during it would remain in place for much longer.
Epilogue
Authors: Balkelis Tomas
Published: April 2018

The epilogue is devoted to the long-term legacy of the post-World War I conflict in Lithuania. The war greatly contributed to the emergence and dissemination of a national and civic identity among Lithuanians. The national movement of patriotic intelligentsia that emerged in the late nineteenth century managed to transform itself into a mass movement during the turbulent period of 1914–23. Yet, in Lithuania, coming to peace after the long-term violence was a complex process that continued through the whole interwar period. The country remained militarized, as its key institutions and major societal groups stayed prepared for the production of violence. The threat of war or a coup d’état remained a constant feature of interwar Lithuanian politics and the raison d’être of a large group of people who believed that their identity was defined by their military service for the nation.
Lost in Translation in the Sino-French War in Vietnam
Authors: Baka Anna Irene , Fei Qi
Published: April 2018

This chapter deals with the Sino-French War of 1883–85 in Tonkin, an area in modern Vietnam that was colonized by the French, with an eye to shedding light as to how cultural and semantic factors interfered with the way the French and Chinese administrations perceived, interpreted, and reacted to the diplomatic and military events that led to the Sino-French war. It suggests that there was a deep communication chasm between the French and Chinese administrations and profound differences in their respective philosophies. There was diplomatic doubletalk, which was further accentuated by the ideological incoherence of the French administration and the atypical organization and functioning of the Qing Empire and particularly the Tsungli Yamen, which was basically the Chinese Foreign Ministry. The ultimate question is how the proactive, amoral Western concept of international legal order could ever coexist peacefully with the Chinese traditional ideas of justice, reasonableness, and Confucian passivity.
Trust, Signalling, and International Relations
Authors: Wheeler Nicholas J.
Published: April 2018

The purpose of this chapter is to show the limits of existing IR approaches to the question of how leaders can accurately interpret signals that are aimed at communicating their peaceful intent. The book’s argument is that it requires trust between sender and receiver for accurate signal interpretation and that this trust develops through face-to-face interaction and the process of bonding it makes possible. The five approaches to trust-building that are discussed in the chapter are: (1) ‘leap in the dark’; (2) incrementalist; (3) identity; (4) individualist; and (5) interpersonal. The chapter argues that none of these approaches adequately explains how trust can build between enemies, and hence how signals that are aimed at communicating peaceful intent can be accurately interpreted.
Enemy Images
Authors: Wheeler Nicholas J.
Published: April 2018

This chapter examines how enemy images are produced and reproduced in relations between two enemies. It identifies four drivers of security competition that block the development of trust. These are: (1) the security dilemma; (2) the problem of offence–defence differentiation; (3) peaceful/defensive self-images; (4) ideological fundamentalism; and (5) uncertainty about future intentions. Using examples such as the military stand-off on the Korean peninsula and the Libyan dismantlement of weapons of mass destruction, the chapter shows how hard it is for face-to-face diplomacy to change enemy images. It also examines the problem of ‘future uncertainty’—the problem of what happens if successor leaders do not share the trust of their predecessors and have malign intent.
The Priority of Trust in Signal Interpretation
Authors: Wheeler Nicholas J.
Published: April 2018

This chapter considers two theories that develop an alternative basis to trust for accurate signal interpretation. The two theories, both of which rely on the proposition that, if a signal can be made costly enough, this will communicate peaceful intent, are Charles Osgood’s GRIT policy and Andrew Kydd’s Reassurance Game. The former is a social-psychological approach, while the latter is a formal modelling approach. The chapter argues that neither has a convincing theory of how trust develops in adversarial contexts, and, as such, neither can explain how signals are interpreted accurately when these are sincerely aimed at communicating peaceful intent. For this, it is necessary to develop relationships of bonded trust and the mental state of trust as suspension that this makes possible.
Proposing a Theoretical Framework for the Criminal Investigation of Human Trafficking Crimes
Authors: Pajón Laura , Walsh Dave
Published: April 2018

Human Trafficking (HT) is considered as one of the most complex crimes to investigate. However, to date, little research has been conducted concerning what occurs during criminal investigations of HT. The present study, through interviewing 21 highly experienced and senior professionals from law enforcement agencies and governmental bodies in the UK, conceptualizes HT investigations under a common framework that underpins a model for the investigation of these crimes. Data from these narratives reveals that a total number of 22 investigative actions are commonly taken throughout the investigative process, following an apparent sequential route. While participants disagreed as to when/how to initiate and conclude an investigation, absolute agreement existed when considering multi-agency collaboration, tactical advice and support, and intelligence sharing (as core elements in HT criminal investigations). Such data enables both academic and practitioner communities to better identify what are effective investigation actions when these crimes are investigated.
Sporangia Production Over Time by Phytophthora ramorum on Rhododendron ‘Cunningham’s White’ After Placement at Different Relative Humidities
Authors: Tooley Paul W. , Browning Marsha
Published: April 2018

We examined the impact of relative humidity (RH) on Phytophthora ramorum sporangia production on Rhododendron ‘Cunningham’s White’. When diseased plants were maintained under continuous moisture in a mist tent, sporangia were collected from some plants for 22 weeks. More than 3,000 sporangia/leaf/week were collected over the first 3 weeks but levels declined to <100 sporangia/leaf/week after 7 weeks. We also examined the impact of drying on P. ramorum sporangia production. Diseased, detached leaves were maintained in humidity chambers (100, 96.2, 84.5, 74.9, and 56.2% RH) for up to 9 weeks and removed weekly to assess sporulation. For comparison, diseased leaves were harvested from plants maintained with dry foliage or subjected to 10 h of simulated dew nightly. All leaves supported sporulation following 5 weeks at 100% RH, 3 weeks at 96.2% RH, and 1 week at 84.5% RH. All leaves collected from plants subjected to nightly dew supported sporulation for 3 weeks; however, only 66.7% of leaves collected from plants with dry foliage supported sporulation after 1 week. Knowledge of the effects of RH levels on P. ramorum sporulation capacity will prove useful in terms of disease management recommendations and for development of predictive models and pest risk assessments.
Prospective Prognostic Cohort Study of Pressure Injuries in Older Adult Patients with Hip Fractures
Authors: Forni Cristiana , D’Alessandro Fabio , Genco Rossana , Mini Sandra , Notarnicola Teresa , Vitulli Arianna , Capezzali Daniela , Morri Mattia
Published: April 2018

OBJECTIVE:

The aim of this study was to assess the rate of pressure injury and real predictors thereof in the older adult population with hip fractures in an orthopedic hospital.

METHODS:

In this prospective prognostic cohort study, all patients admitted with fragility hip fractures were monitored over a 12-month period. On a daily basis, ward nurses and physiotherapists assessed the condition of the patients’ skin and collected data about all the predictors connected to their healthcare and hospital organization until the patients were discharged from hospital or until the onset of pressure injury.

RESULTS:

From October 1, 2013, to September 30, 2014, 467 older adult patients with fragility fractures were enrolled in the study. Of these, 27% (n = 127) developed a pressure injury. Multivariate analysis identified the following predictive factors: age older than 81 years, type of surgery, and placing the limb in a foam rubber splint. No other factor connected to the patient or medical, nursing, or rehabilitation treatment was significantly correlated to the onset of pressure injury, even when the univariate analysis showed some of them were possible predictors.

CONCLUSIONS:

Pressure injury in older adults with hip fractures is a relatively common complication, especially in high-risk patients or following certain treatments. These potential indicators could help provide safe and targeted care by preemptively identifying patients at highest risk of pressure injury.
Wound Care Center of Excellence: A Process for Continuous Monitoring and Improvement of Wound Care Quality
Authors: Howell Raelina S. , Kohan Lauren S. , Woods Jon S. , Criscitelli Theresa , Gillette Brian M. , Donovan Virginia , Gorenstein Scott
Published: April 2018

Patients with chronic wounds require complex care because of comorbidities that can affect healing. Therefore, the goal of this project was to develop a system of reviewing all hospitalized patients seen by the study authors’ wound care service on a weekly basis to decrease readmissions, morbidity, and mortality. Weekly multidisciplinary conferences were conducted to evaluate patient data and systematically assess for adherence to wound care protocols, as well as to create and modify patient care plans. This review of pathology and the performance of root-cause analyses often led to improved patient care.

GENERAL PURPOSE:

To provide information about a study using a new process for continuous monitoring to improve chronic wound care quality.

TARGET AUDIENCE:

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES:

After completing this continuing education activity, you should be better able to:

1. Recognize problems associated with chronic wound care.

2. Identify methods used in this project to improve care.

3. Illustrate the findings from this and similar projects and implications for providing improved wound care.
The Struggle Is Real: Investigating the Challenge of Assigning a Failing Clinical Grade
Authors: Couper Jeannie
Published: April 2018

AIM

The aim of the study was to explore the relationships between role strain, faculty stress, and perceived organizational support for nurse faculty who faced the decision to assign a failing clinical grade.

BACKGROUND

Although faculty are responsible for assigning a grade reflecting students' competence and ability to practice safely, faculty find it troublesome and stressful to assign a failing clinical grade.

METHOD

A national sample consisting of 390 nursing faculty completed an online four-part questionnaire with an open-ended question. Data were analyzed using parametric statistical testing and conventional content analysis.

RESULTS

Statistically significant relationships were found between role strain, faculty stress, and perceived organizational support. Ten issues related to system breakdown were identified. Most (82.6 percent) reported assigning the failing grade; many reported changes in teaching practices following the deliberation to assign a failing grade.

CONCLUSION

The decision to assign a failing clinical grade remains a significant issue for undergraduate and graduate clinical nurse faculty.
California Universal Health Care Bill: An Economic Stimulus and Life-saving Proposal
Authors: Galvani Alison P. , Durham David P. , Vermund Sten H. , Fitzpatrick Meagan C.
Published: April 2018

(Abstracted from Lancet 2017;390:2012–2014)

On June 1, 2017, the Healthy California Act was approved by the California Senate to establish universal, single-payer coverage to California residents in an effort to improve access to and efficiency in health care. Universal health care would extend coverage to the 14.7 million Californians currently uninsured or underinsured; however, political hesitation remains regarding the feasibility of universal health care at both the state and federal levels.
Continuous Glucose Monitoring in Pregnant Women With Type 1 Diabetes (CONCEPTT): A Multicenter International Randomised Controlled Trial
Authors: Feig Denice S. , Donovan Lois E. , Corcoy Rosa , Murphy Kellie E. , Amiel Stephanie A. , Hunt Katharine F. , Asztalos Elizabeth , Barrett Jon F. R. , Sanchez J. Johanna , de Leiva Alberto , Hod Moshe , Jovanovic Lois , Keely Erin , McManus Ruth , Hutton Eileen K. , Meek Claire L. , Stewart Zoe A. , Wysocki Tim , O'Brien Robert , Ruedy Katrina , Kollman Craig , Tomlinson George , Murphy Helen R.
Published: April 2018

(Abstracted from Lancet 2017;390:2347–2359)

It is established that optimal maternal glycemic control throughout pregnancy is associated with a decrease in adverse fetal outcomes. A proper glycemic index can be difficult to control in women with type 1 diabetes during pregnancy because of the complexity of insulin dose adjustment, gestational changes in insulin sensitivity, and day-to-day changes to insulin absorption in late pregnancy. Nationwide UK data show the rates of severe hypoglycemia, particularly in early pregnancy, are 5 times higher among pregnant women than nonpregnant and that only 40% of women with type 1 diabetes achieve target glycated hemoglobin (HbA1c) after 24 weeks of gestation. Continuous glucose monitoring (CGM) provides real-time quantitative information on the direction and rate of change of glucose levels.
Effects of Hearing Loss and Fast-Acting Compression on Amplitude Modulation Perception and Speech Intelligibility
Authors: Wiinberg Alan , Jepsen Morten Løve , Epp Bastian , Dau Torsten
Published: April 2018

Objective:

The purpose was to investigate the effects of hearing-loss and fast-acting compression on speech intelligibility and two measures of temporal modulation sensitivity.

Design:

Twelve adults with normal hearing (NH) and 16 adults with mild to moderately severe sensorineural hearing loss were tested. Amplitude modulation detection and modulation-depth discrimination (MDD) thresholds with sinusoidal carriers of 1 or 5 kHz and modulators in the range from 8 to 256 Hz were used as measures of temporal modulation sensitivity. Speech intelligibility was assessed by obtaining speech reception thresholds in stationary and fluctuating background noise. All thresholds were obtained with and without compression (using a fixed compression ratio of 2:1).

Results:

For modulation detection, the thresholds were similar or lower for the group with hearing loss than for the group with NH. In contrast, the MDD thresholds were higher for the group with hearing loss than for the group with NH. Fast-acting compression increased the modulation detection thresholds, while no effect of compression on the MDD thresholds was observed. The speech reception thresholds obtained in stationary noise were slightly increased in the compression condition relative to the linear processing condition, whereas no difference in the speech reception thresholds obtained in fluctuating noise was observed. For the group with NH, individual differences in the MDD thresholds could account for 72% of the variability in the speech reception thresholds obtained in stationary noise, whereas the correlation was insignificant for the hearing-loss group.

Conclusions:

Fast-acting compression can restore modulation detection thresholds for listeners with hearing loss to the values observed for listeners with NH. Despite this normalization of the modulation detection thresholds, compression does not seem to provide a benefit for speech intelligibility. Furthermore, fast-acting compression may not be able to restore MDD thresholds to the values observed for listeners with NH, suggesting that the two measures of amplitude modulation sensitivity represent different aspects of temporal processing. For listeners with NH, the ability to discriminate modulation depth was highly correlated with speech intelligibility in stationary noise.
Hatchet Flap With Transposed Nasal Inset for Midfacial Reconstruction
Authors: Custer Philip L. , Maamari Robi N.
Published: April 2018

Purpose:

The purpose of this study is to report the surgical technique and functional outcomes of the hatchet flap with transposed nasal inset for midfacial defect repairs.

Methods:

An Institutional Review Board–approved, retrospective review was performed to identify patients treated using the hatchet flap with transposed nasal inset. Patient demographics, disease etiology, defect characteristics, and postoperative complications were collected from preoperative and follow-up visits.

Results:

The hatchet flap with transposed nasal inset was performed in 5 patients between March 2016 and April 2017. Two patients developed mild transient ischemia of the nasal inset flap tip without necrosis. A suture granuloma was removed in 1 patient. No additional surgical procedures were required after the nasal inset cheek flap.

Conclusions:

The hatchet flap with transposed nasal inset is an effective procedure to address defects involving the upper cheek, lower eyelid, and medial canthus. Incorporation of the nasal inset helps prevent distortion of the ala and facilitates closure of the flap donor site. This technique may be employed in certain patients as an acceptable alternative to more extensive Mustardé or paramedian forehead flaps.
Transfer of Fresh Versus Frozen Embryos in Ovulatory Women
Authors: Shi Yuhua , Sun Yun , Hao Cuifang , Zhang Heping , Wei Daimin , Zhang Yunshan , Zhu Yimin , Deng Xiaohui , Qi Xiujuan , Li Hong , Ma Xiang , Ren Haiqin , Wang Yaqin , Zhang Dan , Wang Bo , Liu Fenghua , Wu Qiongfang , Wang Ze , Bai Haiyan , Li Yuan , Zhou Yi , Sun Mei , Liu Hong , Li Jing , Zhang Lin , Chen Xiaoli , Zhang Songying , Sun Xiaoxi , Legro Richard S. , Chen Zi-Jiang
Published: April 2018

(Abstracted from N Engl J Med 2018;378:126–136)

A previous randomized controlled trial involving women with polycystic ovary syndrome (PCOS) compared fresh-embryo transfer with elective freezing of all embryos followed by frozen-embryo transfer. The data showed that frozen-embryo transfer had a higher live-birth rate in these women compared with fresh-embryo transfer. Whether frozen-embryo transfer also increases live-birth rates among ovulatory women with infertility without PCOS is uncertain.
Pregnant Trauma Victims Experience Nearly 2-Fold Higher Mortality Compared to Their Nonpregnant Counterparts
Authors: Deshpande Neha A. , Kucirka Lauren M. , Smith Randi N. , Oxford Corrina M.
Published: April 2018

(Abstracted from Am J Obstet Gynecol 2017;217(5):590.e1–590.e9)

The World Health Organization and Centers for Disease Control and Prevention (CDC) exclude trauma-related death from national maternal mortality reports. This policy may explain why little is known about the impact of trauma on maternal mortality, despite trauma being the leading nonobstetric cause of death among reproductive-age women in the United States. The literature shows that pregnancy may increase the risk of violent trauma. In addition to maternal mortality, trauma among pregnant women can cause adverse fetal outcomes such as preterm labor, preterm premature rupture of membranes, abruption, and miscarriage. Altered maternal physiology and a lack of provider expertise with trauma in pregnant women complicate therapeutic management of these cases.
Improving Documentation of Inpatient Problem List in Electronic Health Record: A Quality Improvement Project
Authors: Rajbhandari Prabi , Auron Moises , Worley Sarah , Marks Michelle
Published: April 2018

Background

The problem list is critical in electronic documentation. It is a powerful tool for clinical decision-making because it provides a concise view of all patient problems in one place and is also a criterion for the Medicare meaningful use incentive program.

Objective

To measure the rate of utilization of problem list in electronic health records (EHR) in a pediatric hospital medicine unit and implement sequential interventions to increase the rate of use of problem list to more than 80% by the end of 2015, as measured by at least one documented hospital problem at discharge.

Methods

We performed a quality improvement process starting with a series of educational interventions. Gradual electronic changes were also made in our EHR to reach our goal.

Results

The use of the problem list for pediatric hospital medicine rose from 47% to 100% in June 2015 and continues to maintain well above the goal of 80%. The problem list usage throughout the children’s hospital also rose to 100% within 9 months of project implementation.

Conclusions

Educational interventions and technology leveraging allowed us to achieve and sustain improvement in appropriate problem list usage.
Surgery, Complications, and Quality of Life
Authors: Archer Stephanie , Pinto Anna , Vuik Sabine , Bicknell Colin , Faiz Omar , Byrne Ben , Johnston Maximilian , Skapinakis Petros , Athanasiou Thanos , Vincent Charles , Darzi Ara
Published: April 2018

Objective:

To determine whether psychosocial factors moderate the relationship between surgical complications and quality of life (QoL).

Background:

Patients who experience surgical complications have significantly worse postoperative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear whether they affect QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients postoperatively.

Methods:

This is a longitudinal cohort study; data were collected pre-op, 1 month post-op, 4 months post-op, and 12 months post-op. A total of 785 patients undergoing major elective gastrointestinal, vascular, or cardiothoracic surgery who were recruited from 28 National Health Service sites in England and Scotland took part in the study.

Results:

Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (P < 0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL.

Conclusions:

Surgical complications alongside other sociodemographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies before surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow-up procedures.
Six-month follow-up of the injured trauma survivor screen: Clinical implications and future directions
Authors: Hunt Joshua C. , Chesney Samantha A. , Brasel Karen , deRoon-Cassini Terri A.
Published: April 2018

BACKGROUND

The injured trauma survivor screen (ITSS) has been shown to predict posttraumatic stress disorder (PTSD) and depression risk at 1 month after traumatic injury. This study explored the ability of the ITSS to predict chronic distress after injury, as well as the impact of combining the ITSS with an additional screening measure.

METHODS

Patients were enrolled following admission to a Level I trauma center. Baseline measurements were collected during initial hospitalization, and follow-up measures were collected an average of 6.5 months after injury. Receiver operating characteristic (ROC) curve analyses were run to determine predictive accuracy, controlling for participants who had mental health intervention and for those who experienced additional potentially psychologically traumatic events since their injury event.

RESULTS

Utilizing a cut score of 2, the ITSS PTSD scale had a sensitivity of 85.42%, specificity of 67.35%, negative predictive value (NPV) of 91.9% and positive predictive value (PPV) of 51.4%. The combined PTSD risk group (risk positive on the baseline ITSS and the PTSD checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) had a sensitivity of 72.92%, specificity of 81.63%, NPV of 88.2%, and PPV of 61.6%. Also using a cut score of 2, the ITSS Depression Scale had a sensitivity of 72.50%, specificity of 70.29%, NPV of 91.1%, and PPV of 37.9%.

CONCLUSION

The nine-item ITSS, which takes approximately 5 minutes to administer, is a stable screening tool for predicting those most at risk for PTSD and/or depression 6 months after admission to a Level I trauma center following traumatic injury. The combined PTSD risk group data provide evidence that symptom evaluation by a psychologist can improve specificity. These results further inform the recommendation of the American College of Surgeons Committee on Trauma regarding PTSD and depression screening in trauma centers.

LEVEL OF EVIDENCE

Prognostic study, level III.