Clinical competence in performing and recognising a mediolateral episiotomy of protective angle and length: a systematic review

Objective: It is assumed that all doctors and midwives understand and apply evidence‐based principles in performing episiotomies in their everyday practice. However, remarkable discrepancies between even the most reputable literature sources in defining and describing the technique of performing mediolateral episiotomy (MLE) suggest that there is much ambiguity and confusion for both researchers and clinicians alike. Design: The systematic review protocol was written prior to starting the review and registered in the international prospective register of systematic reviews (PROSPERO/ID CRD42017070523) last updated on December 15, 2017. The review is reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Methods: A database search was performed using: Medline, CINAHL, Scopus, Informit, the Cochrane Library and PubMed from database inception to 17 September 2017, with a final search on 10 February 2017. Studies were included if they examined clinicians' competency in performing an 'ideal' or 'correct' mediolateral episiotomy, as well as those studies that compared the performance of different professional roles. Studies usually defined an 'ideal' incision as one that met the criteria of an acceptable angle of incision from the midline, starting incision point distance from the midline and in terms of the length of the incision created. Results: While many of the studies included in this review were not of high quality (author self‐assessment) and had their own study criteria for a MLE, the literature suggests clinicians are generally unable to perform or simulate episiotomies within such standards. Overall, most of the literature reported doctors were performing more 'ideal', lateral and longer incisions compared to midwives; however, there were studies that found the opposite, showing statistically significant results in favour of midwives performing more protective episiotomies. There was no association between clinicians' participation in formal training courses and their ability to perform the 'ideal' incision, though one study did find an increased number of episiotomies performed under supervision improved clinicians competency. Conclusion: The obvious lack of understanding around defining and performing MLE for clinicians of various professional roles suggests the need to produce a uniform set of guidelines, and to develop a universal, low‐cost approach for teaching and performing the MLE technique in any clinical environment around the world

Constituents of a Global Mindset: An Empirical Study with Japanese Managers

Based on government-inspired economic development in the Meiji Era and again in the aftermath of the Pacific War, Japan had quickly established itself as a major contributor to global business. In the case of the Meiji Era expansion, the dramatic advances have commonly been interpreted as resulting from the herculean efforts of a special group, namely ex-samurai leaders acting as agents of the administration, and in the post-war reconstruction period, a larger societal sub-group, Japanese “salary men,” functioned as the agents of change. Each of these groups has been associated with special qualities, in particular a single-minded dedication to hard work for nation and company. With this historical background in mind, and coming after a period of some two decades of economic decline, the current empirical research study was conducted in order to map out an appropriate global mindset “profile” for Japanese business managers engaged in contemporary global business. After establishing the constructs by which “global mindset intensity” could be assessed, a questionnaire survey (n=71) and subsequent in-depth interviews (n=11) were undertaken with Japanese international managers in western Japan. Based on the findings from this pluralist methodology, the researchers have suggested that the ideal corporate role model of Japan’s post-war reconstruction and growth period, the “salary man,” was now effectively redundant, and that the currently accepted ideal profile for Japanese international businessmen was more worldly and individualistic, with expertise and “global mindset intensity” drawn from personalized international business experience, reminiscent of established Western business ideals

Distributed and Cooperative Link Scheduling for Large-Scale Multihop Wireless Networks

A distributed and cooperative link-scheduling (DCLS) algorithm is introduced for large-scale multihop wireless networks. With this algorithm, each and every active link in the network cooperatively calibrates its environment and converges to a desired link schedule for data transmissions within a time frame of multiple slots. This schedule is such that the entire network is partitioned into a set of interleaved subnetworks, where each subnetwork consists of concurrent cochannel links that are properly separated from each other. The desired spacing in each subnetwork can be controlled by a tuning parameter and the number of time slots specified for each frame. Following the DCLS algorithm, a distributed and cooperative power control (DCPC) algorithm can be applied to each subnetwork to ensure a desired data rate for each link with minimum network transmission power. As shown consistently by simulations, the DCLS algorithm along with a DCPC algorithm yields significant power savings. The power savings also imply an increased feasible region of averaged link data rates for the entire network

Managing dilemmas of resource mobilization through Jugaad: a multi-method study of social enterprises in Indian healthcare

This study focuses on the dilemmas that social entrepreneurs encounter, and the practices used to manage dilemmas over time. Using a multi-method approach involving event structure analysis and an inductive multiple case study, we find four key organizational practices—asset multiplication, leveraging human capital, social embeddedness and affordable quality —that embody jugaad elements of frugality and inclusivity. Adding to social entrepreneurship literature, this study demonstrates that the jugaad approach is conceptually distinct from bricolage and relevant to study resource mobilization processes of social enterprises