Extending Weingarten to the Nonunion Setting: A History of Oscillation

Passed in response to the nineteenth century hostility towards union activity, the NLRA traditionally was viewed as a pro-union statute. However, as much as the Act contains provisions clearly aimed at protecting union activity, the Act explicitly applies to non-union employees as well as union employees. Nevertheless, many nonunion employers and employees are unaware of the existence of the NLRA despite it being the only law governing the relationship between an employer and its employees as a group in most private sector establishments in this country. This Note analyzes the conflicting history surrounding this issue and asserts that the necessary pre-requisites of section 7 (hereinafter § 7) of the NLRA are not satisfied when the Weingarten right is extended to the nonunion setting. The Note will begin the discussion with an analysis of Weingarten, the Supreme Court case that established Weingarten rights in the union setting. Next, the competing NLRB decisions regarding whether Weingarten should be extended to the nonunion setting will be set forth. Having set the stage, the discussion will turn to the definition of protected concerted activity within the meaning of the NLRA, specifically within the meaning of § 7 of the NLRA. The Note will then argue that the essential elements of concertedness and the mutuality are not met when only one employee in the nonunion setting is acting in relation to the employer during an investigatory meeting. As a result, this Note concludes that the Board erroneously grounded its Epilepsy decision on the practical consequences of its decision rather than a sufficient showing of concerted activity and mutuality when one nonunion employee, involved in an investigatory meeting with the employer, seeks the aid of a fellow employee

Patterns of Clinical Reasoning in Physical Therapist Students

Background and Purpose. Clinical reasoning is a complex, nonlinear problem–solving process that is influenced by models of practice. The development of physical therapists’ clinical reasoning abilities is a crucial yet underresearched aspect of entry-level (professional) physical therapist education. Objectives. The purpose of this qualitative study was to examine the types of clinical reasoning strategies physical therapist students engage in during a patient encounter. Methods. A qualitative descriptive case study design involving within and across case analysis was used. Eight second-year, professional physical therapist students from 2 different programs completed an evaluation and initial intervention for a standardized patient followed by a retrospective think-aloud interview to explicate their reasoning processes. Participants’ clinical reasoning strategies were examined using a 2-stage qualitative method of thematic analysis. Results. Participants demonstrated consistent signs of development of physical therapy–specific reasoning processes, yet varied in their approach to the case and use of reflection. Participants who gave greater attention to patient education and empowerment also demonstrated greater use of reflection-in-action during the patient encounter. One negative case illustrates the variability in the rate at which students may develop these abilities. Conclusions. Participants demonstrated development toward physical therapist–-specific clinical reasoning, yet demonstrated qualitatively different approaches to the patient encounter. Multiple factors, including the use of reflection-in-action, may enable students to develop greater flexibility in their reasoning processes

Proteomic analysis of acclimation in the Arabidopsis thaliana thylakoid membrane

Photosynthetic acclimation is the ability of photosynthetic organisms to respond to light irradiance by adjusting the composition of the thylakoid membrane to maintain photosynthetic efficiency. The work described in this thesis utilises mass spectrometry-based proteomics to quantify the changes in thylakoid protein abundance that occur during acclimation in Arabidopsis thaliana. A novel strategy for labelfree quantitative thylakoid proteomics was developed and combined with electron microscopy, structured illumination microscopy, and various biochemical and spectroscopic analyses to further our understanding of thylakoid proteome remodelling in response to environmental conditions. First, the thylakoid proteomes of Arabidopsis plants grown under low, moderate and high light intensity were compared. Arabidopsis grown outdoors in naturally fluctuating light conditions were then investigated to identify mechanisms particularly important for photosynthesis in the field. Finally, the phosphorylation mutants stn7 and tap38, the former previously reported as defective in long term acclimation, grown under different light irradiances were subjected to proteomic analysis, as well as the proton gradient regulation mutant pgr5. The results of this thesis revealed changes in protein abundance associated with light harvesting, electron transfer, thylakoid architecture and photoprotection. STN7 is not essential for acclimation but the effects of perturbed LHCII (de)phosphorylation on grana size and light harvesting are compensated for by alterations to photosystem stoichiometry. While phosphorylation regulates dynamic thylakoid stacking, proteomic analysis revealed changes in CURT1 and RIQ1/2 protein abundance associated with long term alterations in grana size. Low light plants maintain fast relaxation of quenching whereas plants acclimated to high light intensity increase their capacity for linear electron transfer and rapid induction of quenching. Constant light acclimated plants favour PGR5/PGRL1-mediated cyclic electron transfer while those in a natural environment focus on increasing NDH. While individual changes in thylakoid protein abundance have been studied extensively in the past, this data, which includes many regulatory proteins not previously quantified, provides a view of thylakoid proteome remodelling in unprecedented detail

Evaluating conditions for transboundary Marine Spatial Planning: Challenges and opportunities on the island of Ireland

Transboundary cooperation is viewed as an essential element of Marine Spatial Planning (MSP). While much of the MSP literature focuses on the need for, and benefits of, transboundary MSP, this paper explores the political and institutional factors that may facilitate the effective transition to such an approach. Drawing on transboundary planning theory and practice, key contextual factors that are likely to expedite the transition to transboundary MSP are reviewed. These include: policy convergence in neighbouring jurisdictions; prior experience of transboundary planning; and good working relations amongst key actors. Based on this review, an assessment of the conditions for transboundary MSP in the adjoining waters of Northern Ireland and the Republic of Ireland is undertaken. A number of recommendations are then advanced for transboundary MSP on the island of Ireland, including, the need to address the role of formal transboundary institutions and the lack of an agreed legal maritime boundary. The paper concludes with some commentary on the political realities of implementing transboundary MSP

Effects of interventions for women and their partners to reduce or prevent stress and anxiety: A systematic review

© 2021 The Authors Background: The period from conception to two years postpartum (the first 1000 days) represents a normative transitional period, which can be potentially stressful for some parents. Parental stress and anxiety adversely impacts psychological and physical health for parents and children. Aim: The aim of this review is to systematically examine effects of interventions for women and their partners to reduce or prevent stress and/or anxiety during the first 1000 days. Methods: MEDLINE, Embase, CINAHL, PsychINFO, and Maternity and Infant Care were searched from inception to March 2019. Randomised controlled trials examining intervention effects on parental stress and/or anxiety during first 1000 days were eligible for inclusion. Data were independently extracted by two reviewers and narratively synthesised. Findings: Fifteen interventions, reported in 16 studies, met inclusion criteria (n = 1911 participants). Overall, findings were inconsistent and the majority of trials demonstrated high risk of bias. Interventions were predominantly delivered to women during pregnancy and only two studies included fathers. There was some evidence that adapting interventions to the pre and postnatal periods provided benefits for stress and anxiety reduction, however there was limited evidence for individual intervention types or approaches. Conclusions: There is currently inconsistent evidence of what interventions are most effective for women during the first 1000 days and there is insufficient evidence for any interventions for male partners during this period. There is a clear need for rigorous development and examination of interventions developed specifically to reduce or prevent stress and/or anxiety across the first 1000 days

A novel method to quantify fibrin-fibrin and fibrin-α2AP cross-links in thrombi formed from human trauma patient plasma.

The widespread use of the anti-fibrinolytic agent, tranexamic acid (TXA), interferes with the quantification of fibrinolysis by dynamic laboratory assays such as clot lysis, making it difficult to measure fibrinolysis in many trauma patients. At the final stage of coagulation, Factor XIIIa (FXIIIa) catalyses the formation of fibrin-fibrin and fibrin-α2-antiplasmin (α2AP) cross-links which increases clot mechanical strength and resistance to fibrinolysis. Here, we develop a method to quantify fibrin-fibrin and fibrin-α2AP cross-links that avoids the challenges posed by TXA in determining fibrinolytic resistance in conventional assays. Fibrinogen alpha chain (FGA-FGA), fibrinogen gamma chain (FGG-FGG) and FGA-α2AP cross-links were quantified using liquid-chromatography-mass spectrometry (LC-MS) and parallel reaction monitoring (PRM) in paired plasma samples from trauma patients pre- and post-fibrinogen replacement. Differences in the abundance of cross-links in trauma patients receiving cryoprecipitate (cryo) or fibrinogen concentrate (Fg-C) were analysed. The study found that the abundance of cross-links was significantly increased in trauma patients post-cryo, but not Fg-C, transfusion (p < 0.0001). The abundance of cross-links was positively correlated with the toughness of individual fibrin fibres, the peak thrombin concentration and FXIII antigen (p < 0.05). We have developed a novel method that allows us to quantify fibrin cross-links in trauma patients who have received TXA, providing an indirect measure of fibrinolytic resistance. Using this novel approach we have avoided the effect of TXA and shown that cryo increases fibrin-fibrin and fibrin-α2AP cross-linking when compared to Fg-C, highlighting the importance of FXIII in clot formation and stability in trauma patients

A comparison of vaginal versus buccal misoprostol for cervical ripening in women for labor induction at term (the IMPROVE trial): a triple-masked randomized controlled trial

Background Cervical ripening is commonly needed for labor induction. Finding an optimal route of misoprostol dosing for efficacy, safety, and patient satisfaction is important and not well studied for the buccal route. Objective To compare the efficacy and safety of vaginal and buccal misoprostol for women undergoing labor induction at term. Study Design The IMPROVE trial was an institutional review board–approved, triple-masked, placebo-controlled randomized noninferiority trial for women undergoing labor induction at term with a Bishop score ≤6. Enrolled women received 25 mcg (first dose), then 50 mcg (subsequent doses) of misoprostol by assigned route (vaginal or buccal) and a matching placebo tablet by the opposite route. The primary outcomes were time to delivery and the rate of cesarean delivery performed urgently for fetal nonreassurance. A sample size of 300 was planned to test the noninferiority hypothesis. Results The trial enrolled 319 women, with 300 available for analysis, 152 in the vaginal misoprostol group and 148 in the buccal. Groups had similar baseline characteristics. We were unable to demonstrate noninferiority. The time to vaginal delivery was lower for the vaginal misoprostol group (median [95% confidence interval] in hours: vaginal: 20.1 [18.2, 22.8] vs buccal: 28.1 [24.1, 31.4], log-rank test P = .006, Pnoninferiority = .663). The rate of cesarean deliveries for nonreassuring fetal status was 3.3% for the vaginal misoprostol group and 9.5% for the buccal misoprostol group (P = .033). The rate of vaginal delivery in <24 hours was higher in the vaginal group (58.6% vs 39.2%, P = .001). Conclusion We were unable to demonstrate noninferiority. In leading to a higher rate of vaginal deliveries, more rapid vaginal delivery, and fewer cesareans for fetal issues, vaginal misoprostol may be superior to buccal misoprostol for cervical ripening at term

Fidelity of Interventions to Reduce or Prevent Stress and/or Anxiety from Pregnancy up to Two Years Postpartum: A Systematic Review

IntroductionIntervention fidelity refers to whether an intervention is delivered as intended and can enhance interpretation of trial outcomes. Fidelity of interventions to reduce or prevent stress and anxiety during pregnancy and postpartum has yet to be examined despite inconsistent findings for intervention effects. This study systematically reviews use and/or reporting of intervention fidelity strategies in trials of interventions, delivered to (expectant) parents during pregnancy and postpartum, to reduce or prevent stress and/or anxiety.MethodsMEDLINE, Embase, CINAHL, PsychINFO, and Maternity and Infant Care were searched from inception to March 2019. Studies were included if they were randomised controlled trials including pregnant women, expectant fathers and/or partners during pregnancy, and/ or parents within the first two years postpartum. The National Institutes of Health Behavior Change Consortium checklist was used to assess fidelity across five domains (study design, provider training, delivery, receipt, enactment).ResultsSixteen papers (14 interventions) were identified. Average reported use of fidelity strategies was ‘low’ (45%), ranging from 17.5 to 76%. Fidelity ratings ranged from 22% for provider training to 54% for study design.ConclusionsLow levels of intervention fidelity may explain previous inconsistent effects of stress and anxiety reduction interventions. Important methodological areas for improvement include intervention provider training, fidelity of comparator conditions, and consideration of non-specific treatment effects. Increased methodological rigour in fidelity enhancement and assessment will improve intervention implementation and enhance examination of stress and anxiety reduction and prevention interventions delivered during pregnancy and the postpartum