Why the next president should consider making offshore balancing their foreign policy default

Foreign policy experts John Mearsheimer and Stephen Walt recently made a renewed call for the US to adopt an offshore balancing approach to its foreign policy. Christine Gallagher writes that this approach – which pragmatically aims to limit US intervention abroad in favor of local actors checking rising powers themselves – should be seriously considered by the next occupant of the White House, whoever that might be

The Effectiveness of Implementing Standard of Care Best Practices Including Use of Daily Incentive Spirometry to Improve Dyspnea and Quality of Life in Adults with Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease characterized by symptoms of dyspnea, cough, and wheezing. Many patients with COPD are on daily medications for their symptoms yet these symptoms continue to persist, impairing their quality of life. Patients with COPD experience respiratory muscle weakness that contributes to dyspnea and an inability to participate in daily activities. GOLD (2014) guidelines state that the goal of therapy in these patients is to reduce symptoms, increase participation in activities, and restore the highest level of independent functioning. The guidelines recommend the use of inspiratory muscle training (IMT) in the plan of care for these patients in order to reduce symptoms and studies have shown that an incentive spirometer can be used to perform IMT effectively. The incentive spirometer is a simple, cost-effective device that encourages deep breathing, which promotes lung expansion. The purpose of the EBP project was to improve quality of life and dyspnea in adult patients, ages 45-70, with COPD through the daily use of incentive spirometry. The project was based on the GOLD (2014) guidelines. The St. George’s Respiratory Questionnaire and Visual Analogue Scale for breathlessness were administered before and after the protocol and scores were compared. The project showed a decrease in dyspnea and improvement in quality of life after an eight week intervention period. The results of this project demonstrated that including IMT in the plan of care for patients with COPD can reduce dyspnea and improve quality of life, leading to quality, cost-effective, accessible care and optimal outcomes in these patients

Through a Feminist Lens: Language, Power and Identity in Catalan Nationalism

The goal for my master’s thesis is to understand how the working class women of Catalunya (specifically women that lived in the small farming villages in the region of Les Garrigues),contributed to the survival of Catalan. Catalunya is an autonomous region of Spain that endured more than three decades of the Francisco Franco dictatorship (1934-1975) that attempted to eradicate the Catalan language and culture. As stated by Everly (2003): “[…] the regional exile of Catalunya from the rest of Spain acts as a backdrop provoking women to go a step further and experiment with their own sense of gender separation within their particular culture” (p. 15). In other words, not only did Catalan women experience the oppressive effects of the patriarchal Spanish culture, but they also grappled with their Catalan identity under the nation-state ideology where Catalunya was disavowed a voice. Moreover, the significance women played in the survival of the Catalan language cannot be understated: “[…] the language became relegated to secretive hidden corners of the home [during the Franco dictatorship], to the traditionally domestic maternal feminine sphere; in effect, Catalan language was exiled from Catalunya yet survived in the feminine space of the home” (p. 21). Current research regarding Catalan, women, nationalism and feminism uses non ethnographic methods. Everly (2003) examined the writings of four influential Catalan women writers who wrote and published in exile during the Franco dictatorship. Nash (1996) reviewed early 20th century Spanish history to understand the role feminism played in Catalunya with respect to Catalan nationalism. Radcliff (2002) reviewed the housewives’ associations that formed across Spain in the 1960s and 1970s revealing the complexity of the various women’s movement ideologies at play. Previous studies examined at a distance and have not taken an ethnographic approach to gaining a deep cultural understanding of the interplay between the Catalan language, nationalism and feminism. My study uses an ethnographic method to understanding and hearing the voices of the Catalan women that spoke in the private feminine sphere against Franco’s attempts to eradicate the Catalan language. Nine semi-structured ethnographic interviews were conducted in the pueblos of Les Borges Blanques and Juneda. Using the Cultural Discourse Analysis framework, as understood by Carbaugh (2007), I extracted the cultural elements of the communicative acts from the transcribed interview data. The analysis resulted in four major research findings. First, the struggle for gender equality is embedded in gendered labor and gendered spaces (e.g. private and private-public spaces). Second, Catalan norms of communication are complexly tied up in identity, relationships and dwelling. Third, the various levels of proficiency in the Catalan language require that Catalan communication norms flex to accommodate all Catalan native habitants as legitimate Catalan interlocutors. And finally, Catalan mothers perceive their communicative behavior as essential to maintaining the Catalan language and culture. Ultimately, the voices of the working class women that continued to speak Catalan in the private and private-public sphere during the Franco dictatorship remain undiscovered at large. This research cracks open an academic door to reveal complex female communicative behavior under the Franco regime in the pueblos of Les Borges Blanques and Juneda. These unknowingly feminist voices begin to unravel the intersectionality of language, identity and nationalism and show how these elements played out on the bodies of Catalan women, where the nation-body of the autonomous region of Catalunya still survives today on account of flexible Catalan communication norms and Catalan women resisting patriarchal authority

Evaluation of COVID-19 on AMT Part 147 Schools Related to Knowledge-based Testing Scores for AMG, AMA, & AMP Mechanic Certification Examinations

The FAA mandates under CFR 14, Part 65 Subpart D § 65.75 Knowledge requirements, that an applicant for a mechanics certificate must possess. The knowledge-based test, more commonly referred to as the “written” examinations and covers materials specific to either an airframe certificate (AMA) or a powerplant certificate (AMP) with the general (AMG) component being common to each. The prescribed level of testing for a Part 147 school is specifically outlined under § 147.38a Quality of instruction and measured by the results of the KBT examinations for all students tested and measured against a national norm. During the period of COVID both training and learning challenges have taken place throughout the system of approved institutions. This paper investigates standardized national norm scores at a pre-pandemic level and compares them to the time frame of the results during the actual pandemic using data from March 2020 up to the current period. Data gathered from the FAA Form 8080-08 collected by AFS630 was reviewed and analyzed and stratified by institution, regions, and students. A noticeable drop in the national scores and the individual scores related to each of the three testing regimes, AMG, AMA, and AMP of all the accredited schools was documented. This research endeavors to draw possible conclusions as to the underlying fundamental reasons for the phenomena as discussed, offering both insight and possible corrective actions to be considered

Coverage for Obesity Prevention & Treatment Services: Analysis of Medicaid & State Employee Health Insurance Programs

BACKGROUND Despite the high prevalence of obesity among U.S. adults, coverage for evidence-based obesity treatment modalities is inconsistent across states. The primary objective of this study was to examine changes in coverage for adult obesity prevention and treatment services within Medicaid programs and state employee health plans between 2009 and 2017. METHODS Changes in coverage were assessed by comparing data from plan year (PY) 2016/2017 to baseline data collected during PY 2009/2010. Data were obtained through an extensive review of administrative documents, health plan websites, provider manuals, subscriber handbooks, fee schedules, and drug formularies from Medicaid and state employee health insurance programs in all fifty states and the District of Columbia. Source materials were reviewed for indications of coverage and payment policies specific to evidence-based treatment modalities for adults (≥ 21 years of age) with obesity, including behavioral/nutritional counseling, pharmacotherapy, and bariatric surgery. RESULTS Like 2009, state programs were most likely to cover bariatric surgery and least likely to cover pharmacotherapy for members with obesity. Evidence of coverage for adult obesity treatment modalities increased in both Medicaid and state employee programs between 2009 and 2017, with more changes observed among state employee programs. The proportion of state employee programs indicating coverage increased by 37% for behavioral/nutritional counseling, 20% for pharmacotherapy, and 16% for bariatric surgery. The proportion of Medicaid programs indicating coverage increased by 18% for behavioral/nutritional counseling, 4% for pharmacotherapy, and 8% for bariatric surgery. CONCLUSIONS Our findings suggest that some states have bolstered coverage for evidence-based obesity treatment modalities in recent years. However, many states continued to deny reimbursement for non-surgical obesity treatment options that are supported by clinical consensus recommendations. Unclear guidance on what constitutes appropriate and reimbursable care for obesity-related services within Medicaid and state employee health programs likely prevents providers from referring highly-motivated beneficiaries with obesity to effective care. Where reimbursement for evidence-based obesity treatments has expanded, educating providers and beneficiaries on the availability and proper utilization of these services may improve obesity-related health outcomes

The health and health behaviours of Australian metropolitan nurses: An exploratory study

Background: Nurses make up the largest component of the health workforce and provide the majority of patient care. Most health education is delivered by nurses, who also serve as healthy living and behavioural role models. Anything that diminishes their health status can impact their credibility as role models, their availability and ability to deliver quality care, and is potentially disadvantageous for the health of the population. Study aims were to investigate nurses\u27 overall health and the presence of chronic disease; to describe nurses\u27 health-related behaviours and to compare them to those of the general population, with both groups matched by age and gender. Methods: Cross-sectional descriptive paper-based survey of nurses from two Sydney metropolitan hospitals using established instruments and questions and measurements taken with standardised methods. Results: This nursing sample (n = 381) had a mean age of 39.9 (SD 11.7, range 20-67) years, Most (n = 315; 82.7 %) were female, worked full-time (80.0 %), and were shift workers (93.0 %). The majority (94.0 %) indicated good, very good or excellent health, despite 42.8 % indicating they had chronic disease. The most common risk factors for chronic disease were inadequate vegetable (92.6 %) and fruit intake (80.1 %), overweight and obesity (44.0 %) and risky alcohol intake (34.7 %); health screening behaviours were not ideal. Aside from overweight and obesity, these risk factors were more prevalent in nurses than the equivalent group of the New South Wales population, particularly for risky alcohol intake which was much more common in female nurses and most marked in those aged under 35 years. However, 80 % met the guidelines for physical activity, more than the equivalent group of the New South Wales population. Conclusion: There are early \u27warning signs\u27 concerning the health status of nurses. Despite perceiving current good health, support is required for nurses to prevent future chronic disease, particularly in the areas of nutrition and alcohol intake. With these concerns, the nursing workforce ageing and demands for care increasing, it is now time to implement health enhancing strategies for nurses

BlacKkKlansman reverses film's historic power narrative between Blacks and Whites

Spike Lee's new film about the infiltration of the KKK by a black police detective in the 1970s, BlacKkKlansman was released this month. Christine Gallagher writes that not only does the film make allusions to the America of Donald Trump, it also reverses the previously powerful historic film binary where whites are sympathetic and blacks are portrayed negatively

The child, the family and the GP: tensions and conflicts of interest for GPs in safeguarding children May 2006-October 2008 Executive summary May 2009 and Research Brief March 2010

This Executive Summary and Research Brief provide an overview of a research project (full report available on the repository) exploring the key role identified for GPs in safeguarding children. The initial focus of this research was to investigate potential ‘conflicts of interest’ where parents and children were both patients of the GP and to identify strategies for managing these conflicts. In response to initial feedback from the piloting of research tools, the focus of the research was broadened to explore and understand the range of conflicts, interests and tensions that might constrain the participation and engagement of GPs in safeguarding children and child protection processes, and the complexity of relationships between GPs, parents and children, and other professionals. A summary of the study methods, strengths and limitations and key findings is provided, together with messages for policy, research and practice

The mental health of nurses in acute teaching hospital settings: A cross-sectional survey

Background: Nursing is an emotionally demanding profession and deficiencies in nurses\u27 mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses\u27 health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals. Methods: A cross sectional survey design was used. Results: A total of 1215 surveys were distributed with a usable response rate of 382 (31.4%). Altogether 53 nurses (14%) reported a history of mental health disorders, of which n=49 (13%) listed diagnoses of anxiety and/or depression; 22 (6%) were currently taking psychoactive medication. Symptoms that could potentially indicate a mental health issue were more common, with 248 (65.1%) reporting they had experienced symptoms sometimes or often in the last 12month. Conclusion: Nurses and their managers should strive to create workplaces where working practices promote nurses\u27 health and wellbeing, or at least are configured to minimise deleterious effects; where both nurses and their managers are aware of the potential for negative effects on the mental health of the workforce; where cultures are such that this can be discussed openly without fear of stigma or denigration

IT Workforce Trends: Implications for Curriculum and Hiring

A panel on workforce trends in the information technology industry was held at the AMCIS meeting in Toronto, Canada, in August 2008. Panelists discussed a continuing research project about the current state of the IT workforce and future trends, sponsored by the Society for Information Management (SIM). The initial phase was a study of workforce trends in IT client companies, completed in 2006. Results from phase one revealed a shift in the mission of the information system function from delivering technology-based solutions to managing the process of delivering solutions. Client-facing capabilities were found to be critical to this mission as well as business and project-management capabilities. Phase two examined workforce trends in IT provider companies. Results indicate that provider firms are also seeking client-facing capabilities, project management and business domain knowledge over technical capabilities. Panelists compared the results of the two phases and the implications for curriculum design, hiring, and training practices. The results of this research underline a looming crisis in several areas: 1) graduates who are not trained in areas that the marketplace is seeking; 2) thin pipeline for specific technical skills; 3) increasing pressure to source IT capability; and 4) lag in university responsiveness to the needs of the marketplace