Mothers construct fathers: Destabilized patriarchy in La Leche League

This paper examines changing masculine ideals from the point of view of women homemakers through a case study of La Leche League, a maternalist organization dedicated to breastfeeding and mother primacy. We suggest two reasons for studying the League: first, an emerging literature suggests that changing norms are seeping into many such seemingly conservative groups, and second, the League continues to be highly successful among white, middle-class, married women. The paper looks at two aspects of masculinity, examining changes in the League through fieldwork, interviews, and content analysis, and finds that new norms of increased father involvement and decreased rights over women's bodies have both influenced League philosophy. We conclude that while in some respects a measure of the decline of men's patriarchal privileges, the League's changes also may contribute to a “restabilization” of male dominance in a modified, partial form.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43548/1/11133_2004_Article_BF00990071.pd

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

UNDERSTANDING LOCALIZATION OF SERVICE: A CHINESE PERSPECTIVE

[[abstract]]Globalization of business and theory act to draw attention from the local. However, service experiences are culturally construed and extant research supports localisation as a basis for business success. The nature of Chinese collectivist-high context culture stands in marked contrast to Western individualistic-low context culture. Its distinct nature and rising economic significance make it ripe for attention by researchers seeking to develop theoretical explanations of service localization. This paper reports research that deepens understanding of service theory to evaluations of service quality,internal service, adoption of self-service technologies and predisposition to service. The results of this work support a culturally construed theoretical perspective towards localisation of service. This is significant for managers wishing to understand and influence design and delivery of service in the Chinese context

Synchronous learning best practices: An action research study

Low cost and significant advances in technology now allow instructors to create their own virtual learning environments. Creating social interactions within a virtual space that emulates the physical classroom remains challenging. While students are familiar with virtual worlds and video meetings, they are inexperienced as virtual learners. Over a nine year period we applied iterative cycles of action research through numerous large classes to systematically uncover attributes of success when executing synchronous learning in distributed environments. Findings show technology is not the source of problems; rather, difficulties emerge from human behaviors and their interactions with system features. We conclude with practical takeaway guidelines for video conferencing and immersive virtual environments and a model of nexus of control that elaborates software and classroom management attributes that can lead to successful execution