Ouch, That Hurts: Childbirth-Related Pain Management and the Inappropriate Replacement of Traditional Obstetrical Knowledge in Kumaon, Uttarakhand, India

Throughout India, obstetrical knowledge and practice has been developed and passed down by generations of women. In many Indian societies, traditional birth attendants, or dais, remain the gatekeepers of childbirth-related knowledge. Yet with the push towards institutional delivery, traditional knowledge and practices are being increasingly replaced with modern and Western ones. While the trend of hospital deliveries has yielded positive health outcomes, its socio-cultural consequences remain unclear. Situated in Uttarakhand’s Kumaon Himalayas, this study employs a bio-social framework and begins to reveal these consequences. Using labor pain management as an entry point, this study argues that the push towards institutional delivery replaces traditional and culturally appropriate obstetric practices with modern and culturally inappropriate ones. This study begins by articulating ideas about childbirth, pain, and pain management that are shared amongst Kumaoni women. It then documents traditional Kumaoni methods of labor pain management and compares them with methods used in area hospitals. Next, it discuses women’s attitudes towards and experiences in government hospitals and suggests novel reasons for which Indian women fear childbirth. The paper then argues that, despite dais having been systematically disenfranchised by the Indian government, the traditional knowledge they possess remains pertinent. Ultimately, the study advocates for the preservation, institutionalization, and awareness of traditional and culturally appropriate methods of labor pain management as a means to promote institutional delivery while also preserving dai culture and allowing women to have healthful and fulfilling childbirth experiences

Behavioral War Powers

A decade of war has meant a decade of writing on war powers. From the authority to start a war, to restrictions on fighting wars, to the authority to end a war, constitutional lawyers and scholars have explored the classic issues (war initiation, prosecution, and termination) through the classic prisms (text, history, and function) for a new generation of national security challenges. Despite the volume of writing on war powers and the urgency of the debates in the context of Iraq, Afghanistan, Libya, and Syria, war powers debates are widely seen as stagnant. We introduce a new set of perspectives into the war powers literature. Over the last four decades, behavioral psychologists have identified persistent biases in individual and group decisionmaking. The behavioral revolution has had a significant impact on legal scholarship — primarily in law and economics — and has also influenced scholars in international relations, who increasingly write about psychological biases and other decisionmaking challenges. These insights, however, have yet to be applied in the war powers context. This Article brings the behavioral literature into the conversation on war powers, showing how lessons from behavioral psychology are relevant to decisions on war and peace. It outlines a variety of psychological biases that bear on decisions about war and peace, applies these lessons to a variety of war powers debates, and discusses broader institutional design strategies for debiasing decisionmaking. The lessons of psychology provide new functional perspectives on classic war powers debates: the authority of Congress versus the President to initiate wars, the scope of presidential authority to use force, the ability of Congress to restrict the conduct of war, the War Powers Resolution and the termination of wars, and the role of the United Nations. Some of the decisionmaking biases point in conflicting directions, so there are no simple answers or tidy solutions. But understanding where important decisions risk going wrong is the first step in figuring out how to make them go right

Open and Closed Reduction for Developmental Dysplasia of the Hip in New York State: Incidence of Hip Reduction and Rates of Subsequent Surgery.

BackgroundThere are limited data on the incidence and outcomes of open and closed hip reduction in patients with developmental dysplasia of the hip (DDH). The aims of this study were to determine the incidence of open and closed reduction of the hip using population-level data and to assess the rates of subsequent surgery.MethodsChildren aged 3 years and younger with DDH who underwent open or closed reduction of the hip between 1997 and 2013 were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Patient age, sex, race, and insurance status as well as concurrent procedures were extracted. Admissions through 2014 were searched for subsequent surgeries, providing a minimum 1-year post-reduction surveillance for all patients. Age-specific incidence rates were calculated using New York State annual population data. The rates of concurrent and subsequent surgeries were calculated. A sensitivity analysis was performed to provide a range for the rates of subsequent surgery. Univariate analyses consisted of chi-square or Fisher exact tests for categorical variables.ResultsIn total, 897 patients (637 who underwent closed reduction and 260 who underwent open reduction) were identified. The age-specific incidence per 100,000 population was 12.5 for closed reduction and 2.6 for open reduction for <1-year-olds, 2.2 for both closed and open reductions for 1-year-olds, 0.4 for closed reduction and 1.0 for open reduction for 2-year-olds, and <0.3 for closed reduction and 0.5 for open reduction for 3-year-olds. Overall, closed reductions were performed more frequently over the study period (p < 0.01). The estimated rate of subsequent ipsilateral surgery was 12.4% (range, 9.4% to 33.1%) after index closed reduction and was 14.2% (range, 8.5% to 40.1%) after index open reduction.ConclusionsWe found that the incidence of closed or open hip reduction for DDH was small and that there was an increase in the number of closed reductions performed over time. The rates of subsequent surgery remained relatively high for patients after index closed or open hip reduction.Level of evidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence

Estimating the effect of intimate partner violence on women's use of contraception: a systematic review and meta-analysis.

BACKGROUND: Intimate partner violence (IPV) is an important global public health problem. While there is a growing literature on the association between IPV and women's reproductive health (RH) outcomes, most studies are cross-sectional-which weakens inference about the causal effect of IPV on women's RH. This systematic review synthesizes existing evidence from the strongest study designs to estimate the impact of IPV on women's use of contraception. METHODS: We searched 11 electronic databases from January of 1980 to 3 December 2013 and reviewed reference lists from systematic reviews for studies examining IPV and contraceptive use. To be able to infer causality, we limited our review to studies that had longitudinal measures of either IPV or women's use of contraception. RESULTS: Of the 1,574 articles identified by the search, we included 179 articles in the full text review and extracted data from 12 studies that met our inclusion criteria. We limited the meta-analysis to seven studies that could be classified as subject to low or moderate levels of bias. Women's experience of IPV was associated with a significant reduction in the odds of using contraception (n = 14,866; OR: 0.47; 95% CI: 0.25, 0.85; I2 = 92%; 95% CII2: 87%, 96%). Restricting to studies that measured the effect of IPV on women's use of partner dependent contraceptive methods was associated with a reduction in the heterogeneity of the overall estimate. In the three studies that examined women's likelihood of using male condoms with their partners, experience of IPV was associated with a significant decrease in condom use (OR: 0.48; 95% CIOR: 0.32, 0.72; I2 = 51%; 95% CII2: 0%, 86%). CONCLUSIONS: IPV is associated with a reduction in women's use of contraception; women who experience IPV are less likely to report using condoms with their male partners. Family planning and HIV prevention programs should consider women's experiences of IPV

The Communication of Vincentian Culture: Reflections on the Impact of the Vincentian Heritage Tour on Faculty and Staff Participants at DePaul University

Beginning with a literature review, the authors of this study define organizational and institutional culture and stress the importance of communicating Vincentian culture and ideology to DePaul University’s faculty and staff. The specific goals of the Vincentian Heritage Tour (VHT) are summarized. During the VHT, participants visit Vincentian sites and learn about them as they follow in the footsteps of Vincent de Paul. The study assesses the effectiveness of the VHT in deepening participants’ understanding of Vincentian values and ideology. It also examines how participants apply this understanding to their work at DePaul. The study’s methodology and its quantitative and qualitative findings are discussed. Tables presenting the results are included

How not to count the health benefits of family planning

Several influential organisations have attempted to quantify the costs and benefits of expanding access to interventions-like contraceptives-that are expected to decrease the number of pregnancies. Such health economic evaluations can be invaluable to those making decisions about how to allocate scarce resources for health. Yet how the benefits should be measured depends on controversial value judgments. One such value judgment is found in recent analyses from the Disease Control Priority Network (DCPN) and the Study Group for the Global Investment Framework for Women's and Children's Health. Noting the decrease in the number of pregnancies expected to result from providing access to family planning, DCPN and the Study Group claim that a substantial benefit of such interventions is averting the stillbirths and child deaths that would have resulted from those pregnancies. We argue that health economic analyses should not count such averted deaths as benefits in the same way as saved lives. First, by counting averted stillbirths and child deaths as a benefit but not counting as a cost the lives of babies who survive, DCPN and the Study Group implicitly commit themselves to antinatalism. Second, this method for calculating the benefits of family planning interventions implies that infertility treatments are harmful. Determining how potential people should be treated in health economic analyses will require grappling with population ethics

Decisional Conflict and User Acceptance of Multicriteria Decision-Making Aids *

Despite the development of increasingly sophisticated and refined multicriteria decision-making (MCDM) methods, an examination of the experimental evidence indicates that users most often prefer relatively unsophisticated methods. In this paper, we synthesize theories and empirical findings from the psychology of judgment and choice to provide a new theoretical explanation for such user preferences. Our argument centers on the assertion that the MCDM method preferred by decision makers is a function of the degree to which the method tends to introduce decisional conflict. The model we develop relates response mode, decision strategy, and the salience of decisional conflict to user preferences among decision aids. We then show that the model is consistent with empirical results in MCDM studies. Next, the role of decisional conflict in problem formulation aids is briefly discussed. Finally, we outline future research needed to thoroughly test the theoretical mechanisms we have proposed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73461/1/j.1540-5915.1991.tb00371.x.pd

A new architectural perspective on wind damage in a natural forest

Wind damage is a significant driver of forest structure, ecology and carbon cycling in both temperate and tropical regions, but most of the literature on wind damage focusses on conifer plantations. Previous studies in broadleaf forests have been limited by a lack of data on tree architecture, a problem that is potentially overcome by terrestrial laser scanning (TLS). Here we apply novel approaches to estimate the critical wind speeds at which trees will break in a temperate, deciduous forest plot in Wytham Woods, UK, using a combination of field data and finite element analysis. Ash trees (Fraxinus excelsior) tend to have lower critical wind speeds than sycamores (Acer pseudoplatanus), while English oak (Quercus robur) are the most mechanically robust. This difference in critical wind speed (CWS) is driven by tree size and architecture, rather than material properties. We observe a trade-off between CWS and growth rate, both within and across species. Our estimates of critical wind speeds from field data are lower in summer than in winter, emphasizing the importance of the spring and autumn transition periods. Of the three species we studied, those with lower critical wind speeds drop their leaves earlier in autumn, suggesting that the timing of leaf shedding may be under selection pressure to minimize risk of tree damage from winter storms. These results are tentative, but also intriguing and intuitive