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Ignatian Leadership and the Contemporary Leadership Landscape An Exercise in Counter-Cultural Engagement
No full textThis paper is written as a dialogue between two faculty members and scholars working within a Jesuit institution. Through their shared interest in leadership, especially an interest in Ignatian Leadership, the following dialogue has emerged. Kelly works in our institution as a theologian and former director of academic service-learning, and Moss-Breen works in the graduate school directing an interdisciplinary leadership EdD program. Their backgrounds and fields are different, but their interest in the leadership of Ignatius is a common thread between them. Kelly starts the conversation and Moss Breen responds in kind
Water Governance for Sustainable Development
Get PDFThe world is facing critical water risks in relation to water availability, yet the competing demand for water supply is increasing in most countries. To respond to these risks, some governments and water authorities are reforming their governance frameworks to achieve convergence between water supply and demand and ensure freshwater ecosystem services are sustained. Water is recognized as the only natural resource that has the capacity to influence socio-economic growth and poverty alleviation across the globe.
Malawi is generally rich in both surface and ground water resources, however, the pressure on water resources is increasing as a result of a growing population, and competing demands for water for energy generation, agriculture, industrial and domestic purposes. Water is part of the country’s identity, because of its inclusion in the definition of the country’s name and because it is another natural resource in abundance in the country occupying 20% of the surface area in Malawi. Malawi’s economy is dependent on agriculture and it contributes 37.6% to GDP and 80% of the labor force in rural areas. Agriculture is entirely dependent on seasonal rainfall and is accountable for 86% of water withdrawal in Malawi. Now with the effects of climate change and environmental degradation, the country has been experiencing unpredictable weather patterns characterized by poor distribution of rainfall, causing dry spells, droughts and floods in recent years. This is negatively impacting the water supply for domestic use and economic activities, and as a result the country’s economy is extremely vulnerable. Effective policies and governance strategies are therefore important for the sustainable development in Malawi. Successful management of freshwater resources also requires the integration of the different sectors that use this resource. Therefore, water resource management policies should have an integrated approach that involves social, economic and environmental factors
This study therefore, investigated the current water governance system by assessing the legislative and policy frameworks in Malawi. The study also analyzed policy gaps in the existing legislation. This was done through semi-structured interview qualitative data with relevant stakeholders in the water sector.
The results show that there are multiple challenges to water governance in Malawi and that the existing laws are not effectively addressing the current water challenges, because the country is using outdated water laws that are inconsistent with policy frameworks. Other critical gaps identified in this study were weak stakeholder coordination leading to fragmentation of organization in the sector, low national budget financing, weak decentralization and political influence leading to top-down management, failure by government to enforcement water regulations, and failure by government to enact policies to adapt to climate change and natural disasters.
Based on the study results, there is overwhelming evidence that the water governance, regulatory systems and policy frameworks in Malawi have some critical gaps. This poses a great concern for sustainable water supply for future generation and development in Malawi. Therefore, there Malawi needs to consistently review and update the current water laws and policies to ensure they create adaptive to the emerging climate change, natural disaster and rapid population growth challenges. This study therefore, has led to initiation of a project whose main aim is to advocate for policy reforms by influencing the government to update and enact new water laws and policies in Malawi.
Keywords: Water policy, Reforms, governance, Advocacy, Malaw
Increasing standing tolerance in office workers with standing-induced back pain
No full textSit-stand desks are popular however many people have standing-induced low back pain (LBP). People with LBP have fewer standing weight shifts compared with back-healthy people. Participants were classified as standing-tolerant or intolerant. Participants were provided sit-stand desks for 12 weeks. Participants were assigned to intervention (graded standing exposure and exercise) or control (no instruction) conditions. Participants reported weekly sitting time and average/worst LBP. Standing weight shifts and LBP were re-assessed post-intervention. All groups decreased sitting time (range: 30–50%) over 12 weeks. Sitting time and average LBP were correlated in all standing-intolerant individuals, worst LBP and sitting time were correlated for intervention group only. All standing-intolerant individuals increased standing weight shifts and decreased LBP after 12-weeks. Standing-intolerant individuals benefitted from 12-weeks of sit-stand desk use regardless of intervention. Motivated individuals with standing-induced LBP may increase standing tolerance with sit-stand desk use. Additional benefits may exist when structured guidance is provided. Practitioner summary: Many people are standing-intolerant due to low back pain (LBP). This lab and field-based study showed some benefits from structured approaches to gradually progress standing time when transitioning to standing work. Using a sit-stand desk for 12 weeks resulted in decreased LBP and sitting time in standing-intolerant people. Abbreviations: LBP: low back pain; OSPAQ: Occupational Sitting and Physical Activity Questionnaire; VAS: visual analog scale; GRF: ground reaction force; WeekVASMAX: worst low back pain reported on visual analog scale for prior week; WeekVASAVE: average low back pain reported on visual analog scale for prior week; ICC: intraclass correlation coefficient; LabVASMAX: worst low back pain reported on visual analog scale during lab-based standing; LabVASAVE: average low back pain reported on visual analog scale during lab-based standing; FvR,L: vertical ground reaction force for right and left force plate; BWSSMALL: small (10-29% body weight) body weight shift; BWSLARGE: large (\u3e 30% body weight) body weight shift; ActivPALSED: ActivePAL data for sedentary time; ActivPALSTND: ActivePAL data for standing time; ANOVA: analysis of variance; Standing Intolerant-INT: standing intolerant participants assigned to intervention condition; Standing Intolerant-CON: standing intolerant participants assigned to control condition; Standing Tolerant-INT: standing tolerant participants assigned to intervention condition; Standing Tolerant-CON: standing tolerant participants assigned to control condition; SI: standing intolerant; ST: standing tolerant; INT: intervention; CON: control
Cost-Effectiveness of Operative Versus Nonoperative Management of Patients With Intra-articular Calcaneal Fractures
No full textOBJECTIVE: To assess the costs, health gains, and cost-effectiveness of operative versus nonoperative treatment of calcaneal fractures over a 5-year time horizon from both US societal and payer perspectives. METHODS: The societal perspective analysis included both direct medical costs and costs for missed work, whereas the health care payer perspective analysis included only direct medical costs associated with treatment and complications. A decision tree simulation model was developed to estimate the direct medical and indirect costs (2018 US35,110 vs. 50,000 per QALY, operative fixation had an 89% probability of being cost-effective. From a health care payer perspective, operative management remained cost-effective as the incremental cost-effectiveness ratio is below the willingness-to-pay threshold of $50,000/QALY. CONCLUSION: From both US societal and health care payer perspectives, operative treatment of displaced intra-articular calcaneal fractures utilizing an extensile lateral approach is cost-effective at commonly accepted willingness-to-pay thresholds compared with nonoperative treatment over a 5-year time horizon. Patient variability may impact cost-effectiveness and should be explored in future research. LEVEL OF EVIDENCE: Economic Level III. See Instructions for Authors for a complete description of levels of evidence
COVID 19 and manual therapy: international lessons and perspectives on current and future clinical practice and education
No full textBackground: The COVID-19 pandemic has altered clinical practice and education in manual therapy globally. Social distancing has limited in-person care and changed health-care provision. Education in manual therapy has moved to online platforms with in-person instruction restricted. The global impact on the clinical practice of manual therapy and education has to date not been explored. Methods: a questionnaire survey methodology was used. A sample of convenience of global leaders in manual therapy practice and education received an electronic link to two surveys: one on clinical practice and one on education. Contributors could complete one or both surveys. Results: Twenty-five surveys were received on clinical practice and 23 on education in manual therapy, representing the six major continents. Global themes in clinical practice demonstrated a sudden and dramatic shift away from patient contact, with limited modifications to manual therapy in patient care currently adopted. Themes in education were of a major shift to online learning, development of new modes of student instruction including video-based assessment and virtual case-based instruction. Conclusion: The international perspectives provided demonstrate a major change in manual therapy practice and education globally. Various approaches have been taken in practice and education without a uniform approach being demonstrated
Physical therapist decision-making in managing plantar heel pain: cases from a pragmatic randomized clinical trial
No full textIntroduction: Plantar heel pain (PHP) is a common condition managed by physical therapists that can, at times, be difficult to treat. Management of PHP is complicated by a variety of pathoanatomic features associated with PHP in addition to several treatment approaches with varying efficacy. Although clinical guidelines and clinical trial data support a general approach to management, the current literature is limited in case-specific descriptions of PHP management that addresses unique combinations of pathoanatomical, physical, and psychosocial factors that are associated with PHP. Purpose: The purpose of this case series is to describe physical therapist decision-making of individualized multimodal treatment for PHP cases presenting with varied clinical presentations. Treatment incorporated clinical guidelines and recent evidence including a combination of manual therapy, patient education, stretching, resistance training, and neurodynamic interventions. A common clinical decision-making framework was used to progress individualized treatment from a focus on symptom modulation initially to increased load tolerance of involved tissues and graded activity. In each case, patients met their individual goals and demonstrated clinically meaningful improvements in pain, function, and global rating of change that were maintained at the 1–2-year follow-up. Implications: This case series provides details of physical therapist management of a variety of PHP clinical presentations that can be used to complement clinical practice guidelines in the management of PHP
Identification of essential knowledge for inpatient general medicine advanced pharmacy practice experiences
No full textObjective: With diversity in advanced pharmacy practice experience (APPE) preceptors, rotation options, and site characteristics, inpatient general medicine (IGM) APPEs provide varied experiences for students. There is a concern for continuity of essential knowledge standards across experiences. To identify essential knowledge for students to learn during an IGM APPE. Methods: Expert pharmacists in acute care and/or student precepting in an inpatient setting participated in a three-round modified Delphi process to build consensus. Through three rounds of survey consensus building, experts designated 143 pharmacotherapy topics as essential or non-essential for an IGM APPE. Topics that achieved 80% or more agreement met consensus as essential. Topics that achieved less than 80% agreement by the end of the surveys were considered non-essential. Results: Twenty-eight experts reached consensus on 70 (49%) topics as essential, 40 (28%) topics as non-essential, and 33 (23%) topics as indeterminate after round one. Three additional topics suggested by the experts were included with the 33 indeterminate topics for round two considerations. At the conclusion of round three, 73 total topics met consensus as essential for IGM APPE students. Essential topics aligned with the categories of renal, cardiovascular, gastrointestinal, and neurologic disorders as well as infectious diseases. Non-essential topic categories consisted of oncologic, dermatologic, and gynecological/obstetric disorders. Conclusion: Identified essential knowledge, as found in this study, may serve as a guide for preceptors and afford students the opportunity of consistent experiences across varying IGM APPEs. Validation with pharmacy curriculum and postgraduate competency recommendations support many of these consensus findings. More research is needed to identify the appropriate number of topics addressed during APPE rotations and how to assess that knowledge
Hypoglycemia in High-Risk Infants Within the Immediate Postnatal Period
No full textThe incidence of hypoglycemia in the immediate postnatal period is rising because of the increasing rate of preterm births, maternal diabetes, and maternal obesity. Severe hypoglycemia has been considered a risk factor for neuronal cell death and adverse neurodevelopmental outcomes. The American Academy of Pediatrics (AAP) suggests a goal of ≥45 mg/dL (≥2.5 mmol/L) for infants who are asymptomatic within the first 48 hours. The Pediatric Endocrine Society (PES) suggests that infants who are unable to maintain their blood glucose \u3e50 mg/dL (\u3e2.77 mmol/L) within the first 48 hours or \u3e60 mg/dL (\u3e3.33 mmol/L) after the first 48 hours are at risk for persistent hypoglycemia. While there is disagreement for target glucose levels within the first 48 hours, both the AAP and the PES suggest further investigation for persistent hypoglycemia beyond 48–72 hours, which is beyond the scope of this article. However, in the immediate postnatal period, much can be gained with familiarization of the two guidelines, as well as current management techniques. This article presents current definitions and treatment modalities for management of hypoglycemia in infants considered at high risk in the immediate postnatal period
Examining the distinct features of bangladesh’s development: Interactions between growth, poverty, and social development
No full textBangladesh has made considerable progress in reducing the incidence of poverty and in improving social development outcomes, albeit with rising income inequality. In this chapter, it is argued that Bangladesh’s distinct development trajectory lies in its consistency. In nearly half a century since Bangladesh’s independence, there have been no significant reversals of fortune. Bangladesh is also a case in point of a country that, at the aggregate level, has made significant progress in selected areas of social development despite having a low level of per capita income. A similar disconnect between income and social development is found at the disaggregated district level. Other distinct features of Bangladesh’s development thus far are discussed. Attention is also given to the sources of this progress through a political economy lens
Comparison of Hemoglobin A1C Levels Between Married and Single Hispanic Women with Type 2 Diabetes
Get PDFExecutive Summary
Problem. According to the CDC (2019), 34.2 million Americans were diagnosed with Diabetes Mellitus at the end of 2019. Rising rates of diabetes (especially Type 2 Diabetes) among Hispanic and Latino populations in the U.S is of concern.
Purpose. The purpose of this study was to analyze if marital status impacted Hispanic women with T2D with regard to their mean HgbA1C scores.
Goals. Determine if there was a difference in HgbA1C levels within the study population (Hispanic women) with T2D based on marital status. Identify additional factors that may impact results: age, percent poverty, agricultural worker status and employment status.
Objective. Compare differences in the mean HgbA1C for married Hispanic women with T2D and single Hispanic women with T2D.
Plan. Retrospective chart review of the target group over a 2-year period.
Outcomes and Results. Results showed a statistically significant relationship between marital status and HgbA1C values (F=2.456, p
Analysis of findings and interpretation of results. Marital status impacts the mean HgbA1C value for Hispanic women with T2D. Level of poverty, employment and age impact their HgbA1C values