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During the 1930s and 1940s, a group of right-wing intellectuals, sparked by the New Deal, mounted a sustained critique of American democracy and inherited democratic principles. Believing that the progressive democratization of the state had resulted in a decadent, inefficient and morally coarse society, they attacked democracy as the root cause of the nation's problems. Examining the reactionary conservative, libertarian and fascist critiques of democracy, this article suggests that each borrowed ideas from the other, and that their beliefs in autocratic rule or a broadly countermajoritarian politics have not been adequately studied by scholars.
This article proposes building on the success of publicly funded drug research and development and expanding the model to include the full cycle development, testing, manufacture and distribution of innovative and affordable new drugs.
This article examines the Committee for Constitutional Government, a conservative organization that spearheaded a novel form of mass-based mobilization and direct-mail propaganda to counter New Deal reforms from 1937 to the late 1950s. I argue that the members of the committee offered a supple and variegated response to New Deal liberalism, one with deep roots in the American past. Organizationally, the committee differed from other conservative groups of the period in the vastly greater reach of its propaganda, the small-donor financial base of its operations, and its extensive cultivation of a grassroots movement committed to right-wing reform. The committee was a critical political actor from 1937 to 1955, systematically shaping legislation and countering the trend toward social democracy in America. The ultimate result of its campaigns was to retard the growth of the administrative state and help formulate a cogent conservative critique of reformist liberalism.
This study suggests that there may be considerable difficulties in providing accurate calendar age estimates in the Roman period in Europe, between ca. AD 60 and ca. AD 230, using the radiocarbon calibration datasets that are currently available. Incorporating the potential for systematic offsets between the measured data and the calibration curve using the ΔR approach suggested by Hogg et al. (2019), only marginally mitigates the biases in calendar date estimates observed. At present, it clearly behoves researchers in this period to “caveat emptor” and validate the accuracy of their calibrated radiocarbon dates and chronological models against other sources of dating information.
To identify urinary catheter (UC)–associated urinary tract infection (CAUTI) incidence and risk factors.
Design:
A prospective cohort study.
Setting:
The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries.
Participants:
The study included 169,036 patients, hospitalized for 1,166,593 patient days.
Methods:
Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression.
Results:
Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower–middle-income countries (3.05); and with patients in public hospitals (5.89).
The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P < .0001), female sex (aOR, 1.39; P < .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P < .0001), UC DU ratio (aOR, 1.09; P < .0001), public facilities (aOR, 2.24; P < .0001), and neurologic ICUs (aOR, 11.49; P < .0001).
Conclusions:
CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.
Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.
Archaeological fieldwork at Eversley Quarry, Fleet Hill Farm, Finchampstead, Berkshire documented evidence of Mesolithic activity, associated with paleoenvironmental deposits, on the Blackwater River floodplain, a river for which activity of this period was previously unknown. The discovery evolved from initial recognition of worked flint artefacts across a well weathered, stripped subsoil surface in part of the site. Additional material was collected subsequently from the summit of an adjacent low knoll. The findings were of sufficient extent and importance to warrant supplementary archaeological fieldwork using a gridded test pit strategy to evaluate the Mesolithic potential in remaining parts of the site. This resulted in the identification of additional clusters of worked flints, which were preserved in situ.
The clusters were predominantly of Mesolithic date but also included Neolithic and Bronze Age artefacts, indicating prolonged use of the landscape. Concentrations were consistently located on slightly elevated sand bars flanking palaeochannels of a formerly braided river system. The contemporaneity of the palaeodrainage and Mesolithic activity has been confirmed by radiocarbon dates from peat that formed during the Holocene. The collective results mark a significant contribution to knowledge of the Blackwater River valley, a major communications artery in the Mesolithic period linking the west end of the Wealden Greensand to the Rivers Thames and Kennet. These findings also highlight the importance that river valleys can make to locations that have been less well studied but nevertheless enjoyed prolonged use.
The 'gig economy' is a relatively recent term coined to describe a range of working arrangements that have previously been denoted as precarious, flexible and contingent. These may include casual workers, temporary agency workers, those on zero-hours contracts and dependent contractors.
This books seeks to get behind the contemporary buzz surrounding the term and provide some theoretical and empirical analysis of the gig work phenomenon. The book seeks to assess more critically some of the rhetorical claims made about gig work and to provide a balanced appraisal of the ramifications for individuals, employers and the economy and society in general of an increasingly insecure workforce. The regulatory framework, in particular, is examined and is shown to have lagged behind crucial developments in the gig economy, with many labour laws still historically rooted to the notion that a worker has to be an employee to be covered by employment rights.
The authors show that in many respects there is nothing new about the gig economy and that its growth in recent years was in some sense predictable. Perhaps its real significance, they argue, is its potential as a business model to 'gig-ize' other business operations far beyond relatively low-skilled work. When combined with automation and digitalization, the gig economy presents us with an opportunity to re-evaluate our understanding of the nature of work.
Although anesthesiology and endocrinology are two distinct branches of medicine, some recent breakthrough treatments have brought together both medical specialties, particularly those concerned with surgical sciences and critical care. Related to the use of various traditional surgical techniques, the lack of newer and safer drugs, the lack of monitoring tools, and the scarcity of critical care services in the past, managing patients with various endocrine disorders has always been perceived as being more difficult by practicing anesthesiologists.
This study aimed to explore the association between hyperglycemia in pregnancy (type 2 diabetes (T2D) and gestational diabetes mellitus (GDM)) and child developmental risk in Europid and Aboriginal women.
PANDORA is a longitudinal birth cohort recruited from a hyperglycemia in pregnancy register, and from normoglycemic women in antenatal clinics. The Wave 1 substudy included 308 children who completed developmental and behavioral screening between age 18 and 60 months. Developmental risk was assessed using the Ages and Stages Questionnaire (ASQ) or equivalent modified ASQ for use with Aboriginal children. Emotional and behavioral risk was assessed using the Strengths and Difficulties Questionnaire. Multivariable logistic regression was used to assess the association between developmental scores and explanatory variables, including maternal T2D in pregnancy or GDM.
After adjustment for ethnicity, maternal and child variables, and socioeconomic measures, maternal hyperglycemia was associated with increased developmental “concern” (defined as score ≥1 SD below mean) in the fine motor (T2D odds ratio (OR) 5.30, 95% CI 1.77–15.80; GDM OR 3.96, 95% CI 1.55–10.11) and problem-solving (T2D OR 2.71, 95% CI 1.05–6.98; GDM OR 2.54, 95% CI 1.17–5.54) domains, as well as increased “risk” (score ≥2 SD below mean) in at least one domain (T2D OR 5.33, 95% CI 1.85–15.39; GDM OR 4.86, 95% CI 1.95–12.10). Higher maternal education was associated with reduced concern in the problem-solving domain (OR 0.27, 95% CI 0.11–0.69) after adjustment for maternal hyperglycemia.
Maternal hyperglycemia is associated with increased developmental concern and may be a potential target for intervention so as to optimize developmental trajectories.
To identify: 1) best practice aged care principles and practices for Aboriginal and Torres Strait Islander older peoples, and 2) actions to integrate aged care services with Aboriginal community-controlled primary health care.
Background:
There is a growing number of older Aboriginal and Torres Strait Islander peoples and an unmet demand for accessible, culturally safe aged care services. The principles and features of aged care service delivery designed to meet the unique needs of Aboriginal and Torres Strait Islander peoples have not been extensively explored and must be understood to inform aged care policy and primary health care planning into the future.
Methods:
The research was governed by leaders from across the Aboriginal community-controlled primary health care sector who identified exemplar services to explore best practice in culturally aligned aged care. In-depth case studies were undertaken with two metropolitan Aboriginal community-controlled services. We conducted semi-structured interviews and yarning circles with 46 staff members to explore key principles, ways of working, enablers and challenges for aged care service provision. A framework approach to thematic analysis was undertaken with emergent findings reviewed and refined by participating services and the governance panel to incorporate national perspectives.
Findings:
A range of principles guided Aboriginal community-controlled aged care service delivery, such as supporting Aboriginal and Torres Strait Islander identity, connection with elders and communities and respect for self-determination. Strong governance, effective leadership and partnerships, Aboriginal and Torres Strait Islander workforce and culturally safe non-Indigenous workforce were among the identified enablers of aged care. Nine implementation actions guided the integration of aged care with primary health care service delivery. Funding limitations, workforce shortages, change management processes and difficulties with navigating the aged care system were among the reported challenges. These findings contribute to an evidence base regarding accessible, integrated, culturally safe aged care services tailored to the needs of Aboriginal and Torres Strait Islander peoples.
In the crowded field of leadership research, Indigenous leadership remains under-researched. This article explores the Leadership Model of an Aboriginal Community Controlled Primary Health Care Organisation providing services to the Yolngu people of remote northern Australia: the Miwatj Health Aboriginal Corporation (Miwatj).
Background:
The limited research which does exist on Indigenous leadership points to unique challenges for Indigenous leaders. These challenges relate to fostering self-determination in their communities, managing significant community expectations, and navigating a path between culturally divergent approaches to management and leadership.
Methods:
Guided by Indigenous methodology and using a mixed methods approach, semi-structured interviews, self-reported health service data, organisational and publicly available documents, and literature were analysed using a framework method of thematic analysis to identify key themes of the Miwatj Leadership Model.
Findings:
The Miwatj Leadership Model is underpinned by three distinctive elements: it offers Yolngu people employment opportunities; it supports staff who want to move into leadership positions and provides capacity building through certificates and diplomas; and it provides for the physical, emotional, and cultural wellbeing of all Yolngu staff. Furthermore, the model respects traditional Yolngu forms of authority and empowers the community to develop, manage and sustain their own health. The Miwatj Leadership Model has been successful in providing formal pathways to support Indigenous staff to take on leadership roles, and has improved the accessibility and acceptability of health care services as a result of Yolngu employment and improved cultural safety.
Conclusions:
Translating the Miwatj Leadership Model into other health services will require considerable thought and commitment. The Miwatj Leadership Model can be adapted to meet the needs of other health care services in consideration of the unique context within which they operate. This study has demonstrated the importance of having a formal leadership model that promotes recruitment, retention, and career progression for Indigenous staff.
Aboriginal and Torres Strait Islander holistic health represents the interconnection of social, emotional, spiritual and cultural factors on health and well-being. Social factors (education, employment, housing, transport, food and financial security) are internationally described and recognised as the social determinants of health. The social determinants of health are estimated to contribute to 34% of the overall burden of disease experienced by Aboriginal and Torres Strait Islander people. Primary health care services currently ‘do what it takes’ to address social and emotional well-being needs, including the social determinants of health, and require culturally relevant tools and processes for implementing coordinated and holistic responses. Drawing upon a research-setting pilot program, this manuscript outlines key elements encapsulating a strengths-based approach aimed at addressing Aboriginal and Torres Strait Islander holistic social and emotional well-being.
The Cultural Pathways Program is a response to community identified needs, designed and led by Aboriginal and Torres Strait Islander people and informed by holistic views of health. The program aims to identify holistic needs of Aboriginal and Torres Strait Islander people as the starting point to act on the social determinants of health. Facilitators implement strengths-based practice to identify social and cultural needs (e.g. cultural and community connection, food and financial security, housing, mental health, transport), engage in a goal setting process and broker connections with social and health services. An integrated culturally appropriate clinical supervision model enhances delivery of the program through reflective practice and shared decision making. These embedded approaches enable continuous review and improvement from a program and participant perspective. A developmental evaluation underpins program implementation and the proposed culturally relevant elements could be further tailored for delivery within primary health care services as part of routine care to strengthen systematic identification and response to social and emotional well-being needs.
Gambling is considered a public health issue by many researchers, similarly to alcohol or obesity. Statistical risk warnings on gambling products can be considered a public health intervention that encourages safer gambling while preserving freedom of consumer choice. Statistical risk warnings may be useful to gamblers, given that net gambling losses are the primary driver of harm and that gambling products vary greatly in the degree to which they facilitate losses. However, there is some doubt as to whether statistical risk warnings are, in their current form, effective at reducing gambling harm. Here, we consider current applications and evidence, discuss product-specific issues around a range of gambling products and suggest future directions. Our primary recommendation is that current statistical risk warnings can be improved and also applied to a wider range of gambling products. Such an approach should help consumers to make more informed judgements and potentially encourage gambling operators to compete more directly on the relative ‘price’ of gambling products.
Out-of-network air ambulance bills are a pernicious and financially devastating type of surprise medical bill. Courts have broadly interpreted the Airline Deregulation Act to preempt most state attempts to regulate air ambulance billing abuses, so a federal solution is ultimately needed. However, in the absence of a federal fix, states have experimented with a variety of approaches that may survive preemption and provide some protections for their citizens
Hurricanes can interrupt communication, exacerbate attrition, and disrupt participant engagement in research. We used text messaging and disaster preparedness protocols to re-establish communication, re-engage participants, and ensure retention in a human immunodeficiency virus (HIV) self-test study.
Methods:
Participants were given HIV home test kits to test themselves and/or their non-monogamous sexual partners before intercourse. A daily text message-based short message service computer-assisted self-interview (SMS-CASI) tool reminded them to report 3 variables: (1) anal sex without a condom, (2) knowledge of partners’ testing history, and (3) proof of partners’ testing history. A disaster preparedness protocol was put in place for hurricanes in Puerto Rico. We analyzed 6315 messages from participants (N = 12) active at the time of Hurricanes Irma and Maria. Disaster preparedness narratives were assessed.
Results:
All participants were able to communicate sexual behavior and HIV testing via SMS-CASI within 30 days following María. Some participants (n = 5, 42%) also communicated questions. Re-engagement within 30 days after the hurricane was 100% (second week/89%, third week/100%). Participant re-engagement ranged from 0–16 days (average = 6.4 days). Retention was 100%.
Conclusions:
Daily SMS-CASI and disaster preparedness protocols helped participant engagement and communication after 2 hurricanes. SMS-CASI responses indicated high participant re-engagement, retention, and well-being.
In 2018 Pearson et al. published a new sequence of annual radiocarbon (14C) data derived from oak (Quercus sp.) trees from Northern Ireland and bristlecone pine (Pinus longaeva) from North America across the period 1700–1500 BC. The study indicated that the more highly resolved shape of an annually based calibration dataset could improve the accuracy of 14C calibration during this period. This finding had implications for the controversial dating of the eruption of Thera in the Eastern Mediterranean. To test for interlaboratory variation and improve the robustness of the annual dataset for calibration purposes, we have generated a replicate sequence from the same Irish oaks at ETH Zürich. These data are compatible with the Irish oak 14C dataset previously produced at the University of Arizona and are used (along with additional data) to examine inter-tree and interlaboratory variation in multiyear annual 14C time-series. The results raise questions about regional 14C offsets at different scales and demonstrate the potential of annually resolved 14C for refining subdecadal and larger scale features for calibration, solar reconstruction, and multiproxy synchronization.
This chapter builds on the previous discussion that has conceptualized and theorized gig work to explore trends in the gig economy. The first section introduces a discussion on how to operationalize gig work; that is, to define it in terms of categories of work that statistics agencies provide data for – our key postulate here being that there is no distinct statistical measure of gig work, and that a number of types of work share its features. Hence, we operationalize gig work in terms of four highly contingent types of employment: casual work, temporary agency work, zero-hours contracts, and dependent contractors.
The following sections then examine trends in these forms of work and provide a critical analysis of the factors that have driven their growth or resurgence. In so doing, what is notable is that despite widespread claims that gig work will become the “new norm”, empirical evidence suggests that the four forms of work identified still remain as relatively minor components of the workforce in developed countries. However, this is not to down play the significance of gig work, but rather we argue that the impact of gig work on the economy is not in its direct incidence, but rather the potential impact that such forms of work can have on employment elsewhere.
Operationalizing gig work
In attempting to understand trends in gig work, it is first necessary to operationalize gig work in terms of work and employment categories that national and international statistical agencies would utilize. As such, gig work has been seen as most coterminous with the status of being a dependent contractor, in being available on-demand and generally working through one organization (as demonstrated by Uber). A narrower definition of gig work would be to specify contractors or freelancers that are sourced via the intermediary of an online platform, which is where the novelty of the gig economy as a term largely originated. This is the definition cited by De Stefano (2016), who denotes work in the gig economy as constituting both “crowd-work” (that is, where a number of firms and workers are connected via an online platform) and “on-demand work”, whereby a single user firm uses an online platform to match workers to demand for services.