Curved versus straight scissors to avoid 3rd and 4th degree perineal tears: A randomised feasibility study

BackgroundSevere perineal tears sustained during childbirth cause significant distress and morbidity amongst women. The objective of this study was to compare the use of straight scissors for cutting an episiotomy with the use of curved scissors, which are designed to curve away from the anal sphincter.MethodsWe used a single-centre, randomised feasibility trial. The intervention was the use of curved scissors. Women were recruited during a prenatal visit and randomised in the delivery suite, when it became clear that an episiotomy was required. The feasibility outcomes were the proportion of women able to be recruited, randomised and followed up. We also calculated the incidence of obstetric anal sphincter injury when either straight or curved scissors were used to cut an episiotomy. Other outcomes assessed were pain, length of hospital stay, perineal infection and perineal dehiscence.ResultsOf the 155 patients recruited in the prenatal period, only 20 (12.9%) were eventually randomised at birth. The main reasons for the high loss were that women either did not have a vaginal delivery (38, 24.5%), or they did not need an episiotomy (72, 46.5%). Rates of obstetric anal sphincter injury and other outcomes were similar between groups.DiscussionAnal sphincter injury during childbirth remains an important problem. Although the use of curved scissors provides a theoretical solution, we found that the high attrition rate made feasibility of conducting a suitably powered, randomised trial using the current design untenable. Alternative strategies have been suggested to make any future study more viable.     

Hunters and healers: social change and cultural conflict in rural Maine

This is a story of two people with different philosophies concerning use of land and attitudes towards animals. What makes their situation unique is that they share abutting property and live on the same road in a small village in Maine. Phil owns the house and land on which he grew up and has always hunted the surrounding land, including the property more recently acquired by Marie. Marie emigrated from Massachusetts with the intention to create a sanctuary for animals. Their polarized views have resulted in strife between them and illustrate the conflict between hunters and non-hunters in Maine.     

No sign of harm: issues for disabled children communicating about abuse

While all children may be the victims of abuse, disabled children are particularly vulnerable. This paper explores the views of professionals working with children using alternative/augmented communication systems on the issues relating to communication about abuse. Interviews were carried out with 20 staff from eight establishments for disabled children across Scotland. It describes the range of alternative/augmented communication systems used and the barriers to communication about abuse. Staff generally accepted the importance of providing the appropriate vocabulary in augmented communication systems, but systems that provide such vocabulary were not widely used. Staff considered that a major difficulty concerned the level of understanding disabled children might have about concepts of abuse. They were unsure how the appropriate vocabulary could be introduced in a natural way and how links could be made between the signs and their meanings. Staff saw themselves as those most able to protect the children, but it was felt that discovery of abuse was more likely to come from them noticing physical signs, behaviour or mood changes than from the child communicating explicitly about abuse. The need for appropriate training and increased coordination between social work, health and education is highlighted. Copyright © 2001 John Wiley & Sons, Ltd.     

Leveraging the common and outsourcing the distinct: institutional difference and multinational company identity in emerging economies

ABSTRACT

This paper explores the challenges of outsidership faced by multinational companies (MNCs) accessing emerging economies. The paper departs from popular conceptualisations of culture drawing instead on social identity theory as part of an institutions-based view, to explain how employing a singularities approach can allow the identification of commonalities of Indianness and Australianness that can be leveraged to ameliorate negative socially embedded business norms that pose a challenge to MNC success in emerging economies. This study shows that despite recognised formal (regulatory) and informal (cultural) differences, managers of Australian MNCs operating in India were able to innovatively identify and exploit cultural commonalties/singularities to ease cultural adjustment and mitigate intergroup conflict, allowing them to achieve an innovative institutional fit. The paper discusses how, using this approach, sole-venture MNCs can access many of the benefits provided by collaborative entry modes while preserving MNC identity. We further propose that the singularities approach can provide a valuable starting point to develop culturally appropriate competence training initiatives.     

Association of sexual abstinence in adolescence with mental health in adulthood

We examined whether adolescent sexual abstinence predicts better adult mental health. 1,917 adolescents, recruited from middle schools at age 13, were surveyed at ages 13, 18, 23, and 29. In bivariate analyses, adolescent sexual abstinence was associated with better mental health at age 29 for females, but not males; three adolescent factors, educational prospects, family bonding, and unconventionality were investigated as explanatory variables of this relationship. The abstinence-mental health relationship was nonsignificant when educational prospects was included in multivariate models, and marginally significant when family bonding and unconventionality were included; all three explanatory factors accounted for significant proportions of the variance in adult mental health. Girls who are uninvolved in school, have weak family backgrounds, and exhibit unconventionality may have poor adult mental health, whether or not they abstain from sex in adolescence. Interventions that strengthen adolescents' connections to families and schools may reduce risk for long-term mental health problems.     

Trustworthiness in evaluation practice: an emphasis on the relational

As canons for trustworthiness developed explicitly in the discourse of qualitative inquiry, the emphasis was on procedural matters rather than fundamentally relational ones. A nod was made to the relational in such strategies as “member checks” but the issues of how the evaluator actually relates to participants and to the larger communities of practice and discourse—matters subsumed under moral principles and ethical standards—were often marginalized. This chapter posits that the first consideration in designing and conducting rigorous evaluation inquiry, and in critiquing the results of any research, should be the study's trustworthiness. Judging a study's trustworthiness, however, should focus on much more than procedural matters; it should also rely on moral principles and ethical standards which specifically address how we relate to an evaluation's participants. Central to these considerations are cross-cultural sensibilities about the nuanced meanings associated with any principles and standards. The chapter provides a theoretical framework for this position and offers two illustrative examples in the form of dialogues.     

‘Scarier than another storm’: values at risk in the mapping and insuring of US floodplains

How do people respond to the ways in which insurance mediates environmental risks? Socio‐cultural risk research has characterized and analyzed the experiential dimension of risk, but has yet to focus on insurance, which is a key institution shaping how people understand and relate to risk. Insurance not only assesses and communicates risk; it also economizes it, making the problem on the ground not just one of risk, but also of value. This article addresses these issues with an investigation of the social life of the flood insurance rate map, the central technology of the U.S. National Flood Insurance Program (NFIP), as it grafts a new landscape of ‘value at risk’ onto the physical and social world of New York City in the aftermath of Hurricane Sandy. Like other risk technologies, ubiquitous in modern societies as decision‐making and planning tools, the map disseminates information about value and risk in order to tame uncertainty and enable prudent action oriented toward the future. However, drawing together interview, ethnographic, and documentary data, I find that for its users on the ground, the map does not simply measure ‘value at risk’ in ways that produce clear strategies for protecting property values from flooding. Instead, it puts values‐beyond simply the financial worth of places‐at risk, as well as implicates past, present, and future risks beyond simply flooding. By informing and enlarging the stakes of what needs protecting, and from what, I argue that plural and interacting ‘values at risk’ shape how people live with and respond to environmental risks that are mediated by insurance technologies.