Effort Commitment Research Articles

The rectus femoris muscle flap is an underused tool in the vascular surgeon's armamentarium

Mrs Havercamp aFictitious.aFictitious. presents to clinic at 4:00 pm today for an unscheduled appointment. She is a 67-year-old obese diabetic woman who is 10 days status post right common femoral endarterectomy with Dacron patch angioplasty and retrograde iliac stenting for rest pain. Today, she reports increasing pain and drainage from the groin wound. On examination, there is erythema and dehiscence of the skin edges. Cloudy fluid emanates from the wound. I sigh. “Mrs Havercamp, when was the last time you had anything to eat or drink?” Groin wound complications—alarmingly common, occasionally lethal. Amputation may result, but regardless of the outcome, a significant commitment of time, effort, and cost ensues for the patient and the surgeon. That muscle flaps are a valuable adjunct in the treatment of groin wound complications is incontrovertible. Virtually every vascular surgeon has rotated a sartorius flap, usually with success. But what if the sartorius flap fails? or is unavailable? Most of us will have exhausted our toolbox and require the assistance of a plastic surgeon colleague. Indeed, there are myriad reports of other types of muscle flaps used in the management of groin wounds—tensor fascia lata, gracilis, anterolateral thigh myocutaneous, rectus femoris, rectus abdominis, and others. Common among these reports is that they are performed by plastic surgeons in the majority of cases. This study by Ryer and colleagues1Ryer E.J. Garvin R.P. Kapadia R.N. Jorgensen B.D. Green J.O. Fluck M. et al.Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructions.J Vasc Surg. 2020; 71: 905-911Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar describes 24 rectus femoris flaps performed exclusively by vascular surgeons for treatment of complex groin wounds after femoral artery reconstruction. As expected, obesity, diabetes, and chronic real disease were common in this cohort of patients, and more than half of the surgical procedures were performed in fields previously operated on. Outcomes were largely favorable and comparable to other publications for patient survival and limb salvage. There were no instances of flap necrosis, nor were any complications related to flap rotation identified. The technique for creation of these flaps is described and is straightforward. The authors acknowledge a potential disadvantage of the rectus femoris flap: a decrement in knee extension strength. The authors did not attempt to quantify it, and they appear to dismiss its importance among chronically ill patients who engage in little strenuous activity. On the contrary, maintaining all residual strength among these patients whose reserve is marginal may be critically important to maintaining mobility. This study sheds no light on this issue. In addition, harvesting and rotating this flap almost certainly take more time than creating a sartorius flap and do involve a fairly generous counterincision in the thigh. Nevertheless, I suspect that these potential downsides practically have little impact. Will I abandon the sartorius flap? Certainly not, and I suspect the authors will not either. There is clearly a role for this simple flap under the right circumstances. Will I add the rectus femoris flap into my own armamentarium? Absolutely. The opinions or views expressed in this commentary are those of the author and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructionsJournal of Vascular SurgeryVol. 71Issue 3PreviewGroin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Successful techniques include long-term antibiotic therapy, operative débridement, and muscle flap coverage. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap (RFF), has been performed by plastic and reconstructive surgeons. In this study, the experience of vascular surgeons performing RFF in the management of wound complications after femoral artery reconstructions is reported. Full-Text PDF

Implementation of perinatal collaborative care: a health services approach to perinatal depression care.

Our objective was to integrate lessons learned from perinatal collaborative care programs across the United States, recognizing the diversity of practice settings and patient populations, to provide guidance on successful implementation. Collaborative care is a health services delivery system that integrates behavioral health care into primary care. While efficacious, effectiveness requires rigorous attention to implementation to ensure adherence to the core evidence base. Implementation strategies are divided into three pragmatic stages: preparation, program launch, and program growth and sustainment; however, these steps are non-linear and dynamic. The discussion that follows is not meant to be prescriptive; rather, all implementation tasks should be thoughtfully tailored to the unique needs and setting of the obstetric community and patient population. In particular, we are aware that implementation on the level described here assumes commitment of both effort and money on the part of clinicians, administrators, and the health system, and that such financial resources are not always available. We conclude with synthesis of a survey of existing collaborative care programs to identify implementation practices of existing programs.

The Human Challenges of the Digital World: The Paradigm of Employee Expectations in the Banking Sector

The Human Challenges of the Digital World: The Paradigm of Employee Expectations in the Banking Sector

Adapting Mussar to Develop Management Students’ Character

Management educators have been advised to cultivate their students’ character. Yet they lack the instructional resources they need to do so. We were inspired by the principles and techniques of the Jewish spiritual practice of Mussar to put students on a personalized path of continuous character improvement. According to Mussar, everyone has some measure of a given character trait and needs to calibrate it to fill in a deficiency or tone down an excess. Although correcting character deficiencies and excesses requires a commitment of effort, we can, and should, become better versions of ourselves by applying that effort—that is, engaging in reflection, setting goals, monitoring our progress, and making adjustments—to move each of our character traits ever closer to its respective virtuous mean. We have designed materials to increase students’ awareness of character and its importance in organizations, give them a vocabulary of character traits, help them identify the character traits they would like to address, and provide them with a sustainable process for self-enhancement. In this article, we introduce these materials and provide evidence of their effectiveness.

Collaborative governance or private policy making? When consultants matter more than participation in collaborative environmental planning

ABSTRACTThe study of collaborative governance constitutes an established sub-literature within environmental policy and management scholarship. Among the lessons of this literature is that collaborative planning outputs are shaped by the mix of collaborative participants in question and the commitment participants exhibit towards joint planning efforts. This paper argues that a focus on the composition and commitment of collaborative participants ignores an increasingly prevalent actor in environmental planning – private sector contract consultants. We examine the relative influence of stakeholder attendance and the consulting firm providing support and facilitation in the case of integrated water resource management (IWRM) planning in the state of Georgia. Using attendance data derived from meeting minutes for ten concurrently operating regional IWRM councils, we document that neither the strength nor the commitment of collaborative efforts correlate with the content of planning outputs. Instead, the variation observed among regional plans can be largely explained by taking into account the consultant firms that were contracted to advise IWRM councils. Our discussion addresses the practical implications of relying on professional consultant services in environmental policy processes, and the theoretical imperative of incorporating consultant influence when explaining collaborative governance processes, outputs, and outcomes.

Anatomy of a Safe Area: The Military Requirements of Humanitarian Protection During Civil Wars

Civil wars frequently see violence against civilians, generate enormous internal displacement, and produce unmanageable refugee outflows to neighboring countries. Since at least the Second World War, the international community has struggled to provide protection to these war-impacted civilians within the country as well as once they flee. One solution that periodically surfaces in response to this problem is the establishment of a “safe area” for civilians within the borders of the war-torn country. However, little open-source work has evaluated the intricacies of this policy idea, especially its military requirements, costs, and potential risks. This paper provides this much-needed assessment through a close analysis of two possible options for a campaign to establish a safe area in the ongoing Syrian civil war. I find that the option that provides the most complete security to a humanitarian safe area in Syria (an area protected by air and ground assets) would likely be unprecedented in scope and cost, resembling the ground commitment of peak US counterinsurgency efforts, whereas its cheaper alternative (an air-only safe area) does little to address the strategic goals of the safe area and risks the safety of civilians in the process.

The Joy of Noh: Embodied Learning and Discipline in Urban Japan by Katrina L. Moore

Reviewed by: The Joy of Noh: Embodied Learning and Discipline in Urban Japan by Katrina L. Moore Christopher T. Nelson (bio) The Joy of Noh: Embodied Learning and Discipline in Urban Japan. By Katrina L. Moore. SUNY Press, Albany, 2014. xvi, 124 pages. $70.00, cloth; $23.95, paper. In recent years, significant popular attention has been focused on the crisis of aging in Japan. As the overall Japanese population declines, the proportion of the elderly continues to grow. Media representations depict the failure of families and community institutions to come to grips with the problem and a neoliberal ruling regime unwilling or unable to manage the crisis. Japanese scholars have been attentive to these issues, as have growing numbers of academics writing in English: Anne Allison, Jason Danely, and Jieung Kim have all published compelling interventions, complex and nuanced ethnographies that belie the language of catastrophe that colors popular discourse. As Anne Allison recently wrote of the response of the elderly and the dying, taken in the face of this crisis: "This sociality to come is already [End Page 480] emergent today and can be seen in innovations given to dealing with—and learning from—the dead."1 Katrina L. Moore's The Joy of Noh: Embodied Learning and Discipline in Urban Japan explores similar terrain. As the author writes in her introduction, her focus is "women's cultivation of self in later life within communities of learning in urban Japan" (p. 2). However, her book is less an intervention in this particular crisis than a text grounded in a long tradition of Japanese ethnographies that explore the ways Japanese men and women construct meaningful lives. In that sense, it has more in common with the work of John Traphagan, Gordon Matthews, and David Plath. This is not to say that the text is inattentive to crisis: it is simply that the ethnographies in this tradition have long been attentive to the problem of self-fashioning in the face of pressures to the contrary. In her introduction, Moore outlines this problem in very personal terms. When describing her interest in studying nō herself as part of a project to understand the lives of women who practice it, her grandmother—a cultured and accomplished woman—offers a discouraging reply. "How can you understand nō when even a Japanese person cannot?" However, her grandmother follows up this dispiriting assessment by sending the author a shoulder drum that she herself had used as a student in the 1920s, encouraging her to be patient and commit herself to three years of study. Despite the personal and particular nature of the exchange between Moore and her grandmother, the tone is set for a broader ethnographic project. To learn a traditional performing art is demanding. It requires a commitment of time, effort, capital, and self-discipline that will push the aspiring student to her limits. Perhaps it will be impossible. Still, for those who persevere, the self that emerges in practice and in performance might make all of these sacrifices worthwhile. The introduction also lays out the theoretical stakes of Moore's project. The author briefly reviews other ethnographies that consider ways in which the category of leisure affords subjects an opportunity to transform themselves through keiko—the demanding, structured tutelage that characterizes much of traditional Japanese art—in ways that might otherwise be unavailable to them in their daily lives. A short historical chapter follows, tracing the changing relationship between professional and amateur performers, and exploring the place of women in both. However, all of this serves to prepare the reader for the second chapter, the intellectual and affective heart of Moore's project. In "The Biography of a Noh Teacher," Moore collaborates in the narration of the life story of Tsurumi Reiko, founder and primary teacher of the Sumire Kai nō group. Tsurumi first appears in a dramatic encounter [End Page 481] with the author, transforming a performance at a birthday party into an impromptu lesson in nō chanting and commanding her audience to become her students. It is a memorable introduction to the figure who will animate the rest of the ethnography. Speaking of the work of the film essayist Chris Marker...

Using the Public Involvement Impact Assessment Framework to assess the impact of public involvement in a mental health research context: A reflective case study.

BackgroundWe assess the utility of the Public Involvement Impact Assessment Framework (PiiAF) as a resource to support research teams in assessing the impact of Public Involvement across diverse research and public involvement (PI) contexts. PiiAF was developed in response to a well‐documented growth in Public Involvement in health research in the United Kingdom that demands a more sophisticated evidence base to demonstrate its impact.DesignWe used a reflective case study approach drawing on contemporaneous meeting notes, PiiAF website resources and retrospective reflections to describe how PiiAF helped us to develop an impact assessment plan of the PI in a university‐based mental health research centre.DiscussionWe consider key aspects of our experiences of using PiiAF as a tool to help us design an impact assessment of PI, interpret these experiences with reference to relevant theory and research and share insights that may be useful to other teams considering using PiiAF.ConclusionThese insights include understanding the commitment of time and effort required to develop effective PI impact assessment plans; the flexibility of PiiAF and its ability to be used in a range of research and PI contexts; and the advantages of involving all stakeholders (including the public) in the development of an PI assessment plan.

Hippocrates’ complaint and the scientific ethos in early modern England

SUMMARYAmong the elements of the modern scientific ethos, as identified by R.K. Merton and others, is the commitment of individual effort to a long-term inquiry that may not bring substantial results in a lifetime. The challenge this presents was encapsulated in the aphorism of the ancient Greek physician, Hippocrates of Kos: vita brevis, ars longa (life is short, art is long). This article explores how this complaint was answered in the early modern period by Francis Bacon’s call for the inauguration of the sciences over several generations, thereby imagining a succession of lives added together over time. However, Bacon also explored another response to Hippocrates: the devotion of a ‘whole life’, whether brief or long, to science. The endorsement of long-term inquiry in combination with intensive lifetime involvement was embraced by some leading Fellows of the Royal Society, such as Robert Boyle and Robert Hooke. The problem for individuals, however, was to find satisfaction in science despite concerns, in some fields, that current observations and experiments would not yield material able to be extended by future investigations.

Timing of sales commitment in a supply chain with manufacturer-quality and retailer-effort induced demand

A manufacturer can costly invest in new technology to enhance the product quality and a retailer can enroll more sales forces to improve the sales effort level. Although both activities can effectively increase the market demand, the outcome from quality enhancement is generally uncertain and influenced by some random factors. This paper investigates the timing effect of retailer's commitment of sales effort on the firms' equilibrium investment and pricing decisions in a decentralized supply chain. We consider two different scenarios: early commitment and delay commitment, depending on whether the retailer's commitment of sales effort is before or after the manufacturer's enhanced quality level is resolved. It shows that under the delay commitment scenario, both the manufacturer's and the retailer's investment levels become higher than that under the early commitment scenario. This subsequently leads to higher payoffs for the retailer and the supply chain under the delay commitment scenario. However, from the manufacturer's perspective, either timing scenario could be the dominant option, which is dependent on the magnitude of quality enhancement variability. Interestingly, the manufacturer prefers delay commitment when the quality enhancement variability is sufficiently high, which implies that he may voluntarily prefer to personally endure the entire quality risk when its level gets higher.

Intellectual Property Law – Age of Internet

Creating of intellectual property product takes time, effort and great commitment. It requires a lot of effort to protect it as well. In a democratic society the protection of copyright is one of its core values, and guarantees cultural heritage, scientific and technological achievement. This article trying to give clear understanding of intellectual property importance in Internet Age, while interpreting and analyzing the copyright and its related rights, as: Objects of law regulated by legal norms, which are relatively new. Moreover during applying the historical data trying to describe and give outlook to the world where the intellectual product has been very low known, comparing with the recognition and regulation of other institutes of civil law. To achieve the aforementioned purpose would be used the interpretation and analysis method of data collection as: Norms from International Conventions and Domestic Law, practical cases and other relative material to the article focus. My research findings are that the copyright provides the economic basis for the creation and distribution of musical works, literary, artistic, movies, computer programs and other forms of creative expression. Moreover it protects its holder and determines whether and how to copy, distribute, and transmit their works as well as it stimulates talents to create creative ideas and prompts businesses to invest in them. DOI: 10.5901/ajis.2016.v5n3s1p363

Flipped Instruction for Information Literacy: Five Instructional Cases of Academic Librarians

University of California, Berkeley librarians have incorporated the flipped instruction model into information literacy training by focusing on two primary elements: assigning pre-class assignments and increasing active learning techniques. We explore these two elements across five diverse instructional cases, which include one-shot and semester-long classes that were conducted through online or in-person delivery for both graduate and undergraduate students across a range of subject areas (sciences, social sciences, and humanities). We examine the enabling factors and the perceived outcomes of this instructional paradigm. Because students came to class with enhanced library understanding and experience from the pre-class assignment, they were better prepared to engage with the material and articulate additional learning needs. We note students' increased engagement during class and more time available for higher-order learning exercises and discussions. As a result, flipped instruction appears to enable more learning opportunities without increasing classroom time. The challenges of this model are the requisite commitment of time and effort, the need to foster class participation, and the facilitation of active communication within the class. We propose a framework of catalysts, building blocks, and instructional outcomes to help library instructors incorporate flipped instruction elements into their instructional design.

Review: domestic animal forensic genetics - biological evidence, genetic markers, analytical approaches and challenges.

This review highlights the importance of domestic animal genetic evidence sources, genetic testing, markers and analytical approaches as well as the challenges this field is facing in view of the de facto 'gold standard' human DNA identification. Because of the genetic similarity between humans and domestic animals, genetic analysis of domestic animal hair, saliva, urine, blood and other biological material has generated vital investigative leads that have been admitted into a variety of court proceedings, including criminal and civil litigation. Information on validated short tandem repeat, single nucleotide polymorphism and mitochondrial DNA markers and public access to genetic databases for forensic DNA analysis is becoming readily available. Although the fundamental aspects of animal forensic genetic testing may be reliable and acceptable, animal forensic testing still lacks the standardized testing protocols that human genetic profiling requires, probably because of the absence of monetary support from government agencies and the difficulty in promoting cooperation among competing laboratories. Moreover, there is a lack in consensus about how to best present the results and expert opinion to comply with court standards and bear judicial scrutiny. This has been the single most persistent challenge ever since the earliest use of domestic animal forensic genetic testing in a criminal case in the mid-1990s. Crime laboratory accreditation ensures that genetic test results have the courts' confidence. Because accreditation requires significant commitments of effort, time and resources, the vast majority of animal forensic genetic laboratories are not accredited nor are their analysts certified forensic examiners. The relevance of domestic animal forensic genetics in the criminal justice system is undeniable. However, further improvements are needed in a wide range of supporting resources, including standardized quality assurance and control protocols for sample handling, evidence testing, statistical analysis and reporting that meet the rules of scientific acceptance, reliability and human forensic identification standards.

Campus gardens: Food production or sense of place?

Campus gardens can provide opportunities for experiential learning and enhanced physical and mental health; however, they require substantial commitments of time, money, and effort. This formative evaluation explored the perspectives of a university population on the establishment of a campus garden prior to its implementation. Phase 1 involved an electronic survey of the entire population at a small university (N=1300). Phase 2 consisted of 11 in-depth interviews with survey respondents who were interested in furthering the dialogue. The majority (85%) of the 415 individuals who responded to the survey and all interviewees supported the idea of a campus garden. Compared to a shared/community garden or rental plot, participants preferred a low-maintenance forest garden. Food production was secondary to protection of the natural environment and providing a space for rest and reflection. Participants’ sense of community, combined with knowledge of the university’s history, mission, and values, reflected a strong sense of place, a key component of social sustainability. Perhaps it is time to consider alternate options to traditional community gardens on university campuses. This research suggests that forest gardens, with their low-maintenance approach to food production and their potential to promote social sustainability through an enhanced sense of place, may be a good place to start.

Service and Mentoring: The Joy in Academics

Reflections on the role of service and mentorship in an academic career will be discussed in this AAA Ladman award talk. In the US, science functions largely by volunteer activities on the part of faculty, in terms of service to the university and professional disciplines. Faculty volunteer on study sections, review panels, editorial boards, and doing manuscript reviews. Committee work at local levels is required for promotion and tenure. Mentorship is also a key element in the science enterprise within the US. Training the next generation of scientists requires long commitments of faculty time and effort. Both service and mentorship are essential for science to succeed ‐ yet universities and medical schools today increasingly parse out effort reporting along revenue streams that include grant awards and/or tuition recovery through education. Where, then, does service fit in such a model where no direct dollars flow for reimbursement of service efforts? How does the joy of mentoring the next generation of scientists pay itself forward?

Separating the effects of task load and task motivation on the effort–fatigue relationship

A study is reported on the effects of task load and task motivation on the relationship between effort and fatigue in a demanding life-support simulation, aimed to test the hypothesis that effort, rather than demands, was the direct cause of fatigue in task performance. This was done by independently manipulating two factors that affect effort: task load and task motivation. A total of 28 participants were tested in a mixed 3 × 2 factorial design; task load (within-Ss) was varied in terms of the number of manual control systems (1, 3 or 5) that needed to be managed during a 100 min session, while task motivation (between-Ss) was defined by instructions (standard vs. enhanced) designed to influence the level of voluntary commitment to task goals. Effort and fatigue were measured by self report, as were perceived demands and anxiety (included as manipulation checks). While both task load and task motivation led to an increase in effort, there was a stronger fatigue response to task load under enhanced task motivation. As predicted, while both perceived demands and anxiety increased with task load, they were not affected by task motivation. An independent assessment of after-effects of fatigue on a fault finding task showed an increased use of low effort strategies under enhanced task motivation. The findings support the hypothesized effort → fatigue linkage. During task performance, fatigue is a consequence not of task demands per se, but of the level of commitment of effort in meeting demands.

Why nations fail: defense spending, fighting commitment and, inter-nations-prosperity-poverty-gap

Both the increasing defense spending and the widening divergence between rich and poor countries are of great concerns. This paper attempts to explain the two concepts in a unify theory framework. In the view of conflict economics, a nation’s defense spending can be seen as the fighting commitment of distributive effort in the global economy while other is the productive effort. The development of global economy needs the productive efforts from almost every nation, and the distribution of the aggregate output is determined in large degree by the fighting commitment of each nation. The numerical simulation of the model gives a reasonable explanation of the patterns of the divergence/convergence of prosperity-poverty gap between nations, the fact which is evidenced by many empirical analyses. (1) Given the initial wealth ratio between nations fixed, there is a critical value of fighting decisiveness, when the actual value is larger than the critical value, it is more likely to result in Matthew effect; otherwise the gap would gradually be shortened. (2) Given the fighting decisiveness fixed, there is a critical value of initial wealth ratio, when the actual value is larger than the critical value, it is more likely to result in Matthew effect; otherwise, the gap would gradually be shortened. The study gives a new perspective to explain and handle the increasingly defense spending and the prosperity-poverty gap between nations.

Focused or Flexible Targets? How Organizational Design Influences the Definition of Success for Strategic Initiatives

Stakeholder metrics translate strategic objectives into actionable targets. We analyze this dual role of performance metrics: they communicate the target outcomes (i.e., which project outcomes are considered successful), and they incentivize the organizational impetus (i.e., stakeholder effort commitment). Through an agency framework, we find that the same initiative might admit different definitions of success in different organizational structures. High-risk initiatives benefit from flexibility in what is considered successful, whereas the definition of success for low-risk initiatives depends on the organizational design; functional organizations should utilize flexible targets, whereas project-based organizations should utilize focused targets. Flexible targets provide a tolerance for failure to the organizational stakeholders and reduce the incentives required to ensure impetus in functional organizations; yet, such tolerance for failure encourages shirking in project-based organizations. Lastly, as the costs of execution increase, functional organizations benefit from flexible targets, whereas project-based organizations benefit from focus.

Anesthesia Quality and Safety

Anesthesia Quality and Safety

Institutional Investor Collaboration: Enhancing Effectiveness

This paper describes the continuation of previous research on the effectiveness of investor group collaborations funded by the Rotman International Centre for Pension Management (ICPM). Of particular interest is how investor collaboration might redress some of the shortcomings of the financial system that affect institutional investors and the beneficiaries of retirement savings plans.Collaborations have proliferated in recent years, with some groups focusing on broad system change while others act as a conduit for like-minded investors to achieve more specific goals. Investors are increasingly learning the value of coming together to respond to common issues as a group rather than working independently. The resulting collaborations vary in that they may be small and local or large and international, run with or without a financial commitment from members; but in all cases they involve a commitment of time and effort to make collaboration effective.Against this backdrop, this paper examines some of these real-world collaborations and applies an eight-step collaborative framework (Guyatt 2007) to analyze what makes them more or less effective in meeting their goals and objectives.