State Practice Research Articles

Effects of Statistical Practices for Longitudinal Group Comparison of the Penetration-Aspiration Scale on Power and Effect Size Estimation: A Monte Carlo Simulation Study.

Multiple bolus trials are administered during clinical and research swallowing assessments to comprehensively capture an individual's swallowing function. Despite valuable information obtained from these boluses, it remains common practice to use a single bolus (e.g., the worst score) to describe the degree of dysfunction. Researchers also often collapse continuous or ordinal swallowing measures into categories, potentially exacerbating information loss. These practices may adversely affect statistical power to detect and estimate smaller, yet potentially meaningful, treatment effects. This study sought to examine the impact of aggregating and categorizing penetration-aspiration scale (PAS) scores on statistical power and effect size estimates. We used a Monte Carlo approach to simulate three hypothetical within-subject treatment studies in Parkinson's disease and head and neck cancer across a range of data characteristics (e.g., sample size, number of bolus trials, variability). Different statistical models (aggregated or multilevel) as well as various PAS reduction approaches (i.e., types of categorizations) were performed to examine their impact on power and the accuracy of effect size estimates. Across all scenarios, multilevel models demonstrated higher statistical power to detect group-level longitudinal change and more accurate estimates compared to aggregated (worst score) models. Categorizing PAS scores also reduced power and biased effect size estimates compared to an ordinal approach, though this depended on the type of categorization and baseline PAS distribution. Multilevel models should be considered as a more robust approach for the statistical analysis of multiple boluses administered in standardized swallowing protocols due to its high sensitivity and accuracy to compare group-level changes in swallowing function. Importantly, this finding appears to be consistent across patient populations with distinct pathophysiology (i.e., PD and HNC) and patterns of airway invasion. The decision to categorize a continuous or ordinal outcome should be grounded in the clinical or research question with recognition that scale reduction may negatively affect the quality of statistical inferences in certain scenarios.

A matter of choice: a cross-sectional study examining the impact of the overturning of Roe v Wade on U.S. medical students’ perceptions and career decisions

Background In June 2022, the Dobbs decision by the U.S. Supreme Court overturned federal abortion protections. In states with restrictive abortion laws such as Indiana, which also has the country’s largest medical school and the third worst maternal mortality rate, the impact of this ruling may be huge on the medical field. The purpose of this study was to analyze perceptions of medical students in Indiana in their third and fourth years of education after the Dobbs decision to assess if the state’s current abortion restrictions impact their career choice. Methods Between December 2022 and March 2023, an anonymous survey was carried out at Indiana University School of Medicine, which included questions about personal beliefs on abortion and the current abortion laws in Indiana, as well as priorities when choosing residency training and practice locations. Results Our survey found that four-fifths of medical students in Indiana disagreed with the Dobbs decision. While most students (71.4%) had not considered state abortion laws when selecting a medical school, since the Dobbs decision, 66.3% of third-year and 40.3% of fourth-year students indicated that they would take abortion laws into account when choosing a residency program. 47.5% of female students stated that they will be seeking residency in a state where abortion is legal and 55.3% of single students were more likely to leave Indiana to practice medicine. Conclusion Our research suggests that physicians who are more liberal in their views on abortion may now be much less likely to practice in conservative states which will compound the healthcare outcomes secondary to the Dobbs decision. We emphasize the role that abortion laws have in shaping the landscape of healthcare workforce and the need for a more nuanced understanding of how societal structures impact women's reproductive decisions and career paths in medicine.

МОСКВА МАМЛЕКЕТТИК ЛИНГВИСТИКАЛЫК УНИВЕРСИТЕТИНИН САНАРИПТИК ЧӨЙРӨСҮНДӨ КЫРГЫЗ ТИЛИН ЧЕТ ТИЛИ КАТАРЫНДА ОКУТУУ

The article studies the issue of teaching the languages of the CIS countries, including the Kyrgyz language, in the digital environment of the Moscow State Linguistic University as an important aspect of pedagogical science and practice of the CIS member states, which is associated with the growing interest in the languages and culture of the CIS countries. The issue of teaching Kyrgyz language as a foreign language in the digital environment of the university is considered in the context of a personal-activity approach aimed at developing the creative potential of students, taking into account interests and values in the general context. The pace of development of modern infrastructure technologies increases the demand for digital skills. Of course, this phenomenon has brought significant changes to the education system and opens up new opportunities. Kyrgyz is taught as a second foreign language, and general and additional education curricula are being developed.

Being watched: The aftermath of covert policing

AbstractThe ongoing Undercover Policing Inquiry (UCPI) is largely a response to a stream of national media scandals that exposed the illegal and unethical behaviour of undercover police officers in two secretive units. The testimony of those who were the targets of undercover operations has further exposed the human costs stemming from the personalised and highly invasive surveillance undertaken by anonymous state agents. In this article, we reflect upon the existing research on covert policing and identify new areas for conceptual and methodological engagement, with a view to better understanding the harms that these secretive operations can generate. Attending to the inherent and inescapable intimacy of covert policing offers a much‐needed opportunity to explore the effects of a unique state practice that can radically alter the lives of individual surveillance subjects, and which tests our conventional understandings of the legitimacy and limits of force, coercion and police power.

Ten questions concerning statistical data analysis in human-centric buildings research: A focus on thermal comfort investigations

Given the large amount of time we spend indoors, designing and operating buildings that are safe, comfortable, and conducive to productivity and well-being is essential. To achieve this goal, in the past decades, research has been conducted to investigate the influence of the indoor environment on occupants. Thermal comfort has been the subject of most investigations in this field. However, despite being a consolidated research topic since the 1920s, statistical practices for analysing thermal comfort data often rely on simplified premises, which may be due to several possible factors (e.g., limited computational capabilities and lack of training). Consequently, important aspects of data analysis are often absent or overlooked. Recent statistics and statistical software advances have provided more options for effectively modelling complex issues. However, properly using these tools requires a solid understanding of statistical analysis, increasing the risk of misuse in practice. This paper presents ten questions highlighting the most critical issues regarding statistical analysis for thermal comfort research and practice. The first four questions provide general perspectives concerning statistical data analysis, while the remaining ones address specific problems related to thermal comfort research, but that can extend to all human-centric research in the built environment. Additionally, the last five questions demonstrate the practical significance of analysis pitfalls (i.e., sampling variability, selection bias, variable selection, clustered/nested observations, and measurement error) through examples with synthetic data. This study provides insights into the current statistical ‘habits’ in thermal comfort research and, more importantly, help researchers better define and conduct their statistical analyses.

Leveraging the Consolidated Framework for Implementation Research (CFIR) to Develop the American College of Rheumatology's Toolkit for Implementation of Rheumatoid Arthritis Outcome Measures in Clinical Practice: A Qualitative Study.

Despite the recognized benefits of collecting rheumatoid arthritis (RA) outcomes measures, their use in routine care is inconsistent. Using the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews with United States rheumatologists and practice personnel to assess workflows, opportunities, and challenges in collecting RA outcome measures. Using insights from interviews, we developed the RA Measures Toolkit to enhance their utilization in clinical practice. We invited 138 RISE registry practices and 5 academic medical centers with ≥ 30 patients eligible for RA outcome measures to participate in the study. Practices were classified based on their performance in quality payment programs. Recorded interviews were transcribed verbatim and analyzed thematically using deductive and inductive techniques. The findings were used to create the RA Measures Toolkit. We conducted 20 interviews with 38 participants across 20 practices. Key themes within the CFIR domains highlighted the challenges and best practices in RA outcome measure collection and included: 1) Process: the variability in practices' use of RA outcome measures and the importance of streamlined workflows, 2) Intervention: challenges of integrating PROs into electronic health records (EHRs), and 3) Individual characteristics: importance of clinic culture around quality improvement. Using this data, we developed the RA Toolkit, a multimedia online resource, featuring guidelines, best practices, and educational resources to improve the efficiency of current workflows and to enhance patient care. This study identifies critical gaps in the collection of RA outcome measures in U.S. rheumatology practices and provides actionable recommendations and resources to address challenges via the RA Toolkit.

Access to justice as an element of the rule of law in the modern democratic state

The article examines access to justice as an element of the rule of law in a modern democratic state. The issue of securing access to justice in the legislative practice of countries is detailed. Practice is analyzed, where access to justice is considered as an opportunity for any interested person to go to court without hindrance and participate in the legal process at all its stages. At the same time, it is emphasized that such access implies access to national and international justice systems. This significantly contributes to a person’s ability to defend himself against encroachments on his rights, compensation for damage caused by offenses and self-defense in criminal proceedings. It is proven that access to justice is increasingly included in the international and national practice of states and begins to occupy an important place in the organization and functioning of the judiciary. It is noted that today the concept of access to justice does not have a unified approach to its understanding in the circles of the scientific community. The development of this issue continues for a considerable period of time. Long-standing discussions give reasons to testify that access to justice is an extremely broad concept that can be distinguished as a separate concept, principle or right. It is emphasized that in this context it is extremely important to emphasize the mechanisms of human rights protection, that is, its application to those categories of the population that do not have the opportunity and resources to go to court. In view of this, it is extremely important to apply the principle of equality before the court in practice. This will make it possible to ensure equal access to the trial for all participants in the process. The international experience of access to justice and its generalization in legal practice is analyzed. It is noted that international law has singled out an important component of access to justice, which is the right to access international mechanisms for ensuring the protection of human rights. It is emphasized that the justice system can use the norms of international law, including anti-discrimination norms. The key in this process is ensuring access to justice, which is an important basis for the conclusion of international treaties and the effective functioning of international human rights organizations.

Seeking environmental justice through the state: Insider allies in U.S. state and federal government agencies

Geographers and political ecologists have demonstrated settler-colonial states’ longstanding key roles in producing environmental injustice through colonialism, racial capitalism, neoliberalism, and other mechanisms. Such studies tend to conclude, implicitly or explicitly, that environmental justice (EJ) movements’ pursuits of more sustainable and just futures must therefore antagonistically confront the state or work beyond it entirely to create alternative futures that do not reinforce state hegemony and violence. However, other scholars in recent years have critiqued such characterizations of the state as unilaterally and fundamentally oppressive, arguing instead that states are terrains of struggle whose contradictory programs and practices reflect not only the interests of capital but also actions of movements. They demonstrate that movements pursuing more just and sustainable futures find purchase working both through and beyond the state. Here, we follow these scholars but depart from them in one respect – namely, they frame movements as pressuring the state only from outside of it. We argue that conceptualizing the state and movements as ontologically overlapping and permeable realms in which some actors move back and forth illuminates additional movement influence on state practice and additional factors that mediate their efforts. We make this case by following a group of U.S. EJ activists who pursue EJ movements’ goals by taking formal positions inside the government agencies they seek to change. We show that they accomplish meaningful change in these roles and that their work is mediated not only by industry power over state agencies, as other scholars have rightly identified, but also by elements of regulatory workplace culture, insider allies’ skills honed in external EJ advocacy, and solidarity among EJ advocates within and beyond the state. By more fully identifying such mediating factors and showing how they shape insider allies’ work, we hope to highlight new fronts of struggle as former EJ movement activists use their insider ally positions to wrest more control over the state from capital and for liberatory ends.

LucidScript: Bottom-Up Standardization for Data Preparation

Data preparation is an essential step in every data-related effort, from scientific projects in academia to data-driven decision-making in industry. Typically, data preparation is not an interesting piece of a project --- it transforms raw data into a format that enables further innovative work. Because such scripts are never intended to be interesting, are project-specific, and are written in general-purpose languages, they can be tedious to understand and difficult to verify. As a result, data preparation scripts can easily become a breeding ground for poor engineering and statistical practices. Ideally, data preparation scripts are "admirably boring" --- they should serve the project, but otherwise be as simple and as standard as possible. We propose a bottom-up script standardization framework that takes a user's data preparation script and transforms it into a simpler, more standardized version of itself. Our framework takes the user's script not as an unchangeable definition of correctness, but as a sketch of the user's intent. We embedded this framework in a system called LucidScript.

Performance and Interpretation of Lung Scintigraphy: An Evaluation of Current Practices in Australia, Canada, France, Germany, and United States.

Although ventilation/perfusion (V/Q) scintigraphy is a widely used imaging test, different options are possible for the acquisition and interpretation of the scan. The aim of this study was to assess current practices regarding the use and interpretation of lung scintigraphy in various clinical indications. An online survey comprising 25 questions was sent to nuclear medicine departments in Australia, Canada, France, Germany, and United States between 2022 and 2023. A single response per department was consolidated. Four hundred nineteen responses were collected (Australia: 32, Canada: 58, France: 149, Germany: 92, and United States: 88). For acute pulmonary embolism (PE) diagnosis, 82.8% of centers reported using SPECT acquisitions (Australia: 93.3%, Canada: 91.8%, France: 99.2%, Germany: 96.2%, and United States: 32.1%). Among them, SPECT images were combined with a CT scan in 70.5% of centers. A total of 10.6% of centers reported not using ventilation for acute PE diagnosis. SPECT acquisition was used in 97.8% of centers using 99m Tc carbon particles, 97.1% 81m Kr gas, 58.7% 99m Tc-DTPA, and 19.4% 133 Xe gas, respectively. For V/Q SPECT interpretation, the EANM criteria were used in 65.0% of departments. A very wide variety of practices were observed in pregnant women and in COVID-19 patients. SPECT acquisition was widely used in the follow-up of PE and for the screening of chronic thromboembolic pulmonary hypertension (>90% of centers), with inconsistency regarding the interpretation of matched perfusion defects in this setting. This survey shows the strong adoption of SPECT in the various clinical indications of lung scintigraphy, except in the United States, where planar imaging is still mostly used. The survey also shows variability in interpretation criteria both for PE diagnosis and screening for chronic thromboembolic pulmonary hypertension, highlighting the need for further standardizations of practices.

Modeling evolutionary power spectral density functions of strong earthquakes via copulas

This paper proposes a new approach for analyzing seismic accelerograms using the evolutionary Power Spectral Density function (EPSD). The accelerogram of an earthquake can be accurately modeled and simulated from its spectrogram, based on the oscillatory stochastic processes theory. To adequately characterize a spectrogram that is consistent with the response spectra, a parametric model with 16 parameters is proposed. This model describes the square of the amplitude spectrum, an envelope of the square of the accelerogram, and a copula that constructs a time–frequency model from the time and frequency marginals. The use of copulas to model a bivariate probability distribution is a common practice in statistics, particularly when the marginal distributions are known. The periodogram can be viewed as an unnormalized probability density function, where the total energy serves as the normalization constant, since the total energy of a seismic motion is always finite. Additionally, a reduced model consisting of only 10 parameters is presented, which may be especially valuable when only shear wave effects are relevant.

Performing (against) the state

ABSTRACT The reformation of the Arab state in neoliberal times has produced the narratives of the withdrawing versus intervening state. This article complicates these binary notions by taking seriously both top-down and bottom-up state practices in the realm of employment in Tunisia. Drawing on a qualitative analysis of precarious workers’ collective actions, it shows that the precarization of labour relations was structured by state actors’ arbitrary acts for and against a new state image in a neoliberal direction before and after the Uprising. Importantly, bottom-up mobilizations have criticized, challenged and attempted to correct these top-down state practices by performing their image of the state as a coherent entity that is bound by laws and protects the right to decent work.

The affective economy of removal: ethnographic perspectives on deportation and (In)voluntary return

ABSTRACT The removal of undocumented migrants has become a widespread preoccupation of current European migration politics and one of the most emotionally contentious state practices of our times. Not only right-wing populists and their constituencies demand an increase in expulsions, but also mainstream society. Others accuse these positions of being racist or lacking humanism and instead promote solidarity to help people seeking protection in Europe. These divisive views and migrants’ often long-term experience of being ‘unwanted’ and deportable provoke strong and often irreconcilable emotions. The ethnographic explorations assembled here zoom in on the ‘affective economies’ inherent in the arbitrary processes and unpredictable experiences of removals of people from Europe to different parts of the world. This special issue puts forward a twofold argument: First, conceptually, we argue that a focus on affects is indispensable in order to fully unearth the complexities of removal processes. And second, methodologically, we contend that an ethnographic approach, with its deep and often long-term commitment of researchers to their respective field(s) including multiple actors, is essential to comprehensively grasp the affective economy of removal.

Deferred maintenance of physical infrastructure and its association to hospital profitability in Washington State

PurposeThe aim of this study is to understand health-care facilities’ practice of deferring maintenance and to identify the relationship between deferred maintenance and hospital profitability.Design/methodology/approachFinancial statements from hospitals in Washington State were analyzed. Differences in building and equipment values were compared to the capital renewal investment benchmark. Then, linear regression analysis was conducted to identify correlations between deferring or sustaining maintenance and a hospital’s profitability.FindingsThe majority of hospitals in Washington State practice deferred maintenance, investing less in annual facility capital renewal than benchmark amounts. Hospitals in deferred and sustained maintenance states do not significantly differ in terms of facility size and plant operating expenses but there is a statistically significant difference in profit margins. Furthermore, a linear relationship exists between the level of investment in facility renewal and overall hospital expenses, revenue and profit.Practical implicationsThe findings of this research can be used to support fiscal policies related to maintaining aging health-care facility infrastructure. The findings can also be used to overcome barriers to securing capital budgets that are sufficient to optimize the safety and performance of the built environment.Originality/valueHospitals in a state of deferred maintenance return higher profits than do hospitals in a state of sustained maintenance. Nevertheless, hospital spending on deferred maintenance backlog reduction generates a positive return on investment. While hospitals may achieve higher returns, in the short term, by spending less on facility capital renewal and focusing instead on higher-revenue-generating opportunities, additional research in necessary to understand the long-term costs of deferring facility infrastructure repairs and replacement.

Comparison of Laws that Impact Volunteer Response in Three Disaster-Prone Southeastern States.

As natural disasters become more frequent and severe, the ability of impacted states to rapidly scale up their capacity to respond and facilitate recovery through volunteers is ever more crucial. However, the legal landscape that may facilitate or hamper augmentation through volunteers has yet to be fully explored. This study utilized policy surveillance methodology to code relevant laws identified in searches using the Emergency Law Inventory database and Westlaw. We assessed laws in three natural disaster-prone states: North Carolina, South Carolina, and Georgia. We assessed the presence of liability protection, license reciprocity, and scope of practice laws for health care volunteers. Of the three assessed legal domains, liability protection for health care volunteers across all states contained the most robust language. Liability protections apply unless the health care volunteers act with reckless disregard, willful misconduct, or gross negligence. However, nuance exists based on which organizations (state vs charitable) volunteers are affiliated with to qualify for coverage. License reciprocity for out-of-state specific health care professions entering the impacted states was available across all three states. However, only Georgia enacted federal model legislation that provides additional flexibility regarding credentialing and liability protections. Lastly, very few laws addressed the scope of practice in impacted states. Comparisons of laws that impact the ability of health care volunteers to respond and recover from disasters are scarce. More research needs to be performed to better understand the laws that impact volunteers in emergencies, particularly as the public health system is overtasked when providing services to impacted communities.

Drawing the Dragon’s Claw: China Declares Territorial Sea Baselines in the Gulf of Tonkin

Abstract The Chinese Government issued a declaration defining straight baselines between Hainan and Vietnam on 1 March 2024. In doing so, it has completed the definition of baselines off the western side of Hainan through to the terminus of the China-Vietnam land boundary on the coast. Straight baselines can be declared where the coast is complex as a result of coastal indentations or the presence of a fringe of islands along and close to the coast. They provide a simplified baseline along the coast from which to measure maritime zones. Straight baselines can also push the outer limits of the territorial sea further seaward than if ‘normal’ baselines are used. This article outlines China’s recent announcement regarding its territorial sea baselines as well as the limits delineated from them and considers it in light of international jurisprudence and State practice on baselines. It is anticipated that China’s new baselines system will not impact on the already agreed China-Vietnam maritime boundary in the Gulf of Tonkin but that China will likely face criticism about the manner in which it has drawn these baselines although there is currently little prospect of a dispute reaching international adjudication.

State Practice

State Practice

Indonesia: Law No. 16 of 2023, Related to the Continental Shelf

Abstract In April 2023, Indonesia passed Law No. 16 of 2023, related to the continental shelf which supersedes Law No. 1 of 1973 which was based on the 1958 Convention on the Continental Shelf. The new continental shelf law aligns Indonesia’s domestic legislation with the United Nations Convention on the Law of the Sea (unclos). The new law also reaffirms the practice of using separate lines for Exclusive Economic Zone (eez) and continental shelf delimitations and explicitly respects previously negotiated delimitation treaties with neighbouring States. However, there are some rules that might potentially diverge from the general practices of States particularly in relation to artificial islands, platforms, and submarine cables and pipelines. This article examines significant aspects and concerns associated with this legislation.

Some Observations on the ‘Ambulatory’ Nature of the Normal Baseline

Abstract From the start of the discussion about the implications of sea level rise for the entitlements of coastal States to maritime jurisdictional zones, the question of the interpretation of Art. 5 unclos (and the corresponding rule of customary international law) on the ‘normal’ baseline of the territorial sea became an essential element of the debate. The then generally accepted interpretation of Art. 5 assumed that this normal baseline, viz., the low-water line along the coast, when physically moving as a result of sea level rise, would have the effect of also moving the outer limits of the maritime zones. This interpretation became known as the ‘ambulatory’ baseline, and was inter alia adopted by the ila Committee on Baselines in the Law of the Sea and the ila Committee on Sea Level Rise and International law. However, this interpretation has recently been challenged by a few authors, as well as, more importantly, by some States. This contribution briefly examines State practice, and concludes that the normal baseline of the territorial sea is indeed ‘ambulatory’ under the current law as reflected in Art. 5 unclos. However, a significant change in the interpretation (and application) of this provision is developing in State practice, to the effect that coastal States affected by sea level rise should be allowed to maintain their current normal baselines, as determined in accordance with the provisions of unclos, notwithstanding future changes to the low-water line. If this changed interpretation is not also reflected in a change of the text of Art. 5 (which would involve an amendment of unclos under its articles 312 or 313), we may be witnessing an example of tacit amendment (modification) of a treaty provision by subsequent practice. At the same time the relevant rule of customary international law would then be changed as well.

Confronting Medical Diploma Mills: State Licensing Boards, Legislatures, and the Limits of Medical Authority in the 1920s.

In the standard story of the rise of professional authority in medicine in the 1920s, state medical licensing boards were partners in a coalition, led by the American Medical Association, to radically improve medical education. Boards obtained state laws that limited admission to licensing examinations to graduates of schools approved by the AMA, thus bringing about the rapid demise of low-quality schools by about 1925. The reality at the state level was quite different, however. Medical examining boards containing homeopaths, eclectics, and sometimes osteopaths could be far from reliable partners. Passing laws to benefit the medical profession was exceedingly difficult and dependent on local medical politics. Through the lens of a major medical diploma mill scandal revealed by a journalist in 1923, this paper examines reform efforts in three states greatly affected by the scandal: Missouri, where the scandal originated, Connecticut, and Massachusetts. In each of these states, graduates of low-quality schools as well as fake doctors from diploma mills were able to take a state examination and practice. This paper argues that the AMA, far from being the major player in the elimination of inadequate schools, could set standards but had to stay on the sidelines.