Punitive Action Research Articles

Frontline worker perceptions of medication safety in India.

To explore interprofessionals' perceptions about patient safety, particularly medication safety and associated factors and barriers. A total of 389 respondents were recruited using convenience sample in the cross sectional survey. Medication safety was perceived as somewhat safe (60%). One-third of respondents witnessed 3-4 or more medication errors (MEs) within the past 1 year. Out of that, one quarter were reportedly, sentinel events. More sentinel events were witnessed in public hospitals and solo practice clinics compared with corporate hospitals and nursing homes (p < 0.02). No difference was observed in the occurrence of sentinel events in accredited and nonaccredited facilities (p = 0.30). Younger respondents witnessed more MEs, whereas accredited hospitals (mostly corporate hospitals) witnessed significantly fewer MEs and graded overall safety as 'better'. However, most MEs go unreported particularly in solo practice clinics (88%) followed by nursing homes (67%), public hospitals (54%), and corporate hospitals (42%). Error identification and subsequent disclosure was inhibited by several system factors: fear of punitive action and lack of reporting systems. General surgical (46%), medical (42%), and paediatric units (36%), were the most error-prone places. Documentation diverted all healthcare workers from direct patient care. Many doctors and pharmacists from nursing homes, solo clinics and public hospitals reported working overtime. Staff shortages and poor training were overwhelming concerns to all healthcare workers and in public hospitals. Solo clinics and nursing homes perceived more barriers; lack of reporting systems, standard protocol, and resources for patient safety and unfamiliarity with prescribed medications was their overwhelming concern. Other factors threatening MEs were a lack of team approach and openness in interdisciplinary communications, illegible medical orders, and medicines prescribed by brand names. Immediate interventions to improve medication safety include enforcement of legible/printed medical orders in generic names, workforce development, developing standard protocols, and a corresponding change in organizational culture. Accreditation can serve as a driver for improving patient safety.

Should quality of the liver transplant candidate evaluation be measured?

Should quality of the liver transplant candidate evaluation be measured?

O Acordo de Leniência como Instrumento de Tutela da Defesa da Concorrência no Brasil

The market economy countries have significant concerns with the restraint of trade, requiring constitute regulatory frameworks and mechanisms to protect economic competition, so that economic efficiency is governed by legislation determined by the State. To mitigate the problems arising from the formation of a cartel that prevent free competition, causing damage to the community, the Office of the leniency agreement arises, administered by the Board of Directors and Economic Defense - CADE - the body responsible for prevention and repression of offenses against economic order. The leniency agreement is one of the most effective tools used by antitrust authorities to provide effective enforcement of antitrust law as regards the repression of anti-competitive practices although there are some contradictions in the field of ethics. In fulfilling the leniency agreement, the proposing informer may have the extinction of the punitive action or reduction of one to two thirds of the penalty applicable at the administrative level and in the criminal context, automatically terminate the punishment of crimes against the economic order.

Worshipping the colliery-goddess

This article interprets the function of mine workers’ observance of the colliery-goddess cult, described as the Khadan–Kali cult, for gaining access to divine power so as to secure safety, and explains its relationship with the new political and scientific accident-control emphases adopted by workers from the 1920s onwards. Some observers regard the workers’ industrial–religious rites an expression of the pre-bourgeois customs. The latter is understood to have been in contradistinction to the modern principle of secular ethics and reason. Mine workers with such ‘fatalistic’ outlook could make few efforts to curb occupational hazards. Such outlook was an allegory of workers’ loss of control over their own personal destinies and of the price they paid for industrialisation. These observations, my study shows, would overlook, in our case, the fact that the colliery-goddess cult embodied the desire of workers for control over hazardous mining and for self-preservation. Indeed, it gave way to the secular-safety politics and also inscribed newer meanings to the relationship between the deity and her adherents. Miners vested in it a critique of the new official scheme that attributed responsibility for fatality and injury to an individual miner and subjected him/her to certain punitive actions. The article relies on material collected from archives and historical–anthropological survey of 25 former mine workers, undertaken during 2003–09.

Creative Accounting Scam at Satyam Computer Limited: How the Fraud Story Unfolded?

Keen to project a perpetually rosy picture of the Satyam to the investors, employees and analysts, Mr. Raju (CEO and Chairman) manipulated the account books so that it appeared to be a far bigger enterprise than it actually was. The Satyam fraud has shattered the dreams of different categories of investors, shocked the government and regulators alike, and led to questioning of the accounting practices of statutory auditors and CG norms in India. An attempt has been made to provide an explanation for various “intriguing” questions about Satyam scam, such as: What was the need to commit a fraud on such a large scale? How Raju managed to cook-up books? What was Raju’s real modus-operandi to manipulate the accounts for eight years? Why was Raju forced to blow his own whistle? Why was not there a stricter punitive action against the auditors of Satyam PwC?, etc.” Now, after thorough investigations done by the CBI and SEBI, they have unveiled the methodology by which Satyam fraud was engineered. Finally, we recommend that “CA practices should be considered as a serious crime, and as such, accounting bodies, law courts and other regulatory authorities in India need to adopt very strict punitive measures to stop such unethical CA practices”.

Capuchin monkeys punish those who have more

Punishment of non-cooperators is important for the maintenance of large-scale cooperation in humans, but relatively little is known about the relationship between punishment and cooperation across phylogeny. The current study examined second-party punishment behavior in a nonhuman primate species known for its cooperative tendencies—the brown capuchin monkey (Cebus apella). We found that capuchins consistently punished a conspecific partner who gained possession of a food resource, regardless of whether the unequal distribution of this resource was intentional on the part of the partner. A non-social comparison confirmed that punishment behavior was not due to frustration, nor did punishment stem from increased emotional arousal. Instead, punishment behavior in capuchins appears to be decidedly social in nature, as monkeys only pursued punitive actions when such actions directly decreased the welfare of a recently endowed conspecific. This pattern of results is consistent with two features central to human cooperation: spite and inequity aversion, suggesting that the evolutionary origins of some human-like punitive tendencies may extend even deeper than previously thought.

The Transformation of Auto Safety Regulation: Bureaucratic Adaptation to Legal Culture

Created in 1966 primarily as a rulemaking body empowered to force the technology of motor vehicle safety, by the late 1970's the National Highway Safety Administration (NHTSA) had largely abandoned its rulemaking mission in favor of the aggressive recall of defective motor vehicles. That first period adaptation was driven by devastating losses in pre-enforcement judicial review proceedings combined with enthusiastic judicial embrace of the agency's recall efforts. Congressional reaction mimicked the signals from the courts, and the Reagan administration's regulatory reform and relief programs of the 1980's further solidified NHTSA's revised agenda. Prodded by congressional mandates, beginning in1991, but largely of 21st century origin, NHTSA has returned to rulemaking in the last two decades, but in a largely illusory form. Rather than forcing new technologies, the agency has largely required the diffusion of existing technologies already in widespread use -- technologies that might well have reached universal deployment in the absence of the agency's rules. Recalls (which have no demonstrable effect on motor vehicle safety) have continued at increasingly high levels and have been combined with consumer information campaigns, the encouragement of state behavior modification efforts, and agency-industry agreements, to round out NHTSA's emerging model of cooperative regulation. Whether or not this strategy has substantial effects in promoting motor vehicle safety, NHTSA's accommodating posture has resulted in congressional and OMB approval and industry acceptance without litigation. This article describes the evolution of motor vehicle safety regulation and interprets the agency's transformation as an almost perfect adaptation to a legal culture skeptical of ex ante coercive restraints on individual or firm conduct and accepting of post hoc compensatory or punitive action when that conduct fails to live up to broad social norms.

Causas del control judicial a los actos administrativos disciplinarios proferidos por las procuradurías regionales de Tolima y de Cundinamarca

La Jurisdicción de lo Contencioso Administrativo puede ejercer control de legalidad sobre los actos administrativos sancionatorios expedidos por la Procuraduría General de la Nación, sus delegadas y demás agentes a través del medio de control de nulidad y restablecimiento del derecho. No obstante, dicho instrumento procesal no siempre se usa eficazmente porque existe un desconocimiento respecto de la forma de invocar correctamente las causales de nulidad que motivan su ejercicio judicial. Esa ausencia de discernimiento jurídico puede conllevar a que los disciplinados no logren una decisión judicial a su favor. Para contribuir a solucionar esa problemática, se realizaron una revisión bibliográfica y una investigación de corte descriptivo e interpretativo. En este estudio, se analizaron las sanciones disciplinarias proferidas por las procuradurías regionales de Tolima y Cundinamarca cualitativa y cuantitativamente. En concreto, la investigación examinó las causales de la realización de un control judicial a actos disciplinarios emanados de esas dos procuradurías regionales. Los resultados de esas labores investigativas se dan a conocer en el presente artículo.

Interpreting sanctions in Africa and Southeast Asia

The Organization of African Unity (OAU) and the Association of Southeast Asian Nations (ASEAN) were both born to stabilise vulnerable state borders by practising non-interference in domestic affairs. Today, the OAU’s successor, the African Union (AU), uses sanctions against unconstitutional changes of government, while ASEAN continues to rule out any collective punitive action against members. To explain these divergent trajectories, this article first shows how different traditions produced different ways of engaging with sanctions in the early formative cases of South Africa and Vietnam. Thereafter, it examines how these traditions were selectively re-thought when confronted with the dilemmas of international sanctions against Libya and Myanmar. The interpretive approach enables a nuanced account of continuity and change in beliefs about sanctions. The AU’s sanctions doctrine has updated rather than broken with a traditional interpretation of non-interference. For ASEAN, the longstanding tradition of informality – and not strict adherence to non-interference – has continued to rule out regional sanctions.

Physicians' knowledge and practice towards medical error reporting: a cross-sectional hospital-based study in Saudi Arabia.

Identifying reasons for under-reporting is crucial in reducing the incidence of medical errors. We studied physicians' knowledge of the occurrence, frequency and causes of medical errors and their actual practice toward reporting them. A cross-sectional, self-administered questionnaire was answered by 107 physicians at a tertiary-care hospital in Saudi Arabia. The questionnaire had 6 sections covering demographic data, knowledge, attitudes and practice towards reporting medical errors, perceived causes of and frequency of medical errors in their hospital and personal experiences of medical error reporting. Physicians tended not to report medical errors when no harm had occurred to patients. One-third of respondents feared punitive actions if they reported errors and only 56.4% felt that error reporting had led to positive changes in overall care. A majority of errors were related to late interventions and misdiagnosis. Under-reporting of medical errors was common in this hospital. Physicians did not appreciate attempts to improve the system of error reporting and a culture of blame still prevailed.

Counter-Insurgency against ‘Kith and Kin’? The British Army in Northern Ireland, 1970–76

This article argues that state violence in Northern Ireland during the period 1970–1976—when violence during the Troubles was at its height and before the re-introduction of the policy of police primacy in 1976—was on a greatly reduced scale from that seen in British counterinsurgency campaigns in the colonies after the Second World War. When the army attempted to introduce measures used in the colonies—curfews, internment without trial—these proved to be extremely damaging to London's political aims in Northern Ireland, namely the conciliation of the Catholic minority within the United Kingdom and the defeat of the IRA. However, the insistence by William Whitelaw, secretary of state for Northern Ireland (1972–73), on ‘throttling back'—the release of internees and the imposition of unprecedented restrictions on the use of violence by the army—put a serious strain on civil-military relations in Northern Ireland. The relatively stagnant nature of the conflict—with units taking casualties in the same small ‘patch’ of territory without opportunities for the types of ‘positive actions’ seen in the colonies—led to some deviancy on the part of small infantry units who sought informal, unsanctioned ways of taking revenge upon the local population. Meanwhile, a disbelieving and defensive attitude at senior levels of command in Northern Ireland meant that informal punitive actions against the local population were often not properly investigated during 1970–72, until more thorough civilian and military investigative procedures were put in place. Finally, a separation of ethnic and cultural identity between the soldiers and the local population—despite their being citizens of the same state—became professionally desirable in order for soldiers to carry out difficult, occasionally distasteful work.

Using Surgeon-Specific Outcome Reports and Positive Deviance for Continuous Quality Improvement

Using the thoracic morbidity and mortality classification to document all postoperative adverse events between October 2012 and February 2014, we created surgeon-specific outcome reports (SSORs) to promote self-assessment and to implement a divisional continuous quality improvement (CQI) program, on the construct of positive deviance, to improve individual surgeon's clinical performance. Mixed-methods study within a division of six thoracic surgeons, involving (1) development of real-time, Web-based, risk-adjusted SSORs; (2) implementation of CQI seminars (n= 6; September 2013 to June 2014) for evaluation of results, collegial discussion on quality improvement based on identification of positive outliers, and selection of quality indicators for future discussion; and (3) in-person interviews to identify facilitators and barriers to using SSORs and CQI. Interview transcripts were analyzed using thematic analysis. Interviews revealed enthusiastic support for SSORs as a means to improve patient care through awareness of personal outcomes with blinded divisional comparison for similar operations and diseases, and apply the learning objectives to continuous professional development and maintenance of certification. Perceived limitations of SSORs included difficulty measuring surgeon expertise, limited understanding of risk adjustment, resistance to change, and belief that knowledge of sensitive data could lead to punitive actions. All surgeons believed CQI seminars led to collegial discussions, whereas perceived limitations included quorum participation and failing to circle back on actionable items. Real-time performance feedback using SSORs can motivate surgeons to improve their practice, and CQI seminars offer the opportunity to review and interpret results and address issues in a supportive environment. Whether SSORs and CQI can lead to improvements in rates of postoperative adverse events is a matter of ongoing research.

Brazilian uprising

Brazil experienced, in June of 2013, the largest popular demonstrations in its recent history —an event that has been called the June Journeys. In this paper, we briefly address briefly the processes of spatial diffusion and dispersion observed during these journeys. We then reflect on how these processes relate to a politics of identity, and the strategies used by protesters to differentiate themselves from other groups, and by the State to classify the protesters in order to guide the use of police repression. Identity can, therefore, group individuals around a common struggle using as reference the location of the demon-stration as ‘spaces of identity reference’, but can also play an important role in the reproduction of dominant power relations by creating mechanisms with which to legitimate punitive action. The ‘vandal’ is, then, understood as the identity constructed to allow the transition from an indirect regulation to a mode of violent intervention. We conclude the paper by emphasising how both of these processes highlight the role of the politics of identity on this recent series of demonstrations in Brazil.

Assessing the Perceived Level of Institutional Support for the Second Victim After a Patient Safety Event

The objective of this study was to establish a baseline of perceived availability of institutional support services or interventions and experiences following an adverse patient safety event (PSE) in a 650-bed children and adult community teaching hospital. Investigators queried associates about their experiences after a PSE, what institutional support services or interventions they perceived to be available, and how helpful used services were. The investigators used an online modified version of a PSE survey developed by several health related organizations in Boston. One hundred twenty evaluable surveys were analyzed. Sixty-eight percent of respondents were nurses, 99% of whom were female. Only 10% to 30% of respondents reported that various support services or interventions were actively offered, and 30% to 60% indicated that they were not available. Respondents reported having experienced several distressing symptoms after a PSE, most notably, troubling memories (56%) and worry about lawsuits (37%). Less than 32% "agreed" or "strongly agreed" that they could report concerns without fear of retribution or punitive action. More respondents experienced support from clinical colleagues (64%) than from their manager or department chair (38%). These results validate a need by associates for emotional support after a PSE and that associates' perception of available formal institutional support services or interventions is low.

“They Know, They Agree, but They Don’t Do”- The Paradox of Tuberculosis Case Notification by Private Practitioners in Alappuzha District, Kerala, India

BackgroundDespite being a recognized standard of tuberculosis (TB) care internationally, mandatory TB case notification brings forth challenges from the private sector. Only three TB cases were notified in 2013 by private practitioners compared to 2000 TB cases notified yearly from the public sector in Alappuzha district. The study objective was to explore the knowledge, opinion and barriers regarding TB Notification among private practitioners offering TB services in Alappuzha, Kerala state, India.Methods & FindingsThis was a mixed-methods study with quantitative (survey) and qualitative components conducted between December 2013 and July 2014. The survey, using a structured questionnaire, among 169 private practitioners revealed that 88% were aware of mandatory notification. All patient-related details requested in the notification form (except government-issued identification number) were perceived to be important and easy to provide by more than 80% of practitioners. While more than 95% felt that notification should be mandatory, punitive action in case of failure to notify was considered unnecessary by almost two third. General practitioners (98%) were more likely to be aware of notification than specialists (84 %). (P<0.01). Qualitative purposive personal interviews (n=34) were carried out among private practitioners and public health providers. On thematic framework analysis of the responses, barriers to TB notification were grouped into three themes: ‘private provider misconceptions about notification’, ‘patient confidentiality, and stigma and discrimination ’and ‘lack of cohesion and coordination between public and private sector’. Private practitioners did not consider it necessary to notify TB cases treated with daily regimen.ConclusionCommunication strategies like training, timely dissemination of information of policy changes and one-to-one dialogue with private practitioners to dispel misconceptions may enhance TB notification. Trust building strategies like providing feedback about referred cases from private sector, health personnel visit or a liaison private doctor may ensure compliance to public health activities.

Use of criminal justice language in personal narratives of out-of-school suspensions: Black students, caregivers, and educators

Racial disproportionality in out-of-school suspensions is a persistent social justice issue affecting students, families, and schools. This research examined the use of criminal justice language in the personal narratives of out-of-school suspensions of 31 Black students aged 11–17years, 28 caregivers, and 19 educators who participated in individual, semi-structured, audio-recorded interviews. A total of 51 criminal justice and legal terms were spontaneously used 474 times by 59 out of 78 participants. Social language analyses indicted that participants used criminal justice terms in a variety of ways including to speak through the authoritative criminal justice perspective to justify or resist punitive actions, and to create new meanings within the school context. By using criminal justice language, a strong and consistent message is sent to youths about the connection between their misbehaviors at school and the criminal justice system. Indeed, students spoke through the perspective of the criminal defendant using terms such as “crime,” “self-defense,” and “prisoner” to describe themselves, their behaviors and experiences of out-of-school suspensions. The use of criminal justice language at school may impact Black students' perspectives of their own misbehaviors, relevant to the development of a criminalized self and social identity. We discuss the use of criminal justice language to refer to student misbehaviors in school as one potential mechanism in the school-to-prison pipeline. More generally, we discuss implications for resisting the criminalization of Black students through the ways in which we communicate about and with them at school.

Modi’s Strategic Choice: How to Respond to Terrorism from Pakistan

Indian decision makers face a strategic conundrum: how to deter and/or respond to future terrorism emanating from Pakistan. The dilemmas are manifold: punitive action may assuage the desire of an a...

The Flexible Cost of Insulting China: Trade Politics and the “Dalai Lama Effect”

In this article, I investigate trade relations between Norway and China after the 2010 Nobel Peace Prize was awarded to Liu Xiaobo, a leading Chinese dissident. It is a case study of China's political use of economic levers in its international relations. Concluding that Sino-Norwegian trade relationship did not suffer the severe impact that many predicted, I argue that the threshold for China to enact punitive economic actions seems higher than is often acknowledged. China's sensitivity is to the costs and benefits of the relevant country's trade.

Prevalence and Forms of Sexual Harassment of Girls by Male Students of Secondary Schools in Ohafia LGA, Abia State

The study investigated prevalence and forms of sexual harassment of girls by male students of secondary schools in Ohafia Local Government Area-LGA, Abia State. Five specific objectives with corresponding research questions and three null hypotheses guided the study. The cross-sectional survey research design was used for the study. The multi-stage sampling procedure was used to draw a sample of 600 out of 2,400 girls who enrolled in secondary schools during 2011/2012 academic session. Two instruments were used for data collection: A researcher-designed instrument titled Questionnaire on Prevalence and Forms of Sexual Harassment of Girls (QPFSHG) and Sexual Harassment of Girls Focus Group Discussion Guide (SHGFGDG). Split–half method was used to determine the reliability of the entire instrument (QPFSHG) using Spearman–Brown correction formula statistic. Also, Kuder-Richardson-20 formula was used to establish the inter-item reliability co-efficient of the subscale which had nominal data. The reliability co-efficient obtained for the subscale was .77. The data collected were analyzed using frequency and percentage. The hypotheses were tested using Chi-square (2) statistic at .05 level of significance. Based on the findings, the researchers recommended among others that the school authority should establish an office for reporting cases of sexual harassment where confidentiality should be entrenched to encourage victims to lodge complaints and also, there is need to educate girls about sexuality, and human rights. Furthermore, commensurate punitive actions should be taken against sexual harassment offenders when convicted to serve as deterrence to other male students.

Remediation for Human Research Subjects Protections Non-Compliance: Concepts and Approaches

Approximating the extent of non-compliance regarding human research subjects protections is controversial. Nevertheless, based on recent research it can be conservatively estimated at about 1,163 cases per year in the United States alone; whereas, less conservative surveys estimate the problem is more widespread (approx.. 84% higher). Additionally, many notorious cases were preceded by earlier offenses, so there is recidivism. The conventional response to the problem is punitive, that is suspension and/or termination. This usually entails losing the research, research personnel, funding, and bad publicity and loss of the public’s confidence. Unlike punitive action, proponents for an alternative response, namely remediation, argue it offers prevention of recidivism, restoration of trust, and risk management because action plans are established. Yet, there are few if any reports on systems, models, or methodical approaches regarding practical aspects of remediation for human research subjects protection non-compliance. This article is a first yet critical step to fill that void of information in that it: provides a conceptual report on a general linear progression of steps to follow, a triage model or pathway to remediation, conducting a general assessment and specific inventory, visual displaying, causal identification, courses of action, prevention/education, and near zero defect accomplishment. The hope is that researchers can use the fundamental tool chest of ideas and methods described herein-if necessary, and hopefully that will never be the case—to tailor remediation efforts to their particular circumstances.