Renewed Outbreak Research Articles

‘Journalism in another form’: How exile experiences from Burundi renegotiate key elements of journalism

Since the renewed outbreak of the ongoing crisis in Burundi in May 2015, triggering a media crackdown, over one-third of the country’s reporters have gone into exile. They therefore joined an increasing number of journalists worldwide who are forced into exile. Between 2015 and 2021, many of the exiled Burundian journalists continued reporting for newly founded exile media in neighbouring Rwanda. Before their forced closure in 2021, these exile media had established themselves as successful outlets providing the only independent information from an otherwise blacked-out country. Based on semi-structured interviews with 10 exiled Burundian journalists conducted in Rwanda in 2020, this article exemplifies how the condition of exile impacts journalistic practice and norms, and renegotiates ideas of media professionalism. It is shown how Burundian exiled journalists display a strong personal conscience as journalists highlighting the voice of the voiceless and attempting to separate activism from their journalism. At the same time, the findings identify the main struggles of Burundian exiled journalists in maintaining operational objectivity, which depends on funding, providing balanced reporting without access to official sources and conducting verification of information in the unattainable field. These challenges are in line with the findings of several other case studies with exiled journalists from different regions. Therefore, this article complements the rapidly growing body of literature on exile journalism with a Global South perspective, which to date is not well represented on the map of exile journalism that mostly features cases of exile in the Global North. Furthermore, this article shows that situating exile experiences within existing theories and frameworks of journalism presents limits as exile journalism, as in the Burundian case, is journalism ‘in another form’ with new practices and renegotiated standards of professionalism.

Forecast and evaluation of asymptomatic COVID-19 patients spreading in China

In this paper, we propose a new SAIR model to depict the transmission dynamics of a novel coronavirus in China. We focus on the ability of asymptomatic COVID-19 patients to transmit and the potential impact of population movements on renewed outbreak transmission. Qualitative analysis of the model shows that when the basic productive number R0>1, the system will stabilize towards a unique endemic equilibrium and pass through a transcritical bifurcation around its disease-free equilibrium. Furthermore, by constructing an appropriate Lyapunov function, we prove that the disease-free equilibrium and endemic equilibrium are globally asymptotically stable under appropriate parameter conditions. Finally, some important results have been verified by numerical simulations.

Australia: 2021 Article IV Consultation-Press Release; Staff Report; and Statement by the Executive Director for Australia

Strong health and economic policies allowed for quick economic recovery from initial COVID-19-related lockdowns in 2020. Renewed outbreaks and lockdowns have created setbacks since mid-2021, with disproportionate impacts on some regions, sectors, and workers. Accommodative macroeconomic policies have been instrumental in cushioning the economic impact.

The COVID-19 pandemic and new clinical trial activations

BackgroundThe COVID-19 pandemic has caused severe disruptions in care for many patients. A key question is whether the landscape of clinical research has also changed.MethodsIn a retrospective cohort study, we examined the association of the COVID-19 outbreak with new clinical trial activations. Trial data for all interventional and observational oncology, cardiovascular, and mental health studies from January 2015 through September 2020 were obtained from ClinicalTrials.gov. An interrupted time-series analysis with Poisson regression was used.ResultsWe examined 62,252 trial activations. During the initial COVID-19 outbreak (February 2020 through May 2020), model-estimated monthly trial activations for US-based studies were only 57% of the expected estimate had the pandemic not occurred (relative risk = 0.57, 95% CI 0.52 to 0.61, p < .001). For non-US-based studies, the impact of the pandemic was less dramatic (relative risk = 0.77, 95% CI 0.73 to 0.82, p < .001), resulting in an overall 27% reduction in the relative risk of new trial activations for US-based trials compared to non-US-based trials (relative risk ratio = 0.73, 95% CI 0.67 to 0.81, p < .001). Although a rebound occurred in the initial reopening phase (June 2020 through September 2020), the rebound was weaker for US-based studies compared to non-US-based studies (relative risk ratio = 0.87, 95% CI 0.80 to 0.95, p < .001).ConclusionsThese findings are consistent with the disproportionate burden of COVID-19 diagnoses and deaths during the initial phase of the pandemic in the USA. Reduced activation of cancer clinical trials will likely slow the pace of clinical research and new drug discovery, with long-term negative consequences for cancer patients. An important question is whether the renewed outbreak period of winter 2020/2021 will have a similarly negative impact on the initiation of new clinical research studies for non-COVID-19 diseases.

Development of the reproduction number from coronavirus SARS-CoV-2 case data in Germany and implications for political measures

BackgroundSARS-CoV-2 has induced a worldwide pandemic and subsequent non-pharmaceutical interventions (NPIs) to control the spread of the virus. As in many countries, the SARS-CoV-2 pandemic in Germany has led to a consecutive roll-out of different NPIs. As these NPIs have (largely unknown) adverse effects, targeting them precisely and monitoring their effectiveness are essential. We developed a compartmental infection dynamics model with specific features of SARS-CoV-2 that allows daily estimation of a time-varying reproduction number and published this information openly since the beginning of April 2020. Here, we present the transmission dynamics in Germany over time to understand the effect of NPIs and allow adaptive forecasts of the epidemic progression.MethodsWe used a data-driven estimation of the evolution of the reproduction number for viral spreading in Germany as well as in all its federal states using our model. Using parameter estimates from literature and, alternatively, with parameters derived from a fit to the initial phase of COVID-19 spread in different regions of Italy, the model was optimized to fit data from the Robert Koch Institute.ResultsThe time-varying reproduction number (Rt) in Germany decreased to <1 in early April 2020, 2–3 weeks after the implementation of NPIs. Partial release of NPIs both nationally and on federal state level correlated with moderate increases in Rt until August 2020. Implications of state-specific Rt on other states and on national level are characterized. Retrospective evaluation of the model shows excellent agreement with the data and usage of inpatient facilities well within the healthcare limit. While short-term predictions may work for a few weeks, long-term projections are complicated by unpredictable structural changes.ConclusionsThe estimated fraction of immunized population by August 2020 warns of a renewed outbreak upon release of measures. A low detection rate prolongs the delay reaching a low case incidence number upon release, showing the importance of an effective testing-quarantine strategy. We show that real-time monitoring of transmission dynamics is important to evaluate the extent of the outbreak, short-term projections for the burden on the healthcare system, and their response to policy changes.

A continuation of warfare by sportive means: settling conflicts through football in the Eastern Highlands of colonial New Guinea

ABSTRACT This ethnohistorical study of football games from the mid-1940s to the 1970s in the Eastern Highlands of Papua New Guinea explores the potentials and limits of using sport as a conflict-settlement measure. Football was introduced by Australian colonial officers as a peacebuilding exercise, and local communities quickly adapted it to settle conflicts that otherwise could have escalated to war. It was a new mechanism to redress perceived violations and injustices but culturally shaped by pre-existing experiences and understandings. The game, similar to warfare, only came to a conclusion when both sides were exhausted, and the scores considered even. Football thus served a useful purpose to settle conflicts peacefully and efficiently – within limits. Tensions and emotions ran high on the football pitch, resulting in instances where games led to the renewed outbreak of inter-village wars, especially when the underlying ethos of equivalence was breached, and one side dominated the match.

Impact of the Inflow Population From Outbreak Areas on the COVID-19 Epidemic in Yunnan Province and the Recommended Control Measures: A Preliminary Study.

Background: COVID-19 developed into a global pandemic in 2020 and poses challenges regarding the prevention and control capabilities of countries. A large number of inbound travelers from other regions could lead to a renewed outbreak of COVID-19 in the local regions. Globally, as a result of the imbalance in the control of the epidemic, all countries are facing the risk of a renewed COVID-19 outbreak brought about by travelers from epidemic areas. Therefore, studies on a proper management of the inbound travelers are urgent.Methods: We collected a total of 4,733,414 inbound travelers and 174 COVID-19 diagnosed patients in Yunnan province from 21 January 2020 to 20 February 2020. Data on place of origin, travel history, age, and gender, as well as whether they had suspected clinical manifestations for inbound travelers in Yunnan were collected. The impact of inbound travelers on the local epidemic was analyzed with a collinear statistical analysis and the effect of the control measures on the epidemic was evaluated with a sophisticated modeling approach.Results: Of the 174 COVID-19 patients, 60.9% were not from Yunnan, and 76.4% had a history of travel in Hubei. The amount of new daily cases in Yunnan was significant correlated with the number of inbound travelers from Hubei and suspected cases among them. Using Susceptible–Exposed–Infectious–Recovered (SEIR) model analysis, we found that the prevention and control measures dropped the local R0 down to 1.07 in Yunnan province.Conclusions: Our preliminary analysis showed that the proper management of inbound travelers from outbreak areas has a significantly positive effect on the prevention and control of the virus. In the process of resettlement, some effective measures taken by Yunnan province may provide an important reference for preventing the renewed COVID-19 outbreak in other regions.

A Renewed Outbreak of the COVID-19 Pandemic: A Longitudinal Study of Distress, Resilience, and Subjective Well-Being.

Considering the potential impact of COVID-19 on the civil society, a longitudinal study was conducted to identify levels of distress, resilience, and the subjective well-being of the population. The study is based on two repeated measurements conducted at the end of the pandemic’s “first wave” and the beginning of the “second wave” on a sample (n = 906) of Jewish Israeli respondents, who completed an online questionnaire distributed by an Internet panel company. Three groups of indicators were assessed: signs of distress (sense of danger, distress symptoms, and perceived threats), resilience (individual, community, and national), and subjective well-being (well-being, hope, and morale). Results indicated the following: (a) a significant increase in distress indicators, with effect sizes of sense of danger, distress symptoms, and perceived threats (Cohen’s d 0.614, 0.120, and 0.248, respectively); (b) a significant decrease in resilience indicators, with effect sizes of individual, community, and national resilience (Cohen’s d 0.153, 0.428, and 0.793, respectively); and (c) a significant decrease in subjective well-being indicators with effect sizes of well-being, hope, and morale (Cohen’s d 0.116, 0.336, and 0.199, respectively). To conclude, COVID-19 had a severe, large-scale impact on the civil society, leading to multidimensional damage and a marked decrease in the individual, community, and national resilience of the population.

Potential Mechanisms of Cardiac Injury and Common Pathways of Inflammation in Patients With COVID-19.

Due to the lack of prospective, randomized, controlled clinical studies on inflammation and cardiovascular involvement, the exact mechanism of cardiac injury among patients with Coronavirus Disease 2019 (COVID-19) still remains uncertain. It was demonstrated that there is a high and significantly positive linear correlation between troponin T and plasma high-sensitivity C-reactive protein levels, biomarkers of cardiac injury and systemic inflammation, respectively. Cardiac injury and inflammation is a relatively common association among patients hospitalized with COVID-19, and it is related to higher risk of in-hospital mortality. In our literature search, we identified several potential mechanisms of myocardial tissue damage, namely, coronavirus-associated acute myocarditis, angiotensin-converting enzyme 2 receptor binding affinity to the virus Spike protein, increased cytokine secretion, and hypoxia-induced cardiac myocyte apoptosis. Elucidation of the disease pathogenesis and prospective histopathological studies are crucial for future proper treatment in case of renewed outbreaks. Of interest is that with hundred of thousands of bodies available for autopsy studies, no prospective investigation has been reported so far. Strong efforts and continued research of the cardiovascular complications and identification of risk factors for poor prognosis in COVID-19 are steadily needed. The high morbidity and mortality of COVID-19, its monumental economic burden and social impact, the despair of a new pandemic outbreak, and the thread of potential utilization of novel severe acute respiratory syndrome coronavirus 2 as biologic weapons make it a preponderant necessity to better comprehend the therapeutic management of this lethal disease. Emerging as an acute infectious disease, COVID-19 may become a chronic epidemic because of genetic recombination. Therefore, we should be ready for the reemergence of COVID-19 or other coronaviruses.

World Economic Prospects Monthly

Overview: World GDP now seen falling 2.8% in 2020 ▀ With much of the global economy now in some form of lockdown due to the coronavirus pandemic, we expect world GDP to contract by about 7% in H1 2020. Activity is expected to rebound sharply in H2, but even so the severity of the shock is likely to lead to a permanent GDP loss for the global economy. ▀ While Chinese activity picked up in late‐Q1 as lockdown restrictions were unwound, we expect Q1 GDP to have fallen 12% q/q before rebounding sharply in Q2. But this Q2 boost looks set to be swamped by the collapse in activity caused by the rest of the world going into lockdown.▀ Although shutdown restrictions elsewhere are less severe than those imposed in China, business survey and labour market data still point to sharp falls in activity in most countries in Q2. Quarterly GDP declines of 8% or more in the US and eurozone seem likely. Overall, world GDP could fall by about 7% in H1, roughly double the size of the contraction during start of the global financial crisis in 2009.▀ In those economies subject to some form of lockdown, we expect restrictions to begin to be lifted during Q2. As a result, growth should resume in Q3 as sectors that have been forced to shut down see some pick‐up. But despite this rebound, world GDP is now seen shrinking 2.8% in 2020 overall — in 2009, the global GDP fall was 1.1%.▀ The H2 pick‐up, followed by a return to more normal conditions next year, will result in world GDP growth rising to almost 6% in 2021, helped also by the recent collapse in oil prices to about $30pb. But the scale of the disruption means that we expect a permanent loss of output from the shock. We expect global GDP in the medium term to be some 1.5% below the level we had anticipated before the coronavirus outbreak.▀ The risks around this forecast are large and broadly balanced. But were stringent lockdowns or widespread disruption, perhaps due to renewed outbreaks of the virus, to extend into Q3, global GDP could fall by as much as 8% this year.

The trauma of home and (non)belonging in Zimbabwe and its diaspora: ‘Conversion disorder’ in &lt;i&gt;Shadows&lt;/i&gt; by Novuyo Rosa Tshuma

The renewed outbreak of xenophobic attacks in March and April 2015 in Durban, Johannesburg and Cape Town, the killings, looting, and burning of homes and shops, and the flight of thousands of foreign Africans to refugee camps, have brought to the fore not only the question of the African diaspora in South Africa, but also into focus the notions of home and homeland in a diasporic context. In Shadows, for which she was awarded the Herman Charles Bosman Prize in 2014, Zimbabwean writer Novuyo Rosa Tshuma presents the dislocations of life in present-day Zimbabwe and the relocation and double displacement of the Zimbabwean diasporic community in South Africa. The text, comprising a novella, ‘Shadows’, and five other stories, is best approached as a story cycle, the individual narratives being linked not only by the theme of diaspora but also by a number of recurring diasporic situations, figures, and tropes. Drawing on a wide range of contemporary diaspora theory, including the African and intra-African diaspora, as well as current research on Zimbabwe and its diaspora, this article examines the ambiguous diasporic concepts of home and belonging, and inclusion and exclusion, with reference to Tshuma’s fictional depiction of daily township life in Mugabe’s Zimbabwe with its food queues, depleted resources, and crashed economy, as well as in the marginal world of the presentday Zimbabwean diaspora in Johannesburg with its police corruption and brutal exploitation of illegal immigrants. The article considers the psychogenic condition known as ‘conversion disorder’, which Tshuma foregrounds in one of the stories, as a metaphor for understanding the paradoxical diasporic identification with, and alienation from, home, community, and home country in Zimbabwe as well as in the unaccommodating host country, South Africa.

Reduced evolutionary rate in reemerged Ebola virus transmission chains.

On 29 June 2015, Liberia's respite from Ebola virus disease (EVD) was interrupted for the second time by a renewed outbreak ("flare-up") of seven confirmed cases. We demonstrate that, similar to the March 2015 flare-up associated with sexual transmission, this new flare-up was a reemergence of a Liberian transmission chain originating from a persistently infected source rather than a reintroduction from a reservoir or a neighboring country with active transmission. Although distinct, Ebola virus (EBOV) genomes from both flare-ups exhibit significantly low genetic divergence, indicating a reduced rate of EBOV evolution during persistent infection. Using this rate of change as a signature, we identified two additional EVD clusters that possibly arose from persistently infected sources. These findings highlight the risk of EVD flare-ups even after an outbreak is declared over.

Security Sector Reform, Statebuilding and Local Ownership: Securing the State or its People?

It is widely acknowledged that while local ownership is one of the core principles of successful Security Sector Reform (SSR) programmes, the concept is narrowly interpreted in terms of who owns what. Moreover, the focus of SSR is often on building state institutions, rather than building the relationship between people and the state, which further limits the extent to which people, particularly at the community level, are engaged in SSR processes. It is argued that without ensuring meaningful and inclusive local ownership of SSR programmes, public trust and confidence in state security and justice sector institutions will be limited. Crucially, this will leave the state vulnerable to renewed outbreaks of conflict. To rectify this it is proposed that a hybrid SSR approach be promoted by incorporating community safety structures into SSR programmes.

Preliminary evaluation of guava selections for guava wilt disease resistance in South Africa

Guava wilt disease (GWD), caused by Nalanthamala psidii, is a serious disease occurring in the guava-producing areas of the Mpumalanga and Limpopo provinces of South Africa. Two resistant guava rootstocks, TS-G1 and ‘TS-G2’, were developed by the ARC-ITSC in 1995. In 2009, a renewed outbreak of GWD was reported, which also affected the resistant ‘TS-G2’ cultivar, placing the guava industry under threat again. The aim of this study was to seek resistant guava selections by means of in vitro screening of guava seedlings and subsequently testing the most promising selections in inoculation studies with N. psidii. A culture filtrate of N. psidii was used to screen guava seedlings in vitro. Promising selections were multiplied in tissue culture, hardened-off and planted in bags before inoculation with the GWD fungus in a shadehouse trial. The number of plants surviving nine months after inoculation was recorded. Although none of the selections showed complete resistance, selection MS44 showed some tolerance against the G2 isolate of the pathogen obtained from diseased ‘TS-G2’ trees, whilst selection MS70 showed some tolerance against the G1 isolate obtained from diseased TS-G1 trees. These selections were also resistant to the original Fan Retief isolate of the pathogen.

Why Peace Fails: The causes and prevention of civil war recurrence

The aim of this book is to identify causal patterns which explain the recurrence of armed conflict after a civil war has come to an end. The importance of the work is irrefutable, as the latest coup in the Central African Republic and military intervention in Mali underline; this volume discusses earlier wars in both countries. Call finds that political exclusion is the key factor in explaining the recurrence of conflict. Using a multi-method approach, Call starts (after an introductory chapter) by using regression analysis to discern the variables thought to be significant in explaining worldwide war recurrence between 1946 and 2007. Unlike current policy thinking based on the work of scholars like Collier et al. (2003), the author finds that economic factors are not a predictor of war recurrence. Using Liberia as an illustrative case for considering the diverse arguments for civil war recurrence (Chapter 3), he pinpoints the role of political exclusion. The exclusionary behaviour of Charles Taylor played a primary role in causing the renewed outbreak of violence, the author asserts, more so than regional dynamics, international involvement, and the widely discussed theory of ‘greed’ – or economic opportunities (pp. 78–88). Call tests this hypothesis on fifteen cases of civil war recurrence, or ‘mini case-studies’, in the following chapters. He distinguishes between precipitating exclusionary behaviour (in nine cases) and chronic exclusionary behaviour (in two cases), as well as discussing four cases where his hypothesis on political exclusion does not work. In thirteen cases, post-war states engaged in exclusionary behaviour and in almost all of these cases – eleven, or 73 per cent – exclusion is the most important causal factor to explain war recurrence. Call then considers 27 cases of civil wars that did not recur, finding an important historical dimension: non-recurrence despite exclusionary behaviour only occurred prior to 1989. Call discusses the changing normative framework after the Cold War that put more emphasis on negotiations, after which ‘exclusion is no longer a viable path to negative peace’ (p. 201).

Peacebuilding in Indonesia: Christian–Muslim Alliances in Ambon Island

This article aims to examine two major issues: (1) religious roots of reconciliation and forgiveness, which are often unfortunately forgotten in the academic discussion of peacebuilding and peace policy-related issues, and (2) Christians' and Muslims' attempts to quell interreligious violence and prevent renewed outbreaks in the conflict zone of Ambon of the Moluccas (Maluku) in eastern Indonesia. More specifically, it discusses the role of Ambonese Christian and Muslim leaders in the process of interreligious peacemaking and reconciliation. A comparative study of conciliation within Islam and Christianity, the piece investigates factors underlying Christian–Muslim collaboration for establishing peaceful settlement in the region. Unlike most previous analyses and studies, which have tended to undermine the contribution of religion in the conflict settings of Ambon, the article shows that religious identities, discourses, and actors have contributed to and also enhanced the chances for peace and reconciliation. Why and how Ambonese Christian and Muslim leaders were willing to unite to fight against religious extremism and eagerly pursue pacification becomes the central question of this article.

TOWARDS GUAVA WILT DISEASE RESISTANCE IN SOUTH AFRICA

Soil-borne vascular wilt pathogens cause among the most devastating plant diseases worldwide. Guava wilt disease (GWD) caused by Nalanthamala psidii, resulted in the loss of more than half the guava production area in the Limpopo and Mpumalanga provinces of South Africa during the 1980s. Resistant guava selections were developed but renewed outbreaks of guava wilt disease in 2009, now also affecting the tolerant ARC-ITSC developed cultivar 'TS-G2', is placing the guava industry under threat once again. Alternative control measures are currently not available and host resistance remains the most logical choice for control. However, the lack of known sources of plant resistance and the emergence of additional pathogen races pose as major obstacles. Accurate identification and knowledge about the genetic variation within the pathogen population are therefore key aspects in the development of resistant guava cultivars. The aim of this study was firstly to determine the identity of 18 new fungal isolates obtained from infected 'TS-G2' trees. The internal transcribed spacer of the ribosomal RNA gene cluster (ITS), nuclear large ribosomal sub-unit (LSU), as well as the partial second largest subunit of the RNA polymerase II (rpb2) and the larger subunit of ATP citrate lyase (acl1) gene exons and introns of the new fungal isolates and reference isolates were sequenced and compared. Sequence analysis established the identity of the new isolates to be identical to N. psidii reference strain (CBS 439.89) previously isolated in South Africa, but differed from N. psidii stains from Malaysia and Taiwan. Although species diagnosis was possible, it was not possible to show geographic distribution- or determine pathogenicity relationships between isolates. The development of microsatellites or Simple Sequence Repeat (SSR) markers using high throughput sequencing was therefore investigated. A total of 15 645 SSRs were identified consisting mostly of tri- and tertra- nucleotide motifs. Selected SSRs will be used to facilitate further fungal population studies.

Potential role of ticks as vectors of bluetongue virus

When the first outbreak of bluetongue virus serotype 8 (BTV8) was recorded in North-West Europe in August 2006 and renewed outbreaks occurred in the summer of 2007 and again in 2008, the question was raised how the virus survived the winter. Since most adult Culicoides vector midges are assumed not to survive the northern European winter, and transovarial transmission in Culicoides is not recorded, we examined the potential vector role of ixodid and argasid ticks for bluetongue virus. Four species of ixodid ticks (Ixodes ricinus, Ixodes hexagonus, Dermacentor reticulatus and Rhipicephalus bursa) and one soft tick species, Ornithodoros savignyi, ingested BTV8-containing blood either through capillary feeding or by feeding on artificial membranes. The virus was taken up by the ticks and was found to pass through the gut barrier and spread via the haemolymph into the salivary glands, ovaries and testes, as demonstrated by real-time reverse transcriptase PCR (PCR-test). BTV8 was detected in various tissues of ixodid ticks for up to 21 days post feeding and in Ornithodoros ticks for up to 26 days. It was found after moulting in adult Ixodes hexagonus and was also able to pass through the ovaries into the eggs of an Ornithodoros savignyi tick. This study demonstrates that ticks can become infected with bluetongue virus serotype 8. The transstadial passage in hard ticks and transovarial passage in soft ticks suggest that ticks have potential vectorial capacity for bluetongue virus. Further studies are required to investigate transmission from infected ticks to domestic livestock. This route of transmission could provide an additional clue in the unresolved mystery of the epidemiology of Bluetongue in Europe by considering ticks as a potential overwintering mechanism for bluetongue virus.

Eloquent bodies: conflict and ritual in northern Sri Lanka1

It is increasingly apparent that hostilities continue in the aftermath of war and conflict, where presuppositions of peace and safety are rarely reflected on the ground. In Sri Lanka, the 2002 ceasefire agreement between the Sri Lankan government and the Liberation Tigers of Tamil Eelam (LTTE) has recently collapsed. This collapse developed slowly over a period of several years, beginning with cautious optimism before descending into deep pessimism with increasingly high levels of violence brought about by the absence of any real progress. Efforts to rebuild and reintegrate both rural and urban communities in the north of the country have had to take place within an atmosphere of silence, suspicion and a marked escalation towards the renewed outbreak of war. This article, following sixteen months of fieldwork in the northern Jaffna peninsula, examines how Tamil youths – many of whom were imprisoned and tortured during the war – have transformed a well-known ritual that has seen a dramatic increase since occupation of the far north by government troops in 1996. The ritual, previously an act of devotion to a popular Tamil god, Murugan, has transformed into a demonstration of strength and youthful challenge. This article examines how toleration of ritual pain can be contrasted with the pain and suffering of war, and articulated not only for the self, but also for the entire community.

Challenges and promises for nurse education curriculum development in Kosovo: Results of an “accidental ethnography”

Kosovo's infrastructure was devastated by armed conflict through the 1990s; in 1999 a visiting inter-disciplinary team described healthcare services as being in "disarray". Several collaborative programs were initiated to enhance delivery of emergency medical (EM) services. Our inter-disciplinary team traveled to Kosovo in 2004 to evaluate EM physician education and training. A brief renewed outbreak of hostilities created a mass casualty incident. An "accidental ethnography" focused on nurse education was conducted by team members during and after the event. Results indicated low levels of professionalization of nurses as indicated by expressions of professional self-identity and self-esteem, autonomy, and submission to patriarchal attitudes. Undergraduate nurse education is restricted to a diploma program and one foreign training project, one graduate degree program exists abroad, and no national board examination exists. Nurses' social location is described as marginalized and disenfranchised, and retention of nurses is a persistent problem. Based on these observations we outline an inter-professional curriculum development program to foster professionalization of Kosovar nurses through a synthesis of participatory action research with elements of grounded theory and standard curriculum development methodologies. The collaborative, emancipatory, and empowering nature of PAR is described in the context of professionalizing nurse education programs.