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In a legally and politically pluralistic world, multiple actors often claim authority over the same spaces or subjects. Democratic theory must therefore find democratic ways for various actors to coordinate, negotiate, and contest their respective authority claims. Some such practices are well established. Sometimes, actors choose to divide authority between them, as in federal arrangements. In other cases, they engage in shared decision-making, as in consociation systems. This chapter focuses on a less studied set of practices termed ‘conditional authority’. When actors engage in practices of conditional authority, each party accepts and accommodates the independent authority of the other, but only subject to certain conditions. Such practices allow parties to negotiate the boundaries of their respective claims and manage conflict without requiring either a division of authority (federalism) or the presence of co-decision mechanisms (consociationalism). Drawing on examples from the European Union and the relationship between Canada and Indigenous peoples, this chapter argues that practices of conditional authority represent an important and novel form of pluralist praxis.
To validate the two-factor structure (i.e., cognitive and somatic) of the Health and Behaviour Inventory (HBI), a widely used post-concussive symptom (PCS) rating scale, through factor analyses using bifactor and correlated factor models and by examining measurement invariance (MI).
PCS ratings were obtained from children aged 8–16.99 years, who presented to the emergency department with concussion (n = 565) or orthopedic injury (OI) (n = 289), and their parents, at 10-days, 3-months, and 6-months post-injury. Item-level HBI ratings were analyzed separately for parents and children using exploratory and confirmatory factor analyses (CFAs). Bifactor and correlated models were compared using various fit indices and tested for MI across time post-injury, raters (parent vs. child), and groups (concussion vs. OI).
CFAs showed good fit for both a three-factor bifactor model, consisting of a general factor with two subfactors (i.e., cognitive and somatic), and a correlated two-factor model with cognitive and somatic factors, at all time points for both raters. Some results suggested the possibility of a third factor involving fatigue. All models demonstrated strict invariance across raters and time. Group comparisons showed at least strong or strict invariance.
The findings support the two symptom dimensions measured by the HBI. The three-factor bifactor model showed the best fit, suggesting that ratings on the HBI also can be captured by a general factor. Both correlated and bifactor models showed substantial MI. The results provide further validation of the HBI, supporting its use in childhood concussion research and clinical practice.
This edited volume argues that democracy is broader and more diverse than the dominant state-centered, modern representative democracies, to which other modes of democracy are either presumed subordinate or ignored. The contributors seek to overcome the standard opposition of democracy from below (participatory) and democracy from above (representative). Rather, they argue that through differently situated participatory and representative practices, citizens and governments can develop democratic ways of cooperating without hegemony and subordination, and that these relationships can be transformative. This work proposes a slow but sure, nonviolent, eco-social and sustainable process of democratic generation and growth with the capacity to critique and transform unjust and ecologically destructive social systems. This volume integrates human-centric democracies into a more mutual, interdependent and sustainable system on earth whereby everyone gains.
To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.
Prospective observational study.
Neonatal intensive care unit (NICU).
We conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates.
A NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak.
In comparison to fast outbreaks, outbreaks that are “slow and sustained” may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties.
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