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SAFe-Practitioner SAFe 5 Practitioner (SP) book |

SAFe-Practitioner book - SAFe 5 Practitioner (SP) Updated: 2023

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Exam Code: SAFe-Practitioner SAFe 5 Practitioner (SP) book November 2023 by team

SAFe-Practitioner SAFe 5 Practitioner (SP)

Exam Specification: SAFe 5 Practitioner (SP)

Exam Name: SAFe 5 Practitioner
Exam Code: SP
Exam Duration: 90 minutes
Passing Score: 73%
Exam Format: Multiple-choice, multiple-answer

Course Outline:

1. Introduction to SAFe
- Understanding the purpose and benefits of SAFe
- Overview of the SAFe principles and values
- Exploring the SAFe Framework and its key components

2. Agile Release Train
- Understanding the Agile Release Train (ART) and its role in SAFe
- Planning and executing Program Increments (PIs)
- Collaborating with team members and stakeholders within the ART

3. Planning and Executing Iterations
- Understanding the importance of iterations in SAFe
- Planning and executing iterations using the Team Kanban and Scrum processes
- Synchronizing and coordinating activities across multiple teams

4. Agile Product Management
- Applying Lean-Agile principles to product management
- Defining and prioritizing features, stories, and backlog items
- Managing the product backlog and collaborating with stakeholders

5. Agile Development and Quality Practices
- Applying Agile engineering practices to ensure high-quality software development
- Emphasizing continuous integration, test-driven development, and frequent feedback
- Implementing DevOps practices to Excellerate release readiness

6. Scaling Agile
- Scaling Agile principles and practices beyond the team level
- Coordinating and aligning multiple Agile Release Trains (ARTs)
- Managing dependencies and integrating work across ARTs

Exam Objectives:

1. Understand the purpose, benefits, and key components of the SAFe framework.
2. Work effectively within an Agile Release Train (ART) and execute Program Increments (PIs).
3. Plan and execute iterations using Team Kanban and Scrum processes.
4. Apply Lean-Agile principles to Agile product management and prioritize features and backlog items.
5. Implement Agile engineering practices and ensure high-quality software development.
6. Scale Agile practices and coordinate work across multiple Agile Release Trains (ARTs).

Exam Syllabus:

Section 1: Introduction to SAFe (15%)
- Purpose and benefits of SAFe
- SAFe principles and values
- Overview of the SAFe Framework

Section 2: Agile Release Train (ART) (25%)
- Planning and executing Program Increments (PIs)
- Collaboration within the Agile Release Train (ART)
- Roles and responsibilities within the ART

Section 3: Planning and Executing Iterations (20%)
- Importance of iterations in SAFe
- Team Kanban and Scrum processes for iteration planning and execution
- Synchronization and coordination across teams

Section 4: Agile Product Management (20%)
- Applying Lean-Agile principles to product management
- Feature and backlog item prioritization
- Collaboration with stakeholders

Section 5: Agile Development and Quality Practices (15%)
- Agile engineering practices for high-quality software development
- Continuous integration, test-driven development, and feedback
- DevOps practices for improved release readiness

Section 6: Scaling Agile (5%)
- Scaling Agile principles and practices
- Coordinating multiple Agile Release Trains (ARTs)
- Managing dependencies and integration across ARTs
SAFe 5 Practitioner (SP)
Scrum Practitioner book

Other Scrum exams

PSM-I Professional Scrum Master I - 2023
Scrum-PSM-II Professional Scrum Master II
Scrum-Master-Certified Scrum Master Certified
DASM Disciplined Agile Scrum Master
PAL-I Professional Agile Leadership (PAL-I)
PSK-I Professional Scrum with Kanban level I
PSPO-I Professional Scrum Product Owner I
PSPO-II Professional Scrum Product Owner II
SAFe-DevOps SAFe 5 DevOps Practitioner (SDP)
SAFe-Practitioner SAFe 5 Practitioner (SP)
SSM SAFe 5 Scrum Master (SSM)
SAFe-RTE Certified SAFe Release Train Engineer (RTE)
DASSM Disciplined Agile Senior Scrum Master
PAL-EBM Professional Agile Leadership - Evidence Based Management (PAL-EBM)
Scrum-PSD Professional Scrum Developer (PSD)
Scrum-PSD-I Professional Scrum Developer (PSD-I)
Scrum-SPS Scaled Professional Scrum (SPS)

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SAFe 5 Practitioner (SP)
Question: 48
By organizing the second operating system around_________ instead of ________, SAFe offers a way for enterprises
to focus on customers, products, innovation, and growth
A. departments, value streams
B. products, features
C. features,components
D. value streams, departments
Answer: D
Question: 49
How long is the Iteration Review?
A. 6 hours
B. 1 day
C. 1 to 2 hours
D. 4 hours
Answer: C
Question: 50
During Iteration Planning, the Scrum Master presents the stories in order of priority and answers clarifying questions
Answer: B
Question: 51
When is the Acceptance Criteria for Features typically defined?
A. during Program Backlog refinement
B. during Iteration Planning
C. during PI Planning
D. during Inspect & Adapt
Answer: A
Question: 52
What is the primary goal of assigning business value to PI Objectives?
A. to help the teams on the train prioritize work
B. to show economic impact to the customer
C. none of the above
D. to have Business Owner buy-in
Answer: A
Question: 53
Business Agility is the ability to compete and thrive in the digital age by quickly responding to market changes and
emerging opportunities with innovative, digitally-enabled business solutions
Answer: A
Question: 54
SAFe Lean-Agile principles support centralised decision-making.
Answer: A
Question: 55
Which of the following is not a primary responsibility of Product Management?
A. Developing the Vision and Roadmap for the ART
B. Facilitating PI Planning
C. Owning and managing the Program Backlog
D. Understanding the customer needs
Answer: B
Question: 56
The Agile Manifesto consists of 4 values and how many principles?
A. seven
B. twelve
C. five
D. ten
Answer: B
Question: 57
Pl System Demo is often led by
A. Product Management
B. All of the above
C. POs
D. System Team
Answer: B
Question: 58
What does the R in the SMART model for PI Objectives stand for?
A. Reliable
B. Rare
C. Relatable
D. Realistic
Answer: D
Question: 59
What does the Continuous Delivery Pipeline enable?
A. Release on Demand
B. Quarterly Release
C. Annual Release
D. Scheduled Releases
Answer: A
For More exams visit

Scrum Practitioner book - BingNews Search results Scrum Practitioner book - BingNews Best Project Management Certifications

Project management certifications claim a place in every top IT certification list because project managers are essential to IT operations. Whether you’re interested in becoming an IT project manager or want to add project management to your skills list, the following certifications will help you boost your skills and increase your value.

What to know about project management roles and certification

Next to top-level IT certifications, project management certifications are among the most sought-after tech credentials. Project management certifications enhance and expand other IT qualifications and add to a professional’s skill set.

Project management involves planning, scheduling, budgeting, executing and reporting on various projects. In the IT realm, events such as hardware and operating system upgrades, platform migrations, security patches, software updates and maintenance tasks are considered “projects,” so project management is incredibly important.

According to staffing firm Robert Half’s 2023 Salary Guide, project managers in the U.S. earn, on average, $119,000 annually; salaries reach almost $200,000 for top earners. Scrum masters earn around $112,000 nationally, and top earners can make over $180,000. Robert Half places Agile and Scrum in the top five in-demand technology methodologies, so earning a top-level certification is a surefire way to become a sought-after and well-paid project manager.

Best project management certifications

More IT professionals are seeking project management certifications these days. Various evergreen IT certifications cover different areas and skills, but all of them can help you navigate your career path and increase your earning potential. Here are several to consider.

Project Management Professional (PMP)

The Project Management Institute (PMI) stands firmly behind its PMP certification. The organization works with academia and training companies to ensure proper coverage and currency in the curricula supporting the PMP and other PMI credentials. With more than 1.2 million PMP-certified professionals globally, PMI’s PMP remains among the most prestigious project management credentials. 

You can obtain college- and university-based PMP training from many institutions. You may also find PMP coverage integrated into specific degree programs (often at the master’s level).

The PMP credential is coveted by employers seeking the most highly skilled project management professionals. It is designed to ensure credential holders possess the skills and qualifications to successfully manage all project phases, including initiating, planning, scheduling, controlling and monitoring, and closing projects.

PMP-certified project managers are well versed and skilled in managing all aspects of the triple constraints: time, cost and scope. Employers depend on PMP professionals to do the following: 

  • Manage budgets
  • Track costs
  • Manage scope creep
  • Identify how changes to the triple constraints may introduce risk to the project
  • Minimize risks to protect the project investment

PMP certification standards are rigorous and include the following: 

  • Skills and education: Credential holders must demonstrate and certify that they have the skills and education necessary to succeed in the project management field.
  • Documentation: Credential seekers should be ready to provide documentation of their education, previous projects and training courses. 
  • Eligibility ID: Candidates must obtain an eligibility ID from PMI before they can register for the exam. 
  • Exam: Once eligible candidates receive their ID, they have one year and three attempts to pass a comprehensive 180-question exam. 

While the certification is difficult to achieve, PMP credential holders enjoy significant rewards. PMI’s salary survey revealed that PMPs in the U.S. earn an average of 32 percent more than their non-credentialed counterparts. In the U.S., PMPs earn a median annual salary of $123,000, compared with $93,000 for non-PMP-certified project managers. Additionally, PMP credential holders can earn significantly more depending on a project’s size and complexity, as well as their experience and expertise.

For those who are interested in program management or who wish to specialize in a project management area, PMI offers several interesting additional credentials:

  • Program Management Professional (PgMP): The PgMP credential targets professionals who manage multiple projects on an organizational level.
  • Portfolio Management Professional (PfMP): The PfMP credential targets professionals who manage organizational project portfolios.
  • PMI Agile Certified Practitioner (PMI-ACP): The PMI-ACP credential targets project management professionals who work with the Agile project management methodology.
  • PMI Professional in Business Analysis (PMI-PBA): The PMI-PBA credential focuses on business analysis and the ability to define stakeholder requirements, project scope and business solution outcomes.
  • PMI Risk Management Professional (PMI-RMP): The PMI-RMP credential is a specialized credential that focuses on risk assessment, identification and mitigation.
  • PMI Scheduling Professional (PMI-SP): The PMI-SP credential is for project managers charged with developing and maintaining project schedules.

The PMP credential remains a nonpareil certification for IT and other professionals whose responsibilities encompass project management. It is the standard against which all other project management credentials are judged.

PMP facts and figures:

Certification name

Project Management Professional (PMP)

Prerequisites and required courses

  • Four-year degree
  • 36 months of leading and directing projects within the past eight years
  • 35 hours of project management education (does not apply to active CAPM certification holders)


  • Secondary degree (high school diploma, associate’s degree or equivalent)
  • 60 months of leading and directing projects within the past eight years
  • 35 hours of project management education (does not apply to active CAPM certification holders)

Note: Credential holders must earn 60 professional development units (PDUs) per three-year cycle to maintain their certification.

Number of exams

One (180 questions, five unscored; 230 minutes to complete)

Cost per exam

Online and in-person (administered by Pearson VUE) computer-based exams:

  • PMI member: $405 (may retake two times within a year for a fee)
  • Nonmember: $555 (may retake two times within a year for a fee)
  • Exams are available in online proctored or center-based test (CBT) formats.

Note: Eligibility ID from PMI is required to register.


Self-study materials

PMI maintains a list of training resources on the PMP test guidance webpage, including these:

Additional training materials (quizzes, publications, books, practice guides and more) are available from the PMI Store.

Numerous books are available, including these:

PMP certification is also recommended for anyone who aspires to become an enterprise IT architect.

Certified Associate in Project Management (CAPM)

PMI also backs the Certified Associate in Project Management (CAPM) credential. In fact, the CAPM is considered a stepping stone for those who wish to attain PMP status. PMI describes the CAPM as an “essential first step in building a career as a project manager” but also a step that “opens the door to opportunities at every stage of your career.”

The CAPM requires the following:

  • A high school diploma (or GED or global equivalent)
  • 23 hours of project management classroom training 
  • The CAPM exam 

No previous experience is required. The education prerequisite can be met by completing PMI’s Project Management Basics online course, which costs $350 for PMI members and $400 for nonmembers.

The CAPM is one of a small set of entry-level certifications for IT professionals who are interested in project management. However, it’s just a stepping stone to the PMP credential. Unless you work in a large organization with a project management team comprising junior and senior positions, the CAPM alone is unlikely to provide a ticket to a project management job. However, it’s ideal for IT professionals for whom project management is a part-time role or for those who want to grow into full-time project management.

PMI issued its existing CAPM test in July 2023, so some older study materials might not be complete. For additional information about the existing test format, visit PMI’s CAPM test Update page.

CAPM facts and figures:

If you want to start building project management skills but aren’t ready to invest in an entry-level certification course, consider exploring free project management training materials.

Certified ScrumMaster (CSM)

Although different Scrum master certifications are available, our pick is the Certified ScrumMaster (CSM) from Scrum Alliance. This nonprofit encourages the adoption of Scrum and Agile practices, promotes user groups and learning events, and provides resources for professional development. The organization boasts more than 1.4 million certified practitioners worldwide.

The Scrum Alliance provides a support system for Scrum practitioners, including Scrum gatherings, professional development and retreats, user groups, virtual communications, coaching, online training and much more. 

In addition to community and advocacy activities, the Scrum Alliance offers numerous Scrum-related certifications. The certifications are designed for team members on the Scrum master, product owner and developer tracks. Each track offers credentials at the foundational, advanced and professional levels. Certification is also available for Agile leadership and guide levels.

  • Scrum master track: Certified ScrumMaster (CSM), Advanced Certified ScrumMaster (A-CSM) and Certified Scrum Professional-Scrum Master (CSP-SM)
  • Product owner track: Certified Scrum Product Owner (CSPO), Advanced Certified Scrum Product Owner (A-CSPO) and Certified Scrum Professional-Product Owner (CSP-PO)
  • Developer track: Certified Scrum Developer (CSD), Advanced Certified Scrum Developer (A-CSD) and Certified Scrum Professional for Developers (CSP-D)
  • Guide-level certifications: Certified Scrum Trainer (CST), Certified Team Coach (CTC) and Certified Enterprise Coach (CEC)
  • Agile leadership: Certified Agile Leadership (CAL), a credential based on a combination of education and validated practice 
  • Agile coaching: Agile Coaching Skills-Certified Facilitator (ACS-CF), which supports groups as they collaborate, create and make decisions.

The CSM is an excellent entry-level credential for project managers who are getting started as Scrum practitioners. Candidates must demonstrate an understanding of Scrum principles and values and will learn how to implement and apply Scrum in practice. The Scrum Alliance provides CSMs with resources, checklists and information about the Scrum master’s servant-leader role.

Certified ScrumMaster facts and figures:

Certification name

Certified ScrumMaster

Prerequisites and required courses

  • General familiarity with Scrum
  • Completion of a 14-hour (usually over two days) CSM training course (price varies by training provider; candidates can expect to pay around $920 to $1,500)

Note: Certification must be renewed every two years by earning 20 Scrum education units (and paying $100 for foundational-level certifications).

Number of exams

One (37 correct answers out of 50 questions required to pass; 60-minute time limit)

Cost per exam

Fees for online tests paid by the training provider


Self-study materials

Scrum Alliance offers blogs, articles, reports, online learning, suggested practicing and presentations online, including these: 

Note: Udemy offers practice tests designed to help test takers pass the CSM certification test on their first attempt.

Certified Six Sigma Black Belt (CSSBB)

The American Society for Quality (ASQ) issues globally recognized certifications that attest to a candidate’s expertise, mastery of industry and regulation standards, and mastery of the ASQ Body of Knowledge. ASQ offers 18 credentials, three of which specifically target project management: 

  • Certified Six Sigma Black Belt (CSSBB) (expert level)
  • Certified Six Sigma Green Belt (CSSGB) (professional level) 
  • Certified Six Sigma Yellow Belt (CSSYB) (entry-level)

The Certified Six Sigma Black Belt is ASQ’s highest Six Sigma credential. The CSSBB is for experienced practitioners who understand Six Sigma methodologies (including the DMAIC model), tools, systems and philosophies. CSSBBs can lead teams or manage team dynamics, roles and responsibilities.

The path to CSSBB certification is rigorous. Candidates must do the following: 

  • Pass a comprehensive exam
  • Complete two projects employing Six Sigma tools and processes, resulting in project improvement and a positive financial impact
  • Submit an affidavit to attest to the project’s veracity 

Alternatively, candidates with at least three years of experience in one or more of the Six Sigma Body of Knowledge areas need to complete only one Black Belt project.

CSSBB candidates are expected to demonstrate mastery of these ASQ Black Belt Body of Knowledge, called standards:

  • Organization-wide Planning and Deployment (organization-wide considerations, leadership)
  • Organization Process Management and Measures (impact on stakeholders, benchmarking, business measures)
  • Team Management (team formation, facilitation, dynamics, training)
  • Define (voice of the customer, business case and project charter, project management tools, analytical tools)
  • Measure (process characteristics, data collection, measurement systems, basic statistics, probability, process capability)
  • Analyze (measuring and modeling relationships between variables, hypothesis testing, risk analysis and management, other analysis methods)
  • Improve (design of experiments, Lean methods, implementation)
  • Control (statistical process control and other controls, maintain controls, sustain improvements)
  • Design for Six Sigma (DFSS) Framework and Methodologies (common DFSS methodologies, design for DFX)

The CSSBB credential is valid for three years. To recertify, candidates must earn 18 recertification units (RUs) or retake the exam. Recertification by RUs costs $90 for ASQ members and $130 for nonmembers.

CSSBB facts and figures:

Certification name

Certified Six Sigma Black Belt (CSSBB)

Prerequisites and required courses

  • Two completed projects with signed project affidavits or one completed project with a signed affidavit (depending on experience level)
  • Three years of experience in one or more areas of the Six Sigma Body of Knowledge

Number of exams

One computer-based or paper-based exam: 

  • Computer-based (165 questions, 15 unscored; 4.5 hours) 
  • Paper-based (150 questions, four hours)

Cost per exam

  • Members: $468 
  • Nonmembers: $568 
  • Retakes: $368

(Exams administered by Prometric)


Self-study materials

ASQ maintains a comprehensive list of exam prep materials, including the following:

  • Training opportunities
  • Question banks
  • Interactive sample exams
  • Books 
  • Recommended references

Note: Udemy offers a course called Six Sigma: Certified Lean Six Sigma Black Belt Accredited.

Certified Six Sigma Green Belt (CSSGB)

Certified Six Sigma Green Belt (CSSGB) is ASQ’s professional-level credential targeting experienced Six Sigma practitioners. Often, a CSSGB works under the direction of the more senior CSSBB or as an assistant. CSSGBs identify issues and drive quality and process improvements in projects.

To earn the credential, candidates must meet the following requirements: 

  • They must have at least three years of experience working with Six Sigma processes, systems and tools.
  • The work experience must have been full-time and compensated. (An unpaid internship, for example, doesn’t count.)
  • The work performed must have been in at least one of the Six Sigma Green Belt Body of Knowledge competency areas.
  • Candidates must pass an test that tests their knowledge of the Six Sigma Green Belt Body of Knowledge. 

Currently, the Green Belt Body of Knowledge includes six competency areas:

  • Overview: Six Sigma and the Organization (organizational goals, Lean principles, design for six sigma methodologies)
  • Define Phase (project identification, voice of the customer, project management basics, management and planning tools, business results for projects, team dynamics and performance)
  • Measure Phase (process analysis and documentation, probability and statistics, statistical distributions, collecting and summarizing data, measurement system analysis, process and performance capability)
  • Analyze Phase (exploratory data analysis, hypothesis testing, additional analysis methods)
  • Improve Phase (design of experiments, implementation planning, Lean tools)
  • Control Phase (statistical process control, sustain improvements, Lean tools for process control)

Overall, this is an excellent credential for those who have some experience but who are not quite ready to take on the roles and responsibilities of a Black Belt.

CSSGB facts and figures:

Certification name

Certified Six Sigma Green Belt (CSSGB)

Prerequisites and required courses

  • Three years of experience in one or more of the Six Sigma Green Belt Body of Knowledge areas; must be a full-time paid position (not internships)

Number of exams

One computer-based or paper-based exam: 

  • Computer-based (110 questions, 10 unscored; 4.5 hours)
  • Paper-based (100 questions, four hours)

Cost per exam

  • Members: $369 
  • Nonmembers $469
  • Retakes: $269

(Exams administered by Prometric)


Self-study materials

ASQ maintains a comprehensive list of exam prep materials, including the following:

  • Training opportunities
  • Question banks
  • Interactive sample exams
  • Books 
  • Recommended references

Note: Udemy offers a course called Six Sigma: Certified Lean Six Sigma Green Belt Accredited.

Project resource management is an element of overall project management. It aims to maximize resources to avoid resource shortages and excess resources.

Thu, 09 Nov 2023 10:01:00 -0600 en text/html
Lean practitioner No result found, try new keyword!We have designed this course to help engineers wishing to gain a practical overview of Lean tools and techniques. The principles of Lean are recognised the world over as the most powerful and ... Mon, 03 Jul 2023 23:46:00 -0500 Big scrum likely for Johnson's book

The autobiography of England rugby captain Martin Johnson is going on sale today, just six days after he led his team to a pulsating victory over Australia in the World Cup final in Sydney.

The book includes his description of the match, including Jonny Wilkinson's drop-goal which clinched the 20-17 victory in the last minute of extra time.

"On his wrong foot, Jonny smashes it through the posts and we are in the lead. People told me later it was an ugly kick but it's the best thing I've ever seen on a rugby field," he writes.

Publishers Headline said that by midday on Monday pre-orders had reached 110,000 and were rising.

Ian Marshall, non-fiction deputy publishing director, said: "On the Sunday morning, I came into the office to work on the last chapter of the book.

"Some months before we'd taken the risky decision to wait until after the tournament before publishing, not least because Martin didn't want to provide any ammunition for his opponents from what he said.

"Despite all the celebrations, dinners and unbelievable media attention, Martin had managed to find some time to himself to sit down and gather his thoughts about what he'd been through.

"As always, he was determined to get it absolutely right."

The book looks at Johnson's career and how the sport has changed since going professional in 1995.

Johnson, who made his England debut in 1993, explains why he led the national team to the brink of a strike in the autumn of 2000, and gives insights into British Lions tours - for the last two of which he was captain.

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Amalia E. Books No result found, try new keyword!Depending on the state, nurse practitioners may act independently or as part of a team supervised by a physician. See all conditions on Amalia E. Books' profile. Let us know if this information is ... Thu, 02 Nov 2023 12:00:00 -0500 International Criminal Law Practitioner Library

Crossref Citations

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Read, Katherine and Griffiths, Laura 2011. Current Awareness. Legal Information Management, Vol. 11, Issue. 3, p. 214.

Garbett, Claire 2013. The truth and the trial: victim participation, restorative justice, and the International Criminal Court. Contemporary Justice Review, Vol. 16, Issue. 2, p. 193.

Madden, Mike 2014. The Exclusion of Improperly Obtained Evidence at the International Criminal Court: A Principled Approach to Interpreting Article 69(7) of the Rome Statute. SSRN Electronic Journal,

Materu, Sosteness Francis 2015. The Post-Election Violence in Kenya. p. 177.

Materu, Sosteness Francis 2015. The Post-Election Violence in Kenya. p. 85.

Stein, Shlomit 2017. In Search of ‘Red Lines’ in the Jurisprudence of the ECtHR on Fair Trial Rights. Israel Law Review, Vol. 50, Issue. 2, p. 177.

Peat, Daniel 2019. Comparative Reasoning in International Courts and Tribunals.

Soler, Christopher 2019. The Global Prosecution of Core Crimes under International Law. p. 3.

2019. The Legacy of Ad Hoc Tribunals in International Criminal Law. p. 73.

Zammit Borda, Aldo 2021. Histories Written by International Criminal Courts and Tribunals. Vol. 26, Issue. , p. 143.

Robles, Alfredo C. 2023. The Defaulting State and the South China Sea Arbitration. p. 189.

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Sarah Book No result found, try new keyword!Depending on the state, nurse practitioners may act independently or as part of a team supervised by a physician. See all conditions on Sarah Book's profile. Let us know if this information is out ... Mon, 09 Oct 2023 11:59:00 -0500 Health in Humanitarian Emergencies

Crossref Citations

This Book has been cited by the following publications. This list is generated based on data provided by Crossref.

Boyd, Andrew T. Cookson, Susan T. Anderson, Mark Bilukha, Oleg O. Brennan, Muireann Handzel, Thomas Hardy, Colleen Husain, Farah Cardozo, Barbara Lopes Colorado, Carlos Navarro Shahpar, Cyrus Talley, Leisel Toole, Michael and Gerber, Michael 2017. Centers for Disease Control and Prevention Public Health Response to Humanitarian Emergencies, 2007–2016. Emerging Infectious Diseases, Vol. 23, Issue. 13,

Omam, Lundi-Anne O’Laughlin, Kelli Tendongfor, Nicholas Wudiri, Zara Hassan, Mohammed Ngubdo Metuge, Alain Oluwafemi, Ooju Omam, Esther Parkes-Ratanshi, Rosalind and Horton, Susan 2023. Exploring factors influencing the selection of primary health care delivery models in conflict-affected settings of North West and South West regions of Cameroon and North-East Nigeria: A study protocol. PLOS ONE, Vol. 18, Issue. 5, p. e0284957.

Omam, Lundi-Anne Jarman, Elizabeth O’Laughlin, Kelli N. and Parkes-Ratanshi, Rosalind 2023. Primary healthcare delivery models in African conflict-affected settings: a systematic review. Conflict and Health, Vol. 17, Issue. 1,

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Obstetrics: A Text-Book for the Use of Students and Practitioners

Medical students today pore over the twentieth edition of Williams' classic obstetrics textbook. The recently released Collector's Edition of the original 1903 text, however, not only opens a window to the soul of US medicine and society in general, circa 1900, but also illustrates the timelessness of some aspects of the art and science of obstetrics.

History can be a source of controversy. To some, history is fascinating. To others, it's. . .well, it's history. There is one view, perhaps the majority, that medicine of the past should stay there. After all, in today's world we have recombinant DNA technology, nuclear magnetic resonance imaging, and remote telemetry units as everyday practice aids. Why should the busy clinician dwell on turn-of-the-century medicine, the pre-antibiotic era, the time of blood-letting instead of blood-banking? What can we learn from that? Well, perhaps the first edition of Williams' classic text can answer that for you -- at least with respect to obstetrics.

Published in 1903, J. Whitridge Williams' Obstetrics: A Text-Book for the Use of Students and Practitioners has become a standard. In fact, it is currently in its twentieth edition. Gary Cunningham and his faculty at the University of Texas Health Sciences Center and Parkland Hospital in Dallas have edited the exact editions of this text. As such, it has a very strong institutional bias. Nevertheless, the book is still a standard, recommended to students, house officers, and practitioners as an authoritative "way" of doing obstetrics.

However, the first issue, now released in a special Collector's Edition of 2500 numbered copies (with an Introduction by Steven Clark and Gary Hankins, 2 well-known and respected professors of ob-gyn), gives the reader a chance to see how far we have come in obstetrics since 1903. Of course, the cynical reader might view this book with a bias: Have we really gone so far?

In 1903, Williams' objective, in his words, was to "set forth. . .the scientific basis for and the practical application of the obstetrical art." To do so, he drew on his own extensive clinical experience and education, as well as the published experience of his colleagues and professional forebears the world over. For example, in his discussion of symphysiotomy, Williams cited Neugebauer's "analysis of 278 cases," the "100 cases operated upon in Pinard's clinic," and Bar's "140 operations performed by himself." Clearly, much of Williams' theory and practice was based on an impressive body of medical experience, as opposed to a couple of "series of 1," as further evidenced by his discussion of birthweight, in which he cited the "nearly 3000 children delivered under [his] supervision."

In their introduction, Clark and Hankins talk about our current (advanced) state of obstetrics having made the "transition from anecdotal to evidence-based practice." Yet it is abundantly clear that Williams attempted to support his practices, and the teaching thereof, with as much evidence as he could gather.

While series of cases do not qualify as the currently favored randomized controlled trial (RCT), one cannot dismiss as simply "anecdotal" the observations of the practitioner who has performed 100 or 140 symphysiotomies. The experienced practitioner knows how they succeed, when they fail, and how they heal. Obstetrics, as much as any branch of medicine, has always been a hands-on specialty.

Although large personal series are now considered type III, or at best type II-3 evidence, much of modern medicine is still based on them, as the RCTs are only now being designed -- often by academics who have not practiced any of the medicine in question. (Don't be misled: Williams did not actually endorse symphysiotomy. He claimed that he did "not expect to perform symphysiotomy under any circumstances, and consider[s] that the present enthusiasm for it will eventually disappear.")

But don't forget that Williams was a man of his time and forced to practice therein. For example, there were no antibiotics to speak of in 1903. Thus, the chapters pertaining to infection are as frightening as they are entertaining. Who today would witness puerperal infection with the "gas bacillus" (Bacillus aerogenes capsulatus) causing maternal death in a "Bohemian woman," after which "[w]ithin a few hours. . .her body had nearly doubled in size as the result of the development of gas in the subcutaneous tissues." Such ghastly descriptions, along with sections on tetanus, diphtheria, and other (now rare) diseases and syndromes, make the reader want to run to the lavatory for a thorough hand washing.

Speaking of hand washing, though, Williams was quick to credit Semmelweiss, Oliver Wendell Holmes, and the other giants who brought us the "germ theory" of disease and the practice of antisepsis. And although his terminology and taxonomy are now dated, Williams did a creditable job in 1903 of listing the bacterial species causing puerperal infection, for instance.

Of course, it's hard to resist the temptation to compare the original with the copy. Certainly, in terms of modern medicine, there is no comparison between Williams' book and the exact edition by Cunningham and colleagues. Not only does the original Williams text have no mention of antibiotics, electronic fetal monitoring, or electron micrographs, but it didn't even include an Apgar score! Still, the descriptions of normal vaginal delivery were remarkably similar in 1903 to the ones in 1997. Indeed, some things never change: the "ideal food for the newly born child is the milk of its mother," said Williams in 1903 -- a similar comment to Cunningham's in the twentieth edition: "[H]uman milk is the ideal food for neonates." (This is a trick, of course. As the twentieth edition appropriately states, breast-feeding fell out of vogue in the 1960s and 1970s. Obviously, Williams was quite a bit more modern than many of his disciples' disciples.)

On the other hand, obvious differences are often evident. Eclampsia, according to Williams, is "always serious," with a "maternal mortality [that] varies from 20 to 25 percent." Williams advocated control of convulsions with chloroform, large doses of morphine, the application of hot packs (for diuresis), and croton oil/olive oil mixture for catharsis. The pregnancy should then be terminated as expeditiously as possible. The syndrome usually disappears after delivery, although "[i]f the patient does not show marked signs of improvement shortly after delivery, from 300 to 500 cubic centimeters of blood should be withdrawn. If beneficial results follow, the procedure may be repeated as necessary." As expected, Cunningham and associates at Parkland agree that "eclampsia is still a deadly disease," but advocate "(1) control of convulsions, (2) correction of hypoxia and acidosis, (3) blood pressure control, and (4) delivery after control of convulsions." Obviously, bleeding the patient is no longer in favor in Dallas, even though their protocol has many similarities, at least in theory, to Williams'.

Perhaps one of the more impressive aspects of Williams' first text, even today, is the illustrations. Multiple line drawings, even of micrographs, were provided by K.M. Montague and F.S. Lockwood, whom Williams acknowledged in his book. Aside from the obvious (ie, genuine photographs, photomicrographs, and the like), the illustrations in the current Parkland text, by multiple artists, are often nearly exact copies of drawings from the original edition, and sometimes not as good. In fact, almost all of Williams' artwork could have been used in the new edition without apology.

Pure medicine aside, the history buff will find the social anthropology represented by this book fascinating. Speaking on the course of induced abortion, Williams said that the patient's "statements are entitled to but little weight, and the decision to interfere [ie, perform the abortion] should be based entirely upon objective symptoms and conditions," rather than the patient's desires. This authoritative approach to patient care is fairly alien to our current respect for patient autonomy and informed consent.

In another vein, consider the discussion of the racial differences in pelvic architecture:

"The mesatipellic variety [of pelvis] is observed in the women of the lower races, notably among the Bushmen, Hottentots, and the lower classes of negroes; while the platypellic forms are found in all the higher races. But even among civilized whites considerable racial differences are not infrequently noted, and it is generally stated that the pelves of the English and Holstein women are broader than other nationalities; while the Jewesses living in the vicinity of Dorpat have extremely small pelves."

The reader might wonder, "Did people really talk like that?" More to the point, "Did people really think like that?" The answer, of course, is yes. Dr. J. Whitridge Williams was a Professor at Johns Hopkins University; Obstetrician-in-Chief to the Johns Hopkins Hospital; and Gynaecologist to the Union Protestant Infirmary, Baltimore. Turn-of-the-century US produced no better, either scientist or gentleman. Thus, a practicing of Williams' first edition serves as a window to the soul of US medicine, and society in general, circa 1900. It is for the reader to decide what, if anything, "is history."

Tue, 17 Oct 2023 12:00:00 -0500 en text/html
Why is Johanna a great teacher for the Professional Agile Leadership – Essentials course?

Power of Passion

One of the things that immediately stands out about Johanna’s approach to the Professional Agile Leadership class is her unbridled passion. I’ve heard her say, more than once, that this is her favourite class to teach.  📌

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As I’ve always believed, when Johanna or I engage in transformative conversations, convincing somebody in a leadership position to move towards agility means helping many.

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Can’t tell a ruck from a scrum? Here’s everything you need to know about rugby lingo and rules before the World Cup final

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