4,711 research outputs found

    Non-Market Food Practices Do Things Markets Cannot: Why Vermonters Produce and Distribute Food That\u27s Not For Sale

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    Researchers tend to portray food self-provisioning in high-income societies as a coping mechanism for the poor or a hobby for the well-off. They describe food charity as a regrettable band-aid. Vegetable gardens and neighborly sharing are considered remnants of precapitalist tradition. These are non-market food practices: producing food that is not for sale and distributing food in ways other than selling it. Recent scholarship challenges those standard understandings by showing (i) that non-market food practices remain prevalent in high-income countries, (ii) that people in diverse social groups engage in these practices, and (iii) that they articulate diverse reasons for doing so. In this dissertation, I investigate the persistent pervasiveness of non-market food practices in Vermont. To go beyond explanations that rely on individual motivation, I examine the roles these practices play in society. First, I investigate the prevalence of non-market food practices. Several surveys with large, representative samples reveal that more than half of Vermont households grow, hunt, fish, or gather some of their own food. Respondents estimate that they acquire 14% of the food they consume through non-market means, on average. For reference, commercial local food makes up about the same portion of total consumption. Then, drawing on the words of 94 non-market food practitioners I interviewed, I demonstrate that these practices serve functions that markets cannot. Interviewees attested that non-market distribution is special because it feeds the hungry, strengthens relationships, builds resilience, puts edible-but-unsellable food to use, and aligns with a desired future in which food is not for sale. Hunters, fishers, foragers, scavengers, and homesteaders said that these activities contribute to their long-run food security as a skills-based safety net. Self-provisioning allows them to eat from the landscape despite disruptions to their ability to access market food such as job loss, supply chain problems, or a global pandemic. Additional evidence from vegetable growers suggests that non-market settings liberate production from financial discipline, making space for work that is meaningful, playful, educational, and therapeutic. Non-market food practices mend holes in the social fabric torn by the commodification of everyday life. Finally, I synthesize scholarly critiques of markets as institutions for organizing the production and distribution of food. Markets send food toward money rather than hunger. Producing for market compels farmers to prioritize financial viability over other values such as stewardship. Historically, people rarely if ever sell each other food until external authorities coerce them to do so through taxation, indebtedness, cutting off access to the means of subsistence, or extinguishing non-market institutions. Today, more humans than ever suffer from chronic undernourishment even as the scale of commercial agriculture pushes environmental pressures past critical thresholds of planetary sustainability. This research substantiates that alternatives to markets exist and have the potential to address their shortcomings

    Communicating a Pandemic

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    This edited volume compares experiences of how the Covid-19 pandemic was communicated in the Nordic countries – Denmark, Finland, Iceland, Norway, and Sweden. The Nordic countries are often discussed in terms of similarities concerning an extensive welfare system, economic policies, media systems, and high levels of trust in societal actors. However, in the wake of a global pandemic, the countries’ coping strategies varied, creating certain question marks on the existence of a “Nordic model”. The chapters give a broad overview of crisis communication in the Nordic countries during the first year of the Covid-19 pandemic by combining organisational and societal theoretical perspectives and encompassing crisis response from governments, public health authorities, lobbyists, corporations, news media, and citizens. The results show several similarities, such as political and governmental responses highlighting solidarity and the need for exceptional measures, as expressed in press conferences, social media posts, information campaigns, and speeches. The media coverage relied on experts and was mainly informative, with few critical investigations during the initial phases. Moreover, surveys and interviews show the importance of news media for citizens’ coping strategies, but also that citizens mostly trusted both politicians and health authorities during the crisis. This book is of interest to all who are looking to understand societal crisis management on a comprehensive level. The volume contains chapters from leading experts from all the Nordic countries and is edited by a team with complementary expertise on crisis communication, political communication, and journalism, consisting of Bengt Johansson, Øyvind Ihlen, Jenny Lindholm, and Mark Blach-Ørsten. Publishe

    Delivery of supported self-management in asthma reviews: a mixed methods observational study nested in the IMP²ART programme of work

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    BACKGROUND: Supported self-management (SSM) reduces the risk of asthma attacks, improves asthma control and quality of life. During routine primary care asthma consultations, healthcare professional (HCP) communication and behaviour can influence a person's skills, knowledge and confidence to manage their own condition. Therefore understanding how supported self-management is delivered in UK primary care can help towards improved HCP delivery of care. This PhD project has been nested within the IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) programme, which is a UK-Wide trial, developing and evaluating a strategy delivering patient, professional, and organisational resources to improve self-management. AIMS AND OBJECTIVES: The aim of this PhD project was to assess HCP delivery of supported self-management, including patient-centred care and behaviour change strategies to promote asthma self-management during routine primary care reviews. Additional objectives included to explore the influence of the IMP2ART programme on the delivery of supported self-management, and investigate differences (if any) in remote and face-to-face delivery of asthma care. METHODOLOGY: The PhD programme of work consisted of three phases: 1. Understanding the Evidence Base: Firstly, following systematic realist review methodology, I systematically reviewed the existing evidence investigating the delivery of supported self-management during routine remote asthma consultations. The realist review aimed to; 1) identify and synthesise studies that explored remote asthma consultations and the delivery of supported self-management, 2) explore the context and mechanisms that have contributed to clinically effective, safe and acceptable delivery of supported self-management during remote asthma consultations, and 3) produce recommendations and guidelines for best practice in the delivery of supported self-management during remote consultations for people with asthma. 2. Understanding current clinical practice: I conducted an observational study using video-recordings of routine face-to-face and telephone asthma reviews in a sub-sample of practices participating in the IMP2ART UK-wide cluster-randomised controlled trial (implementation n~4; control n~6). Analytical methods included: ALFA Toolkit Multi-Channel Video Observation, to code and quantify types of speech, Patient-Centred Observation Form and The Behaviour Change Counselling Index, to assess patient-centeredness and behaviour change counselling used by HCPs. 3. Understanding the clinician’s perspective: In the qualitative phase of the PhD, I conducted semi-structured interviews with seven HCPs to explore clinician’s perceptions, opinions and experiences of delivering supported self-management during routine asthma reviews. Interviews were audio recorded, transcribed and findings were explored using thematic analysis. Results of the three phases were initially analysed separately using the outlined approaches. A ‘Triangulation Protocol’ process was then conducted to compare, contrast and amalgamate the findings of the mixed methods approaches. RESULTS: 1. Results of the systematic rapid realist review identified six themes using data from 18 articles to describe how supported self-management is delivered during remote asthma consultations. The findings identified positive benefits associated with remote asthma care including; increased convenience, improved access and attendance at reviews, ability to conduct the core content of an asthma review remotely, completion of asthma action plans, and continuity of care. Typically, these overrode any challenges associated with technological difficulties imposed by remote consultations. The data suggest that overall remote consultations were as, or more highly, accepted than in person consultations for the studies I included, and were as effective and safe as face-to-face reviews. 2. Findings of the observational recordings revealed that HCPs spent the most time during a routine review discussing; an individual’s asthma condition and it’s management, collaboratively reviewing and completing personalised asthma action plan and, training for practical self-management activities (e.g., inhaler technique). Areas of patient-centred care delivery which HCPs discussed using a biopsychosocial focus were; creating and maintaining relationships with patients, as well as discussing asthma action plans and medication reconciliation. HCPs delivered empathetic behavioural discussions, however, did not collaboratively discuss individualised approaches for ways in which a patient could proactively change their behaviour. There was a statistically significant difference for the delivery of supported self-management between IMP2ART implementation and control group healthcare professionals. Healthcare professionals from the IMP2ART implementation group spent a higher percentage of time during routine reviews incorporating and discussing SSM strategies (ALFA) (t (62), =2.122, p =0.038). Professionals of implementation group practices also delivered a more person-centred review (PCOF) (t (60), = 2.06, p = 0.044), and used more behaviour change communication strategies (BECCI) (U= 336.5, p = 0.03) than professionals of the IMP2ART control group. I concluded that, on average, professionals in IMP2ART implementation group practices delivered more effective SSM strategies during routine asthma reviews. Findings from the between group analysis of the face-to-face and remote consultation groups found that on average, both groups spent similar percentages of time on SSM tasks during routine asthma reviews (ALFA). Similarly, both groups had similar scores the delivery of patient-centred care (PCOF) and behaviour change discussions (BECCI), showing no significant differences in healthcare professional delivery of SSM between face-to-face and remote consultations. 3. The findings from the qualitative, semi-structured interviews with healthcare professionals identified five themes. The main findings from the themes included; healthcare professionals shared understanding of supported self-management, barriers and facilitators of supported self-management delivery (including healthcare professional motivations, confidence and time barriers), important strategies for supported self-management delivery (including patient education, asthma action plans and inhaler technique), and that there is a place in primary care for remote asthma care. Five key findings emerged from completing the Triangulation Protocol process, which amalgamated the findings of the three phases of the PhD study; 1. HCP confidence and motivations, and general practice culture are facilitators of effective HCP delivery of supported self-management. 2. Lack of time and large, challenging workloads are perceived as barriers to HCP delivery of supported self-management. 3. HCP and patient asthma education is an effective supported self-management strategy. 4. IMP2ART implementation strategies are associated with increased HCP delivery of asthma supported self-management. 5. Remote consultations devote similar proportion of time to face-to-face reviews for delivery of asthma supported self-management. CONCLUSIONS: HCP communication and behaviour can positively or negatively impact a patient’s ability to self-manage their condition. The insights from this mixed methods PhD programme of work, including the observation of routine asthma reviews, has provided evidence that training programmes directed at providing healthcare professionals with the skills they need to implement a motivating and patient-centred asthma review, in which behaviour change and collaborative supported self-management strategies, can be effective, and should be prioritised during the delivery of routine primary care asthma management. Routine remote reviews are also an acceptable alternative to delivery of supported self-management for asthma care for specific patient groups

    EXPRESSO: EXploring the PREvalence, Service utilisation and patient experience of Severe Obesity

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    Background The study’s genesis is the author’s district nursing role caring for increasing numbers of individuals at home with severe obesity (BMI ≥40 kg/m2 ). Such individuals often experience physical disability and functional limitations associated with severe obesity, needing help at home from community health and social care services. Care needs can pose previously unknown challenges for care providers. Little evidence exists to guide quality of care, service development or effective use of resources. Aim To better characterise the population with BMI ≥40 kg/m2 who require help at home from community health and social care services. Key questions are: 1. How many people known to health and social care services have a current BMI ≥40 kg/m2 ? 2. How many of these are known to be housebound or in care? 3. What health and social care services does the BMI ≥40 kg/m2 population use? 4. What are the costs of these health and social care services? 5. What are participants’ experiences of using these services? Methods A scoping review of international measured prevalence data on adult BMI ≥40 kg/m2 applied a broad search strategy, utilising diverse sources. An instrumental case study approach was used to explore the approvals process for this mixed-methods, observational study, engaging routinely-collected data. In a representative United Kingdom local authority, consenting individuals with severe obesity were recruited via community health and social care professionals. Participants were visited at home by the investigator, where height and weight measures were taken using specialist weighing scales and alternative height measures where needed. An investigator-administered questionnaire recorded participants’ self-reported need for help at home, including use of community health and social care services. Data were verified against routinely-collected data in health and social care records. Local and published sources informed a detailed micro-costing. Community services were also asked to identify eligible adults in a “census” of their caseloads. A nested qualitative element involved participants undertaking individual, audiorecorded, semi-structured interviews, which were transcribed and analysed using reflexive thematic analysis. Results Eighteen countries, across five continents, reported BMI ≥40 kg/m2 prevalence data in surveys since 2010: 11% of eligible national surveys examined. Prevalence of BMI ≥40 kg/m2 ranged from 1.3% (Spain) to 7.7% (USA) for all adults, 0.7% (Serbia) to 5.6% (USA) for men and 1.8% (Poland) to 9.7% (USA) for women. Limited trend data covering recent decades support significant growth of the population with BMI ≥40 kg/m2. Formal approvals by nine separate stakeholders from four different organisations took nearly three years, including fifteen initial or revised applications, assessments, or agreements. Fragmented data systems, multiple data controllers, and a changing data governance environment created challenges to using routine data, requiring study design modification. Twenty-five individuals (15 women) participated, aged 40-87 (mean=62) years, BMI 40-77 (mean=55) kg/m2 : 20 participants (80%) were housebound. Incomplete census data identified a further 261 eligible individuals. Weights ranged from 98.4 to 211.8 kg (mean=150 kg), with 16 participants requiring bariatric scales. For six people unable to stand, wheelchair scales(n=1), bed weighing scales (n=2), routine weights from care home records (n=2) or weight data from hospital records (n=1) were used. The standard portable stadiometer was usable for only one participant: Others required alternative measures from which to estimate height, which gave diverse heights. Twenty-two different cross-sector community health and social care services were used. Only five participants had contact with weight management services. Twenty-four (96%) participants used three or more services, with longest care episode lasting over 14 years. Total annual service costs incurred by participants varied from £2,053 to £82,792 base case estimate, mean £26,594 (lower estimate £2,053 to £80,064, mean £22,462; upper estimate £2,053 to £88,870, mean £30,726), with greatest costs being for social care. Nine women and three men (n=12) participated in qualitative interviews, aged 40-76 (mean 60) years, BMI ranged from 45-74 (mean 59) kg/m2 , eight were housebound. Three overarching themes were identified. Firstly, the hidden struggles of living with a larger body impacted all participants, including functional limitations affecting mobility and personal care. These contributed to a sense of being stuck physically, socially, and biographically, partially due to poor treatment options. A second theme found explicit weight bias was commonly, but not wholly, denied. However, most participants related implicit weight bias by a system structurally unprepared to care for people with severe obesity. The majority of participants showed strong internalised weight bias, linked to shame and self-blame for their poor function and larger bodies. Thirdly, a day-to-day coping theme highlighted strategies regularly used by participants: resigned acceptance, avoidance and denial, exercising choice, and support from informal carers. Conclusion Accurate prevalence data for the population with BMI ≥40 kg/m2 is under reported. International health surveys could improve data availability by publishing disaggregated data beyond BMI ≥30 kg/m2 . Current practice regarding anthropometric measures likely excludes people with severe obesity and functional limitations. Specialist scales and standardised methods for height estimation appropriate for people with severe obesity are needed. Lack of data impairs surveillance of population trends, understanding of causation, societal provision for individuals living with higher weights, and the effectiveness of future service planning. Practitioners face a complex approvals process to use data they routinely collect for research or evaluation purposes. Data sources for poorly documented community health and social care services exist and are navigable at an individual level. Population-level usage of such records needs developed. Adults with severe obesity, including those under 65 years, may need sustained care from multiple community care services, with potentially high annual costs. Economic evaluations of obesity and weight management need to include these wider care costs to ensure completeness. Participants experienced unmet physical and psychological care needs associated with their larger bodies, leading to poor quality of care and life. Given rising prevalence, changes to care services are required. Specific recommendations include staff training about needs of people with severe obesity, ensuring the physical infrastructure of care services can safely accommodate people with severe obesity, and improving access to effective, person-centred weight management treatments, with strategies to tackle internalised weight bias. Future research could explore how the duration and severity of obesity affects an individual’s functional limitations, subsequent need for care, and quality of life

    Undergraduate Catalog of Studies, 2022-2023

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    Gratitude in Healthcare an interdisciplinary inquiry

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    The expression and reception of gratitude is a significant dimension of interpersonal communication in care-giving relationships. Although there is a growing body of evidence that practising gratitude has health and wellbeing benefits for the giver and receiver, gratitude as a social emotion made in interaction has received comparatively little research attention. To address this gap, this thesis draws on a portfolio of qualitative methods to explore the ways in which gratitude is constituted in care provision in personal, professional, and public discourse. This research is informed by a discursive psychology approach in which gratitude is analysed, not as a morally virtuous character trait, but as a purposeful, performative social action that is mutually co-constructed in interaction.I investigate gratitude through studies that approach it on a meta, meso, macro, and micro level. Key intellectual traditions that underpin research literature on gratitude in healthcare are explored through a metanarrative review. Six underlying metanarratives were identified: social capital; gifts; care ethics; benefits of gratitude; staff wellbeing; and gratitude as an indicator of quality of care. At the meso (institutional) level, a narrative analysis of an archive of letters between patients treated for tuberculosis and hospital almoners positions gratitude as participating in a Maussian gift-exchange ritual in which communal ties are created and consolidated.At the macro (societal) level, a discursive analysis of tweets of gratitude to the National Health Service at the outset of the Covid-19 pandemic shows that attitudes to gratitude were dynamic in response to events, with growing unease about deflecting attention from risk reduction for those working in the health and social care sectors. A follow-up analysis of the clap-for-carers movement implicates gratitude in embodied, symbolic, and imagined performances in debates about care justice. At the micro (interpersonal) level, an analysis of gratitude encounters broadcast in the BBC documentary series, Hospital, uses pragmatics and conversation analysis to argue that gratitude is an emotion made in talk, with the uptake of gratitude opportunities influencing the course of conversational sequencing. The findings challenge the oftenmade distinction between task-oriented and relational conversation in healthcare.Moral economics are paradigmatic in the philosophical conceptualisation of gratitude. My research shows that, although balance-sheet reciprocity characterised the institutional culture of the voluntary hospital, it is hardly ever a feature ofinterpersonal gratitude encounters. Instead, gratitude is accomplished as shared moments of humanity through negotiated encounters infused with affect. Gratitude should never be instrumentalised as compensating for unsafe, inadequatelyrenumerated work. Neither should its potential to enhance healthcare encounters be underestimated. Attention to gratitude can participate in culture change by affirming modes of acting, emoting, relating, expressing, and connecting that intersect with care justice.This thesis speaks to gratitude as a culturally salient indicator of what people express as worthy of appreciation. It calls for these expressions to be more closely attended to, not only as useful feedback that can inform change, but also because gratitude is a resource on which we can draw to enhance and enrich healthcare as a communal, collaborative, cooperative endeavour

    Reshaping Higher Education for a Post-COVID-19 World: Lessons Learned and Moving Forward

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    Tradition and Innovation in Construction Project Management

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    This book is a reprint of the Special Issue 'Tradition and Innovation in Construction Project Management' that was published in the journal Buildings

    Honors Colleges in the 21st Century

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    Table of Contents Acknowledgments Introduction | Richard Badenhausen Part I: Honors College Contexts: Past and Present CHAPTER ONE Oxbridge and Core Curricula: Continuing Conversations with the Past in Honors Colleges | Christopher A. Snyder CHAPTER TWO Characteristics of the 21st-Century Honors College | Andrew J. Cognard-Black and Patricia J. Smith Part II: Transitioning to an Honors College CHAPTER THREE Should We Start an Honors College? An Administrative Playbook for Working Through the Decision | Richard Badenhausen CHAPTER FOUR Beyond the Letterhead: A Tactical Toolbox for Transitioning from Program to College | Sara Hottinger, Megan McIlreavy, Clay Motley, and Louis Keiner Part III: Administrative Leadership CHAPTER FIVE “It Is What You Make It’’: Opportunities Arising from the Unique Roles of Honors College Deans | Jeff Chamberlain, Thomas M. Spencer, and Jefford Vahlbusch CHAPTER SIX The Role of the Honors College Dean in the Future of Honors Education | Peter Parolin, Timothy J. Nichols, Donal C. Skinner, and Rebecca C. Bott-Knutson CHAPTER SEVEN From the Top Down: Implications of Honors College Deans’ Race and Gender | Malin Pereira, Jacqueline Smith-Mason, Karoline Summerville, and Scott Linneman Part IV: Honors College Operations CHAPTER EIGHT Something Borrowed, Something New: Honors College Faculty and the Staffing of Honors Courses | Erin E. Edgington and Linda Frost CHAPTER NINE Telling Your Story: Stewardship and the Honors College | Andrew Martino Part V: Honors Colleges as Leaders in the Work of Diversity, Equity, Inclusion, and Access CHAPTER TEN Cultivating Institutional Change: Infusing Principles of Diversity, Equity, and Inclusion into Everyday Honors College Practices | Tara M. Tuttle, Julie Stewart, and Kayla Powell CHAPTER ELEVEN Positioning Honors Colleges to Lead Diversity and Inclusion Efforts at Predominantly White Institutions | Susan Dinan, Jason T. Hilton, and Jennifer Willford CHAPTER TWELVE Honors Colleges as Levers of Educational Equity | Teagan Decker, Joshua Kalin Busman, and Michele Fazio CHAPTER THIRTEEN Promoting the Inclusion of LGBTQ+ Students: The Role of the Honors College in Faith-Based Colleges and Universities | Paul E. Prill Part VI: Supporting Students CHAPTER FOURTEEN Who Belongs in Honors? Culturally Responsive Advising and Transformative Diversity | Elizabeth Raisanen CHAPTER FIFTEEN Fostering Student Leadership in Honors Colleges | Jill Nelson Granger Part VII: Honors College Curricular Innovation CHAPTER SIXTEEN Honors Liberal Arts for the 21st Century | John Carrell, Aliza S. Wong, Chad Cain, Carrie J. Preston, and Muhammad H. Zaman CHAPTER SEVENTEEN Honors Colleges, Transdisciplinary Education, and Global Challenges | 423 Paul Knox and Paul Heilker Part VIII: Community Engagement CHAPTER EIGHTEEN Teaching and Learning in the Fourth Space: Preparing Scholars to Engage in Solving Community Problems | Heidi Appel, Rebecca C. Bott-Knutson, Joy Hart, Paul Knox, Andrea Radasanu, Leigh E. Fine, Timothy J. Nichols, Daniel Roberts, Keith Garbutt, William Ziegler, Jonathan Kotinek, Kathy Cooke, Ralph Keen, Mark Andersen, and Jyotsna Kapur CHAPTER NINETEEN Serving Our Communities: Leveraging the Honors College Model at Two-Year Institutions | Eric Hoffman, Victoria M. Bryan, and Dan Flores About the Authors About the NCHC Monograph Serie
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