Hoping to Help: The Promises and Pitfalls of Global Health Volunteering

Volunteers and the organizations that send them for short periods to poorer countries often describe the trips as “missions” or “brigades.” Both words describe organized, purposeful ventures to accomplish a goal. “Mission” has been used in religious contexts; “brigade” is primarily a military term. In whatever use, both words denote a group with a purpose, a calling, and a common cause. What I am exploring here is the purpose of these missions and brigades and whether these hundreds of weekly arrivals really bring hope (or housing or health benefits) to Haiti or to the thousands of other poor communities around the world that receive international volunteers every year. It may seem obvious that the goal is to accomplish good for the communities visited, to “make a difference,” and often to “give back.” Whether this actually happens, and what other objectives might be involved in these volunteer trips, is rarely considered. These issues motivate this book. Do volunteers help or hurt? In what ways? Can these missions be handled more effectively

Increasing Postsecondary Enrollments in Maine: Changes Needed in Higher Education Policies

Why does Maine rank so low in higher education participation? What factors may be influencing whether Maine citizens pursue education beyond high school? Much of the debate to answer these questions has focused on students and described the problem as a lack of aspirations. David Silvernail provides another look at this issue. While student aspirations are important, Silvernail suggests that factors related to Maine\u27s higher education system also may contribute to the problem of low enrollment. He compares Maine to six peer states and finds that for a number of factors such as cost and program accessibility, Maine ranks poorly. He concludes that a part of the solution lies in changes to higher education, and offers his perspective on what changes might make a difference

Institutionalizing Mediation: The Role of Lawyers and Bar Associations

The world of trusts and estates is changing before our eyes - the multidiscipline practice trend may radically change the traditional practice of the probate bar. There is one constant, however, besides change and that is conflict. That conflict is oftentimes lurking beneath the surface when a lawyer becomes involved in the estate planning process. All of the technical knowledge you may possess about the legal system and its rules is valuable and necessary. But, the estate planning lawyer is preeminently a counselor at law. In the strongest possible way I urge students to become aware of conflict management skills and I specifically recommend that they take advantage of learning more about what mediation has to offer. My message is the same to all of you, but I offer an additional challenge to all of you: Get involved in your state or local bar association and determine how you might build that house and how you might make sure that all have access to that house. The field of mediation is still very wide open and much still needs to be done at the structural level. You may find, as I did, that this activity is both meaningful and self-satisfying. Your participation and hard work CAN make a difference

It could be a ‘Golden Goose’: a qualitative study of views in primary care on an emergency admission risk prediction tool prior to implementation

BACKGROUND: Rising demand for health care has prompted interest in new technologies to support a shift of care from hospital to community and primary care, which may require clinicians to undertake new working practices. A predictive risk stratification tool (Prism) was developed for use in primary care to estimate patients’ risk of an emergency hospital admission. As part of an evaluation of Prism, we aimed to understand what might be needed to bring Prism into effective use by exploring clinicians and practice managers’ attitudes and expectations about using it. We were informed by Normalisation Process Theory (NPT) which examines the work needed to bring an innovation into use. METHODS: We conducted 4 focus groups and 10 interviews with a total of 43 primary care doctors and colleagues from 32 general practices. All were recorded and transcribed. Analysis focussed in particular on the construct of ‘coherence’ within NPT, which examines how people understand an innovation and its purpose. RESULTS: Respondents were in agreement that Prism was a technological formalisation of existing practice, and that it would function as a support to clinical judgment, rather than replacing it. There was broad consensus about the role it might have in delivering new models of care based on active management, but there were doubts about the scope for making a difference to some patients and about whether Prism could identify at-risk patients not already known to the clinical team. Respondents did not expect using the tool to be onerous, but were concerned about the work which might follow in delivering care. Any potential value would not be of the tool in isolation, but would depend on the availability of support services. CONCLUSIONS: Policy imperatives and the pressure of rising demand meant respondents were open to trying out Prism, despite underlying uncertainty about what difference it could make. TRIAL REGISTRATION: Controlled Clinical Trials no. ISRCTN55538212

How indeterminism shapes ecologists’ contributions to managing socio-ecological systems

To make a difference in policy making about socio-ecological systems, ecologists must grasp when decision makers are amenable to acting on ecological expertise and when they are not. To enable them to do so we present a matrix for classifying a socio-ecological system by the extent of what we don’t know about its natural components and the social interactions that affects them. We use four examples, Midcontinent Mallards, Laysan Ducks, Pallid Sturgeon, and Rocky Mountain Grey Wolves to illustrate how the combination of natural and social source of indeterminism matters. Where social indeterminism is high, ecologists can expand the range of possible science-based options decision makers might consider even while recognizing societal-based concerns rather than science will dominate decision making. In contrast, where natural indeterminism is low, ecologists can offer reasonably accurate predictions that may well serve as inputs into decision making. Depending on the combination of natural and social indeterminism characterizing a particular circumstance, ecologists have different roles to play in informing socio-ecological system management

Teaching online (book excerpt from a work in progress)

The way we facilitate learning in higher education has undergone change. No longer are we constrained by time and space (Erisman & Steele, 2015). In their report, Erisman & Steele find institutions of higher education serving a much larger population of returning adult learners for whom advanced degrees and certifications can provide a difference in their working and personal lives. In the current online learning environments, we no longer have as much flexibility over the instructional strategies we want to use. Content and activities are built through the use of readings, videos, reference websites, mandated discussions, selfreflection activities and structured assignments. Faculty are hired to teach through establishing a feedback working relationship with students. In building this relationship, the nature of how you communicate and work together changes. What may have been effective in a face‐to‐face learning environment may not work online. This adds a new dimension to how faculty do their jobs. You may ask how educators bring the richness and expertise normally added to learning environments into an established course that we probably did not create. To facilitate learning effectively, adding new skills to our teaching toolbox helps us make the best use of online learning environments. This article represents an opportunity to take what might feel like a sterile learning environment and build on your own teaching skills to become a more effective educator. You are the one who will support student learning and provide students with a quality learning experience based on the working relationship you build with your learners. Online teaching may sound like a lot more work. It is not. You are working differently and hopefully after reading this article, working more effectively

Clinical- and cost-effectiveness of a nurse led self-management intervention to reduce emergency visits by people with epilepsy

People with chronic epilepsy (PWE) often make costly, and clinically unnecessary emergency department (ED) visits. Some do it frequently. No studies have examined interventions to reduce them. An intervention delivered by an epilepsy nurse specialist (ENS) might reduce visits. The rationale is it may optimize patients' self-management skills and knowledge of appropriate ED use. We examined such an intervention's clinical- and cost-effectiveness. Eighty-five adults with epilepsy were recruited from three London EDs with similar catchment populations. Forty-one PWE recruited from two EDs received treatment-as-usual (TAU) and formed the comparison group. The remaining 44 PWE were recruited from the ED of a hospital that had implemented a new ENS service for PWE attending ED. These participants formed the intervention group. They were offered 2 one-to-one sessions with an ENS, plus TAU. Participants completed questionnaires on health service use and psychosocial well-being at baseline, 6- and 12-month follow-up. Covariates were identified and adjustments made. Sixty-nine (81%) participants were retained at follow-up. No significant effect of the intervention on ED visits at 12 months or on other outcomes was found. However, due to less time as inpatients, the average service cost for intervention participants over follow-up was less than for TAU participants' (adjusted difference £558, 95% CI, −£2409, £648). Covariates most predictive of subsequent ED visits were patients' baseline feelings of stigmatization due to epilepsy and low confidence in managing epilepsy. The intervention did not lead to a reduction in ED use, but did not cost more, partly because those receiving the intervention had shorter hospital admissions. Our findings on long-term ED predictors clarifies what causes ED use, and suggests that future interventions might focus more on patients' perceptions of stigma and on their confidence in managing epilepsy. If addressed, ED visits might be reduced and efficiency-savings generated