Seeing the Fitz Center Principles In Action

The initial River Stewards orientation exposed me to the Fitz Center principles. These principles are a framework that guide leaders as they navigate through the community. The principles are as follows: Community assets: Communities meet needs and solve problems with their gifts, strengths, and assets. Social capital: Trustful relationships are necessary for community building and strengthening. Constructive public conversations: Balanced inquiry and advocacy is critical in all dialogue. Adaptive capacity: Change comes from learning together. Widely shared vision: A collective community vision is more powerful than any individual vision

LMDA New & Noteworthy, May 2019

Contents include: Crossing Borders, Pt. 2: Action in a Time of Division; Q&A | Katie Welsh; Post-Apprenticeship Reflections: How We Learned by Doing; The Kennedy Center New Play Dramaturgy Intensive 2019; Call for Translators.https://soundideas.pugetsound.edu/lmdanewsletter/1041/thumbnail.jp

Exploring the perspectives of selectors and collecters of trial outcome data : An international qualitative study

Acknowledgements The authors would like to thank all interviewees that took part in this study, as well as our colleagues and fellow members of the Trial Forge, HRB-TMRN, and MRC Trial Methodology Hubs networks that supported in identifying potential participants. Funding This project was funded by the Chief Scientist Office, grant number HIPS/18/04Peer reviewedPublisher PD

A good use of time? : Providing evidence for how effort is invested in primary and secondary outcome data collection in trials

BACKGROUND: Data collection is a substantial part of trial workload for participants and staff alike. How these hours of work are spent is important because stakeholders are more interested in some outcomes than others. The ORINOCO study compared the time spent collecting primary outcome data to the time spent collecting secondary outcome data in a cohort of trials. METHODS: We searched PubMed for phase III trials indexed between 2015 and 2019. From these, we randomly selected 120 trials evaluating a therapeutic intervention plus an additional random selection of 20 trials evaluating a public health intervention. We also added eligible trials from a cohort of 189 trials in rheumatology that had used the same core outcome set. We then obtained the time taken to collect primary and secondary outcomes in each trial. We used a hierarchy of methods that included data in trial reports, contacting the trial team and approaching individuals with experience of using the identified outcome measures. We calculated the primary to secondary data collection time ratio and notional data collection cost for each included trial. RESULTS: We included 161 trials (120 phase III; 21 core outcome set; 20 public health), which together collected 230 primary and 688 secondary outcomes. Full primary and secondary timing data were obtained for 134 trials (100 phase III; 17 core outcome set; 17 public health). The median time spent on primaries was 56.1 h (range: 0.0-10,746.7, IQR: 226.89) and the median time spent on secondaries was 190.7 hours (range: 0.0-1,356,832.9, IQR: 617.6). The median primary to secondary data collection time ratio was 1.0:3.0 (i.e. for every minute spent on primary outcomes, 3.0 were spent on secondaries). The ratio varied by trial type: phase III trials were 1.0:3.1, core outcome set 1.0:3.4 and public health trials 1.0:2.2. The median notional overall data collection cost was £8015.73 (range: £52.90-£31,899,140.70, IQR: £20,096.64). CONCLUSIONS: Depending on trial type, between two and three times as much time is spent collecting secondary outcome data than collecting primary outcome data. Trial teams should explicitly consider how long it will take to collect the data for an outcome and decide whether that time is worth it given importance of the outcome to the trial.Peer reviewe

Hope for “Continued Vitality”: Qualitative Study of Adults With Traumatic Brain Injury and Low Mood on Their Rehabilitation

ObjectiveDepression is highly comorbid with traumatic brain injury (TBI) with often complex and interacting symptomology that contributes to the experience of disability. Comorbid depression results in poorer TBI rehabilitation and downstream participation outcomes yet perspectives of this group regarding person-centered care is unknown.PurposeThis study aimed to explicate the perspectives of persons with TBI and depression on their values, preferences, and desired outcomes for optimal rehabilitation.MethodsA qualitative descriptive approach was taken. Thirteen adults [mean age: 40.5 (standard deviation 9.8)] diagnosed with TBI and with self-reported low mood were recruited through convenience sampling. Participants were predominantly female (n = 12) with concussion/mild TBI and at least 6 months post-injury. One-on-one, semi-structured interviews were conducted by phone with Canadian participants (March-May 2020). Interviews were transcribed; data were analyzed thematically by two researchers and the thematic map refined by the research team.ResultsThree themes were identified on values, preferences, and desired outcomes in person-centered care. Participants valued “validation” from healthcare providers and the health system to feel seen and believed about their conditions and concerns. They preferred for healthcare providers to “share the burden of managing care” through improved interactions and better access to concussion care. Participants expressed that “meaningful outcomes” were to be symptom free, to resume valued life activities, and to be able to adapt/be resilient. The latter indicated hope for “continued vitality” for life participation despite past and ongoing challenges.ConclusionsMany adults with TBI and self-identified low mood expressed rehabilitation experiences that were invalidating. Their identified values, preferences, and desired outcomes provide directions for better person-centered care by healthcare providers and health systems to support participation

Factors Influencing Dietetic Interns\u27 Dietary Habits During Supervised Practice

Supervised practice is a prerequisite to becoming a registered dietitian. Research suggests that environmental and social factors may affect dietary choices. This focus group research aimed to gather opinions from dietetic interns to understand what factors related to supervised practice, if any, affected their dietary habits. Qualitative data were collected via seven recorded virtual focus groups in which trained moderators facilitated a discussion using a series of controlled questions. Participants, dietetic interns (n = 42) who were currently completing or had completed their supervised practice within the previous six months, attended one of seven virtual focus groups. Each focus group had five to eight participants. Transcripts were separately coded by two trained researchers using a grounded theory approach to identify themes and subthemes. Researchers discussed any disagreements in coding and established a consensus. Elements related to the dietetic internship were observed to influence participants’ dietary choices. Main themes included time, finances, food access and availability, physical and mental effects, non-supervised practice factors, and social factors. Dietetic programs and preceptors should explore ways to raise interns’ awareness and minimize the potential negative impacts of these factors on interns’ dietary habits to improve their overall internship experience

Definition and assessment of paediatric breakthrough pain: A qualitative interview study

Infants, children and young people with life-limiting or life-threatening conditions often experience acute, transient pain episodes known as breakthrough pain. There is currently no established way to assess breakthrough pain in paediatric palliative care. Anecdotal evidence suggests that it is frequently underdiagnosed and undertreated, resulting in reduced quality of life. The development of a standardised paediatric breakthrough pain assessment, based on healthcare professionals’ insights, could improve patient outcomes. This study aimed to explore how healthcare professionals define and assess breakthrough pain in paediatric palliative care and their attitudes towards a validated paediatric breakthrough pain assessment. This was a descriptive qualitative interview study. Semi-structured interviews were conducted with 29 healthcare professionals working in paediatric palliative care across the UK. An inductive thematic analysis was conducted on the data. Five themes were generated: ‘the elusive nature of breakthrough pain,’ ‘breakthrough pain assessment,’ ‘positive attitudes towards’, ‘reservations towards’ and ‘features to include in’ a paediatric breakthrough pain assessment. The definition and assessment of breakthrough pain is inconsistent in paediatric palliative care. There is a clear need for a validated assessment questionnaire to improve assessment, diagnosis and management of breakthrough pain followed by increased healthcare professional education on the concept

The conservation status of mammals and avifauna in the Montagne des Français massif, Madagascar

The Montagne des Français is a limestone massif in northern Madagascar, which is characterised by a wide range of biotopes including xerophytic karst, gallery forest, dry western forest, grassland and caves. It is situated only 12 km from the regional capital, Antsiranana, and few, if any areas of primary forest remain. In the first comprehensive study to have been carried out at this location we report the presence of 12 mammal species. We also report the presence of 63 bird species. We use data derived from both structured and semi-structured interviews to assess the conservation status of the mammals and birds within the massif. Our study shows that local beliefs are dominated by taboos or fady and that these vary within families and communities. Current anthropogenic pressures on biodiversity include zebu grazing, charcoal production, hunting and rice cultivation. The massif was afforded Temporary Protected Area Status in 2006 and our results suggest that this protection should be made permanent. We propose opportunities for further research and sustainable development initiatives that could contribute to the conservation of the biological resources within the massif. Success in conserving this area will only be achieved if the local communities are fully engaged. RÉSUMÉ La Montagne des Français est un massif calcaire au nord de Madagascar, caractérisé par une vaste gamme de biotopes, y compris une formation calcaire connue localement sous le nom de ‘tsingy’ avec une végétation xérophyte, une forêt riveraine, une forêt sèche de l’ouest, des zones herbeuses et des grottes. Elle se trouve à 12 km seulement de la plus grande ville du nord, Antsiranana, et présente une couverture de forêts intactes extrêmement réduite. Le travail sur le terrain a été réalisé par des bénévoles de Frontier et des chercheurs de Frontier et de l’Université d’Antsiranana. Des inventaires on été effectués pendant une année, au cours de quatre périodes d’essais qui s’étalaient chacune sur une durée de l’ordre de neuf semaines. Les inventaires sur les mammifères ont fait appel à trois méthodes, dont les lignes de trous-pièges, l’emploi de pièges Sherman et des recherches nocturnes aléatoires. Un inventaire sur les oiseaux a été compilé, utilisant la technique de la liste de recensement McKinnon. Au cours de cette première étude détaillée portant sur cette localité, nous avons relevé la présence de 12 espèces de mammifères ainsi que la présence de 63 espèces d’oiseaux. Neuf des espèces de mammifères recensés sont endémiques à Madagascar et la plupart de ces espèces semblaient être représentées par des effectifs réduits sur la Montagne des Français au cours de la période d’étude. De toutes les espèces d’oiseaux reportées, 26 (41% ) sont endémiques de Madagascar. Afin d’évaluer l’état de conservation des mammifères et des oiseaux rencontrés à la Montagne des Français, nous avons utilisé des données recueillies au cours d’entrevues formelles et semi-formelles. Notre étude montre que les croyances locales sont dominées par des tabous ou fady et que ceux-ci varient selon les familles et communautés. Les pressions anthropogéniques actuelles qui pèsent sur la biodiversité sont représentées par le pâturage des zébus, la production de charbon de bois, la chasse et la culture de riz. En 2006 le massif a bénéficié d’un statut d’Aire Protégée Temporaire mais nos résultats suggèrent qu’un statut de protection permanente serait justifié. Nous proposons de poursuivre les efforts en matière de recherche et encourageons toute entreprise de développement durable qui pourrait contribuer à la conservation des ressources biologiques à l’intérieur du massif. La réussite de la protection de cette région ne pourra se faire sans la totale adhésion de l’ensemble des communautés locales

Problem Management Plus (PM plus ) in the management of common mental disorders in a specialized mental healthcare facility in Pakistan; study protocol for a randomized controlled trial

Additional file 1. Appendix A