Expert yet vulnerable: Understanding the needs of transit dependent riders to inform policy and design

Transportation is a crucial resource that links people to jobs, social networks, community and services. The transit dependent -- those who do not own private vehicles -- occupy a unique position. They are expert in their knowledge of public transportation while vulnerable to the failures and limitations of transit. This paper presents the results of a study that is aimed at understanding the lived experience of transit dependent riders. Using a framework of structuration theory as an analytic lens, we provide a thematic analysis of qualitative data including interviews with socially connected groups of people and video diaries. The results demonstrate the expertise that transit dependent riders have about transit and its policies and how they deploy that expertise in productive and cunning ways to make the system work for them. The analysis of this data resulted in three categories of agency to consider when designing for vulnerable populations: resourcefulness, reciprocity and powerlessness. The paper concludes by advocating for a human-centered approach to designing systems in community informatics and offers a set of guiding questions for designers of information and communication technologies (ICTs) to consider, especially with regards to vulnerable populations

Expert Yet Vulnerable: Understanding the Needs of Transit Dependent Riders to Inform Policy and Design

Transportation is a crucial resource that links people to jobs, social networks, community and services. The transit dependent -- those who do not own private vehicles -- occupy a unique position. They are expert in their knowledge of public transportation while vulnerable to the failures and limitations of transit. This paper presents the results of a study that is aimed at understanding the lived experience of transit dependent riders. Using a framework of structuration theory as an analytic lens, we provide a thematic analysis of qualitative data including interviews with socially connected groups of people and video diaries. The results demonstrate the expertise that transit dependent riders have about transit and its policies and how they deploy that expertise in productive and cunning ways to make the system work for them. The analysis of this data resulted in three categories of agency to consider when designing for vulnerable populations: resourcefulness, reciprocity and powerlessness. The paper concludes by advocating for a human-centered approach to designing systems in community informatics and offers a set of guiding questions for designers of information and communication technologies (ICTs) to consider, especially with regards to vulnerable populations

Transport analysis in an uncertain world

This short article reflects upon the task of informing policymaking and investment decisions in times of deep uncertainty, in the face of problems that are more 'wicked' than 'tame' and in the context of ever present biases

Team-focused implementation strategies to improve implementation of mental health screening and referral in rural Children\u27s Advocacy Centers: Study protocol for a pilot cluster randomized hybrid type 2 trial

BACKGROUND: Children\u27s Advocacy Centers (CACs) use multidisciplinary teams to investigate and respond to maltreatment allegations. CACs play a critical role in connecting children with mental health needs to evidence-based mental health treatment, especially in low-resourced rural areas. Standardized mental health screening and referral protocols can improve CACs\u27 capacity to identify children with mental health needs and encourage treatment engagement. In the team-based context of CACs, teamwork quality is likely to influence implementation processes and outcomes. Implementation strategies that target teams and apply the science of team effectiveness may enhance implementation outcomes in team-based settings. METHODS: We will use Implementation Mapping to develop team-focused implementation strategies to support the implementation of the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), a standardized screening and referral protocol. Team-focused strategies will integrate activities from effective team development interventions. We will pilot team-focused implementation in a cluster-randomized hybrid type 2 effectiveness-implementation trial. Four rural CACs will implement the CPM-PTS after being randomized to either team-focused implementation (n = 2 CACs) or standard implementation (n = 2 CACs). We will assess the feasibility of team-focused implementation and explore between-group differences in hypothesized team-level mechanisms of change and implementation outcomes (implementation aim). We will use a within-group pre-post design to test the effectiveness of the CPM-PTS in increasing caregivers\u27 understanding of their child\u27s mental health needs and caregivers\u27 intentions to initiate mental health services (effectiveness aim). CONCLUSIONS: Targeting multidisciplinary teams is an innovative approach to improving implementation outcomes. This study will be one of the first to test team-focused implementation strategies that integrate effective team development interventions. Results will inform efforts to implement evidence-based practices in team-based service settings. TRIAL REGISTRATION: Clinicaltrials.gov, NCT05679154 . Registered on January 10, 2023

Adapting the Posterior Probability of Diagnosis Index to Enhance Evidence-Based Screening: An Application to ADHD in Primary Care

This study adapts the Posterior Probability of Diagnosis (PPOD) Index for use with screening data. The original PPOD Index, designed for use in the context of comprehensive diagnostic assessments, is overconfident when applied to screening data. To correct for this overconfidence, we describe a simple method for adjusting the PPOD Index to improve its calibration when used for screening. Specifically, we compare the adjusted PPOD Index to the original index and Naïve Bayes probability estimates on two dimensions of accuracy, discrimination and calibration, using a clinical sample of children and adolescents (N = 321) whose caregivers completed the Vanderbilt Assessment Scale to screen for Attention-Deficit/Hyperactivity Disorder (ADHD) and who subsequently completed a comprehensive diagnostic assessment. Results indicated that the adjusted PPOD Index, original PPOD Index, and Naïve Bayes probability estimates are comparable using traditional measures of accuracy (sensitivity, specificity, AUC) but the adjusted PPOD Index showed superior calibration. We discuss the importance of calibration for screening and diagnostic support tools when applied to individual patients

Global Governance Behind Closed Doors : The IMF Boardroom, the Enhanced Structural Adjustment Facility, and the Intersection of Material Power and Norm Change in Global Politics

Up on the 12th floor of its 19th Street Headquarters, the IMF Board sits in active session for an average of 7 hours per week. Although key matters of policy are decided on in the venue, the rules governing Boardroom interactions remain opaque, resting on an uneasy combination of consensual decision-making and weighted voting. Through a detailed analysis of IMF Board discussions surrounding the Enhanced Structural Adjustment Facility (ESAF), this article sheds light on the mechanics of power in this often overlooked venue of global economic governance. By exploring the key issues of default liability and loan conditionality, I demonstrate that whilst the Boardroom is a more active site of contestation than has hitherto been recognized, material power is a prime determinant of both Executive Directors’ preferences and outcomes reached from discussions. And as the decisions reached form the backbone of the ‘instruction sheet’ used by Fund staff to guide their everyday operational decisions, these outcomes—and the processes through which they were reached—were factors of primary importance in stabilizing the operational norms at the heart of a controversial phase in the contemporary history of IMF concessional lending

Finding Ophthalmic Risk and Evaluating the Value of Eye exams and their predictive Reliability (FOREVER)—A cohort study in a Danish high street optician setting: Design and methodology

Purpose The purpose of the study was to describe the rationale and design of Project FOREVER (Finding Ophthalmic Risk and Evaluating the Value of Eye exams and their predictive Reliability). Design Project FOREVER will build a comprehensive database of clinical eye and vision data collected from ~280 000 adults at 100 optician stores across Denmark. The FOREVER database (FOREVERdb) includes detailed data from refraction, visual acuity, intraocular pressure, corneal thickness, visual field assessments and retinal fundus images. Linkage to the comprehensive Danish national registries with, that is diagnostic and prescribing data permits investigation of rare associations and risk factors. 30 000 individuals over 50 also provide a saliva sample for later genetic studies and blood pressure measurements. Of these 30 000, 10 000 will also get optical coherence tomography (OCT) nerve and retinal scans. This subpopulation data is reviewed by ophthalmologists for disease detection. All participants will be asked to complete a questionnaire assessing lifestyle, self‐perceived eye health and general health. Enrolment of participants began in April 2022. Perspective The FOREVERdb is a powerful tool to answer a wide range of research questions that can pave the way for better eye health. This database will provide valuable insights for future studies investigating the correlations between eye and general health in a Danish population cohort, enabling research to identify potential risk factors for a range of diseases

Care team and practice-level implementation strategies to optimize pediatric collaborative care: Study protocol for a cluster-randomized hybrid type III trial

BACKGROUND: Implementation facilitation is an effective strategy to support the implementation of evidence-based practices (EBPs), but our understanding of multilevel strategies and the mechanisms of change within the black box of implementation facilitation is limited. This implementation trial seeks to disentangle and evaluate the effects of facilitation strategies that separately target the care team and leadership levels on implementation of a collaborative care model in pediatric primary care. Strategies targeting the provider care team (TEAM) should engage team-level mechanisms, and strategies targeting leaders (LEAD) should engage organizational mechanisms. METHODS: We will conduct a hybrid type 3 effectiveness-implementation trial in a 2 × 2 factorial design to evaluate the main and interactive effects of TEAM and LEAD and test for mediation and moderation of effects. Twenty-four pediatric primary care practices will receive standard REP training to implement Doctor-Office Collaborative Care (DOCC) and then be randomized to (1) Standard REP only, (2) TEAM, (3) LEAD, or (4) TEAM + LEAD. Implementation outcomes are DOCC service delivery and change in practice-level care management competencies. Clinical outcomes are child symptom severity and quality of life. DISCUSSION: This statewide trial is one of the first to test the unique and synergistic effects of implementation strategies targeting care teams and practice leadership. It will advance our knowledge of effective care team and practice-level implementation strategies and mechanisms of change. Findings will support efforts to improve common child behavioral health conditions by optimizing scale-up and sustainment of CCMs in a pediatric patient-centered medical home. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04946253 . Registered June 30, 2021