Developing Inclusive Language Competency in Clinical Teaching

Drawing from legal pedagogy, litigation practice, and teaching experience, this article seeks to compile a set of key considerations for inclusive language decision-making in the clinical setting. Using a multi-factor framework--accuracy, precision, relevance, audience, and respect-this analysis explores the process for deciding on terms to use in practice and the potential implications of those choices on student learning, case outcomes, and attorney-client relationships. In addition, this article explores some current trends and best practices when adopting these principles in the context of specific groups. This article connects these principles to broader academic and practice is- sues, including the American Bar Association accreditation standards and Rules of Professional Conduct

The Control of Fe and pH on the Photodegradation and Characterization of Dissolved Organic Matter in Small, Oligotrophic Canadian Shield Freshwaters

Carbon is an essential building block for life and is involved in many biotic and abiotic processes. Thus it is imperative to have a comprehensive understanding of carbon cycling. Recent research has established that inland lakes are important contributors to the regional carbon cycle because they store, process and emit large masses of carbon over relatively short timescales (ie. days to years). Lakes receive 1.9 Pg C y-1 of terrestrially-derived carbon but only export approximately half of that to oceans while the remainder is either transferred to the sediment as particulate organic carbon (POC) or evaded to the atmosphere as carbon dioxide (CO2; Molot and Dillon, 1996; Cole et al. 2007). Increased atmospheric CO2 has caused global environmental problems including ocean acidification, temperature increases leading to melting glacial ice and sea level rise, and changes in precipitation patterns including extreme weather resulting in flooding and droughts. Investigating the mechanisms that affect these processes is important for understanding the global carbon cycle and predicting future changes to the lake systems under the stress of climate change. As the largest input of terrestrial carbon to lakes, dissolved organic carbon (DOC) (composed of a complex mixture of thousands of different organic molecules less than 0.1-0.7μm) is important to lake ecosystem function. Large quantities of DOC are converted into other forms of carbon within lakes and some of the transport mechanisms between sources and sinks do not add up. Photodegradation of DOC is an important abiotic process for DOC loss. Products of DOC photodegradation including POC, dissolved organic carbon (DIC; can evade to the atmosphere as CO2), and photolytically altered DOC affect the size of carbon pools in lakes. Concomitantly, pH and Fe can influence the rates of carbon transformation, yet these influences are poorly understood. The goal of my research was to explain an important gap in our understanding of why some carbon goes to the atmosphere as CO2 and some goes into the lake sediments as POC. This has implications for contaminant transport, lakes recovering from acidification, increasing lake water temperatures, and climate change modeling. In laboratory experiments, pH and Fe of three boreal streams (two from the Experimental Lakes Area, Kenora, ON and one near Dorset, ON) were manipulated to observe the impact on DOC photodegradation and POC formation. Measurement of carbon pools during the photolysis experiment allowed for the determination of DOC loss (production of DIC and POC formation) and carbon and isotopic mass balances. A novel size exclusion chromatography method, liquid chromatography organic carbon detection (LC-OCD), was used with other measures of quality to identify changes in DOC composition resulting from photodegradation. While photodegradation was an important process that transformed stream organic carbon (rates decreased at pH 6.5 and increased with increased Fe concentrations), no significant POC was generated from this process. Thus it is still unknown as to how large portions of DOC in oligotrophic boreal freshwater lakes ends up in the sediments as POC. Experiments were also conducted to study the influence of pH, Fe(II) and Fe(III) on measures of DOC quality (specifically absorbance and LC-OCD). This work has demonstrated that certain measures of DOC quality are influenced by pH, Fe(II) and Fe(III) and thus, these parameters must be considered when making conclusions about DOC quality when using such measures

Experiences of Black and Latino Residents During the COVID-19 Response in Missouri

Experiences of Black and Latino Residents During the COVID-19 Response in Missouri centers conversations from focus groups and interviews with Black and Latino Missourians from the St. Louis and Southwest regions during the state’s response to COVID-19. The report examines challenges that Black and Latino Missourians faced during the pandemic and how inequities in response efforts hampered their reach, effectiveness, and further exacerbated the pandemic’s impact on people of color in Missouri. Lessons learned from these conversations provide ways that leaders in public health, health care, social service, and government sectors can create stronger, more equitable systems of care. The findings in this report focus on the period of the pandemic from March 2020 through May 2021, before the proliferation of the delta and omicron variants. The Public Health Response to COVID-19 in the Southwest Region of Missouri, The Public Health Response to COVID-19 in the Northeast Region of Missouri, The Public Health Response to COVID-19 in the St. Louis Region of Missouri, and Experiences of Black and Latino Residents During the COVID-19 Response in Missouri, are part of a series of reports that were used to inform the state-level recommendations in the report Missouri’s Public Health Response to COVID-19: Key Findings and Recommendations for State Action and Investment

Challenges in language services: Identifying and responding to patients\u27 needs

Objective: Identify characteristics of hospitalbased language services (LS), and describe practices of identifying patients with limited English proficiency (LEP) and interpreter training. Participants: Seventy-one hospitals applied to participate in a national initiative. Applicants were non-federal, acute care hospitals with substantial LEP populations, at least 10,000 discharges, and in-person interpreters. Methods: Descriptive statistics were generated on language, collection of language data, LEP volume and service utilization, staffing and training requirements and organizational structure. The relationship between admissions and encounters was analyzed. Results Ninety percent of hospitals collect primary language data. Spanish is the most common language (93% of hospitals). We found no statistically significant correlation between admissions and encounters. Eighty-four percent require training. Eightynine percent have a designated LS department but no clear organizational home. Conclusions: Hospital-based LS programs are facing challenges identifying patients with language needs, staffing and training a workforce, and creating an organizational identity. Need is not associated with utilization, suggesting that LS are not reaching patients

ASPIRE-2-PREVENT: a survey of lifestyle, risk factor management and cardioprotective medication in patients with coronary heart disease and people at high risk of developing cardiovascular disease in the UK.

OBJECTIVE: To determine in patients with coronary heart disease (CHD) and people at high risk of developing cardiovascular disease (CVD) whether the Joint British Societies' guidelines on CVD prevention (JBS2) are followed in everyday clinical practice. DESIGN: A cross-sectional survey was undertaken of medical records and patient interviews and examinations at least 6 months after the recruiting event or diagnosis using standardised instruments and a central laboratory for measurement of lipids and glucose. SETTINGS: The ASPIRE-2-PREVENT survey was undertaken in 19 randomly selected hospitals and 19 randomly selected general practices in 12 geographical regions in England, Northern Ireland, Wales and Scotland. PATIENTS: In hospitals, 1474 consecutive patients with CHD were identified and 676 (25.6% women) were interviewed. In general practice, 943 people at high CVD risk were identified and 446 (46.5% women) were interviewed. RESULTS: The prevalence of risk factors in patients with CHD and high-risk individuals was, respectively: smoking 14.1%, 13.3%; obesity 38%, 50.2%; not reaching physical activity target 83.3%, 85.4%; blood pressure ≥130/80 mm Hg (patients with CHD and self-reported diabetes) or ≥140/85 mm Hg (high-risk individuals) 46.9%, 51.3%; total cholesterol ≥4 mmol/l 52.6%, 78.7%; and diabetes 17.8%, 43.8%. CONCLUSIONS: The potential among patients with CHD and individuals at high risk of developing CVD in the UK to achieve the JBS2 lifestyle and risk factor targets is considerable. CVD prevention needs a comprehensive multidisciplinary approach, addressing all aspects of lifestyle and risk factor management. The challenge is to engage and motivate cardiologists, physicians and other health professionals to routinely practice high quality preventive cardiology in a healthcare system which must invest in prevention

A qualitative study of sedentary behaviours in stroke survivors:non-participant observations and interviews with stroke service staff in stroke units and community services

Purpose Sedentary behaviour (SB) is associated with negative health outcomes and is prevalent post-stroke. This study explored SB after stroke from the perspective of stroke service staff. Methods Qualitative mixed-methods study. Non-participant observations in two stroke services (England/Scotland) and semi-structured interviews with staff underpinned by the COM-B model of behaviour change. Observations were analysed thematically; interviews were analysed using the Framework approach. Results One hundred and thirty-two observation hours (October - December 2017), and 31 staff interviewed (January –June 2018). Four themes were identified: (1) Opportunities for staff to support stroke survivors to reduce SB; (2) Physical and psychological capability of staff to support stroke survivors to reduce SB; (3) Motivating factors influencing staff behaviour to support stroke survivors to reduce SB; (4) Staff suggestions for a future intervention to support stroke survivors to reduce SB. Conclusions Staff are aware of the consequences of prolonged sitting but did not relate to SB. Explicit knowledge of SB was limited. Staff need training to support stroke survivors to reduce SB. Sedentary behaviour in the community was not reported to change markedly, highlighting the need to engage stroke survivors in movement from when capable in hospital, following through to home. Implications for rehabilitation Stroke survivor sedentary behaviour is influenced, directly and indirectly, by the actions and instructions of stroke service staff in the inpatient and community setting. The built and social environment, both in the inpatient and community settings, may limit opportunities for safe movement and can result in stroke survivors spending more time sedentary. Stroke service staff appreciate the benefit of encouraging stroke survivors to stand and move more, if it is safe for them to do so. Staff would be amenable to encourage stroke survivors to reduce sedentary behaviour, provided they have the knowledge and resources to equip them to support this

A co-production approach guided by the behaviour change wheel to develop an intervention for reducing sedentary behaviour after stroke

Background Stroke survivors are highly sedentary; thus, breaking up long uninterrupted bouts of sedentary behaviour could have substantial health benefit. However, there are no intervention strategies specifically aimed at reducing sedentary behaviour tailored for stroke survivors. The purpose of this study was to use co-production approaches to develop an intervention to reduce sedentary behaviour after stroke. Methods A series of five co-production workshops with stroke survivors, their caregivers, stroke service staff, exercise professionals, and researchers were conducted in parallel in two-stroke services (England and Scotland). Workshop format was informed by the behaviour change wheel (BCW) framework for developing interventions and incorporated systematic review and empirical evidence. Taking an iterative approach, data from activities and audio recordings were analysed following each workshop and findings used to inform subsequent workshops, to inform both the activities of the next workshop and ongoing intervention development. Findings Co-production workshop participants (n = 43) included 17 staff, 14 stroke survivors, six caregivers and six researchers. The target behaviour for stroke survivors is to increase standing and moving, and the target behaviour for caregivers and staff is to support and encourage stroke survivors to increase standing and moving. The developed intervention is primarily based on co-produced solutions to barriers to achieving the target behaviour. The developed intervention includes 34 behaviour change techniques. The intervention is to be delivered through stroke services, commencing in the inpatient setting and following through discharge into the community. Participants reported that taking part in intervention development was a positive experience. Conclusions To our knowledge, this is the first study that has combined the use of co-production and the BCW to develop an intervention for use in stroke care. In-depth reporting of how a co-production approach was combined with the BCW framework, including the design of bespoke materials for workshop activities, should prove useful to other researchers and practitioners involved in intervention development in stroke