Addressing health literacy in patient decision aids

MethodsWe reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews.ResultsAim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies in which health literacy needs were addressed.ConclusionLower health literacy affects key decision-making outcomes, but few existing PtDAs have addressed the needs of lower health literacy users. The specific effects of PtDAs designed to mitigate the influence of low health literacy are unknown. More attention to the needs of patients with lower health literacy is indicated, to ensure that PtDAs are appropriate for lower as well as higher health literacy patients

A social-economic study of land development for farm settlement at Butler's

Commissioned by: Commissioner of Crown Lands Department of Lands and Survey, Hokitika.The primary aim of the study is to identify the likely impacts of publicly-funded programmes of land development for farm settlement on the social life and economy of small communities in the West Coast Region. As this is a preliminary, or scoping, type of analysis the investigation focuses on the identification of important issues regarding land development and settlement rather than a definitive assessment of particular impacts. Specifically, the study attempts to identify the key issues of major planning importance for the Butler's development block in Westland County. The proposed Butler's development, a 5427 hectare Lands and Survey Department block located between Ross and Hokitika, is representative of land development opportunities and related issues on the West Coast generally

What is lacking in current decision aids on cancer screening?

Recent guidelines on cancer screening have provided not only more screening options but also conflicting recommendations. Thus, patients, with their clinicians' support, must decide whether to get screened, which modality to use, and how often to undergo screening. Decision aids could potentially lead to better shared decision‐making regarding screening between the patient and the clinician. A total of 73 decision aids concerning screening for breast, cervical, colorectal, and prostate cancers were reviewed. The goal of this review was to assess the effectiveness of such decision aids, examine areas in need of more research, and determine how the decision aids can be currently applied in the real‐world setting. Most studies used sound study designs. Significant variation existed in the setting, theoretical framework, and measured outcomes. Just over one‐third of the decision aids included an explicit values clarification. Other than knowledge, little consistency was noted with regard to which patient attributes were measured as outcomes. Few studies actually measured shared decision‐making. Little information was available regarding the feasibility and outcomes of integrating decision aids into practice. In this review, the implications for future research, as well as what clinicians can do now to incorporate decision aids into their practice, are discussed. CA Cancer J Clin 2013. © 2013 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98159/1/CAAC_21180_Supp_Appendix_Tables.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/98159/2/21180_ftp.pd

Soils, Science and Community ActioN (SoilSCAN): a citizen science tool to empower community-led land management change in East Africa

Pastoralist communities worldwide face complex challenges regarding food and feed productivity. Primary production systems are under stress, nutritional choices are changing and the relationship between development and agriculture is undergoing profound transformation. Under increasing pressure from climate and land use change, East African agro-pastoral systems are approaching a tipping point in terms of land degradation. There is an urgent need for evidence-led sustainable land management interventions to reverse degradation of natural resources that support food and water security. A key barrier, however, is a lack of high spatial resolution soil health data wherein collecting such information for each individual community is beyond their means. In this context, we tested whether bridging such data gaps could be achieved through a coordinated programme at the boundary between participation and citizen science. Key outputs included a community-led trial of a hand-held soil scanner, which highlighted a range of positive benefits and practical challenges in using this technology in this context, with identification of some potential solutions; and a targeted soil organic matter and nutrient status dataset in a small catchment-based community setting. The results show that if the practical challenges can be resolved, use of portable soil scanner technology has the potential to fill key knowledge gaps and thereby improve resilience to the threat of land degradation through locally responsive farmer and community decision-making

Dual-Energy X-Ray Performs as Well as Clinical Computed Tomography for the Measurement of Visceral Fat

Visceral adipose tissue (VAT) is associated with adverse health effects including cardiovascular disease and type 2 diabetes. We developed a dual-energy X-ray absorptiometry (DXA) measurement of visceral adipose tissue (DXA-VAT) as a low cost and low radiation alternative to computed tomography (CT). DXA-VAT was compared to VAT assessed using CT by an expert reader (E-VAT). In addition, the same CT slice was also read by a clinical radiographer (C-VAT) and a best-fit anthropomorphic and demographic VAT model (A-VAT) was developed. Whole body DXA, CT at L4–L5, and anthropometry were measured on 272 black and white South African women (age 29 ± 8 years, BMI 28 ± 7 kg/m2, waist circumference (WC) 89 ± 16 cm). Approximately one-half of the dataset (n = 141) was randomly selected and used as a training set for the development of DXA-VAT and A-VAT, which were then used to estimate VAT on the remaining 131 women in a blinded fashion. DXA-VAT (r = 0.93, standard error of the estimate (SEE) = 16 cm2) and C-VAT (r = 0.93, SEE = 16 cm2) were strongly correlated to E-VAT. These correlations with E-VAT were significantly stronger (P < 0.001) than the correlations of individual anthropometry measurements and the A-VAT model (WC + age, r = 0.79, SEE = 27 cm2). The inclusion of anthropometric and demographic measurements did not substantially improve the correlation between DXA-VAT and E-VAT. DXA-VAT performed as well as a clinical read of VAT from a CT scan and better than anthropomorphic and demographic models

Atmospheric sampling of Supertyphoon Mireille with NASA DC-8 aircraft on September 27,1991, during PEM-West A

The DC-8 mission of September 27, 1991, was designed to sample air flowing into Typhoon Mireille in the boundary layer, air in the upper tropospheric eye region, and air emerging from the typhoon and ahead of the system, also in the upper troposphere. The objective was to find how a typhoon redistributes trace constituents in the West Pacific region and whether any such redistribution is important on the global scale. The boundary layer air (300 m), in a region to the SE of the eye, contained low mixing ratios of the tracer species O3, CO, C2H6, C2H2, C3H8, C6H6and CS2 but high values of dimethylsulfide (DMS). The eye region relative to the boundary layer, showed somewhat elevated levels of CO, substantially increased levels of O3, CS2 and all nonmethane hydrocarbons (NMHCs), and somewhat reduced levels of DMS. Ahead of the eye, CO and the NMHCs remained unchanged, O3 and CS2 showed a modest decrease, and DMS showed a substantial decrease. There was no evidence from lidar cross sections of ozone for the downward entrainment of stratospheric air into the eye region; these sections show that low ozone values were measured in the troposphere. The DMS data suggest substantial entrainment of boundary layer air into the system, particularly into the eye wall region. Estimates of the DMS sulphur flux between the boundary layer and the free troposphere, based on computations of velocity potential and divergent winds, gave values of about 69 μg S m−2 d−1 averaged over a 17.5° grid square encompassing the typhoon. A few hours after sampling with the DC-8, Mireille passed over Oki Island, just to the north of Japan, producing surface values of ozone of 5.5 ppbv. These O3 levels are consistent with the low tropospheric values found by lidar and are more typical of equatorial regions. We suggest that the central eye region may act like a Taylor column which has moved poleward from low latitudes. The high-altitude photochemical environment within Typhoon Mireille was found to be quite active as evidenced by significant levels of measured gas phase H2O2 and CH3OOH and model-computed levels of OH

Advancing Alternative Analysis: Integration of Decision Science.

Decision analysis-a systematic approach to solving complex problems-offers tools and frameworks to support decision making that are increasingly being applied to environmental challenges. Alternatives analysis is a method used in regulation and product design to identify, compare, and evaluate the safety and viability of potential substitutes for hazardous chemicals.Assess whether decision science may assist the alternatives analysis decision maker in comparing alternatives across a range of metrics.A workshop was convened that included representatives from government, academia, business, and civil society and included experts in toxicology, decision science, alternatives assessment, engineering, and law and policy. Participants were divided into two groups and prompted with targeted questions. Throughout the workshop, the groups periodically came together in plenary sessions to reflect on other groups' findings.We conclude the further incorporation of decision science into alternatives analysis would advance the ability of companies and regulators to select alternatives to harmful ingredients, and would also advance the science of decision analysis.We advance four recommendations: (1) engaging the systematic development and evaluation of decision approaches and tools; (2) using case studies to advance the integration of decision analysis into alternatives analysis; (3) supporting transdisciplinary research; and (4) supporting education and outreach efforts

“We will change whether we want it or not”: Soil erosion in Maasai land as a social dilemma and a challenge to community resilience

This is the final version. Available on open access from Elsevier via the DOI in this recordSoil erosion is a major environmental challenge that undermines economic development in many regions of the world. While much previous work explored physical processes behind this problem, less attention has been paid to social, cultural, and psychological parameters that make a significant impact on soil erosion through the land use practices that they support. The present paper addresses this gap by conducting a qualitative exploration of agro-pastoralist stakeholders’ experiences of soil erosion in northern Tanzania, using the community resilience framework and the social dilemmas approach as theoretical lenses. Interview data suggests that the factors that make communities vulnerable to soil erosion challenges include the centrality of cattle keeping practice to pastoralists’ cultural identity, lack of social cohesion, lack of alternative livelihood opportunities, and weak governance structures. We argue that the ways towards resolving the dilemma lie in addressing relevant cultural norms, building cohesive and open communities, and strengthening local governance.Natural Environment Research Council (NERC)British Academ

Belonging to a different landscape: repurposing nationalist affects

This is an article about the embodied, sensual experience of rural landscape as a site where racialized feelings of national belonging get produced. Largely impervious to criticism and reformation by 'thin' legal-political versions of multicultural or cosmopolitan citizenship, it is my suggestion that this racialized belonging is best confronted through the recognition and appreciation of precisely what makes it so compelling. Through an engagement with the theorization of affect in the work of Divya Praful Tolia-Kelly, I consider the resources immanent to the perception of landscapes of national belonging that might be repurposed to unravel that belonging from within. I suggest that forms of environmental consciousness can unpick the mutually reinforcing relationships between nature and nation, opening up opportunities for thinking identity and belonging in different ways, and allowing rural landscapes to become more hospitable places

Learning to Teach About Ideas and Evidence in Science : The Student Teacher as Change Agent

A collaborative curriculum development project was set up to address the lack of good examples of teaching about ideas and evidence and the nature of science encountered by student teachers training to teach in the age range 11-16 in schools in England. Student and teacher-mentor pairs devised, taught and evaluated novel lessons and approaches. The project design required increasing levels of critique through cycles of teaching, evaluation and revision of lessons. Data were gathered from interviews and students' reports to assess the impact of the project on student teachers and to what extent any influences survived when they gained their first teaching posts. A significant outcome was the perception of teaching shifting from the delivery of standard lessons in prescribed ways to endeavours demanding creativity and decision-making. Although school-based factors limited newly qualified teachers' chances to use new lessons and approaches and therefore act as change-agents in schools, the ability to critique curriculum materials and the recognition of the need to create space for professional dialogue were durable gains