Evaluation of a Comprehensive, Long Term Home Care Program for Chronically Impaired Elderly

This dissertation reports the findings of an evaluation of the Five Hospital Homebound Elderly Program in Chicago. The Program is a model long term home care demonstration project which is community-based and provides a unique combination of medical and social supportive services to chronically impaired homebound elderly. The Program differs from most Medicare certified and reimbursed programs and is a potential model for expanded benefit programs now being considered in Congress. The evaluation of the Program encompassed both impact and process issues, utilizing a pre/post test quasi-experimental design with a non-equivalent control group. Within this design, the comprehensive functional status of 122 consecutively admitted Five Hospital clients and of 123 controls was assessed at time of acceptance to service and nine months later, using the Duke/OARS Multidimensional Functional Assessment Questionnaire. The control group consisted of recipients of OAA Title III home-delivered meals who live in an area that is geographically contiguous to the Five Hospital Program's catchment area and who were similarly elderly and impaired. Rates of hospitalization, institutionalization and mortality were also obtained in addition to rates of home care services utilization for both groups. Analysis of pretest data, which was obtained on 75% of newly accepted FHHEP clients and 74% of control group clients, revealed that, overall, the two groups were remarkably similar on measured variables with the exception of. the fact that Five Hospital clients were significantly older (x̄ age 80.4) and more impaired in Instrumental Activities of Daily Living than controls but also enjoyed better social supports. These differences were of interest because advanced age, poor ADL and poor social supports are variables which have been reported to be associated with admission to long term care institutions in the literature. At post test, functional status data were obtained on 83% of experimentals and 81% of controls, with mortality being the major cause of attrition in both groups (12% and 11%, respectively). Major findings derived from the analysis of outcome measures revealed no difference between the two groups with respect to mortality rates. However, bivariate analysis revealed interesting differences between the two groups with respect to the characteristics of subjects who died. Variables which appeared to be similarly and differentially associated with increased incidence of mortality in the two groups were therefore identified and discussed. However, the number of subjects who experienced this outcome in both groups was too small to permit any conclusions to be drawn. The fact that mortality rates were almost identical for the two groups, given the greater age and ADL impairment of experimental subjects at pretest, is interpreted as suggestive of a possible beneficial effect of treatment which might warrant follow-up in a study with a larger sample size. Effects of treatment on functional status included a trend towards perception of improved social supports. mental health and physical health, as well as a significant decrease in unmet needs among experimental subjects (p < .05). Somewhat paradoxically, these beneficial changes were accompanied by a significant (p < .01) deterioration in Physical Activities of Daily Living. It is suggested that this change in PADL status may be confounded with the reception of the treatment which consisted of regular assistance with ADL tasks. Comparison of pre and post test hospitalization rates revealed no differences between the two groups, with the exception of the fact that fewer Five Hospital subjects were repeat users at pre and post test. A highly significant difference was observed in the rates of institutionalization for the two groups with experimental subjects experiencing this outcome less frequently than controls (p < .01). Multivariate analysis which attempted to control for selection differences and other explanatory variables failed to degrade this effect which remained significant. Furthermore. when the above outcome measures were analyzed according to level of treatment received, the same relationships described above were observed. The above findings were interpreted to indicate that, overall, the Program had beneficial effects on its clientele and that this model of long term care services has important implications for the development of national long term care policy

Building employability into a traditional curriculum: partnerships and frameworks to help transform distance education curricula in Myanmar

Higher participation rates in higher education support the social and economic development of countries. Distance education is an effective way of increasing the participation rate quickly rather than building more universities. But at the same time the curricula and qualifications being offered need to be aligned with the social and economic needs of the country so that graduates can be productive workers and responsible citizens. This paper reports on part of a large scale international development project (Transformation through Innovation in Distance Education or TIDE ) working with over 30 Myanmar universities involved in the country’s unique distance education provision. This distance education provision account for 60% of all higher education students in Myanmar but is based on traditional knowledge focused curricula that is not being taught using modern pedagogies and educational technologies. Working in the context of the Sustainable Development Goals this project is focused not only on enhancing online and distance education practices per se but also on enhancing the teaching of Environment and Sustainable Development in the curriculum. In trying to support the transformation of curriculum and teaching models the project is both providing a professional development programme for university staff on both areas but is also engaging with employers and other organizations with interests in the capabilities of graduates. Through this latter engagement we are trying to help develop both a generic graduate skills framework and also the expected graduate competencies needed by someone wishing to undertake Environmental Impact Assessments in Myanmar. These frameworks will hopefully help guide universities as they reform their curricula and introduce more teaching of practical and professional skills and behaviours for students taking these new qualifications

Peru's ancient water systems can help protect communities from shortages caused by climate change

Water is essential for human life, but in many parts of the world water supplies are under threat from more extreme, less predictable weather conditions due to climate change. Nowhere is this clearer than in the Peruvian Andes, where rising temperatures and receding glaciers forewarn of imminent water scarcity for the communities that live there.Throwing money and resources into engineering projects does not always guarantee success when trying to combat the effects of climate change and protect vulnerable communities. But the marriage of ancient and modern technologies offers promising solutions to the threat of water scarcity in Peru, and places like it all across the world.Fil: Conlon, Susan. University of Bristol; Reino UnidoFil: Lane, Kevin John. Universidad de Buenos Aires. Facultad de Filosofía y Letras. Instituto de Arqueología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

The divorce experience and its impact on the father-child relationship

This project began with the notion that an in-depth examination of perceived changes in the parent-child relationship as reported by the noncustodial father would be both beneficial to mental health professionals as well as to paraprofessional groups and organizations working with divorced fathers. The authors were aware of much related research pertaining to the children of divorced parents and also the plight of divorced mothers, but felt there to be a lack of data concerning the noncustodial father and thus identified this area as an important mental health concern

Farmers' understandings of genetically modified crops within local communities

Background Much of the debate around the science and technology of genetically modified (GM) crops has focussed on the policies and practices of national governments and international organisations or on the acceptability of GM products with consumers. Little work had been done with the primary users of such technologies – farmers. Further, the management of knowledge has become a significant issue for all sectors of the economy and yet little attention had again been given to farmers as a particular societal group of small to medium sized enterprises subject to ‘knowledge-based’ influences from many other societal groups. Aims and objectives This project investigated the attitudes, intentions and practices of farmers regarding the new technology of GM crops (both those with experience of them and those without) in relation to their social setting. The relationship building research approach we developed had three phases that used three different, and progressively more interactive, discussion and mapping techniques to engage with (often the same) participants. Telephone and face-to-face interviews with farmers, and a workshop with farmers and others involved in agriculture, helped: 1. Explore how farmers construct their understandings of GM crops through their interactions with others, in particular family members, neighbouring farmers, seed companies, farming advisors and the local community. 2. Ascertain the acceptability to farmers of recommended management practices for GM crops used in the Government sponsored Farm Scale Evaluations (FSEs). 3. Develop models of social learning systems appropriate to support individual farmers within informal social settings who decide to adopt contentious new technologies such as GM crops. Key findings Farmers’ understandings of GM crops as a new technology: Farmers view GM crops as a technology derived from new practices in plant breeding that build upon previous technologies and contribute to the running of the whole farm business. They are responding to them much as they would to any new technology, as a technology that provides improvements that are assessed for their value in practice by experimentation in the individual farm context. Farmers who had been involved in the FSEs, and those who had not, believed that GM crops offer clear economic and environmental benefits to themselves and the wider public. New technologies, such as GM crops are attractive to farmers as a way of reconciling conflicting demands to deliver high quality products at low cost and also to farm in an environmentally responsible way. Farmers’ acceptance of recommended management practices: The farmers involved in the FSEs had no problems following the recommended management practices and several could see ways in which to modify them to create benefits to themselves and to others if GM crops were licensed in the UK, in particular by using lower rates of herbicide. Farmers’ social learning systems and links to their communities: Farmers’ learning is dominated by informal learning, beyond any initial formal training, and this occurs through experimenting and the use of tacit knowledge arising from using new technologies in practice on their own farm. They also actively engage with other farmers (their network of practice) and many organisations that impact on their work (their community of influencers). That is, they draw on and exchange knowledge and experience from the range of people in their social environment. Farmers’ network of practice is widely distributed rather than being local while their community of influencers is complex, but relatively stable and consistent over time, and largely not local, although the degree of influence of individual members of the community may change. Some influence over practice is one-way (e.g. regulations that impose restrictions on what can be done) while some influences result from two-way negotiation (e.g. with agricultural advisers on agronomic matters). Key individuals within organisations in their community of influencers are often important, rather than simply the organisations themselves. Most farmers have to act individually at the boundary between their network of practice and community of influencers in order to find and exchange information and knowledge. For example, with the decline in public funding for the former Agricultural Development and Advisory Service (ADAS) there is a lack of official people working at the boundary between farmers’ network of practice and other key communities of practice within a farmer’s community of influencers. Similarly, there is a less effective connection between both the scientific research occurring in the agricultural science community of practice and agricultural policy development occurring in government departments and agencies, with the day-to-day agricultural practices and long term plans of farmers. The value of our research approach: Farmers appreciated the use of a more participatory approach that sought the inclusion of their views, as users, into the broader conversations about new technologies. They also valued the interactive, relationship-building nature of the research approach. Dissemination of findings An integral part of the project has been the sharing of the outcomes of each phase of the study with the participants and with key stakeholders in the agricultural sector. A project website, project reports, conference papers, journal articles and an executive summary document are being used to disseminate the findings to different audiences. Implications for policy and practice Based on our findings there is a need for: • An enabling environment that is responsive to farmers’ needs, with clear, consistent and long-term policy signals about the future of agriculture, to allow them time to adapt to changing demands. • Improved connections between farmers and consumers. • Greater awareness amongst policy makers, regulators, scientists and the supermarkets, of what farmers can and cannot do. • Independent, trustworthy, sources of research and advice for farmers. • The valuing of farmers’ informal learning from experience, for example in the shaping of agricultural research. The following features are among those that would most improve the systems of support available to farmers in their decisions about new technologies: • horizon-scanning on behalf of farmers, to synthesise information, look at the potential of new technologies, and develop clear long-term directions for agriculture • government-sponsored intermediaries qualified in and knowledgeable about agriculture, to improve the links between government policies, scientific research and the grassroot

Consumer Health: Public and Academic Libraries Partnering for Community Events about Mobile Health Resources

The article describes a consumer health workshop regarding mobile health apps provided as a partnership between a public and academic library

Farmers' understandings of genetically modified crops within local communities

Background Much of the debate around the science and technology of genetically modified (GM) crops has focussed on the policies and practices of national governments and international organisations or on the acceptability of GM products with consumers. Little work had been done with the primary users of such technologies – farmers. Further, the management of knowledge has become a significant issue for all sectors of the economy and yet little attention had again been given to farmers as a particular societal group of small to medium sized enterprises subject to ‘knowledge-based’ influences from many other societal groups. Aims and objectives This project investigated the attitudes, intentions and practices of farmers regarding the new technology of GM crops (both those with experience of them and those without) in relation to their social setting. The relationship building research approach we developed had three phases that used three different, and progressively more interactive, discussion and mapping techniques to engage with (often the same) participants. Telephone and face-to-face interviews with farmers, and a workshop with farmers and others involved in agriculture, helped: 1. Explore how farmers construct their understandings of GM crops through their interactions with others, in particular family members, neighbouring farmers, seed companies, farming advisors and the local community. 2. Ascertain the acceptability to farmers of recommended management practices for GM crops used in the Government sponsored Farm Scale Evaluations (FSEs). 3. Develop models of social learning systems appropriate to support individual farmers within informal social settings who decide to adopt contentious new technologies such as GM crops. Key findings Farmers’ understandings of GM crops as a new technology: Farmers view GM crops as a technology derived from new practices in plant breeding that build upon previous technologies and contribute to the running of the whole farm business. They are responding to them much as they would to any new technology, as a technology that provides improvements that are assessed for their value in practice by experimentation in the individual farm context. Farmers who had been involved in the FSEs, and those who had not, believed that GM crops offer clear economic and environmental benefits to themselves and the wider public. New technologies, such as GM crops are attractive to farmers as a way of reconciling conflicting demands to deliver high quality products at low cost and also to farm in an environmentally responsible way. Farmers’ acceptance of recommended management practices: The farmers involved in the FSEs had no problems following the recommended management practices and several could see ways in which to modify them to create benefits to themselves and to others if GM crops were licensed in the UK, in particular by using lower rates of herbicide. Farmers’ social learning systems and links to their communities: Farmers’ learning is dominated by informal learning, beyond any initial formal training, and this occurs through experimenting and the use of tacit knowledge arising from using new technologies in practice on their own farm. They also actively engage with other farmers (their network of practice) and many organisations that impact on their work (their community of influencers). That is, they draw on and exchange knowledge and experience from the range of people in their social environment. Farmers’ network of practice is widely distributed rather than being local while their community of influencers is complex, but relatively stable and consistent over time, and largely not local, although the degree of influence of individual members of the community may change. Some influence over practice is one-way (e.g. regulations that impose restrictions on what can be done) while some influences result from two-way negotiation (e.g. with agricultural advisers on agronomic matters). Key individuals within organisations in their community of influencers are often important, rather than simply the organisations themselves. Most farmers have to act individually at the boundary between their network of practice and community of influencers in order to find and exchange information and knowledge. For example, with the decline in public funding for the former Agricultural Development and Advisory Service (ADAS) there is a lack of official people working at the boundary between farmers’ network of practice and other key communities of practice within a farmer’s community of influencers. Similarly, there is a less effective connection between both the scientific research occurring in the agricultural science community of practice and agricultural policy development occurring in government departments and agencies, with the day-to-day agricultural practices and long term plans of farmers. The value of our research approach: Farmers appreciated the use of a more participatory approach that sought the inclusion of their views, as users, into the broader conversations about new technologies. They also valued the interactive, relationship-building nature of the research approach. Dissemination of findings An integral part of the project has been the sharing of the outcomes of each phase of the study with the participants and with key stakeholders in the agricultural sector. A project website, project reports, conference papers, journal articles and an executive summary document are being used to disseminate the findings to different audiences. Implications for policy and practice Based on our findings there is a need for: • An enabling environment that is responsive to farmers’ needs, with clear, consistent and long-term policy signals about the future of agriculture, to allow them time to adapt to changing demands. • Improved connections between farmers and consumers. • Greater awareness amongst policy makers, regulators, scientists and the supermarkets, of what farmers can and cannot do. • Independent, trustworthy, sources of research and advice for farmers. • The valuing of farmers’ informal learning from experience, for example in the shaping of agricultural research. The following features are among those that would most improve the systems of support available to farmers in their decisions about new technologies: • horizon-scanning on behalf of farmers, to synthesise information, look at the potential of new technologies, and develop clear long-term directions for agriculture • government-sponsored intermediaries qualified in and knowledgeable about agriculture, to improve the links between government policies, scientific research and the grassroot

‘To TA then BA’: recognising the importance of the ‘told’ life journeys of learners returning to formal education - an investigation into the impact of life experiences on learning

The told life journeys of learners returning to formal education are important to recognise in order to name the learning that occurs in the social contexts of family, community and work and, secondly, to appreciate the compelling connection between this learning and Higher Education (HE). The concept of what is viewed as important lies at the heart of this study which gives voice to the often overlooked mature, part-time student in order to recognise their assets. Despite previous research on older students in HE there is little on their brought assets, gained through past experiences. A biographical approach using semi-structured interviews based on a life-history grid allowed for the voices of the learners to be heard and their stories acknowledged. Findings indicate learning does arise from the everyday and there is a pattern to what is said about the specific intra and interpersonal attitudes and skills accrued. Past experiences are a resource for the adult learner and time spent away from the classroom is not a learning gap. The resulting affective assets are significant to academic study, enhancing and supporting the cognitive. HE needs to see the value of these assets, including motivation, resilience, independence, team work and emotional intelligence, to resurrect the social justice agenda of widening participation and lifelong learning and to seize this academic potential for the benefit of the learners and the academy alike

A Concept Paper for a VCU Social Sciences Initiative

This project proposes the development of a Social Sciences Initiative at the undergraduate and graduate levels that will provide educational, research and service opportunities for faculty and students. These opportunities are envisioned as interdisciplinary, with a focus on community issues and priorities, and with the potential to create new links among existing educational/research units within the University. The development of a Social Sciences Initiative provides a direct link to the Mission of VCU through several of the Mission’s intents: “activities that increase knowledge and understanding of the world and inspire and enrich teaching” The Social Sciences Initiative will expand current activities and promote innovative teaching in an interdisciplinary manner. “diverse educational programs” The Social Sciences Initiative increases the diversity of educational program offerings. “development of innovative approaches to meet the changing needs of our society” The Social Sciences Initiative will directly address the changing societal needs through support of interdisciplinary education, research, and service. Further, this initiative is consistent with the VCU Vision in that it will “advance a climate of scholarly inquiry…serve as a model of diversity in higher education…addressing urban issues in the nation and the world…build upon its substantial foundations in the…applied social sciences.” (VCU Strategic Plan for the Future of Virginia Commonwealth University, Phase II, 1998)