Constructing spaces of authentic engagement through embodied practice: an exploration of deaf peoples’ and nurses’ experiences of interacting

Background: British Sign Language (BSL) is the visual-spatial language of deaf people in Scotland. For deaf, BSL users all contact with the NHS takes place in a hearing led context where spoken English is the primary mode of communication. Healthcare can therefore be challenging for deaf people to access and engage in. The implicit assumptions of the biomedical perspective, that views deafness as an illness to be ‘cured’, often underpin and shape healthcare practices. In this context, there is a lack of acknowledgement of deaf peoples’ linguistic and cultural status. There has been recognition in healthcare literature that access to healthcare is problematic for deaf people. However, the majority of this literature is informed by the biomedical perspective, privileging positivist approaches to treating deaf people. This has resulted in knowledge that does acknowledge the social world in which deaf peoples’ experiences of healthcare take place. Conceptualising healthcare as a form of social relationship, this research explored nurses’ and deaf peoples’ experiences of interacting with one another. Approach and methods: This research is situated in the critical creative paradigm and underpinned by Gadamer’s hermeneutics and Merleau-Ponty’s philosophy of embodiment. The hermeneutic perspective enabled exploration of participants’ relational and contextual experiences of interacting, and creative methods enabled access to the participants’ and researcher’s embodied knowledge of these experiences. Semi-structured interviews with deaf, BSL users and nurses who had provided care for a deaf person were undertaken over a period of 10 months. A focus group of BSL/English interpreters was also carried out. Findings: The findings revealed that nurses often articulated and embodied predominantly biomedical understandings of what it means to be deaf. Approaching care from this perspective, nurses often struggled to acknowledge or respond to deaf peoples’ visual-spatial ways of being and knowing. Healthcare environments were therefore frequently experienced by deaf people as hearing spaces in which they were systematically disempowered due to the oppression of their visual-spatial nature and language. This created divisive boundaries between deaf people and nurses that limited the potential for an effective nursing relationship to develop. Nurses who displayed qualities of openness and curiosity developed alternative ways of thinking about deafness. These had the potential to transform their approaches to practice that enabled collaborative relationships to develop. Conclusions and implications: This research has demonstrated that healthcare spaces are relational and therefore constructed by the social actions of the people in them. For nurses to construct spaces that are respectful of and embodied deaf culture, the significance of the whole body in developing relational practice must be recognised. Such understanding and knowledge could enable nurses to approach practice with an awareness of how both their own and deaf peoples’ embodied experiences can inform care. This necessitates reflexivity in which nurses recognise and question the assumptions that underpin their practice. Recognising the significance of deaf peoples’ visual-spatial experience and embodied understanding of the world has the potential to contribute to emancipatory and empowering approaches to caring for deaf people. Keywords: deaf, British Sign Language, embodiment, embodied practice, creative hermeneutic

CONVICTION CELERITY, PUNISHMENT SEVERITY, AND TREATMENT COMPLIANCE AS PREDICTORS OF DUI RECIDIVISM: MEDIATION AND MODERATION MODELS OF DETERRENCE

Driving under the influence (DUI) is one of the most frequently committed offenses in the United States and approximately one-third of DUI offenders are recidivists. Researchers have evaluated multiple DUI prevention approaches, most of which have been rooted in deterrence theory. Recently, the criminal justice system has moved away from deterrence-based approaches and begun employing various forms of rehabilitation to reduce DUI recidivism. This shift in the criminal justice system has lead researchers to begin exploring the effects of rehabilitation on DUI offenders, including an examination of offender compliance with rehabilitation programs. Although each of these areas has been investigated separately, existing studies have not incorporated deterrence-related measures, rehabilitation compliance, and offender recidivism into a single model. Utilizing a statewide sample of Kentucky DUI offenders, the primary goal of this dissertation was to examine whether rehabilitation compliance mediates the relationship between deterrence-related variables (conviction celerity and punishment severity) and DUI offender recidivism. Second, because existing studies have produced inconclusive or mixed results regarding deterrence among DUI offenders, analyses were conducted to examine the potential moderating effects of age, gender, substance use problem severity, and location on the relationship between deterrence-related variables and DUI recidivism. Overall, the hypothesized mediation models were unsupported. There was no direct correlation between the deterrence-related variables and DUI recidivism. In addition, while there was some evidence of moderation, the hypothesized moderation models were also largely unsupported. Despite these results, compliance was significantly related to DUI recidivism in all four models, and there was evidence of relationships between both compliance and DUI recidivism with age, gender, problem severity, and location. Findings highlight the importance of compliance and social and environmental variables in predicting DUI recidivism, suggesting that these variables may be more accurate predictors of DUI recidivism than deterrence-based variables. Results demonstrate a need for the criminal justice system to place more emphasis on offenders’ treatment needs, treatment accessibility, and retention of DUI offenders in rehabilitation programs in order to decrease DUI recidivism

A Comparison of Appalachian and Non-Appalachian Kentucky DUI Offenders

Background: Driving under the influence has been an overlooked consequence of the opioid epidemic. Although recent reports have highlighted the increased prevalence of DUI in rural communities and the extensive mental health problems and criminal and drug use histories among rural Appalachian DUI offenders, it is unclear how Appalachian DUI populations compare to DUI offenders in other regions. Purpose: To help fill this void in the literature, the current study uses a statewide sample to examine how Appalachian DUI offenders differ from non-Appalachian DUI offenders in a predominantly rural state. Methods: Assessment records were examined for 11,640 Kentucky DUI offenders who completed an intervention in 2017. Appalachian DUI offenders were compared to non-Appalachian metro and nonmetro DUI offenders. Demographic information, DUI violation details, DSM-5 substance-use disorder criteria, and referral information were compared using ANCOVAs and logistic regression models. Results: More than one fourth of the sample were convicted in an Appalachian county. Compared to non-Appalachian DUI offenders, Appalachian offenders were significantly older and more likely to have a prior DUI conviction, to meet DSM-5 criteria for a drug-use disorder, and to drive while drug-impaired. Referral and intervention compliance also varied across groups. Implications: Results suggest that Appalachian DUI offenders are more drug-involved and have increased risk of recidivism. Findings indicate a need for practitioners to consider the distinct needs of Appalachian DUI offenders during service delivery. Future research should explore alternative intervention methods for preventing continued impaired driving in Appalachia given limited treatment availability in the region

An approach to light-frame disaster relief housing

An Approach to Light-Frame Disaster Relief Housing investigated the use of bamboo structures to provide safe, affordable and easily constructible housing in developing countries that are prone to natural disasters. The team chose to use the Cagayan Valley Region in Northern Philippines that has a demonstrated need for relief housing due to its susceptibility to high seismic activity, monsoons, and floods. The proposed solution includes a complete structural and geotechnical foundation design of a house that can resist the demand loads determined for the region. The structural system is designed using bamboo and includes a lateral force resisting system, and gravity force resisting system, and roof and floor diaphragms. The structural system ties into the foundation, which was designed to withstand flood loads and provide a proper load path from the structural system to the ground

Retailer Involvement in Sustainability and Demand for Sustainable Apparel and Textiles from South Africa

South Africa\u27s textile and apparel industries are struggling to rebuild after a period of weak investment during Apartheid and increasing competition from imports. One outcome was vertical disintegration where suppliers that had previously operated plants handling spinning through made-ups, dropped some operations. A recent investment of South Africa\u27s Clothing & Textile Competitiveness Programme was a Sustainable Cotton Cluster (SCC) that aims to reintegrate a supply chain that includes all nodes of the chain from cotton farmers through retail. The purpose of this research was to understand the extent of retailer involvement in sustainability and their demand for sustainable apparel and textile products from South Africa. Comparative case study research included four retailers that operate stores in South Africa. The Sustainable Apparel Coalition\u27s Higg 2.0 Brand Modules (environment and social/labor) were used as a foundational framework. These modules measure sustainability performance based on a company\u27s efforts on environmental and social/labor challenges

Text Data Mining Beyond the Open Data Paradigm: Perspectives at the Intersection of Intellectual Property and Ethics

This poster highlights outcomes from an IMLS-funded National Forum project on text data mining with content that is subject to use conditions due to intellectual property rights. It argues that developing strong frameworks for conducting text mining with IP-limited data is an urgent priority for supporting responsible, sustainable research in the twenty-first century.Institute for Museum and Library Services (LG-73-17-0070-17)Ope

Rural Re-entry and Opioid Use: Identifying Health-Related Predictors of Relapse Among Formerly Incarcerated Women in Appalachia

Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women, there exists a gap regarding the relationship between health, health care access, and relapse among rural women returning to the community during the opioid epidemic. Purpose: With an emphasis on health care access, this study examined health-related factors associated with opioid relapse among women reentering the community in rural Appalachia. Methods: As part of a larger study, 400 rural women reporting a history of substance use were recruited from three Appalachian jails in Kentucky. Analyses focused on participants reporting a history of illicit opioid use prior to incarceration, who had also completed follow-up interviews at 6- and 12-months post-release from jail. Results: Fifty-five percent of participants reported relapse to opioids during the 12-month follow-up period. Compared to those who did not use opioids during this time, women who relapsed reported poorer mental and physical health, as well as encountered more barriers to needed health services. They were also more likely to report a usual source of care. Multivariate regression analyses reveal that, even when controlling for other known correlates of opioid use and relapse to any non-opioid drug during the follow-up period, the number of barriers to health service utilization was a significant predictor of opioid relapse. Implications: Stakeholders should address the complex reentry needs of women who use opioids in rural Appalachia. This includes examining innovative approaches to reduce extensive barriers to quality health care utilization, such as implementing telehealth for opioid use treatment

Motivational Interviewing Tailored Interventions for Heart Failure (MITI-HF): Study Design and Methods

OBJECTIVE: Lack of engagement in self-care is common among patients needing to follow a complex treatment regimen, especially patients with heart failure who are affected by comorbidity, disability and side effects of poly-pharmacy. The purpose of Motivational Interviewing Tailored Interventions for Heart Failure (MITI-HF) is to test the feasibility and comparative efficacy of an MI intervention on self-care, acute heart failure physical symptoms and quality of life. METHODS: We are conducting a brief, nurse-led motivational interviewing randomized controlled trial to address behavioral and motivational issues related to heart failure self-care. Participants in the intervention group receive home and phone-based motivational interviewing sessions over 90-days and those in the control group receive care as usual. Participants in both groups receive patient education materials. The primary study outcome is change in self-care maintenance from baseline to 90-days. CONCLUSION: This article presents the study design, methods, plans for statistical analysis and descriptive characteristics of the study sample for MITI-HF. Study findings will contribute to the literature on the efficacy of motivational interviewing to promote heart failure self-care. PRACTICAL IMPLICATIONS: We anticipate that using an MI approach can help patients with heart failure focus on their internal motivation to change in a non-confrontational, patient-centered and collaborative way. It also affirms their ability to practice competent self-care relevant to their personal health goals