"Bend a Little to Move it Forward": Pro-Social Rule Breaking in Public Health Practice

Background: Pro-social rule breaking (PSRB) is when an employee chooses to break an organization's rules in order to meet organizational goals, or to help others. It is relatively new area of study; there are no studies conducted on public health administration. This exploratory study examines why and how mid-level public health practitioners make decisions to engage in, and what and how organizations can learn from this practice. Methods: This qualitative study used a purposive sampling strategy to recruit 12 participants from among state directors and managers of programs funded by CDC's Division of Cancer Prevention and Control. Data was collected through semi-structured interviews conducted from March to May 2013. Results: Participants averaged 16 years of experience and worked under an average of five sets of rules. Seventy-five percent worked on more than one program. Over 80% participants reported engaging in PSRB. Instances of PSRB were mostly likely to be in response to state and organizational level rules. Key themes include: participants believe they are breaking the rules to meet programmatic goals and help the public; the need to meet multiple sets of expectations causes high levels of frustration; participants generally see positive outcomes from PSRB; they sometimes break the rules because they cannot figure out any other way to get their work done and meet goals; and making the rules clearer and more flexible will make them easier and more likely to be followed. Participants suggested examining the unintended costs of rules; relationship-building across offices, and establishing productive dialogue as ways of reducing the incidence of PSRB and improve organizational functioning. Conclusions: PRSB appears to be a positive way of responding to difficult and sometimes absurd situations. Participants displayed good leadership and management skills in response to organizational barriers. The organizational climate--rules, flexibility, degree of centralization, levels of approval--acts as mediator for participants' decisions to engage in PRSB, and changes to the organization climate may decrease PSRB and improve functioning and results.Doctor of Public Healt

Socioeconomic status and modification of atherosclerotic cardiovascular disease risk prediction: Epidemiological analysis using data from the Atherosclerosis Risk In Communities study

OBJECTIVE: Examine whether the relationship between the pooled cohort equations (PCE) predicted 10-year risk for atherosclerotic cardiovascular disease (ASCVD) and absolute risk for ASCVD is modified by socioeconomic status (SES). DESIGN: Population-based longitudinal cohort study-Atherosclerosis Risk in Communities (ARIC)-investigating the development of cardiovascular disease across demographic subgroups. SETTING: Four communities in the USA-Forsyth County, North Carolina, Jackson, Mississippi, suburbs of Minneapolis, Minnesota and Washington County, Maryland. PARTICIPANTS: We identified 9782 ARIC men and women aged 54-73 without ASCVD at study visit 4 (1996-1998). PRIMARY OUTCOME MEASURES: Risk ratio (RR) differences in 10-year incident hospitalisations or death for ASCVD by SES and PCE predicted 10-year ASCVD risk categories to assess for risk modification. SES measures included educational attainment and census-tract neighbourhood deprivation using the Area Deprivation Index. PCE risk categories were 0%-5%, \u3e5%-10%, \u3e10%-15% and \u3e15%. SES as a prognostic factor to estimate ASCVD absolute risk categories was further investigated as an interaction term with the PCE. RESULTS: ASCVD RRs for participants without a high school education (referent college educated) increased at higher PCE estimated risk categories and was consistently \u3e1. Results indicate education is both a risk modifier and delineates populations at higher ASCVD risk independent of PCE. Neighbourhood deprivation did modify association but was less consistent in direction of effect. However, for participants residing in the most deprived neighbourhoods (referent least deprived neighbourhoods) with a PCE estimated risk \u3e10%-15%, risk was significantly elevated (RR 1.65, 95% CI 1.05 to 2.59). Education and neighbourhood deprivation inclusion as an interaction term on the PCE risk score was statistically significant (likelihood ratio p≤0.0001). CONCLUSIONS: SES modifies the association between PCE estimated risk and absolute risk of ASCVD. SES added into ASCVD risk prediction models as an interaction term may improve our ability to predict absolute ASCVD risk among socially disadvantaged populations

The impact of autotrophic versus heterotrophic nutritional pathways on colony health and wound recovery in corals

For animals that harbor photosynthetic symbionts within their tissues, such as corals, the different relative contributions of autotrophy versus heterotrophy to organismal energetic requirements have direct impacts on fitness. This is especially true for facultatively symbiotic corals, where the balance between host‐caught and symbiont‐produced energy can be altered substantially to meet the variable demands of a shifting environment. In this study, we utilized a temperate coral–algal system (the northern star coral, Astrangia poculata, and its photosynthetic endosymbiont, Symbiodinium psygmophilum) to explore the impacts of nutritional sourcing on the host's health and ability to regenerate experimentally excised polyps. For fed and starved colonies, wound healing and total colony tissue cover were differentially impacted by heterotrophy versus autotrophy. There was an additive impact of positive nutritional and symbiotic states on a coral's ability to initiate healing, but a greater influence of symbiont state on the recovery of lost tissue at the lesion site and complete polyp regeneration. On the other hand, regardless of symbiont state, fed corals maintained a higher overall colony tissue cover, which also enabled more active host behavior (polyp extension) and endosymbiont behavior (photosynthetic ability of Symbiondinium). Overall, we determined that the impact of nutritional state and symbiotic state varied between biological functions, suggesting a diversity in energetic sourcing for each of these processes.PADI Foundation; Cell Signaling Technologies; Boston University Marine Program Warren McLeod Fellowship; New England Aquarium; National Science Foundation, Grant/Award Number: IOS-1354935 (PADI Foundation; Cell Signaling Technologies; Boston University Marine Program Warren McLeod Fellowship; New England Aquarium; IOS-1354935 - National Science Foundation)Published versio

The impact of autotrophic versus heterotrophic nutritional pathways on colony health and wound recovery in corals

For animals that harbor photosynthetic symbionts within their tissues, such as corals, the different relative contributions of autotrophy versus heterotrophy to organismal energetic requirements have direct impacts on fitness. This is especially true for facultatively symbiotic corals, where the balance between host‐caught and symbiont‐produced energy can be altered substantially to meet the variable demands of a shifting environment. In this study, we utilized a temperate coral–algal system (the northern star coral, Astrangia poculata, and its photosynthetic endosymbiont, Symbiodinium psygmophilum) to explore the impacts of nutritional sourcing on the host's health and ability to regenerate experimentally excised polyps. For fed and starved colonies, wound healing and total colony tissue cover were differentially impacted by heterotrophy versus autotrophy. There was an additive impact of positive nutritional and symbiotic states on a coral's ability to initiate healing, but a greater influence of symbiont state on the recovery of lost tissue at the lesion site and complete polyp regeneration. On the other hand, regardless of symbiont state, fed corals maintained a higher overall colony tissue cover, which also enabled more active host behavior (polyp extension) and endosymbiont behavior (photosynthetic ability of Symbiondinium). Overall, we determined that the impact of nutritional state and symbiotic state varied between biological functions, suggesting a diversity in energetic sourcing for each of these processes.PADI Foundation; Cell Signaling Technologies; Boston University Marine Program Warren McLeod Fellowship; New England Aquarium; National Science Foundation, Grant/Award Number: IOS-1354935 (PADI Foundation; Cell Signaling Technologies; Boston University Marine Program Warren McLeod Fellowship; New England Aquarium; IOS-1354935 - National Science Foundation)Published versio

Calibrating and adjusting expectations in life: A grounded theory on how elderly persons with somatic health problems maintain control and balance in life and optimize well-being

Aim: This study aims at exploring the main concern for elderly individuals with somatic health problems and what they do to manage this. Method: In total, 14 individuals (mean = 74.2 years; range = 68–86 years) of both gender including hospitalized and outpatient persons participated in the study. Open interviews were conducted and analyzed according to grounded theory, an inductive theory-generating method. Results: The main concern for the elderly individuals with somatic health problems was identified as their striving to maintain control and balance in life. The analysis ended up in a substantive theory explaining how elderly individuals with somatic disease were calibrating and adjusting their expectations in life in order to adapt to their reduced energy level, health problems, and aging. By adjusting the expectations to their actual abilities, the elderly can maintain a sense of that they still have the control over their lives and create stability. The ongoing adjustment process is facilitated by different strategies and result despite lower expectations in subjective well-being. The facilitating strategies are utilizing the network of important others, enjoying cultural heritage, being occupied with interests, having a mission to fulfill, improving the situation by limiting boundaries and, finally, creating meaning in everyday life. Conclusion: The main concern of the elderly with somatic health problems was to maintain control and balance in life. The emerging theory explains how elderly people with somatic health problems calibrate their expectations of life in order to adjust to reduced energy, health problems, and aging. This process is facilitated by different strategies and result despite lower expectation in subjective well-being

The Social Impacts of Condominium Conversion in the Vieux Carré Neighborhood, New Orleans, La

In order to better understand the effects of condominium conversions, this study explores the nature and extent of the conversion trend, and its social impacts on the Vieux Carré neighborhood. The increasing number of conversions in the Vieux Carré, also known as the French Quarter, has been the focus of recent controversy and has been perceived by many residents as a threat to the viability of the historic district as a neighborhood. Long-term Vieux Carré residents and neighborhood organizations have expressed fears that the converted rental units are being used as short-term rentals to tourists or second homes, which may be contributing to the decline of the neighborhood\u27s residential base. As a framework for understanding the social impacts of condominium conversions in the Vieux Carré neighborhood, this study includes a review of the literature on neighborhood change, neighborhood health, and neighborhood attachment. Since the issue of condominiums is intertwined with the ongoing research on tourism in this historic district, a review of the literature on condominium conversion, tourism impacts and the Vieux Carré also is included. In addition, this study contains the results of a mail survey of occupants of converted condominium units in the Vieux Carré. While survey respondents report formal and informal participation in the neighborhood, only half of the occupants (53%) of the converted units consider the Vieux Carré as their primary residence or are registered to vote in New Orleans. Although many condominium residents do exhibit a sense of neighborhood attachment, half are not present in the neighborhood on a full-time basis; therefore, they have limited opportunities to participate politically on behalf of the neighborhood. The findings of the survey suggest the social impacts of the condominium conversion in the Vieux Carré are likely to contribute to the decline of the neighborhood

The Social Impacts of Condominium Conversion in the Vieux Carré Neighborhood, New Orleans, La

In order to better understand the effects of condominium conversions, this study explores the nature and extent of the conversion trend, and its social impacts on the Vieux Carré neighborhood. The increasing number of conversions in the Vieux Carré, also known as the French Quarter, has been the focus of recent controversy and has been perceived by many residents as a threat to the viability of the historic district as a neighborhood. Long-term Vieux Carré residents and neighborhood organizations have expressed fears that the converted rental units are being used as short-term rentals to tourists or second homes, which may be contributing to the decline of the neighborhood\u27s residential base. As a framework for understanding the social impacts of condominium conversions in the Vieux Carré neighborhood, this study includes a review of the literature on neighborhood change, neighborhood health, and neighborhood attachment. Since the issue of condominiums is intertwined with the ongoing research on tourism in this historic district, a review of the literature on condominium conversion, tourism impacts and the Vieux Carré also is included. In addition, this study contains the results of a mail survey of occupants of converted condominium units in the Vieux Carré. While survey respondents report formal and informal participation in the neighborhood, only half of the occupants (53%) of the converted units consider the Vieux Carré as their primary residence or are registered to vote in New Orleans. Although many condominium residents do exhibit a sense of neighborhood attachment, half are not present in the neighborhood on a full-time basis; therefore, they have limited opportunities to participate politically on behalf of the neighborhood. The findings of the survey suggest the social impacts of the condominium conversion in the Vieux Carré are likely to contribute to the decline of the neighborhood

Burmester2018_PolypExtension

Polyp Extension Scores for symbiotic and aposymbiotic colonies of A. poculata across time under fed and starved conditions (.xlsx file