53 research outputs found
Navigating the Boundaries of Youth Violence Prevention and Reduction: Reflections on Power in Community Engaged Scholarship
Community-engaged scholars grapple with power asymmetries in community-university partnerships, generally working from the assumption that deliberate practices are required to moderate the researchersâ power vis-a-vis that of the community. In this article, we suggest that this dyadic framing masks the complexity of power dynamics within communities, of which the university is just one part, and examine how power is negotiated in the boundary zones of a partnership. We use Third Generation Cultural Historical Activity Theory (CHAT) as a conceptual framework to analyse the structural and cultural dimensions of the boundary zone in which research, learning and action in our partnership occurred (EngestroÌm 1996). A brief story sheds light on our boundary work which uses research and data to span, broker and shake institutional boundaries for the purpose of youth violence prevention and intervention. Our analysis illuminates the potential and limitations of our power to foster transformational change. It also allows us to show that underestimating power differentials and the diversity of values and cultures within an organisation and between a university and a community partner, and certainly across multiple institutions in the case of a cross-sector partnership, can slow down and even thwart work to address societal problems
Assessing Students\u27 Acquisition of Scientific Reasoning in an Experimental Psychology Class
This pilot study is an initial exploration of a theoretical rubric proposed to describe the progress of studentsâ acquisition of scientific inquiry (Halonen et al., 2003, p. 196), and an application of the utility of the rubric. Twenty-two undergraduates from a womanâs college participated in two sections of experimental psychology. Students consisted of sophomores, juniors, and seniors who completed general psychology courses. Consistent with the Halonen et al. (2003) model, results indicated that authentic research experiences in the first phase of the course were positively correlated with changes in scientific thinking in a second phase. In turn, experiences in the second phase were positively correlated with evidence of advanced thinking skills in a third phase. The findings suggest that much of the basic skill knowledge acquired in the beginning lectures, textbook readings, and writing instruction of the course enhanced studentsâ ability to apply that knowledge in later classes and the lab components. Further, the authentic learning experiences were instrumental in fine-tuning the skills learned from the lectures and textbooks readings. As a result, the current authors advocate the use of authentic experiences in teaching research methods, as a way for teachers to transform such classes in a beneficial and systematic way, in order to enhance acquisition of scientific thinking skills and to examine changes in scientific thinking as explicated in the Halonen et al. (2003) model
Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence
Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decision-making for clinicians interested in providing patient-centered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of non-adherence to medications for chronic conditions
Recommended from our members
Effects of Concurrent Depressive Symptoms and Perceived Stress on Cardiovascular Risk in Lowâ and HighâIncome Participants: ...
Background: Psychosocial risk for cardiovascular disease (CVD) may be especially deleterious in persons with low socioeconomic status. Most work has focused on psychosocial factors individually, but emerging research suggests that the confluence of psychosocial risk may be particularly harmful. Using data from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study, we examined associations among depressive symptoms and stress, alone and in combination, and incident CVD and allâcause mortality as a function of socioeconomic status.
Methods and Results At baseline, 22 658 participants without a history of CVD (58.8% female, 41.7% black, mean age 63.9±9.3 years) reported on depressive symptoms, stress, annual household income, and education. Participants were classified into 1 of 3 psychosocial risk groups at baseline: (1) neither depressive symptoms nor stress, (2) either depressive symptoms or stress, or (3) both depressive symptoms and stress. Cox proportional hazards models were used to predict physicianâadjudicated incident total CVD events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) and allâcause mortality over a median of 7.0 years (interquartile range 5.4â8.3 years) of followâup. In fully adjusted models, participants with both depressive symptoms and stress had the greatest elevation in risk of developing total CVD (hazard ratio 1.48, 95% CI 1.21â1.81) and allâcause mortality (hazard ratio 1.33, 95% CI 1.13â1.56) but only for those with low income (< 35 000) income. This pattern of results was not observed in models stratified by education.
Conclusions Findings suggest that screening for a combination of elevated depressive symptoms and stress in lowâincome persons may help identify those at increased risk of incident CVD and mortality
The Prevalence of Cognitive Impairment Among Adults With Incident Heart Failure: The âReasons for Geographic and Racial Differences in Strokeâ (REGARDS) Study
Background
Cognitive impairment (CI) is estimated to be present in 25%â80% of heart failure (HF) patients, but its prevalence at diagnosis is unclear. To improve our understanding of cognition in HF, we determined the prevalence of CI among adults with incident HF in the REGARDS study.
Methods and Results
REGARDS is a longitudinal cohort study of adults â„45 years of age recruited in the years 2003â2007. Incident HF was expert adjudicated. Cognitive function was assessed with the Six-Item Screener. The prevalence of CI among those with incident HF was compared with the prevalence of CI among an age-, sex-, and race-matched cohort without HF. The 436 participants with incident HF had a mean age of 70.3 years (SD 8.9), 47% were female, and 39% were black. Old age, black race, female sex, less education, and anticoagulation use were associated with CI. The prevalence of CI among participants with incident HF (14.9% [95% CI 11.7%â18.6%]) was similar to the non-HF matched cohort (13.4% [11.6%â15.4%]; P < .43).
Conclusions
A total of 14.9% of the adults with incident HF had CI, suggesting that the majority of cognitive decline occurs after HF diagnosis. Increased awareness of CI among newly diagnosed patients and ways to mitigate it in the context of HF management are warranted
Cardiovascular Health and Incident Cardiovascular Disease and Cancer
The American Heart Association's âSimple 7â offers a practical public health conceptualization of cardiovascular health (CVH). CVH predicts incident cardiovascular disease (CVD) in younger populations, but has not been studied in a large, diverse population of aging postmenopausal women. The extent to which CVH predicts cancer in postmenopausal women is unknown
The Key Driver Implementation Scale (KDIS) for practice facilitators: Psychometric testing in the âSoutheastern collaboration to improve blood pressure controlâ trial
Background Practice facilitators (PFs) provide tailored support to primary care practices to improve the quality of care delivery. Often used by PFs, the âKey Driver Implementation Scaleâ (KDIS) measures the degree to which a practice implements quality improvement activities from the Chronic Care Model, but the scaleâs psychometric properties have not been investigated. We examined construct validity, reliability, floor and ceiling effects, and a longitudinal trend test of the KDIS items in the Southeastern Collaboration to Improve Blood Pressure Control trial. Methods The KDIS items assess a practiceâs progress toward implementing: a clinical information system (using their own data to drive change); standardized care processes; optimized team care; patient self-management support; and leadership support. We assessed construct validity and estimated reliability with a multilevel confirmatory factor analysis (CFA). A trend test examined whether the KDIS items increased over time and estimated the expected number of months needed to move a practice to the highest response options. Results PFs completed monthly KDIS ratings over 12 months for 32 primary care practices, yielding a total of 384 observations. Data was fitted to a unidimensional CFA model; however, parameter fit was modest and could be improved. Reliability was 0.70. Practices started scoring at the highest levels beginning in month 5, indicating low variability. The KDIS items did show an upward trend over 12 months (all p < .001), indicating that practices were increasingly implementing key activities. The expected time to move a practice to the highest response category was 9.1 months for standardized care processes, 10.2 for clinical information system, 12.6 for self-management support, 13.1 for leadership, and 14.3 months for optimized team care. Conclusions The KDIS items showed acceptable reliability, but work is needed in larger sample sizes to determine if two or more groups of implementation activities are being measured rather than one
Foundations of Translational Ecology
Ecologists who specialize in translational ecology (TE) seek to link ecological knowledge to decision making by integrating ecological science with the full complement of social dimensions that underlie today\u27s complex environmental issues. TE is motivated by a search for outcomes that directly serve the needs of natural resource managers and decision makers. This objective distinguishes it from both basic and applied ecological research and, as a practice, it deliberately extends research beyond theory or opportunistic applications. TE is uniquely positioned to address complex issues through interdisciplinary team approaches and integrated scientistâpractitioner partnerships. The creativity and context-specific knowledge of resource managers, practitioners, and decision makers inform and enrich the scientific process and help shape use-driven, actionable science. Moreover, addressing research questions that arise from on-the-ground management issues â as opposed to the top-down or expert-oriented perspectives of traditional science â can foster the high levels of trust and commitment that are critical for long-term, sustained engagement between partners
Patient-centered interventions to improve medication management and adherence: A qualitative review of research findings
Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior
Fire as a fundamental ecological process: Research advances and frontiers
© 2020 The Authors.Fire is a powerful ecological and evolutionary force that regulates organismal traits, population sizes, species interactions, community composition, carbon and nutrient cycling and ecosystem function. It also presents a rapidly growing societal challenge, due to both increasingly destructive wildfires and fire exclusion in fireâdependent ecosystems. As an ecological process, fire integrates complex feedbacks among biological, social and geophysical processes, requiring coordination across several fields and scales of study.
Here, we describe the diversity of ways in which fire operates as a fundamental ecological and evolutionary process on Earth. We explore research priorities in six categories of fire ecology: (a) characteristics of fire regimes, (b) changing fire regimes, (c) fire effects on aboveâground ecology, (d) fire effects on belowâground ecology, (e) fire behaviour and (f) fire ecology modelling.
We identify three emergent themes: the need to study fire across temporal scales, to assess the mechanisms underlying a variety of ecological feedbacks involving fire and to improve representation of fire in a range of modelling contexts.
Synthesis: As fire regimes and our relationships with fire continue to change, prioritizing these research areas will facilitate understanding of the ecological causes and consequences of future fires and rethinking fire management alternatives.Support was provided by NSFâDEBâ1743681 to K.K.M. and A.J.T. We thank Shalin HaiâJew for helpful discussion of the survey and qualitative methods.Peer reviewe
- âŠ