Case 12 : Policy Meets Practice – People Who Inject Drugs (PWID)

Dr. Silverman is the Chief of Infectious Diseases at London Health Sciences Centre (LHSC) and St. Joseph’s Health Care in London, Ontario. He is concerned about the increasing prevalence of people who inject drugs (PWID) in London, and the risk to PWID of bacterial infections due to contamination (e.g., improperly or unsterilized injection equipment, skin not being sterilized before injection). Of primary concern is the risk of infective endocarditis (IE), an infection in a patient’s heart. Treatment for IE entails antibiotics administered through the intravenous (IV) route. IE is generally treated through home care; in London, the South West Community Care Access Centre (CCAC) is responsible for delivering home care. To treat IE at home, a patient would need a peripherally inserted central catheter (a PICC-line) and assistance from a CCAC nurse to administer the antibiotics. This option, however, is not viable for some patients, including those who fall under the category of PWID or who may not have a fixed address. In the case of PWID, the PICC-line, in effect, becomes a “highway” for injecting other drugs; in instances where a patient may not have secure housing or be homeless, the CCAC nurse may not be able to track down the individual. When a patient in one of these situations is being treated for IE, it puts the care team in a difficult position. The alternatives to home care are hospital admittance or no treatment at all, neither of which are ideal solutions. Dr. Silverman is currently in this position, as he must decide on a treatment plan for Mr. W., a patient who has IE, has struggled with drug addiction (the likely cause of his IE), and who does not have stable housing. In making his decision, Dr. Silverman has included on Mr. W.’s care team two other physicians from LHSC, a representative from the CCAC, and the managing director of London CAReS, a community-based housing-first organization. The care team must determine the best treatment plan for Mr. W

Support from Adult Children and Parental Health in Rural America

Adult children are a primary source of care for their aging parents. Parents in rural areas, however, live further from their adult children than parents in urban areas, potentially limiting the support they receive and compromising their health and ability to age in place. We use two waves of the Panel Study of Income Dynamics (2013 and 2017) to investigate the relationships among geographic proximity, adult children’s instrumental and financial support, and parental health. Rural parents live further from their adult children and receive less financial support, but they are more likely to receive instrumental assistance. In addition, rural parents have worse health and more functional limitations than urban parents, and these differences persist after controlling for proximity to and support from adult children. Our findings indicate that factors beyond proximity influence the complex relationships between spatial and social boundaries and their consequences for older adults’ health and well-being

BASE (Broadening Access to Science Education) Camp for Young Women

This poster will describe the development and implementation of an annual two-week residential summer science enrichment program for 24 rising female juniors and seniors from Bridgeport, CT, a community comprised of many health disparity populations traditionally underrepresented in science. The program, entitled BASE (Broadening Access to Science Education), has an overall goal to excite and inform students from local health disparity populations about the process and promise of science in an effort to increase interest in the pursuit of STEM and health careers after college. The program includes three key components. The first component is the Research Immersion Experience, a weeklong scientific research experience that engages students in faculty-led research projects. The second component of the camp is the Science and Health Careers Exploration that exposes students to various careers in science, technology, and health sciences and the academic paths required to get there. The final component of the program is the College Admissions Counseling in which the Fairfield University Office of Undergraduate Admissions educates the students about the process and requirements for admission to college, informs students about financial aid opportunities, and engages students in mock interviews and essay writing. We will present pre- and post-camp participant, and post-camp counselor, and faculty survey results from 2012. Camper feedback is overwhelmingly positive, and the program appears to be meeting its goals to excite and inform students from health disparity populations about science and to inspire them to pursue scientific careers

BASE (Broadening Access to Science Education): A Research and Mentoring Focused Summer STEM Camp Serving Underrepresented High School Girls

BASE (Broadening Access to Science Education) Camp is a hands-on two-week residential summer science experience on the Fairfield University campus, in Fairfield CT, USA. The annual program targets 24 young women who attend high school in our neighboring city of Bridgeport, CT, the most economically depressed city in CT. The camp, which is free to students, includes three components. The first is the week-long Research Immersion Experience, which engages students in faculty-mentored science research projects assisted by current undergraduate STEM majors. The second component is Career Exploration, which allows students to explore a variety of careers in science, technology, and healthcare, as well as the academic paths required to get there. The third component is College Admissions Counseling, which links campers with Fairfield University’s undergraduate admissions staff for mentoring on the college application process. This program is particularly unique in that it rests entirely on a female staff, engaging Fairfield University’s women STEM faculty and undergraduate STEM majors. BASE Camp was founded and developed through funding from several organizations, and is currently supported by a five-year R25 grant from the NIMHD (National Institute on Minority Health and Health Disparities), National Institutes of Health. After four years in this format, the program has engaged close to 100 young women. Data collected show nearly 100% camper satisfaction with the program. In addition, we found the camp increased camper perception of their science knowledge and confidence, as well as understanding of skills required to succeed in careers in science and health. Finally, in a follow-up survey we found that 95% have applied to, or plan to apply to, college, and 87% are interested in pursuing a STEM or health-related career. The close mentorship of these young women by female role models at the faculty and undergraduate levels has greatly contributed to the success and efficacy of this experience. We hope our program can be used as a model for others to create programming in an effort to promote and support underrepresented women in the pursuit of STEM careers

Impacts of a mindful eating intervention on healthy food-related behaviors and mindful eating practices among elementary school children: A Pilot Study

Background and Purpose: Mindful eating approaches encourage paying purposeful attention on purpose to body sensations, thoughts and emotions related to food and eating. The current study examined the impact of Foodie U, a mindful-eating intervention, among elementary school children and their families. Methods: A total of 178 third- through fifth grade children and their parents in rural northern California participated in Foodie U. The quasi-experimental intervention included two parent workshops, six monthly in-class mindful eating lessons and activities, and mindful eating activities to complete at home. Outcomes included food consumption, mindful-eating practices, emotional eating, and cue-elicited food craving among children. Results: T-tests and linear regression results revealed that students who received the intervention reported significantly less intense craving responses, especially among female and Hispanic students. The impact of the intervention on food craving was significant after controlling for gender and ethnicity. Fruit consumption significantly increased among intervention students. The mindful eating awareness score significantly increased among female intervention students. Conclusions: Foodie U had a positive impact on some food-related behaviors among elementary school-aged students. Further research is needed to examine the effectiveness of each element of the intervention

Scat DNA as a non-invasive method for estimating the abundance of the vulnerable mala (Lagorchestes hirsutus)

Context: Population-monitoring programs often use direct (e.g. live capture or spotlighting) or indirect (e.g. scats sightings) observations to estimate population abundance. Such methods, however, are often inadequate for rare, elusive, or cryptic species due to the difficulty in achieving sufficient encounters or detection rates. The mala (Lagorchestes hirsutus), a small native Australian macropod, listed as Vulnerable by the IUCN, is difficult to capture, susceptible to capture myopathy, and not easily sighted in their dense habitat; consequently, the population size cannot always be estimated. The use of molecular markers to identify individual genotypes from non-invasively collected samples is increasingly being used in wildlife conservation and may be an alternative approach for mala. Aim: The aim of this study was to evaluate the efficacy of non-invasive scat DNA sampling to estimate the population abundance of mala. Methods: A panel of microsatellite markers was developed for the identification of individual mala via profiling of their scats. Scats were systematically collected from a wild mala population located in an 1100-ha fenced reserve in Western Australia. Individual genotypes were determined using the microsatellite markers, and the abundance of mala was estimated using the genotypes with spatially explicit capture–recapture (SECR) and mark–resight analyses. Key results: The genetic markers proved variable and with sufficient exclusionary power to confidently identify unique individuals (mean locus genotyping error rate: 3.1%). Individual genetic identification from scat sampling, when used with traditional mark–recapture/resight analytical models, provides feasible estimates of population abundance. This is the first reliable abundance estimate of this mala population, suggesting a \u3e70% increase in population size since the initial reintroduction of 64 individuals in 2011–13. Conclusions: Given the inherent difficulties in surveying mala, this approach would be valuable to ensure effective monitoring of the few remaining fenced and island mala populations to prevent further decline of this vulnerable species. Implications: This is the first study to identify species-specific microsatellite markers for mala and use genetic-capture sampling with scat DNA to estimate the abundance of a mala population. The study provides an evaluation of a valuable species monitoring technique that can be applied to other rare, elusive, or cryptic threatened species

Experiences of COVID-19 pandemic-related stress among sexual and gender minority emerging adult migrants in the United States

There is a dearth of research that examines COVID-19-related stress among multiply marginalised individuals who are in the developmental phase of emerging adulthood. This qualitative study investigated how the intersection of emerging adulthood, sexual and gender minority (SGM) identity, and migrant status were reflected in the experiences of SGM individuals (n = 37; ages 20–25 years old) who migrated to various parts of the United States in the last 5 years. Data were collected online using semi-structured interviews. Thematic analysis revealed that participants\u27 developmental processes (e.g., identity exploration, building financial independence) were shaped by pandemic-related stressors, especially unemployment and financial instability. Participants who were able to maintain employment did so but at the risk of their health and safety. Findings also showed that participants experienced feelings of anxiety and depression due to social isolation, but online communication played an important role in combatting loneliness. Findings highlight the potential for trauma-informed and intersectional approaches to practice with SGM emerging adult migrants and expanded health services and temporary entitlement programs to mitigate the pandemic\u27s effects on this population\u27s psychosocial and financial well-being

Review: The Newsletter of the Literary Managers and Dramaturgs of the Americas, volume 13, issue 1

Contents include: Reading Review (Again), Radical from the Root, Arthur Ballet Recipient of the 2002 LMDA Loessing Award, Notes from the Lunatic Fringe, Regional Reports Info: News and Previews From All Over, Review is Inaugurating a New Section in the Next Issue: Projects-In-Process, and LMDA Prize in Drammatury 2002 The Elliott Hayes Award. Issue editors: D.J. Hopkins, Shelley Orr, Liz Engelman, Madeline Oldham, Jacob Zimmerhttps://soundideas.pugetsound.edu/lmdareview/1026/thumbnail.jp

Is Enrichment Always Enriching and How Would You Know? Unintended Consequences and the Importance of Formal Assessment of Enrichment Programs in Bottlenose Dolphins (Tursiops truncatus)

Bottlenose dolphins (Tursiops truncatus) are viewed as a highly intelligent species capable of complex behaviors. This requires marine parks to maintain dynamic environmental enrichment programs in order to ensure dolphins’ optimal psychological and physiological well-being while in human care. In this study, two experiments were conducted to determine the effects of different forms of enrichment on the behavior of four bottlenose dolphins. In Experiment 1, multiple forms of novel enrichment resulted in a shift away from individual swim patterns – a change that is associated with increased behavioral diversity and so often considered an improvement in animal welfare – but also resulted in avoidance behavior and initially resulted in a decrease in affiliative behavior. In Experiment 2, introducing choice of enrichments resulted in unintended social consequences, such as agonistic behaviors. These two experiments together demonstrated that interpreting the results of enrichment programs may not be as straightforward as often presumed. The results suggest that unique forms of enrichment and variable schedules might be particularly effective but also that consistent evaluation continues to be necessary to minimize unintended behavioral consequences

How does facilitation in healthcare work? Using mechanism mapping to illuminate the black box of a meta-implementation strategy

BACKGROUND: Healthcare facilitation, an implementation strategy designed to improve the uptake of effective clinical innovations in routine practice, has produced promising yet mixed results in randomized implementation trials and has not been fully researched across different contexts. OBJECTIVE: Using mechanism mapping, which applies directed acyclic graphs that decompose an effect of interest into hypothesized causal steps and mechanisms, we propose a more concrete description of how healthcare facilitation works to inform its further study as a meta-implementation strategy. METHODS: Using a modified Delphi consensus process, co-authors developed the mechanistic map based on a three-step process. First, they developed an initial logic model by collectively reviewing the literature and identifying the most relevant studies of healthcare facilitation components and mechanisms to date. Second, they applied the logic model to write vignettes describing how facilitation worked (or did not) based on recent empirical trials that were selected via consensus for inclusion and diversity in contextual settings (US, international sites). Finally, the mechanistic map was created based on the collective findings from the vignettes. FINDINGS: Theory-based healthcare facilitation components informing the mechanistic map included staff engagement, role clarification, coalition-building through peer experiences and identifying champions, capacity-building through problem solving barriers, and organizational ownership of the implementation process. Across the vignettes, engagement of leaders and practitioners led to increased socialization of the facilitator\u27s role in the organization. This in turn led to clarifying of roles and responsibilities among practitioners and identifying peer experiences led to increased coherence and sense-making of the value of adopting effective innovations. Increased trust develops across leadership and practitioners through expanded capacity in adoption of the effective innovation by identifying opportunities that mitigated barriers to practice change. Finally, these mechanisms led to eventual normalization and ownership of the effective innovation and healthcare facilitation process. IMPACT: Mapping methodology provides a novel perspective of mechanisms of healthcare facilitation, notably how sensemaking, trust, and normalization contribute to quality improvement. This method may also enable more efficient and impactful hypothesis-testing and application of complex implementation strategies, with high relevance for lower-resourced settings, to inform effective innovation uptake