Education and learning to support a just transition in Central Appalachia

This case study explores the learning and education of a community organization involved with multiple Just Transition initiatives in Eastern Kentucky where the economies were formerly dominated by the coal industry. Sixteen semi-structured interviews were conducted of leaders within the organization in addition to exploring the educational materials. Although non-formal learning plays an important part, informal learning, activist exchanges, and communities of practice play a more fundamental role in the activist learning

Social Movement Learning for a Just Transition in Appalachia

This article explores Just Transition and social movement learning as a part of community development and organizing strategies to move beyond coal in Appalachia

Estrogen Receptor Levels Higher in “Bad” Maternal Rats than in “Good” Maternal Rats

In mammalian species, parental care is critical for the survival as well as the mental and physical well-being of offspring (Dulac, 2014). This is particularly true in humans; researchers have long been interested in what the effects are of differences in parental upbringing, including the absence of parents (e.g., Cabrera et al., 2000) and differences in disciplinary parenting styles (e.g., Baumrind, 1967). Though tempting to think of all parents as “good” parents in both the human and animal worlds, that clearly is not the case; sadly, there are “bad” parents as well. For instance, cross-sectional studies in humans on parent-child relationships have shown that adverse and traumatic childhood experiences including neglect, abuse, or parental loss correlate to mood and anxiety disorders later in life (Bodensteiner, 2014). Moreover, such individuals have tendencies to form antisocial personalities and impulsive aggression. There are quantifiable physical effects of poor parenting as well - girls lacking proper parent-child relationships experience a variety of physiological and sociological changes vs. their “normal” counterparts, including ‘decreased age at menarche, earlier onset of sexual behavior, and increased number of sexual partners.’ These traits often have both physiological and psychological repercussions (Bodensteiner, 2014). In sum, early life experience, though relatively brief, are critical for molding the future of an individual’s success and overall fitness to survive the demands of life (Anacker, 2013). Thus, it is especially important to understand factors that can lead to lower levels of parental care (“bad” parenting) than expected from “good” or “average” parental care. These factors may be sociological, psychological, environmental, or genetic and their effects in humans are not trivial. For example, postpartum depression affects more than 10% of mothers in the United States, potentially resulting in poor care for offspring that then lead to negative consequences described earlier (Dulac, 2014). Given the complexity of human interactions and conditions, researchers can attempt to examine the factors that affect maternal behaviors in a model rat system - allowing us to control for more variables - in hopes of better understanding the factors that affect maternal behaviors in humans

Palliative Care and Hospice: Opportunities to Improve Care for the Sickest Patients

The article discusses how palliative care and hospice services address the quality and cost concerns in the U.S. health care system. By focusing on symptom management, coordination among providers, and improved transitions of care, the services meet the needs of the sickest persons at lower costs. The author suggests putting in place the right leadership and resources and strengthening the workforce to successfully expand the programs

Implementation of a Heart Failure Quality Initiative in a Skilled Nursing Facility: Lessons Learned

Skilled nursing facilities (SNFs) are organizations that represent complex adaptive systems, offering barriers to the implementation of quality improvement (QI) initiatives. The current article describes the authors’ efforts to use the approach of reflective adaptive process to implement a new model of care (i.e., the Skilled Heart Unit Program) for effective heart failure (HF) care in one SNF. A team of stakeholders from the local hospital system and a local SNF was convened to design and implement this new model. Evaluation of the implementation processes confirmed the value of the implementation approach, which centered on team-based approaches, staff engagement, and flexibility of processes to respect the SNF’s needs and culture. Interviews with facility staff and the administrator revealed their perceptions that the strategy resulted in better HF care, enhanced teamwork between staff and clinicians, and improved staff job satisfaction. This work provides a unique blueprint of strategic QI implementation for patients with HF in the SNF setting

Nursing Home Regulations Redefined: Implications for Providers

The Centers for Medicare and Medicaid Services (CMS) finalized a comprehensive update to nursing home requirements of participation in October 2016. Nearly 10,000 public comments were received regarding the proposed rule, and CMS made multiple modifications based on comments from providers, advocacy organizations, and others before issuing the final rule. The final rule describing nursing home requirements of participation modernizes nursing home regulation. It is being implemented in three phases—beginning in November 2016, November 2017, and November 2019. There are multiple provisions that have implications for clinicians caring for nursing home residents, particularly in terms of management of infections, medication prescribing and monitoring, and delegation of medical orders

Care Consistency With Documented Care Preferences: Methodologic Considerations for Implementing the “Measuring What Matters” Quality Indicator

A basic tenet of palliative care is discerning patient treatment preferences and then honoring these preferences, reflected by the inclusion of “Care Consistency With Documented Care Preferences” as one of 10 “Measuring What Matters quality” indicators. Measuring What Matters indicators are intended to serve as a foundation for quality measurement in health care settings. However, there are a number of logistic and practical issues to be considered in the application of this quality indicator to clinical practice. In this brief methodologic report, we describe how care consistency with documented care preferences has been measured in research on patients near the end of life. Furthermore, we outline methodologic challenges in using this indicator in both research and practice, such as documentation, specificity and relevance, preference stability, and measuring nonevents. Recommendations to strengthen the accuracy of measurement of this important quality marker in health care settings include consistent recording of preferences in the medical record, considerations for selection of treatment preferences for tracking, establishing a protocol for review of preferences, and adoption of a consistent measurement approach