Dementia Caregiving in the Context of Late‐Life Remarriage: Support Networks, Relationship Quality, and Well‐being

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/100144/1/jomf12059.pd

P4‐655: Addressing Ad Health Disparities Through A Cultural Lens

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153187/1/alzjjalz201909021.pd

Evaluation of Syracuse Healthy Start’s Program for Abnormal Flora Management to Reduce Preterm Birth Among Pregnant Women

Randomized trials of bacterial vaginosis (BV) treatment among pregnant women to reduce preterm birth have had mixed results. Among non-pregnant women, BV recurs frequently after treatment. Randomized trials of early BV treatment for pregnant women in which recurrence was retreated have shown promise in reducing preterm birth. Syracuse’s Healthy Start (SHS) program began in 1997; in 1998 prenatal care providers for pregnant women living in high infant mortality zip codes were encouraged to screen for abnormal vaginal flora at the first prenatal visit. Vaginal swabs were sent to a referral hospital laboratory for Gram staining and interpretation. SHS encouraged providers to treat and rescreen women with bacterial vaginosis or abnormal flora (BV). We abstracted prenatal and hospital charts of live births between January 2000 and March 2002 for maternal conditions and treatments. We merged abstracted data with local electronic data. We evaluated the effect of BV screening before 22 weeks gestation, treatment, and rescreening using a retrospective cohort study design. Among 838 women first screened before 22 weeks, 346 (41%) had normal flora and 492 (59%) women had BV at a mean of 13 weeks gestation; 202 (24%) did not have treatment documented and 290 (35%) received treatment at a mean of 15 weeks gestation; 267 (92%) of those treated were rescreened. Among pregnant women with early BV, 42 (21%) untreated women and 28 (10%) treated women delivered preterm (Odds Ratio [OR] 0.4, 95% confidence interval [CI] 0.2–0.7)). After adjustment for age, race, prior preterm birth and other possible confounders, treatment remained associated with a reduced risk of preterm birth compared to no treatment (aOR = 0.5, 95% CI 0.3–0.9); the aOR for women with normal flora was not significantly different. Conclusion: Screening, treatment, and rescreening for BV/abnormal flora between the first prenatal visit and 22 weeks gestation showed promise in reducing preterm births and deserves further study

Adult Out of Court Disposal Pilot Evaluation - Final Report

This report combines the findings from the process and impact evaluations of the Adult Out of Court Disposal (OOCD) pilot which aimed to: assess whether (a) the pilot achieved the requirements of greater simplicity and transparency, with (b) acceptable wider implications for Criminal Justice Partners (i.e., police, HMCTS, CPS, NOMS)

Experience of localized flooding predicts urban flood risk perception and perceived safety of nature-based solutions

Understanding community members' flood risk perceptions is critical for developing new approaches to managing flood risks for climate resilience. “Risk as feelings” has informed research on how people perceive flood risks based on intuition and personal experiences, complementing experts' technical assessment. However, attention has been primarily on riverine and coastal flooding. We expand the “risk as feelings” concept to investigate community members' risk perceptions of urban pluvial flooding as well as perceived safety of novel vs. familiar nature-based solutions (NBS). For the novel practice, we focus on floodable sites that temporarily inundate urban open spaces under storm conditions. For the familiar practice, we focus on retention ponds that store excessive runoff under storm conditions. Data were collected through visualization-assisted surveys of residents from high and low flood hazard areas in three US cities (N = 884). We found that over half of respondents indicated some degree of worry about stormwater-related damage, and overall, respondents perceived floodable as less safe than retention ponds under storm conditions. Further, respondents who had more frequently experienced localized flooding near their homes were more worried about potential property damage caused by flooding. They also perceived floodable sites as less safe under storm conditions. However, more frequent experience of localized flooding was not associated with perceived safety of retention ponds under storm conditions. Some other contextual and socio-demographic factors (e.g., prior stormwater-related property damage, knowledge of and involvement in stormwater management issues, gender, age, race, and having children) also had notable effects on flood risk perception and perceived safety of NBS. We discuss the implications of these findings for urban flood risk management and NBS development

Learning physics in context: a study of student learning about electricity and magnetism

This paper re-centres the discussion of student learning in physics to focus on context. In order to do so, a theoretically-motivated understanding of context is developed. Given a well-defined notion of context, data from a novel university class in electricity and magnetism are analyzed to demonstrate the central and inextricable role of context in student learning. This work sits within a broader effort to create and analyze environments which support student learning in the sciencesComment: 36 pages, 4 Figure

Long-Term Citizen-Collected Data Reveal Geographical Patterns and Temporal Trends in Lake Water Clarity

We compiled a lake-water clarity database using publically available, citizen volunteer observations made between 1938 and 2012 across eight states in the Upper Midwest, USA. Our objectives were to determine (1) whether temporal trends in lake-water clarity existed across this large geographic area and (2) whether trends were related to the lake-specific characteristics of latitude, lake size, or time period the lake was monitored. Our database consisted of >140,000 individual Secchi observations from 3,251 lakes that we summarized per lake-year, resulting in 21,020 summer averages. Using Bayesian hierarchical modeling, we found approximately a 1% per year increase in water clarity (quantified as Secchi depth) for the entire population of lakes. On an individual lake basis, 7% of lakes showed increased water clarity and 4% showed decreased clarity. Trend direction and strength were related to latitude and median sample date. Lakes in the southern part of our study-region had lower average annual summer water clarity, more negative long-term trends, and greater interannual variability in water clarity compared to northern lakes. Increasing trends were strongest for lakes with median sample dates earlier in the period of record (1938–2012). Our ability to identify specific mechanisms for these trends is currently hampered by the lack of a large, multi-thematic database of variables that drive water clarity (e.g., climate, land use/cover). Our results demonstrate, however, that citizen science can provide the critical monitoring data needed to address environmental questions at large spatial and long temporal scales. Collaborations among citizens, research scientists, and government agencies may be important for developing the data sources and analytical tools necessary to move toward an understanding of the factors influencing macro-scale patterns such as those shown here for lake water clarity

Innovative demand creation strategies to increase voluntary medical male circumcision uptake: a pragmatic randomised controlled trial in Zimbabwe.

INTRODUCTION: Reaching men aged 20-35 years, the group at greatest risk of HIV, with voluntary medical male circumcision (VMMC) remains a challenge. We assessed the impact of two VMMC demand creation approaches targeting this age group in a randomised controlled trial (RCT). METHODS: We conducted a 2×2 factorial RCT comparing arms with and without two interventions: (1) standard demand creation augmented by human-centred design (HCD)-informed approach; (2) standard demand creation plus offer of HIV self-testing (HIVST). Interpersonal communication (IPC) agents were the unit of randomisation. We observed implementation of demand creation over 6 months (1 May to 31 October 2018), with number of men circumcised assessed over 7 months. The primary outcome was the number of men circumcised per IPC agent using the as-treated population of actual number of months each IPC agent worked. We conducted a mixed-methods process evaluation within the RCT. RESULTS: We randomised 140 IPC agents, 35 in each arm. 132/140 (94.3%) attended study training and 105/132 (79.5%) reached at least one client during the trial period and were included in final analysis. There was no evidence that the HCD-informed intervention increased VMMC uptake versus no HCD-informed intervention (incident rate ratio (IRR) 0.87, 95% CI 0.38 to 2.02; p=0.75). Nor did offering men a HIVST kit at time of VMMC mobilisation (IRR 0.65, 95% CI 0.28 to 1.50; p=0.31). Among IPC agents that reported reaching at least one man with demand creation, both the HCD-informed intervention and HIVST were deemed useful. There were some challenges with trial implementation; <50% of IPC agents converted any men to VMMC, which undermined our ability to show an effect of demand creation and may reflect acceptability and feasibility of the interventions. CONCLUSION: This RCT did not show evidence of an effect of HCD-informed demand intervention or HIVST on VMMC uptake. Findings will inform future design and implementation of demand creation evaluations. TRIAL REGISTRATION NUMBER: PACTR201804003064160

Natural Knowledge, Inc.: The Royal Society as a Metropolitan Corporation

This article attempts to think through the logic and distinctiveness of the early Royal Society's position as a metropolitan knowledge community and chartered corporation, and the links between these aspects of its being. Among the knowledge communities of Restoration London it is one of the best known and most studied, but also one of the least typical and in many respects one of the least coherent. It was also quite unlike the chartered corporations of the City of London, exercising almost none of their ordinary functions and being granted very limited power and few responsibilities. I explore the society's imaginative and material engagements with longer-established corporate bodies, institutions and knowledge communities, and show how those encounters repeatedly reshaped the early society's internal organization, outward conduct and self-understanding. Building on fundamental work by Michael Hunter, Adrian Johns, Lisa Jardine and Jim Bennett, and new archival evidence, I examine the importance of the city to the society's foundational rhetoric and the shifting orientation of its search for patronage, the development of its charter, and how it learned to interpret the limits and possibilities of its privileges through its encounters with other chartered bodies, emphasizing the contingent nature of its early development

Relative efficiency of demand creation strategies to increase voluntary medical male circumcision uptake: a study conducted as part of a randomised controlled trial in Zimbabwe.

BACKGROUND: Supply and demand-side factors continue to undermine voluntary medical male circumcision (VMMC) uptake. We assessed relative economic costs of four VMMC demand creation/service-delivery modalities as part of a randomised controlled trial in Zimbabwe. METHODS: Interpersonal communication agents were trained and incentivised to generate VMMC demand across five districts using four demand creation modalities (standard demand creation (SDC), demand creation plus offer of HIV self-testing (HIVST), human-centred design (HCD)-informed approach, HCD-informed demand creation approach plus offer of HIVST). Annual provider financial expenditure analysis and activity-based-costing including time-and-motion analysis across 15 purposively selected sites accounted for financial expenditures and donated inputs from other programmes and funders. Sites represented three models of VMMC service-delivery: static (fixed) model offering VMMC continuously to walk-in clients at district hospitals and serving as a district hub for integrated mobile and outreach services, (2) integrated (mobile) modelwhere staff move from the district static (fixed) site with their commodities to supplement existing services or to recently capacitated health facilities, intermittently and (3) mobile/outreach model offering VMMC through mobile clinic services in more remote sites. RESULTS: Total programme cost was $752 585 including VMMC service-delivery costs and average cost per client reached and cost per circumcision were$58 and $174, respectively. Highest costs per client reached were in the HCD arm-$68 and lowest costs in standard demand creation ($52) and HIVST ($55) arms, respectively. Highest cost per client circumcised was observed in the arm where HIVST and HCD were combined ($226) and the lowest in the HCD alone arm ($160). Across the three VMMC service-delivery models, unit cost was lowest in static (fixed) model ($54) and highest in integrated mobile model ($63). Overall, economies of scale were evident with unit costs lower in sites with higher numbers of clients reached and circumcised. CONCLUSIONS: There was high variability in unit costs across arms and sites suggesting opportunities for cost reductions. Highest costs were observed in the HCD+HIVST arm when combined with an integrated service-delivery setting. Mobilisation programmes that intensively target higher conversion rates as exhibited in the SDC and HCD arms provide greater scope for efficiency by spreading costs. TRIAL REGISTRATION NUMBER: PACTR201804003064160