In Any Language: Improving the Quality and Availability of Language Services in Hospitals

Showcases initiatives and interventions implemented in ten hospitals participating in RWJF's Speaking Together initiative to measure and enhance language services delivery. Discusses factors for success, strategies for improvement, and lessons learned

In the School, Not of the School : Co-Performing Critical Literacies with English Amped

The purpose of this study was to explore the possibilities and limitations of “amplifying” critical literacy practices within an urban high school English and creative writing class. This action research project defamiliarized English education and created conditions for participants to imagine and perform alternative possibilities by bringing together critical research, community involvement, creative writing and performance in an extended class with high school, university, and community-based collaborators. Participants were high school juniors, partnering teachers, university-based student teachers, and community members who collaborated to form the English Amped program in the 2014-2015 academic year. Ethnographic methods were used to collect data through field notes, semi-structured interviews, photographs, writing samples, questionnaires, and audio recordings. Findings demonstrated that the socially structured and habituated alienation of working-class students of color in urban schools delimited the ways that participants imagined and enacted critical literacy in school. Historically-based and persistent experiences of school as it is limited the legibility of school as it could be. The de-familiarization of traditional schooling provoked both euphoria and anxiety for participants. English Amped produced thresholds of contact between differently positioned people, institutions, ways of knowing, and forms of experience. Over time, these thresholds helped English Amped participants to experience performances of possibility that generated new repertoires of critically grounded knowledge and forms of relationality. Participants could later draw on these repertoires to produce more sustained forms of solidarity, agency, and well-being. Performances of possibilities helped students, teachers, and teacher candidates to experience increased agency and connection, which in turn helped participants to navigate the anxieties of critical literacies in school. This study points to the humanizing and emancipatory possibilities of critical literacy projects that construct collaborative, cross-institutional networks embedded deeply within urban high schools. Ultimately, English Amped demonstrated that the proliferation of critical literacy in urban public high schools may grow from concrete sites of practice and networks of relationality that enable people to create alternative repertoires over time, and thus co-perform transformative possibilities of school as it could be

Is it Worth the shot? Ontario Women's Negotiations of Risk, Gender and the Human Papillomavirous(HPV) Vaccine

This research project has been an endeavor in understanding how Human Papillomavirus (HPV) vaccine policy became gendered in Canada, how women in Ontario negotiated the concepts of “risk” and “gender” deployed in pharmaceutical marketing and public health programming, and how they folded these mediations into decision making about the vaccine. Eighteen months of ethnographic fieldwork revealed that the federal and Ontario governments developed HPV vaccine policy by using gender based analyses frames, based on the parameters of Merck Frosst’s gender-based marketing. This case study of the HPV vaccine highlights how corporations and governments work hand and hand to set public health policy in the neoliberal era of public health. However, these sales/governance strategies and the gendered at-risk subject formation they created and circulated were not passively integrated by women into their daily lives. The women interviewed – mothers of daughters affected by the grade eight school vaccination program, women university students and patients at a hospital vaccine clinic – demonstrated that the concepts of “risk” and “gender” are productive and movable ontological modes of being, which shift in and out of focus depending upon the context. Mothers were intensely focused on gender and doing mothering, students were doing gender politics and intermittent risk, and patients were living with risk. What sales/governance strategies had tried to “fix,” women continually unfixed. These accounts of situated risk and gender demonstrated that when assembled, women’s experiences helped transform their ethical being or sense of self. This knowledge of the self then informed vaccination decisions. Thus, decision making was not a discrete event or a linear, cost-benefit analysis. Instead it was an inherently social and cultural process, which was embedded in women’s experiences of finding meaning in their efforts to be good mothers, strong young women emerging into adulthood and pre-cancerous patients seeking respite amid the anxiety of protracted medical procedures. Women’s ontological decision making provides an analytical framework through which to tie together risk- and gender-related theory, individual accounts of risk encounters and the social, political, historical and economic context in which these mediations occur

Integrating archaeology and ancient DNA analysis to address invasive species colonization in the Gulf of Alaska

The intentional and unintentional movement of plants and animals by humans has transformed ecosystems and landscapes globally. Assessing when and how a species was introduced are central to managing these transformed landscapes, particularly in island environments. In the Gulf of Alaska, there is considerable interest in the history of mammal introductions and rehabilitating Gulf of Alaska island environments by eradicating mammals classified as invasive species. The Arctic ground squirrel (Urocitellus parryii) is of concern because it affects vegetation and seabirds on Gulf of Alaska islands. This animal is assumed to have been introduced by historic settlers; however, ground squirrel remains in the prehistoric archaeological record of Chirikof Island, Alaska, challenge this timeline and suggest they colonized the islands long ago. We used 3 lines of evidence to address this problem: direct radiocarbon dating of archaeological squirrel remains; evidence of prehistoric human use of squirrels; and ancient DNA analysis of dated squirrel remains. Chirikof squirrels dated to at least 2000 years ago, and cut marks on squirrel bones suggested prehistoric use by people. Ancient squirrels also shared a mitochondrial haplotype with modern Chirikof squirrels. These results suggest that squirrels have been on Chirikof longer than previously assumed and that the current population of squirrels is closely related to the ancient population. Thus, it appears ground squirrels are not a recent, human‐mediated introduction and may have colonized the island via a natural dispersal event or an ancient human translocation.We thank T. Rick, D. Grayson, R. Fleischer, M. Hawkins, A. West, and C. Mikeska for their contributions to this research. We also thank 3 reviewers and the editors of Conservation Biology who greatly improved this paper. This work was funded by the National Geographic Society, the University of Maine, the Smithsonian Institution, and Boston University. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the U.S. Fish and Wildlife Service. (National Geographic Society; University of Maine; Smithsonian Institution; Boston University)Published versio

Building a High-Quality Language Services Program Toolkit

Ten hospitals with racially and ethnically diverse patient populations participated in the Robert Wood Johnson Foundation\u27s Speaking Together: National Language Services Network, a program aimed at improving the quality and availability of health care language services for patients with limited English proficiency (LEP). This toolkit provides advice to hospitals on improving quality and accessibility of language services

Planned early delivery versus expectant management for hypertensive disorders from 34 weeks gestation to term

Cluver, C., et al. 2017. Planned early delivery versus expectant management for hypertensive disorders from 34 weeks gestation to term. Cochrane Database of Systematic Reviews, 1:1-76, Art. CD009273, doi:10.1002/14651858.CD009273.pub2The original publication is available at https://www.cochranelibrary.comBackground: Hypertensive disorders in pregnancy are significant contributors to maternal and perinatal morbidity and mortality. These disorders include well‐controlled chronic hypertension, gestational hypertension (pregnancy‐induced hypertension) and mild pre‐eclampsia. The definitive treatment for these disorders is planned early delivery and the alternative is to manage the pregnancy expectantly if severe uncontrolled hypertension is not present, with close maternal and fetal monitoring. There are benefits and risks associated with both, so it is important to establish the safest option. Objectives: To assess the benefits and risks of a policy of planned early delivery versus a policy of expectant management in pregnant women with hypertensive disorders, at or near term (from 34 weeks onwards). Search methods: We searched Cochrane Pregnancy and Childbirth Trials Register (12 January 2016) and reference lists of retrieved studies. Selection criteria: Randomised trials of a policy of planned early delivery (by induction of labour or by caesarean section) compared with a policy of delayed delivery ("expectant management") for women with hypertensive disorders from 34 weeks' gestation. Cluster‐randomised trials would have been eligible for inclusion in this review, but we found none. Studies using a quasi‐randomised design are not eligible for inclusion in this review. Similarly, studies using a cross‐over design are not eligible for inclusion, because they are not a suitable study design for investigating hypertensive disorders in pregnancy. Data collection and analysis: Two review authors independently assessed eligibility and risks of bias. Two review authors independently extracted data. Data were checked for accuracy. Main results: We included five studies (involving 1819 women) in this review. There was a lower risk of composite maternal mortality and severe morbidity for women randomised to receive planned early delivery (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.57 to 0.83, two studies, 1459 women (evidence graded high)). There were no clear differences between subgroups based on our subgroup analysis by gestational age, gestational week or condition. Planned early delivery was associated with lower risk of HELLP syndrome (RR 0.40, 95% CI 0.17 to 0.93, 1628 women; three studies) and severe renal impairment (RR 0.36, 95% CI 0.14 to 0.92, 100 women, one study). There was not enough information to draw any conclusions about the effects on composite infant mortality and severe morbidity. We observed a high level of heterogeneity between the two studies in this analysis (two studies, 1459 infants, I2 = 87%, Tau2 = 0.98), so we did not pool data in meta‐analysis. There were no clear differences between subgroups based on our subgroup analysis by gestational age, gestational week or condition. Planned early delivery was associated with higher levels of respiratory distress syndrome (RR 2.24, 95% CI 1.20 to 4.18, three studies, 1511 infants), and NICU admission (RR 1.65, 95% CI 1.13 to 2.40, four studies, 1585 infants). There was no clear difference between groups for caesarean section (RR 0.91, 95% CI 0.78 to 1.07, 1728 women, four studies, evidence graded moderate), or in the duration of hospital stay for the mother after delivery of the baby (mean difference (MD) ‐0.16 days, 95% CI ‐0.46 to 0.15, two studies, 925 women, evidence graded moderate) or for the baby (MD ‐0.20 days, 95% CI ‐0.57 to 0.17, one study, 756 infants, evidence graded moderate). Two fairly large, well‐designed trials with overall low risk of bias contributed the majority of the evidence. Other studies were at low or unclear risk of bias. No studies attempted to blind participants or clinicians to group allocation, potentially introducing bias as women and staff would have been aware of the intervention and this may have affected aspects of care and decision‐making. The level of evidence was graded high (composite maternal mortality and morbidity), moderate (caesarean section, duration of hospital stay after delivery for mother, and duration of hospital stay after delivery for baby) or low (composite infant mortality and morbidity). Where the evidence was downgraded, it was mostly because the confidence intervals were wide, crossing both the line of no effect and appreciable benefit or harm. Authors' conclusions: For women suffering from hypertensive disorders of pregnancy after 34 weeks, planned early delivery is associated with less composite maternal morbidity and mortality. There is no clear difference in the composite outcome of infant mortality and severe morbidity; however, this is based on limited data (from two trials) assessing all hypertensive disorders as one group. Further studies are needed to look at the different types of hypertensive diseases and the optimal timing of delivery for these conditions. These studies should also include infant and maternal morbidity and mortality outcomes, caesarean section, duration of hospital stay after delivery for mother and duration of hospital stay after delivery for baby. An individual patient meta‐analysis on the data currently available would provide further information on the outcomes of the different types of hypertensive disease encountered in pregnancy.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009273.pub2/fullPublisher's versio

Clams and climate in the Kodiak Archipelago, Alaska: insights from oxygen isotope sclerochronological analysis of S. gigantea from middle to late holocene archaeological deposits

The paleoenvironmental record reflects fluctuating marine conditions throughout the Gulf of Alaska during the Late Holocene. The effects of changes in regional climate patterns, as well as human responses to such change, however, can exhibit great variability locally. In the Kodiak Archipelago in the Gulf of Alaska, changing environmental conditions, population growth, technological transitions, and contact with other communities likely promoted the transition from needs based maritime hunter-gatherers to surplus based, semi-permanent villages. The precise role of climate in this transition is understudied. Few paleoclimate reconstructions are available for the Kodiak Archipelago and while climate reconstructions for the Gulf of Alaska are not uncommon, regional climate reconstructions are often insufficient for archaeological research. Many climate reconstructions lack sub-annual resolution and cannot produce a detailed understanding of seasonal behaviors in human populations. Sclerochronological and sclerochemical analysis of shellfish remains from archaeological sites in the archipelago may provide additional paleoenvironmental information. The length of shellfish growing season has been found to decrease with increasing latitude and decreasing temperature. Measuring and comparing the length of seasonal shell growth in select species of bivalves may complement stable oxygen isotope analysis, together providing a more precise paleoclimate reconstruction. This research utilizes the growth of Saxidomus gigantea, abundant both on modern and ancient coastlines to provide information about the length of its growing seasons. Archaeological samples were obtained from four sites from the Kodiak Archipelago, Alaska to determine if changes in seasonality, as measured by the number of circalunidian growth increments in one year, is detectable through time. Three samples from the Rice Ridge site (KOD-363), five samples from the Uyak site (KOD-145) represent sequences from Kachemak period, two samples from the Settlement Point site (AFG-105), and two samples from the New Karluk site (KAR-001) were analyzed.Accepted manuscrip

Geophysical-geotechnical sensor networks for landslide monitoring

Landslides are often the result of complex, multi-phase processes where gradual deterioration of shear strength within the sub-surface precedes the appearance of surface features and slope failure. Moisture content increases and the build-up of associated pore water pressures are invariably associated with a loss of strength, and thus are a precursor to failure. Consequently, hydraulic processes typically play a major role in the development of landslides. Geoelectrical techniques, such as resistivity and self-potential are being increasingly applied to study landslide structure and the hydraulics of landslide processes. The great strengths of these techniques are that they provide spatial or volumetric information at the site scale, which, when calibrated with appropriate geotechnical and hydrogeological data, can be used to characterise lithological variability and monitor hydraulic changes in the subsurface. In this study we describe the development of an automated time-lapse electrical resistivity tomography (ALERT) and geotechnical monitoring system on an active inland landslide near Malton, North Yorkshire, UK. The overarching objective of the research is to develop a 4D landslide monitoring system that can characterise the subsurface structure of the landslide, and reveal the hydraulic precursors to movement. The site is a particularly import research facility as it is representative of many lowland UK situations in which weak mudrocks have failed on valley sides. Significant research efforts have already been expended at the site, and a number of baseline data sets have been collected, including ground and airborne LIDAR, geomorphologic and geological maps, and geophysical models. The monitoring network comprises an ALERT monitoring station connected to a 3D monitoring electrode array installed across an area of 5,500 m2, extending from above the back scarp to beyond the toe of the landslide. The ALERT instrument uses wireless telemetry (in this case GPRS) to communicate with an office based server, which runs control software and a database management system. The control software is used to schedule data acquisition, whilst the database management system stores, processes and inverts the remotely streamed ERT data. Once installed and configured, the system operates autonomously without manual intervention. Modifications to the ALERT system at this site have included the addition of environmental and geotechnical sensors to monitor rainfall, ground movement, ground and air temperature, and pore pressure changes within the landslide. The system is housed in a weatherproof enclosure and is powered by batteries charged by a wind turbine & solar panels. 3D ERT images generated from the landslide have been calibrated against resistivity information derived from laboratory testing of borehole core recovered from the landslide. The calibrated images revealed key aspects of the 3D landslide structure, including the lateral extent of slipped material and zones of depletion and accumulation; the surface of separation and the thickness of individual earth flow lobes; and the dipping in situ geological boundary between the bedrock formations. Time-lapse analysis of resistivity signatures has revealed artefacts within the images that are diagnostic of electrode movement. Analytical models have been developed to simulate the observed artefacts, from which predictions of electrode movement have been derived. This information has been used to correct the ERT data sets, and has provided a means of using ERT to monitor landslide movement across the entire ALERT imaging area. Initial assessment of seasonal changes in the resistivity signature has indicated that the system is sensitive to moisture content changes in the body of the landslide, thereby providing a basis for further development of the system with the aim of monitoring hydraulic precursors to failure