Exploring the relationship between forest resource users and their disappearing forest: what do rural Gambians think are the causes and solutions for deforestation?

Master's Project (M.S.) University of Alaska Fairbanks, 2017This is a case study of a small rural community in The Gambia where I was a Peace Corps volunteer for 27 months. The savannah woodland there is classified as a dry tropical forest and like many such areas in the Sahel, the population is growing rapidly. During my time there, I observed a great dependence on local forests but no apparent management. One man told me, "If all the trees perish, then we will all perish." Given this level of dependence, I was surprised to see little evidence that they were planting trees or taking other measures to protect the forest. I wanted to find out just how dependent people were on the forest and whether they saw deforestation as a problem. If they saw it as a problem, what did they feel were the causes of it and what did they think would solve it? Since I was living in the area, I was able to use participant observation as a method in my research. I also used semi-structured interviews of key informants and focus group interviews in five communities that were located close together. I found that the people are extremely dependent on the local forest for firewood, lumber for houses and fences, foods like baobab and mangoes, and herbs for medicines (they had limited access to commercial medicines). This dependence places them in a precarious situation as rural poverty and food insecurity forces farmers to expand their agricultural fields at the expense of the forests. Everyone saw deforestation as a problem and noted that they have to walk farther to gather firewood and that the forest was once thick with trees and wild animals, but now "many trees have perished" and there are few animals. They saw population growth as the primary cause of deforestation, because that forces them to clear trees to make room to grow more crops. They also mentioned illegal logging, drought and bushfires as problems for the forest. They viewed tree planting as the primary solution and would like to plant trees near their homes where they could protect them, but there are a host of challenges to growing seedlings in this region. The biggest problems are watering the seedlings, as that requires carrying many gallons of water to each seedling on a daily basis, and protecting young trees from termites as well as goats and other animals. They would like to have more support from the Gambian government to teach them better ways to plant and grow trees, to learn more about manure and other ways to improve soil fertility, to help them pay for good fences, and to combat bushfires. There are many studies regarding tree planting, but few of them address the cultural perspective of forest use and management in the way this study does. These people face a life-threatening dilemma in trying to solve the problem of deforestation. They have had little success planting trees and will face serious shortages of essential items like firewood, lumber, medicines and food if the problem continues. They do not have the income to buy these goods. I hope this study will contribute to understanding the complexity of the situation, which in turn should assist NGOs and others to develop workable solutions to the problem of deforestation in this and other dry tropical forests of the Sahel

Barriers to Cardiac Rehabilitation Participation: Predicting Enrollment in an Urban, Safety-Net Hospital

The Centers for Disease Control and Prevention (CDC) suggest that cardiovascular disease (CVD) is the leading cause of death in the United States. It is estimated that approximately 600,000 people die each year from CVD-related causes (Kochanek, Xu, Murphy, Minino, & Kung, 2011). However, these mortality rates vary among socioeconomic classes. There are more risk factors associated with CVD-related mortality in individuals of lower socioeconomic status (SES) compared to those of middle or high SES, such as less access to effective health care services, increased likelihood of sedentary lifestyles, greater exposure to tobacco, and lack of health insurance (Mead, Andres, Ramos, Siegal, & Regenstein, 2010). Although these risk factors are present, some of these are modifiable by secondary prevention efforts such as cardiac rehabilitation (CR). CR has been shown to be effective in improving clinical outcomes of patients with CVD (Dunlay et al., 2009). Specifically, CR is associated with decreased risk of subsequent cardiac events as well as cardiac-related mortality. Although CR is associated with beneficial outcomes following CVD, referral to and participation rates in CR are low (Grace et al., 2009). Among eligible CR patients, it is estimated that approximately 14% to 55% of those referred actually participate, with even lower participation rates reported among women, elderly, minorities, and economically disadvantaged populations (Dunlay et al., 2009). Previous research has examined psychosocial, demographic, and clinical predictors of participation in CR predominantly with patients of middle to high-income status, most of whom had health insurance. For example, Lane, Carroll, Ring, Beevers, and Lip (2001) examined predictors of attendance after myocardial infarction (MI). Among 263 eligible participants, 108 (41%) attended CR. Results showed that those who did not attend CR were more likely to be female, live alone, lack employment, live in economicallydeprived areas, show more symptoms of depression and anxiety, and exercise infrequently prior to MI. Additionally, Dunlay et al. (2009) investigated perceived barriers to participation in CR. Among 179 survey respondents, 115 (64.2%) attended CR. Patient and clinical characteristics associated with CR participation included younger age, male sex, lack of diabetes, more severe myocardial infarctions (MI), no prior MI, and no prior CR attendance. The psychosocial factors associated with participation included placing a high importance on CR, feeling that CR was necessary, better perceived health prior to MI, the ability to drive, and post-secondary education. Results showed that the most commonly endorsed barriers to participating in CR were the associated costs and lack of insurance coverage (27.9%), and perceived inconvenience (20.1%). Although these findings are significant in discovering factors associated with participation in CR, their sample included middle and high SES participants, and was predominantly (90%) European American. More information regarding perceived barriers to participation in CR is necessary to understand how social and psychological factors impact outcomes following a CVD diagnosis. The purpose of the current study was to examine rates of enrollment, demographic characteristics, and perceived barriers to participation in CR within a diverse sample of patients eligible for CR at a safety-net hospital. Further, I sought to investigate the relationship of demographic characteristics and perceived barriers in predicting enrollment in CR within this sample

Promoting Crew Autonomy: Current Advances and Novel Techniques

Since the dawn of the era of human space flight, mission control centers around the world have played an integral role in guiding space travelers toward mission success. In the International Space Station (ISS) program, astronauts and cosmonauts have the benefit of near constant access to the expertise and resources within mission control, as well as lifeboat capability to quickly return to Earth if something were to go wrong. As we move into an era of longer duration missions to more remote locations, rapid and ready access to mission control on earth will no longer be feasible. To prepare for such missions, long duration crews must be prepared to operate more autonomously, and the mission control paradigm that has been successfully employed for decades must be re-examined. The team at NASA's Payload Operations and Integration Center (POIC) in Huntsville, Alabama is playing an integral role in the development of concepts for a more autonomous long duration crew of the future via research on the ISS

AN IMPLEMENTATION ANALYSIS OF NEEDLE EXCHANGE PROGRAMS IN KENTUCKY: IMPLEMENTATION BARRIERS AND FACILITATORS IDENTIFIED BY STAKEHOLDERS

Kentucky law authorizes county health departments to implement harm reduction needle exchange programs given that the county receives approval from all governing authorities including the local and/or district boards of health, the county government, and the city government in the jurisdiction in which the exchange is intended to operate. As of April 2016, five county health departments operate needle exchange programs and around 20 other county health departments are seeking approval from their governing authorities or beginning to discuss engaging in this process. I conducted qualitative interviews with key stakeholders in the implementation process to determine the facilitators and barriers of needle exchange program implementation. In counties that have implemented programs, the political climates were supportive or became supportive after being educated about harm reduction. However, in two counties that are currently stalled in implementation efforts, education alone has not proven to be an effective facilitator at all levels of government. Instead, the political leaders either will not agree that the program is needed or cannot agree on the logistics of the intended program. This is due in part to the influence of the political climate. The implications of this study are that disseminating knowledge about evidence-based policies and the process of implementation is complex, particularly with needle exchange program implementation, due to a lack of understanding or a lack of acceptance of evidence based research and due to debate among governing authorities. The findings of this study show that implementation facilitators such as presenting evidence-based research and gaining support from key partners alone do not cause approval. Other factors such as acceptance by all stakeholders, recognition of the drug issue, the climate, and the views of the electorate are more influential in policy decision-making

Mental health encounters between general practitioners and individuals with a refugee background : Help seeking and provision in the resettlement context

Background: Research suggests that individuals with a refugee background have higher rates of certain mental health problems and unmet mental healthcare needs than non-refugee populations in resettlement countries. The mechanisms underlying these disparities are still being delineated. The general practitioner (GP) plays an important role in refugees’ mental healthcare, managing cases of mild to moderate mental health problems within primary care and acting as gatekeeper to specialist services. However, GPs have reported feeling uncertain about working with refugee patients, and it has been suggested that individuals with a refugee background may not necessarily consider the GP as a source of help for mental health concerns, although this may vary based on level of integration in the resettlement society. The overall aim of this thesis is to examine how GPs experience and manage the provision of mental healthcare to individuals with a refugee background with a focus on perceived barriers and facilitators. Furthermore, this thesis aims to examine how the GP fits into the larger context of mental health help-seeking preferences among Syrians with a refugee background living in Norway, and the role of integration in considering the GP as a source of help. Methods: First, we conducted semi-structured interviews with 15 GPs working in Norway, to investigate barriers and facilitators regarding the provision of mental healthcare to individuals with a refugee background. Inspired by the findings from these interviews, we developed and distributed an online experimental survey to GPs in Norway (N=133), to examine whether they made different clinical decisions about simulated clinical consultations with Somali refugee vs. Norwegian patients. Participants were randomized to watch a film vignette of a simulated consultation with either a female Norwegian, female Somali refugee, male Norwegian, or male Somali refugee vignette character, presenting the same symptoms of depression. GPs indicated which diagnoses, assessments, and treatments they would endorse for the patient and their level of certainty in their decisions. To examine the help-seeking preferences of Syrians with a refugee background living in Norway (N=92), we conducted a combined text vignette and survey design. We explored how the GP fits into the larger context of help-seeking preferences among this sample, what barriers they perceived in accessing help from the GP, and how indicators of integration relate to seeking help from the GP. Results: The main challenges presented by GPs regarding working with refugees suffering from mental health problems related to language barriers, that refugee patients had different expectations of them than other patients did, that they had different understandings of health and illness than refugee patients, and that GPs felt unprepared to work with this patient group. However, they highlighted that the above-mentioned challenges were improved when they had a trusting relationship with their patient and pointed out that working with refugee patients was meaningful for them. The experimental survey revealed that GPs’ clinical decisions about Somali refugee and Norwegian vignette characters displaying identical symptoms of depression were similar, with a few exceptions. There was less consensus regarding the first prioritized diagnosis for Somali characters vs. Norwegian characters. Somalis more frequently received PTSD diagnoses, while Norwegians received diagnoses of feeling depressed. GPs endorsed sick leave more often for Norwegian characters and medication for physical complaints for Somali characters. However, despite having mentioned feelings of uncertainty during the interviews, we found no strong evidence of a substantial difference in GPs’ self-reported certainty regarding clinical decisions made about Somali vs. Norwegian vignette characters. Finally, the survey conducted among Syrians with a refugee background found that participants were somewhat likely to seek help from the GP, although it was indicated that seeking help from one’s relationship with Allah/God and one’s partner was preferred. Furthermore, while the GP was rated a somewhat likely help-seeking source, most participants indicated an average of two barriers to seeking help from the GP. The most common barriers included ‘language barriers’, ‘I don’t think it would help’, ‘the waiting times are too long’, and ‘I don’t think my GP would understand’. Finally, social ties to the majority population in the form of social integration and feelings of connectedness with the host country (psychological integration) were positively correlated with likelihood of seeking help from the GP. Conclusions: The findings suggest that GPs and Syrians with a refugee background living in Norway perceive both practical as well as interpersonal barriers to providing, and accessing, mental healthcare. Our findings suggest that even in the absence of barriers and confounding variables, GPs may be influenced by patient characteristics when making clinical decisions, albeit to a small degree. Furthermore, our findings suggest that the GP is considered a viable source of help among Syrians with a refugee background in the current sample, but that their willingness and ability to seek help from the GP may be influenced by perceived barriers. A main take home message from this thesis is the facilitating effect of social connection, both between GP and patient, in the form a trusting relationship, but also regarding the patient’s social network in the host country. This suggests that a focus on a trusting relationship and a consideration of the patients’ social network may act as a facilitator to being able to offer appropriate mental healthcare, as well as facilitate refugee patients’ ability to consider and access this care. Furthermore, findings highlight the impact of psychological integration, i.e., feelings of connectedness with the host country, as a potential facilitator of considering the GP as a viable source of help for mental health problems. Our findings give an important insight into how the GP can be understood in the integration/resettlement process, and what the characteristics are of individuals, who are more or less likely to seek professional help.Bakgrunn: Forskning viser at personer med flyktningbakgrunn har høyere forekomst av psykiske lidelser og udekkede behov for psykisk helsevern enn majoritetsbefolkningen. Mekanismene som ligger til grunn for disse forskjellene er fortsatt ikke helt klare. Fastlegene spiller en viktig rolle i flyktningers psykiske helsevern, håndterer tilfeller av milde til moderate psykiske problemer i primærhelsetjenesten og fungerer som døråpner til spesialisttjenester. Fastleger har imidlertid rapportert at de føler seg usikre på det å arbeide med flyktningpasienter. Det har blitt antydet at personer med flyktningbakgrunn ikke nødvendigvis anser fastlegen som en kilde til hjelp for psykiske helseproblemer, selv om dette kan variere basert på integreringsnivå i det nye landet. Målet med denne doktorgraden er å undersøke hvordan fastleger opplever og håndterer kliniske møter med flyktninger som har psykiske lidelser, og i hvilken grad flyktninger selv vurderer fastlegen som en kilde for hjelp i slike situasjoner. Metoder: Først gjennomførte vi semistrukturerte intervjuer med 15 fastleger i Norge, for å undersøke hva de syntes sto i veien for, eller hjalp, det å kunne gi effektiv psykisk helsehjelp til personer med flyktningbakgrunn. Inspirert av funnene fra intervjuene utviklet og distribuerte vi en nettbasert eksperimentell undersøkelse, for å undersøke om fastleger (N=133) tok ulike kliniske beslutninger om simulerte kliniske møter med somaliske flyktninger vs. norske pasienter. Deltakerne ble randomisert til å se en kort filmsnutt av enten en kvinnelig norsk, kvinnelig somalisk, mannlig norsk eller mannlig somalisk vignettkarakter, som presenterte de samme symptomene på depresjon. Vi spurte fastleger til å angi hvilke diagnoser, vurderinger og behandlinger de ville ha valgt for pasienten og deres grad av sikkerhet i den beslutningen. For å undersøke preferansene til å søke psykisk helsehjelp blant syrere med flyktningbakgrunn i Norge (N=92), gjennomførte vi en undersøkelse hvor syriske deltakere leste en vignette som beskrev personer som viste symptomer på depresjon. Etterpå spurte vi deltakerne til å angi hvor de hadde søkt hjelp, dersom de følte seg som vignettekarakteren. Vi spurte også om hvilke barrierer de oppfattet som kunne stå i veien for å søke hjelp fra fastlegen. Til slutt undersøkte vi hvilken rolle deltakernes integrering spilte i deres sannsynlighet til å søke hjelp fra fastlegen. Resultater: Hovedutfordringene fastlegene beskrev og fortalte om i intervjuene var knyttet til språkbarrierer, at flyktningpasienter hadde andre forventninger til helsetjenestene enn andre pasienter, at fastleger hadde en annen forståelse av helse og sykdom enn flyktningpasienter, og at fastlegene følte seg uforberedt til å jobbe med denne pasientgruppen. Utfordringene lettet imidligertid når de hadde fått bygge et tillitsfullt forhold til pasienten sin og påpekte at arbeidet med flyktningpasienter var meningsfullt. Den eksperimentelle undersøkelsen viste at fastlegenes kliniske beslutninger om somaliske og norske vignettkarakterer var like, med noen få unntak. Det var mindre enighet om den første prioriterte diagnosen for somaliske karakterer vs. norske karakterer. Somaliere var de eneste som fikk PTSD-diagnoser, mens nordmenn oftere fikk diagnosen ‘feeling depressed’. Fastlegene foreslo oftere å skrive ut sykemelding for norske karakterer, og oftere medisiner for fysiske plager for somaliske karakterer. Til tross for å ha nevnt følelser av usikkerhet under intervjuene, fant den eksperimentelle undersøkelsen ingen vesentlige forskjeller i fastlegenes selvrapporterte sikkerhet angående kliniske avgjørelser tatt for somaliske vs. norske vignettkarakterer. Til slutt fant undersøkelsen utført blant syrere med flyktningbakgrunn at deltakerne beskrev noe sannsynlighet for å søke hjelp fra fastlegen for psykiske plager, selv om det ble indikert at det å søke hjelp fra Allah/Gud og ens partner var foretrukket. Videre, mens fastlegen ble vurdert som en noe sannsynlig kilde for hjelp, anga de fleste deltakerne i gjennomsnitt to barrierer for å søke hjelp hos fastlegen. De mest indikerte barrierene inkluderer «språkbarrierer», «Jeg tror ikke det ville hjelpe», «ventetidene er for lange» og «Jeg tror ikke fastlegen min ville forstå». Til slutt var sosiale tilknytning til majoritetsbefolkningen i form av sosial integrasjon og følelser av tilknytning til det nye landet (psykologisk integrasjon) positivt korrelert med sannsynligheten for å søke hjelp hos fastlegen. Konklusjoner: Funnene tyder på at fastleger og pasienter oppfatter både praktiske og mellommenneskelige barrierer i det å gi eller få psykisk helsehjelp. Funnene våre tyder også på at selv i situasjoner der barrierer og andre faktorer ikke spiller inn, kan fastleger bli påvirket av pasientens bakgrunn og kjønn når de tar kliniske beslutninger, men bare i liten grad. Videre tyder våre funn på at fastlegen anses som en aktuell kilde til psykisk helse hjelp blant syrere med flyktningbakgrunn i utvalget vårt, men at deres vilje og evne til å søke hjelp hos fastlegen kan være påvirket av opplevde barrierer. Et hovedbudskap fra denne doktorgraden er den gode effekten av sosial tilknytning, både mellom fastlege og pasient, i form av et tillitsfullt forhold, men også når det gjelder pasientens sosiale nettverk i det nye landet samt følelser av tilknytning til det nye landet. Dette tyder på at det å legge vekt på å bygge et tillitsfullt forhold og å ta hensyn til pasientenes sosiale nettverk kan bidra til å kunne gi bedre psykisk helsehjelp, samt å legge til rette for flyktningpasienters mulighet til å få tilgang til denne omsorgen. Våre funn gir videre et viktig innblikk i hvordan det å gå til fastlegen kan forstås i flyktningens integrerings-/bosettingsprosessen, og hvem som har mindre sannsynlighet for å søke profesjonell psykisk helsehjelp.Doktorgradsavhandlin

Addressing Human Error in International Space Station Flight Control Teams: Advances in Ground Training for Science Operators

In flight control, as with any human in the loop system, operator error is an inevitable reality. On the International Space Station (ISS) where crew time and physical resources are precious and often irreplaceable, operator errors can result in significant, irreversible consequences. Flight controllers at the Payload Operations Integration Center (POIC) located at NASA's Marshall Space Flight Center (MSFC) in Huntsville, Alabama know this reality well. At the POIC, operator errors can be caused by a variety of factors, from poor hardware or software design to environmental factors such as time pressure or fatigue. The most difficult errors to address, however, are those which result from ineffective teamwork. To address these teamwork errors, trainers at the POIC have drawn best practices from high reliability industries as well as from our sister ISS control center at the Johnson Space Center (JSC) in Houston, Texas, to develop and implement a new training program focused specifically on teamwork skills. This training program, called Team Skills Training, is inspired by modern and historical training programs developed by NASA and is specifically tailored to the needs of the payload operations flight control team at the POIC. The program consists of training for both certified and trainee flight controllers, and covers team skills topics such as situational awareness, leadership, and communication skills. To maximize effectiveness, the program uses novel instructional techniques which extend beyond the classroom to encourage students to apply what they have learned to their day to day work. Minimizing operator errors in flight control is an endeavor which requires constant vigilance and continuous improvement. At the POIC, Team Skills Training is an important step in this journey

Addressing Human Error in International Space Station Flight Control Teams: Advances in Ground Training for Science Operators

In flight control, as with any human in the loop system, operator error is an inevitable reality. On the International Space Station (ISS) where crew time and physical resources are precious and often irreplaceable, operator errors can result in significant, irreversible consequences. Flight controllers at the Payload Operations Integration Center (POIC) located at NASAs Marshall Space Flight Center (MSFC) in Huntsville, Alabama know this reality well. At the POIC, operator errors can be caused by a variety of factors, from poor hardware or software design to environmental factors such as time pressure or fatigue. The most difficult errors to address, however, are those which result from ineffective teamwork.Academic research in teamwork has resulted in the identification of many factors which make cross-functional teaming difficult, including leadership, trust building, and communication challenges. These factors, especially when combined with the challenging environmental factors flight control teams must contend with daily, make the goal of minimizing operator errors in payload operations challenging to achieve. To address such teamwork errors, trainers at the POIC have drawn best practices from high reliability industries such as commercial aviation, healthcare, and nuclear power plants, as well as from our sister ISS control center in Houston, Texas, to develop and institute a new training program focused specifically on teamwork skills.This training program, called the Team Skills Curriculum, is based on the concept of Crew Resource Management (CRM) which was developed by NASA in the 1970s for the commercial aviation industry in response to a series of aviation disasters resulting from ineffective teamwork. CRM was later tailored by the Johnson Space Center (JSC) for use in astronaut and flight control training. The result, called Space Flight Resource Management (SFRM) was formally introduced into manned spaceflight training in the late 90s. SFRM has evolved over the years, but the focus has remained on helping operators develop the skills needed to work as part of an effective team. Using these concepts as well as the latest research in cross-functional teaming and data on specific errors occurring at the POIC, trainers in the integrated flight control training branch created a custom training program for both new and certified payload operations specialists

Exploring Young People's Constructions of a First Episode of Psychosis

Background: Mental health services have been demonstrated to play a key role in shaping how people make sense of their experiences of psychosis. Past research has highlighted the dominance of the biomedical model within services, however, first-person accounts suggest this is not always meaningful or helpful for recovery. Early Intervention in Psychosis (EIP) services aim to provide a more holistic, non-stigmatising approach for young people experiencing a First Episode of Psychosis (FEP). However, there is very limited research exploring how these services might impact upon how young people construct their experiences. This study aimed to explore the culturally available narratives drawn upon by young people accessing EIP services and the consequences of these for service utilisation and subjectivity. Method: Semi-structured interviews were carried out with five young people (aged 18-35) who were accessing an EIP service for a FEP. A Narrative Analysis (NA) approach facilitated exploration of how young people constructed their experiences of a FEP and how they narrated this had changed since accessing the EIP service. Results: The participant’s narratives emphasised the idiosyncratic ways they constructed their FEP, drawing on a range of culturally available discourses. While accessing the EIP service appeared to facilitate the exploration of a range of casual theories, often drawing on a biopsychosocial model, their narratives also highlighted the implicit power of the biomedical approach in shaping their sense of self and the future. Conclusions: The findings support previous literature that highlights the importance of meaning-making for young people experiencing a FEP. The discourses available within EIP services appear to play a key role in shaping young people’s constructions and this study highlights the value of privileging multiple perspectives when supporting people to make sense of their experiences of psychosis

Employer Perceptions of Newly Credentialed Athletic Trainers as They Transition to Practice

Please enjoy Volume 5, Issue 1 of the JSMAHS. In this issue you will find Professional and under graduate research abstracts, case reports, and critically appraised topics. Thank you for viewing this 5th Annual OATA Special Edition

Community outreach initiatives at UNCG Libraries: the ROI of ROI outreach

The notion of “community outreach” can be complicated for academic libraries, because both “community” and “outreach” can have multiple meanings. While many academic libraries have a mission or administrative mandate to engage with local and regional communities, these initiatives are not always backed with material support, adequate staffing, or equal distribution of responsibilities within the library. Thus, it can be difficult for academic libraries to engage in community outreach while still serving the core constituency of the institution: students, faculty, and staff. In response to this issue, this paper discusses various strategic planning models that can be used to plan for community outreach initiatives within academic libraries, featuring a case study of a health information literacy outreach event planned and executed by a team of librarians from the Research, Outreach, and Instruction department within UNC Greensboro’s University Libraries. Additionally, the authors of the paper propose a framework for determining the return on investment and feasibility of outreach opportunities, which is in turn applied to the case study