Engaging Youth in Local Government: Lessons from the Boston Region

There is widespread consensus that young people have a right to be directly involved in decisions that affect them, and an understanding that adults are the ones who must create formal pathways of engagement. Yet there remains limited empirical information about the best ways to do so. This paper identifies key lessons gleaned from a multi-method study of twenty-four operating municipal youth councils throughout the greater Boston region. The insight assembled here is based on interviews with youth and adult stakeholders, observations of council meetings, a review of council documents, as well as a review of relevant academic literature. It is intended to guide practitioners in developing or reforming local youth councils.Boston University Initiative on Citie

“\u3cb\u3ePICO\u3c/b\u3e”: \u3cb\u3eP\u3c/b\u3eractice EBM skills, \u3cb\u3eI\u3c/b\u3encrease student interests with \u3cb\u3eC\u3c/b\u3eollaboration of librarians and improve \u3cb\u3eO\u3c/b\u3eutcomes

Available literature on teaching evidence-based medicine (EBM) to medical students focuses on teaching critical appraisal skills, often in the context of a journal club, workshops or lectures. Being able to utilize EBM effectively means that a learner is able to take a clinical scenario, develop a clinically relevant question, search for the evidence, appraise that evidence, and apply the results of this appraisal back to the individual patient. Hence EBM activity is more likely to become a part of clinical decision-making if medical students practice the skills in the context of direct patient care

Evidence-Based Practice for Medical Students in a Family Medicine Clerkship: Collaborative, Active Learning for Clinical Decision Skills

Objectives: This active learning experience was designed to enhance the information literacy knowledge and skills of medical students for patient-centered, evidence-based decisions at the point of care. It includes formulating clinical questions using patient/problem, intervention, comparison, outcome (PICO), accessing the highest level of evidence-based medicine (EBM) information available in an effective manner, and evaluating the information in relation to a specific patient in an outpatient setting. Methods: Third-year medical students participate in a small-group collaborative, patient-centered learning experience during the family medicine clerkship, coordinated by the clerkship directors with participation by two medical librarians. At orientation, the clerkship directors provide the students with an overview of the evidence-based process and creating PICO questions. Librarians then direct a hands-on instruction session covering evidence-based resources and search strategies for finding point-of-care EBM information. Students select a clinical question from a patient encounter in their outpatient clinics. Each student submits a worksheet providing the PICO question, resources consulted, search strategy, selected bibliographic references, and clinical recommendations for their patient. Librarians provide a written assessment and suggestions for improvement relative to the students\u27 search strategies and resource selections. Students then present their patient clinical question, research, and recommendations to the clinical faculty and student group. Results: In the most recent 6 months of this course, 85% of the 55 students participating were rated as “competent” in the areas of resource selection and literature searching on their EBM assignment. Pre- and post-tests results indicate that a majority of the students had an increased familiarity with and appreciation of key evidence-based medicine resources such as Cochrane Reviews, ACP PIER, and FPIN after completing the EBM assignment. Student evaluations reflect increased interest and value in EBM through this experience. Conclusion: Providing an active learning, patient-centered experience with collaboration between clinical faculty and medical librarians has been successful in improving third-year medical student knowledge and skills in medical information literacy for clinical decision making. The project has also provided useful data for ongoing discussions with the college of medicine regarding increasing the longitudinal role of the library throughout the curriculum

Texas Livestock Prices and Statistics.

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Home is where the future is: The BrightFocus Foundation consensus panel on dementia care

IntroductionA national consensus panel was convened to develop recommendations on future directions for home‐based dementia care (HBDC).MethodsThe panel summarized advantages and challenges of shifting to HBDC as the nexus of care and developed consensus‐based recommendations.ResultsThe panel developed five core recommendations: (1) HBDC should be considered the nexus of new dementia models, from diagnosis to end of life in dementia; (2) new payment models are needed to support HBDC and reward integration of care; (3) a diverse new workforce that spans the care continuum should be prepared urgently; (4) new technologies to promote communication, monitoring/safety, and symptoms management must be tested, integrated, and deployed; and (5) targeted dissemination efforts for HBDC must be employed.DiscussionHBDC represents a promising paradigm shift to improve care for those living with dementia and their family caregivers: these recommendations provide a framework to chart a course forward for HBDC.HighlightsFive core BrightFocus Foundation panel recommendations:Home‐based dementia care should be considered the nexus of new long‐term care models.New payment models are needed to stimulate, reward, and support home care practices.A skilled new workforce spanning long‐term care needs to be developed and equipped.New technologies to promote best practices must be tested, integrated, and deployed.Value propositions and improved public health communication are needed.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152597/1/alzjjalz201710006.pd

Understanding earthquake hazards in southern California - the "LARSE" project - working toward a safer future for Los Angeles

The Los Angeles region is underlain by a network of active faults, including many that are deep and do not break the Earth’s surface. These hidden faults include the previously unknown one responsible for the devastating January 1994 Northridge earthquake, the costliest quake in U.S. history. So that structures can be built or strengthened to withstand the quakes that are certain in the future, the Los Angeles Region Seismic Experiment (LARSE) is locating hidden earthquake hazards beneath the region to help scientists determine where the strongest shaking will occur

Study protocol for a type III hybrid effectiveness-implementation trial of strategies to implement firearm safety promotion as a universal suicide prevention strategy in pediatric primary care

BACKGROUND: Insights from behavioral economics, or how individuals\u27 decisions and behaviors are shaped by finite cognitive resources (e.g., time, attention) and mental heuristics, have been underutilized in efforts to increase the use of evidence-based practices in implementation science. Using the example of firearm safety promotion in pediatric primary care, which addresses an evidence-to-practice gap in universal suicide prevention, we aim to determine: is a less costly and more scalable behavioral economic-informed implementation strategy (i.e., Nudge ) powerful enough to change clinician behavior or is a more intensive and expensive facilitation strategy needed to overcome implementation barriers? METHODS: The Adolescent and child Suicide Prevention in Routine clinical Encounters (ASPIRE) hybrid type III effectiveness-implementation trial uses a longitudinal cluster randomized design. We will test the comparative effectiveness of two implementation strategies to support clinicians\u27 use of an evidence-based firearm safety practice, S.A.F.E. Firearm, in 32 pediatric practices across two health systems. All pediatric practices in the two health systems will receive S.A.F.E. Firearm materials, including training and cable locks. Half of the practices (k = 16) will be randomized to receive Nudge; the other half (k = 16) will be randomized to receive Nudge plus 1 year of facilitation to target additional practice and clinician implementation barriers (Nudge+). The primary implementation outcome is parent-reported clinician fidelity to the S.A.F.E Firearm program. Secondary implementation outcomes include reach and cost. To understand how the implementation strategies work, the primary mechanism to be tested is practice adaptive reserve, a self-report practice-level measure that includes relationship infrastructure, facilitative leadership, sense-making, teamwork, work environment, and culture of learning. DISCUSSION: The ASPIRE trial will integrate implementation science and behavioral economic approaches to advance our understanding of methods for implementing evidence-based firearm safety promotion practices in pediatric primary care. The study answers a question at the heart of many practice change efforts: which strategies are sufficient to support change, and why? Results of the trial will offer valuable insights into how best to implement evidence-based practices that address sensitive health matters in pediatric primary care. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04844021 . Registered 14 April 2021

Implementing nudges for suicide prevention in real-world environments: project INSPIRE study protocol

Background: Suicide is a global health issue. There are a number of evidence-based practices for suicide screening, assessment, and intervention that are not routinely deployed in usual care settings. The goal of this study is to develop and test implementation strategies to facilitate evidence-based suicide screening, assessment, and intervention in two settings where individuals at risk for suicide are especially likely to present: primary care and specialty mental health care. We will leverage methods from behavioral economics, which involves understanding the many factors that influence human decision making, to inform strategy development. Methods: We will identify key mechanisms that limit implementation of evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health through contextual inquiry involving behavioral health and primary care clinicians. Second, we will use contextual inquiry results to systematically design a menu of behavioral economics-informed implementation strategies that cut across settings, in collaboration with an advisory board composed of key stakeholders (i.e., behavioral economists, clinicians, implementation scientists, and suicide prevention experts). Finally, we will conduct rapid-cycle trials to test and refine the menu of implementation strategies. Primary outcomes include clinician-reported feasibility and acceptability of the implementation strategies. Discussion: Findings will elucidate ways to address common and unique barriers to evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health care. Results will yield refined, pragmatically tested strategies that can inform larger confirmatory trials to combat the growing public health crisis of suicide

Effect of Deutetrabenazine on Chorea Among Patients With Huntington Disease A Randomized Clinical Trial

Importance Deutetrabenazine is a novel molecule containing deuterium, which attenuates CYP2D6 metabolism and increases active metabolite half-lives and may therefore lead to stable systemic exposure while preserving key pharmacological activity. Objective To evaluate efficacy and safety of deutetrabenazine treatment to control chorea associated with Huntington disease. Design, Setting, and Participants Ninety ambulatory adults diagnosed with manifest Huntington disease and a baseline total maximal chorea score of 8 or higher (range, 0-28; lower score indicates less chorea) were enrolled from August 2013 to August 2014 and randomized to receive deutetrabenazine (n = 45) or placebo (n = 45) in a double-blind fashion at 34 Huntington Study Group sites. Interventions Deutetrabenazine or placebo was titrated to optimal dose level over 8 weeks and maintained for 4 weeks, followed by a 1-week washout. Main Outcomes and Measures Primary end point was the total maximal chorea score change from baseline (the average of values from the screening and day-0 visits) to maintenance therapy (the average of values from the week 9 and 12 visits) obtained by in-person visits. This study was designed to detect a 2.7-unit treatment difference in scores. The secondary end points, assessed hierarchically, were the proportion of patients who achieved treatment success on the Patient Global Impression of Change (PGIC) and on the Clinical Global Impression of Change (CGIC), the change in 36-Item Short Form– physical functioning subscale score (SF-36), and the change in the Berg Balance Test. Results Ninety patients with Huntington disease (mean age, 53.7 years; 40 women [44.4%]) were enrolled. In the deutetrabenazine group, the mean total maximal chorea scores improved from 12.1 (95% CI, 11.2-12.9) to 7.7 (95% CI, 6.5-8.9), whereas in the placebo group, scores improved from 13.2 (95% CI, 12.2-14.3) to 11.3 (95% CI, 10.0-12.5); the mean between-group difference was –2.5 units (95% CI, –3.7 to –1.3) (P < .001). Treatment success, as measured by the PGIC, occurred in 23 patients (51%) in the deutetrabenazine group vs 9 (20%) in the placebo group (P = .002). As measured by the CGIC, treatment success occurred in 19 patients (42%) in the deutetrabenazine group vs 6 (13%) in the placebo group (P = .002). In the deutetrabenazine group, the mean SF-36 physical functioning subscale scores decreased from 47.5 (95% CI, 44.3-50.8) to 47.4 (44.3-50.5), whereas in the placebo group, scores decreased from 43.2 (95% CI, 40.2-46.3) to 39.9 (95% CI, 36.2-43.6), for a treatment benefit of 4.3 (95% CI, 0.4 to 8.3) (P = .03). There was no difference between groups (mean difference of 1.0 unit; 95% CI, –0.3 to 2.3; P = .14), for improvement in the Berg Balance Test, which improved by 2.2 units (95% CI, 1.3-3.1) in the deutetrabenazine group and by 1.3 units (95% CI, 0.4-2.2) in the placebo group. Adverse event rates were similar for deutetrabenazine and placebo, including depression, anxiety, and akathisia. Conclusions and Relevance Among patients with chorea associated with Huntington disease, the use of deutetrabenazine compared with placebo resulted in improved motor signs at 12 weeks. Further research is needed to assess the clinical importance of the effect size and to determine longer-term efficacy and safety