Summary of Major Findings: Learn and Serve America, Higher Education

This report provides an overview of results from the first year evaluation of Learn and Serve America, Higher Education (LSAHE), an initiative of the Corporation for National Service (CNS). The evaluation assessed the impacts of LSAHE on communities, students, and institutions in fiscal year 1995

The Policy Implications of Interactions Among Financial Aid Programs

Various gift-aid, loan, and work-study programs help college students fill the gap between educational costs and their financial resources. Previous research generally has examined the effects of a given program by itself. What is missing are studies that investigate interactions among programs, such as how state or university grants reinforce or offset the targeting policies that are embedded in the Pell program. This article draws on research conducted on colleges in Indiana to describe how federal, state, private, and college-based financial aid programs and practices interact with each other to determine the total amount of gift-aid a student receives. It discusses how these relationships can dilute or enhance a program\u27s implicit targeting policies. The lessons learned from this experience provide important insights for developing a fuller appreciation of how current and future gift-aid programs may affect each other

Evaluation of Learn and Serve America, Higher Education: First Year Report, Volume I

This report presents evaluation results for the first year of the Learn and Serve America, Higher Education (LSAHE) initiative, sponsored by the Corporation for National and Community Service (CNS). It addresses impacts of LSAHE on communities, higher education institutions, and service providers

Poor access to kidney disease management services in susceptible patient populations in rural Australia is associated with increased aeromedical retrievals for acute renal care

Background Inequalities in access to renal services and acute care for rural and remote populations in Australia have been described but not quantified. Aim To describe: the coverage of renal disease management services in rural and remote Australia; and the characteristics of patients who had an aeromedical retrieval for renal disease by Australia's Royal Flying Doctor Service (RFDS). Methods Data from the RFDS, the Australian Bureau of Statistics, and Health Direct were used to estimate provision of renal disease management services by geographic area. RFDS patient diagnostic data were prospectively collected from 2014 to 2018. Results Many rural and remote areas have limited access to regular renal disease management services. Most RFDS retrievals for renal disease are from regions without such services. The RFDS conducted 1636 aeromedical retrievals for renal disease, which represented 1.6% of all retrievals. Among retrieved patients, there was a higher proportion of men than women (54.6% vs 45.4%, P < 0.01), while indigenous patients (n = 546, 33.4%) were significantly younger than non‐indigenous patients (40.9 vs 58.5, P < 0.01). There were significant differences in underlying diagnoses triggering retrievals between genders, with males being more likely than females to be transferred with acute renal failure, calculus of the kidney and ureter, renal colic, obstructive uropathy, and kidney failure (all P < 0.01). Conversely, females were more likely to have chronic kidney disease, disorders of the urinary system, acute nephritic syndrome, tubulo‐interstitial nephritis, and nephrotic syndrome (all P < 0.01). Conclusion Aeromedical retrievals for acute care were from rural areas without regular access to renal disease prevention or management services

Rural and remote dental care: Patient characteristics and health care provision

Objective: To describe the characteristics of patients who used the Royal Flying Doctor Service dental clinics and determine Royal Flying Doctor Service and nonRoyal Flying Doctor Service dental service provision in mainland Australia. Design: A prospective cohort study. Setting: All Royal Flying Doctor Service dental clinics located throughout rural and remote Australia. Participants: All patients who accessed an Royal Flying Doctor Service dental clinic from April 2017 to September 2018. Interventions: Royal Flying Doctor Service mobile dental clinics. Main outcome measures: Patient demographics and dental procedures conducted (by age, sex and Indigenous status); and the dental service provision and coverage (Royal Flying Doctor Service and non-Royal Flying Doctor Service) within mainland rural and remote Australia. Results: There were 8992 patient episodes comprising 3407 individual patients with 27 897 services completed. There were 920 (27%) Indigenous and 1465 (43%) nonIndigenous patients (n = 1022 missing ethnicity data). The mean (SD) age was 31.5 (24.8) years; the age groups 5-9 years and 10-14 years received 17.6% and 15.1% of the services, respectively. There were 1124 (33%) men and 1295 (38%) women (n = 988 with missing sex data). Women were more likely (all P < .05) to receive preventive services, diagnostic services, restorative services, general services, endodontics and periodontics. Men were more likely (both P < .05) to receive oral surgery and prosthodontics. There are many rural and remote people required to travel more than 60 minutes by vehicle to access dental care. Conclusion: Without increasing dental provision and preventive services in rural areas, it seems likely that there are and will be unnecessary oral emergencies and hospitalisations

Acceptability, feasibility and preliminary efficacy of low-moderate intensity Constraint Induced Aphasia Therapy and Multi-Modality Aphasia Therapy in chronic aphasia after stroke

Background: High-intensity Constraint-Induced Aphasia Therapy Plus (CIAT-Plus) and Multi-Modality Aphasia Therapy (M-MAT) are effective interventions for chronic post-stroke aphasia but challenging to provide in clinical practice. Providing these interventions may be more feasible at lower intensities, but comparative evidence is lacking. We therefore explored feasibility, acceptability, and preliminary efficacy of the treatments at a lower intensity. Methods: A multisite, single-blinded, randomized Phase II trial was conducted within the Phase III COMPARE trial. Groups of participants with chronic aphasia from the usual care arm of the COMPARE trial were randomized to M-MAT or CIAT-Plus, delivered at the same dose as the COMPARE trial but at lower intensity (6 hours/week × 5 weeks rather than 15 hours/week × 2 weeks). Blinded assessors measured aphasia severity (Western Aphasia Battery-Revised Aphasia Quotient), word retrieval, connected speech, multimodal communication, functional communication, and quality of life immediately post interventions and after 12 weeks. Feasibility and acceptability were explored. Results: Of 70 eligible participants, 77% consented to the trial; 78% of randomized participants completed intervention and 98% of assessment visits were conducted. Fatigue and distress ratings were low with no related withdrawals. Adverse events related to the trial (n = 4) were mild in severity. Statistically significant treatment effects were demonstrated on word retrieval and functional communication and both interventions were equally effective. Conclusions: Low–moderateintensity CIAT-Plus and M-MAT were feasible and acceptable. Both interventions show preliminary efficacy at a low–moderate intensity. These results support a powered trial investigating these interventions at a low–moderate intensity

“Communication is taking a back seat”: speech pathologists’ perceptions of aphasia management in acute hospital settings

Background: Current service provision to people with aphasia in the acute hospital setting is reported to be inconsistent with best-practice recommendations. While speech pathologists (SPs) have been noted to express dissatisfaction with this, the underlying reasons for this evidence-practice gap are unclear. Change is required in order to move towards the provision of gold-standard aphasia management in acute hospitals. The voices of SPs working in this setting, and knowledge of their perceptions of the factors that influence their current practice, are essential in order to facilitate their capacity to act as agents for change

'That doesn't translate': The role of evidence-based practice in disempowering speech pathologists in acute aphasia management

BackgroundAn evidence-practice gap has been identified in current acute aphasia management practice, with the provision of services to people with aphasia in the acute hospital widely considered in the literature to be inconsistent with best-practice recommendations. The reasons for this evidence-practice gap are unclear; however, speech pathologists practising in this setting have articulated a sense of dissonance regarding their limited service provision to this population. A clearer understanding of why this evidence-practice gap exists is essential in order to support and promote evidence-based approaches to the care of people with aphasia in acute care settings

The consequences of the consequences: The impact of the environment on people with aphasia over time

Understanding the impact of the environment on the participation of people with aphasia depends on one's perspective. A long-term perspective provides a unique insight into the myriad of ways in which the environment can influence the participation of people living with aphasia over decades. In this article, the authors present the real-life story of "Hank," who has lived with aphasia for more than 15 years. The authors consider how 2 different conceptual frameworks-the International Classification of Functioning, Disability and Health and the Social Determinants of Health-account for Hank's experience. The International Classification of Functioning, Disability and Health is useful to conceptualize the range of factors that influence living with aphasia at a particular point in time. In contrast, the Social Determinants of Health is useful to conceptualize the cumulative impact of living with aphasia on long-term health and well-being. Viewing aphasia as a social condition that impacts social determinants of health has potentially wide ranging implications for service design and delivery and the role of speech-language pathologists