Intuition as Design Dialogue: Discovering a Language beyond Words

Henri Bergson considered the truest form of knowing to be attainable only through acts of intuition, as he believed the intuitive state created a direct connection to reality itself.For architecture, a field that is grounded in experience, it is important to balance the drive of the intellect with intuitive strategies, which help move toward the unification of data under an experiential aegis. Drawing primarily upon the writings of Bergson and Martin Heidegger, this paper describes how the reductive proclivities of the intellect tend to obscure the embodied insights of intuition, and how the listening response of intuition reveals a primal language that is activated by the immersed dialogue of one experiencing the world

Placing the Fourfold: Topology as Environmental Design

In his later writing, Martin Heidegger outlines an existential structure called the fourfold, which is composed of earth, sky, mortals, and divinities. Gathering the fourfold is the ‘thing’, which, by its ‘thinging’ makes manifest a world. This is the happening of ‘place’, and Heidegger’s descriptions of this happening offer a certain lyrical beauty, but are not particularly illuminating if left undigested. In order to get to the real wealth one must examine the phenomena suggested, moving beyond the intellect into the experiences themselves. In light of such reading, considering environmental issues – particularly the way we build– might suggest directions toward more responsive and attuned practices that both acknowledge and activate the nuances of place. Although Heidegger says at the beginning of his essay “Building Dwelling Thinking” that he is not trying to ‘discover architectural ideas’ or develop ‘rules for building’, I still believe it is important to delve into this work with an eye toward architecture, as he lays out some beautiful and insightful ideas by which we might better assess our place in the environment. If we read Heidegger with the phenomena in mind, a richness emerges from the poetic quality of his writing that reflects the imbrication of time, culture, growth, human responsibility, and those things of significance within our world. My hope is that through such reading and thinking, possibilities might surface for designers to develop deeper phenomenological connections between building and place. In this way, Heidegger’s poetic descriptions of the thing and the fourfold can be a catalyst in shedding new light on the way we think about building with environments. This approach seeks to question the often myopic view of sustainability as technological upgrade and instrumental efficiency; for example, solar panels on a sweatshop would not demonstrate the depth of attunement that Heidegger’s writings endorse. In order to move beyond simply limiting ecological damage and maximising natural resources, it becomes important for mortals to create things that bring us together with the earth, sky, and divinities; and in so doing gather a place for a sustainable future

E-cigarettes, Hookah Pens and Vapes: Adolescent and Young Adult Perceptions of Electronic Nicotine Delivery Systems: Table 1.

Most studies have assessed use of “e-cigarettes” or “electronic cigarettes,” potentially excluding new electronic nicotine delivery systems (ENDS), such as e-hookahs and vape pens. Little is known about how adolescents and young adults perceive ENDS and if their perceptions vary by sub-type. We explored ENDS perceptions among these populations

Implementing community-based provider participation in research: an empirical study

Abstract Background Since 2003, the United States National Institutes of Health (NIH) has sought to restructure the clinical research enterprise in the United States by promoting collaborative research partnerships between academically-based investigators and community-based physicians. By increasing community-based provider participation in research (CBPPR), the NIH seeks to advance the science of discovery by conducting research in clinical settings where most people get their care, and accelerate the translation of research results into everyday clinical practice. Although CBPPR is seen as a promising strategy for promoting the use of evidence-based clinical services in community practice settings, few empirical studies have examined the organizational factors that facilitate or hinder the implementation of CBPPR. The purpose of this study is to explore the organizational start-up and early implementation of CBPPR in community-based practice. Methods We used longitudinal, case study research methods and an organizational model of innovation implementation to theoretically guide our study. Our sample consisted of three community practice settings that recently joined the National Cancer Institute’s (NCI) Community Clinical Oncology Program (CCOP) in the United States. Data were gathered through site visits, telephone interviews, and archival documents from January 2008 to May 2011. Results The organizational model for innovation implementation was useful in identifying and investigating the organizational factors influencing start-up and early implementation of CBPPR in CCOP organizations. In general, the three CCOP organizations varied in the extent to which they achieved consistency in CBPPR over time and across physicians. All three CCOP organizations demonstrated mixed levels of organizational readiness for change. Hospital management support and resource availability were limited across CCOP organizations early on, although they improved in one CCOP organization. As a result of weak IPPs, all three CCOPs created a weak implementation climate. Patient accrual became concentrated over time among those groups of physicians for whom CBPPR exhibited a strong innovation-values fit. Several external factors influenced innovation use, complicating and enriching our intra-organizational model of innovation implementation. Conclusion Our results contribute to the limited body of research on the implementation of CBPPR. They inform policy discussions about increasing and sustaining community clinician involvement in clinical research and expand on theory about organizational determinants of implementation effectiveness

Connecting Community With Campus to Address Cancer Health Disparities: A Community Grants Program Model

With growing interest in the CBPR approach to cancer health disparities research, mechanisms are needed to support adherence to its principles. The Carolina Community Network (CCN), 1 of 25 Community Network Programs funded by the National Cancer Institute (NCI), developed a model for providing funds to community-based organizations

Using Practice Facilitation to Increase Rates of Colorectal Cancer Screening in Community Health Centers, North Carolina, 2012–2013: Feasibility, Facilitators, and Barriers

INTRODUCTION: Practice facilitation involves trained individuals working with practice staff to conduct quality improvement activities and support delivery of evidence-based clinical services. We examined the feasibility of using practice facilitation to assist federally qualified health centers (FQHCs) to increase colorectal cancer screening rates in North Carolina. METHODS: The intervention consisted of 12 months of facilitation in 3 FQHCs. We conducted chart audits to obtain data on changes in documented recommendation for colorectal cancer screening and completed screening. Key informant interviews provided qualitative data on barriers to and facilitators of implementing office systems. RESULTS: Overall, the percentage of eligible patients with a documented colorectal cancer screening recommendation increased from 15% to 29% (P < .001). The percentage of patients up to date with colorectal cancer screening rose from 23% to 34% (P = .03). Key informants in all 3 clinics said the implementation support from the practice facilitator was critical for initiating or improving office systems and that modifying the electronic medical record was the biggest challenge and most time-consuming aspect of implementing office systems changes. Other barriers were staff turnover and reluctance on the part of local gastroenterology practices to perform free or low-cost diagnostic colonoscopies for uninsured or underinsured patients. CONCLUSION: Practice facilitation is a feasible, acceptable, and promising approach for supporting universal colorectal cancer screening in FQHCs. A larger-scale study is warranted

Adolescents’ and Young Adults’ Knowledge and Beliefs About Constituents in Novel Tobacco Products

Novel tobacco products, such as little cigars, cigarillos, hookah, and e-cigarettes, and their smoke or aerosol contain chemicals which the FDA has determined to be Harmful or Potentially Harmful Constituents. We explored adolescents’ and young adults’ knowledge and beliefs about constituents in novel tobacco products and their smoke or aerosol, in order to inform risk communication messages

“My First Thought was Croutons”: Perceptions of Cigarettes and Cigarette Smoke Constituents Among Adult Smokers and Nonsmokers

Understanding what people think about harmful and potentially harmful constituents in cigarettes and cigarette smoke has new urgency given legislation requiring US Food and Drug Administration (FDA) to disclose constituent information. Our study sought to obtain qualitative information on what people think about these constituents and the language they use to talk about them

Qualitative evaluation of barriers and facilitators to hepatocellular carcinoma care in North Carolina

Background Many patients with hepatocellular carcinoma (HCC) never receive cancer-directed therapy. In order to tailor interventions to increase access to appropriate therapy, we sought to understand the barriers and facilitators to HCC care. Methods Patients with recently diagnosed HCC were identified through the University of North Carolina (UNC) HCC clinic or local hospital cancer registrars (rapid case ascertainment, RCA). Two qualitative researchers conducted in-depth, semi-structured interviews. Interviews were audiotaped, transcribed, and coded. Results Nineteen interviews were conducted (10 UNC, 9 RCA). Key facilitators of care were: physician knowledge; effective communication regarding test results, plan of care, and prognosis; social support; and financial support. Barriers included: lack of transportation; cost of care; provider lack of knowledge about HCC; delays in scheduling; or poor communication with the medical team. Participants suggested better coordination of appointments and having a primary contact within the healthcare team. Limitations We primarily captured the perspectives of those HCC patients who, despite the challenges they describe, were ultimately able to receive HCC care. Conclusions This study identifies key facilitators and barriers to accessing care for HCC in North Carolina. Use of the RCA system to identify patients from a variety of settings, treated and untreated, enabled us to capture a broad range of perspectives. Reducing barriers through improving communication and care coordination, assisting with out-of-pocket costs, and engaging caregivers and other medical providers may improve access. This study should serve as the basis for tailored interventions aimed at improving access to appropriate, life-prolonging care for patients with HCC