Education and Interpretation on Public Lands: Lessons from Research and New Directions

Decades of research confirm that interpretation and environmental education on public lands can accomplish a wide variety of positive outcomes for participants, ranging from personal learning and growth to stewardship behaviors both onand off-site. This research note offers a brief summary of the state-of-the-field of interpretation and environmental education research as applied to public lands. It highlights the general state of knowledge and identifies opportunities for researchers to further enhance our understanding about education on public lands to maximize benefits for visitors and managers alike. In particular, we emphasize the value of large-scale comparative studies as well as collaborative approaches to adaptive management, in which researchers support active experimentation through iterative data collection and analysis within a learning network of multiple program providers. This latter approach promotes evidenced-based learning within a larger community practice in which participants can benefit from the diverse knowledge, experiences, and data that each brings into the network.

Hearing loss: Conductive versus sensorineural

Hearing loss has a significant impact on quality of life, and may even compromise an individual’s ability to work and their safety – we use our hearing to constantly detect and react to environmental hazards around us. Hearing loss can have a profound impact on a person’s life. This is especially true for certain patient groups. For instance, the elderly, and those with co-existing problems that affect their ability to communicate (such as dementia, cerebrovascular disease or psychiatric disorders). Even those without co-morbidities suffer the burden of disease where communication is impaired: the young who are developing their speech and language skills and adults with language barriers or other impediments to their speech. The hearing apparatus is made up of conductive and sensorineural pathways, which may be affected by pathology, leading to deafness. This article describes the aetiology of conductive and sensorineural deafness, details the relevant clinical assessment and outlines management strategies in community practice.

A method for defining the CORE of a psychosocial intervention to guide adaptation in practice: Reciprocal imitation teaching as a case example

Defining the central components of an intervention is critical for balancing fidelity with flexible implementation in both research settings and community practice. Implementation scientists distinguish an intervention’s essential components (thought to cause clinical change) and adaptable periphery (recommended, but not necessary). While implementing core components with fidelity may be essential for effectiveness, requiring fidelity to the adaptable periphery may stifle innovation critical for personalizing care and achieving successful community implementation. No systematic method exists for defining essential components a priori. We present the CORE (COmponents & Rationales for Effectiveness) Fidelity Method—a novel method for defining key components of evidence-based interventions—and apply it to a case example of reciprocal imitation teaching, a parent-implemented social communication intervention. The CORE Fidelity Method involves three steps: (1) gathering information from published and unpublished materials; (2) synthesizing information, including empirical and hypothesized causal explanations of component effectiveness; and (3) drafting a CORE model and ensuring its ongoing use in implementation efforts. Benefits of this method include: (1) ensuring alignment between intervention and fidelity materials; (2) clarifying the scope of the adaptable periphery to optimize implementation; and (3) hypothesizing—and later, empirically validating—the intervention’s active ingredients and their associated mechanisms of change. Lay abstract Interventions that support social communication include several “components,” or parts (e.g. strategies for working with children and families, targeting specific skills). Some of these components may be essential for the intervention to work, while others may be recommended or viewed as helpful but not necessary for the intervention to work. “Recommended” components are often described as “adaptable” because they can be changed to improve fit in different settings where interventions are offered or with different individuals. We need to understand which parts of an intervention are essential (and which are adaptable) when translating interventions from research to community settings, but it is challenging to do this before studying an intervention in the community. This article presents the CORE (COmponents & Rationales for Effectiveness) Fidelity Method—a new method for defining the essential components of evidence-based interventions—and applies it to a case example of Reciprocal Imitation Teaching, an intervention that parents are taught to deliver with their young children with social communication delays. The CORE Fidelity Method involves three steps: (1) gathering information from multiple sources; (2) integrating information from previous research and theory; and (3) drafting a CORE model for ongoing use. The benefits of using the CORE Fidelity Method may include: (1) improving consistency in intervention and research materials to help all providers emphasize the most important skills or strategies; (2) clarifying which parts of the intervention can be adapted; and (3) supporting future research that evaluates which intervention components work and how they work.

The Practice of 'Aisyiyah Women's Community in Communicating during the Covid 19 Pandemic

The values ??of religiosity color the awareness that essentially men and women are equal before God. Because of this, Aisyiyah pioneered the women's movement in all fields, and did not hesitate to cooperate with men. Men and women are given the same potential intellectually, morally and spiritually. Every organization has its own cultural style. This paper is based on the perspective of community practice and stakeholder relations. The research method uses a qualitative method with a case study approach, because it examines the natural environment comprehensively in a single case in the Aisyiyah Women's Organization in Bandung City as one of the pioneer organizations in social movements and women's ruhuddin in Indonesia. Data collection techniques: (1) interviewing the Head of Aisyiyah Regional Leadership (PDA) Bandung City; (2) Focus Group Discussion (FGD) with the management of the Bandung City Economic Council PDA; and (3) distributing questionnaires to representatives of Aisyiyah Branch Managers throughout the city of Bandung. The data analysis was carried out using an interactive model and multiple triangulation for the validity of the data. The results of the study show that the various programs of 'Aisyiyah can continue to run with most of them using information technology tools. Meetings are limited to a few participants, so that organizational meetings attended by thousands of participants can still be held virtually. The group communication facility in WhatsApp groups has become an additional means for organizational consolidation. Meetings as official organizational communication can still be held using the zoom meeting application. Therefore, physical movement restrictions during this pandemic, there are almost no significant obstacles for the Aisyiyah Organization to continue implementing the program.

On challenges to respect for autonomous decision making in primary care

Primary health care is characterised by timely and appropriate health care access, delivered continuously over time to a specific population, providing a comprehensive service, with coordination of care for those that need it. Practitioners deal with a multiplicity of clinical issues within longitudinal relationships, embedded in the context of families and communities. We propose that these aspects of primary care have a bearing on how matters of decision making are considered and implemented. Further, the standard account of autonomous decision making is not wholly adequate when applied to clinician–patient encounters in primary care. We add considerations of the impact of illness (however defined) and self-identity as also relevant to a more measured and full account. The context of primary care is quite different from that of secondary care. Although there are generalists who work in hospitals, we argue that this aspect and the other attributes of primary care generate special ethical considerations. One of these is how autonomy, or more fully, how respect for the principle of autonomy is considered and operationalised in community practice. In this study, we describe some theoretical aspects of autonomy and seek to apply, and challenge, these aspects in the context of clinical work in primary care. In doing so we will review the descriptors of primary care: why in essence it is different from other contexts of clinical work.

“It is not that I didn’t already know these places, but I never thought of them like this.” Methodological approaches to community research in early childhood education in Denmark

The aim of this article is to discuss how participatory methods might contribute to research concerning the development of inclusive, socially just and community-oriented pedagogical practices within the field of early childhood education, as well as contributing to shared knowledge production about relations between kindergartens1 and local communities. The article starts from a critique of dominant political and institutional approaches in Denmark to patterns of cooperation between kindergartens, parents, and local communities, which often in practice lead to top-down and compensatory approaches to cooperation, in which parents are expected to adapt to the agendas of the institutions. We argue that there is a need to develop alternatives to these approaches. This article explores how kindergartens might respond to the needs and views of parents and local communities, rather than the other way around. We explore this by asking what (local) communities for children and parents are and might be, and how kindergartens as significant shapers of children’s lives and experiences might create links between children’s lives inside and outside of the kindergarten. We discuss how communities, pedagogues and children might cooperate in pedagogical research processes and how such research processes affect (understandings of) children’s lives, communities, and kindergartens. Furthermore, we look at how these cooperations and insights might contribute to the development of more inclusive, community-oriented pedagogical practices. Our findings show that shared explorations of the many relations between kindergartens and communities have the potential to build more respectful and reciprocal dialogues and innovative pedagogical practices. Yet at the same time they show that this is an unfinished, imperfect endeavor that requires continuous attention to the complex and changing nature of communities, and to the closures and exclusions entailed by any community practice. Also, the findings point to an understanding of communities as performative phenomena that develop and grow through the very process of involvement and shared engagement. We argue that participatory, community-oriented pedagogical research methods should reflect these dynamics. The article describes and discusses research methods, showing how participatory research methods can deepen our understanding of the complex roles of early childhood education for children and communities, while also inspiring inclusive and community-oriented pedagogical practices.

Measuring veterinary client preferences for autonomy and information when making medical decisions for their pets

OBJECTIVE To adapt the 3 scales of the Autonomy Preference Index to veterinary medicine and validate the 3 new scales to measure pet owner preferences for autonomy and information when making medical decisions for their pets. SAMPLE 10 small-animal veterinarians and 10 small-animal clients at a veterinary school–based community practice (pilot study) and 311 small-animal clients of the practice (validation study), of which 47 participated in a follow-up survey. PROCEDURES Wording of items in the Autonomy Preference Index was adapted, and instrument wording was finalized on the basis of feedback obtained in the pilot study to create 3 scales: the Veterinary General Decision-Making Preferences Scale (VGDMPS), Veterinary Clinical Decision-Making Preferences Scale (VCDMPS), and Veterinary Information-Seeking Preferences Scale (VISPS). The 3 scales were then validated by means of administering them to small-animal clients in a clinical setting. RESULTS The 3 scales had acceptable reliability and validity, but clients expressed concern over item wording in the VGDMPS during the pilot study. Overall, results showed that clients had a very high preference for information (mean ± SD VISPS score, 4.78 ± 0.36 on a scale from 1 to 5). Preferences for autonomy varied, but mean values reflected a low-to-moderate desire for autonomy in clinical decision-making (mean ± SD VCDMPS score, 2.04 ± 0.62 on a scale from 1 to 5). CONCLUSIONS AND CLINICAL RELEVANCE The VCDMPS was a reliable and valid instrument for measuring client preferences for autonomy in clinical decision-making. Veterinarians could potentially use this instrument to better understand pet owner preferences and tailor their communication approach accordingly.

Project ADAPT: Developing an Academic and Community Practice Collaborative Care Model for Metastatic Breast Cancer Care: A Study Design (Preprint)

BACKGROUND Metastatic breast cancer (MBC) remains incurable despite significant treatment advances. Coordinating care for patients with MBC can be challenging given the various treatment options, available clinical trials, and frequent need for ancillary services. To optimize the care of those with MBC, we designed an academic and community practice collaborative care model based on the Ending Metastatic Breast Cancer for Everyone (EMBRACE) program developed at the Dana Farber Cancer Institute entitled Project ADAPT. OBJECTIVE To describe the implementation science-based study design and innovative components of Project ADAPT. METHODS Project ADAPT utilizes the Dynamic Adaptation Process informed by the Exploration, Preparation, Implementation, and Sustainment framework. Washington University School of Medicine (WUSM) partnered with three community hospitals in the St. Louis region covering rural and urban settings. The Exploration and Preparation phases provide patient and provider feedback on current referral practices to finalize the approach for the Implementation phase. At the Implementation phase, we will enroll patients with MBC at these three community sites to evaluate potential collaborative care at WUSM and assess the impact of this collaborative care model on referral satisfaction and acceptability for patients with MBC and their providers. Patients may then return to their community site for care or continue to receive part of their care at WUSM. We are incorporating virtual and digital health strategies in our approach to improving MBC care coordination to minimize the patient burden. RESULTS The Exploration phase is ongoing. As of August 2021, we have recruited 21 patient and provider participants to complete surveys of the current collaborative care process at WUSM. Throughout this phase and in preparation for the Implementation phase, we have iteratively updated and refined our surveys for the Implementation phase based on testing of our data collection instruments. Our partner sites are in various stages of the single Institutional Review Board (IRB) approval process, which involves a signed reliance agreement between the institutions as well as a site registration and study application process. We have ongoing engagement with all partner sites, which helped solidify our participant recruitment strategies and design patient-friendly recruitment materials. In addition, we have included a patient advocate on the research team. Members of the research team have launched a single IRB Support Network at WUSM to create a repository of the single IRB procedures to streamline partner sites’ onboarding process and facilitate enhanced collaboration across institutions. CONCLUSIONS With this robust model, we expect that patients with MBC will receive optimal care regardless of geographical location and will improve the patient and provider experiences when navigating the health systems