Project description:Coaching is proposed as a means of improving the learning culture of medicine. By fostering trusting teacher-learner relationships, learners are encouraged to embrace feedback and make the most of failure. This paper posits that a cultural shift is necessary to fully harness the potential of coaching in graduate medical education. We introduce the deliberately developmental organization framework, a conceptual model focusing on three core dimensions: developmental communities, developmental aspirations, and developmental practices. These dimensions broaden the scope of coaching interactions. Implementing this organizational change within graduate medical education might be challenging, yet we argue that embracing deliberately developmental principles can embed coaching into everyday interactions and foster a culture in which discussing failure to maximize learning becomes acceptable. By applying the dimensions of developmental communities, aspirations, and practices, we present a six-principle roadmap towards transforming graduate medical education training programs into deliberately developmental organizations.
Project description:Since the acceptance of the Healthy DC - Go Local proposal in November 2007, members of the District of Columbia Area Health Sciences Libraries group supported the project by offering their time to select health care services, perform data entry, review records, and promote the database to their organizations. Although the amount of work required to sustain the database became more than the Go Local team was able to handle, the collaboration, dedication, and persistence of project managers, volunteers, and part-time staff members was what made the project a truly collaborative one and an ultimately successful resource for Washington, DC health care consumers.
Project description:Phagocytosis is an essential step in the innate immune response to invasive fungal infections. This process is carried out by a proverbial "village" of professional phagocytic cells, which have evolved efficient machinery to recognize and ingest pathogens, namely macrophages, neutrophils and dendritic cells. These innate immune cells drive early cytokine production, fungicidal activity, antigen presentation and activation of the adaptive immune system. Despite the development of antifungal agents with potent activity, the biological activity of professional phagocytic innate immune cells has proven indispensable in protecting a host from invasive fungal infections. Additionally, an emerging body of evidence suggests non-professional phagocytes, such as airway epithelial cells, carry out phagocytosis and may play a critical role in the elimination of fungal pathogens. Here, we review recent advances of phagocytosis by both professional and non-professional phagocytes in response to fungal pathogens, with a focus on invasive aspergillosis as a model disease.
Project description:BackgroundResidential treatment facilities for eating disorders are becoming increasingly common and purport to provide recovery-orientated care in a less restrictive environment than traditional hospital settings. However, minimal attention has focused on individuals' lived experiences of these residential services.AimsThis study explores participants' lived experiences of care at Australia's first residential facility for the treatment of eating disorders.MethodQualitative data were collected as part of a clinical evaluation (June 2021 to August 2023). Fifteen women participated in semi-structured interviews about their experience of treatment following discharge. Data were analysed with inductive reflexive thematic analysis.ResultsThree main themes were generated from the data that included participants' journeys to treatment, experiences of treatment and the transitions associated with and following discharge. Cutting across these main themes were participants' encounters of barriers, setbacks and hope. Participant experiences of residential treatment were complex and multifaceted, marked by inherent ideological dilemmas that arose in balancing standardised treatment protocols with person-centred and recovery-oriented care. Participants also spoke of reclaiming a sense of self and identity beyond their eating disorder, emphasising the importance of relationships and consistent and collaborative care.ConclusionsParticipant accounts of residential treatment emphasised the importance of holistic, person-centred and recovery-oriented care. Despite the complexities of treatment experiences, participant narratives underscored how recovery may be more about the reclamation of a sense of identity outside of the eating disorder than merely symptom improvement. As such, adopting person-centred and recovery-oriented treatment approaches within residential treatment settings may maximise individual autonomy and promote holistic recovery pathways.
Project description:BackgroundPrevious studies suggest that neighborhood social capital is associated with children's mental health. The purpose of this study was to examine the association between neighborhood collective efficacy and children's psychosocial development.MethodsWe used data on children and their parents (n = 918) who were part of the Japanese study of Stratification, Health, Income, and Neighborhood (JSHINE) from 2010 to 2013 (wave 1 and wave 2). Households were recruited from the Tokyo metropolitan area through clustered random sampling. Changes in children's psychosocial development (assessed using a child behavioral checklist) between waves 1 and 2 were regressed on parents' perceptions of changes in neighborhood collective efficacy (social cohesion and informal social control).ResultsChange in perception of neighborhood social cohesion was inversely associated with change in child total problems (β = -0.22; 95% confidence interval [CI]: -0.37 to -0.001; effect size d = -0.03). Change in perceptions of neighborhood informal social control was inversely associated with change in children's externalizing problems (β = -0.16; 95% CI: -0.30 to -0.03; d = -0.02).ConclusionsThe results of these fixed-effects models suggest that strengthening neighborhood collective efficacy is related to improvements in child psychosocial development.
Project description:Scientific consensus is that diverse tree species positively impact forest productivity, especially when species are functionally dissimilar. Under the complementarity hypothesis, differences in species traits reduce competition among neighboring tree species. However, while this relationship has been extensively studied at the community level, there is a lack of understanding regarding how individuals of different species specifically respond to a functionally dissimilar neighborhood. In this study, we used permanent plots from Quebec, Canada, and 19 focal tree species to test whether: (1) tree growth response to neighborhood dissimilarity varies with their identity and competition intensity, and (2) focal tree species' traits explain their response to neighborhood dissimilarity. We demonstrate that: tree growth is primarily influenced by competition, species identity, and their interactions, but that dissimilarity, alone and in interaction with the main drivers of tree growth, explains an additional 1.8% of the variation in species growth. Within this context, (1) most species' respond positively to neighborhood dissimilarity, with magnitude being species and competition dependent, and (2) focal tree traits partly explain these dependencies, with shade-intolerant species benefiting most from dissimilar neighbors under high competition. Our study provides empirical support for the complementarity hypothesis, emphasizing the small but consistent positive effect of functional dissimilarity on tree growth in local neighborhoods. Our findings identify the species with the highest potential of benefiting from dissimilar neighbors but also demonstrate that the positive effect of neighborhood dissimilarity is not limited to a select few species with specific traits; rather, it is observed across a diverse range of species. The cumulative growth responses of individuals to functionally dissimilar neighbors may help explain the commonly observed higher productivity in more diverse communities.
Project description:BackgroundPhysical activity (PA) among Hispanic and other minority adolescents in the U.S. lag behind White, non-Hispanic adolescents. Previous studies have examined the beneficial impact of culturally informed, community-based health programs within the Hispanic community on PA levels. There is a need for longer term follow up to determine the impact on family and individual habits over time. Our study aims to explore the aspects of a two-year PA and nutrition program, Families Inspired Together 4 Youth Empowered to Succeed (FIT4YES), that continue to influence family health habits and child development.MethodsCommunity-based focus groups were held in Milwaukee, WI with Hispanic parent participants of the FIT4YES program three years after program conclusion. A semi-structured guide of open-ended questions was used to facilitate the discussion of the lasting impact of FIT4YES. Each group was audio recorded, transcribed, and translated from Spanish when necessary. Four student researchers utilized a grounded theory qualitative approach to identify overarching themes.ResultsThree focus groups with 16 total parents (N = 16) spoke about the program. Three overarching themes emerged from the transcripts indicating that cultural exposure, relationships, and self-growth were necessary for families to sustain the healthy behaviors promoted in FIT4YES. Specifically, parents discussed increased comfort levels with their children participating in school sports, the impact of shared experiences with community members, and continued skills initially taught and practiced during active programming.ConclusionsOur group adapted our previously published model to a "post-program" state that incorporated the major themes and sub-themes with levels of the social-ecological model. Although the FIT4YES program ended, multiple ideals instilled by the program continued, we believe, due to the common themes illustrated by our model. This study utilized a community check-in approach to gain insight into the long-term impacts of the FIT4YES program. We propose three recommendations for consideration in the creation of community-based health programs: utilize dynamic, culturally appropriate components based on the intended community; understand the strength of the program as a whole is dependent on the strength of each individual component; and incorporate an anchor institution for consistency and trust within the community.
Project description:BackgroundMultiple areas in the United States of America (USA) are experiencing high rates of overdose and outbreaks of bloodborne infections, including HIV and hepatitis C virus (HCV), due to non-sterile injection drug use. We aimed to identify neighbourhoods at increased vulnerability for overdose and infectious disease outbreaks in Rhode Island, USA. The primary aim was to pilot machine learning methods to identify which neighbourhood-level factors were important for creating "vulnerability assessment scores" across the state. The secondary aim was to engage stakeholders to pilot an interactive mapping tool and visualize the results.MethodsFrom September 2018 to November 2019, we conducted a neighbourhood-level vulnerability assessment and stakeholder engagement process named The VILLAGE Project (Vulnerability Investigation of underlying Local risk And Geographic Events). We developed a predictive analytics model using machine learning methods (LASSO, Elastic Net, and RIDGE) to identify areas with increased vulnerability to an outbreak of overdose, HIV and HCV, using census tract-level counts of overdose deaths as a proxy for injection drug use patterns and related health outcomes. Stakeholders reviewed mapping tools for face validity and community distribution.ResultsMachine learning prediction models were suitable for estimating relative neighbourhood-level vulnerability to an outbreak. Variables of importance in the model included housing cost burden, prior overdose deaths, housing density, and education level. Eighty-nine census tracts (37%) with no prior overdose fatalities were identified as being vulnerable to such an outbreak, and nine of those were identified as having a vulnerability assessment score in the top 25%. Results were disseminated as a vulnerability stratification map and an online interactive mapping tool.ConclusionMachine learning methods are well suited to predict neighborhoods at higher vulnerability to an outbreak. These methods show promise as a tool to assess structural vulnerabilities and work to prevent outbreaks at the local level.
Project description:BackgroundMaternal mortality remains a challenge in Ghana, where 263 women per 100 000 live births die during pregnancy or childbirth. Barriers to reaching the recommended antenatal care (ANC) include poor access to quality health care, cultural factors, and lack of support for pregnant women.MethodsWe piloted two cross-randomized interventions: durbars, or local community meetings that incorporated education about ANC and supporting pregnant women, and an enhanced ANC model that added phone calls and a home visit to standard care. The study took place in 30 villages in the Upper East Region of Ghana between August 2021 and November 2022.ResultsWe tracked 277 women during pregnancy, with 120 women randomly assigned to the enhanced ANC intervention and 142 women living in villages randomized to the durbar intervention. Women who were randomized to the enhanced ANC intervention were 13.2 percentage points (pp) (95% confidence interval (CI) = 0.1, 24.3) more likely to have average or above average knowledge of pregnancy danger signs, 22.1 pp (95% CI = 9.1, 36.5) more likely to have a birth plan, 28.2 pp (95% CI = 13.0, 42.4) more likely to prepare the plan with their partners, and 16.4 pp (95% CI = 0.9, 29.3) more likely to pay for delivery with funds set aside in birth plan. They were also 35 pp (95% CI = 16.1, 48.1) more likely to make blood donor arrangements than control women who made birth plans. We found no impact of the durbar intervention on study outcomes.ConclusionsEvidence from this pilot suggests that interventions that increase interactions between health providers and pregnant women outside of the health facility may substantially improve women's experience during pregnancy and maternal health outcomes. Providing structured ways for men to get engaged in ANC increased their involvement. Although we found no evidence the community meetings improved study outcomes, larger studies with repeated meetings and community-wide surveys are needed to make causal conclusions.RegistrationAmerican Economic Association RCT Registry: 10360; ISCRNT: ISRCTN95961119.