Search

This study was designed to (a) gather band directors' opinions of skills and characteristics important to teaching and (b) examine the relative effectiveness of electronic versus paper survey methods. Survey respondents ranked lists of music, teaching, and personal skills or characteristics in order of importance and answered open-ended items regarding advice for 1st-year teachers and the struggles and rewards of band directing. The final response rate was 66% (N = 235). Personal and teaching skills and characteristics were ranked higher than music skills. The items "maintain high musical standards," "be able to motivate students," and "enthusiastic, energetic" were the highest ranked skills or characteristics. Perseverance, patience, and long-term vision were the most common forms of advice to 1st-year teachers. Issues related to classroom management and student success were the most-often-cited struggles and rewards of band directing, respectively. An experiment comparing response rate and response quality as a function of survey method (i.e., e-survey vs. paper survey) and follow-up notification (i.e., postnote, no postnote) also was completed using a smaller subsample of respondents ( n = 102). Response rates for the e-survey conditions were better than those for the paper survey conditions. Greater proportions of respondents from the paper survey conditions completed the open-ended items. (Contains 6 tables and 1 figure.)

Objectives: To develop and validate a short form, disease-specific version of the KOOS appropriate for the young active ACL deficient population: the KOOS-ACL. Methods: A baseline dataset of 605 young patients (< 25 years) with ACL tears was divided into a development and validation sample. Exploratory factor analyses were conducted in the development sample to identify the underlying factor structure and reduce the number of KOOS items based on statistical and conceptual indicators. Confirmatory factor analyses were conducted to check fit indices of the proposed KOOS-ACL model in both samples. Structural validity, reliability, and responsiveness to change were assessed in the full sample at five timepoints: baseline and 3 months, 6 months, 12 months and 24 months post-operatively. Results: Two factors were deemed most appropriate for the KOOS-ACL: Functionality and Sport. Fifteen items were removed from the full length KOOS based on discriminant validity (i.e., lack of distinctiveness between some proposed constructs) and another fifteen items were removed for repetitive content. The final KOOS-ACL model showed acceptable structural validity (CFI and TLI > 0.9, RMSEA and SRMR < 0.08), internal consistency reliability (a > 0.8), and responsiveness to change (effect size > 0.8) at all five timepoints in the dataset. The KOOS-ACL showed strong and significant correlations to the original KOOS and IKDC at all timepoints (r > 0.7). Conclusions: The new KOOS-ACL questionnaire contains 12 items and two subscales relevant to young active ACL patients. The KOOS-ACL would reduce patient burden by more than two thirds and provides improved structural validity compared to the full length KOOS while maintaining adequate psychometric properties and relatedness to other popular outcome measures currently used following ACL injuries. The KOOS-ACL may be a more relevant outcome to use with young active ACL patients within the two years of surgery. [ABSTRACT FROM AUTHOR]

This reaction article highlights areas of agreement and disagreement with the study conducted by Hughes, Rycus, Saunders-Adams, Hughes, and Hughes on the current state of research and practice in differential response (DR). Overall, we agree with several of the arguments put forth by Hughes et al. regarding the limitations of DR research and the lack of a consistently defined and implemented DR practice model. These areas of agreement offer common ground on which to work together to move the field forward. However, we have concerns about the methodological rigor of the Hughes et al. study and questions about some of their findings and conclusions. We draw upon our current evaluation of a five-county DR research and demonstration project in Colorado to provide recommendations for enhancing the design and implementation of research on DR.

In response to the dearth of research agendas that connect teacher education and teaching in the field and to the call for more programmatic research, the purpose of this paper is to present the Agenda for Researching Teaching (ART). The ART is a visual research agenda that spans the time from a teacher candidate learning to teach to impacting student achievement as a teacher. Furthermore, we include research questions based on the extant literature for researching teachers and teacher education. It is hoped that the model will assist researchers who investigate teachers, teacher education programs, and so forth, to focus their work in order to move forward teacher education pipelines, programs, and professional development opportunities. (Contains 1 figure and 2 tables.)

Qualitative research methodologies comprise distinct traditions, each of which is based on its own assumptions and discrete methods for collecting, analyzing and reporting data. This paper examines a distinctive approach to qualitative research that was employed in a recent study to open a gateway to understanding the impact of the shootings at Columbine High School. Using the Columbine study as a model, it analyzes and delineates a process for collecting data through modified oral history practices, displaying data through stories using a specialized form of poetic representation, and disclosing results through strategies adapted from educational criticism and connoisseurship. (Contains 2 tables.)

Background and Objectives Ageism is oftentimes sugarcoated within humor. Paper birthday cards are 1 delivery approach in which ageist messages are perpetuated and reinforced through humor. Research Design and Methods A convenience sample of birthday cards (k = 227), all indicating a decade of age, were acquired from 7 national retail stores in Colorado Springs, CO. The decades sampled ranged from 21 to 100. With a predeveloped codebook, 3 raters coded the decade birthday cards on various variables, including age group, ageist tone, and humor. Results Birthday cards intended for age 30–60 contained significantly more ageist messages compared to cards intended for age 21 and age 70–100, which did not show a significant difference from each other. Additionally, birthday cards with humor showed more ageist messages than cards without humor. Characteristics of decade birthday cards were also explored. Discussion and Implications Consumers need to learn to evaluate these ageist messages in birthday cards to reduce the perpetuation of damaging stereotypes. [ABSTRACT FROM AUTHOR]

The article discusses a study that aims to expand the extant literature that addresses the modality by which respondents to a health services survey returned study materials. Study highlights include adaptation of the recruitment process from the tailored design method, distribution of income and educational attainment according to chi-square likelihood ratio tests, and a table that outlines characteristics of survey respondents by response format.

Social determinants profoundly impact health. Many primary care practices now seek to screen their patients for health‐related social needs (HRSN) and refer them to resources in the community. However, there is little empirical evidence to guide communication with patients in order to ensure their comfort with the process and increase the likelihood that it results in positive outcomes. This paper describes the first phase of the Improving Messaging Around Gaps in Needs and rEfferals (IMAGINE) study—a multi‐phase study aiming to develop and test patient‐centred messages about screening and referral for HRSN. In this initial qualitative phase, our objective was to identify communication strategies that might make western Colorado primary care patients more comfortable with the HRSN screening and referral process. From May to July 2020 we interviewed 10 staff members responsible for HRSN screening from primary care practices participating in the western Colorado Accountable Health Communities (AHC) initiative and 20 patients from 2 of these practices. We used a rapid qualitative analysis process that involved summarising interview transcripts across key domains of interest and then identifying emergent themes within each domain using a data matrix. Through this process, we examined current communication about HRSN screening, as well as suggestions for messages and other strategies that could improve communication. In most practices, the AHC Screening Tool was handed to patients by front desk staff at check‐in with little explanation as to its purpose. Patients and staff alike recommended that patients be provided with information that: normalises the screening and referral process; assures privacy; clarifies that the purpose is to help and support rather than judge or report; emphasises community benefits; and respects patient autonomy. Interviewees also suggested broader strategies to support more effective communication, such as practice staff and clinicians building trusting relationships with patients and understanding and acknowledging the complex structural barriers that often prevent patients from accessing meaningful assistance. These findings provide actionable suggestions for improving communication about HRSN screening and referral in primary care settings. The next steps include developing specific messages based on these findings and testing their impact on screening tool completion rate, referral uptake, and patient‐reported comfort with the process. [ABSTRACT FROM AUTHOR]

Researchers have widely adopted computer programs for reference management, such as Mendeley, due to their ability to support a variety of research practices, including organization and storage of pdfs. These programs also afford participation and networking within new scholarly information landscapes. This paper uses a survey and semi-structured interviews to explore use of Mendeley at the University of Colorado and to provide an initial snapshot of scholars' adoption of new digital practices. Because these new practices call for different capacities, the authors then used the results to design meaningful learning opportunities for scholars and students. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Adolescent overweight and obesity are serious health risks, with prevalence varying by sociodemographic group. Studies link children's weight status and sex/race-ethnic differences with meeting recommendations for physical activity and diet. But, research examining the intersection of sociodemographic characteristics, behavior, and weight status is limited. This paper aims to identify sociodemographic differences in the association between adolescent weight status and meeting 6 national obesity-related recommendations. METHODS In 2011-2012, the Healthy Kids Colorado Survey was administered to all Denver high school students. Using descriptive and multivariate modeling, we examined subgroup associations between students' self-reported weight status and physical activity and diet. RESULTS Students (N = 6652) who met at least 1 recommendation were less likely to be at an unhealthy weight (OR = 0.87); also true for students who met at least 1 physical activity recommendation (OR = 0.80). However, the association varied across subgroups. The association between weight status and meeting at least 1 nutritional recommendation (OR = 0.91) was inconsistent across subgroups. Unexpected patterns also emerged in subgroup associations between meeting specific recommendations and weight status. CONCLUSIONS Identifying subgroup differences in meeting recommendations and the association with weight status is important in identifying high risk groups and improving policy and programs that target childhood obesity prevention. [ABSTRACT FROM AUTHOR]

In a 2023 sequential explanatory mixed-methods study in four US states, we identified barriers and facilitators experienced by Vaccines for Children (VFC) program providers in reporting vaccination data to state immunization information systems (IISs). We found the following: VFC providers value accurate, robust, and widely used IISs. IIS reporting is easier with but does not require an electronic health record. Negative interactions with IISs and VFC officials and limited practice capacity are barriers to reporting. The COVID-19 pandemic highlighted the need for a nationwide vaccination database. (Am J Public Health. 2024;114(6):569–574. https://doi.org/10.2105/AJPH.2024.307638) [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore perspectives of Somali refugees on female genital mutilation/cutting (FGM/C) and potential changes in these after migration.Design/methodology/approach Qualitative semi-structured interviews were conducted in Denver, Colorado, USA, with 13 Somali refugees. Thematic content analysis was used to analyze the data.Findings Change of perspectives regarding the support of FGM/C were noted among all participants, with most opposing infibulations, FGM/C type III, after migration but supporting Sunna, the cutting of the clitoris, FGM/C type I. Changes were prompted by education on FGM/C and resettling resulting in an awareness that infibulation is not a religious requirement nor undergone by all women. Cultural beliefs regarding the importance of virginity, purity and honor to the family underpinning the rationale of FGM/C were prevalent and some confusion in dealing with these cultural values was found. Women reported health care providers (HCPs) not being culturally prepared for women with FGM/C.Research limitations/implications Despite limitations to the study, findings indicate the complex process of migration and acculturation, leaving communities with cultural values in a context where these are not accepted. More research and discussion with the Somali immigrant community is required to better understand the practice of FGM/C after immigration, and how to deal with these cultural values.Originality/value Findings suggest some girls may still be at risk of some types of FGM/C after migration. Public health professionals, social and immigration workers should be aware of a potential risk. HCPs should prepare for caring for women with FGM/C. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine factors that are associated with tooth loss in older adults living in the San Luis Valley (SLV), Colorado, which is a rural and large geographical area (roughly the size of Connecticut) that has a large population age 60 years or older. Data used in this manuscript were collected as a part of the SLV Community Health Survey. The analyzed sample included 308 adults over the age of 65 years who completed the survey. Basic descriptive statistics and a series of step-wise binary logistic regression analyses were conducted; the dependent variable was the number of permanent teeth removed because of tooth decay or gum disease. Fifty-two percent of the participants were male, Hispanic participants made up 40 % of the sample and 76 % of the participants had at least a high school education. Tooth loss was significantly associated with older age ( OR = 1.09; p = 0.02), lower income ( OR = 0.01; p = 0.00), less than high school education ( OR = 0.32; p = 0.01), being Hispanic ( OR = 2.15; p = 0.05), self-reported fair-poor health status (OR 2.94; p = 0.02), consumption of one or more than one sweet beverage per day ( OR = 4.52 ; p = 0.00), no dental insurance ( OR = 4.70; p = 0.01) and length of time since last dental visit ( OR = 0.21; p = 0.01). The findings of the present study suggest possible causes for tooth loss in rural adults and underscore the need for in-depth research to study the overall oral health of rural older adults living in SLV. [ABSTRACT FROM AUTHOR]

The Study to Explore Early Development (SEED) is a multi-site case-control study designed to explore the relationship between autism spectrum disorder (ASD) phenotypes and etiologies. The goals of this paper are to (1) describe the SEED algorithm that uses the Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) to classify children with ASD, (2) examine psychometric properties of different ASD classification methods, including the SEED method that incorporates rules for resolving ADI-R and ADOS discordance, and (3) determine whether restricted interests and repetitive behaviors were noted for children who had instrument discordance resolved using ADI-R social and communication scores. Results support the utility of SEED criteria when well-defined groups of children are an important clinical or research outcome. [ABSTRACT FROM AUTHOR]

This paper examines predictors of cancer-specific distress among posttreatment adult leukemia and lymphoma survivors (LLS). Using a survey mailed to LLS in the Colorado Central Cancer Registry (N = 477), the authors developed a multivariable risk profile for distress. Thirty one percent of LLS reported indicators of distress. Significantly higher distress was associated with younger age (p < 0.001) in bivariate analyses. The risk profile included fear of recurrence, financial burden, and younger age. Distress did not attenuate based on time since treatment completion and may persist up to 4 years posttreatment, suggesting a need for intervention, particularly among high-risk LLS. [ABSTRACT FROM PUBLISHER]

Adverse childhood experiences (ACEs) are traumatic events experienced before the age of 18 and include experiences of abuse, neglect, and household dysfunction. Exposure to ACEs early in life is a risk factor for adverse physical and mental health outcomes in adulthood, which may lead to subsequent child abuse, neglect, and household dysfunction. This study examined a rural community's barriers and facilitators to addressing ACEs in families with young children from the perspective of organizations serving children and families. The Innovation Corps (I-Corps) methodology was used to develop an ecosystem map of 64 community stakeholders, including 12 government, 13 healthcare, 27 early childhood education (ECE), and 12 community-based organizations, involved in the community's system of care for families with young children. Representatives from the stakeholder organizations identified in the ecosystem map were then recruited via purposeful and snowball sampling, and semistructured interviews were conducted with 37 participants. Transcribed notes and direct quotes were analyzed using a constant comparison analysis approach, and five themes emerged from the analysis. Barriers to addressing ACEs included limited mental health resources in ECE settings for both children and teachers, stigma, and limited access to local healthcare, while facilitators included establishing trusted relationships between organizations and families and using strengths-based approaches with families. This study characterized facilitators and barriers to addressing ACEs in families with young children residing in a rural community and provides guidance to inform future community-level ACEs interventions and policies. [ABSTRACT FROM AUTHOR]

Introduction/Review of Literature: Medical error is inevitable due to complex environments and human fallibility. Other professions have published extensively on error reduction and students as a contributing aspect of clinical error. The physical therapy profession has lagged behind. Purpose: To explore doctor of physical therapy (DPT) student experiences with patient safety during clinical education, including factors that could potentially contribute to error. Subjects: Seventy DPT students at the University of Colorado. Methods: Sequential explanatory mixed methods design including quantitative (survey) and qualitative (focus group) data collection. Results and Conclusion: Ninety-one percent of students participated in the survey, and 13% in the focus groups. Five themes were identified, including 1) Facility safety culture, 2) Communication methods and frequency, 3) Widespread clinical education/clinical instructor variability, 4) Dual identity as student and clinician, and 5) Student stress. These themes all have the potential to increase patient safety risk. Discussion and Conclusion: Some issues identified in this paper are specific to students and need to be addressed at the clinical education level but with a focus on patient safety risk. However, many of the issues were related to the broader system and clinical environment and may have occurred without the student present. There are many opportunities for better academic and clinical partnerships with dual goals of improving educational excellence and reducing patient safety risk. [ABSTRACT FROM AUTHOR]

This paper challenges conventional understandings of how we think about consumer food waste by investigating the food purchasing/wasting views and practices of 102 Colorado (USA) residents (67 households). The methods used in this study included the triangulation of surveys, self-reported pictures of food waste and related daily reports over a two-week period, and focus groups. Understanding who is, and what are, driving food waste is important if the aim is to create policy interventions that meaningfully mitigate loss. This paper approaches concepts like consumer sovereignty and agency through a non-essentialist lens, which is to say it repositions food waste as a mode of ordering as opposed to an outcome of discrete, self-evident products-e.g., attitudes, autonomous consumers. Doing this opens the analysis up to connections that might otherwise go unrecognized when those categories are assumed to be absolute and obvious. After presenting numerical data gleaned from online surveys, findings are organized around the following themes: humans-as-assemblage; storage devices-as-assemblage; and mobility-as-assemblage. The paper concludes synthesizing these themes while suggesting interventions mindful of these fluid socio-material coming-togethers. [ABSTRACT FROM AUTHOR]

An effective approach to drug regulation is a growing concern. Since 2012, 10 US States and Uruguay have taken the step to revoke prohibition and legalize the recreational cannabis market. Based on the findings from a study ('Cannalex') carried out in 2015-2017 in Colorado, Washington and Uruguay by the French Monitoring Centre for Drugs and Drug Addiction (OFDT) and the Institute of Security and Justice (INHESJ), relying on a hundred of in-depth interviews analyzed in line with the existing official statistics and studies, this paper shows heterogeneous policy-making models and contexts for reform. It also examines the early outcomes of the cannabis policy change. A mixed picture is emerging from the regulatory regimes currently implemented. This paper discusses the reform processes and their early outcomes, with a specific focus on the less documented area: the political processes that led to legalizing cannabis, analyzed with qualitative data. It argues that the different outcomes reported across Colorado, Washington and Uruguay are framed by the regulatory options that were taken, depending on specific dynamics of reform. The discussion focuses on some hot topics raised by the effective regulations, stressing that the array of cannabis regulatory options is a public debate that has just begun. [ABSTRACT FROM AUTHOR]

Rural school nurses are on the front lines of providing health care for children and families in rural Colorado, but there is little research from their perspective. To fill this gap, a descriptive phenomenological study examined the experiences of nine rural school nurses through in-person audiotaped interviews. Analysis of data revealed three main themes: (1) rural school nurses' efforts to meet students' extensive physical and mental health issues, (2) school nurses struggle to help rural students in extreme poverty, and (3) communication challenges experienced by rural school nurses. The findings of this study give voice to the experiences and challenges faced by rural school nurses in southern Colorado. [ABSTRACT FROM AUTHOR]

Despite promising results from individual-level studies, state-level studies of the effectiveness of comprehensive background-check (CBC) policies in reducing firearm fatalities have yielded null results in multiple states. These prior studies focused on CBC laws adopted in the 1990s, when record keeping was far less complete. We estimated the effect of the implementation of CBC policies on state-level firearm homicide and suicide rates in states implementing CBC policies from 2013 to 2015 (Colorado, Delaware, Oregon, and Washington). We compared age-adjusted firearm homicide and suicide rates, measured annually from 15 years prior to policy implementation until 2019, in each treated state to rates in control groups constructed using the synthetic control group method. Differences in firearm homicide rates for Colorado, Oregon, and Washington post treatment were all small (0.09 to 0.18 per 100,000 residents per year) and not well distinguished from natural variation. Oregon had on average 0.80 per 100,000 fewer firearm suicides per year than did synthetic Oregon post treatment. However, these results were inconsistent across modeling approaches and not well distinguished from natural variation. Our models produced poor fit for Delaware. Coupled with previous null results from Indiana, California, Maryland, Pennsylvania, and Tennessee, the present results suggest that extending background check requirements to private transfers alone and implementing these policies as is currently done is not sufficient to achieve significant state-level reductions in firearm fatalities. [ABSTRACT FROM AUTHOR]

Introduction: A practice embarks on a radical reformulation of how care is designed and delivered when it decides to integrate medical and behavioral health care for its patients and success depends on managing complex change in a complex system. We examined the ways change is managed when integrating behavioral health and medical care.Method: Observational cross-case comparative study of 19 primary care and community mental health practices. We collected mixed methods data through practice surveys, observation, and semistructured interviews. We analyzed data using a data-driven, emergent approach.Results: The change management strategies that leadership employed to manage the changes of integrating behavioral health and medical care included: (a) advocating for a mission and vision focused on integrated care; (b) fostering collaboration, with a focus on population care and a team-based approaches; (c) attending to learning, which includes viewing the change process as continuous, and creating a culture that promoted reflection and continual improvement; (d) using data to manage change, and (e) developing approaches to finance integration.Discussion: This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. We offer an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Background: Despite lung cancer being a leading cause of death in the United States and lung cancer screening (LCS) being a recommended service, many patients eligible for screening do not receive it. Research is needed to understand the challenges with implementing LCS in different settings. This study investigated multiple practice members and patient perspectives impacting rural primary care practices related to LCS uptake by eligible patients. Methods: This qualitative study involved primary care practice members in multiple roles (clinicians n = 9, clinical staff n = 12 and administrators n = 5) and their patients (n = 19) from 9 practices including federally qualified and rural health centers (n = 3), health system owned (n = 4) and private practices (n = 2). Interviews were conducted regarding the importance of and ability to complete the steps that may result in a patient receiving LCS. Data were analyzed using a thematic analysis with immersion crystallization then organized using the RE-AIM implementation science framework to illuminate and organize implementation issues. Results: Although all groups endorsed the importance of LCS, all also struggled with implementation challenges. Since assessing smoking history is part of the process to identify eligibility for LCS, we asked about these processes. We found that smoking assessment and assistance (including referral to services) were routine in the practices, but other steps in the LCS portion of determining eligibility and offering LCS were not. Lack of knowledge about screening and coverage, patient stigma, and resistance and practical considerations such as distance to LCS testing facilities complicated completion of LCS compared to screening for other types of cancer. Conclusions: Limited uptake of LCS results from a range of multiple interacting factors that cumulatively affect consistency and quality of implementation at the practice level. Future research should consider team-based approaches to conduct of LCS eligibility and shared decision making. [ABSTRACT FROM AUTHOR]

Background: Valid and reliable tools must be implemented to measure nursing students' evidence-based practice (EBP) knowledge and skills that transfer to their practice. Purpose: To-translate and validate the English version of the Evidence Based Practice Competence Questionnaire (EBP-COQ-E). Methods: The EBP-COQ developed by Ruzafa-Martinez in Spain was administered to a sample of 279 undergraduate nursing students. Results: The content validity index was 96.16%, indicating that all items were correlated with the measurement of EBP competence. The Cronbach's alpha was 0.83, indicating good internal consistency. In confirmatory factor analysis, a three-factor solution was extracted with an eigenvalue greater than one, indicating a good measure of what it purports to be measuring. Conclusion: EBP-COQ-E can be recommended for standard implementation in English-speaking students taking EBP courses. [ABSTRACT FROM AUTHOR]

Objectives: It is important to understand the unique perspectives and values that motivate patients and clinicians in rural primary care settings to participate in clinical care activities. Our objective was to explore perspectives, preferences, and values related to primary care that could influence implementation of evidence-based programs. Methods: Qualitative study utilizing semi-structured interviews and using immersion/crystallization and thematic analysis. Participants were primary care practice members (clinicians, clinical staff, and administrators) and their patients in rural Colorado. Results: Twenty-six practice members and 23 patients across 9 practices participated. There were 4 emergent themes that were consistent across practice members and some patients. Patient perspectives are located in parenthesis. They included: (1) Focus on quality patient care, patient satisfaction, and continuity of care (patients appreciated quality and compassionate care), (2) Importance of prevention and wellness (patients appreciated help with preventing health problems), (3) Clinician willingness and ability to meet patient preferences for care (patients described comfort with local care), and (4) Passion for serving underserved, uninsured, or vulnerable populations (patients described their vulnerabilities). There were differences in how the perspectives were operationalized by practice member role, illustrating the importance of different ways of addressing these values. Conclusions: Successful implementation requires consideration of context, and much of context is understanding what is important to those involved in the primary care experience. This study sheds light on salient values of rural primary care practice members and their patients, which may inform interventions designed with and for this setting. [ABSTRACT FROM AUTHOR]

The topics of counselling and reconciliation seem controversial in developing countries because of their intrigued relationship. Likewise, the goal and processes are in question across cultures. In this study, qualitative research approach employing a case study method was carried out with deliberately selected elder counsellors in the Oromo community. Data were gathered using interviews and observations in the field. The results indicated that reconciliation is concurrently practised with counselling, which is the most important instrument to manage differences and to calm everyone involved. It serves to maintain peace and stability between conflicting groups and kinship; saves lives and prevents destruction of property; assists in progressing community rules and regulations; and supports family challenges. The research also identified that processes, tools of operation and time to conduct vary between communities. In conclusion, the goal of counselling and reconciliation is to retain peace and stability through thorough discussion, self‐evaluation and redeeming processes. Equally, pre‐ and post‐counselling sessions in reconciliation are useful approaches cohesive with reality and truth‐seeking behaviours to settle disputes in the community. [ABSTRACT FROM AUTHOR]

Youth experiencing homelessness (YEH) face myriad injustices regarding their reproductive and sexual health and rights. Reproductive and sexual health research with YEH often explores condom-use and sexually transmitted infections, potentially contributing to narrow conceptualizations of YEH as "unclean" or in need of disease-screening. A narrative theory perspective was applied to this study, which allowed for the emergence of alternative storylines, or counter-narratives, which attend to manifestations of power and oppression within the lives of marginalized individuals. Qualitative interviews engaged 30 young people (ages 18–21) accessing shelter services. Narrative analyses identified YEHs' documentations of dominant narratives related to structural oppressions, stigma, and numerous dimensions of reproductive and sexual health including how they create, through their resistance, counter-narratives that include their preferred futures. YEH emphasized systemic sources of stigma and outlined their criticisms of the state. Within-group stigma emerged as a noteworthy theme, with YEH showing both empathy and ambivalence towards other YEH, along with internalization of stigmatizing narratives about pregnancy and homelessness. Approaches to service provision that further amplify youths' voices in naming and challenging the many oppressions and stigmas they face should be prioritized. Moreover, policies should be implemented to dismantle the actual root causes of challenges faced by YEH, rather than perpetuating them through measures rooted in interlocking oppressions of discrimination, inequity, and judgment. [ABSTRACT FROM AUTHOR]

Purpose: This case study aims to explore the appropriateness of an adaptive riding program for persons living with dementia through examining family members' (care partners) reported outcomes. Design/methodology/approach: Using convenience sampling, persons living with dementia and their care partners were recruited in Northern Colorado; after meeting inclusion criteria, they were invited to participate in the adaptive riding program. The program occurred for weekly, hour-long sessions for eight weeks. Field notes were collected during each session, and semi-structured interviews were conducted with five care partners after the program and analyzed by using theoretical thematic analysis. Findings: Care partners found the adaptive riding program appropriate. Reported outcomes comprised three themes: well-being, meaning through social connections and function in daily life and aligned with the positive emotions, engagement, relationships, meaning, accomplishment (PERMA) theory of well-being. Originality/value: To the best of the authors' knowledge, this is the first study to explore the appropriateness of an adaptive riding program for persons living with dementia and their care partners who broadened understandings of the emotional, social and physical benefits. Findings support the inclusion of care partners in adaptive riding and may inform health-care providers' recommendations for such programs. [ABSTRACT FROM AUTHOR]

Objective: Automated Truck-Mounted Attenuators (ATMAs) have the potential to improve work zone safety by removing the human driver out of a vehicle that is positioned in work zones to absorb impact from errant vehicles. However, this automated technology is expensive and can be detrimental to safety and project success if operated incorrectly (e.g., operating limitations and procedures not followed). Therefore, it is important to understand users' perceptions of ATMAs and how training can improve appropriate adoption of this technology. The objective of this study was to evaluate how work zone workers perceive the usefulness of and the capabilities of automation in Truck-Mounted Attenuators.Methods: A survey study was conducted with 13 Department of Transportation (DOT) workers in Colorado and California. Each of the DOT workers in this study had some previous experience with the ATMA, either in real-world applications and/or formal training. The survey collected information on participant job specifications, experience with the ATMA, training received, trust in the ATMA, usability of the HMIs, and operating capabilities of the automation.Results: Workers reported an overall positive acceptance of this technology. This was supported by their expectation that it would reduce crash severity; that there was a reasonable workload associated with operating procedures for the automation; and by their overall trust in the automation's reliability. However, workers noted concerns regarding their trust in the automation under various contexts, such as poor visibility and denser traffic volumes. Further, trust in the technology was greatest among workers with higher levels of ATMA training and longer experience working with the ATMA.Conclusions: This research presents a novel perspective on user acceptance of ATMA technology. These findings can help jurisdictions achieve the safety improvements that investment and deployment of automation in work zones offers, by identifying the disconnect between operators and technology. [ABSTRACT FROM AUTHOR]

Contracting between private health plans and hospitals has been described as "chaos behind a veil of secrecy." We develop a novel algorithm that classifies inpatient claims as one of three contract types-discounted charges, fixed rates, or per diems-and apply it to the 2009-2014 Colorado All Payer Claims Database. Of $1.1 billion in classifiable private health plan payments for inpatient care in Colorado, we find that 42.1% were fixed rates, 41.1% were discounted charges, and 16.0% were per diems. We find wide variation in contract types among private health plans and hospital types, and a pronounced shift over the study period in private plans' contract types, away from discounted charges, and toward fixed rates. To test our algorithm's validity, we apply it to Colorado Medicare and Medicaid claims-both of which are known primarily to pay using fixed rates-and find, reassuringly, that 86.3% of Medicare payments (98.6% when we exclude Medicare claims with special payment rules) and 79.7% of Medicaid payments are classified as fixed rates. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity remains a serious concern in the United States and in many other countries. Direct experience preparing and tasting healthful foods and increasing activity during the school day are promising prevention approaches. Engaging parents and families remains an important challenge. Fuel for Fun: Cooking with Kids Plus Parents and Play is a multi-component school- and family-based intervention for 4th graders and their families intended to promote positive food and activity environments, policies and behaviors at the individual, family and school levels. This paper describes the design and evaluation plan.Methods/design: Four cohorts of 4th-graders and their parents from 8 schools in 2 districts in the same Northern Colorado region are participating in a 4-arm cluster randomized controlled trial. Theory-based Fuel for Fun consists of 5 components delivered over 1 school year: 1) Cooking with Kids - Colorado; an experiential classroom-based cooking and tasting curriculum, 2) Cafeteria Connections; cafeteria-based reinforcements of classroom food experiences using behavioral economic strategies, 3) SPARK active recess; a playground intervention to engage children in moderate to vigorous activity, 4) Fuel for Fun Family; multi-element supports targeting parents to reinforce the 3 school-based components at home, and 5) About Eating; an online interactive program for parents addressing constructs of eating competence and food resource management. Outcomes include child and parent measures of fruit and vegetable preferences and intake, cooking, physical activity, sedentary behaviors and attitudes. School level data assess lunch plate waste and physical activity at recess. In-depth diet and accelerometry assessments are collected with a subsample of parent-child dyads. Data are collected at baseline, immediately post-intervention at 7 months, and at 12 month follow-up. We anticipate recruiting 1320-1584 children and their parents over the length of the project.Discussion: The Fuel for Fun study design allows for impact assessment of school-, family- and online parent-based intervention components separately and in combination. Study strengths include use of theory- and evidence-based programs, valid child and parent self-report instruments, and objective measures of food, cooking, and physical activity behaviors at the individual, family and school levels. Parent involvement and engagement is examined through multiple strategies.Trial Registration: Clinicaltrials.gov registration number NCT02491294 . Registered 7 July, 2015. [ABSTRACT FROM AUTHOR]

Objective: There are concerns that some non-profit organisations, financed by the food industry, promote industry positions in research and policy materials. Using Freedom of Information (FOI) requests, we test the proposition that the International Life Sciences Institute (ILSI), one prominent non-for profit in international health and nutrition research, promotes industry positions.Design: U.S. Right to Know filed five FOI from 2015 to 2018 covering communications with researchers at four US institutions: Texas A&M, University of Illinois, University of Colorado and North Carolina State University. It received 15 078 pages, which were uploaded to the University of California San Francisco's Industry Documents Library. We searched the Library exploring it thematically for instances of: (1) funding research activity that supports industry interests; (2) publishing and promoting industry-sponsored positions or literature; (3) disseminating favourable material to decision makers and the public and (4) suppressing views that do not support industry.Results: Available emails confirmed that ILSI's funding by corporate entities leads to industry influence over some of ILSI activities. Emails reveal a pattern of activity in which ILSI sought to exploit the credibility of scientists and academics to bolster industry positions and promote industry-devised content in its meetings, journal and other activities. ILSI also actively seeks to marginalise unfavourable positions.Conclusions: We conclude that undue influence of industry through third-party entities like ILSI requires enhanced management of conflicts of interest by researchers. We call for ILSI to be recognised as a private sector entity rather than an independent scientific non-profit, to allow for more appropriate appraisal of its outputs and those it funds. [ABSTRACT FROM AUTHOR]

Background and Objectives Cannabis use among older adults is on the rise. Despite growing interest in the topic, there exists a paucity of standardized measures capturing cannabis-specific attitudes among older adults. Using data from a survey of older Coloradans, we create two scales that separately measure medical and recreational cannabis attitudes. We also examine how these two attitudes relate to individual-level characteristics. Research Design and Methods We assess reliability using Cronbach's alpha and item-rest correlations and perform confirmatory factor analyses to test the two attitude models. We conduct a seemingly unrelated regression estimation to assess how individual characteristics predict medical and recreational cannabis attitude scores. Results Twelve indicators combined into two valid and reliable scales. Both scales had a three-factor structure with affect, cognition and social perception as latent dimensions. For both scales, fit indices for the three-factor model were statistically superior when compared with other models. The three-factor structure for both scales was invariant across age groups. Age, physical health, and being a caregiver differentially predicted medical and recreational cannabis attitude scores. Discussion and Implications Medical and recreational cannabis attitude scales can inform the development and evaluation of tailored interventions targeting older adult attitudes that aim to influence cannabis use behaviors. These scales also enable researchers to measure cannabis-specific attitudes among older adults more accurately and parsimoniously, which in turn can facilitate a better understanding of the complex interplay between cannabis policy, use, and attitudes. [ABSTRACT FROM AUTHOR]

Background: Cannabis plays a role in symptoms management in HIV, especially the alleviation of pain and nausea and stimulation of appetite, and prevalence of cannabis use in HIV-positive populations exceeds that of the general U.S. population. Previous research has described an "overlap" between medical and recreational cannabis use among persons living with HIV. Methods: To understand better the motives associated cannabis use among young men who have sex with men living with HIV (HIV + YMSM), we conducted semi-structured interviews with 30 HIV + YMSM in Denver and Chicago. Interviews were audio-recorded, transcribed, and coded by a diverse team of analysts. Results: In addition to findings that mapped onto previously identified medical motives and recreational motives, we identified several themes that straddled medical and recreational use in a domain we describe as therapeutic. Themes identified in this therapeutic domain of cannabis use include (a) enhanced introspection among individuals that promotes psychological adjustment to an HIV diagnosis, improved medical management, and future orientation; (b) reflection processes that mitigate interpersonal conflict and improve interpersonal communication; and (c) a social-therapeutic phenomena of cannabis use among young persons with living HIV that is characterized by both enhanced introspection and improved interpersonal communication. Conclusions: Our findings suggest a spectrum of cannabis use among HIV + YMSM that may be characterized not only by an overlap between medical and recreational use, but also by a distinct therapeutic domain that incorporates stress alleviation and cognitive expansion processes to improve focus on HIV management and self-care. [ABSTRACT FROM AUTHOR]

Objective: The National Committee for Quality Assurance recommends response and remission as indicators of successful depression treatment for the Healthcare Effectiveness and Data Information Set. Effect size and severity-adjusted effect size (SAES) offer alternative metrics. This study compared measures and examined the relationship between baseline symptom severity and treatment success.Methods: Electronic records from two large integrated health systems (Kaiser Permanente Colorado and Washington) were used to identify 5,554 new psychotherapy episodes with a baseline Patient Health Questionnaire (PHQ-9) score of ≥10 and a PHQ-9 follow-up score from 14-180 days after treatment initiation. Treatment success was defined for four measures: response (≥50% reduction in PHQ-9 score), remission (PHQ-9 score <5), effect size ≥0.8, and SAES ≥0.8. Descriptive analyses examined agreement of measures. Logistic regression estimated the association between baseline severity and success on each measure. Sensitivity analyses evaluated the impact of various outcome definitions and loss to follow-up.Results: Effect size ≥0.8 was most frequently attained (72% across sites), followed by SAES ≥0.8 (66%), response (46%), and remission (22%). Response was the only measure not associated with baseline PHQ-9 score. Effect size ≥0.8 favored episodes with a higher baseline PHQ-9 score (odds ratio [OR]=2.3, p<0.001, for 10-point difference in baseline PHQ-9 score), whereas SAES ≥0.8 (OR=0.61, p<0.001) and remission (OR=0.43, p<0.001) favored episodes with lower baseline scores.Conclusions: Response is preferable for comparing treatment outcomes, because it does not favor more or less baseline symptom severity, indicates clinically meaningful improvement, and is transparent and easy to calculate. [ABSTRACT FROM AUTHOR]

In 2016, the University of Colorado Colorado Springs (UCCS) library acquired ProQuest's discovery tool Summon. To determine when information literacy instruction using Summon would be effective and what aspects should be taught, librarians conducted a usability study. Students completed tasks focused on determining whether Summon is intuitive and whether the interface needs to be taught. Results indicate that students are comfortable with the interface and have few problems with the tool. Instead, participants struggled with critical thinking processes associated with research. Results were used to integrate the ACRL Framework for Information Literacy for Higher Education into instruction. [ABSTRACT FROM AUTHOR]

Objective This qualitative study explored parent and patient navigator perspectives of home visitation as part of a childhood obesity program in a low-income, largely Latino population. Methods Three patient navigators and 25 parents who participated in a home-based, childhood obesity program participated in focus groups or interviews. Emergent themes were identified through content analysis of qualitative data. Results Three overall themes were identified. Patient navigators and parents perceived: (1) enabling characteristics of home-based program delivery which facilitated family participation and/or behavior change (i.e., convenience, increased accountability, inclusion of household members, delivery in a familiar, intimate setting, and individualized pace and content); (2) logistic and cultural challenges to home-based delivery which reduced family participation and program reach (i.e., difficulties scheduling visits, discomfort with visitors in the home, and confusion about the patient navigator’s role); and (3) remediable home-based delivery challenges which could be ameliorated by additional study staff (e.g., supervision of children, safety concerns) or through organized group sessions. Both patient navigators and participating parents discussed an interest in group classes with separate, supervised child-targeted programming and opportunities to engage with other families for social support. Conclusions for Practice A home visitation program delivering a pediatric obesity prevention curriculum in Denver was convenient and held families accountable, but posed scheduling difficulties and raised safety concerns. Conducting home visits in pairs, adding obesity prevention curriculum to existing home visiting programs, or pairing the convenience of home visits with group classes may be future strategies to explore. [ABSTRACT FROM AUTHOR]

This qualitative study identified nonpunitive and nonexclusionary discipline strategies used in schools with low out-of-school suspension rates. Interviews and focus groups with 198 educators from 33 low-suspending schools in a large urban district were conducted to learn more about the approaches that were essential to their school's success. Data were analyzed with inductive and deductive approaches to identify themes regarding efficacious approaches across schools. Relationship building was noted as a key strategy in reducing exclusionary discipline outcomes and racial disparities in out-of-school suspension. Specific relationship-building strategies and the rationales behind these practices are described, including home visits, greetings, morning meetings, advisory periods, increased adult visibility in and out of school, and positive contact with families. [ABSTRACT FROM AUTHOR]

Objectives: Interest is increasing in collaborations between public health and primary care to address the health of a community. Although the understanding of how these collaborations work is growing, little is known about the barriers facing these partners at the local level. The objective of this study was to identify barriers to collaboration between primary care and public health at the local level in 4 states. Methods: The study team, which comprised 12 representatives of Practice-Based Research Networks (networks of practitioners interested in conducting research in practice-based settings), identified 40 key informants from the public health and primary care fields in Colorado, Minnesota, Washington State, and Wisconsin. The key informants participated in standardized, semistructured telephone interviews with 8 study team members in 2014 and 2015. Interviews were audio recorded and transcribed verbatim. We analyzed key themes and subthemes by drawing on grounded theory. Results: Primary care and public health participants identified similar barriers to collaboration. Barriers at the institutional level included the challenges of the primary care environment, in which providers feel overwhelmed and resources are tight; the need for systems change; a lack of partnership; and geographic challenges. Barriers to collaboration included mutual awareness, communication, data sharing, capacity, lack of resources, and prioritization of resources. Conclusions: Some barriers to collaboration (eg, changes to health care billing, demands on provider time) require systems change to overcome, whereas others (eg, a lack of shared priorities and mutual awareness) could be addressed through educational approaches, without adding resources or making a systemic change. Overcoming these common barriers may lead to more effective collaboration. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated a videoconference-based psychiatric emergency consultation program (telepsychiatry) at geographically dispersed emergency department (ED) sites that are part of the network of care of an academic children's hospital system. The study compared program outcomes with those of usual care involving ambulance transport to the hospital for in-person psychiatric emergency consultation prior to disposition to inpatient care or discharge home.Methods: This study compared process outcomes in a cross-sectional, pre-post design at five network-of-care sites before and after systemwide implementation of telepsychiatry consultation in 2015. Clinical records on 494 pediatric psychiatric emergencies included ED length of stay, disposition/discharge, and hospital system charges. Satisfaction surveys regarding telepsychiatry consultations were completed by providers and parents or guardians.Results: Compared with children who received usual care, children who received telepsychiatry consultations had significantly shorter median ED lengths of stay (5.5 hours and 8.3 hours, respectively, p<.001) and lower total patient charges ($3,493 and $8,611, p<.001). Providers and patient caregivers reported high satisfaction with overall acceptability, effectiveness, and efficiency of telepsychiatry. No safety concerns were indicated based on readmissions within 72 hours in either treatment condition.Conclusions: Measured by charges and time, telepsychiatry consultations for pediatric psychiatric emergencies were cost-efficient from a hospital system perspective compared with usual care consisting of ambulance transport for in-person consultation at a children's hospital main campus. Telepsychiatry also improved clinical and operational efficiency and patient and family experience, and it showed promise for increasing access to other specialized health care needs. [ABSTRACT FROM AUTHOR]

Background: Intellectual disability (ID) is characterized by limitations in intellectual functioning and adaptive behavior. Adults with ID exhibit higher rates of obesity and poorer health status compared to the general population. Continuity of care and barriers to health-related activities may contribute to the poorer health status observed in this population. To address this problem, a tailored weight management online health information and communication technology platform, known as POWERSforID, was developed and is being tested to determine if this delivery mechanism can improve weight maintenance/weight loss in adults with ID.Methods: Obese adults with mild-to-moderate ID (n = 70) are randomized to the POWERS forID intervention or control group for a 24-week trial. Each group undergoes an assessment that includes body weight, waist circumference, and percent body fat at baseline and at weeks 6, 12, and 24. Physical activity barriers, healthy eating barriers, food frequency, and psychosocial wellbeing are measured at baseline and at weeks 12 and 24. Blood lipids are assessed at baseline and 24 weeks. Participants randomized to POWERS forID receive access to the POWERS forID website and calls from a health coach (weekly during weeks 1-12, biweekly during weeks 13-24). The health coach employs motivational interviewing techniques adapted for individuals with ID to promote behavior change. Participants randomized to the control group receive standard clinical weight-loss care. Differences in weight, waist circumference, blood lipids, percent body fat, and psychosocial self-report will be assessed. Barriers and facilitators of implementation as well as perception of study outcomes will be conducted via qualitative analysis.Discussion: POWERS forID is a novel information and communication technology platform designed to address health needs for adults with ID. This article describes the development and components of POWERS forID. The overall aim is to assess usability and feasibility of POWERS forID for promoting weight loss for obese adults with ID over the course of a 24-week randomized control trial.Trial Registration: Clinicaltrials.gov, NCT03139760 . Registered on XXX. [ABSTRACT FROM AUTHOR]

Aims To evaluate how young adults perceive and compare harms and benefits of marijuana and tobacco products in the context of a legal marijuana market in Colorado. Design Semi-structured qualitative interviews. Setting Denver, CO, USA. Participants Thirty-two young adults (aged 18-26 years) who used tobacco/marijuana/vaporizers. Measurements Semi-structured interviews addressed perceived harms and benefits of various tobacco and marijuana products and personal experiences with these products. Findings Young adults evaluated harms and benefits using five dimensions: (1) combustion-smoking was considered more harmful than non-combustible products (e.g. e-cigarettes, vaporizers and edibles); (2) potency-edibles and marijuana concentrates were perceived as more harmful than smoking marijuana flower because of potential to receive too large a dose of tetrahydrocannabinol (THC); (3) chemicals-products containing chemical additives were seen as more harmful than 'pure' or 'natural' plant products; (4) addiction-participants recognized physiological addiction to nicotine, but talked primarily about psychological or life-style dependence on marijuana; and (5) source of knowledge-personal experiences, warning labels, campaigns, the media and opinions of product retailers and medical practitioners affected perceptions of harms and benefits. Conclusions Among young adults in Colorado, USA, perceived harms and benefits of tobacco and marijuana include multiple dimensions. Health educational campaigns could benefit from addressing these dimensions, such as the potency of nicotine and cannabis concentrates and harmful chemicals present in the organic material of tobacco and marijuana. Descriptors such as 'natural' and 'pure' in the promotion or packaging of tobacco and marijuana products might be misleading. [ABSTRACT FROM AUTHOR]

Purpose: The authors determined the prevalence of smoking among Arab immigrants living in Colorado. The authors also evaluated the relationship between acculturation and tobacco use, including both cigarettes and hookah among Arab immigrants. Method: A cross-sectional survey of 100 adult Arab immigrants living in Colorado was carried out. Results: The results revealed that 19% of the study participants were current cigarette smokers and 21% were current hookah smokers. Participants who were more integrated into Arab culture were more likely to use tobacco products (p = .03) and to have family members (p = .02) and friends who use tobacco products (p = .007). Conclusions: Acculturation plays a major role in affecting the health habits of Arab immigrants living in Colorado, especially in the area of hookah smoking. Implications for Practice: Understanding some culturally relevant predictors of tobacco use might assist health care providers in designing successful smoking cessation programs. [ABSTRACT FROM AUTHOR]

Hospital initiatives to promote pain management may unintentionally contribute to excessive opioid prescribing. To better understand hospitalists' perceptions of satisfaction metrics on pain management, the authors conducted 25 interviews with hospitalists. Transcribed interviews were systematically analyzed to identify emergent themes. Hospitalists felt institutional pressure to earn high satisfaction scores for pain, which they perceived influenced practices toward opioid prescribing. They felt tying compensation to satisfaction scores commoditized pain. Hospitalists believed satisfaction would improve with increased time spent at the bedside. Focusing on methods to improve patient-physician communication, while maintaining efficiency in clinical practice, may promote both patient-centered pain management and satisfaction. [ABSTRACT FROM AUTHOR]

Background and Objectives: Primary care residency programs continue to adapt and change to become high-performing training sites for advanced primary care. Practice facilitation is a key method to assist practices in implementing organizational changes. This evaluation described the unique nature and essential roles and qualities of practice facilitation for residency program patient-centered medical home (PCMH) transformation.Methods: Evaluation of the Colorado Residency PCMH Project from 2009 through 2014 included template and immersion-crystallization approaches to qualitative analysis of field notes, key informant interviews, and meeting documentation to identify themes related to external facilitation for practice transformation in 11 Colorado primary care residency practices.Results: Important practice facilitator roles in residency practice transformation included supporter of quality improvement and NCQA implementation, connector of practices, and leadership and engagement coach. Key qualities included the relationship development between practice members and facilitators over time, flexibility, consistent presence and communication, and an external nature that provided a valuable outside perspective.Conclusions: Residency programs provide a unique environment that is particularly well-suited for transformation, though it also presents challenges. External practice facilitators that demonstrate key roles and qualities can support residency practices through this complex transformation process. [ABSTRACT FROM AUTHOR]