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While the literature is abundant on hand therapy assessment and treatment of nonsurgical thumb carpometacarpal (CMC) osteoarthritis (OA), clarity and uniformity are meager, making it a desirable diagnosis to establish expert consensus. This study aimed to ascertain if consensus exists for the assessment and treatment of nonsurgical management of thumb CMC OA in the hand therapy clinical setting. This was a consensus paper via the modified Delphi approach. A modified Delphi method was used to determine consensus among an expert panel, including hand therapists and hand surgeons, via two online surveys. A consensus paper steering committee (from the American Society of Hand Therapist's research division) designed the surveys and analyzed responses. Consensus was established as 75% agreement among the expert panel. Demographic information was collected from the expert panel. The expert panel included 34 hand therapists and seven hand surgeons. The survey response rates were 93.6% for the first survey and 90.2% for the second survey. Consensus recommendations were classified according to the World Health Organization categorization. These included evaluating the body structures for clinical signs/clinical testing and body functions for pain, range of motion for palmar abduction, radial abduction, opposition, and thumb metacarpal phalangeal flexion/extension, and grip and tripod pinch strength. Further consensus recommendations were for the assessment of function using a region-specific, upper extremity patient-reported outcome measure (activity and participation), environmental factors, outcome expectation, and illness perception within the patient's unique environmental and social contexts. Treatment recommendations included the use of an orthosis during painful activities, a dynamic stability program (stable C posture, release of tight adductors, and strengthening of stabilizers), patient education, joint protection techniques, adaptive equipment, and functional-based intervention. The findings describe the consensus of a group of experts and provide a clinical reference tool on the hand therapy assessment and treatment of nonsurgical thumb CMC joint OA. • A consensus paper using a modified Delphi process to determine consensus on non-surgical assessment and treatment of thumb CMC OA. • Assessment recommendations: evaluate clinical signs/testing, pain, thumb range of motion grip and tripod pinch, a region-specific PROM, environmental factors, outcome expectation, and illness perception. • Treatment: orthosis during painful activities as needed, a dynamic stability program, patient education, joint protection techniques, adaptive equipment, and functional based intervention. • Findings provide a clinical reference tool on hand therapy assessment and treatment of non-surgical CMC joint OA. [ABSTRACT FROM AUTHOR]

The immunization schedule recommended by the U.S. Advisory Committee on Immunization Practices (ACIP) provides a structure for how 10 different vaccine series should be administered to children in the first 18 months of life. Progress toward US early childhood immunization goals has largely focused on measuring vaccination coverage at age 24 months. However, standard vaccination coverage measures do not reflect whether children received vaccine doses by recommended ages, or whether vaccines were given concomitantly, per the schedule. In this paper, we describe innovations in population-level measurement of immunization schedule adherence through quantifying vaccination timeliness and undervaccination patterns. Measuring vaccination timeliness involves comparing when children received vaccine doses relative to ACIP age recommendations. To assess undervaccination patterns, children's vaccination histories are analyzed to determine whether they were vaccinated consistent with the ACIP schedule. Some patterns, such as spreading out vaccines across visits, are indicative of parental hesitancy. Other patterns, such as starting all recommended series but missing doses, are largely indicative of other immunization services delivery challenges. Since 2003, at least 12 studies have used National Immunization Survey-Child, immunization information system, or integrated health plan data to measure vaccination timeliness or undervaccination patterns at national or state levels. Moving forward, these novel measures can be leveraged for population-based surveillance of vaccine confidence, and for distinguishing undervaccination due to parental vaccine hesitancy from undervaccination due to other causes. Broader adoption of these measures can facilitate identification of targeted strategies for improving timely and routine early childhood vaccination uptake across the United States. [ABSTRACT FROM AUTHOR]

Building on intersectional awareness literature, this paper examines how another individual difference regarding one's perception of identity intersections — bicultural identity conflict (BII-C)— predicts immigrants' interpretations of their social environment and general orientation to take action to support immigrants from one's heritage group (GOA-I). While previous research has shown that BII-C, or perceived conflict (vs. harmony) between multiple cultural identities, is related to negative intergroup outcomes, we extend this research to examine how BII-C relates to social change actions that promote a more equitable society. An experimental study with 165 first- and second-generation immigrants living in the United States found support for a moderated mediation model. BII-C moderated the relationship between discrimination and the degree to which participants attributed discrimination to societal factors. These attributions were associated with GOA-I. Future research should consider additional individual differences, beyond intersectional awareness and BII-C, to see how these orientations may also act as a lens through which people interpret their social environment and are willing to take action to change it. [ABSTRACT FROM AUTHOR]

This paper reports on research into undergraduate students' engagement with university library social media. Social media (SM) applications enable university libraries to reach users in ways that may better meet their needs and preferences, but evidence suggests that undergraduate students' engagement with library social media is limited. This raises the question of whether libraries have a good understanding of student preferences for library SM content and approaches and whether students want to engage with the library at all through SM applications. This research aimed to identify if, how and why undergraduate students in select Nigerian universities engage with their library's SM through a questionnaire survey drawing on the Elaboration Likelihood Model (ELM) of persuasive communication. The results indicate that most students are unaware of university library SM posts. Those who are aware prefer content related to events and happenings on campus as well as news about library service developments. Results of the multiple regression reveal that students attach importance to the content of SM posts suggesting that the university library may still be able to reach them through social media for more meaningful interactions. Recommendations for the management of the content and approach to SM communications for university libraries are provided. [ABSTRACT FROM AUTHOR]

Objective: To determine factors and barriers associated with scholarly activity among faculty members at urology residency programs in the United States.Methods: An online survey was sent to all 134 urology residency program directors. The survey assessed program characteristics including size, location and definition of scholarly activity. It assessed available support for and barriers to resident scholarly activity, faculty participation in scholarly activity and mentorship of residents. Linear regression analysis was used.Results: We had a 40% response rate (N = 40). Faculty attitudes toward conducting scholarly activity (P < .001) and lack of a research curriculum (P = .05) were barriers to the outcome 'participation in scholarly activity'. Faculty attitudes toward conducting scholarly activity was also a barrier to the outcomes 'mentorship of residents' (P = .004) and 'publication of at least 1 paper' (P = .004). Available statistician was positively associated with the outcomes 'publications' (P = .062) and 'presentations' (P = .032). A minimum requirement of a local presentation (P=0.04) and chairman support (P = .015) were positively associated with the outcome 'presentation at a conference.'Conclusion: Training residents in research matters for the resident, the institution and future generations of surgeon scientists. Higher levels of faculty scholarly activity were associated with a minimum requirement for residents to submit a manuscript for publication, strong chairman support for resident research, and the availability of a statistician. A common barrier to faculty scholarly activity, publications, and resident mentorship was faculty attitudes toward resident scholarly activity. Urology residency programs seeking to prioritize scholarly activity among faculty should consider these factors. [ABSTRACT FROM AUTHOR]

In this paper, we analyze the commuting behavior of workers in the United States, with a focus on the differences between employees and the self-employed. Using the American Time Use Survey for the years 2003–2014, our empirical results show that employees spend 7.22 more minutes per day commuting than their self-employed counterparts, which represents a difference of 17% of the average commuting time of employed workers. This is especially prevalent in non-metropolitan areas, and it also appears to depend on the size of the population of the area of residence. Our results suggest that there is a complex relationship between urban form and the commuting behavior of workers. [ABSTRACT FROM AUTHOR]

This paper extends research emphasizing gender and gendered inequalities in rural communities are influenced by goods, jobs, and people moving between rural and urban contexts. Drawing from over 1,800 hours of participant observation in a rural community in the central United States, I analyze men's narratives about their trips to nearby cities to illustrate how they constructed and achieved an intersectional ideal of rural masculinity complicated by race, class, and sexuality. Through this analysis I stress the need to consider how multiple, intersecting dimensions of difference and inequality inform constructions of masculinities in rural contexts as rural communities are increasingly linked with cities. Second, and related, I illustrate perceived divisions between rural and urban spaces inform constructions of intersectional masculinities and inequalities even as rural and urban places are increasingly linked, materially, through political-economic processes such as labor markets and immigration. [ABSTRACT FROM AUTHOR]

To examine the research evidence about whether families were allowed to witness cardiopulmonary resuscitation on hospitalised adult and paediatric patients; and the views of patients, families and health professionals, about witnessed cardiopulmonary resuscitation. An umbrella review methodology of systematic reviews with sufficient methodological quality. Papers published in Spanish and English between, 1 January 2009 and 31 December 2018 were considered. The following databases were searched: PubMed, CINAHL, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, PsycInfo, Embase, the Central Supplier Database and the Joanna Briggs Institute, Evidence-based Practice Database. Two independent reviewers assessed the papers for methodological quality employing instruments from the Joanna Briggs Institute. Critical appraisal , extraction and synthesis were carried out, employing the established methods for umbrella reviews and the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO number CRD42019145610). The search identified 12 systematic reviews with moderate-to-high quality, which covered 110 original papers. Habitually, health professionals expressed controversial views and showed some reluctance to let families be present during cardiopulmonary resuscitation. In contrast, family members felt strongly that they should be present and patients agreed. Key factors that facilitated witnessed cardiopulmonary were a formal institutional policy, educating health professionals, and designating a health professional to support the family. Educational and cultural backgrounds influenced healthcare professionals' experiences and their attitudes towards witnessed cardiopulmonary resuscitation. In general, Anglo-Saxon countries showed greater support for this practice. These included the United States, which was the country that dominated the literature on this subject. The best available evidence supports allowing the family to be present during cardiopulmonary resuscitation. It is necessary to include this practice in educational curricula and to train emergency personnel in its implementation. Culturally sensitive policies need to be designed, and the public to be aware of their right to be present. [ABSTRACT FROM AUTHOR]

In this paper, we delineate how staff of two complex care management (CCM) programs in urban safety net hospitals in the United States understand trauma. We seek to (1) describe how staff in CCM programs talk about trauma in their patients' lives; (2) discuss how trauma concepts allow staff to understand patients’ symptoms, health-related behaviors, and responses to care as results of structural conditions; and (3) delineate the mismatch between long-term needs of patients with histories of trauma and the short-term interventions that CCM programs provide. Observation and interview data gathered between February 2015 and August 2016 indicate that CCM providers define trauma expansively to include individual experiences of violence such as childhood abuse and neglect or recent assault, traumatization in the course of accessing health care and structural violence. Though CCM staff implement elements of trauma-informed care, the short-term design of CCM programs puts pressure on the staff to titrate their efforts, moving patients towards graduation or discharge. Trauma concepts enable clinicians to name structural violence in clinically legitimate language. As such, trauma-informed care and structural competency approaches can complement each other. [ABSTRACT FROM AUTHOR]

There is growing concern among US-based clinicians, patients, policy makers, and in the media about the personal and community health risks associated with opioids. Perceptions about the efficacy and appropriateness of opioids for the management of chronic non-cancer pain (CNCP) have dramatically transformed in recent decades. Yet, there is very little social scientific research identifying the factors that have informed this transformation from the perspectives of prescribing clinicians. As part of an on-going ethnographic study of CNCP management among clinicians and their patients with co-occurring substance use, we interviewed 23 primary care clinicians who practice in safety-net clinical settings. In this paper, we describe the clinical and social influences informing three historic periods: (1) the escalation of opioid prescriptions for CNCP; (2) an interim period in which the efficacy of and risks associated with opioids were re-assessed; and (3) the current period of “opioid pharmacovigilance,” characterized by the increased surveillance of opioid prescriptions. Clinicians reported that interpretations of the evidence-base in favor of and opposing opioid prescribing for CNCP evolved within a larger clinical-social context. Historically, pharmaceutical marketing efforts and clinicians' concerns about racialized healthcare disparities in pain treatment influenced opioid prescription decision-making. Clinicians emphasized how patients' medical complexity (e.g. multiple chronic health conditions) and structural vulnerability (e.g. poverty, community violence) impacted access to opioids within resource-limited healthcare settings. This clinical-social history of opioid prescribing practices helps to elucidate the ongoing challenges of CNCP treatment in the US healthcare safety net and lends needed specificity to the broader, nationwide conversation about opioids. [ABSTRACT FROM AUTHOR]

This paper presents results from a study of driver feedback, driver attitudes, and the adoption of ecodriving behaviors. The study ran for one year; each driver was engaged in the experiment for four weeks. Narrowly defined, ecodriving represents the set of behaviors that a driver can use to minimize the energy use of a trip after the trip has begun. The general ecodriving behaviors are moderating acceleration, top speed, and braking. Ecodriving has long been recognized as a potential source of reductions in transportation energy use, with reduction estimates ranging widely from less than 5% to over 20% depending on context. In-vehicle feedback that provides drivers with salient information suited to their personal goals may be one way to motivate ecodriving. Although many studies have tested unique feedback designs, little research has been conducted into the cognitive precursors to driver behavior change that may underlie the adoption or rejection of ecodriving practices, and therefore underlie the effectiveness of any feedback design. This study examines both precursor cognitive factors and driver behavior changes with the introduction of energy feedback, using a framework hypothesizing that attitudes, social norms, perceived control, and goals influence behavior and behavior change. The study finds that the introduction of a feedback interface can both activate these cognitive factors and result in behavior change. Furthermore, the study finds that there was an overall 4.4% reduction in fuel consumption due entirely to one group that showed increases in their knowledge of fuel economy and reported high levels of technical proficiency during the experiment. Statistically significant relationships are found in this group between the magnitude of cognitive change and the magnitude of behavior change – supporting the theoretical framework. The second group made no improvement and may have been confused by the feedback. The effect of baseline (pre-feedback) performance of the drivers indicates drivers that already have highly efficient driving styles do not benefit much from feedback. [ABSTRACT FROM AUTHOR]

Context: The recurrence of past security breaches in healthcare showed that lessons had not been effectively learned across different healthcare organisations. Recent studies have identified the need to improve learning from incidents and to share security knowledge to prevent future attacks. Generic Security Templates (GSTs) have been proposed to facilitate this knowledge transfer. The objective of this paper is to evaluate whether potential users in healthcare organisations can exploit the GST technique to share lessons learned from security incidents.Methodology: We conducted a series of case studies to evaluate GSTs. In particular, we used a GST for a security incident in the US Veterans' Affairs Administration to explore whether security lessons could be applied in a very different Chinese healthcare organisation.Results: The results showed that Chinese security professional accepted the use of GSTs and that cyber security lessons could be transferred to a Chinese healthcare organisation using this approach. The users also identified the weaknesses and strengths of GSTs, providing suggestions for future improvements.Conclusion: Generic Security Templates can be used to redistribute lessons learned from security incidents. Sharing cyber security lessons helps organisations consider their own practices and assess whether applicable security standards address concerns raised in previous breaches in other countries. The experience gained from this study provides the basis for future work in conducting similar studies in other healthcare organisations. [ABSTRACT FROM AUTHOR]

This paper reports on six Chinese language teachers' experiences and perceptions of their classroom management in the United States of America. The analysis revealed that the teachers experienced cultural mismatches between their Chinese cultural expectations and American students' actual classroom behavior and struggled with challenges of understanding the demands of American classroom management, lack of effective strategies for managing American classroom, and language barriers. However, the teachers were able to adopt strategies commonly used by American teachers to manage their American students while retaining some of their Chinese practices. The findings suggest that cultural differences in classroom management play a significant role in affecting Chinese language teachers' classroom instruction and must be addressed in Chinese language teachers' preparation programs as well as their continued professional development in the U.S. and similar contexts. [ABSTRACT FROM AUTHOR]

How do health professionals with fundamentally different philosophies toward health, and different status levels, manage power in their work relationships? This paper argues that taking a negotiated order interactionist approach, which contends that the social order shapes behavior but is continuously negotiated through social interactions, and synthesizing it with a countervailing powers perspective can yield insight into the power dynamics between health professionals. It focuses on the birth field, with attention to the relationship between two very different types of birth professionals: obstetricians and doulas. Unlike doctors, who maintain a dominant place in health care and subscribe to a biomedical perspective of birth, doulas hold a low-status position and take a holistic approach toward birth, which may cause conflict in the labor room. In-depth interviews with 43 birth doulas based in the US (May–July 2018) found that the doula–doctor relationship is a complex story of power, deference, and countervailing responses. Doulas reported that doctors are more receptive to them now than in the past but that this is an outcome of creative countervailing responses involving deferential maneuvers and direct challenges to physician authority. Doulas' strategic management of their relationships with health professionals has allowed them entry to the hospital, permitting them to represent a holistic voice in the labor room. A minority of doulas have begun to develop relationships with doctors that constitute a collaborative approach toward birth care, indicating that changes in standard care are possible. By revealing how a subordinate actor can challenge physicians and effect change in care, this study contributes to scholarship seeking to understand the nature of unequal relationships between health professionals in a context of biomedical dominance. • Explores the relationship between doulas and doctors in the United States. • By acting deferentially, doulas' relationships with doctors have improved. • Doulas challenge physician authority in primarily indirect but also direct ways. • A minority of doulas have collaborative relationships with doctors. [ABSTRACT FROM AUTHOR]

Self-presentation, the social process by which people reveal information about themselves and perform the social roles that structure everyday interactions, has been significantly altered by today's social technologies. Where Goffman's influential self-presentation framework focused on in-person, real-time role performances, today's technologies routinely involve viewing text and visual content aggregated over time and linked to an individual's persistent online identity, the capacity for both ephemeral and more permanent content, and novel modes of audience engagement such as liking and commenting. These new socio-technical affordances not only allow for novel behaviors, but also alter the temporal dynamics of the self-presentation process in ways that are not well understood. In this paper we address this gap through an interview study of 32 young gay and bisexual male (GBM) Instagram users in the United States. Results extend our understanding of the relationship between social technology affordances and the temporal dynamics of self-presentation. We show how participants drew on Instagram's affordances for identity persistence, content persistence and audience engagement to slow down or speed up their role performances to particular audiences, to increase the visibility of their performances without appearing overtly to seek attention, and to make their audience at any given point in time a part of the performance seen by future audiences. • Unlike in-person, performing social roles online can occur across multiple time scales. • The temporality of online affordances and self-presentation are interrelated and used strategically by participants. • Audience plays a novel role in social media self-presentation, akin to extras on a film set. [ABSTRACT FROM AUTHOR]

The role of fetal development in abortion work is unresolved, mirroring a broader cultural ambivalence regarding the fetus. The collective, cultural notion of fetuses tends to lie on a dichotomy between "clump of cells" and "baby," with little public attention to the realities of fetal development during all stages of pregnancy. This tension is exacerbated by an absence of medically accurate images of aborted fetal tissue available to lay audiences. In this paper, we examine how independent abortion providers manage contradictory messages surrounding the fetus when providing patient-centered pregnancy tissue viewing (PCV). More specifically, we investigate how providers navigate public and private understandings of the fetus in their healthcare provision amidst a void of nuanced fetal imagery. Through interviews with 25 independent abortion providers in the United States, we analyze the discursive framings providers employ to make sense of the fetus and provision of PCV. Using a symbolic interactionism framework, we grouped results into three overarching themes: tensions in language, the impact of gestation as de- or re-stigmatizing, and looking as "making it more real." Our findings support the notion that the fetus is largely socially constructed, mutable, and variant across individuals, context, and time; our findings also highlight abortion providers' ability to hold nuanced and sometimes conflicting thoughts and feelings about fetuses while providing patient-centered care. This study addresses a largely overlooked practice within medical sociology and furthers our understanding of how cultural narratives shape the provision and meanings of patient-centered care, the professional socialization of healthcare workers, and the patient-provider interaction. • The "baby vs clump of cells" cultural binary affects interactions in the clinic. • Fetal symbolism is malleable and variant across individuals, context, and time. • Providers use mirroring and affect assessment to navigate cultural fetal ambiguity. • Language and gestational age shape fetal meaning and PCV makes abortion "more real." • Providers can have complicated feelings about fetuses but be confident in their work. [ABSTRACT FROM AUTHOR]