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Предмет. Стремительное изменение содержания труда и усложнение профессий часто затрудняет или делает вообще невозможным освоение новых умений в образовательной организации. Статья посвящена системному анализу наиболее распространенных моделей обучения на рабочем месте в современных условиях в контексте совершенствования подготовки кадров и развития человеческих ресурсов.Цель исследования — выявление инвариантных характеристик обучения на рабочем месте в рамках полиакторного подхода и определение необходимых условий для его успешной реализации. Исходной методологической позицией является рассмотрение обучения на рабочем месте (ОРМ) как социально-педагогического проекта.Методы. Исследование опирается на диахронический подход с использованием эмпирических методов кабинетного исследования, таких как системно-аналитический метод, текстовый анализ / анализ документов, а также элементов социального проектирования.Результаты. Добавленная стоимость обучения на рабочем месте с использованием программ ученичества и иных конфигураций дуальных моделей заключается не в контрактном оформлении взаимоотношений его акторов, а в целенаправленной организации самого процесса обучения в реальной трудовой среде.Научная новизна исследования заключается в выявлении конфигурации ключвых параметров полиакторного пространства обучения на рабочем месте, актуальных для повышения качества подготовки кадров, адекватных задачам экономики знаний и условиям Индустрии 4.0.Практическая значимость. Выводы и рекомендации могут быть использованы при дальнейшей модернизации профессионального образования, а также для обновления курсов по менеджменту в образовании. The subject of the study comprises the current trends of the work-based learning due to the acceleration of changes in the content of labor and the complexity of professions, which often makes it difficult or even impossible to master new skills in an educational organization. Thus, the article contains a systemic examination of the key most common models of work-based learning against the backdrop of its on-going growing relevance and expansion.The aim of the study is to identify invariant characteristics of the work-based learning from the polyactor communication perspective and to identify conditions for its successful implementation. The employed methodology relies on the diachronic approach supported by the empiric methods of desk-top research such as systems analysis method and text analysis method, as well as elements of social engineeringTheoretical novelty is in the identification of the configuration of the poly-actor dimension of work-based learning and its inherent properties relevant for enhancing quality and efficiency of the work force that would be adequate to the challenges of the knowledge economy and Industry 4.0.It is concluded that the added value of work-based learning in the form of apprenticeships and dual models as well as its other configurations is outside the formal contractual frame integrating its actors and lies in the targeted organization of the process of learning in the real-life work environment.The practical value is in the possibility of using the proposed conclusions and recommendations to further modernize vocational and professional education and courses in management in education.

The article, aimed at mapping ways to enhance the systemic character and sustainability of citizen science, analyses the state of its discourse in the Russian context. The analysis, relying upon the multiple actor interdisciplinary paradigm within the framework of rational agency, applied comparative and analytical methods. The research concentrated on identifying common invariant features in the processes of initiating and developing citizen science projects, as well as on distinguishing core unresolved issues. The article points out the relevance of citizen science, viewing the latter as a reflection of changes in the relationships and activities undertaken by people, communities and society at large, diverse actors getting more and more involved in these activities, with their functionality and impact on social processes being expanded. The research can be considered brandly new, because it defines the role of citizen science as a new synergetic paradigm for the development of science and higher education in Russia, and as an important communication-and-cooperation channel between higher education and society at large. In particular, it is revealed that at the macrolevel, citizen science projects contribute to the democratization of both scientific research and society as a whole by invoking actors from various social spheres and subsystems, as well as by strengthening citizens’ confidence in the state. At the microlevel, the projects contribute to the universities’ educational and social mission, expand and diversify the interaction of HEIs with society, and foster new research questions formulation. The practical use of the research is viewed as a possible integration of our conclusions in the further practice-oriented investigations, in forming citizen science backgrounds, competences, and methodological base. Of no less importance are the materials for the training programmes modernization in the field of science and higher education administration.

Introduction All three evidence-based treatment options for adults with severe obesity – behavioral weight management, weight management medications (WMM), and bariatric surgery – are underutilized in the Veterans Health Administration (VHA) system. Our objective in this study was to develop and pilot-test the TOTAL (Teaching Obesity Treatment Options to Adult Learners) intervention, which seeks to increase Veteran participation in obesity treatment. Methods In this single-site, parallel, pilot RCT, Veterans with severe obesity with an upcoming behavioral weight management visit were sent a recruitment letter after meeting inclusion/exclusion criteria via electronic health record screening. Eligible Veterans were randomized to TOTAL or usual care. TOTAL consisted of an 18-min video highlighting obesity health risks and treatment outcomes, eligibility criteria, and pros/cons of all three evidence-based obesity treatments. The primary outcomes were trial design feasibility (recruitment and retention rates) and acceptability to Veterans, which was assessed via semi-structured interviews with participants one week after randomization to TOTAL. Secondary outcomes included attitudes and self-efficacy to initiate treatment one week post-randomization and BMI change six months post-randomization (assessed via Cohen's d). Results Forty-two Veterans were randomized (recruitment rate = 47.2%), and 40/42 completed one-week assessments (retention rate = 95.2%). The mean participant age was 59.2 ± 11.9 years. Female and non-White participants comprised 14.3% and 11.9% of the cohort, respectively. Semi-structured interviews with all 20 participants who received TOTAL suggested that the delivery logistics and content of TOTAL were acceptable to Veterans. Attitudes toward behavioral weight management and bariatric surgery and weight loss improved in TOTAL vs. usual care patients (Cohen's d ranging from 0.3 to 0.6). Conclusions TOTAL was feasible to implement, acceptable to Veterans, and has the potential to increase obesity treatment participation in VHA. An adequately powered RCT is warranted to assess its impact on population-level weight loss. Trial registration ClinicalTrials.gov NCT03856320.

Prior research demonstrates that family history influences breast cancer prevention decisions among healthy women at elevated risk of the disease. Drawing on in-depth interviews with 50 African American and White women, this study reveals an important psychological mechanism of this relationship: exposure to cancer among loved ones. Four distinct categories of cancer exposure (Abstract, Generalized, Practical, and Traumatic), distinguished by the characteristics of women’s experiences with cancer among family members and close friends, are associated with differences in knowledge and decisions about breast cancer prevention options. Racial differences and distinct experiences among those with BRCA mutations are also discussed.

Chemoprevention is one of several methods that have been developed to help high-risk women reduce their risk of breast cancer. Reasons for the low uptake of chemoprevention are poorly understood. This paper seeks a deeper understanding of this phenomenon by drawing on women’s own narratives about their awareness of chemoprevention and their risk-related experiences. This research is based on a parent project that included fifty in-depth, semi-structured interviews with a purposive sample of African American and White women at elevated risk of breast cancer. This specific study draws on the forty-seven interviews conducted with women at high or severe risk of breast cancer, all of whom are eligible to use chemoprevention for breast cancer risk-reduction. Interviews were analyzed using grounded theory methods. Forty-five percent of participants, and only 21% of African American participants, were aware of chemoprevention options. Women who had seen specialists were more likely to be aware, particularly if they had ongoing specialist access. Aware and unaware women relied on different types of sources for prevention-related information. Those whose main source of information was a healthcare provider were more likely to know about chemoprevention. Aware women used more nuanced information gathering strategies and worried more about cancer. Women simultaneously considered all risk-reduction options they knew about. Those who knew about chemoprevention but were reluctant to use it felt this way for multiple reasons, having to do with potential side effects, perceived extreme-ness of the intervention, similarity to chemotherapy, unknown information about chemoprevention, and reluctance to take medications in general. Lack of chemoprevention awareness is a critical gap in women’s ability to make health-protective choices. Future research in this field must consider complexities in both women’s perspectives on chemoprevention and the reasons they are reluctant to use it.

Objective: To compare outcomes after bariatric surgery between Medicaid and non-Medicaid patients and assess whether differences in social determinants of health were associated with postoperative weight loss. Background: The literature remains mixed on weight loss outcomes and healthcare utilization for Medicaid patients after bariatric surgery. It is unclear if social determinants of health geocoded at the neighborhood level are associated with outcomes. Methods: Patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from 2008 to 2017 and had ≥1 year of follow-up within a large health system were included. Baseline characteristics, 90-day and 1-year outcomes, and weight loss were compared between Medicaid and non-Medicaid patients. Area deprivation index (ADI), urbanicity, and walkability were analyzed at the neighborhood level. Median regression with percent total body weight (TBW) loss as the outcome was used to assess predictors of weight loss after surgery. Results: Six hundred forty-seven patients met study criteria (191 Medicaid and 456 non-Medicaid). Medicaid patients had a higher 90-day readmission rate compared to non-Medicaid patients (19.9% vs 12.3%, P < 0.016). Weight loss was similar between Medicaid and non-Medicaid patients (23.1% vs 21.9% TBW loss, respectively; P = 0.266) at a median follow-up of 3.1 years. In adjusted analyses, Medicaid status, ADI, urbanicity, and walkability were not associated with weight loss outcomes. Conclusions: Medicaid status and social determinants of health at the neighborhood level were not associated with weight loss outcomes after bariatric surgery. These findings suggest that if Medicaid patients are appropriately selected for bariatric surgery, they can achieve equivalent outcomes as non-Medicaid patients., Mini-abstract: The relationship among Medicaid status, social determinants of health, and bariatric surgery outcomes is unclear. Using electronic health record data and social determinant variables geocoded at the neighborhood level, we found that Medicaid status, socioeconomic deprivation, household location (rural vs urban), and neighborhood walkability were not associated with weight loss outcomes after bariatric surgery. However, Medicaid patients had higher readmission rates within 90 days of surgery. Supplemental Digital Content is available in the text.

Background & Objectives: Prior research has documented significant racial disparities in adherence to breast cancer screening recommendations, use of breast-conserving surgery by early stage breast cancer patients, and breast cancer mortality. Decision making about breast cancer prevention options among high risk women has been less thoroughly studied, and racial differences remain mostly unexplored in this arena. The current study employs semi-structured interviews and inductive analytic methods to explore prevention decision making among African American and White women. Its core objective is to investigate the degree to which decision-making processes and outcomes differ across racial groups, and the specific content of these differences, in order to support interventions and programs to facilitate empowered, preventive decision making. Methods: In-depth, semi-structured interviews were conducted with 20 African American and 30 non-Hispanic White women at elevated risk of breast cancer. Allowing women to speak in their own words, these interviews explore women's perception of their risk status; the sources and content of risk information they have obtained; their understanding and consideration of prevention options; decision-making processes; decision-making networks, psychosocial well-being; and women's use of financial, time, and energy resources in coping with risk and prevention. Interviews ranged in length from 30 to 140 minutes and were professionally transcribed. Transcribed data are analyzed through grounded theory methods, using the NVivo 10 software package for qualitative data. Results: High risk African American women's experiences are distinct from those of their White counterparts in a range of ways, including the following. (1) African American women are much less frequently aware of the existence of prophylactic surgeries and chemoprevention options are clinically recommended for women at their own level of risk. (2) Among women who do know about these prevention options, African American women are less likely to consider or undertake prophylactic surgeries or chemoprevention to lower their breast cancer risk. (3) A much higher proportion of African American women have experienced several different types of cancer among their loved ones. These women tend to perceive of themselves as at risk for cancer in general, and not to perceive a specific high risk for breast or ovarian cancer. (4) African American women experience considerably more financial limitations on their ability to access health care and engage in specific prevention activities. Most have been uninsured for some period, and have had at least one health care decision affected by financial constraints. (5) African American women are considerably more likely to reference faith, spirituality, and religion in discussing their perceived risk of cancer and their attitudes toward prevention behavior. Conclusions & Implications: High risk women's narratives reveal substantial racial differences in perceptions, feelings, and choices related to breast cancer prevention. African American women who are clinically determined to be at high risk for breast and ovarian cancer are less likely than similar White women to understand this specific risk, to know about prevention options that could lower the risk, or to consider using these options even when they do know about them. The processes through which African American women navigate risk and prevention are also more heavily influenced by religious faith and financial constraint than those of White women. These distinctions merit further investigation, and confirmation with larger samples. Ultimately, knowledge of such inter-group differences may contribute to tailored interventions to support empowered and health-protective decision making among women at elevated risk. Citation Format: Tasleem J. Padamsee, Anna Muraveva, Electra D. Paskett. Racial Differences in Prevention Decision Making among Women at High Risk of Breast Cancer. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A52.