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Student development theory has been an important guide in practice; however, few theories focus on both the individual and the influence of the environment. Spencer's (1997) Phenomenological Variant of Ecological Systems Theory (PVEST) examines the individual, the environment, and the role of environmental feedback on self-perceptions, with a specific focus on how this feedback influences student experiences and outcomes. PVEST allows for assessing the processes by which an individual can develop strategies to resist negative feedback from oppressive environments, as well as how individuals use different coping mechanisms. In this chapter, we apply PVEST to individual student-level exemplars, as well as examples within counseling and classroom microcontexts to demonstrate the importance of environmental influence as well as phenomenological individual differences in interpretations and self-perception. Ultimately, we demonstrate how PVEST is a theoretical mechanism to focus on both the person and their phenomenological experiences (PEs), and offer larger implications for use in higher education contexts.

In an effort to promote the advancement of the advising profession, this study examines trends related to current knowledge of academic advising and the relationships between various forms of postsecondary advising practices and student outputs. Using content analysis techniques, we analyzed research articles published in "NACADA Journal" between 2004 and 2018 to identify trends in the ways academic advising has been studied. Major findings include the small number of studies (n=18) over a 15-year period that relate advising to outputs and the lack of research focusing on underrepresented student populations despite the continued significant growth of these diverse groups. Recommendations highlight characteristics of academic advising that may benefit from further scholarly inquiry.

Given the size of the adult student population and the student affairs focus on career development in traditional age students, the purpose of this qualitative study was to explore career development and the vocational self-concept (VSC) in 48 California community college welfare-to-work students. Findings suggest the importance of congruence between student roles and other life roles -- as well as the importance of sustained relationships with community college staff, as this was closely associated with VSC development. These sustained relationships are most beneficial when they help participants develop resistance strategies against messages that could damage their self-concepts. Theoretically, our findings call for differentiation between work and career, and show how VSC develops in some adult students, a process heretofore missing from the career literature. Knowing how students have been socialized to think about themselves, understanding if they can participate in career decision-making, and what their responsibilities in out-of-college contexts are is key to helping students find congruence and/or cope with incongruence stemming from balancing multiple life roles.

As trauma surgeons, we focus on the immediate care and needs of the injured patient every day. Historically, trauma and injury research has focused on outcomes such as mortality, complications, and length of stay; and process metrics such as time to CT scan, resuscitation checklist frequencies, or venous thromboembolism prophylaxis rates. These outcomes are perceived by healthcare providers to be important, but patients likely have different perceptions of what outcomes are most important to measure and improve. True patient-centered outcomes research involves the healthcare providers, and the entire team of stakeholders including patients and the community. Understanding the process of stakeholder engagement and the barriers trauma researchers must overcome to effectively enter this field of research is important. This summary aims to inform the trauma research community on the basics of patient-centered outcomes research, priorities for funding from the Patient-Centered Outcomes Research Institute, resources for collaboration around patient-centered outcomes research, and a unique career development and training opportunity for early career trauma surgeons to develop a skill set in patient-centered outcomes research.

This paper describes the current funding, infrastructure growth and future state of trauma research. It also introduces a group of review articles generated from The Future of Trauma Research: Innovations in Research Methodology conference hosted by the American College of Surgeons Committee on Trauma in July 2019.

Objective: To use updated 2021 weighted Pediatric Readiness Score (wPRS) data to identify a threshold level of trauma center emergency department (ED) pediatric readiness. Background: Most children in the United States receive initial trauma care at nonpediatric centers. The aim of the National Pediatric Readiness Project (NPRP) was to ensure that all EDs are prepared to provide quality care for children. Trauma centers reporting the highest quartile of wPRS on the 2013 national assessment have been shown to have lower mortality. Significant efforts have been invested to improve pediatric readiness in the past decade. Study Design: A retrospective cohort of trauma centers that completed the NPRP 2021 national assessment and contributed to the National Trauma Data Bank (NTDB) from 2019 to 2021 was analyzed. Center-specific observed-to-expected mortality estimates for children (0-15 y) were calculated using Pediatric Trauma Quality Improvement Program models. Deterministic linkage was used for transferred patients to account for wPRS at the initial receiving center. Centerspecific mortality odds ratios were then compared across quartiles of wPRS. Results: A total of 66,588 children from 630 centers with a median (interquartile range) wPRS of 79 (66-93) were analyzed. The average observed-to-expected odds of mortality [1.02 (0.97-1.06)] for centers in the highest quartile (wPRS=93) was lower than any of the lowest 3 wPRS quartiles [1.19 (1.14-1.23) (Q1), 1.29 (1.24-1.33) (Q2), and 1.28 (1.19-1.36) (Q3), all P< 0.05). The presence of a pediatric-specific quality improvement plan was the domain with the strongest independent association with mortality [standardized beta -0.095 (-0.146 to -0.044)]. Conclusion: Trauma centers should address gaps in pediatric readiness to include a pediatric-specific quality improvement plan and aim to achieve wPRS =93. [ABSTRACT FROM AUTHOR]

Objective: Despite significant enrollment in community colleges, persistence and graduation rates are quite low. This study aims to better understand how students' person--environment relationships and self-organization together contribute to the persistence decisions of community college students. Using Spencer et al.'s "phenomenological variant on ecological systems theory" (PVEST) framework, we aim to clarify the psychological functioning behind students' persistence that is impacted by diverse systems, including the community college itself, family, and the broader community. Method: This study utilized qualitative interviews with 66 participants across two community colleges. Findings: We find that when participants' experiences were analyzed through a PVEST frame, a majority of students described having phenomenological experiences around their student/learner identities. The feedback from these experiences prompted participants to negatively or positively reorganize their self-perceptions in regard to how they saw themselves as students and learners; this reorganization led to behaviors that influenced persistence plans. When participants' microsystems (e.g., family, work, college) intersected, patterns emerged regarding how participants processed environmental feedback that resulted in a cyclical feedback loop, suggesting a more dynamic relationship with environments than previously presented. Contributions: Using PVEST as a framework allows for a more in-depth examination of the interface between students' psychological foundations, processing of environmental feedback, and the resulting reorganization of self in regard to how role identities (e.g., student) provide greater insight into students' persistence decisions. This study offers PVEST as an important framework for rethinking previous models of researching and supporting community college student persistence.

Patients managed non-operatively have been excluded from risk-adjusted benchmarking programs, including the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). Consequently, optimal performance evaluation is not possible for specialties like emergency general surgery (EGS) where non-operative management is common. We developed a multi-institutional EGS clinical data registry within ACS NSQIP that includes patients managed non-operatively to evaluate variability in non-operative care across hospitals and identify gaps in performance assessment that occur when only operative cases are considered.Using ACS NSQIP infrastructure and methodology, surgical consultations for acute appendicitis, acute cholecystitis, and small bowel obstruction (SBO) were sampled at 13 hospitals that volunteered to participate in the EGS clinical data registry. Standard NSQIP variables and 16 EGS-specific variables were abstracted with 30-day follow-up. To determine the influence of complications in non-operative patients, rates of adverse outcomes were identified and hospitals were ranked by performance with and then without including non-operative cases.2,091 patients with EGS diagnoses were included, 46.6% with appendicitis, 24.3% with cholecystitis, and 29.1% with SBO. The overall rate of non-operative management was 27.4%, 6.6% for appendicitis, 16.5% for cholecystitis, and 69.9% for SBO. Despite comprising only 27.4% of patients in the EGS Pilot, non-operative management accounted for 67.7% of deaths, 34.3% of serious morbidities, and 41.8% of hospital readmissions. After adjusting for patient characteristics and hospital diagnosis mix, addition of non-operative management to hospital performance assessment resulted in 12 of 13 hospitals changing performance rank, with 4 hospitals changing by 3 or more positions.This study identifies a gap in performance evaluation when non-operative patients are excluded from surgical quality assessment and demonstrates the feasibility of incorporating non-operative care into existing surgical quality initiatives. Broadening the scope of hospital performance assessment to include non-operative management creates an opportunity to improve the care of all surgical patients, not just those who have an operation.III, Prognostic and Epidemiological.

BackgroundThe successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear.MethodsWe randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days. The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure, according to treatment group. Secondary outcomes included the duration of therapy and rates of subsequent infections.ResultsSurgical-site infection, recurrent intraabdominal infection, or death occurred in 56 of 257 patients in the experimental group (21.8%), as compared with 58 of 260 patients in the control group (22.3%) (absolute difference, -0.5 percentage point; 95% confidence interval [CI], -7.0 to 8.0; P=0.92). The median duration of antibiotic therapy was 4.0 days (interquartile range, 4.0 to 5.0) in the experimental group, as compared with 8.0 days (interquartile range, 5.0 to 10.0) in the control group (absolute difference, -4.0 days; 95% CI, -4.7 to -3.3; P

The present study explored the prevalence of the r-word in schools and students' bystander behavior in response to hearing the word. In total, 2,297 students from 12 high schools across the country participated in this study. Results revealed the r-word was used frequently among high school students, most often toward individuals without intellectual disability (ID). Students were more likely to take an active bystander role when hearing the r-word used toward students with ID than when hearing it used toward students without ID. Students' gender and prosocialness also played a role in determining their bystander behavior in response to the r-word. This study has implications for reducing the use of the r-word and the stigma associated with ID.

Through a year-long study of welfare-to-work students in the community college CalWORKs program, we investigated what self-authorship development looks like by examining developmental progress, and whether there are patterns in development along the three dimensions of self-authorship. Findings demonstrate progress toward self-authorship, but development across the dimensions was not synchronous. Although the intrapersonal dimension was the most common leading dimension, the greatest amount of development occurred along the cognitive dimension and the interpersonal dimension was most likely to show developmental regression. The theoretical and practical implications of these findings are discussed.

Through a one year-long, qualitative study of welfare-to-work students, this study investigates the developing epistemologies of women enrolled in a community college CalWORKs program. We investigate how poverty as a macro-environment and the community college as a micro-environment influence participants' epistemological development. Findings demonstrate poverty suppresses epistemological development through socialization, as experiences with disenfranchisement impede participants' beliefs in self as knower, and reify the value of absolute submission to authority. Additionally, we find that poverty impacts the types of epistemologies used and normalizes these epistemologies through the experience of intergenerational poverty. Theoretical, practical, and policy implications are discussed.