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In a world that grows increasingly aware of ecological problems such as global warming, rising sea levels, and pollution, we need to reconsider how we connect ourselves to the natural world around us. In this paper, we view makerspaces as ideal locations to shape children's emotional, sociocultural, and educational consciousnesses about the environment and our multi-layered roles undertaken to live in, and conserve, it. We apply third space, makerspace, and relational value theories in the analysis of a research project conducted with children at an early childhood centre. This project invited children to discuss ocean conservation prompted by the picturebook Flotsam (2006) and create three-dimensional exhibits that express how they visualize ocean conservation. Our research shows that children develop strong emotional connections to tangible representations of conservation when they are given the time to invest in making them, and that these emotional connections are driving forces for relational values that create conservation-oriented mindsets. It also shows how important context is for shaping the ways children learn, and that providing opportunities to examine conservation through makerspaces as a third space encourages children to create empathetic and personal relationships with the natural world.

BackgroundChronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice's degree of behavioral health integration.MethodsForty-five primary care practices, with existing onsite behavioral health care, will be recruited for this study. Forty-three practices will be randomized to the intervention or usual care arm, while 2 practices will be considered "Vanguard" (pilot) practices for developing the intervention. The intervention is a 24-month supported practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Each practice's degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups. Practice-level case studies will be conducted to better understand the contextual factors influencing integration.DiscussionAs primary care practices are encouraged to provide IBH services, evidence-based interventions to increase practice integration will be needed. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting.Trial registrationClinicalTrials.gov NCT02868983 . Registered on August 16, 2016.

The existing research on the prevalence and impact of boredom in prison is extensive. The passing of time and its unique meaning in a prison context has been documented. Missing from the research is an analysis of the ways in which "warehouse" prisons do not prioritize meaningful activity, even when there is agreement between correctional staff and incarcerated individuals about the negative impacts of idle time in prison. Based upon research in a Vermont men's prison, we use data involving incarcerated individuals and correctional staff, including focus groups and interviews, surveys, and qualitative feedback on the meaning of the survey results. Synthesizing these various data forms, this article focuses on the relationship between incarcerated persons' perceptions of how they are able to spend their time in the facility, how prepared they feel for release, lack of opportunities to earn money, and the impacts on their wellbeing. "Warehousing," as it is known in prison terms, contributes to the sense of hopelessness that incarcerated people feel, and acknowledgment by staff that the prison function is incapacitation. As this project is aimed at improving prison climate, addressing idle time in prison emerged as a high priority. [ABSTRACT FROM AUTHOR]

The United States has the highest incarceration rate in the world. Incarceration is associated with significant negative mental health implications for both the corrections staff who work in prisons and the individuals incarcerated in them. Despite their scale and impacts, prisons are one of the country's least transparent and most understudied public institutions. Where research on prisons does exist, it is often focused on either the corrections staff population or the incarcerated population. Moreover, the perspectives of those most directly affected, incarcerated populations and correctional staff are rarely included in the process. In this study, we sought to focus on understanding the entire prison ecosystem, measuring the mental health status of corrections staff and incarcerated individuals, and describing potential interrelated factors in the prison environment that may affect these outcomes. We used a community-engaged process to develop a prison survey to measure the prison environment in a pilot facility in rural Vermont, incorporating the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Mental Health 2a instrument to measure the mental health status of the corrections staff and incarcerated individuals. Focus groups and interviews were conducted to inform survey development and understand factors affecting the mental health of these populations. Surveys were administered at three time points. [ABSTRACT FROM AUTHOR]

Background: Infection prevention (IP) behaviors such as hand hygiene (HH) and mobile device disinfection are important to reduce the risk of infection transmission from both family members and hospital staff to critically ill neonates. Purpose: To inform the design of educational interventions to improve both patient family and staff IP behaviors, we engaged separate groups of nurses and family members to understand perceptions about the spread of infection and barriers to implementing effective IP strategies. Methods: This was a qualitative study using focus groups to gather data from neonatal nurses and patient family members. Data were triangulated with hospital-wide survey data and analyzed using inductive content analysis. Results: Twelve nurses and 4 patient family members participated. Themes related to communication about IP between staff and family members emerged: stakeholders expressed discomfort with the timing and nature of just-in-time HH education. These communication challenges contributed to stress levels within the neonatal intensive care unit. This finding was reflected in the hospital-wide survey. Implications for Practice and Research: Steps should be taken to improve communication about IP behaviors between patient family members and frontline staff. Reducing nurse burden of providing just-in-time HH reminders to patient family members through increased IP education may decrease stress and facilitate IP behaviors. This has the potential to decrease infection spread and improve patient outcomes. The development of interventions targeting stakeholder communication is therefore warranted, but additional research is needed to understand the timing and process for delivery of the educational material. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at http://www.w3.org/1999/xlink). [ABSTRACT FROM AUTHOR]

Context: Food, housing, and financial insecurities are social determinants of health that negatively affect health. Little is known about the long-term impact of these insecurities on functional capacity. Objective: To investigate the longitudinal effect of these SDHs on functional capacity. Study Design: Retrospective cohort study Setting or Dataset: Longitudinal surveys from 41 primary care clinics across 13 states (September 2017 to February 2021) Population Studied: 2,426 adult primary care patients with multiple chronic conditions. Outcome Measures: The primary outcome was metabolic equivalents (METs) calculated from the Duke Activity Status Index (DASI). Results: The median time between baseline and follow-up surveys was 636 days. Baseline data were collected pre-COVID-19 and follow-up data were collected during COVID-19. The prevalence of one or more insecurities was 27% at baseline and 23% at follow-up. The median functional capacity was 6.1 at both time points. Compared to no SDH, the presence of one or more SDH at baseline but not follow-up (n=266) was associated with a -0.58 reduction in METs (95% CI: -0.84, - 0.33). Any SDH at follow-up but not baseline (n=172) was associated with a -0.67 reduction in METs (95% CI: -0.97, -0.36 and any SDH at both baseline and follow-up (n=369) was associated with a -0.90 reduction in METs (95% CI: -1.14, 0.66). Conclusions: The presence of these insecurities at baseline, follow-up or both was associated with significantly worse functional capacity compared to never having had these insecurities. This suggests primary prevention of insecurities (food, housing, and financial) are essential. Even participants who had insecurities at baseline and resolved it by follow-up still had poorer functional capacity, suggesting the devastating long-term impacts. Future studies should investigate Primary Care as a resource to screen for and prevent these insecurities., Presenters Levi Bonnell, MPH, PhD Candidate, Benjamin Littenberg, MD, Abigail Crocker, PhD, Constance van Eeghen, DrPH, [...]

Statins have the potential to reduce breast cancer incidence and recurrence as shown in both epidemiologic and laboratory studies. The purpose of this study was to evaluate the effect of a lipophilic statin, atorvastatin, on breast cancer biomarkers of risk [mammographic density (MD) and insulin growth factor 1 (IGF-1)] in high-risk premenopausal women.Premenopausal women at increased risk for breast cancer received either 40 mg of atorvastatin or placebo for 1 year. Biomarker assessment was performed prior to initiation and at completion of study medication. MD was determined using both Breast Imaging Reporting and Data System and the visual analogue scale. Serum IGF-1 was determined by ELISA assay at the end of the study.Sixty-three women were enrolled between December 2005 and May 2010. Sixteen (25%) women withdrew. The mean age of participants was 43 (range, 35-50), 100% were white, and the average body mass index (BMI) was 26.4. The statin group demonstrated a significant decrease in cholesterol and low-density lipoprotein (LDL), suggesting compliance with study medication. After accounting for BMI, there was no difference in change in MD between groups. There was a significant increase in serum IGF-1 in the statin group.In this multi-institutional randomized prospective clinical trial of premenopausal women at increased risk for breast cancer, we did not see an effect of atorvastatin on MD. Further investigation of statins may be warranted; however, design of prior trials and potential mechanism of action of the agent need to be considered in the design of future trials. Cancer Prev Res; 9(5); 379-84. ©2016 AACR.

Integrated behavioral health (IBH) is an approach to patient care that brings medical and behavioral health providers (BHPs) together to address both behavioral and medical needs within primary care settings. A large, pragmatic, national study aimed to test the effectiveness and measure the implementation costs of an intervention to improve IBH integration within primary care practices (IBH-PC). Assess the time and cost to practices of implementing a comprehensive practice-level intervention designed from the perspective of clinic owners to move behavioral service integration from co-location toward full integration as part of the IBH-PC study. IBH-PC program implementation costs were estimated in a representative sample of 8 practices using standard micro-econometric evaluation of activities outlined in the implementation workbook, including program implementation tasks, remote quality improvement coaching services, educational curricula, and learning community activities, over a 24-month period. The total median cost of implementing the IBH-PC program across all stages was $20,726 (range: $12,381 - $60,427). The median cost of the Planning Stage was $10,258 (range: $4,625 - $14,840), while the median cost of the Implementation Stage was $9,208 (range: $6,017 – 49,993). There were no statistically significant differences in practice or patient characteristics between the 8 selected practices and the larger IBH-PC practice sample (N=34). This study aimed to quantify the relative costs associated with integrating behavioral health into primary care. Although the cost assessment approach did not include all costs (fixed, variable, operational, and opportunity costs), the study aimed to develop a replicable and pragmatic measurement process with flexibility to adapt to emerging developments in each practice environment, providing a reasonable ballpark estimate of costs associated with implementation to help guide future executive decisions. [ABSTRACT FROM AUTHOR]

We hypothesized that amplification or overexpression of HER-2 (c-erbB-2), the Ki-67 antigen (Mib1), cyclin D-1 (CD1), interleukin-6 (IL-6), or the transforming growth factor beta II receptor, (TGFβRII), would predict relapse in women with early stage, estrogen (ER) and/or progesterone receptor (PR) positive breast cancer treated with tamoxifen. Conditional logistic regression models and a new novel analytic method––support vector machines (SVM) were used to assess the effect of multiple variables on treatment outcome. All patients had stage I–IIIa breast cancer (AJCC version 5). We paired 63 patients who were disease-free on or after tamoxifen with 63 patients who had relapsed (total 126); both disease-free and relapsed patients were matched by duration of tamoxifen therapy and time to recurrence. These 126 patients also served as the training set for SVM analysis and 18 other patients used as a validation set for SVM. In a multivariate analysis, larger tumor size, increasing extent of lymph node involvement, and poorer tumor grade were significant predictors of relapse. When HER-2 or CD1 were added to the model both were borderline significant predictors of relapse. The SVM model, after including all of the clinical and marker variables in the 126 patients as a training set, correctly predicted relapse in 78% of the 18 patient validation samples. In this trial, HER-2 and CD1 proved of borderline significance as predictive factors for recurrence on tamoxifen. An SVM model that included all clinical and biologic variables correctly predicted relapse in >75% of patients. [ABSTRACT FROM AUTHOR]

Context: Most patients in need of behavioral health (BH) care are seen in primary care, which often has difficulty responding. Some practices integrate behavioral health care (IBH), with medical and BH providers at the same location, working as a team. However, it is difficult to achieve high levels of integration. Objective: Test the effectiveness of a practice intervention designed to increase BH integration. Study Design: Pragmatic, cluster-randomized controlled trial. Setting: 43 primary care practices with on-site BH services in 13 states. Population: 2,460 adults with multiple chronic medical and behavioral conditions. Intervention: 24-month practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Outcomes: Primary outcomes were changes in the 8 Patient-Reported Outcomes Measurement Information System (PROMIS-29) domain scores. Secondary outcomes were changes in medication adherence, self-reported healthcare utilization, time lost due to disability, cardiovascular capacity, patient centeredness, provider empathy, and several condition-specific measures. A sample of practice staff completed the Practice Integration Profile at each time point to estimate the degree of BH integration in that site. Practice-level case studies estimated the typical costs of implementing the intervention. Results: The intervention had no significant effect on any of the primary or secondary outcomes. Subgroup analyses showed no convincing patterns of effect in any populations. COVID-19 was apparently not a moderating influence of the effect of the intervention on outcomes. The intervention had a modest effect on the degree of practice integration, reaching statistical significance in the Workflow domain. The median cost of the intervention was $18,204 per practice. In post-hoc analysis, level of BH integration was associated with improved patient outcomes independent of the intervention, both at baseline and longitudinally. Conclusions: The specific intervention tested in this study was inexpensive, but had only a small impact on the degree of BH integration, and none on patient outcomes. However, practices that had more integration at baseline had better patient outcomes, independent of the intervention. Although this particular intervention was ineffective, IBH remains an attractive strategy for improving patient outcomes., Competing Interests: Authors report none., (© 2021 Annals of Family Medicine, Inc.)