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Small mammals are ubiquitous members of vertebrate communities that are sensitive to habitat change. In the Great Lakes region of North America, small mammal communities have changed rapidly, but experimental tests of potential mechanisms are lacking. Using a before-after, control-treatment design, we quantified the response of small mammals to single-tree selection harvest in Laurentian hardwood forests of Wisconsin, United States. We documented changes in forest structure and small mammal abundance, species diversity, and community similarity from silvicultural treatment. Treatment reduced tree density and canopy cover and increased mean tree diameter, woody stem density, variation in woody stem densitv, and volume of coarse woody debris. Peromyscus and northern short-tailed shrews (Blarina brevicauda) were dominant community members across treatments and years. White-footed mice (P. leucopus) outnumbered woodland deer mice (P. maniculatus gracilis) before treatment, but declined by almost fifty percent after treatment; deer mice and total rodent (i.e., Rodentia) abundances were unchanged. Small mammal species diversity increased twofold following treatment. Our experiment identified species-specific responses within Peromyscus to timber harvest: white-footed mice, the numerically dominant and generalist species, were most sensitive to habitat change, and their response produced cascading effects to small mammal community structure. Future experiments should assess these small mammal responses in a multi-year framework and quantify their effects on the broader vertebrate community., INTRODUCTION Small mammals are widespread and ubiquitous members of terrestrial ecosystems (Kirkland and Layne, 1989; Feldhamer el al, 2015). They perform a range of functional roles, including as prey (Hanski [...]

Guided by Brashers's uncertainty management theory, the purpose of this study was to better understand the experience of family caregivers utilizing Medicaid waivers to subsidize health care for children with disabilities. Specifically, the focus of this study was to explore caregivers' experience with Kentucky's Michelle P. Waiver (MPW), a Medicaid waiver that provides robust benefit offerings to children with disabilities. Little is known about how parents come to know about the waiver, and the communication challenges they experience when applying for and navigating their child's health care through Medicaid. Data were gathered by narratively interviewing 31 parents of children who are currently receiving services through the MPW. Data were analyzed using narrative thematic analysis. The analysis focused on the community-level communication that contributes to parent caregivers' uncertainty about the MPW system. Findings show that parents experience unique personal, social, and medical uncertainties related to the MPW when navigating care for their child in the community. This project contributes to the health communication literature theoretically by expanding the conceptualization of the uncertainty in illness framework to include the means of health care (i.e. Medicaid) as a consequential element of an individual's illness experience. [ABSTRACT FROM AUTHOR]

To better understand what makes cost-of-care communication between oncologists and cancer patients more or less successful, we conducted in-depth interviews with 32 oncologists (22 male, 10 female) who were board-certified in medical, surgical, or radiation oncology. Through qualitative descriptive analysis by four coders, we found that oncologists used six broad strategies to discuss cost with patients: open discussion, avoidance, reassurance, warning, outsourcing, and educating. We also found that oncologists invoked certain meanings of cost conversations: cost conversations as holistic care, coercion, a matter of timing, risking patient suspicions, advocacy, unwanted distraction, transparency, bad news delivery, problem-solving, pointless, informed decision making, or irrelevant. These meanings appeared to be linked to oncologists enacting certain strategies (e.g., oncologists who invoked cost conversations as holistic care tended to enact open discussion, those who saw cost conversations as risky tended to use avoidance). Theoretically, our results suggest that the invoked meaning of a difficult conversation may be a key explanatory mechanism for differentiating high-quality from low-quality communication in cost conversations. Practically, our findings suggest that oncologists should consider how well the invoked meaning of the cost conversation is serving their own and their patients' goals. [ABSTRACT FROM AUTHOR]

Background: Family members of intensive care unit (ICU) patients often report poor communication, feeling unprepared for ICU family meetings, and poor psychological outcomes after decision-making. The objective of this study was to create a tool to prepare families for ICU family meetings and assess feasibility of using Communication Quality Analysis (CQA) to measure communication quality of family meetings. Methods: This observational study was conducted at an academic tertiary care center in Hershey, PA from March 2019 to 2020. Phase 1a involved conceptual design. Phase 1b entailed acceptability testing of 2 versions of the tool (text-only, comic) with 9 family members of non-capacitated ICU patients; thematic analysis of semi-strucutred interviews was conducted. Phase 1c assessed feasibility of applying CQA to audio-recorded ICU family meetings (n = 17); 3 analysts used CQA to assess 6 domains of communication quality. Wilcoxon Signed Rank tests were used to interpret CQA scores. Results: Four themes emerged from Phase 1b interviews: participants 1) found the tool useful for meeting preparation and organizing thoughts, 2) appreciated emotional content, 3) preferred the comic form (67%), and 4) had indifferent or negative perceptions about specific elements. In Phase 1c, clinicians scored higher on the CQA content and engagement domains; family members scored higher on the emotion domain. CQA scores in the relationship and face domains had the lowest quality ratings. Conclusions: Let's Talk may help families become better prepared for ICU family meetings. CQA provides a feasible approach to assessing communication quality that identifies specific areas of strengths and weaknesses in communication. [ABSTRACT FROM AUTHOR]

Genetic testing can detect whether an individual carries a harmful variant in the BRCA1 or BRCA2 (Breast Cancer 1 or 2) gene which, if present, drastically increases a woman’s risk for breast and ovarian cancer. The experience of BRCA gene testing can be an emotionally laden process yielding significant uncertainty. In this study, we examined women’s experiences of BRCA gene testing by exploring how participants communicatively framed and made sense of this process through the use of metaphors. Comparing uncertain and unfamiliar experiences to familiar references through metaphor can help people in challenging health-related situations with sense-making and communicating complex emotions. Furthermore, metaphors can be employed as a therapeutic tool by health care professionals, but their use has not often been studied regarding experiences of genetic testing, including BRCA gene testing. We conducted in-depth interviews with 42 women who have undergone BRCA gene testing (regardless of results), and analyzed data using constant comparative techniques. Eight categories of metaphors that women used surrounding BRCA gene testing were evident in the data, including those related to (a) knowledge is power; (b) gambling; (c) a journey; (d) a rollercoaster; (e) battle, disaster, or wreckage; (f) Pandora’s box or a can of worms; (g) doom and gloom; and (h) the release or placing of a weight. Results enhance our understanding of women’s experiences related to the uncertainty-inducing process of BRCA gene testing and lead to valuable theoretical implications and practical recommendations, including regarding the potential use of metaphors in patient-provider communication about BRCA genetic risk. [ABSTRACT FROM AUTHOR]

Drawing on theoretical principles related to goal pursuit and inference, the present study investigated the extent to which specific message features led to better or worse conversational outcomes of end-of-life discussions between older adults and their adult children. Actor-partner interdependence modeling analysis of longitudinal reports from 66 parent/child dyads revealed that tactical attention to identity, relational, and task goals in conversation predicted change over a 1-year period in advance directive completion, concordance accuracy, and relationship satisfaction and closeness. Quantity features of communication (i.e., number of conversations, number of topics discussed) were not related to the measured outcomes. Routine relationship maintenance and explicit decision making had a positive impact on the outcomes, and underaccommodation, strategic relationship maintenance, avoidance, elaboration, and implicit decision making had a negative impact on the outcomes of end-of-life family talk. The findings provide insight on how to practically improve the quality of end-of-life conversations in families. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Many Medicaid managed care organizations (MCOs) now screen enrollees and connect them to community-based organizations (CBOs) to address unmet social needs. COVID-19 has significantly disrupted health care delivery and overall economic activity in the United States. We examined how partnerships between Medicaid MCOs and CBOs to address social determinants of health have been affected by the pandemic. STUDY DESIGN: Guided by questions and recruitment strategies developed with our stakeholder advisory board, we conducted 26 interviews with representatives from all 6 of Kentucky's Medicaid MCOs. METHODS: In-depth, structured interviews for data collection and iterative content analyses to identify themes. RESULTS: Several themes emerged, including substantial increases in enrollees' unmet needs and the demand to find new ways to be responsive, changing funding patterns, disruptions to and evolving modes of communication, and shifting partner relationships. In virtually all areas of impact, COVID-19 has been associated with both negative and positive change. CONCLUSIONS: Unmet social needs associated with the pandemic placed tremendous strain on CBOs, limiting their capacity to sustain some programs and partnerships. Isolation associated with COVID-19 also had wide-ranging effects on service delivery, communication with enrollees and partners, and the ability to maintain relationships. Nonetheless, the pandemic also had some silver linings, including additional resources and flexibility for addressing unmet needs. Federal and state agencies, along with MCO leaders, should carefully evaluate what innovations have been particularly effective during the pandemic and craft new flexibilities into their policies, procedures, and regulations. [ABSTRACT FROM AUTHOR]

We examined the association between mental health and relationship and wedding factors among engaged women planning their weddings before and during Covid-19. Survey data from 715 non-Covid-19 and 427 Covid-19 participants revealed that Covid-19 participants experienced depression in greater proportion than non-Covid-19 participants. Wedding satisfaction and financial strain were stronger predictors of depression for Covid-19 than non-Covid-19 participants. Other significant predictors of Covid-19 participants' depression included social isolation, relational satisfaction and turbulence, and wedding disillusionment. Additionally, 22.0% of Covid-19 participants reported severe levels of anxiety, which was significantly predicted by social isolation, relational turbulence, wedding financial strain, wedding disillusionment, and wedding satisfaction. According to Covid-19 participants' open-ended responses, less depressed participants liked something better about their revised wedding plans, more anxious participants could not identify positive aspects of their revised plans, and less anxious participants appreciated the perspective that came with revising wedding plans due to Covid-19. [ABSTRACT FROM AUTHOR]

Individuals living with HIV may have a heightened sensitivity to the behaviors of others that may signal bias or discrimination. Identifying and avoiding these potentially problematic behaviors may be especially important for service providers, such as health care personnel, who regularly interact with HIV-positive clientele. This study examines the experiences of 50 male American military veterans living with HIV and their perceptions of HIV stigma within health care contexts. Participants described a variety of behaviors performed by health care personnel that they perceived to be indicative of HIV stigma, ranging from ambiguous nonverbal cues (e.g., minimal eye contact) to blatant discrimination (e.g., physical abuse of HIV-positive patients). These findings extend previous research on HIV stigma in health care settings by (1) focusing on health care personnel's actual behaviors rather than their attitudes and beliefs about HIV-positive patients, (2) including patients' perceptions regarding the behaviors of both clinical and nonclinical health care personnel, and (3) identifying behaviors patients perceive as stigmatizing that are unique to health care contexts. Combined, these findings provide health care personnel a tangible list of behaviors that should either be avoided or further explained to HIV-positive patients, as they may be interpreted as stigmatizing.