A Hybrid Methodology for Modeling Risk of Adverse Events in Complex Health‐Care Settings

In spite of increased attention to quality and efforts to provide safe medical care, adverse events (AEs) are still frequent in clinical practice. Reports from various sources indicate that a substantial number of hospitalized patients suffer treatment‐caused injuries while in the hospital. While risk cannot be entirely eliminated from health‐care activities, an important goal is to develop effective and durable mitigation strategies to render the system “safer.” In order to do this, though, we must develop models that comprehensively and realistically characterize the risk. In the health‐care domain, this can be extremely challenging due to the wide variability in the way that health‐care processes and interventions are executed and also due to the dynamic nature of risk in this particular domain. In this study, we have developed a generic methodology for evaluating dynamic changes in AE risk in acute care hospitals as a function of organizational and nonorganizational factors, using a combination of modeling formalisms. First, a system dynamics (SD) framework is used to demonstrate how organizational‐level and policy‐level contributions to risk evolve over time, and how policies and decisions may affect the general system‐level contribution to AE risk. It also captures the feedback of organizational factors and decisions over time and the nonlinearities in these feedback effects. SD is a popular approach to understanding the behavior of complex social and economic systems. It is a simulation‐based, differential equation modeling tool that is widely used in situations where the formal model is complex and an analytical solution is very difficult to obtain. Second, a Bayesian belief network (BBN) framework is used to represent patient‐level factors and also physician‐level decisions and factors in the management of an individual patient, which contribute to the risk of hospital‐acquired AE. BBNs are networks of probabilities that can capture probabilistic relations between variables and contain historical information about their relationship, and are powerful tools for modeling causes and effects in many domains. The model is intended to support hospital decisions with regard to staffing, length of stay, and investments in safety, which evolve dynamically over time. The methodology has been applied in modeling the two types of common AEs: pressure ulcers and vascular‐catheter‐associated infection, and the models have been validated with eight years of clinical data and use of expert opinion.     

Predicting tree species richness in urban forests

There has been an increasing interest in urban forests and the levels of biodiversity they contain. Currently there are no spatially explicit maps of tree species richness in urban areas. This research tests and identifies GIS and remote sensing metrics (climate, area, productivity, three-dimensional structure) hypothesized to be associated with species richness in native forests and identifies methods that can be applied to predict and map tree species richness in cities. We quantified tree species richness, floristic composition, and structure in 28 1-ha plots in the city of Los Angeles. Climate and remote sensing metrics from high-resolution aerial imagery (10 cm), QuickBird (60 cm), Landsat (30 m), MODIS (250 m), and airborne lidar (2 m) were collected for each plot. There were 1208 individual stems and 108 trees identified to species. Species richness ranged from 2 to 31 species per ha and averaged 17 species per ha. Tree canopy cover from QuickBird explained the highest portion of variance (54%) in tree species richness followed by NDVI from Landsat (42%). Tree species richness can be higher in residential urban forests than native forests in the United States. Spatially explicit species richness maps at 1 ha can be created and tested for cities in order to identify both hotspots and coldspots of tree species richness and changes in species richness over time.     

Religiosity,sexual behaviors,and sexual attitudes during emerging adulthood

The current study examined associations between religiosity and sexual behaviors and attitudes during emerging adulthood. Two hundred and five emerging adults completed surveys about five aspects of their religiosity (group affiliation, attendance at religious services, attitudes, perceptions of negative sanctions, and adherence to sanctions) and their sexual behaviors (abstinence, age of onset, lifetime partners, condom use) and attitudes (conservative attitudes, perceived vulnerability to HIV, and condom‐related beliefs). Associations were found between the measures of religiosity and sexuality, although the patterns differed by measures used. Religious behavior was the strongest predictor of sexual behavior. Many aspects of religiosity were associated with general sexual attitudes, which was not the case for perceived vulnerability to HIV and condom‐related beliefs. The findings support reference group theory and highlight the importance of considering the specific constructs of religiosity and sexuality assessed in studies of these topics.     

Parents' roles and question‐asking during pretend and real activities

All activities—real and pretend—provide children opportunities to learn new facts and skills, and parents are often facilitators. Yet little is known about whether and how parents' roles and interactions differ during pretend versus real activities. Here, we examine whether parents self‐report adopting different roles during pretend and real activities and whether we observe changes in their behavior, in particular in their question‐asking; either could impact the potential learning opportunities available to children. Thirty‐two parents engaged their 4‐year ‐olds in one pretend and one real activity (cleaning and snacking, counterbalanced). They self‐reported their roles, and speech was transcribed and coded. Parents regarded their role as a partner in fun during pretend and as a teacher or monitor during real activities. Across pretend and real contexts, they mostly asked information‐seeking questions, followed by rhetorical and pedagogical questions. They asked significantly more questions during pretend than real activities, particularly rhetorical questions. During real activities, parents' roles were not related to the number or types of questions they asked. However, during pretend, their roles were related to the number of rhetorical questions they asked: Monitors asked significantly fewer than teachers. Possible complementary benefits of each activity based on patterns of roles and questions are discussed.     

“SOCIOECONOMIC DIVERSITY IS OVERRATED”: WHITE ATTITUDES ON RACE AND CLASS IN A RACIALLY INTEGRATED NEIGHBORHOOD

This article investigates homeowners' perceptions of race and class within a racially integrated neighborhood in Baltimore, Maryland. Forty-two semi-structured interviews were completed with 59 white homeowners between September 2005 and September 2006. Adding a social class component to Bonilla-Silva's (2006 ——— . 2006 . Racism Without Racists: Color-Blind Racism and the Persistence of Racial Inequality in the United States, , 2nd edition . Lanham , MD : Rowman & Littlefield . [Google Scholar]) color-blind racism perspective, I ask if white homeowners in a racially-integrated neighborhood accept a color-blind worldview, or if they have an alternate framework for understanding race. Akin to O'Brien's antiracists (2001 Bonilla-Silva , Eduardo. 2001 . White Supremacy and Racism in the Post-Civil Rights Era . Boulder , CO : Lynne Rienner Publishers . [Google Scholar]), there was a range of rejection of color-blindness, from selective to reflexive race cognizance. Most homeowners recognized the institutional basis of racial inequality and their own white privilege. However, many conflated race and class and argued that it was really class differences that caused racial differences. While many supported more racial integration, most rejected class integration in the neighborhood. This paradoxical set of attitudes will most likely continue to be an obstacle to the maintenance of racially integrated neighborhoods.     

Mental Health Workforce Change Through Social Work Education: A California Case Study

The 2004 CaliforniaMental Health Services Act requires large-scale system change in the public mental health system through a shift to recovery-oriented services for diverse populations. This article describes an innovative strategy for workforce recruitment and retention to create and sustain these systemic changes. The California Social Work Education Center Mental Health Program provides stipends to master's of social work students at 17 California universities. In return, students must work for 1 year postgraduation in community mental health practice. Results of a 5-year study show that stipend recipients closely mirror the diverse demographics of the state, and 94% have remained in community mental health practice. The article also discusses lessons learned and implications for social work education in California and other states.     

Don't Ask,Don't Tell and Other LGB Civil Rights Issues: Effects of Terminology on Public Opinion

“Don't Ask, Don't Tell” was devised to combat the perceived costs associated with gays and lesbians openly serving in the military, including low unit cohesion, damage to the military's reputation, and the general population's lack of acceptance for homosexuals serving (Belkin, 2008). However, recent polls and policy reversal have shown growing public support for homosexuals being allowed to serve openly. Interestingly, the amount of support has varied as a function of question wording. Two polls conducted by CBS News found support for homosexuals serving in the military varied with greater support for “gays and lesbians” compared to “homosexuals.” Two studies were conducted to further examine the effect of terminology on reported support. Two samples reported opinions for homosexual civil rights issues. Sexual orientation was described using the terms gay men and lesbians, homosexuals, gay men, or lesbians. Percentage differences were found to be greater than those reported in the CBS polls, as wording choice had an effect on reported openness regarding homosexual civil rights. These differences indicate that it is important to consider precise terminology usage when measuring opinions. Levels of support, stereotypes activated, and the relationship between support for civil rights and general levels of prejudice were examined.     

Watching The Daily Show in Kenya

Global distribution of a popular American television programme – Jon Stewart's Daily Show – offers a rare opportunity to examine transnational contingencies of meaning in political satire. Drawing on focus group discussions in Kenya, this analysis shows how some East Africans appropriated and reinterpreted – indeed unexpectedly subverted – The Daily Show's political content, deriving from it insights that Stewart himself might have found surprising. Kenyan viewers perceived in The Daily Show gaps between the rhetoric and reality of empire and pointed to limitations of Stewart's dissident satire as they rejected its depictions of non-wealthy nations and marginalized peoples. They reconfigured Daily Show episodes as commentaries on global power relations; reflected critically on Kenyan politics, media and their own political subjectivities; and revised their own earlier assumptions about the gap between Africa and supposedly ‘mature’ democracies such as the United States. Thus, American political satire such as The Daily Show can activate in foreign audiences new perceptions of differences between the ‘West’ and the rest and new forms of political imagination.     

Movement Building and the United States Social Forum

Despite the growing academic literature on the World Social Forum process, few scholars have attempted to systematically analyze the social, cultural, and political impact of the forums. This has to do in part with the inherent difficulties of assessing movement consequences, which is particularly complicated for an activity geared toward creating ‘open spaces.’ This article presents an analytic framework for evaluating the impact of the social forums through an analysis of the 2010 United States Social Forum (USSF) in Detroit from the perspective of a local Boston-based delegation called the Boston Freedom Rides. We then use that framework to consider the impact of the 2010 USSF, bridging the academic literature on movement outcomes with activist perspectives. We make two related claims. First, the social forums, and the USSF in particular, should be viewed and their impact assessed in light of their generativity as ‘movement-building machines’: infrastructures designed for the production of social capital, networks, solidarities, meanings, frames, identities, knowledges, strategies, skills, and repertoires. Second, with respect to the Freedom Rides, the 2010 USSF contributed to movement building on multiple levels, but more so within rather than across movement sectors. Our goal is less to make a definitive argument about the impact of the 2010 USSF than to provide a helpful way of thinking about movement building as a social movement outcome, which can be applied and refined through further comparative and longitudinal research. We thus favor breadth over depth in outlining a broad framework for future inquiry.