Mugerauer, Robert. (2021). Professional Judgement in Clinical Practice (Part 2): Knowledge into Practice. Journal Of Evaluation In Clinical Practice, 27(3), 603 – 611.
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Abstract
Rationale, Aims, and Objectives Though strong evidence-based medicine is assertive in its claims, an insufficient theoretical basis and patchwork of arguments provide a good case that rather than introducing a new paradigm, EBM is resisting a shift to actually revolutionary complexity theory and other emergent approaches. This refusal to pass beyond discredited positivism is manifest in strong EBM's unsuccessful attempts to continually modify its already inadequate previous modifications, as did the defenders of the Ptolemaic astronomical model who increased the number of circular epicycles until the entire epicycle-deferent system proved untenable. Methods Narrative Review. Results The analysis in Part 1 of this three part series showed epistemological confusion as strong EBM plays the discredited positivistic tradition out to the end, thus repeating in a medical sphere and vocabulary the major assumptions and inadequacies that have appeared in the trajectory of modern science. Paper 2 in this series examines application, attending to strong EBM's claim of direct transferability of EBM research findings to clinical settings and its assertion of epistemological normativity. EBM's contention that it provides the only valid approach to knowledge and action is questioned by analyzing the troubled story of proposed hierarchies of the quality of research findings (especially of RCTs, with other factors marginalized), which falsely identifies evaluating findings with operationally utilizing them in clinical recommendations and decision-making. Further, its claim of carrying over its normative guidelines to cover the ethical responsibilities of researchers and clinicians is questioned.
Keywords
Judgment (psychology); Professions; Evidence-based Medicine; Science; Medical Research; Application To Clinical Recommendations; Evidence‚Äêbased Medicine; Judgement; Quality Of Evidence; 2009 Cancer-control; Practice Guidelines; Health-care; G. H.; Grade; Quality; Recommendations; Ashcroft; Guyatt; Evidence‐ Based Medicine
Wagenfeld, Amy; Winterbottom, Daniel. (2021). Coping on the Inside: Design for Therapeutic Incarceration Interventions – A Case Study. Work-a Journal Of Prevention Assessment & Rehabilitation, 68(1), 97 – 106.
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Abstract
BACKGROUND: Adjusting to incarceration is traumatic. An under-utilized strategy understood to buffer and counteract the negative impacts of incarceration are nature interventions. OBJECTIVE: Outcomes of an interdisciplinary design studio course focused on developing masterplans for a women's prison in the Pacific Northwest (US) are presented. Course objectives included comprehension and application of therapeutic and culturally expressive design principles to increase the benefits of environmental design within a carceral setting; collaboration, developing a deeper, more representative understanding of how design processes can improve the lives of marginalized populations; and enhancing design skills, including at masterplan and schematic scale using an iterative process and reflection. METHODS: A landscape architect, occupational therapist, and architect teaching team, with support from architects and justice specialists facilitated an elective design studio course to redesign the Washington Corrections Center for Women campus. RESULTS: In a ten-week academic quarter, six student design teams created conceptual masterplans for therapeutic outdoor spaces at the Washington Corrections Center for Women. Students presented their plans to prison staff, current and ex-offenders, and architects and landscape architects in practice, and then received positive feedback. CONCLUSION: Despite well-documented need for and value of nature interventions to improve health and wellbeing for everyone regardless of circumstance or situation, the project awaits administrative approval to move forward to installation.
Keywords
Recovery; Exposure; Health; Correctional Institutions; Environmental Justice; Therapeutic Outdoor Environments; Interdisciplinary Academic Design Studio
Acolin, Arthur; Ramiller, Alex; Walter, Rebecca J; Thompson, Samantha; Wang, Ruoniu. (2021). Transitioning to Homeownership: Asset Building for Low- and Moderate-Income Households. Housing Policy Debate, 31(6), 1032 – 1049.
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Abstract
This article assesses the asset building of households that take part in shared-equity homeownership (SEH) models. The contribution of this article is a comparison of outcomes for households participating in shared-equity programs with other low- and moderate-income households who rent or own properties without restrictions on appreciation. We matched participants in SEH programs to households with similar characteristics from the Panel Study of Income Dynamics (PSID) over the 1997-2017 period. The findings indicate that in real terms, median SEH homeowners accumulated about $1,700 in housing wealth annually or around $10,000 during their holding period. This amount is lower than the $2,100 median annual gain in home equity experienced by similar PSID owners but statistically and economically significantly larger than the $16 in annual gain experienced by similar PSID renters. The findings provide evidence that households participating in SEH programs experienced positive, but modest, wealth gains that were slightly lower than those of homeowners in unrestricted units but substantially higher than those of renters.
Keywords
Appreciation; Households; Property; Wealth; Income; Housing; Dynamic Tests; Home Ownership; Assets; Tenants; Equity; Owners
Duncan, Glen E.; Hurvitz, Philip M.; Moudon, Anne Vernez; Avery, Ally R.; Tsang, Siny. (2021). Measurement of Neighborhood-Based Physical Activity Bouts. Health & Place, 70.
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Abstract
This study examined how buffer type (shape), size, and the allocation of activity bouts inside buffers that delineate the neighborhood spatially produce different estimates of neighborhood-based physical activity. A sample of 375 adults wore a global positioning system (GPS) data logger and accelerometer over 2 weeks under free-living conditions. Analytically, the amount of neighborhood physical activity measured objectively varies substantially, not only due to buffer shape and size, but by how GPS-based activity bouts are identified with respect to containment within neighborhood buffers. To move the neighborhood-effects literature forward, it is critical to delineate the spatial extent of the neighborhood, given how different ways of measuring GPS-based activity containment will result in different levels of physical activity across different buffer types and sizes.
Keywords
Built Environment; Walking; Home; Accelerometry; Geographic Information Systems; Gps; Neighborhood; Physical Activity
Mugerauer, Robert. (2021). Professional Judgement in Clinical Practice (Part 3): A Better Alternative to Strong Evidence-Based Medicine. Journal Of Evaluation In Clinical Practice, 27(3), 612 – 623.
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Abstract
Parts 1 and 2 in this series of three articles have shown that and how strong evidence-based medicine has neither a coherent theoretical foundation nor creditable application to clinical practice. Because of its core commitment to the discredited positivist tradition it holds both a false concept of scientific knowledge and misunderstandings concerning clinical decision-making. Strong EBM continues attempts to use flawed adjustments to recover from the unsalvageable base view. Paper three argues that a promising solution is at hand if we can manage several modes of inclusion. A modified original, moderate version of EBM continues though usually overshadowed. As definitively laid out by Sackett in the 1990s, clinical decision making is intended to be person-centered, recognizing and integrating multiple modes of evidence and knowledge that have been marginalized: professional experience, illness narratives, and individual patients' values and preferences. Complementary resources are at hand: interpretative understanding and practice, such as philosophical anthropology, hermeneutical phenomenology, complexity theory, and phronetic practices respond to the major problems and open new possibilities. Phronesis is especially important in regard to public decision making. Within part 3 an additional tone necessarily occurs. While most of papers 1, 2, and 3 are written in the classical mode of contrasting the theoretical-logical and empirical evidence offered by contending positions bearing on the decision making and judgement in clinical practice, a shift occurs when considerations move beyond what is possible for clinical practitioners to accomplish. A different, discontinuous level of power operates in the trans-personal realm of instrumental policy, insurance, and hospital management practices. In this social-economic-political-ethical realm what happens in clinical practice today increasingly becomes a matter of what is done unto clinical practitioners, of what hampers their professional action and thus care of individual patients and clients.
Keywords
Medical Policy; Judgment (psychology); Professions; Evidence-based Medicine; Patient-centered Care; Phenomenology; Decision Making In Clinical Medicine; Casuistry; Decision Making; Evidence‚Äêbased Medicine; Phronƒìsis; 2009 Cancer-control; Integrating Evidence; Decision-making; Health-care; G. H.; Mental-health; Tonelli; Challenge; Knowledge; Evidence‐ Based Medicine; Phronē Sis
Walter, Rebecca J.; Caudy, Michael; Galvan Salcido, Christine; Ray, James; Viglione, Jill. (2021). Exploring Post-Incarceration Residential Trajectories: Indicators of Housing Stability During the Re-entry Process. Housing, Theory & Society, 38(3), 300 – 319.
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Abstract
Extant research on housing instability focuses on external housing barriers but limited research exists on individual-level indicators of housing stability for individuals returning to society from incarceration. This study addresses this gap with data collected from 70 individuals recently released from incarceration who returned to Bexar County (San Antonio, Texas) that were not placed in specific housing programmes, leaving them to seek housing independently. The study explores residential trajectories and the utility of individual-level characteristics, specifically readiness for change, in relation to housing stability. The findings reveal the importance of assessing the dynamics of each individual living situation since many of the participants are housed but not in stable housing situations. Furthermore, readiness for change (specifically action, self-sufficiency, and human agency) is found to be a significant indicator of housing stability and may represent an important intervention target for re-entry and reintegration programmes. [ABSTRACT FROM AUTHOR]; Copyright of Housing, Theory & Society is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Keywords
Housing Discrimination; Housing; Self-reliant Living; Housing Instability; Housing Stability; Re-entry; Readiness For Change; Residential Trajectories