Mugerauer, Robert. (2021). Professional Judgement in Clinical Practice (Part 1): Recovering Original, Moderate Evidence-Based Health Care. Journal Of Evaluation In Clinical Practice, 27(3), 592 – 602.
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Abstract
Evidence-based medicine announced its entry as heralding a new paradigm in health care practices, but it has been widely criticized for lacking a coherent theoretical basis. This paper presents the first part of a three-article series examining the epistemological, practical, and ethical dimensions of strong EBM, as well as considering alternatives that promise potential solutions to chronic conceptual and practical problems. While the focus is on the details of the arguments and evidence in thoughtful debates over the last 30 years, it is worthwhile to keep in mind the overall trajectory of modern thought, because strong EBM continues discredited positivist positions, thus repeating its major assumptions and inadequacies, now transferred to the medical sphere and vocabulary. Part 1 of the series examines the development of strong EBM by clarifying and critiquing its somewhat discontinuous accounts of scientific knowledge and epistemology, evidence, the differences between statistical probability in regard to populations and understanding the health of individuals, and its claims for direct transfer of research findings to clinical settings-all of which raises more questions regarding its application to provider-patient decision making, pedagogy, and policy.
Keywords
Evidence-based Medicine; Theory Of Knowledge; Medical Ethics; Decision Making In Clinical Medicine; Policy Sciences; Clinical Practice; Epistemology; Ethics; Evidence; Evidence‚Äêbased Medicine; 2009 Cancer-control; Integrating Evidence; Decision-making; G. H.; Tonelli; Discourse; Knowledge; Ashcroft; Guyatt; Evidence‐ Based Medicine
Tillyer, Marie Skubak; Wilcox, Pamela; Walter, Rebecca J. (2021). Crime Generators In Context: Examining ‘place In Neighborhood’ Propositions. Journal Of Quantitative Criminology, 37(2), 517 – 546.
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Abstract
Objectives The present study tests hypotheses regarding the moderating influence of neighborhood-level criminal opportunity on the relationship between crime generators and block-level crime. Methods We first estimated multilevel negative binomial regression models for violent, property, and drug crimes to identify crime-type specific crime generators on each block. We then estimated a series of crime-type specific models to examine whether the effects of violent, property, and drug crime generators are moderated by three census block group-level indicators of neighborhood criminal opportunity-concentrated disadvantage, vehicular traffic activity, and civic engagement. Results The positive relationship between crime generators and crime on blocks was exacerbated in census block groups with high levels of concentrated disadvantage and high levels of traffic activity for all three crime types. The effects of crime generators on block-level crime were significantly tempered in census block groups with high levels of civic engagement. Conclusions Particular place types do not generate crime similarly across varying neighborhood contexts. Rather, the criminogenic effects of micro-places appear to be exacerbated in neighborhoods with extensive criminal opportunity and tempered in neighborhoods with less criminal opportunity.
Keywords
Neighborhoods; Crime; Regression Analysis; Census; Crime And Place; Crime Generators; Multilevel Opportunity; Place In Neighborhood; Alcohol Outlet Density; Block-level Analysis; Social-disorganization; Routine Activities; Longitudinal Analysis; Street Robbery; Land-use; Multilevel; Victimization; Community; Citizen Participation; Traffic; Property Offences; Drugs; Effects; Property
Abu Ashour, Lamis; Dannenberg, Andrew L.; Shen, Qing; Fang, Xun; Wang, Yiyuan. (2021). Paratransit Services For People With Disabilities In The Seattle Region During The Covid-19 Pandemic: Lessons For Recovery Planning. Journal Of Transport & Health, 22.
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Abstract
Introduction: Along with all public transit services, paratransit services for people with disabilities experienced substantially reduced demand and an increased need to provide equitable services while protecting their clients and staff's safety during the COVID-19 pandemic. Paratransit services provide a lifeline for their clients' essential mobility needs, including access to medical appointments and grocery stores. In the absence of pre-existing pandemic response plans, examining transit agencies' responses to provide paratransit services during the pandemic can help inform planning for post-pandemic recovery and future disruptive events. Methods: In September 2020, we conducted semi-structured interviews with 15 decision-makers, planners, and drivers working for the primary transit agency in the Seattle region - King County Metro - and its paratransit contractors. Interview questions were designed to identify current services, policy gaps, and critical challenges for recovery planning and post-pandemic paratransit services. Interview transcripts were analyzed using NVivo software to obtain essential themes. Results: The interviewees provided insights about (1) paratransit service changes in response to the pandemic, (2) anticipated impacts of a returning demand on paratransit service efficiency, equity, and quality during the recovery period, and (3) innovative approaches for maintaining post-pandemic equitable paratransit services while balancing safety measures with available resources. Conclusions: Study findings suggest that paratransit service providers should consider (1) developing guidelines for future disruptive events, (2) examining alternative methods for food delivery to clients, (3) planning scenarios for delivering equitable services in the post-pandemic recovery period, and (4) increasing resilience possibly by establishing partnerships with transportation network companies.
Keywords
Paratransit; Mobility; Equity; Covid19 Pandemic; Scenario Planning; Recovery
Des Roches, Simone; Brans, Kristien, I; Lambert, Max R.; Rivkin, L. Ruth; Savage, Amy Marie; Schell, Christopher J.; Correa, Cristian; De Meester, Luc; Diamond, Sarah E.; Grimm, Nancy B.; Harris, Nyeema C.; Govaert, Lynn; Hendry, Andrew P.; Johnson, Marc T. J.; Munshi-south, Jason; Palkovacs, Eric P.; Szulkin, Marta; Urban, Mark C.; Verrelli, Brian C.; Alberti, Marina. (2021). Socio-evolutionary Dynamics in Cities. Evolutionary Applications, 14(1), 248 – 267.
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Abstract
Cities are uniquely complex systems regulated by interactions and feedbacks between nature and human society. Characteristics of human society-including culture, economics, technology and politics-underlie social patterns and activity, creating a heterogeneous environment that can influence and be influenced by both ecological and evolutionary processes. Increasing research on urban ecology and evolutionary biology has coincided with growing interest in eco-evolutionary dynamics, which encompasses the interactions and reciprocal feedbacks between evolution and ecology. Research on both urban evolutionary biology and eco-evolutionary dynamics frequently focuses on contemporary evolution of species that have potentially substantial ecological-and even social-significance. Still, little work fully integrates urban evolutionary biology and eco-evolutionary dynamics, and rarely do researchers in either of these fields fully consider the role of human social patterns and processes. Because cities are fundamentally regulated by human activities, are inherently interconnected and are frequently undergoing social and economic transformation, they represent an opportunity for ecologists and evolutionary biologists to study urban socio-eco-evolutionary dynamics. Through this new framework, we encourage researchers of urban ecology and evolution to fully integrate human social drivers and feedbacks to increase understanding and conservation of ecosystems, their functions and their contributions to people within and outside cities.
Keywords
Urban Ecology (biology); Urban Research; Urban Ecology (sociology); Social Processes; Biologists; Adaptation; Anthropogenic; Coupled Human-natural Systems; Eco-evo; Socio-ecological Systems; Urbanization; Rapid Evolution; Ecosystem Services; Long-term; Ecological Consequences; Partitioning Metrics; Evosystem Services; Genetic Diversity; Rattus-norvegicus; Local Adaptation; Urban Landscapes; Coupled Human-natural Systems; Eco-evo; Socio-ecological Systems
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