Leading Change in Multiple Contexts: Concepts and Practices in Organizational, Community, Political, Social and Global Settings, by Gill Robinson Hickman

Acknowledgments Introduction The St. Luke Penny Savings Bank: A Change Vignette Purpose, Concepts, and Practices PART I. CONCEPTUAL PERSPECTIVES ON LEADING CHANGE Introduction Ch 1. Causality, Change, and Leadership by Gill Robinson Hickman and Richard A. Couto Barbara Rose Johns Analytical Elements Conclusion PART II. LEADING ORGANIZATIONAL CHANGE Introduction The Environment of Organizational Change Purpose of Organizational Change Change Vignette: Technology Solutions Turns Disaster Into Dividends Ch 2. Concepts of Organizational Change What Kind of Organizational Change Do We Want or Need? Conclusion Ch 3. Concepts of Leadership in Organizational Change What Type of Leadership Do We Want or Need to Accomplish Change? Conclusion Ch 4. Organizational Change Practices Which Practices Do We Employ To Implement Change? Conclusion Applications and Reflections PART III. LEADING COMMUNITIY AND ORGANIZATIONAL CHANGE Ch 5. Community Change Context by Richard A. Couto, Sarah Hippensteel and Marti Goetz Introduction Purpose of Community Change Change Vignette: Citizens for the Responsible Destruction of Chemical Weapons Concepts of Change Concepts of Leadership Change Practices Conclusion Application and Reflection Ch 6. Crossing Organizational and Community Contexts Introduction Change Vignette: Microcredit to Rural Women Concepts of Change Across Organizational and Community Contexts Concepts of Leadership Across Organizational and Community Contexts Change Practices Across Organizational and Community Contexts Conclusion PART IV. LEADING POLITICAL AND SOCIAL CHANGE Ch 7. Political Change Context by Richard A. Couto Introduction Purpose of Political Change Change Vignette: Extraordinary Rendition Concepts of Political Change Concepts of Political Leadership Change Practices Conclusion Application and Reflection Ch 8. Social Change Context Introduction The Purpose of Social Change Change Vignette: OASIS: An Initiative in the Mental Health Consumer Movement Concepts of Social Change Concepts of Social Change Leadership Social Change Practices Conclusion Application and Reflection Ch 9. Crossing Political and Social Contexts Introduction Vignette: The Sikh Coalition Concepts of Political and Social Change Concepts of Political and Social Leadership Change Practices Across Political and Social Contexts Conclusion PART V. LEADING GLOBAL CHANGE Ch 10. Global Change Context by Rebecca Todd Peters and Gill Robinson Hickman Introduction Purpose of Global Change Change Vignette: Chad-Cameroon Pipeline Concepts of Global Change Concepts of Global Leadership Global Change Practices Conclusion Application and Reflection Ch 11. Crossing Global and Social Contexts: Virtual Activism in Transnational Dotcauses, E-Movements, and Internet Nongovernmental Organizations Introduction Change Vignette: Is Global Civil Society a Good Thing? Concepts of Virtual Change Concepts of Virtual Leadership Virtual Change Practices Conclusion Conclusion: Connecting Concepts and Practices in Multiple Contexts Epilogue: Leading Intellectual Change: The Power of Ideas by James MacGregor Burns Index About the Author About the Contributors

Change is in the air we breathe in the early 21 st century, and it's likely that in the years ahead, books, articles, and online resources devoted to understanding, managing, and facilitating change will continue to multiply within both academic and non-academic circles. Leading Change in Multiple Contexts is an interesting case in point. It is an academic textbook designed to serve the learning needs of multiple disciplines and student populations in the wake of growing awareness about the significance of change processes.

The effects of physical context changes and multiple extinction contexts on two forms of renewal in a conditioned suppression task with humans

Treatment Outcomes with Hypomethylating Agents and Venetoclax for AML in the Community Compared to an Academic Setting

e15595 Background: Current guidelines recommend cessation of average risk colorectal cancer screening at age 75, after which a more individualized approach is endorsed. There is limited data on characteristics of colorectal cancer in patients over the age of 75. We aimed to determine if colorectal cancer site and metastasis is greater in the community vs academic setting in patients aged 50-75 compared to those age 75 or older. Methods: Data were analyzed from the National Cancer Database (NCDB) between 2010-2014. Results were divided into two categories (50-75 year old, >75 year old) and included number of patients, site of cancer and site of metastasis. Patient characteristics and survival were compared with Mann-Whitney U, Pearson’s Chi-square, and the Kaplan-Meier method. Results: 167, 059 patients were included in the analysis. In the academic setting, group A (age 50-75) contained 36, 298 patients and group B (>75) contained 13,253 patients. In the community setting, group A involved 77, 657 patients and group B, 39,851 patients. In the academic setting, group A identified 57.7% of cases involving the colon vs 42.3% involving the rectum. In group B, 71.4% cases involved the colon vs 28.6% involving the rectum. In the community setting, group A identified 64.4% of cases involving the colon compared to 35.6% involving the rectum. For group B, 76.2% of cases diagnosed were in the colon vs. 23.8% of cases involving the rectum. Overall, indicating a statistically significant increase seen in colon involvement in the older age group (<0.001). In community and academic practice, there is a statistically significant increase in the cases involving metastasis for group A, compared to group B (p<0.001) This is seen for specific sites as well, including bone, liver and lung, (p< 0.001) but not brain involvement in academic practice. Conclusions: In this study, we found a statistically greater number of cases of involving metastasis in patients aged 50-75 compared to patients aged 75 and older in both academic and community practices. In both the academic and community setting, older patients demonstrated statistically greater involvement of the colon compared to patients aged 50-75. Overall, there were more cases of colon and rectal cancer for both age groups seen in the community setting compared to the academic setting.

This paper provides an overview of the issues raised during a 1990 seminar on the effects of programmes and policies for foreign students and study abroad. The seminar was organised by the Hochschul-Informations-System in co-operation with the Organisation for Economic Co-operation and Development (OECD). In particular, this paper addresses those concerns related to national policy and institutional responses in the light of changing patterns of foreign student flows and against the background of the new global economic and political setting.

Recent evidence from this laboratory suggests that a context switch after operant learning consistently results in a decrement in responding. One way to reduce this decrement is to train the response in multiple contexts. One interpretation of this result, rooted in stimulus sampling theory, is that conditioning of a greater number of common stimulus elements arising from more contexts causes better generalization to new contexts. An alternative explanation is that each change of context causes more effortful retrieval, and practice involving effortful retrieval results in learning that is better able to transfer to new situations. The current experiments were designed to differentiate between these two explanations for the first time in an animal learning and memory task. Experiment 1 demonstrated that the detrimental impact of a context change on an instrumental nose-poking response can be reduced by training the response in multiple contexts. Experiment 2 then found that a training procedure which inserted extended retention intervals between successive training sessions did not reduce the detrimental impact of a final context change. This occurred even though the inserted retention intervals had a detrimental impact on responding (and, thus, presumably retrieval) similar to the effect that context switches had in Experiment 1. Together, the results suggest that effortful retrieval practice may not be sufficient to reduce the negative impact of a context change on instrumental behavior. A common elements explanation which supposes that physical and temporal contextual cues do not overlap may account for the findings more readily.

Educators who work in community settings often encounter participants with a wide array of individual leadership beliefs, attitudes, and experiences. Given this situation, one of the challenges we face is to identify effective methods and tools to teach leadership in community and organizational settings. As an educator, it is important to understand and use quality scholarship and theory in leadership education. At the same time, it is important to use educational methods that respect the life experiences of the participants and that are easy to understand and communicate. At the University of Minnesota Extension Service U-Lead program, we seek to balance the academic and scholarship portion of our work with the application of practical tools and methods that connect with the real-life leadership experiences of our participants. The purpose of this paper is to review the comprehensive leadership education framework we currently use and outline how it addresses this balance.

e15594 Background: The age of life expectancy in the United States is 78.9 years of age and continues to increase with the help of public health initiatives along with scientific and technological breakthroughs in medicine. However, colorectal cancer screening guidelines for those over age 75 are individualized and not recommended in those over 85. We aimed to investigate the demographic differences of colorectal cancer by sex and race in patients aged 75 vs those aged 50-75, in the community and academic practice. Methods: Data were analyzed from the National Cancer Database between 2010-2014. Results were divided into two categories (50-75 year old, >75 year old) and included number of patients, sex and race. Patient characteristics were compared with Mann-Whitney U, Pearson’s Chi-square, and the Kaplan-Meier method. Data was further analyzed comparing sex and race using chi-square analysis. Results: 167, 059 patients were included in the analysis. 49,551 cases identified in the academic practice and 117, 508 in the community practice. In the academic practice, group A (age 50-75), 57.3% (20,810) were male vs. 42.7% (15,488) female. In community practice, group A, 56.5% (43, 915) were male vs 43.5% (33, 742) female (p-value <0.05). Conversely, in the academic practice-group B (age >75), 46.2% (6127) were male vs 53.8% (7126) female. In the community practice-group B, 55.3% (22,027) were female vs 44.7% (17,824) male; (p-value <0.05).For Black patients, decline in cases is seen by age. In academic practice, 16.5% of cases were aged 50-75 vs. 11.9% over age 75. In community practice; 11.5% were aged 50-75 vs. 6.5%, p<0.05). Comparatively there was an increase in cases in White patients by age diagnosed in academic and community practice; 77.5% vs 84.2 in 50-75 and 84.8 vs. 90.9% in >75, respectively (p<0.05). Conclusions: Women age >75 comprised a statistically significant greater proportion of colorectal cancer cases compared to men age >75 in both the community and academic setting. Contrary to established reports detailing higher incidence rates in males aged 50-75. Furthermore, there is an increase in cases with age in White patients in comparison with a decrease in cases in Black patients. These findings may suggest the need for a more universal and less individualized approach for individuals over age 75.

Cue exposure treatment (CET) attempts to reduce the influence of conditioned substance cues on addictive behavior via extinction, but has received only modest empirical support in clinical trials. This may be because extinction learning appears to be context dependent and a change in context may result in a return of conditioned responding (i.e., renewal), although this has received only limited empirical examination. The current study used a 4-session laboratory analogue of CET to examine whether a change in context following 3 sessions of alcohol cue exposure with response prevention would result in renewal of conditioned responding. In addition, this study examined whether conducting extinction in multiple contexts would attenuate renewal of conditioned responding. In one-way between-subjects design, 73 heavy drinkers (71% men) were randomized to 3 conditions: (a) single context extinction (extinction to alcohol cues in the same context for 3 sessions followed by a context shift at the fourth session), (b) multiple context extinction (extinction to alcohol cues in different contexts each day for all 4 sessions), and (c) pseudoextinction control condition (exposure to neutral cues in the same context for 3 sessions followed by exposure to alcohol cues at the fourth session). The results revealed the predicted cue reactivity and extinction effects, but the hypotheses that a context shift would generate renewed cue reactivity and that multiple contexts would enhance extinction were not supported. Methodological aspects of the study and the need for parametric data on the context dependency of extinction to alcohol cues are discussed.

Resilience and Refugees: From Individualised Trauma to Post Traumatic Growth

Back in 1979, Urie Bronfenbrenner proposed his ecological model of human development, a multi-level system which describes how individuals relate with their multiple social contexts. In 1991, Carl Ratner proposed a modification of Bronfenbrenner—s basic model in which the layers are pictured as interpenetrating. This illustrates how the macrosystem passes through an individual—s exosystems and microsystems and how the impacts of all these systems influence the development of an individual. However, although both versions of the model illustrate well how individuals are connected with their multiple contexts they are still models that have a monolithic image of society. What happens in the case of ethnic minority children and young people who are members of a pluralistic society?

Academic Pharmacy Practice Fellowships Address Challenges of Evolving Pharmacist Roles

BackgroundImplementing Point-of-care ultrasound (POCUS) in community practice could help to decide upon and prioritise initial treatment, procedures and appropriate specialist referral or conveyance to hospital. A recent literature review suggests that image quality, portability and cost of ultrasound devices are all improving with widening indications for community POCUS, but evidence about community POCUS use is needed in the UK. We aimed to explore views of clinical practitioners, actively using ultrasound, on their experiences of using POCUS and potential facilitators and barriers to its wider implementation in community settings in the UK.MethodsWe conducted a qualitative interview study with practitioners from community and secondary care settings actively using POCUS in practice. A convenience sample of eligible participants from different clinical specialties and settings was recruited using social media adverts, through websites of relevant research groups and snowball sampling. Individual semi-structured interviews were conducted online using Microsoft Teams. These were recorded, transcribed verbatim, and analysed using a Framework approach supported by NVivo 12.ResultsWe interviewed 16 practitioners aged between 40 and 62 years from different professional backgrounds, including paramedics, emergency physicians, general practitioners, and allied health professionals.Participants identified key considerations and facilitators for wider implementation of POCUS in community settings in the UK: resource requirements for deployment and support of working devices; sufficient time and a skilled workforce; attention to training, education and support needs; ensuring proper governance, guidelines and quality assurance; workforce considerations; enabling ease of use in assisting decision making with consideration of unintended consequences; and more robust evidence to support perceptions of improved patient outcomes and experience.ConclusionsPOCUS could be useful for improving patient journey and health outcomes in community care, but this requires further research to evaluate outcomes. The facilitators identified could help make community POCUS a reality.

Violence exposure within each setting of community, school, or home has been linked with internalizing and externalizing problems. Although many children experience violence in multiple contexts, the effects of such cross-contextual exposure have not been studied. This study addresses this gap by examining independent and interactive effects of witnessing violence and victimization in the community, home, and school on subsequent internalizing and externalizing problems in early adolescence. A community sample of 603 boys and girls (78% African American, 20% Caucasian) participated in a longitudinal study of youth violence. During two assessments 16 months apart, adolescents reported on witnessing violence and victimization in the community, school, and home, and their internalizing and externalizing problems. Multiple regressions tested the independent and interactive effects of witnessing violence or victimization across contexts on subsequent adjustment, after controlling for initial levels of internalizing and externalizing problems and demographic covariates. Witnessing violence at school predicted anxiety and depression; witnessing at home was related to anxiety and aggression; and witnessing community violence predicted delinquency. Victimization at home was related to subsequent anxiety, depression, and aggression; victimization at school predicted anxiety; and victimization in the community was not independently related to any outcomes. Finally, witnessing violence at home was associated with more anxiety, delinquency, and aggression only if adolescents reported no exposure to community violence. Violence exposure at home and school had the strongest independent effects on internalizing and externalizing outcomes. Witnessing community violence attenuated the effects of witnessing home violence on anxiety and externalizing problems, perhaps due to desensitization or different norms or expectations regarding violence. However, no comparable attenuation effects were observed for victimization across contexts.