Community-based Institutions Research Articles

Community based learning for Sustainable Development

The main focus of this paper is to discuss the roles and functions of community-based learning centres and spaces in Asia, within the overall context of the Sustainable Development Goals (SDGs) adopted by the UN General Conference in 2015, with a particular focus on Goal 4 on education towards 2030. This paper reviews how community-based learning institutions emerged within the education for all (EFA) context in Asia and discusses their changing roles and functions through the education for sustainable development (ESD) context; it then explores the potential contribution community-based learning can make to the SDGs. There are three key enabling factors to ensure the roles and functions of community learning centres (CLCs) as community coordinators for sustainable development, namely, community participation, comprehensive programme development and developing networks and linkages. If the main roles and functions in the concept that has emerged for CLCs are carried out, the activities of the CLCs themselves will promote ESD in communities. Abundant local human, natural, information and infrastructure resources are available to tackle local, national and even global issues. CLCs have good potential to act as catalysts to facilitate linkages and partnerships between different stakeholders through intersectoral and intergenerational learning, and thus contribute to developing social capital in the community.

A Contemporary Medicolegal Analysis of Injury Related to Peripheral Nerve Blocks

Background: Closed malpractice claims can provide insight into low-frequency adverse events in many areas of perioperative and chronic pain care. Over the last decade, there have been changes in surgical and regional anesthetic practice, likely impacting adverse event patterns. Given the wide variability and low frequency of complications associated with peripheral nerve blocks, the study of closed malpractice claims offers an opportunity to examine adverse events, and the patient, technical, and provider factors that led to the claim. Knowledge gained from examination of closed claims has already resulted in multiple improvements in processes of care and patient safety. Objectives: An investigation of the factors that contributed to medicolegal claims against anesthesia providers related to peripheral nerve blocks. Study Design: Retrospective analysis. Setting: Inpatient and outpatient surgery facilities. Methods: The Comparative Benchmarking System database is a medical liability database that contains more than 400,000 malpractice claims from more than 400 academic and communitybased institutions accounting for over 30% of malpractice claims in the United States. The present investigation reviewed all (n = 113) available closed malpractice claims related to regional anesthesia (RA) in surgical patients closed between 2006 and 2016, and investigated factors that may have contributed to patient injury, including type of nerve block, type of surgery, nerves injured, resulting neurologic deficits, and potential factors contributing to the injury. Results: Our data analyzed 62 claims related to RA and showed that most closed claims were classified as permanent minor injuries. The greatest number of claims were for brachial plexus injuries associated with interscalene blocks performed for shoulder or rotator cuff repairs. Femoral and sciatic nerve blocks with resulting lower extremity injuries were the most common nerve blocks resulting in payment. The largest contributing factor to these injuries was noted to be “Technical Knowledge/Performance” of the regionalist followed by “Pre-existing Injury/Radiculopathy.” Symptom onset from these claims was most likely to be delayed with the leading initial presenting symptom being paresthesia. Limitations: It is difficult to establish cause-effect relationship, and the small sample size limits the ability to detect clinical differences and associations with specific comorbidities or techniques. There was also limited information related to regional anesthetic techniques and medications used that would have helped explore further relationships between the procedure and cause for litigation. Conclusions: There remains significant room for risk reduction in regional anesthetic practice. Patterns based on the analysis of closed claims show that interscalene blocks are the most common peripheral nerve block resulting in litigation, even when compared with other blocks involving the brachial plexus. Furthermore, patients with existing nerve injury/radiculopathy may also warrant alternative techniques or greater emphasis during informed consent on the increased risk of injury. As most of the presenting symptoms associated with claims are delayed, an opportunity for improvement in postregional care may be better communication with patients following discharge to discuss their postoperative recovery. Key words: Regional, pain, anesthesia, complications, closed claims, liability, nerve, block, injury

Experiential learning for junior residents as a part of community-based medical education in Japan

ABSTRACTA few studies have analysed the experiences of junior residents during the initial stages of their clinical training at community-based medical institutions for gaining initial experience as doctors using an associated learning theory framework. In this study, we investigated this learning process using an experiential learning model. The survey was administered through interviews and a written questionnaire to 10 junior residents involved in the initial postgraduate clinical training at two clinics in Tokyo operated by family physicians. The interview data were analysed qualitatively, whereas the results of the questionnaire, which included an experiential learning scale, were analysed quantitatively.In the qualitative analysis, 59 themes were identified and classified into reflective observation, abstract conceptualisation, and active experimentation, as featured in the experiential learning cycle. The average scores for experiential learning before and after training at a community-based medical institution, as measured based on the experiential learning scale, exhibited a significant increase after the training. Experiential learning of junior residents was observed in various situations during their training period at a community-based medical institution, where active experimentation was the most commonly observed form of experiential learning.

Impact of out-migration of men on women's participation in community-based forestry: insights from Van Panchayats of Uttarakhand, India

Increased out-migration from rural areas indicates a significant socio-demographic shift that is increasingly being studied for its impact on community-based forestry institutions. Previous studies in Nepal, Mexico and India have highlighted changes in community-based forestry institutions through increased participation of women following out-migration of men. Therefore, this paper analyses the participation of women in Van Panchayats in a representative sample of six Van Panchayats from Almora district, which is facing one of the highest rates of out-migration in Kumaon region of India. The analysis suggests there is low participation of women in the leadership positions of Van Panchayats despite landmark legislations to increase women's participation. Further, there was no statistically significant difference between participation of women from migrant versus non-migrant households in general assembly meetings of Van Panchayats, suggesting lack of supporting evidence on previous claims about out-migration leading to increased participation of women. Moreover, the position of women in the household (whether household head or not) was significant in explaining their participation in Van Panchayats, and other community-based institutions. The reported findings are relevant to the design of gender inclusive public policy on Van Panchayats as well as to the literature on impact of out-migration on community-based forestry.

Charting Participatory Action and Interventionist Research Processes for Community-Based Stakeholders in Peri-Urban Contexts: The Proposed St. Cuthbert’s Community Centre, Lorne, Australia

Participatory action combined interventionist research approaches can offer possibilities for community-based facilities and institutions attempting to re-engage with their communities and assert their presence. St. Cuthbert’s Church is a heritage-listed property, located on a major landholding, right in the heart of the summer tourist town of Lorne, on Melbourne’s peri-urban ‘sea change’ fringe. Its sloping hillside vantage offers spectacular views to the beach and Bass Strait, beyond. The congregation, however, is aging, while the broader community is increasingly secular. In response to these circumstances, the Church is looking to assert its relevance with the procurement of a community centre to be erected on the property. Using an interventionist research approach, with a professional facilitator in ‘participatory action design’, it was found that while both residents and visitors to Lorne were favourably disposed to the idea of a community centre, it was also clear that the locus of power that needed to realise this objective lay outside the congregation’s control. A conclusion of this research is that community-based organisations may have to pro-actively engage in professional marketing and prepare business plans, as well as engage in substantial political lobbying both within and external to the Church, if the project is to progress and succeed.

Institutional Responses to Campus Sexual Assault: Examining the Development and Work of A Multidisciplinary Team

ABSTRACTResponding to campus sexual assault can involve complex processes and procedures that span campus, criminal justice, and community-based institutions, particularly when there are co-occurring Title IX and criminal investigations. This study investigated the development of a multidisciplinary team (MDT) that involved campus, criminal justice, and community-based institutions seeking to improve coordinated responses to campus sexual assault. Data included observations of MDT monthly meetings over 16 months as well as individual interviews with MDT members. Transcripts of the MDT meetings and individual interviews were coded to capture major themes. The MDT meetings were dynamic and flexible with a structure that involved intentional agenda setting along with responsiveness to current events and collaborative processes. The MDT invested more time during the meetings addressing the complexity of navigating existing procedures than developing new protocols. Individual interviews with MDT members highlighted logistical challenges that were relevant to MDT effectiveness, such as consistent attendance, supervisor legitimacy, and differences in stakeholder priorities. Implications for future MDT work are discussed.

Strengthening housing finance in emerging markets: the savings and credit cooperative organisation (SACCO) model in Kenya

Savings have long been an essential source of funding for credit. Whether in Europe, North America, Africa, Asia or Latin America, community-based financial institutions have relied on deposits to make financial services accessible to moderate-income borrowers. Despite the foundational role savings and loans have had in financial sector development, emerging markets have largely overlooked the important role these institutions can have in providing shelter credit in their own contexts. Savings and Credit Cooperative Organisations (SACCOs) in the Republic of Kenya illustrate the potential model for deposit-based lending to deliver housing finance for many of the country’s underserved prospective borrowers. This study draws upon the experiences of several savings and loan associations in the industrialized world with applications towards improving the Kenyan SACCO model that provides the most extensive credit union loans on the African continent. The article concludes community finance institutions merit strong consideration towards helping overcome the housing finance sector underdevelopment too often experienced in the developing world.

The Impacts of Conservation and Militarization on Indigenous Peoples : A Southern African San Perspective.

There has been a long-standing debate about the roles of San in the militaries of southern Africa and the prevalence of violence among the Ju/'hoansi and other San people. The evolutionary anthropology and social anthropological debates over the contexts in which violence and warfare occurs among hunters and gatherers are considered, as is the "tribal zone theory" of warfare between states and indigenous people. This paper assesses the issues that arise from these discussions, drawing on data from San in Angola, Namibia, Botswana, and Zimbabwe. Utilizing cases of how San have been affected by military forces and wildlife conservation agencies in what became protected areas in southern Africa, this article shows that indigenous peoples have been treated differentially by state and nongovernmental organizations involved in anti-poaching, shoot-to-kill, and forced resettlement policies. Particular emphasis is placed on the !Xun and Khwe San of southern Angola and northern Namibia and the Tshwa San of western Zimbabwe and northern Botswana, who have been impacted by militarization and coercive conservation efforts since the late nineteenth century. Principal conclusions are that conservation and militarization efforts have led to a reduction in land and resources available to indigenous people, higher levels of poverty, increased socioeconomic stratification, and lower levels of physical well-being. San have responded to these trends by engaging in social activism, forming community-based institutions, and pursuing legal actions aimed at obtaining human rights and equitable treatment.

Patterns of occurrence and implications of neratinib-associated diarrhea in patients with HER2-positive breast cancer: analyses from the randomized phase III ExteNET trial

BackgroundWe characterized patterns of occurrence and the impact of neratinib-associated diarrhea in the absence of protocol-directed antidiarrheal prophylaxis or a formal diarrhea management plan using data from Extended Adjuvant Treatment of Breast Cancer with Neratinib (ExteNET).MethodsExteNET is a multicenter, double-blind, placebo-controlled, randomized phase III trial involving community-based and academic institutions in 40 countries. Women with HER2-positive early-stage breast cancer with prior standard primary therapy and trastuzumab-based (neo)adjuvant therapy were randomized to neratinib 240 mg/day or placebo for 12 months. Safety, a secondary outcome, was assessed using the National Cancer Institute Common Terminology Criteria version 3.0. Health-related quality of life by diarrhea grade was assessed using Functional Assessment of Cancer Therapy-Breast (FACT-B).ResultsTwo thousand eight hundred sixteen women (1408 per group) were safety-evaluable. Grade 3 and 4 diarrhea occurred in 561 (39.8%) and 1 (0.1%) patients with neratinib versus 23 (1.6%) and 0 patients with placebo, respectively. In the neratinib group, 28.6% of patients had grade 3 events during month 1 decreasing to ≤ 6% after month 3. The median cumulative duration of grade 3/4 diarrhea with neratinib was 5 days (interquartile range, 2–9). Serious diarrheal events (n = 22, 1.6%) and diarrheal events requiring hospitalization (n = 20, 1.4%) were rare with neratinib. Changes in FACT-B total score by diarrhea grade in the neratinib group did not meet the threshold for clinically important differences.ConclusionsIn the absence of antidiarrheal prophylaxis, neratinib-related diarrhea is short-lived and not associated with complications or long-term sequelae. This suggests that targeted preventive management with antidiarrheal prophylaxis early during neratinib treatment is appropriate.Trial registrationClinicalTrials.gov NCT00878709. Registered 9 April 2009.

Does credit access lead to expansion of income and multidimensional poverty? A study of rural Assam

PurposeThe purpose of this paper is to evaluate the impact of credit access on income and multidimensional poverty by providing an econometric framework.Design/methodology/approachThe study is conducted in Assam, India and uses a quasi-experiment design to gather primary data. Econometric tools like Heckit procedure, Tobit selection equation and probit model are used for empirical purpose.FindingsThe paper finds that the level of individual welfare is influenced by equivalent factors. In addition, the study observes a larger incidence of poverty among treatment households of semiformal and informal borrowers. The study argues that formal sources are more effective in reducing the number of poor households by lifting those who are closest to the poverty line.Research limitations/implicationsThe study indicates a vicious circle of income and multidimensional poverty among semiformal and informal borrowers. By tradition, as rural Assam gets a dominant role of traditional community-based financial institutions, we should develop the banking structure by involving these institutions. The study excludes other probable explanatory variables while evaluating the impact of credit access on income and multidimensional poverty, and this limitation is left to future research.Originality/valueThis is probably the first empirical paper in Assam showing the impact of credit access on multidimensional poverty by adjusting for endogeneity and selection bias.

Addressing Global and National Concerns into Local Actions: Reflecting Customary Institution’s Involvement in Combating Drug Abuses

The massive movement of transnational drug-dealers has now been approaching society at the lowest level. This article is aimed at exploring how customary institution in Bali-Indonesia, namely desa pakraman (customary village) is involved in any efforts of combating drug abuse, as a complementary means of the official measures taken by Indonesian agencies that responsible for this matter. It is legal research that inquiries relevant legal documents. Besides, it discovers customary village leaders opinion by using informant interview questionnaires as well as impression obtained from direct observation. This paper discovers that there have been many customary villages modified their customary rule by incorporating the norms on prohibition of the use and sale of narcotics as well as adopted customary sanction to be imposed on those who violate it. This article also suggests that the involvement of customary institution may be used as a lesson learned regarding how the non-state actors, especially a community-based institution, may play a role to support the government in the eradication of drug abuses and crimes.

Patching the Pathway and Widening the Pipeline: Models for Developing a Diverse Early Childhood Workforce in Chicago.

With the growing appreciation of the importance of early learning experiences for children's healthy development, attention to the cultivation and maintenance of a qualified workforce has steadily increased. Such a workforce must have not just the knowledge and skills related to child development and early learning, but also be linguistically and culturally prepared to meet the needs of an increasingly diverse child and family population. To ensure a highly qualified workforce, programs and policymakers must attend to both the "pipeline" through which new early childhood educators (ECEs) enter the workforce and the "pathways" by which ECEs work toward and obtain the necessary education and credentials for different roles within the field. In line with the aims of this special issue, this paper leverages the first-person account style to describe barriers to and creative solutions for the development of practitioners in low-resourced communities in Chicago, with the goal of informing practice and policy. We describe three prior and ongoing partnership programs between community-based organizations and institutions of higher education, each tailored to support a unique population in the ECE pipeline on the pathway for increased educational attainment and credentialing. Each program is grounded in a specific community of Chicago, a diverse city with a sizable population of children raised in non-English speaking homes. Each program addresses specific needs of the communities they serve, especially around the recruitment, retention, and promotion of bilingual ECEs. Program administrators and community members describe each programs' goals, development, and key components unique to their target population as well as key takeaways. We conclude with an overview of critical components that we identified across these programs in order to create pathways for change within the workforce and the communities they serve.

“Everything in the Water Column is Connected”: Traditional Ecological Knowledge of Floodplain Fishers of Bangladesh

With ongoing resource depletion and environmental degradation in the floodplains of Bangladesh, there is a clear need to include insights from traditional ecological knowledge (TEK) in developing and implementing plans for sustainable natural resource management. The knowledge, skills, and practices related to fishing in the floodplains of Bangladesh are almost exclusively a product of the local fishers' TEK. As fishers are deeply integrated with their landscapes, they develop and refine their ecological knowledge through multi-generational sharing of experience of and knowledge about fishing and socio-cultural learnings. This study documents the knowledge of floodplain fishers of Bangladesh and examines their decision-making about harvesting as a process based on heuristic rules developed through years of curiosity experimentation, adaptive learning, and empirical and inductive reasonings. Using a participatory ethnographic approach, ten major categories of TEK systems are examined: ethno-topography of floodplains, ethno-taxonomy and aquatic productivity, diurnal and nocturnal variation patterns of fish behavior, birds and other animals, actions for aggregating fish in leased waterbodies, importance of aquatic vegetation for growth and conservation of floodplain fisheries, breeding biology tuned to complex hydrological cycles, fishers' perception of fish ulcerative syndrome, landlocked Hilsa fish from the Hakaluki haor, and fishers' views on biodiversity. This research explores the cognitive mechanisms behind fishers' decision-making about harvesting. Experienced fishers argue that if the important mother fishery sites are protected and managed through community-based institutions, floodplains of the country would benefit immensely in terms of production and biodiversity conservation.

Examination of a paradox: recurrent metastatic breast cancer incidence decline without improved distant disease survival: 1990\u20132011

PurposeDistant relapse metastatic breast cancer (rMBC) incidence and survival are vital measures of breast cancer diagnosis and treatment progress over time.MethodsWe conducted a retrospective cohort study of stage I–III invasive breast cancer, 1990–2011, follow-up through 2016 [N = 8292, rMBC = 964 (12%)] at a community-based institution. Patient and tumor characteristics (treatment, distant recurrence, vital status) from BC registry data were evaluated. Survival analysis and Cox proportional hazards (HzR) with 95% confidence intervals (95% CI) were calculated using distant recurrence and distant disease-specific survival (DDSS) endpoints.ResultsBoth 5- and 10-year distant relapse (rMBC) declined over time from 1990–1998 to 2005–2011 [11% to 5%, 16% to 8% (p < 0.001)]. Proportionately, HER2 + BC distant relapse decreased 9% and triple negative (HR−/HER2−) increased 8% (p = 0.011). In the Cox model, lower stage [stage I: HzR = 0.08 (0.07, 0.10), stage II: 0.29 (0.25, 0.33)], more recent diagnosis years [1999–2004: HzR = 0.60 (0.51, 0.70), 2005–2011: HzR = 0.44 (0.38, 0.52)], HR+ [HzR = 0.62 (0.53, 0.72)], and age 40+ [HzR = 0.81 (0.67, 0.98)] had decreased rMBC risk. Compared to HR+/HER2− BC, triple-negative BC had increased rMBC risk [HzR = 2.02 (1.61, 2.53)] but HER2+ subtypes did not. HR−, age 70+, > 1, or visceral metastases and stage III disease were associated with worse DDSS. DDSS did not improve over time.ConclusionrMBC incidence declined over time with decreased HER2-positive distant recurrence, a shift to more triple-negative BC and consistently poor distant disease survival.

Practice Patterns in the Use of MRI/MRA and Chronic Transfusion Therapy for Monitoring and Treatment of Stroke in Pediatric Patients with Sickle Cell Anemia

Introduction: Current stroke prevention guidelines in pediatric sickle cell anemia (SCA) specify the use of transcranial Doppler (TCD) and chronic red cell transfusion therapy (CRCT) for detection and prevention of stroke. Guidance on the use of MRI/MRA in the context of stroke prevention, screening, and monitoring is less clear. While overt stroke is able to be identified clinically, silent stroke can be more difficult to diagnose and screening guidelines have not been developed. The DISPLACE Consortium (Dissemination and Implementation Looking at the Care Environment) is a multi-center study funded to evaluate optimal implementation of stroke prevention guidelines. The purpose of the present study was to provide information on practice patterns across the DISPLACE Consortium as they relate to the use of MRI/MRA and CRCT for monitoring and treating stroke in pediatric patients with SCA.Methods: DISPLACE is a multi-site study in SCA including 28 centers across the United States. A practice patterns survey was sent to the principal investigator (PI) for each DISPLACE site through RedCap. All PIs are specialty care providers in hematology/oncology who provide care to pediatric patients with SCA. The sites were chosen to represent a range of characteristics, including both urban and rural regions, large and small academic institutions, and community-based institutions. The survey was developed by the study investigators and questions were provided predominantly in a multiple choice format. The following types of questions were asked about MRI/MRA: indication for pediatric patients with SCA in general and for those on CRCT for stroke prevention. The following types of questions were asked about CRCT: indication and frequency of CRCT and target hemoglobin S level.Results: All 28 providers completed the survey (100%). About half of providers were female (53.5%). Most providers identified as White (77.8%), followed by Asian (11.1%) and Black or African American (7.4%). Two identified as Hispanic or Latino (7.4%). MRI was used for the following indications: abnormal TCD (85.7%), conditional TCD (46.4%), recurrent headaches (78.6%), and behavior issues (53.6%). A few sites also reported obtaining an MRI if a child has had poor school performance (10.7%) or if there was concern for developmental delay (3.7%). Indications for MRA were similar. Notably, many sites reported the use of a screening or baseline MRI in the absence of other indications (25.0%). The most common indications for initiating CRCT were abnormal TCD (96.4%) and overt stroke (92.9%), followed by silent stroke (53.6%) and abnormal MRA (50.0%). The majority of sites reported scheduling CRCT at a frequency of every 4 weeks (63.0%), though many (37.0%) described other more frequent transfusions intended to either more rapidly reduce hemoglobin S levels or maintain a level under 30%. Most sites used a target of 30% hemoglobin S, though a few sites noted alternatives including 40% (3.7%) and 50% (3.7%). The frequency of MRI for patients receiving CRCT for stroke prevention was as follows: annually (44.4%), every 2 years (14.8%), and every 5 years (3.7%). Several sites reported obtaining MRIs only if there were new changes or concerns (14.8%) or reported alternative practices (14.8%) that depended on patient characteristics. Frequency for MRA was similar for patients on CRCT.Conclusions: The results of the DISPLACE practice patterns survey suggested nearly universal adoption of CRCT for children with abnormal TCD and prior overt stroke across sites. The use of MRI/MRA in detecting potential cerebrovascular abnormalities in the absence of clinical neurologic symptoms and for monitoring patients on CRCT was much more variable, which likely reflects the minimal amount of guidance for the use of MRI/MRA in SCA. Notably, a number of sites were using MRI/MRA to screen pediatric patients for cerebrovascular abnormalities and to monitor patients on CRCT. The variability in responses for MRI/MRA highlights the importance of future studies evaluating best neuroimaging practices for detecting cerebrovascular abnormalities (apart from TCD) and for using MRI/MRA to monitor patients on CRCT. DisclosuresSchlenz:NHLBI: Research Funding. Mueller:NHLBI: Research Funding. Phillips:NHLBI: Research Funding. Melvin:NHLBI: Research Funding. Adams:NHLBI: Research Funding. Kanter:bluebird bio: Membership on an entity's Board of Directors or advisory committees, Research Funding; NHLBI: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; Apopharma: Research Funding; Sancilio: Research Funding; Global Blood Therapeutics: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; AstraZeneca: Membership on an entity's Board of Directors or advisory committees; ASH: Membership on an entity's Board of Directors or advisory committees.

Results from the Displace Consortium: Practice Patterns on the Use of Transcranial Doppler Screening for Risk of Stroke in Children with Sickle Cell Anemia

Abstract Introduction: Stroke is one of the most devastating complications of sickle cell anemia (SCA). The STOP (Stroke Prevention Trial in Sickle Cell Anemia) protocol has been adopted by National Heart Lung and Blood Institute (NHLBI) as the guideline for stroke screening using transcranial Doppler ultrasound (TCD) and prevention with chronic red cell transfusion therapy (CRCT). Evidence from the STOP I/II studies indicates the protocol is highly effective, yet wide scale implementation has not been achieved. The DISPLACE (Dissemination and Implementation Looking at the Care Environment) project is a multicenter, NHLBI funded consortium of 28 sites across the United States whose purpose is to identify barriers to the implementation of the STOP protocol and test novel methods for overcoming barriers. The purpose of this study was to use data on practice patterns to evaluate current measurement and practice standards at DISPLACE consortia sites. This abstract presents reported TCD screening and CRCT practices. Methods: A practice patterns survey was sent to the principal investigator (PI) for each DISPLACE site via RedCap ©. PIs were hematology/oncology specialty care providers for children with SCA. Sites represent urban and rural regions, large and small academic institutions, and community-based institutions. The survey was developed by the study investigators; questions were predominantly in a multiple-choice format. Items pertaining to TCD screening included: screening technique (including type of TCD); screening frequency; follow-up for abnormal, conditional, and inadequate results; standard value ranges. Results: All 28 PIs completed the survey. About half of the respondents were female (53.5%). Most identified as White (77.8%), followed by Asian (11.1%) and Black or African American (7.4%). Two identified as Hispanic or Latino (7.4%). Slightly more sites reported using standard TCD (57.1%) versus imaging TCD (TCDi) (42.9%). To calculate the time-averaged mean of the maximum (TAMM) velocities and characterize TCD results, nearly all sites use the middle cerebral artery (96.4%); a majority also use the anterior cerebral artery and/or the terminal internal cerebral artery or distal internal cerebral artery (71.4%). Fewer sites use the posterior cerebral artery (35.7%) or the basilar artery (14.3%). In 7.1% of sites, the radiologist determines which vessels to use during the exam. TCD screening is ordered for children with SCA annually in 92.9% of sites and every 6 months in 7.1% of sites. When TCD screening indicates abnormal TAMM velocities, 85.7% of sites initiate CRCT, 7.1% initiate hydroxyurea (HU) therapy, and 3.6% initiate both HU and CRCT. For additional evaluation, an MRI/MRA is obtained at 64.3% of sites. For high conditional results, the most common action is to initiate HU (67.9%). Other responses include obtaining an MRI/MRA (46.4%) and/or repeating the TCD in 2-4 weeks (25.0%), 6-8 weeks (35.7%), or 12-16 weeks (7.1%). Results deemed inadequate led to repeating the TCD in 2-12 weeks (57.1%) or in one year (3.6%), obtaining an MRI/MRA (57.1%), beginning HU therapy (7.1%), or no repeat TCD or change in management (3.6%). Actions for low conditional results include repeating the TCD (71.4%), obtaining an MRI/MRA (32.3%), and/or initiating HU therapy (57.1%). Surprisingly, sites use different TAMM ranges to characterize the normal/abnormal findings (Table 1). Conclusions: Nearly all DISPLACE sites order TCD screening annually, as recommended in the guidelines, with some ordering screening more frequently. A few sites did not report initiation of CRCT per STOP protocol for abnormal TCD results; however, over half of the sites reported following up with an MRI/MRA, which may suggest evaluating for vasculopathy prior to CRCT. Some sites reported beginning HU therapy for abnormal results; this may reflect consideration of patients for whom CRCT is not possible, but data were not collected for confirmation. Interestingly, results suggest a reliance on MRI/MRA since sites commonly reported ordering neuroradiology studies for abnormal, conditional, and inadequate TCD results. This may suggest an unclear pathway for children with borderline TCD results, and an area for future study. While reported value ranges closely approximated those in the STOP protocol, results indicate sites conducting screening with TCDi may use more conservative values than the validated protocol. Disclosures Phillips: NHLBI: Research Funding. Mueller:NHLBI: Research Funding. Schlenz:NHLBI: Research Funding. Melvin:NHLBI: Research Funding. Adams:NHLBI: Research Funding. Kanter:AstraZeneca: Membership on an entity's Board of Directors or advisory committees; bluebird bio: Membership on an entity's Board of Directors or advisory committees, Research Funding; Global Blood Therapeutics: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sancilio: Research Funding; NHLBI: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; Apopharma: Research Funding; ASH: Membership on an entity's Board of Directors or advisory committees.

Water Resources Users Associations in the Mara Basin, Kenya: Pitfalls and Opportunities for Community Based Natural Resources Management

Water Resources Users Associations (WRUAs) in the Mara Basin, Kenya, are community-based natural resources management institutions set-up following the Integrated Water Resources Management framework. They are the most local participatory governance structure currently in place managing the tributaries of the Mara river. WRUAs are the link between environmental services from the river and livelihoods of local communities. Opportunities and pitfalls for the undertaking of their roles are assessed through the analysis of four WRUAs. Recognition of local knowledge, procedural considerations in the setting-up and carrying out of activities, as well as distributional aspects of the WRUA undertakings are evaluated in the paper. The authors argue that typical issues identified in critical community management literature appear in this case study: elite capture, dependency on donor support, lack of meaningful participation, and difficulties for scaling up initiatives. However, WRUAs have positively impacted environmental services in a localized and indirect manner, opening opportunities in terms of awareness, scaling water conservation initiatives, and conflict resolution. Future development of WRUAs can improve environmental flows particularly if a targeted follow-up is maintained by encouraging leadership and monitoring the relationship between donors, elites, and marginalized community members.

Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503)

Increased detection of small-sized, peripheral, non-small-cell lung cancer has renewed interest in sublobar resection instead of lobectomy, the traditional standard of care for early-stage lung cancer. We aimed to assess morbidity and mortality associated with lobar and sublobar resection for early-stage lung cancer. CALGB/Alliance 140503 is a multicentre, international, non-inferiority, phase 3 trial in patients with peripheral non-small-cell lung cancer clinically staged as T1aN0. Patients were recruited from 69 academic and community-based institutions in Australia, Canada, and the USA. Patients were randomly assigned intraoperatively to either lobar or sublobar resection. The random assignment was based on permuted block randomisation without concealment and was stratified according to radiographic tumour size, histology, and smoking status. The primary endpoint of the trial is disease-free survival; here, we report a post-hoc, exploratory, comparative analysis of perioperative mortality and morbidity associated with lobar and sublobar resection. Perioperative mortality was defined as death from any cause within 30 days and 90 days of surgical intervention and was calculated for all randomised patients. Morbidity was graded using Common Terminology Criteria for Adverse Events version 4.0. All analyses were done on an intention-to-treat basis for randomised patients with data available. This trial is registered with ClinicalTrials.gov, number NCT00499330. Between June 15, 2007, and March 13, 2017, 697 patients were randomly allocated to either lobar resection (n=357) or sublobar resection (n=340; 59% wedge resection). Six (0·9%) patients died by 30 days, four (1·1%) after lobar resection and two (0·6%) after sublobar resection; by 90 days, ten (1·4%) patients had died, six (1·7%) after lobar resection and four (1·2%) after sublobar resection (difference at 30 days, 0·5%, 95% CI -1·1 to 2·3; difference at 90 days, 0·5%, 95% CI -1·5 to 2·6). An adverse event of any grade occurred in 193 (54%) of 355 patients after lobar resection and 172 (51%) of 337 patients after sublobar resection. Adverse events of grade 3 or worse occurred in 54 (15%) patients assigned lobar resection and in 48 (14%) patients assigned sublobar resection. No differences between surgical approaches were noted in cardiac or pulmonary complications. Grade 3 haemorrhage (requiring transfusion) occurred in six (2%) patients assigned lobar resection and eight (2%) patients assigned sublobar resection. Prolonged air leak occurred in nine (3%) patients after lobar resection and two (1%) patients after sublobar resection. Our post-hoc analysis showed that perioperative mortality and morbidity did not seem to differ between lobar and sublobar resection in physically and functionally fit patients with clinical T1aN0 non-small-cell lung cancer. These data may affect the daily choices made by patients and their doctors in establishing the best treatment approach for stage I lung cancer. National Cancer Institute.

Development and implementation of an interprofessional education certificate program in a community-based osteopathic medical school

Abstract Community-based medical schools face unique barriers in developing meaningful interprofessional education (IPE) opportunities for their students. Here we describe the development, implementation, and preliminary evaluation of an IPE Certificate Program at a community-based osteopathic medical school. The IPE Certificate Program was developed by incorporating new curricular components with pre-existing requirements to minimize the burden on students, administrators, and faculty. The IPE program is delivered longitudinally to medical students, in collaboration with pharmacy and nursing students, over three years using interactive, volunteer, clinical, and reflective experiences. The primary aims of the IPE Certificate Program are to promote interprofessionalism based on the Core Competencies for Interprofessional Practice and provide additional acknowledgment for the students that participate in the program. Student assessments are based on both participation and the use of standardized grading rubrics based on the various activities' learning objectives. The students' knowledge and attitudes regarding interprofessionalism is also assessed using an adapted survey, while the overall program is evaluated with an end-of-year program evaluation. Preliminary results of the attitudes survey display favorable changes towards interprofessionalism. Due to the overwhelming acceptance by students and the administration, the curriculum has transitioned to a for-credit elective course that will appear on the participants’ academic transcripts. The following resources are included: a course syllabus, the course requirements, a grading rubric, the attitudes towards interprofessionalism survey, and a course evaluation. We propose our model can be used to implement IPE at other community-based institutions.

A Group Randomized Trial to Reduce Obesity among Appalachian Church Members: The Walk by Faith Study.

Background: Appalachia is a rural, socioeconomically disadvantaged region with high rates of cancer and obesity. Using community-based participatory research principles, the Appalachia Community Cancer Network tested an initiative to reduce weight among overweight and obese participants by partnering with churches, an important community-based institution in Appalachia.Methods: A group randomized trial was conducted with counties or groups of counties in five Appalachian states. These groups were randomly assigned to receive either monthly diet and exercise education sessions ("Walk by Faith"; WbF) or an educational program focused on cancer screening and education ("Ribbons of Faith"; RoF) to examine effects on weight change. Participants completed questionnaires and biometric measurements at baseline and 12 months. The primary outcome of the study was weight change from baseline to 12 months.Results: The relative difference in weight loss from baseline to 12 months for WbF compared with RoF was 1.4% but was not statistically significant (P = 0.13). However, results varied by sex and marital status. WbF men experienced a significant 2.8% decrease in body weight, married WbF women a 1.5% decrease, and unmarried WbF women a 1.5% increase compared with their respective RoF subgroups (interaction P = 0.016). Among WbF participants, greater participation in monthly educational sessions was associated with greater weight loss (P = 0.002).Conclusions: WbF facilitated weight loss mainly in male participants. Level of participation in WbF activities correlated with weight loss.Impact: Findings suggest that additional research is needed to better understand factors associated with participation in health promotion programs for underserved rural communities. Cancer Epidemiol Biomarkers Prev; 27(11); 1289-97. ©2018 AACR.