Implications For Other Groups Research Articles

Not the Desired Outcome: Groupthink Undermines the Work of a Literacy Council

A history of school reform failure has prompted concern among literacy researchers and practitioners alike. This article considers the case of a school Literacy Council and its unsuccessful efforts to improve the school’s literacy environment. Mobilizing Janis’s notion of groupthink, I examine discourse among group members and suggest that characteristics of groupthink—problematic antecedents cultivating troubling decision-making symptoms—led to unsuccessful outcomes. During times of low stress, Literacy Council members collaborated effectively, but when the principal’s unilateral curricular decision raised stress levels, the group succumbed to groupthink and experienced failure. This study offers implications for other groups which are shaken by a late-emerging threat. I argue that groupthink theory shines light on problems with group interaction. An awareness of precursors to and symptoms of groupthink may support work teams as they propose and enact important change.

SAT-256 Obesity and Reactive Airway Disease Are Increased Among HIV-Exposed Uninfected Adolescents

Background: Worldwide, over 1 million babies are born to mothers with HIV each year. With the advent of prenatal antiretroviral therapy (ART), the vast majority of these individuals are HIV-exposed but uninfected (HEU). HEU infants and children exhibit impaired growth, mitochondrial toxicity, and immune activation compared to HIV-unexposed peers. Nonetheless, the long-term sequelae of in utero HIV and ART exposure have never before been examined. We hypothesized that in utero HIV/ART exposure may condition fetal development in a manner that predisposes to obesity and reactive airway disease (RAD) later in life. Methods: We leveraged a patient database registry at a U.S. academic health system to compare long-term health outcomes among HEU adolescents and matched controls, and to determine maternal factors associated with adverse HEU outcomes. HEU individuals born since 1990 with medical records available at age ≥ 13 y were identified. Over 200,000 controls also were retrieved from RPDR and matched up to 3:1 on birthdate (±5 y), age of last encounter (±2 y), sex, race, and zip code (SAS 9.4). Charts were manually reviewed to confirm HEU status and to extract health information. BMI was adjusted for age and sex per CDC growth charts. Obesity was defined as BMI ≥ 30 kg/m2 or ≥ 95 percentile. RAD was by clinical report. Results: 50 HEU adolescents (18 [15, 20] y, 54% male) and 141 matched controls (19 [16, 21] y, 55% male) were compared. Mothers of HEU adolescents were 30 ± 4 years old with BMI 26 [24, 30] kg/m2. Mothers had HIV for 4 [1, 7] years with CD4 count 405 [222, 615]/mm3, and 93% received prenatal ART. Obesity was seen in 42% of HEU adolescents compared to 25% of controls (P = 0.04). The prevalence of RAD also was higher among HEU than controls (40% vs. 24%, P = 0.04). Within the HEU group, there was a strong inverse correlation between maternal third trimester CD4 count and adolescent BMI z-score (r = -0.47, P = 0.01). This relationship persisted upon adjustment for prenatal maternal factors including age, BMI, ART, and HIV duration as well as median household income (P < 0.05). Lower third trimester CD4 count also was strongly associated with higher birth weight (r = -0.56, P = 0.006) and placental weight (r = -0.58, P = 0.006). Prenatal maternal CD4 nadir, peak HIV viral load, HIV duration, and ART were not associated with adolescent BMI z-score. Unlike obesity, maternal factors did not relate to RAD among HEU. Conclusions: In utero exposure to HIV/ART may predispose to obesity and RAD in adolescence. Lower prenatal maternal CD4 count – indicative of more severe immune dysfunction – was associated with higher adolescent BMI. Prospective studies are needed to further characterize metabolic and immune dysregulation among the aging and expanding HEU population. Insights learned from these individuals may have implications for other groups exposed to maternal inflammation in utero, including individuals born to obese mothers.

Culturally adapted Family Intervention (CaFI) for African-Caribbean people diagnosed with schizophrenia and their families: a mixed-methods feasibility study of development, implementation and acceptability

BackgroundAfrican-Caribbean people in the UK experience the highest incidence of schizophrenia and the greatest inequity in mental health care. There is an urgent need to improve their access to evidence-based care and outcomes. Family intervention (FI) is a National Institute for Health and Care Excellence-approved psychosocial intervention. Although clinically effective and cost-effective for schizophrenia, it is rarely offered. Evidence for any research into FI is lacking for ethnic minority people generally and for African-Caribbean people specifically.Aims(1) To assess the feasibility of delivering a novel, culturally appropriate psychosocial intervention within a ‘high-risk’ population to improve engagement and access to evidence-based care. (2) To test the feasibility and acceptability of delivering FI via ‘proxy families’.DesignA mixed-methods, feasibility cohort study, incorporating focus groups and an expert consensus conference.SettingTwo mental health trusts in north-west England.ParticipantsWe recruited a convenience sample of 31 African-Caribbean service users. Twenty-six family units [service users, relatives/family support members (FSMs) or both] commenced therapy. Half of the service users (n = 13, 50%), who did not have access to their biological families, participated by working with FSMs.InterventionsAn extant FI model was culturally adapted with key stakeholders using a literature-derived framework [Culturally adapted Family Intervention (CaFI)]. Ten CaFI sessions were offered to each service user and associated family.Main outcome measuresRecruitment (number approached vs. number consented), attendance (number of sessions attended), attrition (number of dropouts at each time point), retention (proportion of participants who completed therapy sessions), and completeness of outcome measurement.ResultsOf 74 eligible service users, 31 (42%) consented to take part in the feasibility trial. The majority (n = 21, 67.7%) were recruited from community settings, seven (22.6%) were recruited from rehabilitation settings and three (9.7%) were recruited from acute wards. Twenty-four family units (92%) completed all 10 therapy sessions. The proportion who completed treatment was 77.42% (24/31). The mean number of sessions attended was 7.90 (standard deviation 3.96 sessions) out of 10. It proved feasible to collect a range of outcome data at baseline, post intervention and at the 3-month follow-up. The rating of sessions and the qualitative findings indicated that CaFI was acceptable to service users, families, FSMs and health-care professionals.LimitationsThe lack of a control group and the limited sample size mean that there is insufficient power to assess efficacy. The findings are not generalisable beyond this population.ConclusionsIt proved feasible to culturally adapt and test FI with a sample of African-Caribbean service users and their families. Our study yielded high rates of recruitment, attendance, retention and data completion. We delivered CaFI via FSMs in the absence of biological families. This novel aspect of the study has implications for other groups who do not have access to their biological families. We also demonstrated the feasibility of collecting a range of outcomes to inform future trials and confirmed CaFI’s acceptability to key stakeholders. These are important findings. If CaFI can be delivered to the group of service users with the most serious and persistent disparities in schizophrenia care, it has the potential to be modified for and delivered to other underserved groups.Future workA fully powered, multicentre trial, comparing CaFI with usual care, is planned.Trial registrationCurrent Controlled Trials ISRCTN94393315.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 32. See the NIHR Journals Library website for further project information.

EU citizenship and social solidarity

In this article, we seek to place the CJEU’s recent case law on social rights for economically inactive EU citizens within the larger political context of the last couple of years that has been characterized by the increased contestation of the type of mobility underpinning EU citizenship. The relationship between EU citizenship and social solidarity – in the form of social rights for mobile EU citizens – has taken centre stage during the Brexit affair. Political debates concerning the free movement of (poor) EU citizens have focused upon the issues of the abuse of free movement rights and welfare tourism, despite a lack of evidence that the two are actually taking place on a large scale within the EU. The now defunct Brexit deal highlights the extension of debates that initially focused on economically inactive EU citizens to EU workers, whose mobility had been considered a positive aspect of EU integration. The scope of social solidarity in the EU is demoted as a result of judicial and political interventions that question the social dimension of EU citizenship and which may have implications for other groups of migrants situated within the EU.

From Toxic Tours to Growing the Grassroots: Tensions in Critical Pedagogy and Community Development

ABSTRACT:Structural inequalities in American public education are inextricably tied to deep-seated patterns of racial and economic segregation. Children in poor neighborhoods are less likely to have the household resources, neighborhood institutions, or school amenities necessary for a good, challenging education. In response, a growing number of organizations have launched initiatives to simultaneously revitalize neighborhoods and improve public education, emphasizing youth participation as an essential component in their efforts. We draw upon ethnographic data from two such organizations to examine their practice of place-based critical pedagogy in community development. We focus on how they engage marginalized, “hard-to-reach” youth via (1) experiential learning, to counter high-stakes testing models and cultivate a sense of ownership in the local community, and (2) empowered deliberative action, in contextualized ways. The tensions embedded in these organizations’ complex efforts have implications for other groups of marginalized youth engaged in community development, especially in their attempts to help students gain concrete outcomes in community development and achieve long-term sustainability.

Non-clinicians’ judgments about asylum seekers’ mental health: how do legal representatives of asylum seekers decide when to request medico-legal reports?

Background: Procedures for determining refugee status across Europe are being speeded up, despite the high prevalence of mental health difficulties among asylum seekers. An assurance given is that ‘‘vulnerable applicants’’ will be identified and excluded from accelerated procedures. Although experts have recommended assessments to be undertaken by experienced clinicians, this is unlikely to happen for political and financial reasons. Understanding how non-clinically qualified personnel perform assessments of mental health issues is timely and crucial. Misrecognition of refugees due to the inappropriate use of accelerated procedures involves the risk of returning the very people who have the right to protection from further persecution.Objective: To examine the decision making of immigration lawyers, who are an example of a group of nonclinicians who decide when and whether to refer asylum-seekers for psychiatric assessment.Method: Semi-structured interviews were conducted with 12 legal representatives working with people seeking refugee or human rights protection in the United Kingdom. The resultant material was analysed using Framework Analysis.Results: Themes clustered around the legal case, the client, the representative and the systems, all with sub-themes. A mapping exercise integrated these themes to show how representatives brought together questions of (1) evidential reasons for a report, influenced by their legal, psychological and case law knowledge, and (2) perceived evidence of mental distress, influenced by professional and personal experiences and expectations.Conclusions: The legal representatives interviewed were well-informed and trained in psychological issues as well as clearly dedicated to their clients. This helped them to attempt quasi-diagnoses of common mental health problems. They nonetheless demonstrated stereotypical understanding of post-traumatic stress disorder and other possible diagnoses and the role of subjectivity. The study has implications for other groups – particularly those less trained and compassionate – who are required to make clinical judgments without the necessary expertise.For the abstract or full text in other languages, please see Supplementary files under Reading Tools online

Marginalized stakeholders and performative politics: dueling discourses in education policymaking

American urban education policy debates pivot around dueling lines of discourse on what ails inner-city youth; such students are portrayed as emblems of a largely African-American and Latino ‘culture of failure’, even as their voices remain largely absent from debates about them. In response, youth-led organizations attempt to forward youth as political stakeholders. I draw upon ethnographic data from two such organizations to examine the performative aspects of their campaign work. I focus on how they engaged in (1) counter-scripting, to imagine themselves as political stakeholders and substantively prepare themselves for their new roles, and in (2) counter-staging, to gain greater access to existing public stages and construct new, alternative spaces, for more deliberative interactions with policymakers. The strengths and weaknesses of these organizations' efforts have implications for other groups of marginalized stakeholders campaigning for policy reform, especially in their attempts to demonstrate local knowledge and expertise.

Sleeping during the day: effects on the 24-h patterns of IGF-binding protein 1, insulin, glucose, cortisol, and growth hormone

Disturbed sleep is a major risk factor for metabolic disturbances, including type 2 diabetes, but the involved mechanisms are still poorly understood. We investigated how an acute shift of sleep to the daytime affected IGF-binding protein 1 (IGFBP1), which is a risk factor for diabetes. Seven healthy men (age, 22-32 years) participated in a night sleep condition (sleep 2300-0700 h) and a day sleep condition (0700-1500 h) with hourly blood samples taken for 25 h (starting at 1900 h) and isocaloric meals every 4th hour awake. The blood samples were analyzed for IGFBP1, insulin, GH, glucose, and cortisol. The acute shift of sleep and meal timing (to 8 h) shifted the 24-h patterns of IGFBP1, glucose, insulin, and GH to a similar degree. However, the day sleep condition also resulted in elevated levels of IGFBP1 (area under curve (AUC)+22%, P<0.05), and reduced glucose levels (AUC-7%, P<0.05) compared with nocturnal sleep. Sleeping during the day resulted in elevated cortisol levels during early sleep and reduced levels in late sleep, but also in increased levels the subsequent evening (P's<0.05). Sleep-fasting seems to be the primary cause for the elevation of IGFBP1, irrespective of sleep timing. However, sleeping during the day resulted in higher levels of IGFBP1 than nocturnal sleep, suggesting altered metabolism among healthy individuals, which may have implications for other groups with altered sleep/eating habits such as shift workers. Moreover, sleep and meal times should be accounted for while interpreting IGFBP1 samples.

Shared Leadership in a Community Theater Group: Filling the Leadership Role

In contrast to research in which an individual leader is assigned or expected to emerge, musical theater productions provide an opportunity to explore how leadership is shared among the director, assistant director, music director, choreographer, and stage manager in a naturally occurring group. This ethnographic study explores how one community theater group managed the sharing of leadership roles when the primary director assumed a passive or ineffective role. The study explores the communication and affective responses of the secondary leaders and cast members when they perceived that the primary leadership failed to function and then examines how secondary leaders and cast members communicated to share the leadership to produce successful theatrical performances. The results have implications for other groups with shared leadership structures.

Regurgitation of the Native Aortic Valve Caused by Thrombus Formation After Heterotopic Heart Transplantation

A 61-year-old man, who had undergone heterotopic heart transplantation, had severe regurgitation through his native aortic valve develop 16 years later, which caused severe heart failure. At operation the regurgitation was found to be due to development of an organized thrombus in the sinuses of Valsalva tethering aortic leaflets. The management of this previously undescribed complication of heterotopic heart transplantation and the implications for other groups of patients (such as those receiving treatment with a left ventricular assist device) are discussed.

A Seat at the Table: Persons with Disabilities and Policy Making

A Seat at the Table documents the participation of disability activists and organizations in public policy making in Canada. The authors combine studies of contemporary federal and provincial policy making with a historical perspective on the progress made by disability groups since World War I. The cases they discuss illustrate the tension between issues of human rights and personal capacities that the disability movement must deal with, but which have implications for other groups as well. An analysis of contemporary social policy networks in Canada makes it possible for the authors to suggest reasons for the inconsistent success that disability organizations have had in translating their requirements into policy. A Seat at the Table illuminates the key social-political factors of resources, roles, and reputations that must be taken into account by excluded groups seeking to gain a seat at the policy table. The insights it provides are important for the development of more professional lobbying practices by disability stakeholders as well as by women, aboriginals, ethnic groups, the elderly, and the poor.

Rural And Urban Inner-City High School Student Knowledge And Perception Of Agriculture

This study was conducted to assess the knowledge and perception of rural and urban inner-city students in two Midwestern states regarding agriculture, food, and natural resources. Since this study was a pilot project, these two subgroups of the United States population were assessed to provide baseline data reflecting the knowledge and perceptions of United States residents regarding agriculture and the food industry. Data were collected from 1121 respondents but did not constitute a representative sample of students in the two Midwestern states. However, the results of this study may have implications for other groups on a practical basis. Three objectives were specified for this study as follows: 1) to assess the level of agricultural knowledge among rural and urban inner-city high school students in a midwest; 2) to assess the level of agricultural perceptions among rural and urban inner-city high school students in the midwest; and, 3) to compare the level of agricultural knowledge and perception of both subgroups. Both groups of respondents were most knowledgeable about Natural Resources concepts whereas the Rural Students were least knowledgeable about the Plants in Agriculture concept area compared to the Urban Inner-City High School Student respondents who were least knowledgeable about the Policy concept area. Overall, respondents had the most positive perception about the Natural Resources concept area and were the least positive about the Agricultural Policy concept area.

Rural And Adult Knowledge And Perceptions Of Agriculture

This study was conducted to assess the knowledge and perception of rural and urban adults in a midwestern state regarding agriculture, food, and natural resources. Since this study was a pilot project, these two subgroups of the United States population were assessed to provide baseline data reflecting the knowledge and perceptions of United States residents regarding agriculture and the food industry. Data were collected from 886 respondents but did not constitute a representative sample of all United States citizens. However, the results of this study may have implications for other groups on a practical basis. Three objectives were specified for this study as follows: 1) To assess the level of agricultural knowledge among rural and urban adults in a midwestern state; 2) To assess the level of agricultural perceptions among rural and urban adults in a midwestern state; 3) To describe the demographic variables of both subgroups that may influence their knowledge or perceptions of agriculture. Both groups of adult respondents were most knowledgeable about the Animals concept and least knowledgeable about the Plants in Agriculture concept. Respondents were most positive about the Natural Resources concept and were the least positive about the Agricultural Policy concept. However, rural adults were also very positive about the Animals concept. Respondents living on farms were more knowledgeable about agriculture than their rural non-farm neighbors, who were more knowledgeable than their urban counterparts. Respondents with high levels of education were more knowledgeable about agriculture than those with less education.

Use of Transdermal Nicotine in a State-Level Prescription Plan for the Elderly

To assess transdermal nicotine use patterns and outcomes in a population of low-income older smokers. A 6-month telephone follow-up survey of smokers filling prescriptions for transdermal nicotine in the first 3 months of 1992. Pennsylvania's Pharmaceutical Assistance Plan for the Elderly, the nation's largest state-level prescription plan for the elderly. A total of 1070 noninstitutionalized male and female smokers aged 65 through 74 years. Self-reported physician/pharmacist advice and adjunctive treatments, concomitant smoking, and 6-month smoking abstinence. Respondents were predominantly long-term heavy smokers. They used nicotine patches for an average of 5 weeks, with few reporting use beyond 3 months or recalling bothersome side effects. Most of those with previous quit attempts rated quitting with the patch "easier." The 29% self-reported 6-month quit rate observed is encouraging. However, compliance with patch use guidelines was far from ideal in this high-risk population: only 54% of respondents received any initial advice or materials from their physicians or pharmacists, fewer than 2% took part in a formal clinic or one-to-one treatment program, and almost half (47%) smoked while using the patch, including 20% who smoked every day. Concomitant smoking was strongly associated with failure to achieve abstinence (P < .001). More frequent contact with physicians and/or pharmacists was associated with less concomitant smoking (P < .001) and higher quit rates (P = .005). This survey offers an important first look at problems and prospects for nicotine patch therapy in older adults, with implications for other groups as well. Prospective studies are needed to clarify optimal treatment regimens and adjuncts.

Challenging the Assumptions Underlying the Use of Participatory Decision-Making Strategies

Participatory or joint decision-making strategies have been suggested as effective in groups with the task of solving unstructured problems or creating innovations. This longitudinal case study of a small task group suggests that there may be important differences between the desire of group participants to use participatory strategies and their ability to do so effectively. After 15 months, the group members failed to accomplish their task. Four problem areas that account for the lack of productivity are identified: expertise, self-oriented needs, permissive operating procedures, and formal status differences. Implications for other groups that attempt to use participatory strategies are discussed.