Ongoing Participation Research Articles

Developing an online art therapy group for learning disabled young adults using WhatsApp

ABSTRACT Background: Learning Disabled (LD) adults commonly experience barriers accessing the same services as non-disabled adults. Communication issues may also contribute to difficulties forming relationships, leading to increased loneliness and isolation. Art therapy groups can help to counter social isolation, providing opportunities to creatively explore challenges within a therapeutic relationship. Context: This paper describes the development of online art therapy during the Novel Coronavirus 2019 (COVID-19) pandemic. Using social media, an online group was developed from an existing studio group for LD clients at risk of isolation. Participants continue to take part and have consented to their images and viewpoints being used. Approach: Primarily influenced by studio models of art therapy, the original approach used is an enabling, art-based approach. After transitioning into online art therapy, art making remains central to the process and intersectionality and the role of touch are explored. Outcomes: Participants of the online group consistently engage, sharing creative responses via the social media platform, WhatsApp. Ongoing participation is perceived as a positive sign and members predominantly agree the adaptation is helpful, however, challenges gathering feedback have arisen. Conclusions: The use of online art therapy in an accessible format enables the group to continue accessing support during the pandemic. The variety of communication methods available on WhatsApp allows participants to remain included. Implications for research: Further research is required to establish whether this approach could be used as a template for other LD services and other client groups. Plain-language summary This paper describes the introduction of an online art therapy group to support young Learning Disabled adults during the COVID-19 pandemic. Online sessions were adapted from an existing studio art therapy group, in which five members met fortnightly in an artist community, with sessions facilitated by two art therapists and a support worker. Prior to the pandemic, Learning Disabled adults likely already had fewer opportunities to socialise. As a result, they may experience greater loneliness and social isolation. Communication issues and difficulties using technology also contribute to their widespread digital exclusion. In an ever-increasing digital era resulting from the pandemic, Learning Disabled adults are at higher risk of mental health issues. Hosting online sessions using the familiar and accessible social media platform, WhatsApp, allows our existing structure and aims to remain largely the same. This creates some sense of consistency in surreal and challenging circumstances. We describe the theoretical approaches which influenced our original model before outlining perspectives which inform and shape our online work. The practicalities of setting up the online group are summarised and online sessions are described with reference to artworks, emerging themes and the benefits and challenges which have arisen. Participants’ views are included, with our observations around the challenges of obtaining feedback with this client group. In conclusion, this paper describes how our approach and the creation of a virtual art therapy studio in absence of an actual studio environment may allow Learning Disabled clients to remain included, connected and supported during a global crisis. More accessible evaluation strategies are needed to establish how effective this model is and further projects may suggest whether this online approach could be replicated with other groups, both LD and other client groups.

Healthcare Worker Experiences Implementing CRE Infection Control Measures at a vSNF—A Qualitative Analysis

Background: During 2017–2019 in the Chicago region, several ventilator-capable skilled nursing facilities (vSNFs) participated in a quality improvement project to control the spread of highly prevalent carbapenem-resistant Enterobacteriaceae (CRE). With guidance from regional project coordinators and public health departments that involved education, assistance with implementation, and adherence monitoring, the facilities implemented a CRE prevention bundle that included a hand hygiene campaign that promoted alcohol-based hand rub, contact precautions (personal protective equipment with glove/gown) for care of CRE-colonized residents, and 2% chlorhexidine gluconate (CHG) wipes for routine resident bathing. We conducted a qualitative study to better understand the ways that vSNF employees engage with the implementation of such infection control measures. Methods: A PhD-candidate medical anthropologist conducted semistructured interviews with management (N = 5), nursing staff (N = 6), and certified nursing assistants (N = 6) at a vSNF in the Chicago region (Illinois) between September 2018 and November 2018. More than 11 hours of semistructured interviews were collected and transcribed. Data collection and analysis focused on identifying healthcare worker experiences during an infection control intervention. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results: Healthcare workers described the facility using language associated with a family environment (Table 1). Furthermore, healthcare workers demonstrated motivation to implement infection control policies (Table 2). However, healthcare workers expressed cultural and structural challenges encountered during implementation, such as their belief that some infection control measures discouraged maintenance of a home-like environment, lack of time, and understaffing. Some healthcare workers perceived that alcohol-based hand rub was ineffective over time and left unpleasant textures on the skin. Additionally, some workers did not trust the available gown and gloves used to prevent transmission. Lastly, healthcare workers typically did not prefer 2% CHG wipes over soap and water, citing residual resident postbathing smell as one indicator of CHG ineffectiveness. Conclusions: In a vSNF we found both considerable support and challenges implementing a CRE prevention bundle from the healthcare worker perspective. Healthcare workers were dedicated to recreating a home-like environment for their residents, which sometimes felt at odds with infection control interventions. Residual misconceptions (eg, alcohol-based hand rub is not effective) and negative worker perceptions (eg, permeability of contact precaution gowns and/or residue from alcohol-based hand rub) suggest that ongoing education and participation by healthcare workers in evaluating infection control products for interventions is critical.Funding: NoneDisclosures: None

Enhancing clarity of clinical trial safety reports for data monitoring committees

ABSTRACT A Data Monitoring Committee (DMC) evaluates patient safety in a clinical trial of an investigational intervention through periodic review of adverse events (AEs) and clinical safety assessments. Our aim was to construct DMC report displays to enhance the DMC safety review through use of graphics and clear identification and adjustment for missing data caused by early discontinuations and ongoing study participation. Suggested displays include a study snapshot graph, enhanced adverse event incidence tables including the incidence density and plotted incidence proportions, line graphs in place of by-patient listings, and trend plots in place of tables for continuous assessments.

Perceived Influence of Medical Students' Community Health Assessment Projects.

To achieve overall health, physicians must understand how community and population health impacts individual health. Although several US medical schools have incorporated community health assessment project requirements into traditional curricula, examples in longitudinal integrated clerkships are unknown. This study was designed to assess alumni perceptions of the influence of community health assessment projects, a core component of the University of Minnesota Rural and Metropolitan Physician Associate Program's (RPAP/MetroPAP) 9-month longitudinal integrated curriculum. This 2018 study consisted of a descriptive cross-sectional survey of 480 RPAP/MetroPAP alumni who completed 457 community health assessment projects between 2004/2005 and 2016/2017. The authors administered a 14-item survey requesting date and location of RPAP/MetroPAP 9-month placement, name of project, source of project idea, and perception of project influence on professional activities. Quantitative data were collected using 4-point Likert scales. We collected qualitative data with open text boxes. The survey response rate was 42.29% (203/480). A key finding was alumni perceived project ideas arising from community partners had greater impact on their acquisition of several community engagement skills. One-half reported projects influenced their professional activities, evidenced by ongoing community engagement, interest and participation in public health and preventive health initiatives, efforts to learn about specific health issues, social determinants of health and patient advocacy. This exploratory study suggests medical student community health assessment projects enhance community engagement and soliciting project ideas from community partners increases student acquisition of community engagement skills.

Service is Not Perishable: Nurturing Ongoing Participation with Conceptual Models

This article explores the nature of conceptual models for designing service participation. Conceptual models are both a representation and a hypothesis, dialectically creating conditions of participation. I first study the nature of a conceptual model and then explore the four arts with focus on the notion of form. Each art reveals a mode of thought regarding the form of the participatory whole: grammatical model of coproduction, rhetorical model of argumentation, poetic model of experience, and dialectic model of commitment. Along with the arts, I present case studies of four distinctive conceptual models that have been used to design for participation.

Multiple criteria analysis of citizens’ information and trust in climate change actions

In the past decades, the stakeholders, due to the evident impacts of climate change, were more involved in strategic actions and informing the public opinion on climate change. However, in order to achieve ongoing and substantial public participation in climate change actions undertaken by the stakeholders, the public will need to be fully informed about the causes and effects of climate change so that a mutual relationship of trust may be established. The present study aims to investigate public perceptions of the information citizens obtain from information sources, stakeholders' share of responsibility for climate change and citizens’ degree of trust in the stakeholders which affects public participation in climate change actions. The study was conducted in Greece, where 1536 questionnaires were collected from January 2014 to June 2015. The collected data were analyzed using descriptive and nonparametric statistics, as well as the MUSA method (MUlticriteria Satisfaction Analysis). The study findings indicated that the citizens do not trust adequately information sources regarding climate change and, at the same time, they perceive that the dissemination of information on climate change is limited and consider that the media which use scientific knowledge provide more objective information. Moreover, Greek citizens consider that industries, oil companies and governments contribute mostly to climate change and they were willing to participate in climate change actions carried out mainly by scientists, environmental groups, citizen groups and non-governmental organizations.

An exploration of the emotional experience of BASE jumping

BASE jumping is an extreme sport, where participants jump from fixed objects and deploy a parachute to land safely. The aim of this study was to explore the emotions that BASE jumpers experience and determine what role and impact these emotions may play for participants. Twenty male BASE jumpers with at least 10 jumps and 3 months of participation in the sport were interviewed, and thematic analysis was undertaken. Participants reported intense emotional experiences of fear, flow and thrill. These emotional states influenced how they negotiate and make meaning in their sport. The experience of fear may become normalised, whilst flow and thrill may lead to an escalation of risk taking. Participants rationalised their participation in such a dangerous sport and emotional dissonance emerged as denial and guilt. Emotions may at times negatively impact risk taking and decision making, while flow and thrill can encourage ongoing participation.

Use It Or Lose It: What Happens To Bone When High-Intensity Exercise Ceases Or Continues?

The LIFTMOR trial was the first to show a high-intensity resistance and impact training program (HiRIT) was safe and efficacious for improving bone and physical function in postmenopausal women with low to very low bone mass. While results were promising, the long-term efficacy and safety of HiRIT outside an RCT setting was unknown. PURPOSE: The primary aim of the current study was to evaluate the effects of continuing or ceasing HiRIT on bone mineral density (BMD) and physical function of LIFTMOR trial participants. METHODS: We report a retrospective observational study of LIFTMOR trial participants. Three years after completion of the LIFTMOR trial, participants in the HiRIT arm of the trial underwent a single testing session. Participants were allocated to one of two groups according to either ongoing HiRIT participation (compliance >25%; HiRIT-HiRIT), or cessation of HiRIT (HiRIT-CON) after LIFTMOR. The LIFTMOR testing protocol was employed, including; BMD at the lumbar spine (LS) and femoral neck (FN), back extensor strength (BES), lower extremity strength (LES), functional reach test (FRT), timed up-and-go test (TUG), five times sit-to-stand (FTSTS) and maximal vertical jump (VJ). Data were analysed using repeated measures ANCOVA comparing final LIFTMOR outcomes to 3 year outcomes. RESULTS: Twenty-three women (HiRIT-HiRIT, n = 7; 64 ± 4 yr, 159.4 ± 6.5 cm, 67.0 ± 7.2 kg and HiRIT-CON, n = 16; 65 ± 4 yr, 161.8 ± 5.9 cm, 61.9 ± 9.5 kg) participated in follow-up testing 3.2 ± 0.6 yrs post-LIFTMOR. There were no characteristic differences between the follow up sample and the LIFTMOR sample at baseline. Significant ongoing gains in BMD were apparent in HiRIT-HiRIT compared with HiRIT-CON at the LS (8.63 ± 5.29% vs 2.18 ± 5.65%, p = 0.042) and FN (3.67 ± 4.45% vs 2.85 ± 5.79%, p = 0.014), while the HiRIT-CON group maintained BMD benefits from the LIFTMOR intervention. Between-group differences in functional outcomes favoured HiRIT-HiRIT but did not reach significance. No injuries were reported. CONCLUSION: Postmenopausal women with low bone mass continuing HiRIT over a 4 year period continued to improve bone mass, while those ceasing HiRIT maintained the gains achieved from 8 months of HiRIT 3 years previously. HiRIT exercise appears to be a highly effective therapy to reduce risk of osteoporotic fracture by improving bone mass.

“Compassionate Dictatorship”: Leading Old Singers in Community Choirs in Australia

In Australia, the ageing population generate challenges, pressures and opportunities for both governmental and community organisations. Involvement in community choirs offers older people diverse benefits that increase with ongoing participation. The music directors/conductors (MD/C) of community choirs are pivotal in the success of ensembles. This paper forms part of our wider study into Well-being and ageing: community, diversity and the arts in Victoria, Australia and addresses the questions, how do music directors/conductors (MD/C) of community choirs understand working with older people? And, how do older choir members understand the role of their MD/C? We interviewed two MD/Cs and thematically analysed our data. We present our findings under two overarching themes that evolved from our data analysis: Understandings of working with older people in a choir and musical leadership in a community setting. We found that the MD/Cs are reflective practitioners who imbued their facilitation and conducting with enthusiasm, skill, knowledge and passion for musical engagement. Our research suggests that to ensure longevity of choirs and to recognise the contribution of MD/Cs, greater attention should be paid to the upskilling of future generations of MD/Cs.

NSCLC: Integrating the “Yale model shared decision-making solution” into the practice setting.

7054 Background: Lung cancer patients are faced with treatment choices that involve complex decisions that can be preference-sensitive. In 2017 the National Quality Forum initiated a “Call to Action” to integrate shared decision-making (SDM) processes into practice in which clinicians and patients work together to make healthcare decisions that align with what matters most to patients. Projects In Knowledge, @Point of Care, Dartmouth and Yale collaborated to develop a pilot educational initiative to address and improve patient-centered care and SDM processes in the institutional cancer-care setting. Methods: Training materials co-developed for the Yale NSCLC team members (oncologists, nurses/NPs, social worker) address SDM, Checkpoint Inhibitor Therapy in NSCLC, and clinician-patient role play methods for implementing SDM in treatment discussions/decisions. Qualitative interview and observational methods were used to assess improved SDM performance by the multidisciplinary Yale NSCLC team by comparing baseline pre-intervention to post-intervention interviews and rating observed performance on case study role-play scenarios. Following the training and assessments, a focus group that included all team members was conducted to assess the acceptability, feasibility, and repeatability of the program and to inform future education. Results: Training empowered all Yale NSCLC team members to show pre- to post-education improvement in SDM (34% to 88%). Areas of greatest improvement: 1) providing reasonable treatment options to patients (+58%); 2) determining decision style preference – to what extent a patient wants to participate in the treatment decision process with their clinician (+76%); 3) determining patients’ risk tolerance regarding treatments that may be more efficacious but may have more side effects (+77); and 4) determining patients’ goals/preferences (+88%). Conclusions: Educational training improved SDM skills by all Yale NSCLC team members, which can lead to improved clinician-patient decision-making and patient-centric care. The training process also facilitated team building and encouraged ongoing participation in SDM.

How clerks understand the requests of people living with aphasia in service encounters

ABSTRACT Aphasia often restricts participation. People living with aphasia (PLWA) engage in fewer activities, which leads to fewer interactions than before aphasia. Analyses of interactions with non-familiar people in activities of daily life could provide knowledge about how to integrate these situations in rehabilitation and facilitate ongoing PLWA participation post-rehabilitation. This qualitative study is the first to examine how PLWA make their requests understood in service encounters despite aphasia. Six people living with moderate or severe aphasia were video-recorded in situations of service encounters, e.g., pharmacies, specialised shops, restaurants, and others. We identified fifty-nine occurrences with one or several difficulties in the formulation of the request. They were examined, including the clerks’ responses and ensuing interaction using multimodal conversation analysis. Results showed that PLWA used nonverbal communication within the physical environment and the context of the interaction to support verbal production. In the majority of situations, the clerks understood the request promptly. In other situations, they both collaborated to achieve a clear understanding of the request. Moreover, the findings attest to the competence of people living with moderate or severe aphasia in engaging in service encounters and add to the knowledge base about interaction and social participation in aphasia.

Recommendations from national regulatory agencies for ongoing cancer trials during the COVID-19 pandemic

Recommendations from national regulatory agencies for ongoing cancer trials during the COVID-19 pandemic

Older Adults' Perceptions of the Usefulness of Technologies for Engaging in Physical Activity: Using Focus Groups to Explore Physical Literacy.

Insufficient physical activity (PA) levels observed among older adults remain extremely high and pose a danger to developing and maintaining their physical literacy (PL). Each person’s level of PL partly depends on their physical and cognitive skills, confidence level, and degree of motivation to practice PA daily. New technologies, such as exergames and wearable fitness trackers, may enable older adults to increase their PL, stimulating uptake and ongoing PA participation. Objective: This focus group study aims to describe older adults’ perceptions of the use of technologies to engage in physical exercise programs. Methods: Fifteen participants were randomly selected from a sample of 40 older adults who completed a randomized controlled trial that investigated the benefits of using technology in the context of group-based exercise programs. Separate post-intervention focus groups were performed with an exergaming group, a conventional physical training group, and a no training group (control). Data were mapped onto constructs from the four domains of PL: affective, physical, cognitive, and behavioral. Results: Generally, participants expressed positive perceptions about the benefits of using technology to engage in PA. These positive feelings outweighed the costs and the lack of familiarization with technology. Common themes for the three groups emerged from the discussions and included familiarization with technology, using fitness tracker to monitor PA, previous exposure to technology, and interaction with peers, staff members, and relatives. In particular, participants from the exergaming group explored the ideas of training their cognitive skills while using the exergame accessories, exercising in an alternative way, competitive versus cooperative play, changes in sense of humor, skill transferability from game to real environment, progressions of the exercise intensities, and the potential use of exergames for rehabilitation. Conclusions: Participants in this study reported positive perceptions about implementing technology into exercise. Emphasizing the benefits of using technology in group-based exercise programs may increase older adults’ PL levels and their future technology adoption. The potential implementation of technology into conventional exercise programs should focus on older adults’ lifelong values, biopsychosocial conditions, and the possibility of reducing age-related risk of injuries and chronic diseases.

Fins and (Mis)fortunes: Managing shark populations for sustainability and food sovereignty

Sharks are simultaneously a subsistence food and a luxury item. Shark fins are consumed during special occasions among primarily the East Asian elite, whereas shark meat is consumed by many globally, including by fishers and their families. Policies guiding the management of shark fisheries vary globally, with inconsistent protections for sharks across their ranges and insufficient consideration of the multifaceted demands for shark products. Banning shark fishing is a popular management strategy; however, a full ban on shark fishing has the potential to threaten both food security and food sovereignty of small-scale fishing communities. In this paper, we investigate the tension between the subsistence and commercial value of sharks, examining the history and current status of shark fishing practices in Madagascar. From this case study, we analyze how current management strategies contribute to shark conservation and food sovereignty. Ultimately, we argue in favor of a rights-based approach to shark fisheries policy in Madagascar, and in other food insecure nations in the process of evaluating and expanding their shark conservation efforts, that considers (a) the end use of the sharks (e.g. implement policies favoring fishers who land sharks for subsistence), (b) the mode of access fishers use to harvest sharks (e.g. imposing greater restrictions on industrial vessels), and (c) direct and ongoing participation of local fishers in decision-making occurring at all scales of governance. While these suggestions pertain to shark fisheries globally, they are especially pertinent to fisheries-dependent countries with high rates of food insecurity in the Global South.

The role of new technologies in monitoring the evolution ofpsychopathology and providing measurement-based care in youngpeople.

The role of new technologies in monitoring the evolution ofpsychopathology and providing measurement-based care in youngpeople.

Understanding the experience of initiating community-based group physical activity by people with serious mental illness: A systematic review using a meta-ethnographic approach.

People living with serious mental illness (SMI) experience debilitating symptoms that worsen their physical health and quality of life. Regular physical activity (PA) may bring symptomatic improvements and enhance wellbeing. When undertaken in community-based group settings, PA may yield additional benefits such as reduced isolation. Initiating PA can be difficult for people with SMI, so PA engagement is commonly low. Designing acceptable and effective PA programs requires a better understanding of the lived experiences of PA initiation among people with SMI. This systematic review of qualitative studies used the meta-ethnography approach by Noblit and Hare (1988). Electronic databases were searched from inception to November 2017. Eligible studies used qualitative methodology; involved adults (≥18years) with schizophrenia, bipolar affective disorder, major depressive disorder, or psychosis; reported community-based group PA; and captured the experience of PA initiation, including key features of social support. Study selection and quality assessment were performed by four reviewers. Sixteen studies were included in the review. We identified a "journey" that depicted a long sequence of phases involved in initiating PA. The journey demonstrated the thought processes, expectations, barriers, and support needs of people with SMI. In particular, social support from a trusted source played an important role in getting people to the activity, both physically and emotionally. The journey illustrated that initiation of PA for people with SMI is a long complex transition. This complex process needs to be understood before ongoing participation in PA can be addressed. Registration-The review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) on 22/03/2017 (registration number CRD42017059948).

Perceptions of the Impact of Non-contact Boxing on Social and Community Engagement for Individuals with Parkinson’s Disease: A qualitative study

Purpose: To explore the perceptions of individuals with Parkinson’s disease (PD) on their experiences within a community based, non-contact boxing program. Specifically, this study considered how these individuals perceived non-contact boxing to influence their social and community engagement and factors influencing ongoing participation in this program. Method: This was a phenomenological case study that utilized qualitative methods for data collection including semi-structured interviews and observation. Colaizzi’s method was used for data analysis. A convenience sample obtained from a boxing club that offered PD specific boxing classes was used. The sample included 10 participants (3 female, 7 male) ranging in age from 52 to 84 years. Participants typically attended a 75 minute boxing class two to three times per week. Results: The exhaustive description of the phenomenon was that individuals with PD have a strong desire to maintain the life they had prior to their diagnosis and chose activities, such as non-contact boxing, which supported their ability to sustain that lifestyle. Two themes were identified which included 1) “The people I’ve met here and spent time with will be friends forever” and 2) “I don’t have to be Muhammed Ali. It’s not about that.” Conclusions: This study provided a basic understanding of the subjective experiences of individuals with PD who participated in non-contact boxing. Findings demonstrated that non-contact boxing facilitates the growth of supportive relationship for individuals with PD. The study also found that individuals with PD believe non-contact boxing provided a variety of physical, cognitive, and emotional benefits which facilitated their ability to maintain participation in valued activities.

“It’s a change your life kind of program”: A Healing-Focused Camping Weekend for Urban Indigenous Families Living in Fredericton, New Brunswick

We present a community-driven research project designed to evaluate an innovative land-based healing initiative – a traditional camping weekend – for urban Indigenous families. The initiative was developed and implemented by Under One Sky Friendship Centre in Fredericton, NB, and involved a weekend-long celebration of culture and community. We gathered data from family members, staff, and stakeholders, and completed a thematic analysis and community review before synthesizing results into a narrative summary. Themes included Skitkəmikw (Land), Cəcahkw (Spirit), Skicinowihkw & Nekwtakotəmocik (Community & Family), and Sakələməlsowakən (Wellbeing). These connections are echoed throughout the article by quotes from participants that capture the essence of the experience. Our research helps to fill a knowledge gap in this area and supports the limited body of existing literature in demonstrating that community-led, land-based healing initiatives support Indigenous wellbeing in many ways that mainstream approaches cannot. Future work is needed to scale up land-based healing initiatives that provide community-led approaches to health promotion, and to examine the effects of ongoing participation on long-term health and wellness outcomes.

Can extension programs improve grazing management in rangelands: a case study in Australia

A key challenge in reducing sediment moving from grazing lands into the Great Barrier Reef in Australia is to encourage beef cattle producers to improve management practices. Excessive grazing pressures cause land degradation, leading to both increased sediment runoff and lower future profits. Although higher grazing rates may be possible (and profitable) in better seasons, slow rates of adjustment to poorer seasons can lead to overgrazing and negative impacts on land condition. For policymakers the challenge is to find mechanisms that encourage or signal producers to be more precise in their management and avoid overstocking. Some of the most common options include extension programs, grant programs that use financial incentives, and regulation. In this paper we outline a conceptual framework that shows why extension may be a more powerful driver of management change than incentive programs, and then test this through an evaluation of a case study program conducted with beef cattle producers in catchments of the Great Barrier Reef, Australia. The pathway involving landholders to implement management change was through improved efficiency and productivity, as these are the issues that drive ongoing participation in broader environmental programs. The results present multiple lines of evidence to infer positive outcomes of an extension program in terms of changed management practices, which may be expected to generate improved productivity and better water quality outcomes. These can be grouped into three key areas. First, outcomes show positive improvement relative to the Grazing Water Quality Risk framework for the Great Barrier Reef catchments, which is designed to assess the links between land management and water quality. This indicates that resource condition is likely to improve and sediment emissions should be reduced over time. A second outcome is increased landholder engagement and improved understanding of their business and engagement in future programs, which should underpin ongoing adoption. A third outcome is improved management of risk and developing the skills to do this through data collection and monitoring, which should improve management responses in drought years.

Vocation, Business Leadership, and the Pursuit of Understanding

To have a vocation is to be called to a life of ongoing participation in the redemptive work of the Son and the Holy Spirit. Being faithful to the vocation we have received requires adopting a stance of continuing alertness, ready to notice, correctly interpret, and effectively respond to the various forms of communication by which God draws us into closer cooperation with the redemptive missions of the Son and the Spirit. In this paper I focus on a particular vehicle by which the divine call is transmitted to us—namely, the God-given desire to know, which we experience whenever we wonder about something, whenever we try to solve a problem, whenever we learn or explore or plan.