Support Services Research Articles

Patient management with Head and Neck tumors-A nationwide data collection in oral and maxillofacial surgery.

This study analyzed oncologic patient management from initial tumor diagnosis to tumor follow-up in oral and maxillofacial surgery (OMFS) in Germany. A dynamic online questionnaire with a total of 44 questions was used to generate general and specific data regarding oncologic patient management with head and neck malignancies, supportive care, and (pre-) rehabilitation from initial tumor diagnosis to tumor follow-up and head and neck cancer center (HNCC) structures in OMFS in Germany. The questionnaire was sent to 81 OMFS departments affiliated with the German-Austrian-Swiss Working Group for Tumors of the Jaw and Facial Region (DÖSAK) and the German Association of Oral and Maxillofacial Surgery (DGMKG). Data analysis was conducted descriptively. Forty-eight OMFS departments participated (response rate 59.26%), of which 36/48 (75%) were certified HNCC. 28/34 (82.4%) reported subjective improvements in oncologic care, most often interdisciplinary collaboration (21/33, 63.64%) and clinic structure changes (21/34, 61.76%). Nearly all OMFS departments present patients in multidisciplinary tumor boards (45/46, 97.83%) and aim for osseous reconstruction post-tumor resection (43/44, 97.73%). Significant discrepancies regarding the frequency of masticatory-functional dental rehabilitation following osseous reconstruction were observed. Before oncologic therapy, patients are offered various supportive services, mostly psychotherapy and psycho-oncological support (24/26, 92.31%). Post-therapy, speech therapy (43/43, 100%), physiotherapy (40/43, 93.02%), lymphatic drainage, and follow-up rehabilitation (39/43, 90.7%, respectively) are most often offered. 17/43 (39.53%) have oncological nursing staff. 36/40 (90%) manage patients and side effects during adjuvant therapy, while 5/41 (12.2%) provide proprietary palliative care. 36/41 (87.8%) offer counseling to patients and families. Oncologic patient care in OMFS is highly standardized and potentially attributable to many certified HNCCs in Germany. Certain treatment aspects are handled differently, possibly due to institution-specific reasons. The high homogeneity in treatment protocols reflects the widespread high and comparable treatment quality of head and neck malignancies in OMFS in Germany.

Stigma or Support? How Gender, Race, and Intersectionality Impact Perceptions of Exonerees

Little research has examined the gendered nature of wrongful convictions and how the intersectionality of gender and race impacts perceptions of exonerees and support for reintegration services. With two vignette experiments, we assess laypeople’s perceptions of female or male, Black or White exonerees (Study 1 and 2) who were wrongfully convicted due to official misconduct or a false confession (Study 2) in varying child-victim cases. When wrongfully convicted of a violent homicide (Study 1), White female exonerees were viewed less favorably than Black females and White males were viewed least favorably. However, in a no-crime Shaken Baby Syndrome case (Study 2), false confessors were viewed least favorably, but gender and race did not impact perceptions. We provide potential explanations for these findings and implications for exonerees’ reintegration experiences.

Teachers and Teaching Assistants – Teamwork as Prevention of School Failure of Pupils During Primary Education

This paper investigates the topic of teacher-teaching assistant collaboration in supporting pupils who are at risk of school failure. This topic was addressed, as one of the subtopics, by a longitudinal research study investigating the causes of school failure/success among primary school pupils in the Czech Republic. The aim of the present study is to describe the activities that teaching assistants pursue in relation to “at-risk” pupils or in relation to other pupils in the classroom. The descriptive part of the paper also reviews various forms of teacher-teaching assistant collaboration during the teaching process. This empirical study consists of two parts. In the theoretical introduction, we describe the system of support and advisory services used to implement inclusive education in Czech schools. We also describe the legislative definition of the teaching assistant position and present his/her job description. The empirical part of the paper presents the conclusions of our research survey, which captures how teaching assistance is currently practiced in Czech primary education.

“We Can’t Work With Them, We Can’t Work Without Them”: The Police-Victim Advocacy Nexus in Processing Sexual Offenses in the Nigerian Justice System

Previous studies posited that survivors of rape receive better treatment from the police when advocates are involved and the police embrace collaboration. However, the collaborative relationship between the Nigerian police and rape victim advocates has yet to receive scholarly attention. To address this, a qualitative study was conducted, with 24 police officers of sexual offense units in six Police Commands, and 50 rape victim advocates from 28 advocacy groups. A thematic analysis of the narratives was carried out. Findings indicated problematic police-advocate collaboration in the process of reporting, interviewing, investigating, and prosecuting rape cases. Advocates stated that officers exhibited rape myth acceptance. Officers stated that advocates often display aggressive approaches in interfering with interviews, are ignorant of police procedures, and often wrongly accuse officers of corrupt practices. These findings have important practical, policy, and further research implications if criminal justice efficiencies and ideal victim support services are to be achieved.

EHR Documentation and Referrals for Intimate Partner Violence and Sexual Assault.

Hospital settings provide a unique opportunity to screen for interpersonal violence (IPV) and sexual assault (SA) yet often lack health IT solutions for generating reliable and valid medico-legal documentation via forensic reports. The objective of the project was to evaluate a pilot, technology "tool" for documenting cases of IPV and SA that could support forensic nurse examiners and related stakeholders in generating high quality documentation and coordinating victim support services. The tool was a digital health intervention implemented for use among forensic nurse examiners, law enforcement, victim support organizations, and more within four counties of California. We conducted a mixed-methods pilot study that captured data around the adoption, use, and impact of having access to the newly implemented tool. The tool successfully went live in all four pilot counties at different time points with different proportions of use by county and form type: exams, referrals, addenda, risk assessments, and other. Participants were motivated to use the tool out of a perceived need for data handling functionalities that went beyond traditional manual (paper) means. Key functionalities included body mapping, data quality controls within validated forms, attaching addenda to already existing case reports, and the means to distribute data to external recipients. Further study and development are needed on functions to incorporate into body maps and forms, and understanding the information needs of law enforcement and victim support organizations. Our evaluation demonstrated the feasibility and acceptability of a health IT tool to support forensic nurse documentation of IPV and SA, and direct information to multiple legal and support-related stakeholders. Areas of future development include integrating IPV and SA-related data standards for digitized forms, enhancements to the body mapping feature, and understanding the needs of those who receive digital data from forensic nurse examiners within the tool.

Perspectives of Teachers on Learning: A Glance on the Reading Proficiency of Kindergarten Learners

This study aimed to describe the experiences of kindergarten teachers in regards to the reading problem issue of kindergarten learners in Samal District, Island Garden City of Samal. The participants were the ten kindergarten teachers, utilizing phenomenological design to explore their challenges, perceived coping mechanisms on the issue and insights. A semi- structured interview guide was used to gather the data. Ethical considerations were observed in data collection. Thematic content analysis was used to extract the themes. The findings were: were poor background knowledge, low phonological awareness skills, local language diversity, limited exposure to reading materials, engagement and attention span struggles, and economic scarcity are the main challenges; the identified teachers’ perception on the reading situations of students in coping with the issues are use of differentiated instruction, individualized support, continuous assessment and monitoring, and collaborative efforts; and importance of early intervention, recognition of learners’ diversity, continual assessment and improvement, family and community engagement, and teacher’s professional development are the insights drawn. The recommendation included allocating resources, funding, and support services by the Department of Education specifically targeted at addressing early literacy disparities and improving outcomes for students at risk of reading difficulties.

Komunikasi Inovasi Jasa Raharja Cabang Riau Dalam Mengimplementasikan Pelayanan Santunan Online Korban Kecelakaan Di Kota Pekanbaru

Innovation communication is a way of conveying the discovery of new ideas to society so that social change occurs. A new innovation that is a solution to Jasa Raharja services which is caused by the high number of accidents in Pekanbaru City. In-person support services take a lot of time and take a long time, online updates make it easier for users of these support services. This research aims to analyze the communication innovation of raharja services in implementing online compensation services for accident victims in Pekanbaru city. This research uses qualitative research methods, with data collection techniques using interviews and analyzing the media used in the innovation diffusion process. As for determining research subjects, a purposive technique was used with five informants, then the data analysis technique used Miles and Huberman data analysis techniques which included data collection, data reduction, data presentation and conclusion drawing. This research uses Rogers and Shoemaker's theory of diffusion of innovation. This theory examines messages in the form of new ideas or thoughts, which cause social change.From the research results, this innovation communication has 4 stages, namely. In this research it can be concluded based on the results of the analysis using Roger's theory which has 4 points, This innovation distribution explains that the involvement of communicators provides information in the form of socialization in the form of a content that states information about how to claim or submit compensation from Jasa Raharja. A communicator does not only work alone, this communicator is the Head of Public Relations, Jasa Raharja, who works together with the compensation service staff to collaborate with the community to make it easier and more affordable. With new innovations, since 2009, compensation services for accident victims have gone from conventional forms to online services. This communication channel uses social media, namely in the form of Instagram and Tik Tok, then uses print media, television media and radio media. By implementing the Innovation Division, it has made progress, but of course there are still new innovations, of course this is influenced by factors that hinder the establishment of this innovation, one of which is awareness. The awareness of users or local people who use vehicles in traffic, whether land, sea or air, of course they do not have awareness.

Retraumatization in Undergraduate Medical Education: Evaluating the Prevalence and Support Resources Available to Students

Background: Retraumatization is the conscious or unconscious reminder of past trauma that results in a re-experiencing of the initial traumatic event. This phenomenon has been well-studied in primary and secondary education and has been shown to negatively impact the learning environment. Retraumatization in the context of undergraduate medical education has yet to be evaluated. Therefore, we sought to explore the prevalence of retraumatization in medical students, identify specific areas of UME that are retraumatizing, and evaluate effectiveness of psychological support available to students. Methods: A survey was created by a multidisciplinary team of health professions educators, revised through an iterative process, and distributed to all medical students at a single, large, academic institution. Respondents who endorsed prior trauma exposure met inclusion criteria for completing the survey. Data was analyzed using Microsoft Excel. Results: Of the school’s 1400 students, 85 responses were recorded for a response rate of 6.07%; this consisted of 20 males (23.5%), 46 females (54.1%), and 19 nonbinary (22.4%) students. 32 (37.6%) students reported no prior trauma and were excluded from survey completion. Of the 53 (62.4%) students completing the survey, retraumatization was experienced by 32 students (60.4%), which represents a prevalence of 37.6% among all medical students surveyed. 50% of females (n=23), 10% of males (n=2), and 36.8% of nonbinary (n=7) students reported retraumatization. Clinical rotations were identified as a retraumatizing setting by 59.3% (n=19) of students. Despite the availability of support services, 11 students (20.8%) reported being unaware of them when experiencing retraumatization. When asked about utilization of services, the majority of those who had experienced retraumatization did not utilize them (65.6%, n=21). Conclusion: Retraumatization is occurring in undergraduate medical education, particularly in the clinical years. Medical schools should attempt to enhance the ease of utilization of support resources to improve the learning environment for students.

A Study on the Employment Support Service System for Visually Impaired College Students in China

At present, the problem of difficult employment for disabled college students in China is becoming more and more prominent, and the construction of an employment support service system for colleges and universities is one of the most important means of alleviating the employment pressure on disabled college students and promoting the healthy development of society. Based on the perspectives of visually impaired college students and colleges and universities, this study adopts qualitative research methods such as interview method and observation method, selects 10 visually impaired students from a college in China as the research object, and statistically analyses the raw data of the interviews with NVivo data analysis tools, and builds a college employment support service system with the core of education and training and support, employment guidance and consulting, social resources integration and enhancing social and enterprise inclusiveness. The service system is of great practical significance for promoting high-quality employment and better integration of visually impaired students into society, as well as creating a harmonious and inclusive employment support environment.

RESEARCH ON THE INCLUSIVE EDUCATION ADAPTABILITY OF VISUALLY IMPAIRED COLLEGE STUDENTS IN CHINA

The education of visually impaired students in China has also gone through a developmental stage from "segregated education" to "special education" and then to "inclusive education". In this paper, we take the visually impaired students at Binzhou Medical College, the first university in China to provide higher education for the disabled, as the research object. The study was carried out to investigate the adaptability of visually impaired students, using various research methods such as literature review method, questionnaire method and case study method, we investigated and researched the adaptation of visually impaired students to inclusive education from several aspects such as quality of life, social support, mental health level, self-esteem and self-efficacy study. Finally, the study proposed several countermeasures and suggestions, such as attaching importance to the physical and psychological rehabilitation of visually impaired students, emphasising the inclusive of education and rehabilitation, strengthening the training of professional teachers for visually impaired students, emphasising the complementarity between schools and professions, and improving the employment support service system for visually impaired students, which are of great significance in promoting the development of the cause of inclusive education for visually impaired students and improving the adaptability of inclusive education for visually impaired students.

Peer support for borderline personality disorder: A critical review of its feasibility, acceptability, and alignment with concepts of recovery.

Many organizations have adopted peer support to increase service alignment with recovery-oriented principles. Yet, few studies have scrutinized borderline personality disorder (BPD)-specific concepts of "recovery" and "recovery-oriented practice," nor evaluated the extent to which existing peer support services (PSS) align with these concepts. We addressed these knowledge gaps in four phases: (a) a literature review to understand BPD-specific concepts of "recovery" and "recovery-oriented practice," (b) a literature review and open web search to describe the implementation, feasibility, or effectiveness of PSS for people with BPD, (c) a landscaping survey of program administrators regarding their BPD-PSS programs, and (d) a critical review of the extent to which current peer support for BPD aligns with "recovery" and "recovery-oriented practice." We identified 40 published sources that defined "recovery" or "recovery-oriented practice" as it pertains to BPD, and narratively summarize these results, nine sources that described PSS for people with BPD, and received survey responses from seven BPD-PSS program administrators. Our critical review highlighted the distinctive but overlapping concepts of "clinical recovery" versus "personal recovery" and underscored the alignment of BPD-PSS with personal recovery goals, including increased self-knowledge and -acceptance, hope, engagement in meaningful social roles and relationships, and self-determination. While peer support is experienced positively by service users, peer supporters, and clinicians, challenges include setting boundaries, minimizing dual roles, and ensuring adequate training, supervision, and personal support to reduce burnout. Peer support appears to be a feasible avenue for meeting the personal recovery goals of people with BPD; however, formal program evaluations are needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Human Rights in the Context of Global Migration

Purpose: The general objective of the study was to explore human rights in the context of global migration. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to human rights in the context of global migration. Preliminary empirical review revealed that global migration is deeply intertwined with significant human rights issues that vary across different regions and migrant populations. Migrants, regardless of their reasons for moving or legal status, frequently faced exploitation, discrimination, inadequate access to essential services, and social exclusion. The study emphasized that these human rights violations were often systemic and influenced by broader socio-political and economic structures. It highlighted the pervasive nature of rights violations at multiple stages of the migration process and pointed out substantial gaps in the implementation and enforcement of international frameworks designed to protect migrants. Specific groups, such as women, children, and undocumented migrants, were identified as particularly vulnerable, necessitating tailored interventions. The study argued that protecting migrants' human rights was both a moral and pragmatic necessity for fostering inclusive societies and called for a renewed commitment from all stakeholders to work collaboratively towards this goal. Unique Contribution to Theory, Practice and Policy: The Human Rights Theory, Push- Pull Theory of Migration and Social Capital Theory may be used to anchor future studies on global migration. The study recommended further development of migration and human rights theories to account for the complexities of contemporary migration flows, suggesting interdisciplinary approaches to enhance theoretical frameworks. Practically, it underscored the need for targeted support services for vulnerable migrant groups, the creation of safe migration pathways, and the establishment of specialized services addressing their unique needs. Policy recommendations included the adoption of comprehensive national and international policies that uphold the rights of all migrants, the enforcement of anti-discrimination laws, and the establishment of independent monitoring bodies. The study advocated for enhanced international cooperation to address migration challenges and suggested investing in data collection and research for informed policy-making. It also recommended promoting public awareness and education campaigns to foster inclusive attitudes towards migrants and counteract negative stereotypes, aiming to create a more just and humane global migration system.

Characteristics of Informal Caregivers and Social Participation of People with Dementia.

Social participation is associated with increased quality of life and well-being but declines following onset of dementia. Informal caregivers may facilitate social participation among people with dementia. This study aims to identify characteristics of informal caregivers associated with social participation of people with dementia in valued activities. This cross-sectional study used data from the 2011, 2015, and 2017 National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC). NHATS respondents with possible or probable dementia and a family caregiver were included (N=1,060). Respondents were asked whether they participated in each of five social activities during the past month. Valued activities were considered somewhat or very important. Survey weighted logistic regression models were computed to identify characteristics of primary informal caregivers associated with participation of people with dementia in social activities. Social participation of people with dementia was not independently associated with sociodemographic variables or relationship to the primary caregiver (spouse/partner, adult child, or other relative/non-relative). Social participation of primary caregivers was associated with increased participation of people with dementia in the same activity for visiting friends/family (OR=1.88, p=0.016), attending religious services (OR=4.82, p<0.001), and volunteering (OR=3.25, p=0.015), while greater caregiver external support was associated with increased participation of people with dementia in organized activities (OR=1.37, p=0.022). Assets of informal primary caregivers found to promote social participation of people dementia include traveling to the person with dementia's home, being socially active themselves and utilizing support services.

Examining the characteristics of children who experience contact with the youth justice system in Queensland: implications for the minimum age of criminal responsibility

ABSTRACT In jurisdictions such as Queensland, where the minimum age of criminal responsibility (i.e., 10 years of age) is out of step with international law and Australian human rights obligations, there are significant concerns about the criminalisation of children. These concerns include the potential for ensnaring young people, particularly First Nations children, into the criminal justice system rather than addressing their underlying needs. We use a birth cohort of individuals registered as born in Queensland in 1990 and followed up to age 24 years to examine the characteristics of young people who experienced their first youth justice system contact between ages 10 and 16 years. First Nations youth were significantly overrepresented among those with the earliest ages of contact (i.e., 10–13 years). Early youth justice contact was largely for minor and less serious forms of offending (i.e., property-related), but those with the earliest ages of onset typically went on to experience more persistent and serious offending outcomes up to age 24 years. Raising the minimum age of criminal responsibility alongside the implementation of culturally relevant early intervention, diversion and support services is likely to significantly reduce the overrepresentation of First Nations people in the criminal justice system.

The Importance of Faculty and Staff Awareness and Perceptions of Student Support Services on College Campuses

Abstract Date Presented 03/22/24 This study explored college faculty and staff awareness and perceptions of student support services. Increased awareness of support services positively correlates with positive perceptions and more referrals and thus greater access to services. Primary Author and Speaker: Elise Ulaj Additional Authors and Speakers: Sara Pellerin Contributing Authors: Pamela Pamela Story, Catherine Cavaliere PhD, OTR/L, John A. Damiao

People, places, systems and society. A qualitative exploration of socio-cultural factors in head and neck cancer survivorship.

BackgroundPeople living with head and neck cancer (HNC) often endure permanent and life changing adverse effects of treatment and reduced health-related quality of life. Study of post-traumatic growth (PTG), is gaining traction to understand why some people living with cancer have better psychosocial outcomes than others.Current theoretical models on PTG point to the importance of ‘socio-cultural influences’ but do not provide insight into how such socio-cultural factors influence survivorship outcomes. This research aimed to illuminate pathways to PTG following HNC by exploring socio-cultural factors in experiences of living with, and moving on from, HNC. MethodSemi-structured interviews with people living with HNC (up to 5 years post-treatment) on experiences of diagnosis, treatment and recovery. Qualitative framework analysis using the environmental factors codes from the International Classification of Functioning, Disability and Health (ICF) HNC core set. Results20 people living with HNC were interviewed (11 male, 9 female; aged 46-83 years). Four inter-related themes described socio-cultural factors that influence (positively and/or negatively) the experience of living with HNC: (1) people and places; (2) healthcare systems and support services; (3) societal attitudes to cancer; (4) work and finances. ConclusionSupport from family, friends and healthcare professionals, as well as societal attitudes, financial and work security and personal experiences all appear to contribute to an individuals’ ability to navigate the HNC experience. These findings could inform development of interventions targeting the socio-cultural factors in the lives of people living with HNC, particularly for those at risk for poorer psycho-social outcomes.

Tobacco control policies and the multidimensional context of tobacco use by gender: The case of Türkiye.

This study aims to determine the indicators of tobacco use in Türkiye within a multidimensional context as socio-demographic, physical, behavioural, and psychological as a response to the tobacco control policies. The Turkish Health Survey data in 2014 and 2019 are employed within a probit model approach and the differences in tobacco are decomposed use by gender in order to reveal the gender differences. The samples in 2014 (total n=19,129; males=8 721, females=10,408) and 2019 (total n=17,084; males=7 784, females=9300) were restricted to 15-year-old and above. The findings indicate that being in the 30-49 age cohort, having lower education, and being married increase the likelihood of tobacco use. Future policies and campaigns should specifically target the single, pre-obese, employed males who consume alcohol. For females, the gender-specific policies should aim to reduce the prevalence of smoking, especially among separated or widows, obese, and out of the labour force. The contribution of mental health indicators on tobacco use has declined over the 5years, which could be a result of the supportive free health services in Türkiye. The findings provide evidence for a significant and increasing gender difference in tobacco use in Türkiye along with reporting that the most significant contributors to gender differences in tobacco use are alcohol consumption and education level. Even though the Ministry of Health and the government have been implementing anti-tobacco policies, legislations, and campaigns for years, the tobacco use prevalence has remained high and even increased in Türkiye.

Probation practice and attention-deficit hyperactivity disorder.

Twenty-one Community Rehabilitation Companies were set up following the division of the National Probation Services during 'Transforming Rehabilitation' in England and Wales, under a 2013 Ministry of Justice initiative. Reunification commenced in 2018. A study completed prior to these changes suggested that probation officers had had little training in recognising attention-deficit hyperactivity disorder (ADHD) and may have been underestimating its prevalence among their clientele. Given the substantial changes in probation staffing and organisation since 2018, a new study seems warranted. The aim of the study was to understand experiences of people under a community sentence who reported having ADHD and of probation staff working with them. Using a qualitative research design, one-to-one semi-structured interviews were conducted with client facing probation staff recruited from one Community Rehabilitation Company. Service users undertaking a community sentence who had been diagnosed with or self-identified as having ADHD were then identified and recruited by these staff; those who consented were also interviewed. Transcripts were analysed using a thematic analytic approach. Thirteen probation staff and six male offenders under community sentences, agreed to participate and completed interviews. The overarching themes emerging from the two groups were similar, both reflecting on descriptions of ADHD; treatment of ADHD; experiences of having or working with ADHD in the wider community and in the criminal justice system specifically and visions of future support needs tied to the order. In addition, probation officers specifically raised the matter of payment by results. Both service users and probation staff identified gaps in knowledge, experience and services, but areas of good practice were also identified. The findings highlight the continuing under-acknowledgement of tailored clinical support for people serving a community sentence who have ADHD together with a lack of support and training about ADHD for probation staff. Return to the national organisation of probation services and recognition of need for a range of relevant skills offers a great opportunity for re-evaluating supervision and management of offenders under community sentences who have ADHD. These findings provide the basis for a template for developing knowledge and support provision for probation staff to recognise ADHD, or its likelihood, and their capacity to follow through with appropriately informed personalised supervision plans and access to specialist service advice and support.

Toward the Development of an Impact-Based Decision Support Tool for Surface-Transportation Hazards. Part II: An Hourly Winter Storm Severity Index

Abstract In line with the continued focus of the National Weather Service (NWS) to provide impact-based decision support services (IDSS) and effectively communicate potential impacts, a new IDSS forecasting tool for surface-transportation hazards is in development at the Weather Prediction Center: the hourly winter storm severity index (WSSI-H). This second part of the series outlines the current algorithms and thresholds for the components of the WSSI-H, which has been developed in line with the approach and considerations discussed in Part I of this series. These components—snow amount, ice accumulation, snow rate, liquid rate, and blowing and drifting snow—each address a specific hazard for motorists. The inclusion of metrics related to driving conditions for untreated road surfaces and time-of-day factoring for active precipitation types helps directly tie forecasted weather conditions to transportation impacts. Impact severity level thresholds are approximately in line with thresholds used by transportation agencies when considering various mitigation strategies (e.g., imposing speed restrictions or closing roadways). Whereas the product is not meant to forecast specific impacts (e.g., road closure or pileup), impact severity levels are designed to scale with increasingly poor travel conditions, which can prompt various mitigation efforts from motorists or transportation agencies to maintain safety. WSSI-H outputs for three winter events are discussed in depth to highlight the potential utility of the product. Overall, the WSSI-H is intended to provide high-resolution situational awareness of potential surface-transportation-related impacts and aid in enhanced collaborations between NWS forecasters and stakeholders like transportation agencies to improve motorist safety. Significance Statement A new impact-based forecast product designed to aid in situational awareness of potential impacts from surface-transportation-related hazards is in development. In this second part of the series, we outline the algorithms and thresholds for the various components of the product, where each component addresses a unique hazard. Product outputs for three winter events are presented to highlight the potential utility of the product in an operational forecast setting. Ultimately, enhanced collaboration between forecasters and transportation agencies alongside guidance from this product will bolster consistent messaging to motorists and improve safety and mobility on roads.

Equitable Care for Children With a Tracheostomy: Addressing Challenges and Seeking Systemic Solutions.

Children with medical complexity (CMC) often face significant barriers to accessing care, obtaining appropriate insurance coverage for medical devices, technology, supplies, home nursingand social services. These challenges, when viewed through the lens of social determinants of health, highlight concerns about healthcare inequity. These inequities can impact CMC by limiting access to follow-up appointments, leading to disproportionate use of emergency department services, restricting support services, reducing the quality of medical productsand increasing the likelihood of adverse events. Addressing these concerns requires comprehensive policy changes at both state and federal levels. Achieving successful collaborations between states and federal agencies is particularly challenging and may take months or even years to accomplish. Through an exploratory qualitative approach, this study facilitates a nuanced inquiry into the experiences and systemic challenges encountered by medical professionals and primary caregivers managing CMC who require a paediatric tracheostomy. Qualitative interviews were conducted with 17 health professionals and primary caregivers residing in the United States. A thematic analysis was used to analyse the transcribed interview data. Using exploratory thematic analysis, we identified challenges and opportunities for improvement regarding (a) access to health insurance, (b) procurement of essential medical supplies, (c) logistical constraintsand (d) identifying interim solutions. Building on our findings, we discuss how socioecological factors impact health and quality of life of CMC and families. Additionally, we address the growing gap in quality of care through a comprehensive approach that considers patient needs, regulatory frameworksand affordability. Medical practitioners and healthcare professionals were actively involved in the development, productionand implementation of the research project. These individuals were given the opportunity to review their statements and review the manuscript before publishing. While caregivers did not engage in member checking, each provided their consent before data collection.