A Pilot Evaluation of Portfolios for Quality Attestation of Clinical Ethics Consultants

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step on the pathway to an eventual certification process for clinical ethics consultants.     

Ethics Consultation Quality Assessment Tool: A Novel Method for Assessing the Quality of Ethics Case Consultations Based on Written Records

Although ethics consultation is offered as a clinical service in most hospitals in the United States, few valid and practical tools are available to evaluate, ensure, and improve ethics consultation quality. The quality of ethics consultation is important because poor quality ethics consultation can result in ethically inappropriate outcomes for patients, other stakeholders, or the health care system. To promote accountability for the quality of ethics consultation, we developed the Ethics Consultation Quality Assessment Tool (ECQAT). ECQAT enables raters to assess the quality of ethics consultations based on the written record. Through rigorous development and preliminary testing, we identified key elements of a quality ethics consultation (ethics question, consultation-specific information, ethical analysis, and conclusions and/or recommendations), established scoring criteria, developed training guidelines, and designed a holistic assessment process. This article describes the development of the ECQAT, the resulting product, and recommended future testing and potential uses for the tool.     

Learning to feel at home. Governing homelessness and the politics of affect

The emotional and affective dynamics of homelessness are an established matter of concern in geographical research. Geographers have called attention to homelessness as an embodied phenomenon and to the emotional distress that affects people experiencing homelessness. What has achieved less attention though are the politics of affect that characterize spaces of care. Attempts to make homeless people ‘housing ready’ often target emotions and try to provide clients with a sense of belonging and feelings of responsibility in matters of housekeeping and homemaking. The paper takes these attempts to create emotionally stable ‘housing ready’ selves as a point of departure to open a set of broader questions concerning the nature of encounters between the welfare state and its citizens. It shows how spaces of care address ‘housing readiness’ as a personal ability and thereby abstract from the complex affective entanglements and prepersonal conditions that characterize dwelling. To highlight the paradoxical effects of therapeutic approaches to dwelling as a subjective emotional skill that can be mastered, I contrast the notion of ‘housing readiness’ with recent work in the field of affective geographies that allows for a different articulation of dwelling as a dense web of practices, atmospheres and relations between people, spaces and things.     

Building a Life Worth Living During a Pandemic and Beyond: Adaptations of Comprehensive DBT to COVID-19

Our team at the Jefferson Center City Clinic for Behavioral Medicine has recently been challenged to find a synthesis between the need to adapt to circumstances associated with the COVID-19 pandemic, while at the same time retaining the spirit and essential components of comprehensive DBT. This fine balance between unwavering centeredness and compassionate flexibility is central to DBT (Linehan, 1993), and has proven essential during these times of uncertainty. This short article highlights challenges and innovations faced by our DBT Team, Skills Group, individual DBT sessions, phone coaching, and also our community at large, as we strive to help our patients and team members build a life worth living during and following a pandemic.     

Consequences of autonomous vehicles: Ambivalent expectations and their impact on acceptance

Connected and autonomous vehicles (CAVs) are within reach of widespread deployment on public roads, but public perceptions are ambivalent. The objective of the present research was to assess expectations about the consequences of CAV introduction. These expectations should explain CAV acceptance, but their relative importance is poorly understood. We conducted a survey with a representatively drawn panel sample (N = 529) from France, Germany, Italy, and the UK. The survey consisted of a large item pool of expected consequences from CAV introduction, as well as general and affective evaluation of CAVs, ease of use, and behavioral intention to use CAVs. Exploratory factor analysis revealed four facets of expected consequences: road safety, privacy, efficiency and ecological sustainability. On average, expectations were mostly positive for ecological sustainability and safety, but negative for privacy. At the same time, substantial variance existed between respondents and between countries. For safety and efficiency, improvement was expected by a third of respondents, while another third expected worsening. Respondents from Italy expected more positive consequences for safety, while respondents from both France and Germany expected more negative consequences for privacy. To different degrees, all four facets predicted the intention to use CAVs in a structural equation model, primarily via affective evaluations. For policy makers, manufacturers, and service providers, understanding the trade-offs inherent to different CAV solutions will be central to ensure citizens’ needs are respected.     

A cluster randomized trial to evaluate need-supportive teaching in physical education on physical activity of sixth-grade girls: A mixed method study

ObjectiveThe purpose of this study was to evaluate the efficacy of need-supportive teaching in physical education on girls' daily moderate-to-vigorous physical activity using a mixed method evaluation.Methods507 sixth-grade girls aged 9–14 years of 33 single-sex physical education classes participated in the cluster randomized control trial. During the 16-week intervention period, trained teachers conducted enhanced physical education lessons which were designed based on self-determination theory. In a randomized process, independent researchers using a computer-based algorithm allocated classes to the trial groups (IG n = 19 classes, CG n = 14). These lessons were subject to repeated systematic observations. The students' perceptions of basic psychological need support and satisfaction in physical education were measured using repeated self-report questionnaires. Students' daily moderate-to-vigorous physical activity (MVPA) was assessed by accelerometry. Semi-structured interviews provided a deeper understanding of how purposively sampled focus groups perceived teacher behavior in physical education. After a separate analysis of qualitative and quantitative data, results were merged to investigate the intervention's efficacy and treatment fidelity.FindingsThroughout the school year, the girls' MVPA levels decreased in both groups. Girls who reported their complete physical activity data had a lower body mass index than girls who reported no, or only one or two sets of physical activity data. Results of mixed measures converge on the finding that the teachers in the intervention group provided slightly stronger need support than the control teachers, however, intervention components were not delivered consistently. Therefore, a significant intervention effect on daily MVPA could not be quantified. Autonomy satisfaction significantly predicted MVPA.ConclusionQualitative insights of teaching behavior in PE underlined the importance of need support and revealed structural barriers, which compromised the implementation quality.Trial registrationEthics Committee of the Technical University of Munich 155/16S; Bavarian Ministry of Education IV.8-BO6106/52/12.FundingGerman Research Foundation grant DE2680/3-1.     

Constructing We‐ness: A Communal Coping Intervention for Couples Facing Chronic Illness

Communal coping occurs when relationship partners view a stressful health problem as “ours,” rather than yours or mine, and take collaborative action to deal with it. Although research employing linguistic (we‐talk) and other measures of communal coping demonstrates relevance to a variety of chronic illnesses, the literature offers little about how clinicians can actively promote we‐ness and teamwork to help patients and their partners achieve the health benefits this appears to confer. This paper highlights clinical and supporting scientific features of a narrative intervention designed to foster communal coping by couples in which one partner has a chronic illness. The illustrative illness is diabetes, but with modification the protocol is suitable for other chronic conditions as well. Grounded in systemic and narrative models of problem maintenance and change, the communal coping intervention represents a distillation of research and clinical experience with family consultation over several decades. In contrast to more directive and educational approaches, the intervention consists entirely of questions, with no direct suggestions or instruction about how patients, partners, or couples should change. These questions comprise 8 sequential modules (Coping Challenges, Trajectory and Focus, Illness as External Invader, You as a Couple, Past Teamwork in Overcoming Adversity, Present and Future Teamwork, Obstacles to Teamwork, and Wrap‐Up), described here in manual‐like detail.     

Research on parking choice behavior of shared autonomous vehicle services by measuring users’ intention of usage

Shared autonomous vehicles (SAVs) are one of the important development directions of smart and green transportation. However, relevant researches are not sufficient at present. The factors influencing the intention to use SAVs and their parking choice behaviors need to be further analyzed. First, in order to better explain, predict, and improve travelers’ intention to use SAVs, the conceptual framework based on technology acceptance model was developed to establish the relationships between the travelers’ intention to use SAVs, social influence of SAVs, attitude toward behavior of SAVs, perceived risk of SAVs, perceived usefulness of SAVs and perceived ease of these use. Then structural equation model (SEM) was established to analyze the relationship between various variables. The results show that the perceived usefulness, behavior attitude, social influence, perceived ease of use, and perceived risk are the main factors that determine the intention to use SAVs. Through the test of direct effect, indirect effect, and total effect in the model, it is found that perceived usefulness has the largest total impact on intention to use SAVs, with a standardized coefficient of 0.765, followed by behavior attitude (0.732), social influence (0.597), perceived ease of use (0.462) and perceived risk of SAVs (−0.452). In addition, through the study of observed indicator variables ATB2 and BI3, it is found that perceived usefulness, perceived ease of use, social influence, perceived risk, attitude toward behavior, and behavior intention all have an impact on parking behavior. In order to study the specific influencing factors of parking choice behavior, a multinomial logit (MNL) model was established to analyze the relationships between travelers’ parking choice behaviors and the influential factors, which include travelers’ individual characteristics, travel attributes, and parking modes’ attributes by extracting from a questionnaire. The results show that the travel time, travel fees, parking charge, cruising fees, parking time and traffic emission are the main factors that determine travelers’ choices of parking. This paper provides advice for operators of SAVs.     

自我决定理论视角下的教师控制

教师控制是指教师通过情感操纵或行为对学生施加压力,迫使学生以特定方式思考、体验或行动。已有研究基于自我决定理论,验证了教师控制对学生的学业表现、情绪、行为等的影响作用和影响机制,但对于教师控制影响的跨文化差异和性别差异问题尚未形成共识。后续研究可进一步精细化分析不同类型的教师控制,采用混合式研究方法和纵向追踪设计分析教师控制的影响,进一步深化教师控制的本土化研究和群体异质性研究。     

How does education lead to healthier behaviours? Testing the mediational roles of perceived control,health literacy and social support

Abstract

Objectives: Educational attainment is increasingly recognised as a unique dimension of socioeconomic status (SES) and a powerful determinant of health behaviour—and thus physical health and mortality. However, very little is known about the specific pathways through which education influences these health behaviours. Design: The present study used a nationally representative US survey to test three potential psychosocial pathways (perceived control, health literacy and social support) through which education might influence intake of fruits and vegetables (FV), physical activity (PA) and sedentary behaviour (SB), controlling for other aspects of SES (income, health insurance status) and demographics (age, gender, race/ethnicity). Results: Both aspects of perceived control (locus of control, cancer fatalism) mediated the impact of education on FV and PA while only locus of control mediated the impact of education on SB. Further, only one aspect of health literacy (ability to understand recommendations) mediated education’s effect on any health behaviour (FV). Social support did not mediate any of the effects of education on health behaviors. Conclusion: Future work explicitly assessing and testing these mediational pathways is needed to better understand how education influences people’s health behaviours throughout their lives.