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A Practical Guide to Investigations and California Administrative Procedure Act Discovery
No full textNavigating Insulin Access for Pediatric Type 1 Diabetes: Caregivers\u27 Experiences and Challenges
Get PDFBetween 2012 and 2018, the annual 14% increase in insulin prices made Type 1 Diabetes (T1D) the most expensive chronic health condition, significantly raising out-of-pocket costs for uninsured or underinsured individuals in the United States (Hayes & Farmer, 2020; Willner et al., 2020). This study utilized a qualitative content analysis methodology to explore the challenges and experiences of parents with children diagnosed with T1D with accessing insulin for their child. Five participants from various areas of the United States responded to open-ended questions both in person and via Zoom. The analysis revealed three main themes: pragmatics of managing diabetic care, the emotional impact and caregiver concerns, and the art of coordination and support networks. Three subthemes emerged: financial constraints, insulin injections/pump, and navigating insurance. The study emphasizes the importance of access to healthcare services in order to address the multifaceted needs of children with T1D and their families, and also raises clinical implications related to T1D management. Practical recommendations for clinicians, educators, and policymakers to enhance support and improve outcomes for pediatric patients with T1D are provided and discussed. Future research should prioritize inclusive recruitment strategies and address barriers to participation among minority populations to ensure interventions are tailored to the diverse needs of all individuals and families affected by T1D, particularly given the widespread mistrust within the healthcare system among marginalized communities. Additionally, exploring systemic barriers, including social determinants of health (SDOH), and advocating for policy reforms aimed at expanding healthcare coverage and promoting health equity are essential steps in addressing healthcare disparities and improving access to care for vulnerable populations affected by T1D
“Invisible Populations”: A policy brief approach to address housing data needs in vulnerable communities
No full textAbstract
Background: Dependent adult children with severe mental illness (ASMI) living with aging parents have been an increasing population over decades due to lack of supportive housing and services in the community. ASMI living with aging parents is a high-risk group for housing instability and future homelessness. Local Problem: A limited amount of literature and data exist to determine the size and needs of the population of ASMI living with aging parents. A collaboration with University of San Francisco (USF) and non-profit, Solutions for Supportive Homes (S4SH) of San Mateo County (SMC) formed to disseminate information and quantify the “invisible population” of ASMI living with aging parents to encourage the need for increased services and supportive housing. Methods: Comprehensive literature review on target population, housing instability, homelessness, and social determinants of health documentation (SDoH) for public presentations and policy development. Interventions: Consolidation of current literature, knowledge, background, and available data to increase population awareness through presentations, pre/post surveys to establish basic needs/concerns assessment, and a policy brief presented to the county aimed at changing housing documentation practices. Results: Awareness of population and importance of SDoH related to ASMI living with aging parents was shown to increase, but population size could not be defined. A policy brief and presentation on the importance of documenting housing status to identify “invisible populations” was presented to the county and is being considered for adoption by SMC pending approval. Conclusion: Mandating the documentation of housing/household status in health records can help identify at-risk “invisible populations” to reduce and prevent homelessness in the county through data-driven, community planning
Enhancing Patient Safety: Fall Prevention through Video Education
No full textAbstract
Problem: Globally, hospital falls remain a leading cause of injuries, increased costs, short and long-term disability and emotional impact on patients/families. Despite required prevention measures, a local hospital experienced rising fall rates during 2024 (n=71);13 of these occurred in the Med-telemetry microsystem. Although multiple strategies and financial investments occurred, nursing compliance with the fall prevention “bundle” remained suboptimal.
Context: Thirteen falls resulted in $182,000 in 2024. A quality improvement (QI) project was initiated over 12 weeks after routine audits revealed inconsistency in application of several components of the required bundle: particularly, the fall prevention video upon admission.
Interventions: A standardized four-minute video highlighted key safety interventions to reduce risk. A clinical nurse leader (CNL) or designate audited compliance and patient understanding of the video using a 3-question survey conducted every shift during rounds.
Outcome Measures: To increase patient video education upon admission to 80% from 0 % baseline. Two process measures included training 90% of staff (n=38) and surveying patients (n=311) to determine improved verbal understanding of safety measures after video education.
Results: Staff adherence to the patient education video increased from 0% to 89%; 5% of patients stated the video was not introduced; and 6% did not remember. The weekly “harm report” indicated that two falls occurred compared to six during a similar timeframe in 2024.
Conclusions: Standardized fall bundles require consistent reinforcement to optimize patient and organizational outcomes. This project increased nursing compliance and decreased falls by targeting patient/family education and enhancing team communication
Preventing Hospital-Acquired Pneumonia in Non-ventilated Oncology Patients
No full textProblem - Hospital Acquired Pneumonia (HAP) remains the leading cause of death among hospital-acquired infections, underscoring the need for effective prevention strategies. Between October 2023-2024, six HAP infections occurred in non-ventilated oncology patients. A routine audit revealed zero adherence to the existing evidenced based ROUTE “bundle” to prevent HAP. ROUTE indicates Respiratory care (R), Oral Care (O), Up in bed (U), Tube care (T), Education (E).
Context – In a 325-bed hospital in Northern California, a 26-bed telemetry/oncology microsystem serves a mixed population including immunocompromised, non-ventilated oncology patients at higher risk for developing HAP. A quality improvement project was initiated by the clinical nurse leader (CNL) to reduce HAP incidence by 33.3% over 8 weeks.
Interventions – Increased communication, education and reinforcement of the hospital’s policy and procedures addressed HAP prevention utilizing the ROUTE “bundle”. In addition, a visual aid served as a reminder of the ROUTE “bundle” components for front line nurses and patient care technicians on all shifts.
Measures – Two process measures included improving adherence with oral care and associated documentation twice daily and increasing patient mobilization. Electronic health record (EHR) audits monitored staff compliance.
Results – Initial results indicated 50% compliance between weeks 1-4; weeks 5-8, results increased to 70%-90% adherence.
Conclusions – The CNL can be effective catalysts for change management and performance improvement to reduce HAP. Lack of adherence to existing organizational policies and procedures is a major barrier to achieve optimal outcomes. Increasing staff communication, education and introduction of attractive visual aids can improve patient and organizational outcomes
Exploring Ignatian Pedagogy\u27s Role In Shaping Holistic Student Success In The Current Neoliberal Era: A Qualitative Inquiry At Saint Ignatius High School, Rwanda, And Lycée Du Saint-Esprit, Burundi
No full textThe growing influence of neoliberalism in education has shifted priorities toward a transactional, utilitarian model that emphasizes technical skills, standardized testing, and market-driven outcomes over holistic development. Education systems increasingly focus on preparing graduates for labor market demands, often sidelining moral, emotional, social, and spiritual formation. This shift creates tension for Jesuit schools, which emphasize a transformational approach to education rooted in ethical leadership, critical thinking, and social responsibility. In countries like Rwanda and Burundi, Jesuit schools face added pressure from state policies and parental expectations shaped by market ideologies. This study examined how Ignatian pedagogy is implemented in this context, the challenges encountered, and the opportunities available to reinforce its mission.
This qualitative study explored how Ignatian pedagogy fosters holistic student formation at Saint Ignatius High School and Lycée du Saint Esprit. Through focus group discussions with students, teachers, and parents, along with participant observation, the study analyzed how Jesuit principles are applied, how schools respond to neoliberal pressures, and what strategies could sustain and strengthen their mission. While primarily directed at Jesuit educators, the findings offer insights for policymakers and faith-based institutions seeking to maintain holistic education.
The study was grounded in two frameworks: Peter-Hans Kolvenbach’s Four Cs—competence, conscience, compassion, and commitment—and Critical Discourse Analysis (CDA). Kolvenbach’s model guided the evaluation of holistic formation, while CDA examined how neoliberal discourse shapes education policy and practice. Data collection included six focus groups and sustained observation of instruction, religious life, clubs, and community service. Thematic analysis revealed how stakeholders interpret and engage with Ignatian pedagogy in an evolving educational context.
Findings showed that both schools implemented Ignatian pedagogy through seven core elements: academic rigor, spiritual formation, service and social justice, leadership and character development, emotional and social well-being, physical development, and international exposure. However, eight key challenges hindered full implementation: competition from elite schools, declining emphasis on humanities, financial constraints, difficulty recruiting qualified teachers, faculty turnover, gaps in teacher formation, limited time for holistic programming, and insufficient parental involvement. Despite these, opportunities emerged: leveraging the global Jesuit network, expanding teacher development, securing financial sustainability, integrating technology, and revitalizing the humanities.
The study concludes that Jesuit schools in Africa must actively resist neoliberal pressures while strategically adapting to contemporary educational demands. It highlights the need for strong faculty formation, sustainable funding, and renewed commitment to Jesuit identity. Teachers and parents must collaborate in supporting students’ growth, while policymakers should expand definitions of educational success beyond employability. Faith-based schools can also draw from Jesuit principles to enrich their models. Through intentional strategies, Jesuit schools can continue forming students who are intellectually competent, ethically grounded, and committed to justice and service
Program Outcome Evaluation Of A Flexibly Structured Individual Outpatient Program For Severe Obsessive Compulsive Disorder In A Private Practice Setting
No full textThe current study is a quantitative program evaluation of the effectiveness private practice for treating obsessive compulsive disorder while incorporating multiple validated components to reduce common barriers of treatment access. There were three outcomes used to evaluate the first being the reduction in symptom severity across treatment, the second being the length of time in treatment before reduction can be seen, and the third being the rates completing treatment as agreed by therapist and participant. The current study was able to complete analysis for the first and third research question, and unable to answer the second. The first and primary finding of the study is that the reduction of YBOCS scores across treatment is significant and achieved a very large effect size of d = 1.173. Participants in treatment were able to achieve significant reduction in the symptom severity of OCD as measured by the YBOCS and achieved a treatment response. Unfortunately, the second research question was not able to be answered due to the amount of missing data across the various timepoints. The third finding of this study is that 50% of the sample left treatment before agreement between therapist and client which is higher than the 20% treatment dropout rate suggested by the literature. Implications, limitations, and suggestions for future research are also discussed
THINK PIECE: Urban Echoes: How the New Historiography on Cities is Reframing our Understanding of Mao’s China
No full textDespite the conventional portrayal of the Chinese revolution as a predominantly peasant-oriented movement, cities emerged as critical arenas for the Chinese Communist Party’s project of modernization and class restructuring during Maoist period (1949–1976). Over the past decade, scholarly attention has increasingly turned to the urban dimensions of the early years of the People’s Republic. This think piece addresses how recent scholarship on cities offers new analytical insights into our understanding of Maoist China by focusing on six recently published monographs. Themes to be discussed in this essay include the contested and evolving notion of socialist modernity, the transformative effects of industrialization on urban social and economic structures, the rise of grassroots activism and individual agency, the incorporation of environmental considerations into state planning, and the interconnectedness of urban centers with their immediate surroundings and broader transregional and international networks. Through these thematic and methodological interventions, the subfield of Maoist urbanism has become markedly more nuanced, comprehensive, and diversified than it was a decade ago
Photo Essay: Japan’s Demographic Changes and Opportunities: A Tale of Two Cities
Get PDFJapan is in the midst of a population implosion. Schools struggle to fill classrooms, and vacant houses are a common sight in smaller towns. While the demographic shift makes it difficult to sustain traditional ways of life, it also brings opportunities for new possibilities. This essay highlights the challenges and opportunities of demographic change through the stories of two communities: Tsushima City in Aichi Prefecture and Ikuno Ward in Osaka City. In Tsushima, residents have embraced a more inclusive approach to their autumn festival, inviting women and non-residents to perform roles previously reserved for male residents. In Ikuno, a closed school was turned into a co-working space for community members and small businesses. The experiences of Tsushima and Ikuno illuminate opportunities for inclusiveness and creativity in the face of demographic transition
The Mudwoman in the Academia: The Spectral Presence of Jane Eyre and Antoinette Cosway in Joyce Carol Oates\u27s \u3cem\u3eMudwoman\u3c/em\u3e
Get PDFWhile Jane Eyre has been lauded as a feminist novel, its modernist prequel Wide Sargasso Sea clearly aims at recovering the lost voice of the much-maligned Bertha Rochester from an altogether different feminist perspective. In her 1985 essay on these two novels, Joyce Carol Oates highlights their dual relationship in terms of romance and anti-romance, regarding Rhys’s novel as “a reverse mirror image of Jane Eyre’s and Rochester’s England.” Commenting upon the brief encounter between Jane and Rochester’s first wife as depicted by Jean Rhys, Oates also points out that, “[i]nhabiting contrary worlds, one woman is a savage to the other; the other, a ghost.” In her 2012 novel Mudwoman, Oates investigates such a complex legacy in the confrontation between M.R. Neukirchen and the traumatic past that resurfaces in her life just as she appears to have reached the pinnacle of her career. The connections between these three novels will help me elucidate the consequences of this tainted inheritance and explore the two faces of feminism guiding Oates’s approach—both the bright side and the dark side of women’s fight for recognition and equality