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Folder 19: Spyri Family Photographs, undated
No full textPhotographs of the Spyri family. (L-R) First image label, J GANZ Phot. Zurich. Annt of Johannah Spyri Tanta Rageli. Second image label, Mother of Johannah Spyri Meta Heusser-An Author. Third image label, Johannah Spyri. Fourth image label, The small son of Madame Spyri who died young. Written on the fourth image reads, "Bernhard Spyri.
On necrocapitalism: A plague journal
No full textM.I. Asma is the collective designation for six authors from Canada and the United States, representing a variety of revolutionary anticapitalist theoretical persuasions: J. Moufawad-Paul, Devin Zane Shaw, Mateo Andante, Johannah May Black, Alyson Escalante, and D. W. Fairlane. As the pandemic transitioned from science fiction to reality in early 2020, a number of writers and thinkers in the imperialist metropoles declared the impossibility of writing in the face of a future that is foreclosed. And yet, due to the nightmare that capitalism has been since its beginning, numerous writers and thinkers from the margins have always written in the face of such foreclosure. Meanwhile, other contemporary thinkers sought to conceptualize the unfolding pandemic according to conceptions of bio/necropolitics, forgetting the foundation upon which these conceptions have always existed.
The M.I. Asma writing group came together to stake out a different terrain, thinking through the pandemic as events unfolded while also always working to think beyond the capitalist imaginary. Writing between April 2020 and May 2021, the authors set out to produce a serial theoretical philosophical project focused on class struggle in the midst of the COVID-19 pandemic. The authors approached the pandemic as an occasion to think capitalism according to what it always has been, what the pandemic reveals about its current ideological deployment, and how we can think about a communist alternative in the face of exterminism.
This book collects, with some revisions and with a new epilogue, the entries from the On Necrocapitalism blog, where M.I. Asma’s interventions first appeared.DC Author's celebration 202
Mental Health Stigmas and Counseling Services Utilization
No full textPersons with mental illness have been marginalized for generations. For many years, those with mental illness were institutionalized or incarcerated. This history of mental health and mental health treatment leaves behind stereotypes and stigmas still present today. There has been an increase in those who experience mental illness, particularly traditional aged college students (18-24). Research shows that the number of students with severe psychological illness is steadily increasing on college campuses. Yet, on a yearly basis, only about one-third of persons with mental illness seek professional treatment (Bathje & Pryor, 2011). The aim for this study is to discover the relationship between self-stigmas of mental health and Valparaiso University students\u27 use of counseling services. Approximately 200 students at Valparaiso University, a small liberal arts college in Indiana, will be anonymously surveyed regarding their perception of mental health, utilization of counseling services, as well as age, academic major, gender, and ethnicity. While numerous studies have been done on self-stigmas\u27 relationship to public stigma and their implications for usage, little research has been done looking at self-stigma as a primary factor in the usage of psychological help- seeking services. Based on the findings of our study, there are implications for counseling services and education about mental health on college campuses
The Social Construction of Authorship: An Investigation of Subjectivity and Rhetorical Authority in the College Writing Classroom
No full textAlthough we use the term author on a daily basis to refer to certain individuals, bodies of work, and systems of ideas, as Michel Foucault and other critics have pointed out, attempting to answer the question “What is an Author?” is by no means a simple proposition. And, starting from the position that there is no single, or definitive answer to this complex question, this dissertation seeks to contribute to the ongoing discussion of the genealogy of authorship by investigating the ways in which conceptions of the author have informed models of the writing subject in the field of rhetoric and composition and the ways in which composition students define and relate to these models.
Drawing on the work of literary critics, cultural theorists, legal scholars, and book historians, the dissertation first reviews the major theoretical frames offered by to interpret the unique status and history of the term author, and the ways in which rhetoric and composition scholars from a range of theoretical positions—current-traditional, expressionist, cognitivist, new rhetorical/social-epistemic—have relied on models of the author to describe student writing subjects.
Secondly, the dissertation presents and analyzes the findings from a 2005 qualitative study of ten composition students at The City College of New York. Key issues that are investigated include: (1) How students define the terms author and writer; (2) The reasons why students consistently apply, or do not apply, these terms to themselves; (3) If those students who conceive of themselves as writers or authors have a different relationship to writing, or various aspects of writing, than students who do not, i.e., a different relationship to audience, rhetorical strategies, technical writing issues; (4) Specific moments in which students achieve an authoritative relationship to writing and how they describe the conditions and circumstances of such moments; (5) If publication and distribution of student work may facilitate a change in a student\u27s relationship to writing, or the conception of him- or herself during the writing process
Open-Access Scheduling
No full textabstract: Declaration of Conflicts: This project has no conflicts of interest to declare.
Context: This project was completed at a federally qualified primary healthcare clinic in Phoenix, Arizona that served patients of all age groups, but primarily cared for the Hispanic population providing primary care, preventative services, family planning, two lab technicians, one promoter, two medical assistant supervisors, five front desk staff, one chief administrative officer, one chief financial officer, two medical directoers who were also providers at the clinic.
Problem and Analysis Assessment: During my clinical rotations, I saw the burden a missed patient appointment had not only on the patients themselves, but also on the clinic, providers, and the staff. It caused delay in treatment for patients, and it did not allow other patients that wanted to be seen to be seen. It also increased unnecessary costs and wasted provider time. Thereafter, I met with some of the leadership team and one of the medical directors to determine a solution to reduce the number of missed appointments that were occurring. An educational session was kept to discuss the findings of this problem to the providers and the staff and when surveys were handed out to the patients, providers, and staff to assess their satisfaction with the old scheduling system versus the new scheduling system, they were also provided with a cover letter discussing the project.
Intervention: In order for improvements in care to occur, a system process change including the way patients are scheduled must occur. In this case, an open-access scheduling system (OAS) was implemented. OAS allows a patient to schedule an appointment on the 'same-day' or the 'next-day' to be seen. One provider at each of the clinics, each day of the week was available for 'same-day' appointments from 1300-1600. The providers were still available for scheduled appointments using the previous scheduling method. Walk-ins were still accepted, and were scheduled based on patient provider preference; however, if an appointment was not available for their preferred provider, they were typically seen with the provider that was the 'same-day' provider for that day.
Strategy for change: Since patients were only allowed to schedule appointments one month in advance, only one month was needed to implement this process change. A recommendation for the future would be to clearly identify the patient encounter type, and label it as a same-day appointment, as this would be helpful when gathering and extracting data for this type of patient group specifically.
Measurement of Improvement: Over a three-month period, a data collection plan was used to determine the number of Mas over a three-month period before and after implementation of this change. Satisfaction scores were measured using likert scales for patients, provider, and staff, and a dichotomous scale was used to determine the likelihood of emergency room or urgent care use. A comparison was done to measure revenue during the same time frame. During the three months, a clinically significant decrease in MAs was seen (68% of all patients, providers and staff reported feeling either very satisfied or extremely satisfied with the new scheduling system. Additionally, patients also reported that they were less likely to visit an emergency room(88%) or urgent care (90%) since they were able to be seen the same-day or the next-day by a provider.
Effects of changes: An incidental finding occurred during this study - where 877 more patients were seen in the three months during the implementation of this project, compared to the three months prior; which likely resulted in a 41% increase in revenue. Additionally this project, allowed patients that wanted to be seen on the same day, to be seen, and it decreased unnecessary costs associated with emergency room or urgent care visits. Some of the limitations involved included the current political environment, appointment slots that were previously 15 minutes in length (in 2016), increased to 20 minutes in length (in 2017), a language barrier was noted for the patient surveys since English was not the first language for many of the patients who completed the survey (although documents were translated), and the surveys used were not reliable instrument given that a reliable instrument in previous studies could not be found.
Lessons learnt: In order to have accuracy of the survey results, it is best for the author of the study to hand out and provide scripture for the survey so that complete data is received from the surveyors.
Messages for others: Begin by making a small process change where only one provider allows for the open-access scheduling so that the entire office is not affected by it, and if results begin to look promising then it can be expanded. Additionally, correct labeling of patients as 'same-day' is also important so that additional data can be gathered when needed regarding the 'same-day' patients.
Patient/Family/Guardian Involvement: Patients who benefited from the new scheduling system (open-access scheduling) were asked to fill out a survey that asked them to disclose some demographic data and asked them to determine their satisfaction with the new vs old scheduling system and their likelihood of visiting an emergency room or urgent care.
Ethics Approval: Arizona State University Institutional Review Board (IRB) Received: September 201
Advance Directives in Long-Term Care: Implementation of Five Wishes
No full textabstract: Background and Purpose The lack of an advance directive (AD) can predispose a person to an aggressive course of treatment despite their wishes. When AD’s are incomplete, the chances of unwanted procedures, such as tube feedings and repeated transitioning between nursing homes and hospitals often result in the risk of increased mortality and morbidity, especially for older adults. Making end-of-life decisions can improve the quality of death by allowing individuals to make decisions to die in a dignified manner. The purpose of this project was to improve AD completion rates by implementing “Five Wishes” (FW) into the admission process in a long-term care facility (LTCF).
Methods The project took place on the skilled nursing units at a LTCF in Southwestern Arizona over a 2-month period of time. Twenty random charts were assessed before the start of the project to determine the residents AD status. Those 20 were then informed about FW’s and encouraged to complete one, along with all newly admitted residents to the skilled nursing units. Logs were used for data collection and each participating resident signed a HIPPA document. Descriptive statistics were used to describe the sample and outcome variables.
Outcomes Of the 20 current residents included in the quantitative chart assessment, 6 (30%) residents completed a FW’s document. Fifty residents were admitted during the project span and 21 (42%) of them completed FW’s.
Conclusions The FW’s completion rates were lower than expected. None of the residents had an AD more detailed than a basic full code or do not resuscitate (DNR) status before being informed of FW’s. It is recommended that the facility social workers would have implemented the intervention to increase the likelihood of adherence
Being Proactive in Geriatric Advance Care Planning
No full textabstract: Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data. The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives
Antecedents to homelessness among women and their children who us public shelters in metroplitan Atlanta, 1987
No full textThe overall objective of this study was to explore those events and circumstances leading to homelessness among women and their children who use public shelters in metropolitan Atlanta. To attain this objective, the researcher did the following: (a) identified the factors that influenced homelessness; (b) explained the various interactions between factors; and, (c) used simple theoretical models to test which of these factors had greater influence. The research design used in the study was an exploratory/descriptive design. A self-administered questionnaire was used to collect data in three shelters. The population served in the three shelters (A, B & C) on a daily basis is approximately 130 women and their children. Samples used in Shelter A equaled to 31 women, Shelter B equaled to 29 women, and Shelter C to 5 women. Simple descriptive statistics were used to analyze the data. Data collected from Shelter C was not used in comparison with the other two shelters since this would distort the findings. Shelters A and B were almost equal and the sample in Shelter C was very small, therefore, Shelter C was excluded from the comparison. The findings reveal that the major contributory factors to homelessness among women and their children are economic, social, political and the legislative. Whereas, the secondary factors are personal crises, such as alcoholism, drug abuse, psychiatric disturbances, physical disablement and limited educational background
A Research Review of The Trials and Errors of Predictive Policing
No full textabstract: The era of mass data collection is upon us and only recently have people begun to consider the value of their data. All of our clicks and likes have helped big tech companies build predictive models to tailor their product to the buying patterns of the consumer. Big data collection has its advantages in increasing profitability and efficiency, but many are concerned about the lack of transparency in these technologies (Dwyer). The dependency on algorithms to make and influence decisions has become a growing concern in law enforcement. The use of this technology is commonly referred to as data-driven decision making, which is also known as predictive policing. These technologies are thought to reduce the biases held in traditional policing by creating statistically sound evidence-based models. Although, many lawsuits have highlighted the fact that predictive technologies do more to reflect historical bias rather than to eradicate it. The clandestine measures behind the algorithms may be in conflict with the due process clause and the penumbra of privacy rights enumerated in the First, Third, Fourth, and Fifth Amendments.
Predictive policing technology has come under fire for over policing historically black and latinx neighborhoods. GIS (Geographical Information Systems) is supposed to help officers identify where crime will likely happen over the next twelve hours. However, the LAPD’s own internal audit of their program concluded that the technology did not help officers solve crimes or reduce crime rate any better than traditional patrol methods (Puente). Similarly, other types of tools used to calculate recidivism risk for bond sentencing are disproportionately biased to calculate black people as having a higher risk to reoffend (Angwin). Lawsuits from civil liberties groups have been filed against the police departments that utilized these technologies. This paper will examine the constitutional pitfalls of predictive technology and propose ways that the system could work to ameliorate its practices. (abstract
Screening, Brief Intervention and Referral to Treatment (SBIRT): Implementation in the Adolescent Inpatient Psychiatric Setting
No full textabstract: BACKGROUND: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of those who use substances, their friends, family members, communities and nations. Screening, Brief Intervention (BI) and Referral to Treatment (SBIRT) provides an evidence-based (EB) framework to detect and treat SU. Evidence shows that mental health (MH) providers are not providing EB SU management. Federally grant-funded SBIRT demonstrated evidence of decreased SU and prevention of full disorders. Implementation outcomes in smaller-scale projects have included increased clinician knowledge, documentation and interdisciplinary teamwork.
OBJECTIVE: To improve quality of care (QOC) for adolescents who use substances in the inpatient psychiatric setting by implementing EB SBIRT practices.
METHODS: Research questions focused on whether the number of SBIRT notes documented (N=170 charts) increased and whether training of the interdisciplinary team (N=26 clinicians) increased SBIRT knowledge. Individualized interventions used existing processes, training and a new SBIRT Note template. An SBIRT knowledge survey was adapted from a similar study. A pre-and post-chart audit was conducted to show increase in SBIRT documentation. The rationale for the latter was not only for compliance, but also so that all team members can know the status of SBIRT services. Thus, increased interdisciplinary teamwork was an intentional, though indirect, outcome.
RESULTS: A paired-samples t-test indicated clinician SBIRT knowledge significantly increased, with a large effect size. The results suggest that a short, 45-60-minute tailored education module can significantly increase clinician SBIRT knowledge. Auditing screening & BI notes both before and after the study period yielded important patient SU information and which types of SBIRT documentation increased post-implementation. The CRAFFT scores of the patients were quite high from a SU perspective, averaging over 3/6 both pre- and post-implementation, revealing over an 80% chance that the adolescent patient had a SU disorder. Most patients were positive for at least one substance (pre- = 47.1%; post- = 65.2%), with cannabis and alcohol being the most commonly used substances. Completed CRAFFT screenings increased from 62.5% to 72.7% of audited patients. Post-implementation, there were two types of BI notes: the preexisting Progress Note BI (PN BI) and the new Auto-Text BI (AT BI), part of the new SBIRT Note template introduced during implementation. The PN BIs not completed despite a positive screen increased from 79.6% to 83.7%. PN BIs increased 1%. The option for AT BI notes ameliorated this effect. Total BI notes completed for a patient positive for a substance increased from 20.4% to 32.6%, with 67.4% not receiving a documented BI. Total BIs completed for all patients was 21.2% post-implementation.
CONCLUSION: This project is scalable throughout the U.S. in MH settings and will provide crucial knowledge about positive and negative drivers in small-scale SBIRT implementations. The role of registered nurses (RNs), social workers and psychiatrists in providing SBIRT services as an interdisciplinary team will be enhanced. Likely conclusions are that short trainings can significantly increase clinician knowledge about SBIRT and compliance with standards. Consistent with prior evidence, significant management involvement, SBIRT champions, thought leaders and other consistent emphasis is necessary to continue improving SBIRT practice in the target setting.
Keywords: adolescents, teenagers, youth, alcohol, behavioral health, cannabis, crisis, documentation, drug use, epidemic, high-risk use, illicit drugs, implementation, mental health, opiates, opioid, pilot study, psychiatric inpatient hospital, quality improvement, SBIRT, Screening, Brief Intervention and Referral to Treatment, substance use, unhealthy alcohol use, use disorder
