And How Are We Supposed to Pay for Health Care? Views of the Poor and the Near Poor on Welfare Reform

The welfare reform debate focuses on the characteristics of who gets government benefits and who pays for them. People perceive the welfare reform debate as the white middle class denying benefits to poor people of color. But larger questions regarding the U.S. lack of comprehensive social policy for health care, education, and child care lurk behind these concerns. Drawing on research with public assistance recipients and working- and middle-class people, in this paper I explore the ways that people interact with and perceive government social programs. I argue that both attitudes and proposed solutions toward welfare reflect different access to government programs and resources such as jobs, savings, and social supports among people who have and have not accessed welfare. Since economic disparity in the United States correlates highly with race, the debate over welfare reform also involves racial attitudes. Changing both the welfare debate and poverty in the United States must start by providing universal benefits, [ public policy, poverty, welfare reform, race, United States ]     

Commentary: Moving From Practice to Research,and Back

It is a widely accepted idea that knowledge from research needs to be better integrated into practice. Considerable energy is dedicated to strengthening the flow of research to practice. Less attention, however, has been paid to strengthening the ways researchers can learn from practice to improve their work. In this commentary, we draw on our work over the past decade to offer reflections on the nature and pace of practice, the gaps between practitioners’ needs and available research, and the importance of trust and relationships. Although there are no easy responses to these challenges, we can create a dialogue about them and begin to work collectively toward overcoming them.     

Hard Times on 125th Street: Harlem's Poor Confront Welfare Reform

Drawing on fieldwork in Harlem at the onset of welfare reform, I argue in this article for both a social structural and a cultural approach to the study of poor families facing the consequences of this historic policy change. Ethnographic understanding of household organization, kinship networks, reciprocal dependencies, intergenerational relations, migration, and gender must be brought to bear if we are to chart the responses of the poor to welfare reform. Meaning and perceived intentions must be central if we are to grasp how the targets of policy change understand the new economic and bureaucratic circumstances of their lives. These themes are illustrated by drawing on accounts of several households in Harlem—African American and Latino—in order to explore how both structural and cultural forces may shape responses to welfare reform, [welfare reform, poverty, household organization, working poor]     

Implementing Evidence-Based Programs: Lessons Learned From the Field

Evidence-based programs (EBPs) are used in many health promotion efforts to ensure that the intended positive behavioral and health outcomes will be achieved. However, because EBPs are developed and tested in research settings, the contextual elements of real world implementation play an important role in their successful delivery in communities. As an intermediary charged with supporting the translation of research to practice for a statewide teen pregnancy prevention initiative, the ACT for Youth Center of Excellence conducted a mid-course evaluation to identify factors that contribute to the successful implementation of EBPs. The findings indicate that successful implementation involves systematic planning that addresses three critical contextual factors: community readiness, organizational capacity, and setting characteristics. By attending both to factors identified from local practice, and to theory and evidence identified through implementation science, practitioners can strengthen programming and enhance the quality of EBP delivery.     

Understanding Youth Development From the Practitioner's Point of View: A Call for Research on Effective Practice

This article calls for research on the expertise of youth development practitioners. We argue for studies focused on understanding youth practice from practitioners' points of view—as they experience and enact it—with the aim of contributing findings and frameworks that are helpful to their work and learning. To improve youth programs, first, it is essential to better understand the challenges frontline staff face in their work. We review evidence showing that running a program and facilitating youth development is more challenging and multidimensional than is generally appreciated. Second, it is essential to understand the strategies effective practitioners employ to address these challenges. Studies indicate that the expertise of frontline staff is central to program impact; we review findings suggesting the diverse, contextually-attuned skills this expertise entails. Case studies in three domains of decision-making (designing programs, youth's motivation, and ethical dilemmas) are used to provide a vision for this research.     

Parkinson's Disease: From Genetics to Clinical Practice

Breakthroughs in genetics over the last decade have radically advanced our understanding of the etiological basis of Parkinson''s disease (PD). Although much research remains to be done, the main genetic causes of this neurodegenerative disorder are now partially unraveled, allowing us to feel more confident that our knowledge about the genetic architecture of PD will continue to increase exponentially. How and when these discoveries will be introduced into general clinical practice, however, remains uncertain. In this review, we provide a general summary of the progress in the genetics of PD and discuss how this knowledge will contribute to the diagnosis and clinical management of patients with, or at risk of this disorder.     

An Audit of Behavioral Indicators of Poor Welfare in Kenneled Dogs in the United Kingdom

This survey-based study describes the prevalence and onset of behavioral indicators of poor welfare in dogs kenneled at United Kingdom rescue shelters. It describes key factors contributing to individual variation in behaviors. At 8 rescue shelters, staff trained in the care of nonhuman animals recorded daily whether dogs in their care displayed each of 15 behaviors. The study originally involved 302 dogs; for the first 14 days, it monitored only 148 dogs daily. The study observed dogs for a maximum of 6 weeks from admittance, observing all 15 behaviors at least once during the first 2 weeks (n = 148). The proportion of dogs observed to perform each behavior differed within the sample. The most commonly observed behavior (24.3% of dogs) was excessive barking. The remaining 14 behaviors ranged from listlessness (20.3%) to repetitive tail-chasing (1.3%). Over the 6 weeks, the proportion observed to pace repetitively and wall bounce increased. The proportion who lacked appetite and displayed fear-associated behavior decreased. Breed differences, gender, and age partially explained variability in the onset and prevalence of behavioral indicators of poor welfare in kenneled dogs.     

A Trust‐Based Pact in Research Biobanks. From Theory to Practice

Traditional Informed Consent is becoming increasingly inadequate, especially in the context of research biobanks. How much information is needed by patients for their consent to be truly informed? How does the quality of the information they receive match up to the quality of the information they ought to receive? How can information be conveyed fairly about future, non‐predictable lines of research? To circumvent these difficulties, some scholars have proposed that current consent guidelines should be reassessed, with trust being used as a guiding principle instead of information. Here, we analyse one of these proposals, based on a Participation Pact, which is already being offered to patients at the Istituto Europeo di Oncologia, a comprehensive cancer hospital in Milan, Italy.     

From Evidence to Best Practice in Laboratory Medicine

Laboratory tests offer value if they provide benefit to patients at acceptable costs. Laboratory testing is one of the most widely used diagnostic interventions supporting medical decisions, yet evidence demonstrating its value and impact on health outcomes is limited. This contributes to wide variations in test utilisation including underdiagnosis, overdiagnosis and misdiagnosis, which may impact the quality and the clinical- and cost-effectiveness of care and patient safety. Therefore implementing evidence into the care of patients is a moral and social imperative to laboratory professionals and all health care staff.This review investigates the reasons research does not get into practice, or only does with a very long delay. Apart from reviewing the common barriers to implementation, it also discusses the drivers of inappropriate test utilisation. By reviewing the theoretical and practical aspects of implementation science, recommendations are made for approaches that are thought to be most effective and that can be adopted to close the gap between evidence and practice, and to facilitate evidence-based laboratory medicine. Passive dissemination of the evidence and educational interventions are insufficient and do not offer sustainable solutions. A multifaceted and individualised implementation strategy, including individually tailored academic detailing, reminder systems, clinical decision support systems, feedback on performance, and participation of doctors and laboratory professionals in quality improvement activities addressing test selection and interpretation and in clinical audits, has greater potential for success. Examples of these initiatives at the laboratory and clinical interface are provided with links to valuable resources.

‘Knowing is not enough; we must apply.Willing is not enough; we must do.’JW von Goethe

     

Prioritizing genomic drug targets in pathogens: application to Mycobacterium tuberculosis

We have developed a software program that weights and integrates specific properties on the genes in a pathogen so that they may be ranked as drug targets. We applied this software to produce three prioritized drug target lists for Mycobacterium tuberculosis, the causative agent of tuberculosis, a disease for which a new drug is desperately needed. Each list is based on an individual criterion. The first list prioritizes metabolic drug targets by the uniqueness of their roles in the M. tuberculosis metabolome ("metabolic chokepoints") and their similarity to known "druggable" protein classes (i.e., classes whose activity has previously been shown to be modulated by binding a small molecule). The second list prioritizes targets that would specifically impair M. tuberculosis, by weighting heavily those that are closely conserved within the Actinobacteria class but lack close homology to the host and gut flora. M. tuberculosis can survive asymptomatically in its host for many years by adapting to a dormant state referred to as "persistence." The final list aims to prioritize potential targets involved in maintaining persistence in M. tuberculosis. The rankings of current, candidate, and proposed drug targets are highlighted with respect to these lists. Some features were found to be more accurate than others in prioritizing studied targets. It can also be shown that targets can be prioritized by using evolutionary programming to optimize the weights of each desired property. We demonstrate this approach in prioritizing persistence targets.     

韧性科学的回顾与展望:从生态理论到城市实践

城市韧性的概念在生态与环境领域正在兴起,如何将城市的结构复杂性和功能多样性与自然、经济和社会要科学地耦合尤为重要。实践方面,城市韧性在国际组织、政府机构和私人基金会等计划的支持下得到世界各地城市的日益重视。对此,回顾了韧性在生态系统科学中的概念起源及其在工程技术与社会学科的应用发展;整合了城市系统的科学知识,以进一步阐述城市韧性的概念及理论发展;举例了目前联合国、洛克菲勒基金会和跨国企业所构建的全球合作网络中韧性城市的实践。基于城市韧性理论的回顾和韧性城市实践,结合城市系统在生态、经济和社会维度的差异性,就我国城市以韧性为导向的转型发展过程中存在的机遇、挑战及解决途径提出了参考建议。