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What would an approach to public humanities that centers the principles of LANDBACK, a movement that locates liberation for Indigenous people in “putting Indigenous Lands back into Indigenous hands,” look like? In this conversation with Megan Red Shirt-Shaw, Meredith McCoy, and Elizabeth Rule—facilitated by Jennifer Guiliano and Roopika Risam—the team behind the Landback Universities project explores the possibilities and urgency of public humanities informed by Indigenous ways of knowing, cultural protocols, and the responsibility of universities to undertake repair work to be in right relation with Indigenous communities they have dispossessed. Topics addressed in this conversation include the limits of “decolonization” as a university discourse and buzzword that, at best, results in land acknowledgments—brief statements about the Native nations whose lands universities occupy, typically without any commitment to address the university’s ongoing participation in dispossession; the tensions between diversity, equity, and inclusion and “decolonization,” which undercut very real, decolonial calls for land restoration and the remaking of systems of power on campuses; the ethics of collaborations on humanities-related initiatives with Indigenous communities; and negotiating right-wing politics that curtail opportunities for this work.
Pragmatic trials aim to speed translation to practice by integrating study procedures in routine care settings. This study evaluated implementation outcomes related to clinician and patient recruitment and participation in a trial of community paramedicine (CP) and presents successes and challenges of maintaining pragmatic study features.
Methods:
Adults in the pre-hospital setting, emergency department (ED), or hospital being considered for referral to the ED/hospital or continued hospitalization for intermediate-level care were randomized 1:1 to CP care or usual care. Referral and enrollment data were tracked administratively, and patient characteristics were abstracted from the electronic health record (EHR). Enrolled patients completed baseline surveys, and a subset of intervention patients were interviewed. All CPs and a sample of clinicians and administrators were invited to complete a survey and interview.
Results:
Between January 2022 and February 2023, 240 enrolled patients (42% rural) completed surveys, and 22 completed an interview; 63 staff completed surveys and 20 completed an interview. Ninety-three clinicians in 27 departments made at least one referral. Factors related to referrals included program awareness and understanding the CP practice scope. Most patients were enrolled in the hospital, but characteristics were similar to the primary care population and included older and medically complex patients. Challenges to achieving representativeness included limited EHR infrastructure, constraints related to patient consenting, and clinician concerns about patient randomization disrupting preferred care.
Conclusion:
Future pragmatic trials in busy clinical settings may benefit from regulatory policies and EHR capabilities that allow for real-world study conduct and representative participation. Trial registration: NCT05232799.
Political polarization is a systemic-level and multifaceted process that severs cross-cutting ties and shifts perceptions of politics to a zero-sum game. When it turns pernicious, political actors and supporters view opponents as an existential threat and the capacity of democratic institutions to process political conflict breaks down. The article identifies four common fault lines of polarization globally – who belongs, democracy, inequality and social contract. It argues that while Latin American countries experience, to varying degrees, all four of the fault lines, it is the deep-seated, persistent social hierarchies oriented around class, race, and place that stand out relative to other countries. Reaching consensus on reforms that may renew or reformulate agreements on the terms of the social contract, boundaries of community membership, and redressing social inequality is a tall task. Yet the region’s sustained consensus on the democratic rules of the game can provide the mechanisms for addressing this task if new majority coalitions can be formed.
The GINI project investigates the dynamics of inequality among populations over the long term by synthesising global archaeological housing data. This project brings archaeologists together from around the world to assess hypotheses concerning the causes and consequences of inequality that are of relevance to contemporary societies globally.
The institutions (i.e., hubs) making up the National Institutes of Health (NIH)-funded network of Clinical and Translational Science Awards (CTSAs) share a mission to turn observations into interventions to improve public health. Recently, the focus of the CTSAs has turned increasingly from translational research (TR) to translational science (TS). The current NIH Funding Opportunity Announcement (PAR-21-293) for CTSAs stipulates that pilot studies funded through the CTSAs must be “focused on understanding a scientific or operational principle underlying a step of the translational process with the goal of developing generalizable solutions to accelerate translational research.” This new directive places Pilot Program administrators in the position of arbiters with the task of distinguishing between TR and TS projects. The purpose of this study was to explore the utility of a set of TS principles set forth by NCATS for distinguishing between TR and TS.
Methods:
Twelve CTSA hubs collaborated to generate a list of Translational Science Principles questions. Twenty-nine Pilot Program administrators used these questions to evaluate 26 CTSA-funded pilot studies.
Results:
Factor analysis yielded three factors: Generalizability/Efficiency, Disruptive Innovation, and Team Science. The Generalizability/Efficiency factor explained the largest amount of variance in the questions and was significantly able to distinguish between projects that were verified as TS or TR (t = 6.92, p < .001) by an expert panel.
Conclusions:
The seven questions in this factor may be useful for informing deliberations regarding whether a study addresses a question that aligns with NCATS’ vision of TS.
Older adults living in residential care often experience challenges in sustaining meaningful social relationships, which can result in compromised health and well-being. Online social networking has the potential to mitigate this problem, but few studies have investigated its implementation and its effectiveness in maintaining or enhancing well-being. This pilot study used a cluster-randomized pre–post design to examine the feasibility of implementing a 12-week group-based technology-training intervention for older adults (n = 48) living in residential care by exploring how cognitive health, mental health, and confidence in technology were impacted. Analysis of variance revealed significant increases in life satisfaction, positive attitudes toward computer use, and self-perceived competence among participants who received the intervention, but increased depressive symptoms for the control group. These findings suggest that, despite challenges in implementing the intervention in residential care, group-based technology training may enhance confidence among older adults while maintaining or enhancing mental health.
OBJECTIVES/GOALS: The goal of the CTSA consortium is to move scientific discoveries to clinical application. Translational science (TS) focuses on the process by which this happens, and NCATS supports pilot projects that propose TS questions. We are developing a rubric to guide program managers’ability to discriminate between TS and translational research (TR). METHODS/STUDY POPULATION: The CTSA External Review Exchange Consortium (CEREC) and CEREC II are reciprocal review collaborations between CTSA hubs that identify reviewers for each other’s pilot grant applications. CEREC and CEREC II partners developed a 31-item rubric, based on NIH’s Translational Science Principles, for discriminating pilot TS grant applications from those proposing TR. The hubs contributed proposals pre-selected as either TS or TR projects. Then, experienced reviewers and/or program administrators from the hubs used the rubric to score each of the proposals. Reliability of the rubric will be assessed using inter-rater reliability (% agreement and kappa). To identify which of the items in the rubric best discriminate between TS and TR, Item Response Theory analysis will be employed. RESULTS/ANTICIPATED RESULTS: Ten CEREC participating hubs submitted 30 applications: 20 TS proposals and 10 TR proposals. Twenty-two reviewers from 12 CEREC hubs evaluated the applications by using the scoring rubric; at least two reviewers evaluated each proposal. The results of the analyses will describe the reliability of the rubric and identify which of the seven TS Principles are most useful for distinguishing between TS and TR pilot grant proposals. Ultimately, this work will yield a scoring rubric that will be disseminated throughout the CTSA network to facilitate the screening of TS applications. DISCUSSION/SIGNIFICANCE: Optimizing research processes is critical to ensure that scientific discoveries are integrated into clinical practice and public health policy as rapidly, efficiently, and equitably as possible. By appropriately identifying and funding TS projects, CTSA hubs can accelerate the impact of clinical and translational research.
Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, “Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease,” includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.
Pragmatic trials aim to generate timely evidence while ensuring feasibility, minimizing practice burden, and maintaining real-world conditions. We conducted rapid-cycle qualitative research in the preimplementation period of a trial evaluating a community paramedic program to shorten and prevent hospitalizations. Between December 2021 and March 2022, interviews (n = 30) and presentations/discussions (n = 17) were conducted with clinical and administrative stakeholders. Two investigators analyzed interview and presentation data to identify potential trial challenges, and team reflections were used to develop responsive strategies. Solutions were implemented prior to the commencement of trial enrollment and were aimed at bolstering feasibility and building ongoing practice feedback loops.
Political parties in Venezuela have historically played a mediating role between the state and the working class and also between labor and the private sector. Indeed, the political party system has been widely credited in the literature with sustaining the rather remarkable electoral democracy in Venezuela since 1958. Yet structural change in the world oil market and the Venezuelan economy in the early 1970s combined with the dynamics of past state-labor-party relations have produced an expanded role for the state in the economy as well as in the system of industrial relations. New patterns of interest mediation have emerged that have facilitated the adjustment of the democratic regime to changing political and economic conditions, thus helping to ensure its survival.
This chapter unpacks and critically discusses the idea of democratic resilience vis-à-vis polarization that becomes “pernicious,” that is, it divides societies into mutually distrustful Us vs. Them camps. Democratic resilience, we argue, is a polity’s ability to produce electoral, programmatic, discursive, and organizational behavior that can jointly contain and reverse pernicious polarization and its democracy-eroding consequences. We apply comparative lessons to assess US resilience and vulnerability to such consequences, focusing on three factors: institutional constraints, formative rifts, and opposition capacities and strategies.
Cerberiopsis candelabra Vieill. is a long-lived, monocarpic (= semelparous) and mass-flowering rain-forest tree, endemic to New Caledonia. Population size structures suggest establishment has been episodic, followed by a recruitment gap that might signal population decline. Here, we use age structures based on tree rings to better assess population dynamics and persistence, and investigate influences of tree size, age and growth rate on flowering. Age structures of populations surveyed in 2007–2008 were unimodal, with establishment over c. 15–81 y, followed by a recruitment gap of c. 23–79 y. Seedling mortality was generally high. High densities of flowering trees or large-scale exogenous disturbances may be necessary for in-situ regeneration. There was no evidence of a simple flowering threshold: flowering in 2017 occurred across a wide range of tree size, age and growth rate. Instead, evidence suggested that size and age at flowering may vary among plants depending on their growth trajectory. Environmental triggers of flowering were not identified by dating tree establishment, but the last three mass-flowering events occurred in years of tropical cyclones. Regeneration and persistence might be facilitated if large-scale disturbances trigger flowering, improving reproductive efficiency by synchronising flowering and linking reproduction with environmental conditions that enhance seedling recruitment.
The University of Arkansas for Medical Sciences (UAMS), like many rural states, faces clinical and research obstacles to which digital innovation is seen as a promising solution. To implement digital technology, a mobile health interest group was established to lay the foundation for an enterprise-wide digital health innovation platform. To create a foundation, an interprofessional team was established, and a series of formal networking events was conducted. Three online digital health training models were developed, and a full-day regional conference was held featuring nationally recognized speakers and panel discussions with clinicians, researchers, and patient advocates involved in digital health programs at UAMS. Finally, an institution-wide survey exploring the interest in and knowledge of digital health technologies was distributed. The networking events averaged 35–45 attendees. About 100 individuals attended the regional conference with positive feedback from participants. To evaluate mHealth knowledge at the institution, a survey was completed by 257 UAMS clinicians, researchers, and staff. It revealed that there are opportunities to increase training, communication, and collaboration for digital health implementation. The inclusion of the mobile health working group in the newly formed Institute for Digital Health and Innovation provides a nexus for healthcare providers and researches to facilitate translational research.
Many institutions evaluate applications for local seed funding by recruiting peer reviewers from their own institutional community. Smaller institutions, however, often face difficulty locating qualified local reviewers who are not in conflict with the proposal. As a larger pool of reviewers may be accessed through a cross-institutional collaborative process, nine Clinical and Translational Science Award (CTSA) hubs formed a consortium in 2016 to facilitate reviewer exchanges. Data were collected to evaluate the feasibility and preliminary efficacy of the consortium.
Methods:
The CTSA External Reviewer Exchange Consortium (CEREC) has been supported by a custom-built web-based application that facilitates the process and tracks the efficiency and productivity of the exchange.
Results:
All nine of the original CEREC members remain actively engaged in the exchange. Between January 2017 and May 2019, CEREC supported the review process for 23 individual calls for proposals. Out of the 412 reviews requested, 368 were received, for a fulfillment ratio of 89.3%. The yield on reviewer invitations has remained consistently high, with approximately one-third of invitations being accepted, and of the reviewers who agreed to provide a review, 88.3% submitted a complete review. Surveys of reviewers and pilot program administrators indicate high satisfaction with the process.
Conclusions:
These data indicate that a reviewer exchange consortium is feasible, adds value to participating partners, and is sustainable over time.
Negotiating peace in a democratic context where public opinion matters and an international context eschewing the past norm of forgive-and-forget to end conflicts poses new dilemmas for peace negotiators. With both domestic constituents and international law demanding retributive justice for the most egregious human rights abuses, how are negotiators to induce combatants to lay down arms and end a conflict? We examine these dilemmas in the Colombia peace talks of 2012–2016 – a case of a protracted conflict in a democracy with relatively strong rule of law institutions; well-organized civil society, and especially human rights organizations; and a vibrant political dynamic involving both the multi-party Congress and public opinion in the approval and implementation of the negotiated agreement.
The upper canopy of some rain forests in New Caledonia is dominated by single species. These monodominants are commonly secondary species, their dominance not persisting without disturbance. We tested whether dominance is associated with efficient uptake and use of nutrients (N, P and K), comparing between seedlings of monodominants (Nothofagus spp., Arillastrum gummiferum and Cerberiopsis candelabra) and 14 subordinates, grown in a nursery house. We also tested whether this trend applies more broadly to shade-intolerant trees that regenerate episodically (ER species) versus shade-tolerant trees that regenerate continuously (CR species). In the sun treatment, monodominants had higher photosynthetic nutrient-use efficiency and productivity for N and K, and uptake efficiency for N, P and K, than subordinates; ER species had higher photosynthetic nutrient-use efficiency for N, P and K, and uptake efficiency for N and P, than CR species. Uptake efficiency and productivity per nutrient mass were uncorrelated across species, yet Nothofagus spp., A. gummiferum and C. candelabra combined high levels of both traits for N, and Nothofagus spp. and A. gummiferum combined moderate to high levels for P, in sun-grown seedlings. This trait combination may contribute substantially to competitiveness and post-disturbance dominance on these nutrient-poor soils.
The history of the low-elevation forest and forest-steppe ecotone on the east side of the Andes is revealed in pollen and charcoal records obtained from mid-latitude lakes. Prior to 15,000 cal yr BP, the vegetation was characterized by steppe vegetation with isolated stands of Nothofagus. The climate was generally dry, and the sparse vegetation apparently lacked sufficient fuels to burn extensively. After 15,000 cal yr BP, a mixture of Nothofagus forest and shrubland/steppe developed. Fire activity increased between 13,250 and 11,400 cal yr BP, contemporaneous with a regionally defined cold dry period (Huelmo/Mascardi Cold Reversal). The early-Holocene period was characterized by an open Nothofagus forest/shrubland mosaic, and fire frequency was high in dry sites and low in wet sites; the data suggest a sharp decrease in moisture eastward from the Andes. A shift to a surface-fire regime occurred at 7500 cal yr BP at the wet site and at 4400 cal yr BP at the dry site, preceding the expansion of Austrocedrus by 1000–1500 yr. The spread of Austrocedrus is explained by a shift towards a cooler and wetter climate in the middle and late Holocene. The change to a surface-fire regime is consistent with increased interannual climate variability and the onset or strengthening of ENSO. The present-day mixed forest dominated by Nothofagus and Austrocedrus was established in the last few millennia.
Some species-rich secondary forests in New Caledonia have a monodominant canopy. Here we investigate growth and biomass allocation traits that might explain single-species’ dominance of these post-disturbance stands, and their later decline in the absence of large-scale disturbance. Seedlings of 20 rain-forest trees were grown in two light treatments in a nursery house. In the sun treatment, monodominants grew faster (56.7 ± 1.4 mg g−1 wk−1) than subordinates (40.2 ± 2.6 mg g−1 wk−1). However, some episodically regenerating (ER) subordinates had high growth rates similar to those of monodominants. In the shade treatment, monodominants and subordinates had similar growth rates (33.7 ± 2.6 and 34.0 ± 1.9 mg g−1 wk−1 respectively). Notably, monodominants in both sun and shade treatments had lower root mass fraction (0.29 ± 0.02 and 0.27 ± 0.02 g g−1 respectively) than subordinates (0.39 ± 0.02 and 0.37 ± 0.02 g g−1). Fast growth in sunny conditions is probably imperative for these relatively shade-intolerant ER monodominants. In field conditions, high shoot mass fraction combined with efficient root performance may facilitate faster growth in monodominants competing with other ER species in sunlit sites. Slower growth in shade may contribute to loss of dominance over time in undisturbed forests.
Several monodominant rain-forest trees in New Caledonia have population size structures suggesting establishment following large-scale disturbance, with eventual replacement by shade-tolerant species predicted in the absence of future disturbance. Links of dominance and population dynamics to leaf-level photosynthesis were investigated in seedlings of 20 tree species from these forests, grown in experimental sun and shade conditions. In particular, we tested whether episodically regenerating (ER) species, including monodominants, have higher assimilation rates at high irradiances and lower tolerance of shade than continuously regenerating species (CR). ER species had higher maximum net assimilation rates (Amax-area) in sun plants (9.6 ± 0.4 μmol m−2 s−1) than CR species (6.2 ± 0.3 μmol m−2 s−1) and high plasticity, typical of shade-intolerant species, but monodominant species did not differ from other ER species. CR species had leaf-level traits consistent with shade tolerance, including lower dark respiration rates (Rd-area = 0.47 ± 0.03μmol m−2 s−1; Rd-mass = 7 ± 1 nmol g−1 s−1) than ER species (Rd-area = 0.63 ± 0.06 μmol m−2 s−1; Rd-mass = 11 ± 2 nmol g−1 s−1) in shade plants. Hence leaf-level assimilation traits were largely consistent with regeneration patterns, but do not explain why some shade-intolerant species can achieve monodominance.