Kearsley A. Stewart

Ten Salient Practices of Undergraduate Research Mentors: A Review of the Literature

This paper identifies salient practices of faculty mentors of undergraduate research (UR) as indicated in the extensive literature of the past two decades on UR. The well-established benefits for students involved in UR are dependent, first and foremost, on high-quality mentoring. Mentorship is a defining feature of UR. As more and different types of colleges and universities strive to meet student demand for authentic scholarly experiences, it is imperative to identify what effective UR mentors do in order to ensure student engagement, quality enhancement, retention, and degree-completion. We offer an original analysis of the literature on UR mentoring in which we identify 10 significant “lessons learned,” or evidence-based practices of effective UR mentors that apply broadly across disciplines, students, institutions, and mentoring approaches.

Toward a Historical Perspective on Sexuality in Uganda: The Reproductive Lifeline Technique for Grandmothers and their Daughters

Current health research on HIV-AIDS in Uganda is predominantly ahistorical and acultural. This is an inadequate analysis of a profoundly social epidemic, especially as the burden of disease shifts from adults to adolescents. As well, many Ugandan adults hold unexamined attitudes about adolescent sexuality, often declaring that todays youth are recklessly sexually active at a much younger age than in the past. This paper presents new data on sexuality reaching across three generations of Ugandans. These data were collected with an original qualitative social scientific research method—the reproductive lifeline technique. Building on the focus group method, this exercise is designed to produce fertility data with historical depth of several generations of women, and to encourage parents to speak more openly with their own children about reproduction and sexuality. This paper analyzes one particular demographic variable, age at first live birth, in an effort to theorize about change over time in another important variable, age at sexual debut. The results were surprising: age at first live birth has not changed significantly over the past forty years in western Uganda and some evidence suggests that age at sexual debut has not changed much either. Several explanations are offered to explain the discrepancy between the demographic evidence and the cultural norms held by adults about adolescent sexual behaviors.

Okukkera Ng'omuzungu (lost in translation): Understanding the social value of global health research for HIV/AIDS research participants in Uganda

Abstract As major global governance entities begin to re-assess the structure and goals of health research in resource-poor settings, social science can make a vital contribution by expanding the traditional field of research ethics to include new concepts such as the social value of global health research. This essay recasts the definition of social value in health research by shifting away from the official spaces where research occurs and towards the meaning of research as it is produced in the everyday spaces inhabited by the local community. We present three cases that reveal the local view of the social value of health research for Ugandans: autonomy and consent; the concept of risk; and what appears to be a classic case of therapeutic misconception between researcher and informant. Ultimately what we see, we argue, is the fundamental collision of the logic of biomedical research with the logic of local social relationships, that is, researchers perform their role as a transaction, while participants anticipate their involvement in research to be transformative. When we expand the analysis of the impact of research from the research/participant dyad to shifting community networks, we conclude that didactic models, such as the therapeutic misconception, are of limited utility for understanding the social value of global health research in resource-poor settings.

Values and moral experience in global health: Bridging the local and the global

Over the past several decades, political conflicts, economic volatility and large-scale cultural and social changes, have strongly influenced not only the global health problem and solution frameworks, but also the very way we conceive of global health as a public good. As politicians, business people and cultural elites employ the language of global health to shape discourse and policies focused on displaced and migratory peoples, they have, perhaps unwittingly, broadened the classic public health agenda. As a consequence, that agenda now includes violence and its traumatic consequences, the health (and mental health) impact of natural and social catastrophes, other health-related problems from obesity to substance abuse, and the effect of pharmaceutical and digital technology innovations not previously considered to be core public health issues. They expand and reformulate the traditional spheres of public health, and challenge classic public health values. As a result, debates shaping global health research, ethics, policy and programmes have developed along two parallel tracks. One can be characterised as a neo-liberal approach combining economics (liberalisation of trade and financing; public private partnerships; cost-effectiveness analysis), disease-specific and biotech programmes and security concerns. The other has focused on human rights, social justice and equity frameworks with a broader, more inclusive model of the determinants of health. This perspective calls for a transformation of the current fractured system of global health governance into a transparent and accountable system better equipped to address the world’s global health agendas. The latter approach embraces public health as one of the essential features of a new moral commitment to remake the world, similar to the environmental/climate change movement. In fact, in 2002, the American Public Health Association explicitly affirmed in their professional code of ethics, Principles of the ethical practice of public health, that the pursuit of public health is an ‘inherently moral’ obligation. Very recently, the two approaches appear to be converging around a values focus to bolster arguments in favour of increased resource allocation for global health programmes. Values embodied by individual behaviours are often rooted in cultural interests or shaped by hegemonic norms that, at times, appear to be so natural as to be invisible. Similarly, values are so central to political life, policy-makers freely admit that political discourse that appropriates the values debate builds political support, consequently driving policy goals. Although for different reasons, values in these two spheres are often unclear and not well articulated. For the political realm, the result is that values are neither consistently applied nor shared across diverse policy sectors. What is new, however, is an emerging recognition that the ‘social context’ of values must be explored before we can begin to understand the meaning of any value, whether personal, political or invoked directly in reference to global

The Hidden Curricula of Medical Education: A Scoping Review.

Purpose To analyze the plural definitions and applications of the term “hidden curriculum” within the medical education literature and to propose a conceptual framework for conducting future research on the topic. Method The authors conducted a literature search of nine online databases, seeking articles published on the hidden, informal, or implicit curriculum in medical education prior to March 2017. Two reviewers independently screened articles with set inclusion criteria and performed kappa coefficient tests to evaluate interreviewer reliability. They extracted, coded, and analyzed key data, using grounded theory methodology. Results The authors uncovered 3,747 articles relating to the hidden curriculum in medical education. Of these, they selected 197 articles for full review. Use of the term “hidden curriculum” has expanded substantially since 2012. U.S. and Canadian medical schools are the focus of two-thirds of the empirical hidden curriculum studies; data from African and South American schools are nearly absent. Few quantitative techniques to measure the hidden curriculum exist. The “hidden curriculum” is understood as a mostly negative concept. Its definition varies widely, but can be understood via four conceptual boundaries: (1) institutional–organizational, (2) interpersonal–social, (3) contextual–cultural, and/or (4) motivational–psychological. Conclusions Future medical education researchers should make clear the conceptual boundary or boundaries they are applying to the term “hidden curriculum,” move away from general musings on its effects, and focus on specific methods for improving the powerful hidden curriculum.

Long shadow of fear in an epidemic: fearonomic effects of Ebola on the private sector in Nigeria

Background The already significant impact of the Ebola epidemic on Guinea, Liberia and Sierra Leone, was worsened by a fear of contagion that aggravated the health crisis. However, in contrast to other Ebola-affected countries, Nigeria fared significantly better due to its swift containment of the disease. The objective of our study was to describe the impact of Ebola on the Nigerian private sector. This paper introduces and defines the term fearonomic effect as the direct and indirect economic effects of both misinformation as well as fear-induced aversion behaviour, exhibited by individuals, organisations or countries during an outbreak or an epidemic. Methods This study was designed as a cross-sectional mixed-methods study that used semistructured in-depth interviews and a supporting survey to capture the impact of Ebola on the Nigerian private sector after the outbreak. Themes were generated from the interviews on the direct and indirect impact of Ebola on the private sector; the impact of misinformation and fear-based aversion behaviour in the private sector. Results Our findings reveal that the fearonomic effects of Ebola included health service outages and reduced healthcare usage as a result of misinformation and aversion behaviour by both patients and providers. Although certain sectors (eg, health sector, aviation sector, hospitality sector) in Nigeria were affected more than others, no business was immune to Ebolas fearonomic effects. We describe how sectors expected to prosper during the outbreak (eg, pharmaceuticals), actually suffered due to the changes in consumption patterns and demand shocks. Conclusion In a high-stressor epidemic-like setting, altered consumption behaviour due to distorted disease perception, misinformation and fear can trigger short-term economic cascades that can disproportionately affect businesses and lead to financial insecurity of the poorest and the most vulnerable in a society.

University leadership for innovation in global health and HIV/AIDS diagnostics

Abstract Medical products used in the developed world often fail to adequately serve resource-limited settings where electricity, transportation and health care workers are not readily available. We suggest that the problem is not only a lack of coordinated financial resources to purchase existing medical products, but also a lack of products that are specifically designed for resource-limited settings. While donor organisations with a focus on global health are increasingly willing to bear the additional financial risk for the research and development of such high-impact medical products, corporations are still reluctant to take their best scientists and engineers away from more commercially attractive projects. Universities, on the other hand, given their teaching and research missions, are well positioned to engage in such high-risk development projects. A group of biomedical, engineering, business and social science researchers at Northwestern University (NU) propose a creative model to address significant social and health needs. The teams initial product focus is a rapid test for diagnosing infants with HIV. The NU model aligns the incentives and expertise of industry, donors and academia to innovate medical products, such as the infant HIV diagnostic test, for resource-limited settings.

Antibiotic overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians

BackgroundAcute respiratory tract infections (ARTIs) are a common reason for antibiotic overuse worldwide. We previously showed that over 80% of outpatients presenting to a tertiary care hospital in Sri Lanka with influenza-like illness received antibiotic prescriptions, although almost half were later confirmed to have influenza. The purpose of this qualitative study was to assess Sri Lankan patients’ and physicians’ attitudes towards ARTI diagnosis and treatment.MethodsSemi-structured interviews were conducted with 50 outpatients with ARTIs and five physicians in the Outpatient Department (OPD) at a large, public tertiary care hospital in southern Sri Lanka. Interviews were audio-recorded, transcribed, and analyzed for themes related to ARTI diagnosis and treatment.ResultsPatients frequently sought ARTI care in the public sector due to the receipt of free care and the perception that government hospitals carried a sense of responsibility for patients’ health. Patients reported multiple medical visits for their illnesses of short duration and many indicated that they were seeking care in the OPD while at the hospital for another reason. While patients generally expected to receive medication prescriptions at their visit, most patients were not specifically seeking an antibiotic prescription. However, more than 70% of patients received antibiotic prescriptions at their OPD visit. Physicians incorrectly perceived that patients desired antibiotics or “capsules,” a common formulation of antibiotics dispensed in this outpatient setting, and cited patient demand as an important cause of antibiotic overuse. Physicians also indicated that high patient volume and fear of bacterial superinfection drove antibiotic overuse.ConclusionsPatients in this study were seeking medication prescriptions for their ARTIs, but physicians incorrectly perceived that antibiotic prescriptions were desired. High patient volume and fear of bacterial superinfection were also important factors in antibiotic overuse. Training of physicians regarding guideline-concordant management and dealing with diagnostic uncertainty, education of patients regarding ARTI etiology and management, and systematic changes in the public outpatient care structure may help decrease unnecessary antibiotic prescriptions for ARTIs in this setting.

Teaching corner: the prospective case study : a pedagogical innovation for teaching global health ethics.

Over the past decade, global health has emerged as one of the fastest growing academic programs in the United States. Ethics training is cited widely as an essential feature of U.S. global health programs, but generally it is not deeply integrated into the global health teaching and training curricula. A discussion about the pedagogy of teaching global health ethics is long overdue; to date, only a few papers specifically engage with pedagogy rather than competencies or content. This paper explores the value of case study pedagogy for a full-semester graduate course in global health ethics at an American university. I address some of the pedagogical challenges of teaching global health ethics through my innovative use of case study methodology—the “prospective case study” (PSC).

The Challenge of Community Representation: Lessons From Six HIV Clinical Research Community Advisory Boards in Uganda.

Although community advisory boards (CABs) are widely used in clinical research, there is limited data regarding their composition and structure, especially in Africa. Our research provides the first qualitative study of the membership practices, selection methods, and qualifications of the six major HIV research centers that comprise the Ugandan National CAB Network (UNCN). Researchers conducted interviews (n = 45) with CAB members and research liaisons at each of the sites. While selection practices and demographics varied between the sites, all six CABs exclusively followed a broad community membership model. Results suggest successful CABs are context dependent and thus distinct guidelines may be needed based on variables including CAB funding level, representation model, and research focus.