Sara F. Jacoby

Digital Animation as a Method to Disseminate Research Findings to the Community Using a Community-Based Participatory Approach

Community-based participatory research (CBPR) has garnered increasing interest over the previous two decades as researchers have tackled increasingly complex health problems. In academia, professional presentations and articles are major ways that research is disseminated. However, dissemination of research findings to the people and communities who participated in the research is many times forgotten. In addition, little scholarly literature is focused on creative dissemination of research findings to the community using CBPR methods. We seek to fill this gap in the literature by providing an exemplar of research dissemination and partnership strategies that were used to complete this project. In this paper, we present a novel approach to the dissemination of research findings to our targeted communities through digital animation. We also provide the foundational thinking and specific steps that were taken to select this specific dissemination product development and distribution strategy.

Quantifying Disparities in Urban Firearm Violence by Race and Place in Philadelphia, Pennsylvania: A Cartographic Study

Objectives To describe variability in the burden of firearm violence by race, income, and place in an urban context. Methods We used Philadelphia Police Department data from 2013 to 2014 to calculate firearm assault rates within census block groups for both victim residence and event locations, stratifying by race and block group income. We used cartographic modeling to determine variations in incidence of firearm assault by race, neighborhood income, and place. Results The overall rate of firearm assault was 5.0 times higher (95% confidence interval [CI] = 4.5, 5.6) for Black people compared with White people. Firearm assault rates were higher among Black people across all victim residence incomes. Relative risk of firearm assault reached 15.8 times higher (95% CI = 10.7, 23.2) for Black residents in the highest-income block groups when compared with high-income White individuals. Firearm assault events tended to occur in low-income areas and were concentrated in several “hot spot” locations with high proportions of Black residents. Conclusions Profound disparity in exposure to firearm violence by race and place exists in Philadelphia. Black people were substantially more likely than White people to sustain firearm assault, regardless of neighborhood income.

Co-creation of a pedagogical space to support qualitative inquiry: An advanced qualitative collective

BACKGROUND Situated in a research-intensive School of Nursing, the Advanced Qualitative Collective (AQC) provides an innovative educational forum for the study of qualitative research by doctoral and postdoctoral scholars. This long-standing collective is guided by a faculty facilitator using a collaborative co-learning approach to address individual and group needs, from the conception of research projects through dissemination of completed qualitative research. This article describes the dynamics of the AQC and the ways a co-created pedagogical entity supports professional development among its diverse members. The informal, participatory style, and dynamic content used by the AQC resists a course structure typical of doctoral education in health sciences, and promotes engagement and self-direction. The AQC provides opportunities for members to examine theoretical frameworks and methodologies rarely addressed within a positivism-dominant learning environment while simultaneously serving as an alternative exemplar for the pedagogy of research.

Firearm Violence as a Disease-"Hot People" or "Hot Spots"?

In this issue of JAMA Internal Medicine, Green and colleagues1 report on firearm violence in Chicago, Illinois, from 2006 to 2014 and show how the violence is transmitted by social interaction through networks of people. The study establishes that the spread of firearm violence can be understood with parameters that have been used for more than half a century to model the spread of infectious diseases. This important finding helps put to rest the mistaken idea that epidemiology, medicine, and public health somehow have no place in the prevention of firearm violence, a disease process that affects roughly 100 000 people in the United States each year.2,3 Firearm violence is a problem that many fields, including criminology, sociology, and law enforcement, have contributed to better understanding and preventing. However, when a person is shot with a firearm in the United States, there is more than just a police and justice system response. If the person survives long enough, he or she will be treated by emergency medical services professionals and then at a trauma or other medical center; if the person dies, a medical examiner or coroner will likely conduct an autopsy. Substantial medical and public health resources are expended in responding to firearm violence. Correspondingly substantial biomedical research resources are also needed to better understand and prevent this acute and often fatal pathophysiological process.3 Although the study by Green and colleagues1 provides innovative quantitative evidence, modeling the transmission of firearm violence as an epidemiological phenomenon is not new. Most prior studies, however, have documented ecological transmission between neighborhoods or other groups of people (eg, gangs and peer groups). A few studies have applied mathematical models to person-to-person transmission of firearm violence4; however, these studies have been simulations. In contrast, Green and colleagues1 took an important next step Related article page 326 Contagion Through Social Networks to Explain and Predict Gunshot Violence Original Investigation Research

The Effect of Microneighborhood Conditions on Adult Educational Attainment in a Subsidized Housing Intervention

Abstract The ACHIEVEability model of affordable housing aims to promote self-sufficiency by requiring enrollment in postsecondary education in exchange for subsidized housing. In this study, we exploit the quasi random assignment of ACHIEVEability participants (N = 84) to subsidized housing units to evaluate whether microneighborhood environments moderated participants’ progress in postsecondary education. Participants progressed in their educational pursuits in line with program requirements, earning about 12 college credits per year. Neighborhood block group characteristics moderated this progress. Participants who were assigned to housing located in poorer, more violent, and less educated block groups earned credits at a significantly slower rate than participants assigned housing in more advantaged block groups. Our results suggest that the micro environments immediately surrounding residents of subsidized housing matter, even if they are situated within broader contexts of spatial and personal disadvantage.

Ridesharing and Motor Vehicle Crashes in 4 US Cities: An Interrupted Time-Series Analysis

Uber, the worlds largest ridesharing company, has reportedly provided over 2 billion journeys globally since operations began in 2010; however, the impact on motor vehicle crashes is unclear. Theoretically, ridesharing could reduce alcohol-involved crashes in locations where other modes of transportation are less attractive than driving ones own vehicle while under the influence of alcohol. We conducted interrupted time-series analyses using weekly counts of injury crashes and the proportion that were alcohol-involved in 4 US cities (Las Vegas, Nevada; Reno, Nevada; Portland, Oregon; and San Antonio, Texas). We considered that a resumption of Uber operations after a temporary break would produce a more substantial change in ridership than an initial launch, so we selected cities where Uber launched, ceased, and then resumed operations (2013-2016). We hypothesized that Ubers resumption would be associated with fewer alcohol-involved crashes. Results partially supported this hypothesis. For example, in Portland, Ubers resumption was associated with a 61.8% reduction (95% confidence interval: 38.7, 86.4) in the alcohol-involved crash rate (an absolute decrease of 3.1 (95% confidence interval: 1.7, 4.4) alcohol-involved crashes per week); however, there was no concomitant change in all injury crashes. Relationships between ridesharing and motor vehicle crashes differ between cities over time and may depend on specific local characteristics.

The effect of early psychological symptom severity on long-term functional recovery: A secondary analysis of data from a cohort study of minor injury patients

BACKGROUND The mental health consequences of injuries can interfere with recovery to pre-injury levels of function and long term wellbeing. OBJECTIVES The purpose of this study was to explore the relationship between psychological symptoms after minor injury and long-term functional recovery and disability. DESIGN This exploratory study uses secondary data derived from a longitudinal cohort study of psychological outcomes after minor injury. SETTING Participants were recruited from the Emergency Department of an urban hospital in the United States. PARTICIPANTS A cohort of 275 patients was randomly selected from 1100 consecutive emergency department admissions for minor injury. Potential participants were identified as having sustained minor injury by the combination of three standard criteria including: presentation to the emergency department for medical care within 24h of a physical injury, evidence of anatomical injury defined as minor by an injury severity score between 2 and 8 and normal physiology as defined by a triage-Revised Trauma Score of 12. Patients with central nervous system injuries, injury requiring medical care in the past 2 years and/or resulting from domestic violence, and those diagnosed with major depression or psychotic disorders were excluded. METHODS Psychological symptom severity was assessed within 2 weeks of injury, and outcome measures for functional limitations and disability were collected at 3, 6 and 12 months. A quasi-least squares approach was used to examine the relationship between psychological symptom scores at intake and work performance and requirement for bed rest in the year after injury. RESULTS Adjusting for demographic and injury covariates, depression symptoms at the time of injury predicted (p≤0.05) both poorer work performance and increased number of days in bed due to health in the year after injury. Anxiety symptoms predicted (p≤0.05) bed days at 3, 6, and 12 months and work performance at 3 months. CONCLUSIONS Depression and anxiety soon after minor injury may help predict important markers of long-term recovery. With further research, simple assessment tools for psychological symptoms may be useful to screen for patients who are at higher risk for poor long-term recoveries and who may benefit from targeted interventions.

Does spending time outdoors reduce stress? A review of real-time stress response to outdoor environments

Abstract Everyday environmental conditions impact human health. One mechanism underlying this relationship is the experience of stress. Through systematic review of published literature, we explore how stress has been measured in real‐time non‐laboratory studies of stress responses to deliberate exposure to outdoor environments. The types of exposures evaluated in this review include: nature viewing, outdoor walks, outdoor exercise and gardening. We characterize study design, modalities of stress measurements, and statistical estimates of effect and significance. Heart rate, blood pressure, and self‐report measures provide the most convincing evidence that spending time in outdoor environments, particularly those with green space, may reduce the experience of stress, and ultimately improve health. More work is needed to understand effects of in situ modifications to outdoor environments on residents’ stress response. HighlightsSystematic review of 43 real‐time non‐laboratory studies of stress responses to outdoor, often natural, environments.Stress outcome measurements were by anthropometric instruments, saliva, blood, urine, actigraph, self‐report and eeg.Environmental exposures included nature viewing, outdoor walk, outdoor exercise, or gardening.Heart rate, blood pressure, and self‐report results provide the most convincing evidence.

Patient Characteristics and Temporal Trends in Police Transport of Blunt Trauma Patients: A Multicenter Retrospective Cohort Study

Abstract Background: Police transport (PT) of penetrating trauma patients has the potential to decrease prehospital times for patients with life-threatening hemorrhage and is part of official policy in Philadelphia, Pennsylvania. We hypothesized that rates of PT of bluntly injured patients have increased over the past decade. Methods: We used Pennsylvania Trauma Outcomes Study registry data from 2006–15 to identify bluntly injured adult patients transported to all 8 trauma centers in Philadelphia. PT was compared to ambulance transport, excluding transfers, burn patients, and private transport. We compared demographics, mechanism, and injury outcomes between PT and ambulance transport patients and used multivariable logistic regression to identify independent predictors of PT. We also identified physiological indicators and injury patterns that might have benefitted from prehospital intervention by EMS. Results: Of 28 897 bluntly injured patients, 339 (1.2%) were transported by police and 28 558 (98.8%) by ambulance. Blunt trauma accounted for 11% of PT and penetrating trauma for 89%. PT patients were younger, more likely to be male, and more likely to be African American or Asian and were more often injured by assault or motor vehicle crash. There were no significant differences presenting physiology between PT and EMS patients. In multivariable logistic regression analysis, male sex (OR 1.89, 95%CI 1.40–2.55), African American race (OR 1.71 95%CI 1.34–2.18), and Asian race (OR 2.25, 95%CI 1.22–4.14) were independently associated with PT. Controlling for injury severity and physiology, there was no significant difference in mortality between PT and EMS. Overall, 64% of PT patients had a condition that might have benefited from prehospital intervention such as supplemental oxygen for brain injury or spine stabilization for vertebral fractures. Conclusions: PT affects a small minority of blunt trauma patients, and did not appear associated with higher mortality. However, PT patients included many who might have benefited from proven, prehospital intervention. Clinicians, EMS providers, and law enforcement should collaborate to optimize use of PT within the trauma system.

The insight and challenge of reflexive practice in an ethnographic study of black traumatically injured patients in Philadelphia

The integrity of critical ethnography requires engagement in reflexive practice at all phases of the research process. In this discussion paper, I explore the insights and challenges of reflexive practice in an ethnographic study of the recovery experiences of black trauma patients in a Philadelphia hospital. Observation and interviews were conducted with twelve patients who were admitted to trauma-designated units of the hospital over the course of a year. During fieldwork, I learned the ways that my background as a professional nurse structured my way of being in clinical space and facilitated a particular interpretation of clinical culture. In analysis, reflection on subjectivities through which I designed this ethnographic research allowed me to see beyond my preconceived and theoretically informed perspective to permit unexpected features of the field to emerge. Reflexive practice also guided my reconciliation of key practical and epistemological differences between clinical ethnographic research and the anthropologic tradition in which it is rooted. I conclude that with careful reflection to the subjectivities that influence the research process, interdisciplinary clinically relevant applied interpretations of critical ethnographic work can be used to generate detailed knowledge across contexts in clinical care, nursing practice, and patient experiences.