17.2: Dissemination and Implementation
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- Leonard A. Jason, Olya Glantsman, Jack F. O'Brien, and Kaitlyn N. Ramian (Editors)
- DePaul University via Rebus
Chapter Eighteen Objectives
By the end of this chapter, you will be able to:
- Know the reasons why “validated” and “effective” interventions are often never used
- Identify effective ways to put research finding to use in order to improve health
- Understand advantages of participatory methods that provide more equitable engagement in the creation and use of scientific knowledge
What if our research on bringing about change was not used by society to deliver better services to others? In other words, if all the programs and interventions that have been reviewed in this book were never used by others, this would be tragic. Well, two major publications from about 20 years ago highlighted this problem of getting the public to use programs that have been validated by research.
The first influential report from the Institute of Medicine (IOM) showed that US healthcare was of low quality (IOM, 2001). So you might ask, why haven’t programs that have been shown to work and are effective been widely implemented throughout our healthcare system? We need to find answers to this question as we all have a stake in getting the most effective and safe healthcare interventions. When this IOM report was released, everyone was shocked to learn how the US healthcare system fell short of national goals for quality programs being used by the public.
There are long delays between scientific discovery and use of research findings in communities. These healthcare quality concerns were followed by a second report that showed it took an average of 17 years of science before an effective health practice program reached patients (Balas & Boren, 2000). Even more depressing, at the end of the 17 years, adoption of these practices only occurred among 15% of providers. Imagine, the healthcare you should be getting at age 20 may not reach you until you are 37 years old! And of course, that’s only if you are the lucky one out of six patients (the 15%) whose healthcare is guided by research. Based on these findings, researchers began to focus on the gap between research evidence and healthcare practices.
Ten years after the original IOM report appeared, Health Affairs , an influential journal, published new research on the “ quality chasm .” And now, after 20 years, researchers are still finding that their discoveries are not used (Brownson, Proctor, & Colditz, 2018). These high impact findings led to the development of a new field called implementation science . Read more about implementation science here .
Implementation science began because health practices, programs, and policies were not achieving their expected benefits based on their research evidence. When research shows that a treatment works, or a program addresses a problem, we want to realize those benefits in the broader world. In other words, we need to find ways to get effective practices used (or implemented) outside of research studies. Dissemination is the process by which this valuable information is made available for our use. But before we come up with solutions to this dissemination problem, let’s first review the different types of evidence, by which programs are evaluated.
WHAT IS KNOWLEDGE AND EVIDENCE?
Scientists often differentiate types of evidence. Efficacy trials (Type I evidence) are often a first step in program development. These trials establish the cause and effect of a program on its intended outcomes. Efficacy trials determine whether a program changes a health outcome under scientifically controlled conditions. Individuals connected to a university often implement these studies. The next step in developing research evidence is typically known as effectiveness trials. This Type II evidence evaluates cause and effect in community settings, and in these studies the people, such as a teacher in a school, implementing the studies are often right from the community setting. So, what has been learned by well-trained researchers from the university is now implemented from people in the field to see if positive effects are once again found. Evidence-based practices are identified through a series of efficacy and effectiveness studies published in peer-reviewed literature. The third type of evidence (Type III evidence) evaluates the implementation context, such as an organization’s readiness to implement a new practice. One community might be ready and interested to implement a program on birth control, for example, whereas another community might not want to even try to do something in this area due to a number of issues, including the controversies that surround this topic or even lack of leadership to take on such a topic. The readiness of the community is a factor that community psychologists point to as key in whether or not an intervention is successfully implemented (Scaccia et al., 2015). An important skill is being able to work with communities differently so that we take into consideration their readiness to implement an intervention.
Community psychologists often link imbalances in resource allocation to social problems. But even in the creation and distribution of the research knowledge, there might be inequitable practices. For example, some say that we should only rely on knowledge created during randomized clinical trials, as this is the best way to know whether an intervention is effective. Many members of the community, however, do not have access to the resources or skills to implement these types of expensive interventions. And more to the point, there might be many other ways to understand whether an intervention is effective. There is an important role that community members might play in the creation of knowledge. The creation of collaborative teams involving researchers and community members might be one way that allows information to be actually perceived as valuable, and then widely disseminated. We will come back to this important issue, but first let’s see how the field of Community Psychology has come up with some strategies to overcome these dissemination problems mentioned at the start of this chapter.
SolutionS TO A COMPLEX PROBLEM
Many people still believe that research knowledge moves efficiently from the research setting (e.g., University) to the community. But this is not always the case. Community psychologists Wandersman and Florin (2003) have examined the gap between research and practice, and they identified a number of the issues that need to be addressed if we are going to effectively deal with the ongoing challenge of putting research to use. It is unfortunate, but just showing that an intervention can improve health does not mean others in society will use those exciting ideas. In other words, just because there is evidence that a particular intervention can solve a health problem, there is no guarantee that it will be adopted by community members and groups. For example, many people might never even get a chance to learn about such an innovation, or the intervention could be poorly implemented so its effectiveness is compromised. Clearly, getting effective programs to be used by others is a complex process, and there are often multiple barriers that need to be addressed. Case Study 18.1 shows a real example of community psychologists addressing these types of implementation issues.
Case Study 18.1
The Veterans Health Administration
The Veterans Health Administration is the largest, integrated US healthcare system. For over 15 years, the Veterans Administration trained thousands of providers to deliver evidence-based addiction and mental healthcare. The Veterans Administration mandates evidence-based care and offers financial incentives for meeting quality measures. Yet, like most US healthcare services, only 3-28% of the Veterans Administration patient population receives the highest quality care. Understanding this limited reach of evidence-based practices is critical to the Veterans Administration policymakers, providers, Veterans, and their families.
To address this problem, Lindsey Zimmerman and her research team of community psychologists used a partnership approach to equitably involve the Veterans Administration stakeholders in implementation research. The program, Modeling to Learn , was designed according to Community Psychology values, methods, principles, and theories. They sought to develop a systems understanding of the Veterans Administration addiction and mental health services. This occurred by empowering frontline providers to improve the limited reach of evidence-based care with their existing staff and local resources (Zimmerman et al., 2016). They prioritized participatory learning, so frontline staff could better meet the needs of their local veteran communities and sustain improvements over time. They also developed and implemented effective methods to address complex problems with care coordination, medication management, psychotherapy, and the overall mix that services teams offer to reduce impairment, relapse, overdose, and suicide.
Preliminary research findings indicate that this innovative program called Modeling to Learn significantly increased the number of patients who received evidence-based care in the Veterans Administration. One important way to increase the chances that research findings like in the case study above will be used, is to be involved in Community Psychology participatory methods, as we will illustrate in the next section. These approaches emphasize more equitable engagement by citizens and scientists in the creation and use of scientific knowledge. When this occurs, it is more likely that effective interventions and improvements will be available.
COMMUNITY PSYCHOLOGY PARTICIPATORY APPROACHES
Community Psychology began when psychologists saw a better way to address some of the most pressing needs and challenges within their communities (see Chapter 1; Jason, Glantsman, O’Brien, & Ramian, 2019). As indicated throughout this book, participatory research methods are a core strategy used by community psychologists (Jason et al., 2004), and they can be effectively used to address implementation problems.
More and more researchers have learned from the field of Community Psychology to bring in community representation in early stages of research. Figure 1 of the National Institute for Drug Abuse Prevention Research Cycle above depicts the need for community input to inform all steps of research development (Robertson, et al., 2012). The NIDA research cycle allows for opportunities to include community input and address contextual factors (dashed lines) earlier in research as opposed to the tendency to use input later (solid lines). Researchers should pursue knowledge of how community factors will impact program implementation and success. The community-centered approach to implementation is community-driven. With a community-centered approach, community psychologists can ensure that their efforts in health, education, practice, policy, and/or research are actually used, as is indicated in Case Study 18.2.
Case Study 18.2
The Infectious Disease Elimination Act Exchange
The Test and Treat Rapid Access Model is designed to start someone who is diagnosed with HIV on Antiretroviral medications immediately. Angela Mooss and her team from Behavioral Science Research Institute partnered with the Infectious Disease Elimination Act Needle Exchange in Miami-Dade County, Florida, to implement this model for their clients in collaboration with community partners (e.g., HIV treatment providers). The needle exchange clientele were active injection drug users who received support to reduce the harm associated with drug use. Although Test and Treat was effectively practiced in Miami with multiple community-based organizations, the Infectious Disease Elimination Act Needle Exchange staff had concerns about their ability to use Test and Treat to link their clientele to HIV care.
Although the Test and Treat model was a best practice, effective use required addressing barriers to implementation so that it could benefit the needle exchange’s clientele. So, what did the Infectious Disease Elimination Act Needle Exchange staff do to put Test and Treat into practice? They used community-centered values and participatory methods to develop their implementation plan. A consumer, Jane Doe, helped with planning from the first meeting and identified key barriers that could have gone unnoticed and impacted the program’s success. Jane pointed out that given the timeframe, individuals who are active injection drug users would experience a “come down” during the Test and Treat process. Even with a care navigator, this would make them more likely to leave mid-way rather than complete enrollment. This would minimize the program’s effectiveness linking vulnerable individuals to life-saving treatment. Read more about the Infectious Disease Elimination Act Needle Exchange program here .
By engaging consumer voices and valuing the expertise of their community, the needle exchange staff prevented a failed implementation and they continue fine-tuning the process with ongoing feedback. As a result, the Infectious Disease Elimination Act Needle Exchange staff have found ways to make services more accessible. This includes Medication Assisted Treatment for individuals willing to begin treatment for opioid use, and the provision of Telehealth services so consumers can enroll directly in Test and Treat from the Infectious Disease Elimination Act Needle Exchange hub. Jane Doe’s voice and expertise were highly valued, and this again shows how community psychologists can partner with community members from the very beginning of their work to have programs more effectively implemented.
Program Adaptation
Successful implementation means that programs often need to be adapted to meet the special needs of the local community, whether they are care managers, foster parents, nurses, teachers, therapists, or physicians. One key question is how much a program needs to be adapted to fit with the local context ( adaptation ) versus how much it needs to be implemented as intended by developers ( fidelity ). Fidelity often declines when a program or practice developed under tightly controlled research conditions is then translated to a new community setting. There is some evidence that the closer the community members can implement the programs in ways similar to those of the researchers, the more positive are the health benefits.
However, fidelity and adaptation need not be at odds. For example, Anyon and colleagues (2019) argue that when adaptations follow some key guiding principles, successful fidelity and adaptation can be achieved (Spoth et al., 2013). If there is a core effective method in an innovation, and it is culturally tailored to a particular community, there is no reason it might not be as effective or even more effective than the original intervention. The key issue is whether the intervention continues to have those basic components that are effective and whether it is implemented in a way to which the community members are receptive. Participatory methodologies bridge the research and practice gap through a mutual flow of knowledge among researchers and communities. This bidirectional knowledge sharing goes on throughout the implementation and evaluation phases of the project.
CAPACITY BUILDING
However, there is another problem that often arises: even when a new program is adopted and used in a setting, it is not sustained. This sometimes occurs because the community has not been provided the means and training to take over the intervention. Here we can rely on another Community Psychology principle which involves building capacities for local communities to sustain their efforts over time.
In Chapter 7, Wolfe (2019) reviewed practice competencies that are used by community psychologists. Community capacity building is one of the key practice competencies to sustain the benefits of research and practice efforts. Capacity building describes activities that build tangible resources, such as a prevention program, and enable the community to sustain it. Capacity building helps to maintain staff, facilities, and other resources to deliver effective programs over time, especially when research funding ends (Brownson et al., 2018). Capacity building activities include developing a communications strategy, establishing a fund-raising plan, improving data collection and measurement systems, training, and strategic planning. Community psychologists are trained for community leadership and mentoring, facilitating small and large group processes, consultation, and resource and organizational development (Dalton & Wolfe, 2012). All of these competencies support community and organizational capacity building. By using community-centered processes to build community capacities, community psychologists help community members gain access to important resources. Learn more about an example of community-centered processes by visiting the “ Power Through Partnerships ” Community Based Participatory Research toolkit for domestic violence researchers. These types of empowering processes lay the groundwork for achieving desired outcomes and sustainability, as is indicated in Case Study 18.3.
Case Study 18.3
Children’s Trust of South Carolina
Children’s Trust of South Carolina (Children’s Trust) is a statewide nonprofit organization focused on the prevention of abuse and neglect. The vision of Children’s Trust is a South Carolina free from child abuse and neglect. The mission of Children’s Trust is to build strong families and empower communities to prevent child abuse by supporting and delivering programs, building coalitions, providing resources, and leading prevention training.
Children’s Trust is considered an intermediary organization, which means that it does not provide direct services, but partners with community-based organizations across the state, who do provide community services. As an intermediary, Children’s Trust performs five core functions: partnership engagement and communications, implementation support, research and evaluation, workforce development, and policy and finance. These functions form the foundation of the Children’s Trust Partnership Assessment , a tool by which Children’s Trust measures their success at building capacities of partner organizations to provide services within the community. The Partnership Assessment examines whether specific capacities have been built and if not, what supports are needed to achieve those specific capacities. In this way, Children’s Trust demonstrates its impact as a partner with community-based organizations to build their capacities for successful and sustained service implementation. Learn more about Children’s Trust here .
ECOLOGICAL PERSPECTIVES
In Chapter 1, the ecological model was described, and it involved multiple layers involving individuals, groups, organizations, communities, and the larger society. As is evident from the many case studies in this textbook, individuals can influence communities and communities can influence societies. In return, societies can influence communities and communities can influence individuals. This ecological model provides a useful framework to better understand the complex relationships among factors that contribute to social and community problems. Program developers and implementers need to be aware of this ecological model, as it provides a strong rationale to target our work toward multiple levels of influence. By considering ecological issues, we are better able to avoid and reduce biases (e.g., attribution effect, victim-blaming, racial prejudice) that can contribute to and perpetuate injustice. This can be particularly important for program implementers who support practitioners working in difficult and under-resourced settings. Case Study 18.4 applies the ecological model to the risk and protective factors involving child abuse and neglect.
Case Study 18.4
The Empower Action Model ®
Children’s Trust, led by Melissa Strompolis, a Community Psychologist, and an interdisciplinary team of researchers, practitioners, and community members developed “The Empower Action Model™” as a blueprint for communities to prevent child abuse and neglect and build well-being and resilience.
The Empower Action Model™ uses an expanded version of the ecological model to ensure that levels of influence are identified and protective factors are promoted among children, families, organizations, communities, and public policies (Srivastav, Strompolis, Moseley, & Daniels, 2019a). For example, parents and caregivers can protect their children by focusing on child resilience. Organizations can emphasize policies and practices that promote employee health and well-being. Communities can build protective environments for children, including parks, schools, faith-based settings, social services, and health facilities. Policymakers can also prioritize programs and initiatives that support child health and well-being (Srivastav, Strompolis, Moseley, & Daniels, 2019b). Adapting the ecological model to the mission of Children’s Trust is helping communities all over South Carolina address the very challenging problem of abuse and neglect.
Figure 3 below is useful in addressing some of the specific implementation problems discussed in this chapter.
GIVING IT AWAY
We conclude this chapter with another barrier that confronts so many people: critical knowledge about the effectiveness of programs remains in privileged settings, such as among academic and scientific audiences, behind paywalls and professional dues. Just as researchers who use participatory methods value community-held knowledge, participatory methods increase the utility and ownership of research findings in communities. Participatory methods aim to support community partners who need to have ongoing access to information and resources.
Community psychologists work to share information to reduce the access imbalance between scientists and communities. As one example, this textbook is an open-access book designed to provide an accessible, free introduction to Community Psychology. Undergraduates can now freely join the Society for Community Research and Action as an Associate member, something that the editors of this textbook successfully advocated for with the leadership of this organization. The Community Psychologist and Global Journal of Community Psychology Practice are also online and open access. Throughout this book, consistent with community-centered values and capacity-building principles, you can learn about free and open blogs, podcasts, and webinars based on collaborations between community psychologists and communities, putting new research knowledge to greater use.
SUMMING UP
In this chapter, we have shown that the research conducted by psychologists does not often have an impact on the social and community problems that need our attention. One reason this information is not widely spread is that many programs, practices, and policies continue to be developed with minimal input from community members. More and more, we are recognizing the problems with this one-sided unidirectional transfer of knowledge.
But the field of Community Psychology does offer a solution to this problem, and by following its values, there is a higher likelihood that the research will be used by community members and those in a position of policy. This chapter has shown the advantages of using participatory research methods, which emphasize more equitable engagement in the creation and use of scientific knowledge. When using such methods, there is a higher chance that the research will actually translate into programs and be used by members of the community even when the researchers have finished their work. A key to this approach is building capacities for local communities to sustain and grow their efforts. Often problems that we face are complicated, and the field of Community Psychology offers an ecological approach to target multi-layered contributors to problems so that useful and effective approaches are widely implemented.
Critical Thought Questions
- Where have you seen a new policy or practice implemented that was not effective?
- What Community Psychology approaches would have helped in this situation?
- What are the advantages of partnering with those closest to community problems to improve implementation?
- In the case studies, what types of organizations are the community psychologists working in or partnering with to address implementation problems?
- After reading this chapter, which implementation problems do you believe are hardest to address?
Take the Chapter 18 Quiz
View the Chapter 18 Lecture Slides
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REFERENCES
Anyon, Y., Roscoe, J., Bender, K., Kennedy, H., Dechants, J., Begun, S., & Gallager, C. (2019). Reconciling adaptation and fidelity: Implications for scaling up high quality youth programs. The Journal of Primary Prevention , 40 , 35–49
Balas, E. A., & Boren, S. A. (2000). Managing clinical knowledge for health care improvement. Y earbook of Medical Informatics , 9 , 65-70.
Brownson, R. C., Coldtiz, G. A., & Proctor, E. K. (2018). Dissemination and implementation research in health: Translating science to practice (2nd edition) . New York, NY: Oxford University Press.
Dalton, J., & Wolfe, S. M. (2012). Joint column: Education connection and the community practitioner. The Community Psychologist , 45 , 7-13.
Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st century . Washington, DC: National Academy Press. Retrieved from http://www.nationalacademies.org/hmd/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx
Jason, L. A., Glantsman, O., O’Brien, J. F., & Ramian, K. N. (2019). Introduction to the field of Community Psychology. In L. A. Jason, O. Glantsman, J. F. O’Brien, & K. N. Ramian (Eds.), Introduction to Community Psychology: Becoming an agent of change . Retrieved from https://press.rebus.community/introductiontocommunitypsychology/chapter/intro-to-community-psychology/
Jason, L. A., Keys, C. B., Suarez-Balcazar, Y., Taylor, R. R., Davis, M., Durlak, J., & Isenberg, D. (Eds.). (2004). Participatory community research: Theories and methods in action . Washington, DC: American Psychological Association.
Robertson E. B., Sims B. E., & Reider E. E. (2012). Partnerships in drug abuse prevention services research: Perspectives from the National Institute on Drug Abuse. Administration and Policy in Mental Health and Mental Health Services Research , 39, 327–330.
Scaccia, J. P., Cook, B. S., Lamont, A., Wandersman, A., Castellow, J., Katz, J., & Beidas, R. S. (2015). A practical implementation science heuristic for organizational readiness: R = Mc2. Journal of Community Psychology , 43 (4), 484–501. doi.org/10.1002/jcop.21698
Spoth, R., Rohrbach, L. A., Greenberg, M., Leaf, P., Brown, C. H., Fagan, A., … & Hawkins, J. D. (2013). Addressing core challenges for the next generation of type 2 translation research and systems: The translation science to population impact (TSci Impact) framework. Prevention Science , 14 , 319–351.
Srivastav, A., Strompolis, M., Moseley, A., & Daniels, K. (2019a). The Empower Action Model©: Mobilizing prevention to promote well-being and resilience . Retrieved from https://scchildren.org/wp-content/up...arch-brief.pdf
Srivastav, A., Strompolis, M., Moseley, A., & Daniels, K. (2019b). The Empower Action Model©: A framework for promoting equity, health, and well-being. Health Promotion Practice .
Wandersman, A., & Florin, P. (2003). Community interventions and effective prevention. American Psychologist , 58 , 441-448.
Wolfe, S. M. (2019). Practice competencies. In L. A. Jason, O. Glantsman, J. F. O’Brien, & K. N. Ramian (Eds.), Introduction to Community Psychology: Becoming an agent of change . Retrieved from https://press.rebus.community/introductiontocommunitypsychology/chapter/practice-competencies/
Zimmerman, L., Lounsbury, D. W., Rosen, C. S., Kimerling, R., Trafton, J. A., & Lindley, S. E. (2016). Participatory system dynamics modeling: Increasing stakeholder engagement and precision to improve implementation planning in systems. Administration and Policy in Mental Health and Mental Health Services Research , 1–16.


33.1.6: Phylum Mollusca
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Learning Objectives
- Describe the unique anatomical and morphological features of molluscs
Phylum Mollusca
Phylum Mollusca is the predominant phylum in marine environments. It is estimated that 23 percent of all known marine species are mollusks; there are around 85,000 described species, making them the second most diverse phylum of animals. The name “mollusca” signifies a soft body; the earliest descriptions of mollusks came from observations of unshelled cuttlefish. Mollusks are predominantly a marine group of animals; however, they are known to inhabit freshwater as well as terrestrial habitats. Mollusks display a wide range of morphologies in each class and subclass. They range from large predatory squids and octopus, some of which show a high degree of intelligence, to grazing forms with elaborately-sculpted and colored shells. In spite of their tremendous diversity, however, they also share a few key characteristics, including a muscular foot, a visceral mass containing internal organs, and a mantle that may or may not secrete a shell of calcium carbonate.
Mollusks have a muscular foot used for locomotion and anchorage that varies in shape and function, depending on the type of mollusk under study. In shelled mollusks, this foot is usually the same size as the opening of the shell. The foot is a retractable as well as an extendable organ. It is the ventral-most organ, whereas the mantle is the limiting dorsal organ. Mollusks are eucoelomate, but the cavity is restricted to a region around the heart in adult animals. The mantle cavity develops independently of the coelomic cavity.
The visceral mass is present above the foot in the visceral hump. This includes digestive, nervous, excretory, reproductive, and respiratory systems. Mollusk species that are exclusively aquatic have gills for respiration, whereas some terrestrial species have lungs for respiration. Additionally, a tongue-like organ called a radula, which bears chitinous tooth-like ornamentation, is present in many species, serving to shred or scrape food. The mantle (also known as the pallium) is the dorsal epidermis in mollusks; shelled mollusks are specialized to secrete a chitinous and hard calcareous shell.
Most mollusks are dioecious animals where fertilization occurs externally, although this is not the case in terrestrial mollusks, such as snails and slugs, or in cephalopods. In some mollusks, the zygote hatches and undergoes two larval stages, trochophore and veliger, before becoming a young adult; bivalves may exhibit a third larval stage, glochidia.
Key Points
- A mollusk’s muscular foot is used for locomotion and anchorage, varies in shape and function, and can both extend and retract.
- The visceral mass inside the mollusk includes digestive, nervous, excretory, reproductive, and respiratory systems.
- Most mollusks possess a radula, which is similar to a tongue with teeth-like projections, serving to shred or scrape food.
- The mantle is the dorsal epidermis in mollusks; in some mollusks it secretes a chitinous and hard calcareous shell.
Key Terms
- visceral mass : the soft, non-muscular metabolic region of the mollusc that contains the body organs
- mantle : the body wall of a mollusc, from which the shell is secreted
- radula : the rasping tongue of snails and most other mollusks


10.22: Visual_Processing
Visual signals are processed in the brain through several different pathways.
- Describe the complexity of visual processing in the brain
Key Points
- The magnocellular pathway carries information about form, movement, depth, and differences in brightness; the parvocellular pathway carries information on color and fine detail.
- The optic chiasma allows us to coordinate information between both eyes and is produced by crossing optical information across the brain.
- Visual signals move from the visual cortex to either the parietal lobe or the temporal lobe.
- Some signals move to the thalamus, which sends the visual signals to the primary cortex.
- Visual signals can also travel from the retina to the superior colliculus, where eye movements are coordinated with auditory information.
- Visual signals can move from the retina to the suprachiasmatic nucleus (SCN), the body’s internal clock, which is involved in sleep/wake patterns and annual cycles.
Key Terms
- superior colliculus : the primary area of the brain where eye movements are coordinated and integrated with auditory information
- optic chiasma : found at the base of the brain and coordinates information from both eyes
- suprachiasmatic nucleus : cluster of cells that is considered to be the body’s internal clock, which controls our circadian (day-long) cycle
Higher Processing
The myelinated axons of ganglion cells make up the optic nerves. Within the nerves, different axons carry different parts of the visual signal. Some axons constitute the magnocellular (big cell) pathway, which carries information about form, movement, depth, and differences in brightness. Other axons constitute the parvocellular (small cell) pathway, which carries information on color and fine detail. Some visual information projects directly back into the brain, while other information crosses to the opposite side of the brain. This crossing of optical pathways produces the distinctive optic chiasma (Greek, for “crossing”) found at the base of the brain and allows us to coordinate information from both eyes.
Once in the brain, visual information is processed in several places. Its routes reflect the complexity and importance of visual information to humans and other animals. One route takes the signals to the thalamus, which serves as the routing station for all incoming sensory impulses except smell. In the thalamus, the magnocellular and parvocellular distinctions remain intact; there are different layers of the thalamus dedicated to each. When visual signals leave the thalamus, they travel to the primary visual cortex at the rear of the brain. From the visual cortex, the visual signals travel in two directions. One stream that projects to the parietal lobe, in the side of the brain, carries magnocellular (“where”) information. A second stream projects to the temporal lobe and carries both magnocellular (“where”) and parvocellular (“what”) information.
Another important visual route is a pathway from the retina to the superior colliculus in the midbrain, where eye movements are coordinated and integrated with auditory information. Finally, there is the pathway from the retina to the suprachiasmatic nucleus (SCN) of the hypothalamus. The SCN is a cluster of cells that is considered to be the body’s internal clock, which controls our circadian (day-long) cycle. The SCN sends information to the pineal gland, which is important in sleep/wake patterns and annual cycles.
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2.4: Post-test
1. Put in order of importance, or the order in which needs should be met, the following needs from Maslow’s Hierarchy of Needs:
- Safety and Security Needs
- Love and Belonging Needs
- Physical Needs
- Self-actualization Needs
- Self-esteem Needs
2. Which of the following statements best reflects cultural competence?
- Telling an Asian child, “You must get all A’s in math because all Asians are good at math.”
- Telling a Spanish speaking patient, “You are in America now. You should learn to speak English.”
- Telling your boss, “I will only work with Caucasian patients.”
- Asking your patient who is Native American, “Tell me about your beliefs so that I can understand you more.”
3. True or False: It is important to find out your patient’s gender preference, preferred name, and who is considered to be part of their family to ensure health care is provided in a culturally competent manner.
4. Which of the following is NOT a cliche?
- “It will all work out for the best.”
- “I know exactly how you feel.”
- “Hang in there. It will get better.”
- “You sound as if you are feeling scared. Would you like to talk about it?”
- “We are never given more than we can handle.”
5. Which of the following are nonverbal methods of communication? Select all that apply.
- Nodding
- Tone of voice
- Crossing arms over the chest
- Eye contact
- Touching a shoulder
- How near a person stands to another
- Slouching in a seat
- Rolling of the eyes
- Sighing
6. Which of the following are things you can do to show you are a good listener? Select all that apply.
- Face the person you are speaking.
- Respect cultural differences and beliefs
- Avoid calling patients “honey” or “dear” and use their preferred name of address.
- Provide silence so a patient can gather their thoughts.
- Restate what you heard the patient say and ask for clarification when you are unsure of what they are trying to express.
- Don’t finish the patient’s sentences or interrupt them while they are speaking.
7. Which of the following is an effective means of communicating with a person who has a hearing impairment?
- Shout as loud as you can.
- Stand behind the patient while talking to them.
- Use a high pitched and loud voice.
- Avoid talking to the patient at all, because they can’t hear you anyway.
- Stand in front of the patient and use a clear, low voice while speaking.
8. Which of the following is an effective way to help a person with a visual impairment?
- Ensure the patient wears their glasses.
- Use the clock method to indicate where food is during mealtimes.
- Ensure the patient knows the objects in their path while walking.
- Keep the environment clutter free to avoid falls.
- Read aloud to the patient if they are unable to do so.
9. What is the best way to establish a therapeutic relationship?
- Don’t allow patients to make choices. Tell them what to do.
- Arrive to work on time and complete assigned tasks.
- Do things for the patient they are able to do independently, as it is important they rely on the home care worker as much as possible.
- Tell anyone who asks about the patient as much information as you know.
10. True or False: It is okay to continue to visit a patient once they are no longer receiving home care services from the agency.
11. Which of the following is an example of objective information that can be included in documentation?
- “The patient was very rude to me this morning when I tried to bathe him.”
- “The patient’s right leg is swollen, red, and warm to the touch.”
- “I don’t think the patient should be allowed to visit with their family because she cries when they leave.”
- “I think the patient has a cold because he sneezed a lot today.”
12. True or False: Documentation should be completed immediately after a home care visit once tasks have been completed, and before moving on to work with the next patient.
13. True or False: An error in documentation should have one line drawn through it with the home care worker’s initials and the date next to the error.
14. True or False: It is okay to document all the tasks on the home care worker’s assigned task list before they are completed.
15. True or False: Abuse that is witnessed or suspected must always be documented and reported to a supervisor immediately.
16. Which of the following are examples of abuse and/or neglect? Select all that apply.
- Bite marks
- Yelling at a patient
- Violence witnessed in the home
- Not pureeing food as directed in the Care Plan, for a patient who cannot chew
- Harshly pushing a fork into a patient’s mouth when they refuse to open their mouth
- Allowing a patient to lie in their own urine or feces
- Burn marks
- Pressure ulcers
17. True or False: Patients have a right to be informed of the health care they are to receive and they have a right to refuse treatment and make decisions about their own health care.
18. Which of the following are ways to protect patient confidentiality? Select all that apply.
- Only share information with people the patient designates can receive information.
- Don’t include identifying patient information in voicemails or emails.
- Don’t take photos of a patient, their home, or belongings.
- Don’t talk about patients in public places.
- Don’t tell family, friends, or people outside the healthcare team information about the patient.
19. True or False: A DNR order is a physician order which states the patient does not want CPR to be performed.
20. True or False: HIPPA is a law that protects a patient’s right to privacy about their health care. If a HHA/PCA violates this right to privacy, it can result in monetary fines, prison sentence, and/or getting fired.
- Answer
-
1. C, A, B, E, D
2. D
3. True
4. D
5. These are all nonverbal methods of communication
6. All are ways to show you are a good listener
7. E
8. All are effective ways to help a person with a visual impairment
9. B
10. False
11. B
12. True
13. True
14. False
15. True
16. All are signs of abuse or neglect
17. True
18. All are ways to protect patient confidentiality.
19. True
20. True


1.1: History and Current Issues in Women's Health
Chapter Objectives:
- Outline events that had, or continue to have, a significant impact on women’s health
- Explore topics that impact your own personal health
- Discuss current issues regarding health care for women in the US
- Explore how health care options for women in the US compare to healthcare options in other countries
- Explore factors that impact a woman’s access to quality and affordable health care
- Identify criteria for finding valid and reliable health information on the Internet
Women’s Health History
I’m interested in women’s health because I am a woman. I would be a darn fool to not be on my own side. ~Maya Angelou
Communities and countries and ultimately the world are only as strong at the health of their women. – Michelle Obama
Development of Women’s Health Care in the US
If you had to pick just one, what event, discovery, development or invention do you feel has had the greatest impact on women’s health? Ideas such as birth control or women’s right to vote, Roe vs Wade or even Title IX may quickly come to mind. What about safe birthing practices or the women’s health movement of the 1970’s? Consider that women from minority groups are now better represented in the health care field? In reading the following articles about the history of health care in the US, reflect on how our choices today may be different if not for these developments.
Article: History of Women’s Health Movement in the 20th Century
Understanding Personal Health History
Considering how significant events in our collective health history impact resources and accessibility is the first step. Next, we need to explore how current health accessibility, education, and regulations impact our personal wellness and health choices today. As you begin to ask yourself about choices you make for your health now and information you will need for future health choices, it is important to explore criteria for defining health and wellness as well as understanding how to seek valid and reliable sources of health information.
Broad Perspectives of Health
The most widely used of the broader definitions of health if from the World Health Organization (WHO), which defines health “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. This classic definition is important, as it identifies the vital components of health. Well-being includes the presence of positive emotions and moods, the absence of negative emotions, satisfaction with life, fulfillment and positive functioning. In simple terms, well-being can be described as judging life positively and feeling good. Well-being is associated with numerous health, job, family, and economically related benefits. For example, higher levels of well-being are associated with decreased risk of disease, illness, and injury; better immune functioning; speedier recovery; and increased longevity. Individuals with high levels of well-being are more productive at work and are more likely to contribute to their communities. Many practitioners have expanded their focus to include wellness at the positive end of the health continuum. Wellness is being in good physical and mental health. Because mental health and physical health are linked, problems in one area can impact the other. At the same time, improving your physical health can also benefit your mental health, and vice versa. It is important to make healthy choices for both your physical and mental well-being. Remember that wellness is not just the absence of illness or stress. One can still strive for wellness even while experiencing these challenges in life. To more fully understand the meaning of health, it is important to understand each of its individual components of wellness.
The Six Dimensions of Wellness
Think of each dimension as a continuum that can include more healthful or less healthful behaviors. Goals can be set to move each individual marker towards better balance rather then expecting perfection in all areas.
Physical
Body functioning; recognizing the need for physical activity, healthy foods, and adequate sleep. Avoiding unhealthy habits.
 Having positive relationships
Intellectual
Recognizing creative abilities and finding ways to expand knowledge and skills. Being open-minded.
Emotional
Coping effectively with life and expressing emotions in an appropriate manner.
Spiritual
Having a sense of purpose and meaning in life; establishing peace, harmony, and balance in our lives.
Environmental
Occupying pleasant, healthy, and safe environments that support wellbeing. Positively impacting the quality of our surroundings (including protecting and preserving nature).
Learning about the Six Dimensions of Wellness can help a person choose how to make healthful choices a part of everyday life.
Determinants of Health
The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health . What makes some people healthy and others unhealthy? We may know what actions promote health but for various reasons may not have access to the tools necessary to make long term, positive changes. How can we create a society in which everyone has a chance to live a long, healthy life?
Determinants of health are factors that contribute to a person’s current state of health. These factors may be biological, socioeconomic, psychosocial, behavioral, or social in nature. Scientists generally recognize five determinants of health of a population:
Policymaking
Policies at the local, state, and federal level affect individual and population health. Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products.
Some policies affect entire populations over extended periods of time while simultaneously helping to change individual behavior. For example, the 1966 Highway Safety Act and the National Traffic and Motor Vehicle Safety Act authorized the Federal Government to set and regulate standards for motor vehicles and highways. This led to an increase in safety standards for cars, including seat belts, which in turn reduced rates of injuries and deaths from motor vehicle accidents.
Does all policy contribute positively to health for all? We will be exploring this question more in future chapters.
Social Factors
Social determinants of health reflect the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age. Also known as social and physical determinants of health, they impact a wide range of health, functioning, and quality-of-life outcomes. Examples of social determinants include:
- Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods
- Social norms and attitudes, such as discrimination
- Exposure to crime, violence, and social disorder, such as the presence of trash
- Social support and social interactions
- Exposure to mass media and emerging technologies, such as the Internet or cell phones
- Socioeconomic conditions, such as concentrated poverty
- Quality schools
- Transportation options
- Public safety
- Residential segregation
Examples of physical determinants include:
- Natural environment, such as plants, weather, or climate change
- Built environment, such as buildings or transportation
- Worksites, schools, and recreational settings
- Housing, homes, and neighborhoods
- Exposure to toxic substances and other physical hazards
- Physical barriers, especially for people with disabilities
- Aesthetic elements, such as good lighting, trees, or benches
Poor health outcomes are often made worse by the interaction between individuals and their social and physical environment. For example, millions of people in the United States live in places that have unhealthy levels of ozone or other air pollutants. In counties where ozone pollution is high, there is often a higher prevalence of asthma in both adults and children compared with state and national averages. Poor air quality can worsen asthma symptoms, especially in children.
Health Services
Both access to health services and the quality of health services can impact health. Healthy People 2020 directly addresses access to health services as a topic area and incorporates quality of health services throughout a number of topic areas.
Lack of access, or limited access, to health services greatly impacts an individual’s health status. For example, when individuals do not have health insurance, they are less likely to participate in preventive care and are more likely to delay medical treatment.
Barriers to accessing health services include:
- Lack of availability
- High cost
- Lack of insurance coverage
- Limited language access
These barriers to accessing health services lead to:
- Unmet health needs
- Delays in receiving appropriate care
- Inability to get preventive services
- Hospitalizations that could have been prevented
Individual Behavior
Individual behavior also plays a role in health outcomes. For example, if an individual quits smoking, his or her risk of developing heart disease is greatly reduced. Many public health and health care interventions focus on changing individual behaviors such as substance abuse, diet, and physical activity. Positive changes in individual behavior can reduce the rates of chronic disease in this country.
Examples of individual behavior determinants of health include:
- Diet
- Physical activity
- Alcohol, smoking, vaping, and other drug use
- Hand washing
Biology and Genetics
Some biological and genetic factors affect specific populations more than others. For example, older adults are biologically prone to being in poorer health then adolescents due to the physical and cognitive effects of aging.
Sickle cell disease is a common example of a genetic determinant of health. Sickle cell is a condition that people inherit when both parents carry the gene for sickle cell. The gene is most common in people with ancestors from West African countries, Mediterranean countries, South or Central American countries, Caribbean islands, India, and Saudi Arabia.
Examples of biological and genetic social determinants of health include:
- Age
- Sex
- HIV status
- Inherited conditions, such as sickle-cell anemia, hemophilia, and cystic fibrosis
- Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and ovarian cancer
- Family history of heart disease
Health Disparities
Although the term disparities is often interpreted to mean racial or ethnic disparities, many dimensions of disparity exist in the United States, particularly in health. If a health outcome is seen to a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. Healthy People strives to improve the health of all groups.
To better understand the context of disparities, it is important to understand more about the U.S. population. In 2008, the U.S. population was estimated at 304 million people.
- In 2008, approximately 33%, or more than 100 million people, identified themselves as belonging to a racial or ethnic minority population.
- In 2008, 51%, or 154 million people, were women.
- In 2008, approximately 12%, or 36 million people not living in nursing homes or other residential care facilities, had a disability.
- In 2008, an estimated 70.5 million people lived in rural areas (23% of the population), while roughly 233.5 million people lived in urban areas (77%).
- In 2018, an estimated 4% of the U.S. population ages 18 to 44 identified themselves as lesbian, gay, bisexual, or transgender.
Healthy People 2020 defines health equity as the “attainment of the highest level of health for all people”. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”
Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”
Over the years, efforts to eliminate disparities and achieve health equity have focused primarily on diseases or illnesses and on health care services. However, the absence of disease does not automatically equate to good health. Powerful, complex relationships exist between health and biology, genetics, and individual behavior, and between health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies. These factors, which influence an individual or population’s health, are known as determinants of health.
For all Americans, other influences on health include the availability of and access to:
- High-quality education (including quality health education)
- Nutritious food
- Decent and safe housing
- Affordable, reliable public transportation
- Culturally sensitive health care providers
- Health insurance
- Clean water and non-polluted air
Risk Factors and Levels of Disease Prevention
Part of learning how to take charge of one’s health requires understanding risk factors for different diseases. Risk factors are things in life that increase your chances of getting a certain disease. Some risk factors are beyond your control. A person may be born with them or have exposure with no fault assigned.
Some risk factors that you have little or no control over include:
- Family history of a disease
- Sex
- Ancestry
Some controllable risk factors include:
- What you eat
- How much physical activity you get
- Whether you use tobacco or vape
- How much alcohol you drink
- Whether you misuse drugs
In fact, it has been estimated that almost 35 percent of all U.S. early deaths in 2000 could have been avoided by changing just three behaviors:
- Stopping smoking
- Eating a healthy diet (for example, eating more fruits and vegetables and less red meat)
- Getting more physical activity
A person can have one risk factor for a disease or many. The more risk factors a person has, the more likely they will get the disease. For example, if people eat healthy, exercise on a regular basis, and control blood pressure, their chances of getting heart disease are less than those of diabetics, smokers, and sedentary people. To lower your risks, take small steps toward engaging in a healthy lifestyle, and you’ll see big rewards.
People with a family health history of chronic disease may have the most to gain from making lifestyle changes. You can’t change your genes, but you can change behaviors that affect your health, such as smoking, inactivity, and poor eating habits. In many cases, making these changes can reduce your risk of disease even if the disease runs in your family. Another change you can make is to have screening tests, such as mammograms and colorectal cancer screening. These screening tests help detect disease early. People who have a family health history of a chronic disease may benefit the most from screening tests that look for risk factors or early signs of disease. Finding disease early, before symptoms appear, can mean better health in the long run.
Levels of Disease Prevention
Prevention includes a wide range of activities — known as “interventions” — aimed at reducing risks or threats to health. You may have heard researchers and health experts talk about three categories of prevention: primary, secondary and tertiary. What do they mean by these terms?
Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur. Examples include:
- Legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets)
- Education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking)
- Immunization against infectious diseases.
Secondary prevention aims to reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent re-injury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems.
Examples include:
- Regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer)
- Daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes
- Suitably modified work so injured or ill workers can return safely to their jobs.
Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy. Examples include:
- Cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.)
- Support groups that allow members to share strategies for living well
- Vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible.
Current Issues in Women’s Health
Understanding health history, factors that influence wellness and behaviors that improve personal wellness all contribute to a persons current state of health. Now, lets look at current issues or policy in our society that impact a person’s access to health care or influence health care choices.
Podcast: How the US Fails Women When it Comes to Health
Valid and Reliable Health Resources
How can you learn more about your own personal health history, disparities, risk factors and possible impact on your life now? As you begin to seek information to improve your own wellness, it is important to understand where to find reliable health information. As you know, anyone can create a a web page and post any information they choose for public perusal. Some of this information, subtly or not so subtly, may have an ulterior motive in selling products, influencing your actions or even your vote. So, when looking for information to care for your own health, how do you discern useful and accurate information from the rest? In other words, who are you willing to trust with your health?
Article: How To Find Reliable Health Information on the Internet
Check for Understanding
- Reflecting on the reading, what event, development or discovery do you feel has had the greatest impact on women’s health?
- What current issues in women’s health are of particular interest to you and why?
- What are the dimensions of wellness and how might these factors influence each other?
- What are the determinants of health and give examples of how these determinist may impact your personal health.
- What is a risk factor an what is the difference between uncontrollable and controllable risk factors?
- What are the three levels of disease prevention?
- How does US health care compare to that of other developed countries? Name one area the US is doing well and one area we are failing.
- What factors might impact a woman’s access to quality, affordable health care?
- When researching health information online, what are at least 4 things you should know about the article to judge validity and reliability?


8.2: Is there a "hidden curriculum"? Where is it hiding?
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by Aubrey W. Bibbs, Jr.
Learning Objectives
1. Reader should be able to recognize various types of hidden curriculum/character education.
2. Reader will be able to identify reasons for implementing a hidden curriculum/character education into an existing curriculum.
3. Readers are expected to distinguish the differences between the goals associated with hidden curriculum/character education from those of a traditional/formal curriculum
Introduction
The Random House College Dictionary (1988) defines curriculum as: “the aggregate of courses of study given in a school, college, etc” (p. 328). The term “hidden curriculum” comes from the concept that such an aggregate of courses is comprised of a curriculum which is both formal and informal, also known as written or directed curriculum and unwritten or undirected curriculum respectively. Formal curriculum is traditionally an explicit lesson plan, either produced by the individual teacher or created by the school/school district intended to address intellect and/or vocation, and teach lessons in areas of study such as: mathematics, science, reading, writing and art. Informal curriculum, commonly referred to as hidden curriculum, due to its implicit nature, addresses behavioral and character aspects of life which include, but are not limited to: social responsibility, personal relationships, competition, respect for authority and time management. These aspects are taught by such methods, techniques and procedures as class bells, restroom passes, dress codes, classroom etiquette, class rank charts, etc.
The general consensus is that hidden curriculum has the potential to teach, stimulate and foster good or bad lessons, behavioral pattern and character traits respectively. Some educators feel that hidden curriculum is creating more negative repercussions for students and society, than it is positive results. John Taylor Gatto (1992) expressed his concern during a speech by stating, “…these are the things you pay me to teach. 1. CONFUSION…2. CLASS POSITION…3. INDIFFERENCE…4. EMOTIONAL DEPENDENCY…5. INTELLECTUAL DEPENDENCY…6. PROVISIONAL SELF-ESTEEM…7. ONE CAN’T HIDE…” (p. 2-12). His main argument was that hidden curriculum was “dumbing us down” (Gatto). This was a popular sentiment echoed throughout school systems and communities in the U.S. over the past thirty to forty years.
Teaching Character
Recently, in the past ten to fifteen years, there has been a collective effort by parents, educators and politicians alike for schools to look into placing more focus on areas of hidden curriculum such as, character education; also referred to as value education or moral education intended to help students “to acquire certain character strengths: sound judgment, a sense of responsibility, personal courage, and self-mastery” (Ryan & Bohlin, 1999, p. 207), and realize both the individual benefit and the benefit to the greater good of society when they “internalize these lifelong habits” (p. 207). This movement was brought on by obvious indications that our nation's youth was lacking sufficient moral fiber as demonstrated through “frightening statistics about youth homicides and suicides and by soaring numbers of teen pregnancies“ (p. xiii), staggering high school drop out rates and gang affiliation. As a result of the movement to create formal programs which propagate positive outcomes by focusing on the potential that hidden curriculum has to influence character development, the term “hidden curriculum” has become synonymous with character education. Another point presented by advocates for character education is that a value/moral driven curriculum was deemed a necessity by our nation’s founding fathers, such a Thomas Jefferson, who believed that formally teaching virtue early on was integral to the ultimate success of our nation and its established structure (Lickona, 1991).
Note
“To educate a person in mind and not in morals is to educate a menace to society” (Lickona, 1991, p. 3).
Criticism
One would be hard pressed to find a teaching philosophy, idea or technique that was introduced without some form of criticism, skepticism or opposition. So, despite concerns from educators in regards to the countless challenges that students face beyond the scope of academics, an air of skepticism still lingers among many. Taking into consideration the enormous pressures placed on educators to create and implement lesson plans in accordance with No Child Left Behind legislation, consequently forcing many teachers to make drastic adjustments to their preexisting curricula and teaching styles; many educators find it unfeasible to introduce and implement a character driven curriculum while simultaneously maintaining a traditional academic driven curriculum (Allred, 2008, November). Another source of pessimism stem from claims that character education “amounts to imposing particular values or personality traits on young people or crude manipulations of children by dominant powers in their lives” (Ryan & Bohlin, 1999, p. 140). Simply put, some educators feel that character education is nothing short of “brainwashing” (Ryan & Bohlin, p. 140) children. Aside from fear of a decline in academic standing, failing to meet academic benchmarks or indoctrination, educators are open to and optimistic about employing a curriculum that encompasses both academic advancement and character development.
Character Education Programs
There are dozens of character education programs in practice today, making it unfeasible to discuss each one individually. Instead, an overview of some of the key overlapping points from the numerous character education programs currently in use is a more practical approach. Most programs adopt a curriculum centered on a structure that promotes a synergy among the individual student, community and society. Essentially, these programs expect to teach students to make positive decisions not just for self benefit, but for the well being of others. Due to the nature of such programs and their goals, they are often divided into components or levels. Some programs consist of more components than others (components within components), but essentially share three similar components: the school, the family and the community. Additionally, these programs rely heavily on a philosophy that encourages students to use a three division cycle of self-reflection in order to develop good character habits. This cycle is comprised of a continuum of moral knowing/thoughts/thought, moral feeling/feelings/emotion, moral actions/actions/response. Supplemental lessons/techniques common to character education programs include: leading by example, moral literature, storytelling, and cooperative learning to name a few.
Positive Action, a character education program which has been widely used in the state of California for over five years is an example of a program that has successfully incorporated a synergistic structure in its lesson format combined with a self-reflecting philosophy in efforts to build good character traits and behavior while maintaining, and in many cases improving academic standards. In fact, “it was recognized as the only program in the nation to simultaneously improve academics and behavior in character education” (Allred, 2008, November, p. 27) by the U.S. Department of Education What Works Clearinghouse.
Note
“Only a virtuous people are capable of freedom. As nations become corrupt and vicious, they have more need of a master…Nothing is of more importance for the public weal, than to form and train up youth in wisdom and virtue" (Ryan & Bohlin, 1999, p. 220).
Conclusion
Hidden curriculum, more specifically, character education has been revered by many as an essential educational element since the birth of our nation and the development of our nation's educational system. Despite mild criticism, character education has an abundance of benefits on an individual, communal and societal level having both immediate and long term pay outs. Additionally, taking inventory of the moral issues associated with our nation’s teenage demographic couple with evidence that character education has the ability to simultaneously instill strong morals and values, creating good character and improve academic performance is proof positive that there is an ever present need for a curriculum that incorporates character education into traditional academic driven education.
Exercise \(\PageIndex{1}\)
1. Which of the following is an aspect of hidden curriculum?
a. Intellect
b. Vocation
c. Competition
d. Formal education
2. Which of the following is not an issue which sparked the movement for implementing character education?
a. A national increase in mathematical aptitude
b. Gang affiliation
c. Teen Pregnancy
d. Youth suicide rates
3. Ms. Trinidad is a second grade teacher at Lakeview Elementary in Portsmouth, Virginia. She feels that she's under a tremendous amount of pressure to succeed, considering she's a first year educator. Ms. Trinidad has recently attended a lecture about character education. She was impressed by the lecture, but isn't sure she can manage merging any new programs with her existing curriculum. What's something Ms. Trinidad can do to implement character education without effecting her current curriculum too much?
a. Teach a traditional curriculum for the first half of the year, and character education for the second half of the year
b. Try a different technique everyday until she finds one that's reasonable
c. Adopt a new curriculum which is completely dedicated to character education
d. Integrate moral literature into her daily story telling time.
4. Mr. Carver, one of Ms. Trinidad's colleagues has noticed drastic improvement in the general behavior and class conduct of Ms. Trinidad's students since she's implemented a few character education techniques into her lesson plans. Mr. Carver is extremely impressed and ponders on the potential of such techniques to help improve his students' behavior, but is reluctant implement such techniques into his lesson plan. What could be potentially holding Mr. Carver back from implementing character techniques of his own into his current curriculum?
a. Doing so has the potential to interfere with and/or ruining a preexisting state exam preparation schedule
b. That implementing such techniques will actually help improve his students' behavior
c. That his colleagues will judge him for blending character education into his formal curriculum
d. He feels that character education techniques are not as likely to work on his class of fifth graders as well as it did for Ms. Trinidad's class second graders
- Answer
-
1.) c.
2.) a.
3.) d.
4.) a
References
Allred, C.G. (2008, November). Improving academics, behavior and character. Leadership , 38(2), 26-29. Retrieved December 12, 2008, from Education Research Complete database.
Gatto, J.T. (1992). Dumbing us down . Philadelphia: New Society.
Hagee, A. (2003). Educating the heart . Tucson, AZ: Zephyr Press.
Licona, T. (1991). Educationg for character: How our schools can teach respect and responsibility . New York: Bantam Books.
Ryan, K., Bohlin, K.E. (1999). Building character in schools: Practical ways to bring moral instruction to life . San Francisco: Jossey-Bass.
Ryan, K., Bohlin, K.E. (1999). Preface. Building character in schools: Practical ways to bring moral instruction to life . San Francisco: Jossey-Bass.
Ryan, K., Bohlin, K.E. (1999). Appendix. Building character in schools: Practical ways to bring moral instruction to life . San Francisco: Jossey-Bass.
Stein, J., Hauck, L.C., SU, P.Y. (Eds.). (1988). Curriculum. The Random House college dictionary (Revised ed.). New York: Random House.


15.0: Prelude to Next Steps
“How can you know what you’re capable of if you don’t embrace the unknown?”—Esmeralda Santiago
In 2010, two graduate students participated in a project to assist post-earthquake relief efforts for Haitians. These two students focused on the need for light. For most people, we turn on a light switch and seldom ever consider how important light is to our safety and extending our sight beyond dependence on the sun for daylight. Andrea Sreshta and Ana Stork analyzed the problems people have after a disaster and noticed that no one addressed the challenges of lack of light. Recognizing the opportunity to solve this problem, these two social entrepreneurs created a reusable solar powered light source, LuminAID.
Now that you have learned how to create a business plan and understand more about entrepreneurship, we turn to the challenges that many entrepreneurs face as they start their venture, with advice to help you overcome them and consider your next steps beyond the current venture’s successes.
In this chapter, we consider some of the challenges faced by entrepreneurs along the journey, identify reasons why these occur, and discuss what we can do to avoid these challenges through proactive problem solving and understanding biases and habits that get in the way of our success. Some of the themes in this chapter include being open-minded, possessing a willingness to re-evaluate and adapt to new information, and avoiding mistakes through learning from past contributors to the field of entrepreneurship.


23.3A: Lipid Molecules
Fats and oils, which may be saturated or unsaturated, can be unhealthy but also serve important functions for plants and animals.
- Differentiate between saturated and unsaturated fatty acids
Key Points
- Fats provide energy, insulation, and storage of fatty acids for many organisms.
- Fats may be saturated (having single bonds) or unsaturated (having double bonds).
- Unsaturated fats may be cis (hydrogens in same plane) or trans (hydrogens in two different planes).
- Olive oil, a monounsaturated fat, has a single double bond whereas canola oil, a polyunsaturated fat, has more than one double bond.
- Omega-3 fatty acid and omega-6 fatty acid are essential for human biological processes, but they must be ingested in the diet because they cannot be synthesized.
Key Terms
- hydrogenation : The chemical reaction of hydrogen with another substance, especially with an unsaturated organic compound, and usually under the influence of temperature, pressure and catalysts.
- ester : Compound most often formed by the condensation of an alcohol and an acid, by removing water. It contains the functional group carbon-oxygen double bond joined via carbon to another oxygen atom.
- carboxyl : A univalent functional group consisting of a carbonyl and a hydroxyl functional group (-CO.OH); characteristic of carboxylic acids.
Fats have important functions, and many vitamins are fat soluble. Fats serve as a long-term storage form of fatty acids and act as a source of energy. They also provide insulation for the body.
 Glycerol is an alcohol with three carbons, five hydrogens, and three hydroxyl (OH) groups. Fatty acids have a long chain of hydrocarbons with a carboxyl group attached and may have 4-36 carbons; however, most of them have 12-18. In a fat molecule, the fatty acids are attached to each of the three carbons of the glycerol molecule with an ester bond through the oxygen atom. During the ester bond formation, three molecules are released. Since fats consist of three fatty acids and a glycerol, they are also called triacylglycerols or triglycerides.
Triacylglycerols : Triacylglycerol is formed by the joining of three fatty acids to a glycerol backbone in a dehydration reaction. Three molecules of water are released in the process.
Saturated vs. Unsaturated Fatty Acids
Fatty acids may be saturated or unsaturated. In a fatty acid chain, if there are only single bonds between neighboring carbons in the hydrocarbon chain, the fatty acid is said to be saturated. Saturated fatty acids are saturated with hydrogen since single bonds increase the number of hydrogens on each carbon. Stearic acid and palmitic acid, which are commonly found in meat, are examples of saturated fats.
When the hydrocarbon chain contains a double bond, the fatty acid is said to be unsaturated. Oleic acid is an example of an unsaturated fatty acid. Most unsaturated fats are liquid at room temperature and are called oils. If there is only one double bond in the molecule, then it is known as a monounsaturated fat; e.g. olive oil. If there is more than one double bond, then it is known as a polyunsaturated fat; e.g. canola oil. Unsaturated fats help to lower blood cholesterol levels whereas saturated fats contribute to plaque formation in the arteries.
Unsaturated fats or oils are usually of plant origin and contain cis unsaturated fatty acids. Cis and trans indicate the configuration of the molecule around the double bond. If hydrogens are present in the same plane, it is referred to as a cis fat; if the hydrogen atoms are on two different planes, it is referred to as a trans fat. The cis double bond causes a bend or a “kink” that prevents the fatty acids from packing tightly, keeping them liquid at room temperature.
Fatty Acids : Saturated fatty acids have hydrocarbon chains connected by single bonds only. Unsaturated fatty acids have one or more double bonds. Each double bond may be in a cis or trans configuration. In the cis configuration, both hydrogens are on the same side of the hydrocarbon chain. In the trans configuration, the hydrogens are on opposite sides. A cis double bond causes a kink in the chain.
Trans Fats
In the food industry, oils are artificially hydrogenated to make them semi-solid and of a consistency desirable for many processed food products. During this hydrogenation process, gas is bubbled through oils to solidify them, and the double bonds of the cis-conformation in the hydrocarbon chain may be converted to double bonds in the trans-conformation.
Margarine, some types of peanut butter, and shortening are examples of artificially-hydrogenated trans fats. Recent studies have shown that an increase in trans fats in the human diet may lead to an increase in levels of low-density lipoproteins (LDL), or “bad” cholesterol, which in turn may lead to plaque deposition in the arteries, resulting in heart disease. Many fast food restaurants have recently banned the use of trans fats, and food labels are required to display the trans fat content.
Essential Fatty Acids
Omega Fatty Acids : Alpha-linolenic acid is an example of an omega-3 fatty acid. It has three cis double bonds and, as a result, a curved shape. For clarity, the carbons are not shown. Each singly bonded carbon has two hydrogens associated with it, also not shown.
Essential fatty acids are fatty acids required for biological processes, but not synthesized by the human body. Consequently, they have to be supplemented through ingestion via the diet and are nutritionally very important. Omega-3 fatty acid, or alpha-linoleic acid (ALA), falls into this category and is one of only two fatty acids known to be essential for humans (the other being omega-6 fatty acid, or linoleic acid). These polyunsaturated fatty acids are called omega-3 because the third carbon from the end of the hydrocarbon chain is connected to its neighboring carbon by a double bond. Salmon, trout, and tuna are good sources of omega-3 fatty acids.
Research indicates that omega-3 fatty acids reduce the risk of sudden death from heart attacks, reduce triglycerides in the blood, lower blood pressure, and prevent thrombosis by inhibiting blood clotting. They also reduce inflammation and may help reduce the risk of some cancers in animals.


9.1: Introduction
9.1.1 Fibonacci Numbers
One of the most well-known recurrences arises from a simple story. Suppose that a scientist introduces a pair of newborn rabbits to an isolated island. This species of rabbits is unable to reproduce until their third month of life, but after that produces a new pair of rabbits each month. Thus, in the first and second months, there is one pair of rabbits on the island, but in the third month, there are two pairs of rabbits, as the first pair has a pair of offspring. In the fourth month, the original pair of rabbits is still there, as is their first pair of offspring, which are not yet mature enough to reproduce. However, the original pair gives birth to another pair of rabbits, meaning that the island now has three pairs of rabbits. Assuming that there are no rabbit-killing predators on the island and the rabbits have an indefinite lifespan, how many pairs of rabbits are on the island in the tenth month?
Let's see how we can get a recurrence from this story. Let fn denote the number of pairs rabbits on the island in month \(n\). Thus, \(f_1=1, f_2=1, f_3=2\), and \(f_4=3\) from our account above. How can we compute \(f_n\)? Well, in the \(n^{th}\) month we have all the pairs of rabbits that were there during the previous month, which is \(f_{n−1}\); however, some of those pairs of rabbits also reproduce during this month. Only the ones who were born prior to the previous month are able to reproduce during month \(n\), so there are \(f_{n−2}\) pairs of rabbits who are able to reproduce, and each produces a new pair of rabbits. Thus, we have that the number of rabbits in month \(n\) is \(f_n=f_{n−1}+f_{n−2}\) for \(n \geq 3\) with \(f_1=f_2=1\). The sequence of numbers {\(f_n:n \geq 0\)} (we take \(f_0=0\), which satisfies our recurrence) is known as the Fibonacci sequence after Leonardo of Pisa, better known as Fibonacci, an Italian mathematician who lived from about 1170 until about 1250. The terms \(f_0,f_1,…,f_{20}\) of the Fibonacci sequence are
\(0,1,1,2,3,5,8,13,21,34,55,89,144,233,377,610,987,1597,2584,4181,6765\).
Thus, the answer to our question about the number of pairs of rabbits on the island in the tenth month is 55. That's really easy to compute, but what if we asked for the value of \(f_{1000}\) in the Fibonacci sequence? Could you even tell whether the following inequality is true or false—without actually finding \(f_{1000}\)?
\(f_{1000}<232748383849990383201823093383773932\)
Consider the sequence \(\{f_{n+1}/f_n:n \geq 1\}\) of ratios of consecutive terms of the Fibonacci sequence. Figure 9.1 shows these ratios for \(n \leq 18\).
The ratios seem to be converging to a number. Can we determine this number? Does this number have anything to do with an explicit formula for \(f_n\) (if one even exists)?
The Fibonacci sequence would not be as well-studied as it is if it were only good for counting pairs of rabbits on a hypothetical island. Here's another instance which again results in the Fibonacci sequence. Let \(c_n\) count the number of ways a \(2 \times n\) checkerboard can be covered by \(2 \times 1\) tiles. Then \(c_1=1\) and \(c_2=2\) while the recurrence is just \(c_{n+2}=c_{n+1}+c_n\), since either the rightmost column of the checkerboard contains a vertical tile (and thus the rest of it can be tiled in \(c_{n+1}\) ways) or the rightmost two columns contain two horizontal tiles (and thus the rest of it can be tiled in \(c_n\) ways).
9.1.2 Recurrence for strings
In Chapter 3, we saw several times how we could find recurrences that gave us the number of binary or ternary strings of length \(n\) when we place a restriction on certain patterns appearing in the string. Let's recall a couple of those types of questions in order to help generate more recurrences to work with.
Let \(a_n\) count the number of binary strings of length \(n\) in which no two consecutive characters are 1's. Evidently, \(a_1=2\) since both binary strings of length 1 are “good.” Also, \(a_2=3\) since only one of the four binary strings of length 2 is “bad,”, namely (1,1). And \(a_3=5\), since of the 8 binary strings of length 3, the following three strings are “bad”:
\((1,1,0),(0,1,1),(1,1,1)\).
More generally, it is easy to see that the sequence satisfies the recurrence \(a_{n+2}=a_{n+1}+a_n\), since we can partition the set of all “good” strings into two sets, those ending in 0 and those ending in 1. If the last bit is 0, then in the first \(n+1\) positions, we can have any “good” string of length \(n+1\). However, if the last bit is 1, then the preceding bit must be 0, and then in the first \(n\) positions we can have any “good” string of length \(n\).
As a result, this sequence is just the Fibonacci numbers, albeit offset by 1 position, i.e, \(a_n=f_{n+1}\).
Let \(t_n\) count the number of ternary strings in which we never have (2,0) occurring as a substring in two consecutive positions. Now \(t_1=3\) and \(t_2=8\), as of the 9 ternary strings of length 2, exactly one of them is “bad.” Now consider the set of all good strings grouped according to the last character. If this character is a 2 or a 1, then the preceding \(n+1\) characters can be any “good” string of length \(n+1\). However, if the last character is a 0, then the first \(n+1\) characters form a good string of length \(n+1\) which does not end in a 2. The number of such strings is \(t_{n+1}−t_n\). Accordingly, the recurrence is \(t_{n+2}=3t_{n+1}−t_n\). In particular, \(t_3=21\).
9.1.3 Lines and regions in the plane
Our next example takes us back to one of the motivating problems discussed in Chapter 1. In Figure 9.5 , we show a family of 4 lines in the plane. Each pair of lines intersects and no point in the plane belongs to more than two lines. These lines determine 11 regions.
We ask how many regions a family of 1000 lines would determine, given these same restrictions on how the lines intersect. More generally, let \(r_n\) denote the number of regions determined by \(n\) lines. Evidently, \(r_1=2, r_2=4, r_3=7\) and \(r_4=11\). Now it is easy to see that we have the recurrence \(r_{n+1}=r_n+n+1\). To see this, choose any one of the \(n+1\) lines and call it \(l\). Line l intersects each of the other lines and since no point in the plane belongs to three or more lines, the points where \(l\) intersects the other lines are distinct. Label them consecutively as \(x_1,x_2,…,x_n\). Then these points divide line \(l\) into \(n+1\) segments, two of which (first and last) are infinite. Each of these segments partitions one of the regions determined by the other \(n\) lines into two parts, meaning we have the \(r_n\) regions determined by the other \(n\) lines and \(n+1\) new regions that \(l\) creates.


9.17: Hypothesis Test for Difference in Two Population Proportions (4 of 6)
Learning Objectives
- Under appropriate conditions, conduct a hypothesis test for comparing two population proportions or two treatments. State a conclusion in context.
- Given the description of a statistical study, evaluate whether conclusions are reasonable.
Reminder about Finding P-values
In a hypothesis test, the P-value is based on the assumption that the null hypothesis is true. But the P-value is also related to the alternative hypothesis. The logic here is the same logic we used in Inference for One Proportion with hypothesis tests.
When H a : p 1 − p 2 < 0, the difference in sample proportions from the data must be significantly less than zero to provide evidence against the null hypothesis and in favor of the alternative hypothesis. In this case, the P-value describes differences in sample proportions that are less than the difference observed in the data. This is the area to the left of the test statistic. We call it a left-tailed test .
Similarly, when H a : p 1 − p 2 > 0, the difference in sample proportions observed in the data must be significantly greater than zero to provide evidence against the null hypothesis and in favor of the alternative hypothesis. In this case, the P-value describes differences in sample proportions that are greater than the difference observed in the data. This is the area to the right of the test statistic. We call it a right-tailed test.
When H a : p 1 − p 2 ≠ 0, the difference in sample proportions observed in the data must be significantly different from zero to provide evidence against the null hypothesis and in favor of the alternative hypothesis. In this case, the P-value is two-tailed. It is twice the area of the smaller tail defined by the test statistic.
The next two activities provide more practice with conducting a hypothesis test for a difference between two population proportions. You will need the simulation below to complete these activities.
Click here to open this simulation in its own window.
Try It
Is a New Antidepressant Effective in Treating Depression?
Depression has many effective treatment options. Suppose that in a clinical trial researchers study a new antidepressant. They randomly assign 90 depressed teens to one of two groups: 40 teens receive the antidepressant Fluoxetine with psychiatric therapy. Of these, 25 improve. The remaining 50 teens receive placebos with psychiatric therapy. Among this group, 18 improve. The experiment is double blind, so neither the teens nor the psychiatrists know which participants receive Fluoxetine or placebo.
Define p 1 and p 2 to be the proportions of all teens who improve when taking Fluoxetine and placebo, respectively, with psychiatric treatment. We will test the claim, at 1% significance (α = 0.01), that the proportion of teens who improve after the Fluoxetine treatment is greater than the proportion for teens who received a placebo.
https://assessments.lumenlearning.co...sessments/3648
https://assessments.lumenlearning.co...sessments/3942
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Are There Racial Differences in Antidepressant Use?
The following excerpt is from an article by Kerry Sheridan, “In the US, Many with Severe Depression Go Untreated” ( AFP , Oct. 19, 2011).
- The United States is a world leader in rates of antidepressant use, but as many as two-thirds of Americans with severe depression are not on medication….The data also showed significant racial and ethnic differences, with almost 14 percent of non-Hispanic whites taking antidepressants compared to four percent of African-Americans and three percent of Mexican-Americans….[E]ven though non-whites are getting treated less often, studies have shown that they are just as likely as whites to suffer from depression. Income appeared to play no role in the prevalence of antidepressant usage, said the study.
The data in this study comes from 12,637 people who were interviewed as part of the National Health and Nutrition Examination Surveys (NHAMES) from 2005 to 2008.
https://assessments.lumenlearning.co...sessments/3943
https://assessments.lumenlearning.co...sessments/3944
Contributors and Attributions
- Concepts in Statistics. Provided by : Open Learning Initiative. Located at : http://oli.cmu.edu . License : CC BY: Attribution