Course Description In this course, we will explore the question of the actual and potential connections between democracy and education. Our focus of attention will be placed on a critical examination of democratic theory and its implications for the civic education roles and contributions of teachers, adult educators, community development practitioners, and community organizers. We will survey and deal critically with a range of competing conceptions of democracy, variously described as classical, republican, liberal, radical, marxist, neomarxist, pragmatist, feminist, populist, pluralist, postmodern, and/or participatory. Using narrative inquiry as a means for illuminating and interpreting contemporary practice, we will analyze the implications of different conceptions of democracy for the practical work of civic education.

Democracy and education.

Objective: To review 16 years of National Collegiate Athletic Association injury surveillance data for women’s lacrosse and identify potential areas for injury prevention initiatives. Background: Women’s lacrosse is a fast-paced, primarily noncontact sport. Participation in collegiate women’s lacrosse almost doubled between the 1988–1989 and 2003–2004 seasons. Lacrosse equipment consists of sticks made of wood or a synthetic material and a hard rubber ball. Until recently, mouth guards were the only required protective equipment. Main Results: Collegiate women’s lacrosse game injury rates increased over the 16-year study period. More than 60% of all severe game injuries were lower extremity sprains and strains and knee internal derangements, most frequently the result of noncontact incidents. The most common injury scenarios by injury mechanism and player activity were no contact while ball handling (16.4%) and contact from a stick while ball handling (10.5%). Contact from a stick or a ball accounted for 5.6% and 5.2% of injuries sustained during shooting activities, respectively. Approximately 22% of all game and 12% of all practice injuries involved the head and neck. Contact from a stick accounted for the majority (56.0%) of above-the-neck injuries in games; contact from the ball accounted for 20.0% of these injuries. Participants had 5 times the risk of sustaining a concussion in a game as in a practice (0.70 versus 0.15 injuries per 1000 athletic-exposures, rate ratio 4.7, 95% confidence interval 3.8, 6.5). Recommendations: To reduce the lower extremity injuries that comprise the greatest injury burden in women’s lacrosse, future researchers should evaluate proprioceptive, plyometric, and balance training interventions designed specifically for female players. Other research areas of great interest involve determining whether protective eyewear (mandated in 2004) reduces injuries to the eye, orbit, and nasal area and identifying any unintended consequences of the mandate, such as increased risk of injuries to other areas of the face or more aggressive play.

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Descriptive epidemiology of collegiate men's football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

Objectives To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined. Data sources We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010. Review methods We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence. Results We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and whites. The strength of evidence of numeracy studies was insufficient to low, limiting conclusions about the influence of numeracy on health care service use or health outcomes. Two studies suggested numeracy may mediate the effect of disparities on health outcomes. We found no evidence concerning oral health literacy and outcomes. Among intervention studies (27 randomized controlled trials [RCTs], 2 cluster RCTs, and 13 quasi-experimental designs), the strength of evidence for specific design features was low or insufficient. However, several specific features seemed to improve comprehension in one or a few studies. The strength of evidence was moderate for the effect of mixed interventions on health care service use; the effect of intensive self-management inventions on behavior; and the effect of disease-management interventions on disease prevalence/severity. The effects of other mixed interventions on other health outcomes, including knowledge, self-efficacy, adherence, and quality of life, and costs were mixed; thus, the strength of evidence was insufficient. Conclusions The field of health literacy has advanced since the 2004 report. Future research priorities include justifying appropriate cutoffs for health literacy levels prior to conducting studies; developing tools that measure additional related skills, particularly oral (spoken) health literacy; and examining mediators and moderators of the effect of health literacy. Priorities in advancing the design features of interventions include testing novel approaches to increase motivation, techniques for delivering information orally or numerically, "work around" interventions such as patient advocates; determining the effective components of already-tested interventions; determining the cost-effectiveness of programs; and determining the effect of policy and practice interventions.

/pdf/health-literacy-interventions-and-outcomes-an-updated-chswt8nilu.pdf

Health literacy interventions and outcomes: an updated systematic review.

It is now recognized that contracting skeletal muscle may synthesize and release interleukin-6 (IL-6) into the interstitium as well as into the systemic circulation in response to a bout of exercise. Although several sources of IL-6 have been demonstrated, contracting muscles contributes to most of the IL-6 present in the circulation in response to exercise. The magnitude of the exercise-induced IL-6 response is dependent on intensity and especially duration of the exercise, while the mode of exercise has little effect. Several mechanisms may link muscle contractions to IL-6 synthesis: Changes in calcium homeostasis, impaired glucose availability, and increased formation of reactive oxygen species (ROS) are all capable of activating transcription factors known to regulate IL-6 synthesis. Via its effects on liver, adipose tissue, hypothalamic-pituitary-adrenal (HPA) axis and leukocytes, IL-6 may modulate the immunological and metabolic response to exercise. However, prolonged exercise involving a significant muscle mass in the contractile activity is necessary in order to produce a marked systemic IL-6 response. Furthermore, exercise training may reduce basal IL-6 production as well as the magnitude of the acute exercise IL-6 response by counteracting several potential stimuli of IL-6. Accordingly, a decreased plasma IL-6 concentration at rest as well as in response to exercise appears to characterize normal training adaptation.

Interleukin-6 in acute exercise and training: what is the biological relevance?

Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.

https://bjsm.bmj.com/content/bjsports/50/17/1030.full.pdf

How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness

OBJECTIVE: To compare the perceptions of students and clinical instructors regarding helpful clinical instructor characteristics. DESIGN AND SETTING: We developed a questionnaire containing helpful clinical instructor characteristics for facilitating student learning from a review of the medical and allied health clinical education literature. Respondents rated clinical instructor characteristics from 1 (among the least helpful) to 10 (among the most helpful). Respondents also identified the overall 10 most helpful and 10 least helpful characteristics. SUBJECTS: A total of 206 undergraduate students and 46 clinical instructors in the National Athletic Trainers' Association District 4 athletic training education programs accredited by the Commission on Accreditation of Allied Health Education Programs responded to the survey. MEASUREMENTS: We computed individual-item and subgroup mean scores for students, clinical instructors, and combined students and instructors. Pearson product moment correlations were computed to evaluate the level of agreement between students and instructors. Correlations were also computed to evaluate the level of agreement between the open-ended responses and the Likert-scale responses. RESULTS: Agreement was high between the students' and the clinical instructors' ratings of individual items. Agreement was also high between individual-item means and the directed, open-ended 10 most helpful and 10 least helpful clinical instructor characteristics. Modeling professional behavior was considered the most helpful subgroup of clinical instructor characteristics. Integration of knowledge and research into clinical education was considered the least helpful subgroup of clinical instructor characteristics. CONCLUSIONS: Clinical instructors should model professional behavior to best facilitate student learning. Integration of research into clinical education may need more emphasis.

Clinical Instructors' and Student Athletic Trainers' Perceptions of Helpful Clinical Instructor Characteristics.

Objective: To present a historical perspective of the development and evolution of clinical education in the medical and allied health professions, with a special interest in athletic training; to gain a better understanding and appreciation of the depth and breadth of the structured and formal clinical education needed in athletic training, for both the present and the future.
Data Sources: Information was drawn from the Educational Resources Information Center (1966–2001), MEDLINE (1966–2001), SPORT Discus (1830–2002), and CINAHL (1982–2002) searches of historical literature relating to the development of medical, allied health, and athletic training clinical education. Key words searched were clinical education, clinical instruction, medical education, allied health education, history of medical education, athletic training education, and history of clerkships. We also used reference materials cited in historical textbooks on medical education.
Data Synthesis: Clinical education in American medical schools evolved from a primarily didactic process to the clinical-clerkship model. In contrast, athletic training professional preparation was initially more steeped in clinical experiences and less in didactic instruction.
Conclusions/Recommendations: Reviewing medical education over the past century and allied health clinical education over the past 30 years provides interesting insights about the past, present, and future of athletic training professional preparation. Athletic training clinical education is undergoing reform and development, which will subsequently enhance the profession. Athletic training has entered an exciting era in its history.

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Historical Perspective of Athletic Training Clinical Education.

Context: Athletic training educators often anecdotally suggest that athletic training students enhance their learning by teaching their peers. However, peer-assisted learning (PAL) has not been examined within athletic training education in order to provide evidence for its current use or as a pedagogic tool. 

Objective: To describe the prevalence of PAL in athletic training clinical education and to identify students' perceptions of PAL. 

Design: Descriptive. 

Setting: “The Athletic Training Student Seminar” at the National Athletic Trainers' Association 2002 Annual Meeting and Clinical Symposia. 

Patients or Other Participants: A convenience sample of 138 entry-level male and female athletic training students. 

Main Outcome Measure(s): Students' perceptions regarding the prevalence and benefits of and preferences for PAL were measured using the Athletic Training Peer-Assisted Learning Assessment Survey. The Survey is a self-report tool with 4 items regarding the prevalence of PAL and 7 items regarding perceived benefits and preferences. 

Results: A total of 66% of participants practiced a moderate to large amount of their clinical skills with other athletic training students. Sixty percent of students reported feeling less anxious when performing clinical skills on patients in front of other athletic training students than in front of their clinical instructors. Chi-square analysis revealed that 91% of students enrolled in Commission on Accreditation of Allied Health Education Programs–accredited athletic training education programs learned a minimal to small amount of clinical skills from their peers compared with 65% of students in Joint Review Committee on Educational Programs in Athletic Training–candidacy schools (χ2 3 = 14.57, P < .01). Multiple analysis of variance revealed significant interactions between sex and academic level on several items regarding benefits and preferences. 

Conclusions: According to athletic training students, PAL is occurring in the athletic training clinical setting. Entry-level students are utilizing their peers as resources for practicing clinical skills and report benefiting from the collaboration. Educators should consider deliberately integrating PAL into athletic training education programs to enhance student learning and collaboration.

/pdf/peer-assisted-learning-in-the-athletic-training-clinical-2jeo39c5h5.pdf

Peer-Assisted Learning in the Athletic Training Clinical Setting

Context: Certified athletic trainers who serve as Approved Clinical Instructors (ACIs) in the collegiate setting are balancing various roles (eg, patient care and related administrative ta...

Role strain in collegiate athletic training approved clinical instructors.

Objective: To examine the occurrence, benefits, and preferences for peer assisted learning (PAL) in medical and allied health clinical education, and to identify areas in athletic training which ne...

/pdf/peer-assisted-learning-in-clinical-education-literature-u63yvioi9b.pdf

Thomas G. Weidner

Papers

Clinical Instructors' and Student Athletic Trainers' Perceptions of Helpful Clinical Instructor Characteristics.

Historical Perspective of Athletic Training Clinical Education.

Peer-Assisted Learning in the Athletic Training Clinical Setting

Role strain in collegiate athletic training approved clinical instructors.

Peer Assisted Learning in Clinical Education: Literature Review