Abstract. Agile methods have proven their worth in keeping a development team focused on producing high-quality code quickly. But these methods generally have little to say about how to incorporate user-centered design techniques. Also the question has been raised whether agile methods can scale up to larger systems design. In this paper we show how one user-centered design method, Contextual Design (CD), forms a natural fit with agile methods and recount our experience with such combined projects.
Relational reasoning, which has been defined as the ability to discern meaningful patterns within any informational stream, is a foundational cognitive ability associated with education, including in scientific domains. This study entailed the analysis of instructional conversations in which an attending clinical neurologist and his team of residents made diagnostic and therapeutic decisions about actual patients in a hospital setting. The primary goal was to investigate the role of 4 manifestations of relational reasoning (i.e., analogy, anomaly, antinomy, and antithesis) in medical education and diagnostic and therapeutic decision making. Results indicated that the degree to which members of the medical team used the 4 forms of relational reasoning depended on their role and expertise, as well as the time point in the problem-solving process. Specific reasoning patterns that emerged in the discourse and a prototypical model of the reasoning process are described and implications for research and practice are considered.
BackgroundHepatitis C virus (HCV) infection is a growing problem among people who inject drugs. Strategies to reduce disease transmission (eg, syringe exchange programs) and facilitate HCV screening and linkage are available but are under-utilized in many communities affected by injection drug use. Novel approaches to increasing the use of these strategies are needed.ObjectiveThe goals of this project are to (1) develop and pilot test a computerized tailored intervention for increasing HCV screening and decreasing risky drug use behavior among people who inject drugs and (2) determine the feasibility of disseminating such an intervention using peer-based referrals in the setting of a community-based syringe exchange program.MethodsThis 2-arm, randomized pilot study is being conducted in a large-volume, multisite syringe exchange program in southern Wisconsin. A social network–based strategy was used to recruit a total of 235 adults who reported past-month injection of opioids, cocaine, or methamphetamine. Network recruiters were identified among clients requesting services from the syringe exchange program and were enlisted to refer eligible peers to the study. All participants completed a computer-adapted questionnaire eliciting information about risk behaviors and their knowledge, attitudes, and prior experiences related to HCV screening. Subjects were then randomly assigned to receive usual care, consisting of standard counseling by syringe exchange staff, or the Hep-Net intervention, which provides algorithm-based, real-time tailored feedback and recommendations for behavior change in the style of motivational interviewing. Changes in drug use behaviors and attitudes will be assessed during a second session between 90 and 180 days after the baseline visit. Frequency of repeat HCV testing and HCV incidence will be assessed through a database search 1 year after study completion.ResultsRecruitment for this study was completed in April 2015. Follow-up of enrolled participants is expected to continue until March 2016. Network recruiters were enrolled who referred a total of 195 eligible peers (overall N=235). At baseline, the median age was 34 years; 41.3% (97/235) were non-white; and 86.4% (203/235) reported predominantly injecting heroin. Most participants (161/234, 68.8%) reported sharing injection equipment in the past and of these, 30.4% (49/161) had never been tested for HCV.ConclusionsThis study will provide preliminary evidence to determine whether incorporating computerized behavioral interventions into existing prevention services at syringe exchange programs can lead to adoption of healthier behaviors.Trial RegistrationClinicalTrials.gov NCT02474043; https://clinicaltrials.gov/ct2/show/NCT02474043 (Archived by WebCite at http://www.webcitation.org/6dbjUQG7J)
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