We studied the impacts of colonists, two groups of indigenous residents (Miskitu and Mayangna), and management by the Nicaraguan Ministry of Environment and Natural Resources (MARENA) on the forest of the Bosawas International Biosphere Reserve. Indigenous people and colonists subsist on the natural resources of the reserve, and MARENA is responsible for protecting the area from colonization and illicit exploitation. Using geostatistical procedures and Landsat images at three different time periods, we compared per capita deforestation and boundary stabilization in areas with colonists and areas with indigenous peoples. We also examined whether the Mayangna deforested less than the Miskitu and whether the Nicaraguan government has effectively defended the Bosawas boundary against the advance of the agricultural frontier. In addition, we analyzed the current distribution of land uses within the reserve and its contiguous indigenous areas with a supervised classification of current land cover. Indigenous demarcations protected the forest successfully, whereas the Bosawas boundary itself did not inhibit colonization and consequent deforestation. Indigenous farmers deforested significantly less per capita than colonists, and the two indigenous groups in Bosawas did not differ significantly in their effects on the forest. Our results show that indigenous common-property institutions and indigenous defense of homeland have been powerful factors in protecting the forests of Bosawas and that the difficult evolution of a nested cross-scale governance system in Bosawas-under pressure from indigenous peoples-is probably the key to the forest's survival thus far.
The psychology of motivation can help us understand the impact of electronic health records (EHRs) on clinician burnout both directly and indirectly. Informatics approaches to EHR usability tend to focus on the extrinsic motivation associated with successful completion of clearly defined tasks in clinical workflows. Intrinsic motivation, which includes the need for autonomy, sense-making, creativity, connectedness, and mastery is not well supported by current designs and workflows. This piece examines existing research on the importance of 3 psychological drives in relation to healthcare technology: goal-based decision-making, sense-making, and agency/autonomy. Because these motives are ubiquitous, foundational to human functioning, automatic, and unconscious, they may be overlooked in technological interventions. The results are increased cognitive load, emotional distress, and unfulfilling workplace environments. Ultimately, we hope to stimulate new research on EHR design focused on expanding functionality to support intrinsic motivation, which, in turn, would decrease burnout and improve care.
Objective
To identify needs in a clinical decision support tool development by exploring how primary care providers currently collect and use family health history (FHH).
Design
Survey questionnaires and semi-structured interviews were administered to a mix of primary and specialty care clinicians within the University of Utah Health system (40 surveys, 12 interviews).
Results
Three key themes emerged regarding providers’ collection and use of FHH: (1) Strategies for collecting FHH vary by level of effort; (2) Documentation practices extend beyond the electronic health record’s dedicated FHH module; and (3) Providers desire feedback from genetic services consultation and are uncertain how to refer patients to genetic services.
Conclusion
Study findings highlight the varying degrees of engagement that providers have with collecting FHH. Improving the integration of FHH into workflow, and providing decision support, as well as links and tools to help providers better utilize genetic counseling may improve patient care.
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