6 results on '"Kimberly Lee"'
Search Results
2. Food insecurity in paradise
- Author
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Joshua Gruver, Kimberly Lee, and Emily Hayes
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food security ,food system sustainability ,resilience ,semi-structured interviews ,U.S. Virgin Islands ,Agriculture ,Human settlements. Communities ,HT51-65 - Abstract
Despite being a world-class tourist destination, the U.S. Virgin Islands (USVI—St. Thomas, St. Croix, and St. John) face significant challenges related to diversified crop production, food distribution, and food security. High poverty rates among islanders perpetuated by historical iniquities, frequent hurricane damage, drought, poor soil quality, high food production costs, and limited food distribution networks are just a few of the challenges residents face. Consequently, 97% of the food consumed in the USVI is imported. Frequent hurricane damage, such as the recent damage from Irma and Maria (back-to-back Category 5 storms that hit the islands in 2017) complicated these challenges even more and disrupted food import processes. This manuscript focuses on a case study involving a literature review, participant observation, and a series of semi-structured, face-to-face interviews with key informants about issues related to food insecurity, resilience, and farmer needs regarding business sustainability. The results highlight how the political, economic, and cultural complexities of the USVI stymie efforts to lower barriers related to food accessibility and affordability. The results also reveal a new and vibrant entrepreneurial spirit among native islanders and transplants alike, providing novel entryways into food system change and development. Finally, we share policy implications and next steps toward building agriculture and food system resiliency.
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- 2024
- Full Text
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3. Opportunity for Early De-escalation in Enterobacterales Bacteremia with Rapid Blood Culture Identification Technology
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Erin Deja, Jihye Kim, Adam Greenfield, Kimberly Lee, Melissa Godwin, Alexandra Bryson, Sangeeta Sastry, and Christopher Doern
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: The BioFire FilmArray Blood Culture Identification 2 (BCID2) Panel is used to identify organisms present in positive blood cultures within hours of detection at Virginia Commonwealth University Health System (VCUHS). BCID2 is also able to detect common resistance mechanisms including CTX-M, the most common extended-spectrum beta-lactamase (ESBL) in the United States, and several carbapenemases. The Antimicrobial Stewardship Program (ASP) at VCUHS established optimal treatment recommendations for each organism identified by BCID2 based on the detection of a resistance mechanism and local resistance patterns. The recommendation for the majority of Enterobacterales without a detected resistance mechanism is ceftriaxone. However, providers are often reluctant to de-escalate antibiotics without confirmed susceptibility testing, as there may be other mechanisms of antibiotic resistance in Gram-negative organisms. The objective of this evaluation was to measure the degree of congruence between BCID2 resistance mechanism detection and susceptibility testing by disk diffusion, and to validate the adequacy of the VCUHS ASP BCID2 treatment recommendations for Enterobacterales bacteremia. Methods: Patients with positive Enterobacterales BCID2 results from March 12 to June 19, 2023 were retrospectively identified. Organisms identified by BCID2 that were considered high-risk for clinically significant AmpC production due to an inducible AmpC gene (i.e., K. aerogenes, E. cloacae complex) were excluded. Results: A total of 270 results were included. The most commonly identified organism was E. coli (n = 139, 51.5%), followed by K. pneumoniae (n = 74, 27.4%). There were 27 (10%) isolates positive for CTX-M and 1 (0.4%) isolate positive for KPC. All CTX-M isolates were ceftriaxone resistant, and the KPC isolate was meropenem resistant. The remaining 242 isolates were negative for all resistance markers detected by BCID2. Of these, only 3 (1.2%) were resistant to ceftriaxone and notably, 8 (3.3%) were resistant to piperacillin/tazobactam. Overall, BCID2 CTX-M detection was 90% sensitive and 100% specific for predicting ceftriaxone resistance in Enterobacterales. Conclusion: CTX-M detection by BCID2 is highly sensitive and specific for predicting ceftriaxone resistance in Enterobacterales. CTX-M negative isolates were more often susceptible to ceftriaxone than to piperacillin/tazobactam, which is commonly used as empiric therapy for Gram-negative organisms at our institution. This highlights an excellent opportunity for safe and effective early de-escalation of antibiotics for treatment of Enterobacterales bacteremia.
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- 2024
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- View/download PDF
4. Antimicrobial use patterns during the COVID-19 pandemic at an academic medical center
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Jacob Pierce, Erin Deja, Kimberly Lee, Michelle Doll, and Michael Stevens
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: The COVID-19 pandemic has made a significant impact on antimicrobial use patterns across health systems. We have described antibiotic use patterns at an academic medical center in Richmond, Virginia, before and after the onset of COVID-19. We also examined the impact on the proportional consumption of carbapenems (PoCC) metric. PoCC represents meropenem utilization relative to the narrower-spectrum antipseudomonal agents cefepime and piperacillin-tazobactam. Our institution practices antimicrobial restriction for meropenem. All other antibiotics included in the study data can be freely ordered by any provider. Methods: We evaluated antimicrobial use data from September 2018 through August 2021 using days of therapy (DOT) per 1,000 patient days. We included 18 months of data before and after the first recorded COVID-19 admission at our institution in March 2020. Mean comparisons were performed using the Welch 2-sample t test. The Bonferonni correction for multiple comparisons was utilized to determine significance with an initial baseline α of 0.05. All data analyses were performed using R software (R Foundation for Statistical Computing, Vienna, Austria, 2021). Results: Normality was evaluated with QQ-plots and all data demonstrated normality. Bonferroni correction produced an adjusted α value of 0.007. We detected significant increases in the use of cefepime, piperacillin-tazobactam, ceftriaxone, and azithromycin following the onset of the COVID-19 pandemic. We noted a significant decrease in the PoCC metric during this period. No significant change was noted for levofloxacin or meropenem. Conclusions: The COVID-19 pandemic produced significant changes in antimicrobial use patterns at our institution. We noted statistically significant increases in bacterial community-acquired pneumonia-focused antibiotics (ceftriaxone and azithromycin). We observed significant increases for cefepime and piperacillin-tazobactam. Interestingly, relative utilization of carbapenems as measured by the PoCC metric continued to decrease during this time. This trend was primarily driven by increases in cefepime and piperacillin-tazobactam utilization while meropenem utilization remained relatively constant. This study highlights the importance of looking at normalized antibiotic consumption data and not relative-use data alone.
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- 2022
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5. White Faculty Members Resisting White Supremacy Culture in Service Learning and Community Engagement: A Critical Narrative Analysis
- Author
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Cotrupi, Catherine Lynn, Higher Education, Robbins, Claire Kathleen, Harrison, Anthony Kwame, Faulkner, Brandy S., and Niewolny, Kimberly Lee
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White Supremacy Culture ,Critical Narrative Analysis ,Service Learning and Community Engagement ,Faculty - Abstract
The purpose of this study was to deconstruct how and to what extent white faculty members resisted upholding white supremacy culture (WSC; Okun, 1999) during a critical event (Mertova and Webster, 2019) in their service learning and community-engaged (SLCE) practice. There are many critiques of SLCE practices, especially due to the perpetuation of colonization (Hernandez, 2017), assumptions based in racism and classism (Green, 2003), Whiteness (Applebaum, 2016; Leonardo, 2002) and characteristics of white supremacy culture (Okun, 1999). These topics have received more attention over the past decade, but there is still significantly less research on actions taken by SLCE faculty to actively resist perpetuating them (Mitchell et al., 2012). Guided by critical event narrative inquiry (Mertova and Webster, 2019) and framed by both first- and second-wave Critical Whiteness Studies (Jupp and Badenhorst, 2021), six participants were engaged in two empathetic interviews to answer the following research questions: 1. What impact has the examination of their own Whiteness had on white faculty members' SLCE praxis? 2. How did white faculty members resist upholding Whiteness (Leonardo, 2002) and characteristics of white supremacy culture (Okun, 1999) during critical events in their service learning and community-engaged (SLCE) practice? 3. How do white faculty members continue to resist Whiteness and WSC in their SLCE praxis despite barriers, challenges, and tensions they have faced on their campuses and within their communities in doing so? Critical narrative analysis (Langdridge, 2007) was used to deconstruct the faculty members' experiences during these critical events (Mertova and Webster, 2019) in their SLCE practice. Findings relate to the importance of considering the setting, context, and impact of action taken within specific academic fields as well as the field of service learning and community engagement more broadly. Doctor of Philosophy Service Learning and Community Engagement (SLCE) describes the ways in which faculty and students engage with off-campus community organizations for the supposed benefit of all involved. The assumption is that students explore and experience topics they learn about in their classes, faculty members can have more direct impact with their teaching and research, and community partners reap the benefits of this student involvement and faculty engagement. There are many concerns, however, about the presence and perpetuation of colonization (Hernandez, 2017), assumptions based in racism and classism (Green, 2003), Whiteness (Applebaum, 2016; Leonardo, 2002) and characteristics of white supremacy culture (Okun, 1999) through SLCE. These topics have received more attention over the past decade, but there is still significantly less research on actions taken by SLCE faculty to actively resist perpetuating them (Mitchell et al., 2012). The purpose of this study was to explore the ways that white faculty members addressed these topics in their own teaching, research, and service work. Through two interviews each of the six participants shared more about their own identities and the impact these had on their development and experiences. They also provided context about their academic fields, the relationships they have with their community partners, and the ways in which they have taken action to address the topics of Whiteness and the characteristics of white supremacy culture in their SLCE. The findings of this study relate to the importance of considering the setting, context, and impact of action taken within specific academic fields as well as the field of service learning and community engagement more broadly.
- Published
- 2023
6. The Ecotonal Nature of Community Food Work: A Case Study of Trauma-Informed Care and Agential Change Space
- Author
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Bendfeldt, Eric S., Agricultural, Leadership, and Community Education, Niewolny, Kimberly Lee, Stewart, Anne Leona, Archibald, Thomas Greig, and Stephenson, Max O.
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ontological politics ,ecotone ,agency ,community food work ,trauma-informed care - Abstract
Communities of color in particular have experienced a traumatic history of structural violence, interpersonal racism, segregation, and oppression. The unjust history of structural violence and the deleterious treatment of people and cultures in the U.S., that in part stems from neoliberal policies and rationality, continues to plague communities and people within the food system. Many people and communities are working to actualize the social-ethical ideal of a non-violent 'beloved community' to counter this unjust history and expand the boundaries of what is possible for individuals and society. Historical and systemic injustices ramify the adverse experiences and trauma affecting vulnerable people's lives. The effects and pervasiveness of individual and collective trauma at a global scale has highlighted a serious need for broader-scale awareness and adoption of a trauma-informed care approach by community food work organizations, practitioners, and social change leaders. A trauma-informed care approach was developed as a health care framework based on the importance of adverse childhood events to poor distal health and mental health outcomes. Without a deeper understanding of how extensive the collective impact of such trauma and injustice is on people and the food system; community food work researchers and practitioners may reify uninformed responses that result in continued trauma and injustice. However, there are few examples of community food work organizations using a trauma-informed care approach as an organizational change process to promote community transformation and resilience. This research examined and specifically analyzed how a community food work organization that is engaged in mutual aid and social-ecological activism embodies trauma-informed care; engenders an agential change space; and grapples with the aspirations and tensions of being an organization seeking to ameliorate the effects of anthropogenic trauma and expand the boundaries of what is possible individually and collectively. A narrative inquiry methodology was used to critically explore and study the perceptions and thoughts of 17 study participants of how a trauma-informed approach to care is embodied and agential change space provided as mutual aid and community food work. The seventeen study participants' narratives were coded and analyzed using the Principles of a Trauma-Informed Care Framework defined by SAMHSA (2014), Bowen and Murshid (2016), and Hecht et al (2018). The narrative inquiry of seventeen narratives demonstrated that an integrated trauma-informed care approach as an organizational change process is essential to the formation of agential change space and has wide-reaching applicability to mutual aid efforts and community food work pedagogy and praxis, especially as organizations and practitioners confront ongoing systemic trauma and injustices that have resulted from structural violence and continue to persist due to the dominant hegemonic neoliberal framing that exists in relation to race, gender, and socioeconomic class. Doctor of Philosophy Communities of color in particular have experienced a traumatic history of structural violence, interpersonal racism, segregation, and oppression. The unjust history of structural violence and the deleterious treatment of people and cultures in the U.S., that in part stems from neoliberal policies and rationality, continues to plague communities and the food system. Many people and communities are working to actualize the social-ethical ideal of a non-violent 'beloved community' to counter this unjust history and expand the boundaries of what is possible individually and collectively. Without a deeper understanding of how extensive the collective impact of such trauma and injustice is on people and the food system; community food work researchers and practitioners may reify uninformed responses that result in continued trauma and injustice. However, there are few examples of community food work organizations using a trauma-informed care approach as an organizational change process to promote food system transformation. This research examined the ecotonal nature of community food work and specifically analyzed how a community food work organization that is engaged in mutual aid and social-ecological activism embodies trauma-informed care; engenders an agential change space; and grapples with the aspirations and tensions of being an organization seeking to ameliorate the effects of anthropogenic trauma and expand the boundaries of what is possible individually and collectively. A case study and narrative inquiry methodology was used to critically explore perceptions and thoughts of 17 study participants and stakeholders of meaningful support as embodying a trauma-informed care approach and participative interaction as engendering agential change space as mutual aid and community food work. The seventeen study participants' narratives were coded and analyzed using the Principles of a Trauma-Informed Care Framework defined by SAMHSA (2014), Bowen and Murshid (2016), and Hecht et al. (2018). The narrative inquiry of seventeen narratives demonstrated that an integrated trauma-informed care approach as an organizational change process is essential to the formation of agential change space and has wide-reaching applicability to mutual aid efforts and community food work as pedagogy and praxis, especially as organizations and practitioners confront ongoing systemic trauma and injustices that have resulted from structural violence and continue to persist due to the dominant hegemonic neoliberal framing that exists in relation to race, gender, and socioeconomic class.
- Published
- 2023
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