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Context Advance care planning (ACP) is an important process that involves discussing and documenting one's values and preferences for medical care, particularly end-of-life treatments. Objectives This convergent, mixed-methods study assessed whether an end-of-life conversation card game is an acceptable and effective means for performing ACP for patients with chronic illness and/or their caregivers when deployed in a community setting. Methods Twenty-two games (n = 93 participants) were held in community settings surrounding Hershey, PA in 2016. Participants were recruited using random sampling from patient databases and also convenience sampling (i.e., flyers). Quantitative questionnaires and qualitative focus group interviews were administered to assess the game experience and subsequent performance of ACP behaviors. Results Both quantitative and qualitative data found that Community Game Day was a well-received, positive experience for participants and 75% of participants performed ACP within three months post-intervention. Conclusions These findings suggest that using a conversation game during community outreach is a useful approach for engaging patients and caregivers in ACP. The convergence of quantitative and qualitative data strongly supports the continued investigation of the game in randomized controlled trials.

Park visitors’ experiences and outdoor lighting are linked, but no studies have investigated visitor preferences for lighting in these locations, nor reasons for such preferences. Visitors’ preferences for lighting may help parks regulate and utilize lighting in a way that both protects resources and provides for quality night experiences. Brightness, Correlated Color Temperature (CCT), and context affects human perceptions of lighting. This paper examines these variables and related lighting preferences in settings common to parks: pathways, amphitheaters, and restrooms. Experimental lighting scenarios were setup at Acadia National Park for brightness ranges typical of each setting. CCTs were chosen based on those common for outdoor lighting – 3000K (yellow), 4200K (white), and 6000K (blue-white). Scenario light fixtures were operated by control boxes that enabled participants to switch between the three CCTs and to adjust brightness. A survey and semi-structure interviews collected data from visitors. Participants preferred 3000K at both the restroom and amphitheater, but 4200K at the pathway. A 6000K CCT was undesirable for all locations. Visitors’ preferred brightness ranged from 1.4 lux on the pathway to 10.5 lux at the restroom. The most frequently cited reasons for these choices were the desire to provide natural nighttime light levels, maintain natural darkness, create a soothing or subtle setting, and to avoid tripping or falling. Many participants indicated having both negative and positive experiences in parks caused by outdoor lighting. Parks must address outdoor lighting if they are to comprehensively manage the nighttime environment and nighttime visitor experiences common in these places.

Background Wrist pain associated with weight-bearing gymnastic activities may be linked to musculoskeletal impairments, faulty movement patterns, and poor training techniques. Inadequate proximal control may adversely impact the loading mechanics throughout the upper extremities and contribute to a gymnast's complaint of wrist pain. The purpose of this case report is to describe the management of a young gymnast with primary complaint of bilateral wrist pain associated with upper extremity weight-bearing activities. Case Description A 10 year-old male gymnast presented with a 6-month history of bilateral wrist pain aggravated by weight-bearing gymnastic activities. Based on the findings from a physical therapy examination, a 3-stage progressive rehabilitation program was designed using an impairment-based, multi-modal approach to treat key musculoskeletal impairments and movement deficiencies. Consistent with the principle of activity simulation, treatment targeted areas of weakness considered key to activity performance and included a progression of exercises and techniques that simulated activities reported by the gymnast to be painful. Outcomes The gymnast was treated for 11 visits over 8 weeks. He demonstrated improved strength, motor control, and self-reported outcome scores that allowed pain-free return to all gymnastic activities.