. Using a supply chain analysis to assess the sustainability of farm-to-institution programs. Journal of Agriculture, Food Systems, and Community Development, 1(4) AbstractInterest in local and sustainable food among colleges and universities has risen considerably in the last decade. This study focuses on how to foster farm-to-institution programs by exploring barriers, opportunities, and potential solutions from different perspectives in the supply chain. We use a values-based supply chain approach to see what unique insights can be offered to people developing and maintaining these programs. Three research methods -a national survey of college students, a survey of institutional food service buyers in California, and in-depth interviews of people in the California distribution system, including farmers, distributors, and food service buyers -are used to collect data and perspectives from throughout the supply chain. Using the concepts from supply chain literature of product flows, financial flows, and information flows, we highlight key insights for various participants in the supply chain. Strengthening information flows and building relationships that allow all parties to build trust over time emerged as one of the most important elements in the success of these valuesbased supply chains. Educational institutions and the media can support these chains by becoming the vehicles for ongoing exchange of information among supply chain partners and the public.

The Apprenticeship in Ecological Horticulture (AEH) at the University of California, Santa Cruz, has been teaching people organic and ecological horticulture for 43 years. This paper examines the extent to which the program has met the goals of growing farmers and gardeners, and contributing to change in the food system. It also explores specific programmatic ways the AEH contributed to these outcomes. We surveyed program alumni from 1989 through 2008. Findings suggest that the program has successfully met its goals. According to alumni suggestions, the primary way the program contributed to these outcomes was by developing apprentice knowledge and skills through hands-on activities. In addition, other educational components, not always explicitly addressed in similar programs, were also key. We use different learning theories to help understand the AEH's success and make recommendations for similar programs.

Many soil health assessment methods are being developed. However, they often lack assessment of soil-borne diseases. To better address management strategies for soil-borne disease and overall soil and plant health, the concept of Integrated Soil Health Management (ISHM) is explored. Applying the concept of Integrated Pest Management and an agroecological transdisciplinary approach, ISHM offers a framework under which a structure for developing and implementing biointensive soil health management strategies for a particular agroecosystem is defined. As a case study, a history of soil-borne disease management in California strawberries is reviewed and contrasted with a history of arthropod pest management to illustrate challenges associated with soil-borne disease management and the future directions of soil health research and soil-borne disease management. ISHM system consists of comprehensive soil health diagnostics, farmers' location-specific knowledge and adaptability, a suite of soil health management practices, and decision support tools. As we better understand plant-soil-microorganism interactions, including the mechanisms of soil suppressiveness, a range of diagnostic methodologies and indicators and their action thresholds may be developed. These knowledge-intensive and location-specific management systems require transdisciplinary approaches and social learning to be co-developed with stakeholders. The ISHM framework supports research into the broader implications of soil health such as the “One health” concept, which connects soil health to the health of plants, animals, humans, and ecosystems and research on microbiome and nutrient cycling that may better explain these interdependencies.

INTRODUCTION: Often, implications of the effect of CME is difficult to determine due to reliance on single data points of pre-post knowledge questions. Using aggregation methodology, we were able to thematically combine the assessments of 3 similar educational activities to determine the immediate and lasting effect of education on IBD practice. METHODS: Surveys were designed based on learning objectives of 3 accredited CME activities on IBD. Outcomes measurements were taken directly before and after the activities, as well as 3-months after activity completion. This 3-month follow-up sample was matched at the same time to a control sample of clinicians who did not participate in the education. RESULTS: Based on the themes of the pre-post questions, we were able to aggregate the scores of the three activities and determine overall changes in understanding key risk factors, establishing appropriate goals, choice of guideline-based therapy, and knowledge of clinical trials. Compared to pre-activity, learners had significant improvements in each of these areas, showing effectiveness of the education. Hodge's g effect sizes were run on all pre-post data to better compare the effect of education across themes. The most robust effects were seen in recognizing risk factors (g = 0.75) and clinical trial results (g = 0.71) while more modest effects were seen in establishing goals of treatment (g = 0.40) and selecting treatment (g = 0.59). Some of this modest effect seen in establishing goals can be attributed to a high baseline level of knowledge (a pre-score of 70.8%). However, looking at the scores of learners compared to a control group of similar clinicians that did not attend the education, robust effects can be seen even 30 days after the activity. Assessment of risk had an effect of 0.67 while establishing goals (g = 0.81) and treatment choice (g = 0.85) had even higher effects. CONCLUSION: Aggregating the outcomes of multiple educational activities allows us to understand effect by theme, providing opportunities to inform key stakeholders of the value of educational interventions. Further it allows educators opportunities to understand the continuing need of the community that has not attended these activities, and focus future interventions on improving areas where they are needed most.

BACKGROUND: Prior authorization (PA) poses a burden to HCPs and their staffs when prescribing biologic therapy for patients with IBD. Our aim was to determine the effectiveness of 3 CME activities on clinician knowledge, confidence, and performance related to PA processes and success rates for biologic therapy. METHODS: Outcomes measurements were taken directly before (n ≥ 241) and after the activities (n ≥ 229), as well as 3-months after activity completion. This 3-month follow-up sample (n = 30) was matched at the same time to a control sample of clinicians who did not participate in the education (n = 30). RESULTS: 4,840 learners completed the 3 modules, including 1,195 downloads of the podcast version. Key knowledge improvements were shown in helping patients with medication co-pays, use of specialty pharmacists, standardizing EHR clinical documentation of patients with IBD, requesting peer-to-peer review, and expediting submissions with the use of templates. Prior to participation, confidence in the current processes to manage prior authorizations was low. Three months following education, nearly all clinicians surveyed indicated that they were “confident” or “extremely confident” in these elements of care. Comparative analysis shows a large effect when comparing the educational learners pre- vs. post-activity (Cohen’s d = 1.37) and pre- vs. 3 –month follow-up (d = 0.55). However, comparing post-participation vs. a non-participant control is smaller (d = 0.20, 15%). This shows that our particular educational learners were coming at this program with more knowledge and practice gaps in the pre-authorization process than the general clinician population. Predictive modeling utilized a regression analysis showed increasing confidence in the use of AGA Care Pathways will significantly increase documentation of pertinent lab results and imaging related to IBD and significantly increase use of a template. CONCLUSION(S): This program achieved large reach with education targeted specifically to those clinicians who needed it most. The education increase clinician knowledge and confidence in the use of this knowledge to acquire prior authorization for biologics. For future PA initiatives, learners may benefit from a mock review of a PA request to best explain individual elements of the decision-making process.