Evaluating the impact of statewide policy implementation on interorganizational collaboration at the regional level : an application of network analysis.

One challenge to improving population health in the United States is that the systems tasked with the responsibility of providing services across the continuum of care often operate in silos, missing opportunities to provide quality, coordinated care. In 2011, Texas received approval from the Centers for Medicare and Medicaid Services (CMS) for a five-year 1115(a) Medicaid Waiver Demonstration Project. This dissertation focuses on one element of the Waiver, the Delivery System Reform Incentive Payment (DSRIP) Program, which was designed to incentivize activities that support organizations’ collaborative efforts with other organizations in addressing the Triple Aim strategies. DSRIP was implemented through the formation of 20 Regional Healthcare Partnerships (RHPs) across Texas. These RHPs represent networks comprised of organizations within sectors and across sectors, including hospitals, community mental health centers (CMHCs), and public health departments among others. Three overarching research questions were posed: 1. To what extent did participation in DSRIP affect the role CMHCs had within their RHPs? 2. To what extent did the formation of RHPs impact intersectoral collaboration under DSRIP? 3. Which community-based partners did DSRIP providers perceive as critical to delivery system reform, and what types of connections were formed with such partners? 4. A non-randomized, pre-post interorganizational network study design was used to assess collaboration within each RHP, where data were collected for three time periods. The findings suggest: 1. The Waiver prioritized mental health, promoted collaboration, and allowed CMHCs to provide intergovernmental transfer funds, all of which elevated the role and power of CMHCs in their RHPs. 2. The Waiver promoted meaningful opportunities for intersectoral collaboration, particularly around resource and data sharing for service integration efforts. This allowed otherwise unintegrated organizations, such as public health agencies and CMHCs to assume more central roles in delivery system reform. 3. DSRIP-participating organizations worked extensively and uniquely with community-based partners to integrate more forcefully the social determinants of health with health care in order to address the needs of low-income populations. Future waivers should consider expanding the pool of providers to include social service and non-traditional partners who are critical to population health improvement and health service delivery transformation

KORELASI ANTARA RELIGIUSITAS DENGAN GRATITUDE (KEBERSYUKURAN) PADA MAHASISWA PENERIMA BANTUAN BIAYA PENDIDIKAN BIDIKMISI DI UNIVERSITAS PENDIDIKAN INDONESIA

The problems of Bidikmisi students at Indonesia University of Education are low GPA scores, slow completion of studies, and some even cannot complete their studies. That problem can be caused by ungratefulness. One of the factors that causes gratitude is religiosity. For this reason, this study aims to determine how much the relationship between religiosity and gratitude for Bidikmisi students at Indonesia University of Education. The method of this research is correlational research. The subjects in this study were 100 Bidikmisi students studying at Indonesia University of Education. The correlation technique used is the Pearson Product Moment correlation technique. The results of this study indicate that religiosity is significantly correlated with gratitude in Bidikmisi students

What Do You Do When You Don\u27t Know How to Respond? Supporting Pre-Service Teachers to Use Picture Books to Facilitate Difficult Conversations

In this paper, the authors – a preservice teacher (PST) and a teacher educator – consider how teacher education might better prepare PSTs to use picture books to facilitate difficult conversations in elementary classrooms. They share missed opportunities from their own experiences in a fourth-grade fieldwork classroom and in a graduate-level elementary literacy methods course where they felt unprepared to respond to students’ comments about “controversial” topics. They reimagine how these experiences might have been transformed to be more educative for PSTs, first by considering how they could have responded more thoughtfully in the moment and then by thinking about how they could have built upon these particular moments to deepen PST learning. Lastly, authors share ideas for how current assignments in a literacy methods course could be revised to more intentionally support PSTs to use picture books to engage with content that may be difficult to address with elementary learners

Do Exchange Rates Fluctuations Influence Gold Price in G7 Countries? New Insights from a Nonparametric Causality-in-Quantiles Test

In the recent era, gold is considered an essential investment source, a source of hedging inflation, and a medium of monetary exchange. The gold and exchange rate nexus become prominent after events like sovereign debt crisis, subprime mortgage crisis, low-interest rate problem, and global financial market solvency. These events attract the attention of researchers and academician for investigating the dynamics of the relationship between gold and exchange rates, and the majority of the studies discusses the linear dynamics, but the non-linear dynamics are ignored. Therefore, the current research investigates the non-linear dynamics of gold price and exchange rate relationship in G7 countries using the new technique named the nonparametric causality approach. This study uses monthly data from the years 1995(January)-2017 (March). The empirical results show that exchange rate return causes gold prices in four out of G7, especially at the low tails. This study also gives valuable insights for monetary policymakers, gold exporter’s international portfolio managers, and hedge fund managers

Evaluating the effectiveness of \u27MCQ development workshop using cognitive model framework: A pre-post study

A workshop on MCQ development using cognitive model framework was conducted for health educators from Aga Khan University (AKU) and other academic institutions. The aim was to develop the skill of preparing MCQs for assessing higher cognitive levels. A pre-post study was conducted, participant satisfaction was evaluated and pre-post test scores were used to assess learning capability of the workshop participants. Out of the 19 who attended the workshop, 16 participated in the pre- and post-tests and were included in the study through convenience sampling. The total duration of the study was six months. There was a significant difference in the overall pre-post test scores of the participants with a mean difference of -4.176 ± 4.83 (p-value \u3c 0.05). A significant difference was observed in the mean pre-post test scores of junior faculty (-6.350± 4.5829; p-value = 0.02). The mean pre-test scores of junior faculty were significantly lower 4.950±2.83 as compared to the senior faculty 10.417±1.56 (p-value= 0.001). Active participation in faculty development workshops may lead to enhancing skills for preparing one-best MCQs based on international guidelines

Intrauterine growth retardation - small events, big consequences

Intrauterine growth retardation refers to a rate of growth of a fetus that is less than normal for the growth potential of a fetus (for that particular gestational age). As one of the leading causes of perinatal mortality and morbidity, intrauterine growth retardation has immense implications for the short term and long term growth of children. It is an important public health concern in the developing countries. Health statistics encompassing parameters for maternal and child health in the Indian subcontinent have shown improvement in the past few years but they are still far from perfect. Maternal health, education and empowerment bears a strong influence on perinatal outcomes including intrauterine growth retardation and should be the primary focus of any stratagem targeted at reducing the incidence of intrauterine growth retardation. A concerted liaison of various medical and social disciplines is imperative in this regard

IMPLEMENTASI METODE PERMAINAN BISIK BERANTAI DAN MEDIA CANVA DALAM MENINGKATKAN PENGUASAAN MUFRODAT

Penguasaan mufrodat sangat penting bagi siswa dalam mempelajari bahasa Arab. Meski demikian, banyak siswa yang masih menghadapi kesulitan dalam menguasainya karena minat belajar yang kurang. Hal tersebut terjadi dikarenakan metode dan media ajar yang dipakai tidak sesuai. Oleh sebab itu, penelitian ini bertujuan untuk menilai seberapa efektif proses pembelajaran siswa dalam mengimplementasikan metode permainan bisik berantai dan media Canva dalam meningkatkan kemampuan siswa kelas V SDIT At-Taqwa Gegerkalong Bandung dalam mempelajari mufrodat bahasa Arab. Penelitian ini menggunakan pendekatan tindakan kelas dua siklus serta melibatkan 22 siswa sebagai subjek penelitian. Data yang dikumpulkan mencakup data kualitatif yang diperoleh melalui observasi peneliti di sekolah, serta data kuantitatif diperoleh melalui angket siswa dan nilai tes (pre-test) dan (post-test). Hasil analisis menunjukkan bahwa penggunaan metode permainan bisik berantai dan media Canva terbukti efektif dalam meningkatkan penguasaan mufrodat bahasa Arab siswa, dengan peningkatan nilai siswa dari 45,4% pada siklus I menjadi 81,8% pada siklus II

SMOKING STATUS AFFECTING SURVIVAL OF ADENOCARCINOMA LUNG CANCER PATIENTS IN KUALA LUMPUR, MALAYSIA

  Objective: Adenocarcinoma (AC) of the lung is now the most common histologic type of non-small cell lung cancer (NSCLC) worldwide since the past 20 years. This study was conducted to investigate survival difference among smoker and non-smoker lung AC patients.Methods: A retrospective observational study was conducted for 81 advanced NSCLC adult Malaysian patients in Radiotherapy and Oncology Clinic at Hospital Kuala Lumpur, Malaysia. A total of adult 30 Malaysian smokers and 51 non-smokers with lung AC were included. Ex-smokers were not included in the study. Demographic and clinical data were collected and described. For survival analysis, Kaplan–Meier test and log-rank test were used to calculate overall survival (OS) and analyse the difference in the survival curve. Cox proportional hazard model was used to identify prognostic significance of smoking status.Results: Non-smokers showed a significant association with female gender and Stage IV NSCLC. The median OS was higher for non-smokers (493 days) as compared to smokers (230 days). The Cox proportional hazard model showed higher hazard ratio for smokers.Conclusion: Non-smoking is an independent positive prognostic factor in lung AC

Clinicopathologic features predictive of distant metastasis in patients diagnosed with invasive breast cancer

Purpose: National Comprehensive Cancer Network and European Society for Medical Oncology guidelines suggest screening for distant metastasis (M1) in symptomatic patients or those with locally advanced breast cancer. These guidelines are based on studies that often used pathologic staging for analysis. Physician variability in screening for M1 has also resulted in overuse of diagnostic tests. We sought to identify clinicopathologic features at diagnosis that could guide testing for metastatic disease.Methods: Patients diagnosed with invasive breast cancer between January 2014 and December 2015 were identified from our institutional database. Demographic and clinical variables were collected, including receptor profiles and clinical TNM staging. Rates of upstaging for each clinical stage and rates of concordance of pathologic and clinical staging were analyzed. Univariate analysis and multivariate regression analysis (P \u3c .05) identified predictors of upstaging to stage IV disease.Results: A total of 370 patients met the inclusion criteria. Seventy patients (18.9%) had metastatic disease at diagnosis. The rate of upstaging for stages I, IIA, IIB, and III were 0%, 5.6%, 18.8%, and 36.6%, respectively. Advancing clinical stage, tumor size, and nodal status resulted in a significantly higher rate (P \u3c .001) of upstaging to M1 disease. Age and hormone receptor status were not associated with upstaging to stage IV disease. Clinical stages I-III were concordant with pathologic staging in 65(42.8%) of 152 patients (kappa\u27s index, 0.197; P \u3c .000).Conclusion: Advancing clinical stage, tumor size, and nodal status at diagnosis were predictive of upstaging to M1 disease in patients with breast cancer. Distant metastatic workup should be considered in patients with clinical stage IIB disease or higher

Development And Evaluation Of Bioadhesive, Thermosensitive, In Situ Gelling Formulation Of Metronidazole And Diclofenac Potassium For Treatment Of Periodontal Disease

The target in treatment of periodontal disease is to eliminate the pathogens responsible for infection and decrease the tissue inflammation. Treatment using non-surgical scaling and root planning could leave behind microorganisms leading to re-colonization. Administration of anti-microbial and anti-inflammatory drugs orally, even at therapeutic doses in patients leads to some side effects. Local administration of drugs obviates the drawbacks of other routes of administration. The study was aimed to develop a syringeable, bioadhesive, sustained release, thermosensitive in situ gelling formulation of metronidazole and diclofenac potassium for the treatment of periodontal disease, which was delivered directly to the site of action. A simple HPLC-UV method that could simultaneously determine metronidazole and diclofenac potassium concentrations was developed and validated. The method was specific, precise and accurate. The two drug peaks were well resolved with good resolution. The sample run time was less than 12 min. The method was applied in drug assay, in vitro drug release study, in vitro drug permeation study and stability study of the gel formulations. Poloxamers 407 and 188 were used to prepare the in situ gelling formulations. Poloxamer of 30%w/w (poloxamer 407 and 188 at ratio of 2:1) showed gelation temperature close to the physiological temperature of the oral cavity. Xanthan gum and Carbopol 934 were incorporated to provide bioadhesive properties and sustain the drug release