Can Sexuality Education Advance Gender Equality and Strengthen Education Overall? Learning from Nigeria's Family Life and HIV Education Program

The imperative to prepare the largest generation of young people in history for adulthood has driven a search for fresh approaches to educating adolescents about their bodies and sexuality. Recently, there have been calls among health experts and educators for a comprehensive, integrated approach to sexuality education that addresses not only health issues such as HIV and pregnancy, but also helps to achieve broader outcomes such as ensuring gender equality, increasing access to education for girls, and improving the quality of education overall. Considerable international attention has been paid to the Family Life and HIV Education (FLHE) program in Nigeria. While the program does not formally aim to achieve broader development goals, nongovernmental organizations in some states have effectively brought a strong commitment to gender equality into local FLHE programs.This report synthesizes a two-tiered review of the FLHE program. It draws both on a formal case study examining effects of the training on teacher attitudes and practices and on a wider, more informal program analysis. The findings from both resonate with each other and are synthesized in this report

Do Expenditures for Student Support Services Lead to Demonstrable Gains in Student Achievement?

Wood, Allemand, Anderson, and Cheslock present a brief overview and analysis of the article, Relationship between types of school district expenditures and student performance, originally published in Applied Economics Letters. The authors present a summary of the key components of the article including the introduction, method and results of the study. They offer an additional analysis of implications for future practice, including a discussion of legislation and the conflicting evidence that school counseling and support services benefit students in academic and social competencies, as well as evidence that the cost seems to outweigh the benefits

Infallible Proofs : Math, Knowledge, and Religion in the Medieval Islamicate World

The status of mathematics in the Islamic world underwent a dramatic change from c. 750 to 1100 that enabled it to endure a significant theological and epistemological shift in the eleventh century. In that time, math was first recognized for its utility in confronting problems that faced Islamic society. Established as a respectable form of knowledge, math gained further scholastic interest as texts translated from Sanskrit, then Greek, introduced new problems and methods to Islamicate mathematics. It gained epistemic clout as practitioners relied increasingly on proofs to support their claims. In the eleventh century, theological changes gradually lowered the value given to human reason, but as mathematical proof was increasingly considered to transcend reason, math remained a legitimate way of knowing in the Islamicate world

Ergonomic redesign using quality improvement for pre-hospital care of acute myocardial infarction

Context: Frontline emergency ambulance clinicians collaborated in a national quality improvement (QI) initiative to improve pre-hospital care for patients with acute myocardial infarction (AMI). Problem: The National Ambulance Clinical Performance Indicator (CPI) care bundle for AMI (consisting of aspirin, GTN, pain assessment and administration of analgesia) highlighted a consistent shortfall in patient pain assessment and inadequate provision of analgesia. Ineffective pain management in AMI has negative physiological and psychological effects that can be detrimental to patient outcomes. The aim is to increase the delivery of the entire AMI care bundle to 90% by March 2012 Assessment of problem and analysis of its causes: We explored barriers to effective pain management using process maps, cause-and-effect diagrams and thematic analysis of audio recordings from QI collaborative workshops and semi-structured interviews. We found that ergonomic factors (interaction between human and system factors), which included ineffective and inefficient pain assessment methods, ineffective feedback processes and poor access to analgesia were root causes for suboptimal pain management in AMI. Intervention: Through collaboration with frontline ambulance clinicians, solutions were found to overcome these root causes. These included: •Provider prompts (e.g. aide memoires and checklists) to prompt care bundle delivery. •Modified pain assessment tools (integrating Wong-baker faces, numerical verbal scores from 0 to 10 and descriptive intensity scales). •Individual clinical feedback by a clinical leader. •The introduction of small nitrous oxide canisters to increase availability and administration of analgesia earlier in the care pathway. Strategy for change: We used Plan-Do-Study-Act (PDSA) cycles to improve processes of care in AMI. Once improvements developed through PDSA cycles were identified, these were spread to county divisions and then trust-wide. Results were shared through QI workshops, face-to-face dialogue, e-forums, bulletins, newsletters and magazines locally and nationally. Measurement of improvement: Statistical Process Control (SPC) control methods were used to evaluate the effects of changes implemented. Improvements in the delivery of analgesia and the entire care bundle were achieved through initial awareness raising and implementation of system changes; e.g. provider prompts and revised pain assessment tool etc. We have already seen improvements in performance in the delivery of analgesia and also the care bundle as a whole. Effects of changes: An increase in pain assessment and the delivery of analgesia for patients experiencing AMI will help improve patient outcomes. The preliminary results of this study show improvement in the pain management in AMI. The sustainability of improvements recognised so far, and any variations that may occur as a consequence of subsequent interventions, continue to be monitored. Lessons learnt: A deeper understanding of the current system of care has been achieved by adopting a collaborative approach using QI methods focusing on ergonomics. Greater efforts earlier in the project to nurture a culture for improvement and to foster ownership and support from senior executives could have been an additional facilitator for these activities. Message for others: Systems of care can be ergonomically designed using QI methods to foster an environment that minimises opportunities for mistakes, accidental slips, lapses as well as routine (i.e. purposeful) and exceptional (i.e. unavoidable) violations in pre-hospital pain management

Standardized Precipitation Index: User Guide

Over the years, there has been much discussion on what drought indices should be used in a particular climate and for what application. Many drought definitions and indices have been developed and attempts have been made to provide some guidance on this issue. With this in mind, the Interregional Workshop on Indices and Early Warning Systems for Drought was organized and held at the University of Nebraska-Lincoln, United States of America, from 8 to 11 December 2009. It was jointly sponsored by the School of Natural Resources (SNR) of the University of Nebraska, the United States National Drought Mitigation Center (NDMC), the World Meteorological Organization (WMO), the United States National Oceanic and Atmospheric Administration (NOAA), the United States Department of Agriculture (USDA) and the United Nations Convention to Combat Desertification (UNCCD). The workshop brought together 54 participants representing 22 countries from all over the world. They reviewed the drought indices currently in use in different regions of the world to explain meteorological, agricultural and hydrological droughts; assessed the capacity for collecting information on the impacts of drought; reviewed the current and emerging technologies for drought monitoring, and discussed the need for consensus standard indices to describe different types of droughts. The experts at the meeting elaborated and approved the Lincoln Declaration on Drought Indices, which recommended that the Standardized Precipitation Index (SPI) be used by all National Meteorological and Hydrological Services (NMHSs) around the world to characterize meteorological droughts, in addition to other drought indices that were in use in their service. The Lincoln Declaration also recommended the development of a comprehensive SPI user manual. In June 2011, the Sixteenth World Meteorological Congress adopted a resolution that endorsed both of these recommendations. The Congress also requested that the SPI manual be published and distributed in all official languages of the United Nations. The full Lincoln Declaration on Drought Indices can be found on the WMO website at http:// www.wmo.int/pages/prog/wcp/agm/meetings/wies09/documents/Lincoln_Declaration_Drought_ Indices.pdf

Joining the dots: measuring the effects of a national quality improvement collaborative in ambulance services

Context: We undertook a national collaborative to improve cardiovascular care by frontline clinicians in 12 English Ambulance Services. Data were collected by clinical audit staff and submitted centrally where they were collated and analysed. Problem: Cardiovascular disease is the commonest cause of death in the United Kingdom (UK). Acute Myocardial Infarction (AMI) causes 250,000 deaths per year and 1 in 3 heart attack victims die before reaching hospital. There are approximately 152,000 strokes per year causing more than 49,000 deaths. Early and effective treatment decreases death rates for AMI and stroke, improves long-term health and reduces future disability. National guidelines for ambulance clinicians are based on evidence for best clinical practice for AMI and stroke care by ambulance services as defined in the National Service Framework for CHD and National Stroke Strategy. Whilst ambulance clinicians were good at delivering specific aspects of care they were less effective at delivering whole bundles of care. Assessment of problem and analysis of its causes: The process of care delivered by English ambulance services is now assessed using National Clinical Performance Indicators (nCPIs) which include measures of complete bundles of care. The care bundle for AMI is: administration of aspirin and GTN, pain score recorded before and after treatment and administration of analgesia. The stroke care bundle consists of recording of FAST, blood glucose and blood pressure. A key project aim was to produce a sustained improvement in the national rate of care bundle delivery for AMI from 43% (range 26.2%-90.32%) to 90% and for stroke from 83.1% (range 39.4 %– 97.6%) to 90% within 2 years. Intervention: Frontline clinicians identified barriers and facilitators to delivery of care bundles and designed and tested new processes using quality improvement (QI) methods after being trained in process mapping, root cause analysis and Plan Do Study Act cycles. The effects of interventions were tracked using annotated control charts. Strategy for change: Quality Improvement Teams and Fellows were appointed in each service to form QI collaboratives. Collaboratives were responsible for developing and trialling localised interventions and spreading successful interventions more widely within Trusts. QI Fellows were to meet regularly to share learning. Measurement of improvement: Statistical Process control (SPC) methods were utilised to measure the effectiveness and sustainability of interventions. Effects of changes: With 6 months of the project left to run, the nCPIs have shown improvements in the care bundle for STEMI (mean 58.8%) and Stroke (mean 89.8%) with significant improvements in some trusts. There is evidence in some Trusts that interventions (particularly those affecting a whole Trust) are being reflected in the data although more data is needed to see whether these changes will be sustained. Lessons learnt: Small sample sizes sometimes made local level measurement of change problematic and ways of overcoming this were developed. Barriers in service reconfiguration caused delays in starting collaboratives or trialling interventions; this highlighted the importance o f ensuring that corporate bodies clearly understood the scale and purpose of the collaboratives. Baseline and prospective data collection took longer than expected and resources for this were stretched, particularly in Trusts without electronic systems. If running similar projects on a similar scale greater clarity about roles and expectations around resourcing data collection would be needed from the outset. Annotation of the control charts proved invaluable in monitoring the effects of interventions and their sustainability. Message for others: Annotated control charts were a powerful tool in determining whether and to what extent interventions led to improvements in care. This enabled an evidence base for spreading intervention within and beyond ambulance services on a national scale