A training-model scale's validity and reliability coefficients: expert evaluation in Indonesian professional psychology programs

Very little information has been available on training models in professional psychology programs in Indonesia, despite the Indonesian National Accreditation Body recommending that scientist-practitioner models be applied in the education of psychologists. By contrast, research abounds on such training models in Western countries. This discrepancy raises the importance of developing a measurement tool appropriate for assessing training models in Indonesian professional psychology programs. This article describes the process of testing the validity and reliability of such a training model measuring tool in the Indonesian context. The authors used the expert evaluation method and the Aiken formula to calculate a coefficient of content validity and item’s internal consistency reliability. This process formed a training model scale comprising 77 items with satisfactory validity and reliability indexes for measuring Indonesian professional psychology program training models

Comparative safety of pioglitazone versus clinically meaningful treatment alternatives concerning the risk of bladder cancer in older US adults with type 2 diabetes

Aims: To compare bladder cancer incidence between patients initiating pioglitazone treatment and patients initiating treatment with dipeptidyl-peptidase-4 inhibitors [DPP-4s] or sulfonylureas. Methods: We identified Medicare beneficiaries aged >65 years who initiated treatment with pioglitazone (N = 38 700), DPP-4s (N = 82 552) or sulfonylureas (N = 126 104) between 2007 and 2014 after at least 6 months without prescriptions for these drug classes. Patients were followed from second prescription until bladder cancer outcome (2 claims within 60 days) using a 6-month induction/latency period, censoring for treatment change, death or end of 2014. We used propensity score-weighted Cox proportional-hazards models to obtain adjusted hazard ratios (aHR) and their 95% confidence intervals. Results: Overall mean age of participants was 75 years and 41% were men. Over a median of 1.2 treatment years, 727 beneficiaries developed bladder cancer. Pioglitazone initiators had an increased incidence of bladder cancer (308 vs 204 [DPP-4s] or 231 [sulfonylureas] per 100 000 person-years; aHR, 1.57 [1.23-2.00] vs DPP-4s and 1.32 [1.02-1.70] vs sulfonylureas). The increased risk emerged within the first 2 years of treatment (aHR, 1.63 [1.22-2.17] vs DPP-4s and 1.32 [0.98-1.78] vs sulfonylureas). If treatment was discontinued within the first 2 years, the risk after 2 years post initiation was attenuated (aHR, 0.89 [0.61-1.28]) compared with patients treated for more than 2 years (aHR, 1.45 [0.93-2.26]) both vs DPP-4s. Findings were consistent across secondary and sensitivity analyses. Conclusions: Pioglitazone was associated with an elevated risk of bladder cancer compared with DPP-4s and sulfonylureas. The elevated risk emerged within the first 2 years of treatment and was attenuated after discontinuing. Pioglitazone's relative effectiveness should be weighed against a small absolute increase in risk of bladder cancer

Study design choices for evaluating the comparative safety of diabetes medications: An evaluation of pioglitazone use and risk of bladder cancer in older US adults with type-2 diabetes

Aim: The aim of the study was to empirically demonstrate the effect of varying study designs when evaluating the safety of pioglitazone in treating bladder cancer. Methods: We identified Medicare beneficiaries above 65 years of age with diabetes between 2008 and 2015 and with classified exposure (at least two claims within 180 days) to glucose-lowering drugs (GLD), pioglitazone or another drug. The effects of varying the following study design parameters on bladder cancer risk were assessed: use of a new vs existing drug, choice of referent (all non-users and users of GLDs, non-insulin GLDs and DPP-4s) and whether or not censoring accounted for treatment change. We used the Cox proportional hazards model to obtain adjusted HRs and 95% CIs. Results: We included 1,510,212 patients classified as pioglitazone users (N = 135,188) or non-users (N = 1,375,024). Users had more diabetic complications than non-users, but fewer than insulin users. The HR ranged from 1.10 (1.01-1.20) to 1.13 (0.99-1.29) when censoring ignored treatment change, suggesting a weak association or none between pioglitazone and bladder cancer, probably under-estimating risk. However, the HR was 1.20 (1.01-1.42) when cohorts were restricted to new users, censored upon treatment change, and when DPP-4 was used as the referent, suggesting an increased risk of bladder cancer associated with pioglitazone. Conclusions: The continued demand for new GLDs indicates the need for more robust observational methods to improve the value of generating real-world evidence in equipping clinicians to make informed prescribing decisions. Although there is no one-size-fits-all approach, we recommend active comparator new user study designs that compare therapeutically equivalent drugs and account for treatment changes during follow-up to present the least biased comparative safety estimates

Entanglement required in achieving entanglement-assisted channel capacities

Entanglement shared between the two ends of a quantum communication channel has been shown to be a useful resource in increasing both the quantum and classical capacities for these channels. The entanglement-assisted capacities were derived assuming an unlimited amount of shared entanglement per channel use. In this paper, bounds are derived on the minimum amount of entanglement required per use of a channel, in order to asymptotically achieve the capacity. This is achieved by introducing a class of entanglement-assisted quantum codes. Codes for classes of qubit channels are shown to achieve the quantum entanglement-assisted channel capacity when an amount of shared entanglement per channel given by, E = 1 - Q_E, is provided. It is also shown that for very noisy channels, as the capacities become small, the amount of required entanglement converges for the classical and quantum capacities.Comment: 9 pages, 2 figures, RevTex

Functional characterisation of novel NR5A1 variants reveals multiple complex roles in Disorders of Sex Development

Variants in the NR5A1 gene encoding SF1 have been described in a diverse spectrum of disorders of sex development (DSD). Recently, we reported the use of a targeted gene panel for DSD where we identified 15 individuals with a variant in NR5A1, nine of which are novel. Here, we examine the functional effect of these changes in relation to the patient phenotype. All novel variants tested had reduced trans-activational activity, while several had altered protein level, localization, or conformation. In addition, we found evidence of new roles for SF1 protein domains including a region within the ligand binding domain that appears to contribute to SF1 regulation of Mu¨llerian development. There was little correlation between the severity of the phenotype and the nature of the NR5A1 variant. We report two familial cases of NR5A1 deficiency with evidence of variable expressivity; we also report on individuals with oligogenic inheritance. Finally, we found that the nature of the NR5A1 variant does not inform patient outcomes (including pubertal androgenization and malignancy risk). This study adds nine novel pathogenic NR5A1 variants to the pool of diagnostic variants. It highlights a greater need for understanding the complexity of SF1 function and the additional factors that contribute

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Kompetensi inti dalam profesi psikologi: penerapannya dalam kurikulum pendidikan profesi psikologi di Indonesia [Core competencies in professional psychology: application in the curricula of Indonesian professional psychology programs]

Diskusi mengenai kurikulum pendidikan sudah mengarah pada penggunaan bahasa kompetensi untuk merumuskan tujuan pembelajaran pada sebuah proses pendidikan. Pendidikan psikologi di tingkat internasional tidak terlepas dari pergerakan ini. Secara lebih spesifik, pendidikan untuk mempersiapkan calon psikolog- pendidikan profesi psikologi- sudah mengalami apa yang dinamakan era 'budaya kompetensi'. Beberapa hasil perumusan mengenai suatu set kompetensi yang harus dimiliki oleh psikolog berpraktek dan yang perlu dikembangkan melalui pendidikan profesi psikologi sudah bermunculan dalam literatur, termasuk adanya gugus tugas khusus untuk menghasilkan kesepakatan internasional mengenai kompetensi seorang psikolog secara global. Artikel ini merupakan salah satu bagian dari sebuah penelitian studi kasus mengenai kurikulum pendidikan profesi psikologi di Indonesia, dan berusaha menyajikan hasil tinjauan literatur mengenai sejarah pergerakan pendidikan profesi psikologi menuju era kompetensi dan beberapa rumusan mengenai kompetensi psikolog yang sudah dipaparkan oleh beberapa ahli, termasuk di dalamnya pemaparan kesepakatan internasional terbaru mengenai kompetensi inti dalam profesi psikologi. Selanjutnya, artikel ini juga akan melakukan telaah terhadap perkembangan kurikulum pendidikan profesi psikologi di Indonesia, dengan mengacu pada hasil-hasil kesepakatan dan peraturan yang diterapkan saat ini dan kaitannya dengan pergerakan menuju era kompetensi yang terjadi secara internasional. Artikel ini kemudian menawarkan sebuah alternatif upaya pengayaan pendidikan psikologi Indonesia dengan cara menerapkan prinsip kompetensi inti profesi psikologi, melalui sebuah inisiatif kurikulum yang bersifat performance-based learning. Rekomendasi langkah-langkah menuju penerapan kurikulum yang mengacu pada suatu set kompetensi inti profesi psikologi pada program profesi di Indonesia juga akan dibahas pada makalah ini

Preparing for mental health care services: professional psychology curricula in Indonesia

Mental health is an important issue in the Indonesian health arena, given the existing large gap between the number of people with mental disorders and mental health services available for them. One concern raised is the extent to which Indonesian psychologists - as mental health professionals - can bridge this identified gap, in terms of both quality and accessibility of services provided. The involvement of psychologists in the provision of mental health services in primary health care facilities is one of the many initiatives intensively discussed by the parties involved in mental health care service in Indonesia. The writer argues that there are at least two important points that need to be addressed by the Indonesian health services community in relation to the above: the competencies expected of a health service psychologist and the extent to which the curricula for prospective Indonesian psychologists equip graduates to be able to meet the demands for these competencies. Scholars have identified roles and capabilities expected of mental health service psychologists in this area, which are presented briefly in this paper. In relation to the latter, this article describes the structure of Indonesian professional psychology education and identifies curriculum content in several of the country's professional programs that are closely related to specific competencies required by health service psychologists. Further, content considered relevant to the preparation of psychologists working in health settings that is currently missing from Indonesian curricula will also be identified. In conclusion, some important aspects of preparing mental health service psychologists for practice will be discussed. Suggestions will also be made on areas of research that might be pursued in the future