Challenging the status quo : results of an acceptability and feasibility study of hypertensive disorders of pregnancy (HDP) management pathways in Indonesian primary care

Background: Hypertensive disorders of pregnancy (HDP) are the leading cause of maternal mortality in Indonesia. Focused HDP management pathways for Indonesian primary care practice have been developed from a consensus development process. However, the acceptability and feasibility of the pathways in practice have not been explored. This study reports on the implementation process of the pathways to determine their acceptability and feasibility in Indonesian practice. Methods: The pathways were implemented in three public primary care clinics (Puskesmas) in Yogyakarta province for a month, guided by implementation science frameworks of Medical Research Council (MRC) and the Practical Robust Implementation and Sustainability Model (PRISM). The participating providers (general practitioners (GPs), midwives, and nurses) were asked to use recommendations in the pathways for a month. The pathway implementation evaluations were then conducted using clinical audits and a triangulation of observations, focus groups (FGs), and interviews with all of the participants. Clinical audit data were analysed descriptively, and qualitative data were analysed using a mix of the inductive-deductive approach of thematic analysis. Results: A total of 50 primary care providers, four obstetricians, a maternal division officer in the local health office and 61 patients agreed to participate, and 48 of the recruited participants participated in evaluation FGs or interviews. All of the providers in the Puskesmas attempted to apply recommendations from the pathways to various degrees, mainly adopting preeclampsia risk factor screenings and HDP monitoring. The participants expressed that the recommendations empowered their practice when it came to HDP management. However, their practices were challenged by professional boundaries and hierarchical barriers among health care professionals, limited clinical resources, and regulations from the local health office. Suggestions for future scale-up studies were also mentioned, such as involving champion obstetricians and providing more patient education toolkits. Conclusion: The HDP management pathways are acceptable and feasible in Indonesian primary care. A further scale-up study is desired and can be initiated with investigations to minimise the implementation challenges and enhance the pathways’ value in primary care practice

Exploring general practitioners' experience of informing women about prenatal screening tests for foetal abnormalities: A qualitative focus group study

Background: Recent developments have made screening tests for foetal abnormalities available earlier in pregnancy and women have a range of testing options accessible to them. It is now recommended that all women, regardless of their age, are provided with information on prenatal screening tests. General Practitioners (GPs) are often the first health professionals a woman consults in pregnancy. As such, GPs are well positioned to inform women of the increasing range of prenatal screening tests available. The aim of this study was to explore GPs experience of informing women of prenatal genetic screening tests for foetal abnormality.Methods: A qualitative study consisting of four focus groups was conducted in metropolitan and rural Victoria, Australia. A discussion guide was used and the audio-taped transcripts were independently codedby two researchers using thematic analysis. Multiple coders and analysts and informant feedback were employed to reduce the potential for researcher bias and increase the validity of the findings.Results: Six themes were identified and classified as \u27intrinsic\u27 if they occurred within the context of the consultation or \u27extrinsic\u27 if they consisted of elements that impacted on the GP beyond the scope of theconsultation. The three intrinsic themes were the way GPs explained the limitations of screening, the extent to which GPs provided information selectively and the time pressures at play. The three extrinsicfactors were GPs\u27 attitudes and values towards screening, the conflict they experienced in offering screening information and the sense of powerlessness within the screening test process and the healthcare system generally. Extrinsic themes reveal GPs\u27 attitudes and values to screening and to disability, as well as raising questions about the fundamental premise of testing.Conclusion: The increasing availability and utilisation of screening tests, in particular first trimester tests,has expanded GPs\u27 role in facilitating women\u27s informed decision-making. Recognition of the importanceof providing this complex information warrants longer consultations to respond to the time pressures that GPs experience. Understanding the intrinsic and extrinsic factors that impact on GPs may serve to shapeeducational resources to be more appropriate, relevant and supportive.<br /

An Alternative Undergraduate Teacher Preparation Program: A Comprehensive One-to-One iPad Initiative Model

To date, little literature has been published on how an alternative undergraduate teacher preparation program infuses mobile devices such as the iPad and its applications, model classrooms, and a high-tech computer lab to prepare teacher candidates. Preparing teacher candidates to generalize technological skills is most effective when it is hands on, using the varied devices and support available to them. Meaningful instruction, application and maintenance of technological usage is the key to 21st century teaching and learning but it will not occur without a designed plan of action or model. This article focuses on the prominence of the use of iPads for teacher candidates in higher education and its potential impact on the learning of students with varying backgrounds and abilities in public schools. Further, it provides conceptual, systematic, comprehensive, and ready-to-use three phases of an existing one-to-one iPad initiative model at a southeast institution of higher education in the United States of America. Keywords: iPads in Higher Education, Mobile Learning, Pre-service Teachers, Teacher Candidates, Alternative Teacher Preparation Progra

Reliability of grading using a rubric versus a traditional marking scheme in statistics

Assessment grading in statistics and mathematics has often been approached in an ad-hoc manner, using marking schemes that attach marks to specific steps of a model solution and often do not explicitly reference assessment criteria. Another approach for grading is to use rubrics. Rubrics are recognised to have several advantages for assessment, but research on the reliability of grading with rubrics is equivocal and mostly conducted in less quantitative disciplines. We present a direct comparison of the reliability of marking of a written statistics assignment using a rubric and using the traditional marking scheme approach. We use a Bayesian statistical analysis and find that both methods yield similar levels of inter-rater and intra-rater reliability

Criterion-based assessment of statistical reasoning, thinking and literacy – early stages

Statistical reasoning, thinking and literacy (SRTL) is a popular framework for considering learning outcomes in statistics education [1]. In this ideas exchange workshop participants will discuss the role of SRTL in undergraduate science education in Australia. We will take steps towards a shared understanding of statistical thinking, reasoning and literacy amongst academics. We will gauge interest for a potential extension to the mathsassess OLT project (www.mathsassess.org) [2] to develop supporting resources for assessment of SRTL in undergraduate statistics and other disciplines where statistics is an integral part of the curriculum. The session is intended to help refine the scope and aims of the proposed extension project and will lay the ground for future workshops in this area

The Properties of Type Ia Supernova Host Galaxies from the Sloan Digital Sky Survey

We investigate the properties and environments of Type Ia Supernova (SN Ia) host galaxies in the Stripe 82 of the Sloan Digital Sky Survey-II Supernova Survey centered on the celestial equator. Host galaxies are defined as the galaxy nearest to the supernova (SN) in terms of angular distance whose velocity difference from the SN is less than 1000 km s^{-1}. Eighty seven SN Ia host galaxies are selected from the SDSS Main galaxy sample with the apparent r-band magnitude m_r < 17.77, and compared with the SDSS Main galaxies. The SN Ia rates for early and late-type galaxies are 0.81 +- 0.19 SN (100yr)^{-1} and 0.99 +- 0.21 SN (100yr)^{-1}, respectively. We find that the host galaxies have a color distribution consistent with that of the Main galaxies, regardless of their morphology. However, host galaxies are on average brighter than the Main galaxies by ~ 0.3 mag over the range of -18.3 > M_r > -21.3. But the brighter ends of their luminosity distributions are similar. The distribution of the distance to the nearest neighbor galaxy shows that SNe Ia are more likely to occur in isolated galaxies without close neighbors. We also find that the SN Ia host galaxies are preferentially located in a region close to massive galaxy clusters compared to the Main galaxies.Comment: 10 pages, 8 figures, accepted for publication on Ap

Integrating Behavioral Health & Primary Care in New Hampshire: A Path Forward to Sustainable Practice & Payment Transformation

New Hampshire residents face challenges with behavioral and physical health conditions and the interplay between them. National studies show the costs and the burden of illness from behavioral health conditions and co-occurring chronic health conditions that are not adequately treated in either primary care or behavioral health settings. Bringing primary health and behavioral health care together in integrated care settings can improve outcomes for both behavioral and physical health conditions. Primary care integrated behavioral health works in conjunction with specialty behavioral health providers, expanding capacity, improving access, and jointly managing the care of patients with higher levels of acuity In its work to improve the health of NH residents and create effective and cost-effective systems of care, the NH Citizens Health Initiative (Initiative) created the NH Behavioral Health Integration Learning Collaborative (BHI Learning Collaborative) in November of 2015, as a project of its Accountable Care Learning Network (NHACLN). Bringing together more than 60 organizations, including providers of all types and sizes, all of the state’s community mental health centers, all of the major private and public insurers, and government and other stakeholders, the BHI Learning Collaborative built on earlier work of a NHACLN Workgroup focused on improving care for depression and co-occurring chronic illness. The BHI Learning Collaborative design is based on the core NHACLN philosophy of “shared data and shared learning” and the importance of transparency and open conversation across all stakeholder groups. The first year of the BHI Learning Collaborative programming included shared learning on evidence-based practice for integrated behavioral health in primary care, shared data from the NH Comprehensive Healthcare Information System (NHCHIS), and work to develop sustainable payment models to replace inadequate Fee-for-Service (FFS) revenues. Provider members joined either a Project Implementation Track working on quality improvement projects to improve their levels of integration or a Listen and Learn Track for those just learning about Behavioral Health Integration (BHI). Providers in the Project Implementation Track completed a self-assessment of levels of BHI in their practice settings and committed to submit EHR-based clinical process and outcomes data to track performance on specified measures. All providers received access to unblinded NHACLN Primary Care and Behavioral Health attributed claims data from the NHCHIS for provider organizations in the NH BHI Learning Collaborative. Following up on prior work focused on developing a sustainable model for integrating care for depression and co-occurring chronic illness in primary care settings, the BHI Learning Collaborative engaged consulting experts and participants in understanding challenges in Health Information Technology and Exchange (HIT/HIE), privacy and confidentiality, and workforce adequacy. The BHI Learning Collaborative identified a sustainable payment model for integrated care of depression in primary care. In the process of vetting the payment model, the BHI Learning Collaborative also identified and explored challenges in payment for Substance Use Disorder Screening, Brief Intervention and Referral to Treatment (SBIRT). New Hampshire’s residents will benefit from a health care system where primary care and behavioral health are integrated to support the care of the whole person. New Hampshire’s current opiate epidemic accentuates the need for better screening for behavioral health issues, prevention, and treatment referral integrated into primary care. New Hampshire providers and payers are poised to move towards greater integration of behavioral health and primary care and the Initiative looks forward to continuing to support progress in supporting a path to sustainable integrated behavioral and primary care

Anxiety and cognitive bias in children and young people who stutter

Psychologists recognise various forms of anxiety, such as generalized anxiety disorder, separation anxiety and social phobia. People who stutter are at risk of elevated levels of anxiety, especially social phobia. Recent research has suggested that anxiety may be caused and maintained by cognitive biases such as preferentially allocating attention towards threat stimuli. These biases can be re-trained using cognitive bias modification with resulting improvements in levels of anxiety. In the present study, we measured different forms of anxiety and attentional bias for faces among 8-18 year olds attending the Michael Palin Centre for treatment for stuttering. The clients and their parent(s) completed the child and parent versions, respectively, of the Screen for Childhood Anxiety Related Emotional Disorders (SCARED), which provides an overall anxiety score and sub-scores, with clinical cut-offs, for generalized anxiety disorder, separation anxiety, social phobia, school avoidance and panic. The clients also performed a computerised measure of attentional bias for faces, using schematic stimuli. Levels of anxiety were higher than in the general population, and prevalence increased with age. There was a significant correlation between SCARED scores produced by clients and their parents. Socially anxious participants showed a bias towards sad faces

The Role of Environment in the Mass-Metallicity Relation

Using a sample of 57,377 star-forming galaxies drawn from the Sloan Digital Sky Survey, we study the relationship between gas-phase oxygen abundance and environment in the local Universe. We find that there is a strong relationship between metallicity and environment such that more metal-rich galaxies favor regions of higher overdensity. Furthermore, this metallicity-density relation is comparable in strength to the color-density relation along the blue cloud. After removing the mean dependence of environment on color and luminosity, we find a significant residual trend between metallicity and environment that is largely driven by galaxies in high-density regions, such as groups and clusters. We discuss the potential source of this relationship between metallicity and local galaxy density in the context of feedback models, with special attention paid to quantifying the impact of environment on the scatter in the mass-metallicity relation. We find that environment is a non-negligible source of scatter in this fundamental relation, with > 15% of the measured scatter correlated with environment.Comment: Submitted to MNRA

Galaxy Assembly Bias on the Red Sequence

Using samples drawn from the Sloan Digital Sky Survey, we study the relationship between local galaxy density and the properties of galaxies on the red sequence. After removing the mean dependence of average overdensity (or "environment") on color and luminosity, we find that there remains a strong residual trend between luminosity-weighted mean stellar age and environment, such that galaxies with older stellar populations favor regions of higher overdensity relative to galaxies of like color and luminosity (and hence of like stellar mass). Even when excluding galaxies with recent star-formation activity (i.e., younger mean stellar ages) from the sample, we still find a highly significant correlation between stellar age and environment at fixed stellar mass. This residual age-density relation provides direct evidence for an assembly bias on the red sequence such that galaxies in higher-density regions formed earlier than galaxies of similar mass in lower-density environments. We discuss these results in the context of the age-metallicity degeneracy and in comparison to previous studies at low and intermediate redshift. Finally, we consider the potential role of assembly bias in explaining recent results regarding the evolution of post-starburst (or post-quenching) galaxies and the environmental dependence of the type Ia supernova rate.Comment: Accepted for publication in MNRA