Understanding settlement services literacy and the provision of settlement services for humanitarian migrants in Australia : a service provider perspective

Over the past 40 years, successive Australian Governments have developed a comprehensive programme of settlement services (SS) designed to improve settlement outcomes for humanitarian migrants. Many humanitarian migrants do not arrive with the appropriate skills and abilities to fully benefit from available SS. “Settlement services literacy” (SSL) has been proposed as a framework to contextualise factors that may enable or constrain humanitarian migrants' utilisation of SS. The aim of this study was to investigate the provision of SS in relation to SSL, that is humanitarian migrants' ability to effectively access information and services, to critically assess services, and to politically mobilise and effect change. Qualitative interviews were conducted with 26 service providers representing 19 organisations in Greater Western Sydney (n = 8) and Melbourne (n = 11). The study found that SS programmes address many of the indicators that promote SSL acquisition. However, this is not achieved systematically, nor do the programmes reflect all indicators across the three SSL levels. This study provides new insights into various factors impacting the effectiveness of SS provision and SSL acquisition. These insights can inform future programme policy reforms and contribute to more effective and responsive service systems that meet the diverse and complex needs of humanitarian migrants

Establishing the psychometric properties of constructs from the conceptual 'settlement services literacy' framework and their relationship with migrants' acculturative stress in Australia

Background: Effective migration often requires supports for new arrivals, referred to as settlement services. Settlement services literacy (SSL) is key to ensuring new migrants have the capability to access and utilise the information and services designed to support the resettlement process and achieve positive settlement outcomes. To date, however, no research has sought to empirically validate measures of SSL or to assess individual migrants' levels of SSL. The aim of this study was to establish the psychometric properties of constructs from the conceptual SSL framework. Design Using a snowball sampling approach, trained multilingual research assistants collected data on 653 participants. The total sample was randomly divided into two split-half samples: one for the exploratory factor analysis (EFA; N = 324) and the other for the confirmatory factor analysis (CFA; N = 329) and scale validation. The final SSL scale included 30 questions. The full data set was used to test the nomological validity of the scale regarding whether the components of SSL impact on migrants' level of acculturative stress. Results: The EFA yielded five factors: knowledge (eight items, α = 0.88), empowerment (five items, α = 0.89), competence (four items, α = 0.86), community influence (four items, α = 0.82), and political (two items, α = 0.81). In the CFA, the initial model demonstrated a poor to marginal fit model. Its re-specification by examining modification indices resulted in a good model fit: CMIN/DF = 3.07, comparative fit index = 0.92, root mean square error of approximation = 0.08 and standardised root mean square residual = 0.07, which are consistent with recommendations. All the path coefficients between the second-order construct (SSL) and its five dimensions (knowledge, empowerment, competence, community influence and political) were significant at an α = .05 level, giving evidence for the validity of different SSL dimensions. We found that SSL is significantly related to migrants' acculturative stress (β = - 0.39, p < 0.05) in the nomological model. Conclusions The study provides evidence of the construct validity and reliability of the SSL tool. It provides the basis for integrating the measures of SSL into evaluation of settlement services. This will allow for more effective decision-making in designing and implementing settlement services as well as funding and service agreements to address any deficiencies

A precision study of two eclipsing white dwarf plus M dwarf binaries

We use a combination of X-shooter spectroscopy, ULTRACAM high-speed photometry and SOFI near-infrared photometry to measure the masses and radii of both components of the eclipsing post common envelope binaries SDSS J1212-0123 and GK Vir. For both systems we measure the gravitational redshift of the white dwarf and combine it with light curve model fits to determine the inclinations, masses and radii. For SDSS J1212-0123 we find a white dwarf mass and radius of 0.439 +/- 0.002 Msun and 0.0168 +/- 0.0003 Rsun, and a secondary star mass and radius of 0.273 +/- 0.002 Msun and 0.306 +/- 0.007 Rsun. For GK Vir we find a white dwarf mass and radius of 0.564 +/- 0.014 Msun and 0.0170 +/- 0.0004 Rsun, and a secondary star mass and radius of 0.116 +/- 0.003 Msun and 0.155 +/- 0.003 Rsun. The mass and radius of the white dwarf in GK Vir are consistent with evolutionary models for a 50,000K carbon-oxygen core white dwarf. Although the mass and radius of the white dwarf in SDSS J1212-0123 are consistent with carbon-oxygen core models, evolutionary models imply that a white dwarf with such a low mass and in a short period binary must have a helium core. The mass and radius measurements are consistent with helium core models but only if the white dwarf has a very thin hydrogen envelope, which has not been predicted by evolutionary models. The mass and radius of the secondary star in GK Vir are consistent with evolutionary models after correcting for the effects of irradiation by the white dwarf. The secondary star in SDSS J1212-0123 has a radius ~9 per cent larger than predicted.Comment: 21 pages, 14 Figures and 11 Tables. Accepted for publication in MNRA

Motivations and barriers for clinical mental health help-seeking in Bangladeshi university students: a cross-sectional study

Abstract Background University and college students are vulnerable to developing depressive symptoms. People in low-income countries are disproportionately impacted by mental health problems, yet few studies examine routes to accessing clinical services. Examining motivation and barriers toward seeking clinical mental health services in university students in Bangladesh is important. Method Using a cross-sectional survey (n = 350), we assess the relationship between the constructs of autonomy, relatedness, and competency toward using clinical mental health practices (i.e. using professional resources, taking medication) with (1) positive views, (2) perceived need, and (3) use of clinical mental health services among Bangladeshi university students. Results Results showed that the perceived need for mental health support was the predictor of the largest magnitude (aOR = 4.99, p = 0.005) for using clinical services. Having a positive view of clinical services was predictive of clinical service use (aOR = 2.87, p = 0.033); however, that association became insignificant (p = 0.054) when adjusting for the perceived need for mental health care. Of the SDT constructs, social influences were predictive of perceiving a need for mental health support, and mental health knowledge was predictive (aOR = 1.10, p = 0.001) of having a positive view of clinical mental health care. Conclusion Our findings show that knowledge of mental health is associated with positive views of mental health services, and that higher levels of stress and the presence of people with mental health problems are associated with the perception of a need for mental health care, which is ultimately responsible for using the services

Testing the white dwarf mass-radius relationship with eclipsing binaries

We present high-precision, model-independent, mass and radius measurements for 16 white dwarfs in detached eclipsing binaries and combine these with previously published data to test the theoretical white dwarf mass–radius relationship. We reach a mean precision of 2.4 per cent in mass and 2.7 per cent in radius, with our best measurements reaching a precision of 0.3 per cent in mass and 0.5 per cent in radius. We find excellent agreement between the measured and predicted radii across a wide range of masses and temperatures. We also find the radii of all white dwarfs with masses less than 0.48 M⊙ to be fully consistent with helium core models, but they are on average 9 per cent larger than those of carbon–oxygen core models. In contrast, white dwarfs with masses larger than 0.52 M⊙ all have radii consistent with carbon–oxygen core models. Moreover, we find that all but one of the white dwarfs in our sample have radii consistent with possessing thick surface hydrogen envelopes (10−5 ≥ MH/MWD ≥ 10−4), implying that the surface hydrogen layers of these white dwarfs are not obviously affected by common envelope evolution

IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT) : cluster randomised controlled trial study protocol

Background: Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidencebased clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim: This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).The trial is funded by the NHMRC by way of a Primary Health Care Project Grant (334060). JF has 50% of her time funded by the Chief Scientist Office3/2006). of the Scottish Government Health Directorate and 50% by the University of Aberdeen. PK is supported by a NHMRC Health Professional Fellowship (384366) and RB by a NHMRC Practitioner Fellowship (334010). JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. All other authors are funded by their own institutions

Baseline hospital performance and the impact of medical emergency teams: Modelling vs. conventional subgroup analysis

<p>Abstract</p> <p>Background</p> <p>To compare two approaches to the statistical analysis of the relationship between the baseline incidence of adverse events and the effect of medical emergency teams (METs).</p> <p>Methods</p> <p>Using data from a cluster randomized controlled trial (the MERIT study), we analysed the relationship between the baseline incidence of adverse events and its change from baseline to the MET activation phase using quadratic modelling techniques. We compared the findings with those obtained with conventional subgroup analysis.</p> <p>Results</p> <p>Using linear and quadratic modelling techniques, we found that each unit increase in the baseline incidence of adverse events in MET hospitals was associated with a 0.59 unit subsequent reduction in adverse events (95%CI: 0.33 to 0.86) after MET implementation and activation. This applied to cardiac arrests (0.74; 95%CI: 0.52 to 0.95), unplanned ICU admissions (0.56; 95%CI: 0.26 to 0.85) and unexpected deaths (0.68; 95%CI: 0.45 to 0.90). Control hospitals showed a similar reduction only for cardiac arrests (0.95; 95%CI: 0.56 to 1.32). Comparison using conventional subgroup analysis, on the other hand, detected no significant difference between MET and control hospitals.</p> <p>Conclusions</p> <p>Our study showed that, in the MERIT study, when there was dependence of treatment effect on baseline performance, an approach based on regression modelling helped illustrate the nature and magnitude of such dependence while sub-group analysis did not. The ability to assess the nature and magnitude of such dependence may have policy implications. Regression technique may thus prove useful in analysing data when there is a conditional treatment effect.</p

Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis.

BACKGROUND: Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension. METHODS AND FINDINGS: Medline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016). Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes-change in mean clinic or ambulatory BP and proportion controlled below target at 12 months-were available from 15/19 possible studies (7,138/8,292 [86%] of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months (-3.2 mmHg, [95% CI -4.9, -1.6 mmHg]). However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (-1.0 mmHg [-3.3, 1.2]), to a 6.1 mmHg (-9.0, -3.2) reduction when monitoring was combined with intensive support. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Ambulatory BP data at 12 months were available from 4 trials (1,478 patients), which assessed self-monitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (clinic -0.2 mmHg [-2.2, 1.8]; ambulatory 1.1 mmHg [-0.3, 2.5]). Results for diastolic blood pressure (dBP) were similar. The main limitation of this work was that significant heterogeneity remained. This was at least in part due to different inclusion criteria, self-monitoring regimes, and target BPs in included studies. CONCLUSIONS: Self-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions (including systematic medication titration by doctors, pharmacists, or patients; education; or lifestyle counselling) leads to clinically significant BP reduction which persists for at least 12 months. The implementation of self-monitoring in hypertension should be accompanied by such co-interventions

A unified approach to estimate land and water reflectances with uncertainties for coastal imaging spectroscopy

Coastal ecosystem studies using remote visible/infrared spectroscopy typically invert an atmospheric model to estimate the water-leaving reflectance signal. This inversion is challenging due to the confounding effects of turbid backscatter, atmospheric aerosols, and sun glint. Simultaneous estimation of the surface and atmosphere can resolve the ambiguity enabling spectral reflectance maps with rigorous uncertainty quantification. We demonstrate a simultaneous retrieval method that adapts the Optimal Estimation (OE) formalism of Rodgers (2000) to the coastal domain. We compare two surface representations: a parametric bio-optical model based on Inherent Optical Properties (IOPs); and an expressive statistical model that estimates reflectance in every instrument channel. The latter is suited to both land and water reflectance, enabling a unified analysis of terrestrial and aquatic domains. We test these models with both vector and scalar Radiative Transfer Models (RTMs). We report field experiments by two airborne instruments: NASA's Portable Remote Imaging SpectroMeter (PRISM) in an overflight of Santa Monica, California; and NASA's Next Generation Airborne Visible Infrared Imaging Spectrometer (AVIRIS-NG) in an overflight of the Wax Lake Delta and lower Atchafalaya River, Louisiana. In both cases, in situ validation measurements match remote water-leaving reflectance estimates to high accuracy. Posterior error predictions demonstrate a closed account of uncertainty in these coastal observations