Washington Metropolitan Area Transit Authority (WMATA): Issues and Options for Congress

This report provides background information about the Washington Metropolitan Area Transit Authority (WMATA) system, describes the major issues WMATA currently faces, and discusses possible approaches for addressing these issues

Perspectives and experiences of community health workers in Brazilian primary care centers using m-health tools in home visits with community members

Abstract Background Mobile health (m-health) tools are a promising strategy to facilitate the work of community health workers (CHWs) in low- and middle-income countries (LMICs). Despite their potential value, little is known about CHWs’ experiences working with m-health tools in their outreach activities with community members. Methods To understand the benefits of and barriers to using m-health tools for CHWs, we conducted semi-structured interviews with 57 CHWs employed in six primary care centers in São Paulo, Brazil. All CHWs had experience using a cell phone application called Geohealth for collecting health and demographic data of community members. We assessed their experiences using Geohealth and recommendations for improvements. Results CHWs described key benefits of using Geohealth as helping them save time with bureaucratic paperwork, organizing the data that they needed to collect, and by replacing sheaves of paper, reducing the weight that they carried in the field. However, there were many technical and social barriers to the successful adoption of the m-health tool. Key among these were poor quality hardware, faulty software programs, and negative community member perceptions of the m-health program. The CHWs provided valuable input as to how Geohealth could be improved to fit their needs. Conclusion m-health tools have the potential to facilitate the work of CHWs in LMICs. However, such tools must be designed and implemented thoughtfully. Technical barriers related to both hardware and software must be anticipated and addressed to maximize their efficiency and successful adoption. CHW input on the design of the tool should be sought to maximize its utility and minimize barriers to use.https://deepblue.lib.umich.edu/bitstream/2027.42/138148/1/12960_2017_Article_245.pd

Formal vs. informal coach education

The training of coaches is considered central to sustaining and improving the quality of sports coaching and the ongoing process of professionalisation. Sports coaches participate in a range of learning opportunities (informal to formal) that contribute to their development to varying degrees. In this article, we present our collective understanding on the varying types of learning opportunities and their contribution to coach accreditation and development. The authors presented these views (from a sports pedagogy perspective) as part of a workshop entitled "Formal vs. Informal Coach Education" at the 2007 International Council of Coach Education Master Class in Beijing. These reflections seek to stimulate the on-going, and often sterile, debate about formal versus informal coach education/learning in order to progress scholarship in coaching

Outside the gate: sub-urban legal practices in early medieval England

Many aspects of English early medieval (Anglo-Saxon) legal landscapes can be discerned in archaeological and toponymic evidence, ranging from the locations of legislative councils and judicial assemblies to sites of capital punishment. Among the corpus of such sites a striking group can be detected at the periphery of urban spaces. Gates into a number of towns appear to have functioned as legislative meeting-places, and even gave their names to some legally constituted communities, while suburban locations also feature prominently as sites of gallows and public punishment. In this paper historical, archaeological and toponymic evidence is used to examine this phenomenon of suburban legal practices and to pose questions about the wider dimensions of the early medieval legal landscape

STARD 2015: An Updated List of Essential Items for Reporting Diagnostic Accuracy Studies.

Incomplete reporting has been identified as a major source of avoidable waste in biomedical research. Essential information is often not provided in study reports, impeding the identification, critical appraisal, and replication of studies. To improve the quality of reporting of diagnostic accuracy studies, the Standards for Reporting of Diagnostic Accuracy Studies (STARD) statement was developed. Here we present STARD 2015, an updated list of 30 essential items that should be included in every report of a diagnostic accuracy study. This update incorporates recent evidence about sources of bias and variability in diagnostic accuracy and is intended to facilitate the use of STARD. As such, STARD 2015 may help to improve completeness and transparency in reporting of diagnostic accuracy studies

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes

To examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes (GDM) and maternal and perinatal outcomes

Defining failed induction of labor

BACKGROUND: While there are well-accepted standards for the diagnosis of arrested active-phase labor, the definition of a "failed" induction of labor remains less certain. One approach to diagnosing a failed induction is based on the duration of the latent phase. However, a standard for the minimum duration that the latent phase of a labor induction should continue, absent acute maternal or fetal indications for cesarean delivery, remains lacking. OBJECTIVE: The objective of this study was to determine the frequency of adverse maternal and perinatal outcomes as a function of the duration of the latent phase among nulliparous women undergoing labor induction. METHODS: This study is based on data from an obstetric cohort of women delivering at 25 U.S. hospitals from 2008-2011. Nulliparous women who had a term singleton gestation in the cephalic presentation were eligible for this analysis if they underwent a labor induction. Consistent with prior studies, the latent phase was determined to begin once cervical ripening had ended, oxytocin was initiated and rupture of membranes (ROM) had occurred, and was determined to end once 5 cm dilation was achieved. The frequencies of cesarean delivery, as well as of adverse maternal (e.g., cesarean delivery, postpartum hemorrhage, chorioamnionitis) and perinatal outcomes (e.g., a composite frequency of either seizures, sepsis, bone or nerve injury, encephalopathy, or death), were compared as a function of the duration of the latent phase (analyzed with time both as a continuous measure and categorized in 3-hour increments). RESULTS: A total of 10,677 women were available for analysis. In the vast majority (96.4%) of women, the active phase had been reached by 15 hours. The longer the duration of a woman's latent phase, the greater her chance of ultimately undergoing a cesarean delivery (P<0.001, for time both as a continuous and categorical independent variable), although more than forty percent of women whose latent phase lasted for 18 or more hours still had a vaginal delivery. Several maternal morbidities, such as postpartum hemorrhage (P < 0.001) and chorioamnionitis (P < 0.001), increased in frequency as the length of latent phase increased. Conversely, the frequencies of most adverse perinatal outcomes were statistically stable over time. CONCLUSION: The large majority of women undergoing labor induction will have entered the active phase by 15 hours after oxytocin has started and rupture of membranes has occurred. Maternal adverse outcomes become statistically more frequent with greater time in the latent phase, although the absolute increase in frequency is relatively small. These data suggest that cesarean delivery should not be undertaken during the latent phase prior to at least 15 hours after oxytocin and rupture of membranes have occurred. The decision to continue labor beyond this point should be individualized, and may take into account factors such as other evidence of labor progress

Does the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes?

To evaluate whether the presence of condition-specific obstetric protocols within a hospital was associated with better maternal and neonatal outcomes

An exploration of the relationship between educational background and the coaching behaviours and practice activities of professional youth soccer coaches

This paper is closed access until 12 December 2019.Background and purpose: Despite the proliferation in recent years of higher education establishments offering tertiary-level study in the field of sports coaching, there is a lack of research into the impact of such courses on coaching practice. The behaviours employed and activities used by coaches during practice sessions is an area where one might expect to see such impact, indeed certain studies have tentatively noted the educational qualifications of coaches and suggested that this may play a role in the application of behaviours more aligned with player learning. The purpose of this study was therefore to compare youth soccer coaches with and without tertiary-level qualifications, examining their coaching behaviours and practice activities. Method: The participants were 10 male professional youth soccer coaches aged 24–55 with an average of 13 years coaching experience. Five of the coaches had completed undergraduate degree courses related to sport coaching. All of the coaches worked with players aged under 9 to under 18 in the youth academy of an English professional soccer club. Systematic observation of coach behaviour and practice activities was carried out using the Coach Analysis and Intervention System (Cushion et al. 2012), while follow-up interviews were used to elicit the coaches’ perceptions of, and rationale for, their behaviour. Findings: The observation data showed that graduate coaches used significantly more divergent questioning than non-graduate coaches, while the interview data revealed a general trend for graduate coaches to show greater self-awareness of behaviours and changes in behaviour between practice types. Graduate coaches also provided more comprehensive rationales, for example, seeing silence as a means of facilitating player decision-making as well as for observation. In contrast to previous research, sessions featured a higher proportion of playing form than training form activities and at over 20% of session duration, the ‘other’ practice state was a prominent feature of contact time with players. While some coaches saw ‘other’ as wasted time, graduate coaches identified this as an opportunity for group discussion and social interaction. The study adds to existing data about coach behaviours and practice activities, providing evidence that education background may indeed influence coaching practice