Determining the psychometric properties of the Enhancing Decision-making Assessment in Midwifery (EDAM) measure in a cross cultural context

© 2016 Jefford et al. Background: The ability to act on and justify clinical decisions as autonomous accountable midwifery practitioners, is encompassed within many international regulatory frameworks, yet decision-making within midwifery is poorly defined. Decision-making theories from medicine and nursing may have something to offer, but fail to take into consideration midwifery context and philosophy and the decisional autonomy of women. Using an underpinning qualitative methodology, a decision-making framework was developed, which identified Good Clinical Reasoning and Good Midwifery Practice as two conditions necessary to facilitate optimal midwifery decision-making during 2nd stage labour. This study aims to confirm the robustness of the framework and describe the development of Enhancing Decision-making Assessment in Midwifery (EDAM) as a measurement tool through testing of its factor structure, validity and reliability. Method: A cross-sectional design for instrument development and a 2 (country; Australia/UK) x 2 (Decision-making; optimal/sub-optimal) between-subjects design for instrument evaluation using exploratory and confirmatory factor analysis, internal consistency and known-groups validity. Two 'expert' maternity panels, based in Australia and the UK, comprising of 42 participants assessed 16 midwifery real care episode vignettes using the empirically derived 26 item framework. Each item was answered on a 5 point likert scale based on the level of agreement to which the participant felt each item was present in each of the vignettes. Participants were then asked to rate the overall decision-making (optimal/sub-optimal). Findings: Post factor analysis the framework was reduced to a 19 item EDAM measure, and confirmed as two distinct scales of 'Clinical Reasoning' (CR) and 'Midwifery Practice' (MP). The CR scale comprised of two subscales; 'the clinical reasoning process' and 'integration and intervention'. The MP scale also comprised two subscales; women's relationship with the midwife' and 'general midwifery practice'. Conclusion: EDAM would generally appear to be a robust, valid and reliable psychometric instrument for measuring midwifery decision-making, which performs consistently across differing international contexts. The 'women's relationship with midwife' subscale marginally failed to meet the threshold for determining good instrument reliability, which may be due to its brevity. Further research using larger samples and in a wider international context to confirm the veracity of the instrument's measurement properties and its wider global utility, would be advantageous

INTEGRATE-Neo: A pipeline for personalized gene fusion neoantigen discovery

Abstract Motivation While high-throughput sequencing (HTS) has been used successfully to discover tumor-specific mutant peptides (neoantigens) from somatic missense mutations, the field currently lacks a method for identifying which gene fusions may generate neoantigens. Results We demonstrate the application of our gene fusion neoantigen discovery pipeline, called INTEGRATE-Neo, by identifying gene fusions in prostate cancers that may produce neoantigens. Availability and Implementation INTEGRATE-Neo is implemented in C ++ and Python. Full source code and installation instructions are freely available from https://github.com/ChrisMaherLab/INTEGRATE-Neo. Supplementary information Supplementary data are available at Bioinformatics online. </jats:sec

Making a Business Case for Reducing Racial and Ethnic Disparities in Health Care: Key Issues and Observations

Offers lessons from RWJF's Finding Answers program around issues involved in laying out financial reasons for providers, caregivers, and others to adopt ongoing, effective interventions to improve quality of care for minority patients

1966-a year of challenge for monetary management

Monetary policy - United States

SeaWiFS technical report series. Volume 6: SeaWiFS technical report series cumulative index: Volumes 1-5

The Sea-viewing Wide Field-of-view Sensor (SeaWiFS) is the follow-on ocean color instrument to the Coastal Zone Color Scanner (CZCS), which ceased operations in 1986, after an eight year mission. SeaWiFS is expected to be launched in August 1993, on the Sea Star satellite, being built by Orbital Sciences Corporation (OSC). The SeaWiFS Project at the NASA/Goddard Space Flight Center (GSFC) has undertaken the responsibility of documenting all aspects of this mission, which is critical to the ocean color and marine science communities. This documentation, entitled the SeaWiFS Technical Report Series, is in the form of NASA Technical Memoranda Number 104566. All reports published are volumes within the series. This volume serves as a reference, or guidebook, to the previous five volumes and consists of four main sections including an index to key words and phrases, a list of all references cited, and lists of acronyms and symbols used. It is our intention to publish a summary index of this type after every five volumes in the series. This will cover the topics published in all previous editions of the indices, that is, each new index will include all of the information contained in the preceding indices

K Giants in Baade's Window. II. The Abundance Distribution

This is the second in a series of papers in which we analyze spectra of over 400 K and M giants in Baade's Window, including most of the stars with proper motions measured by Spaenhauer et al. [AJ, 103, 297 (1992)]. In our first paper, we measured line--strength indices of Fe, Mg, CN and H$\beta$ and calibrated them on the system of Faber et al. [ApJS, 57, 711 (1985)]. Here, we use the $\langle{\rm Fe}\rangle$ index to derive an abundance distribution in [Fe/H] for 322 stars with effective temperatures between 3900 K and 5160 K. Our derived values of [Fe/H] agree well with those measured from high--resolution echelle spectra (e.g., McWilliam \& Rich [ApJS, 91, 749 (1994)]) for the small number of stars in common. We find a mean abundance $\langle{\rm [Fe/H]}\rangle = -0.11 \pm 0.04$ for our sample of Baade's Window K giants. More than half the sample lie in the range $-0.4 <$ \feh\ $<+0.3$. We estimate line--of--sight distances for individual stars in our sample and confirm that, in Baade's Window, most K giants with $V < 15.5$ are foreground disk stars, but the great majority (more than 80\%) with $V > 16$ belong to the bulge. We also compare the metallicities derived from the CN and Mg$_2$ indices to those from iron. Most of the metal--rich stars in our sample appear to be CN--weak, in contrast to the situation in metal--rich globular clusters and elliptical galaxies. The metal--poor half of our sample ([Fe/H] $< 0$) shows evidence for a mild Mg overenhancement ([Mg/Fe] $\sim +0.2$); but this is not seen in the more metal--rich stars ([Fe/H] $\geq$ 0). The K giants in Baade's Window therefore share some, but not all, of the characteristics of stars in elliptical galaxies as inferred from their integrated light.Comment: Accepted for publication in the Astronomical Journal, tentatively scheduled for July, 1996. LaTex source which generates 40 pages of text (no figures or tables). Complete (text + 15 figs + 5 tables) preprint in gzip/tar format is also available at ftp://bessel.mps.ohio-state.edu/pub/terndrup/kg2.tar.gz (227 kbyte

Projective techniques: Are they a victim of clashing paradigms?

This paper reviews the concept and historical development of projective techniques. It considers why, given the importance of their psychoanalytical foundations to the underlying paradigms of management theory, they have been generally marginalised as a mainstream business and management research tool. Projective techniques are defined and their historical origins delineated. This is followed by an overview of projective ‘types’. Some of the general advantages and current issues associated with employing projective techniques are also presented. Thereafter a discussion of the reasons projective techniques have not been widely adopted by positivist academic management researchers is made. We put forward the central argument that since many of the challenges facing management research are due to the restrictions introduced by bounded rationality, projective techniques offer a possible alternative to traditional mixed methods.Projective Techniques; Management Research;