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Despite practice guidelines for multiculturally competent care, including spiritual/religious diversity, most mental health graduate training programs do not formally address spiritual/religious competencies. Thus, we enhanced the Spiritual Competency Training in Mental Health (SCT-MH) course curriculum to train graduate students in foundational attitudes, knowledge, and skills for addressing clients spirituality and/or religion (S/R). The hybrid (online and in-person) SCT-MH course curriculum was integrated into existing required graduate clinical courses (replacing 15% of a courses curriculum) and taught to 309 students by 20 instructors in 20 different graduate training programs across counseling, psychology, and social work disciplines. Using a multiple baseline waitlist control design in which students served as their own controls, students completed validated assessments at three timepoints evaluating their spiritual/religious competencies for understanding the intersection between S/R and mental health. We also collected qualitative data from the students to evaluate acceptability of the content and format of the training program. Students scores on all seven measures of spiritual/religious competencies had a statistically significant positive increase after engaging with the SCT-MH curriculum compared to the control period. At the end of the course, 97% of the students envisioned using spiritually integrated therapy techniques with their clients at least some of the time, 92% or more rated the materials as helpful and relevant, and 96% were satisfied with the training modules. Results demonstrate that dedicating a small (i.e., 6 hours of class time; 10 hours outside class time) but intentional amount of course time to teaching spiritual/religious competencies increases students attitudes, knowledge, and skills for attending to clients S/R in clinical practice. The SCT-MH hybrid course content is freely available to all graduate programs on our website. https://www.spiritualandreligiouscompetenciesproject.com/resources/sct-mh.

COVID-19 necessitated the rapid transition to online learning, challenging the ability of Science, Technology, Engineering, and Math (STEM) professors to offer laboratory experiences to their students. As a result, many instructors sought online alternatives. In addition, recent literature supports the capacity of online curricula to empower students of historically underrepresented identities in STEM fields. Here, we present PARE-Seq, a virtual bioinformatics activity highlighting approaches to antimicrobial resistance (AMR) research. Following curricular development and assessment tool validation, pre- and post-assessments of 101 undergraduates from 4 institutions revealed that students experienced both significant learning gains and increases in STEM identity, but with small effect sizes. Learning gains were marginally modified by gender, race/ethnicity, and number of extracurricular work hours per week. Students with more extracurricular work hours had significantly lower increase in STEM identity score after course completion. Female-identifying students saw greater learning gains than male-identifying, and though not statistically significant, students identifying as an underrepresented minority reported larger increases in STEM identity score. These findings demonstrate that even short course-based interventions have potential to yield learning gains and improve STEM identity. Online curricula like PARE-Seq can equip STEM instructors to utilize research-driven resources that improve outcomes for all students, but support must be prioritized for students working outside of school.

The importance of online learning in higher education settings is growing, not only in wake of the Covid-19 pandemic. Therefore, metrics to evaluate and increase the quality of online instruction are crucial for improving student learning. Whereas instructional quality is traditionally evaluated with course observations or student evaluations, course syllabi offer a novel approach to predict course quality even prior to the first day of classes. This study develops an online course design characteristics rubric for science course syllabi. Utilizing content analysis, inductive coding, and deductive coding, we established four broad high-quality course design categories: course organization, course objectives and alignment, interpersonal interactions, and technology. Additionally, this study exploratively applied the rubric on 11 online course syllabi (N = 635 students) and found that these design categories explained variation in student performance.

This study examined the effectiveness of lectures and inquiry-based instruction in supporting learning for language minority (LM) students in science gateway courses at a large public research university. Utilizing institutional data from 6,911 students across nine years, we fitted cross-lagged panel designs to model associations between lecture courses and inquiry-based laboratory courses for both LM and non-LM students in two-course sequences of introductory college Physics and Chemistry. We found that initial performance in lectures and laboratory sessions can be a predictor of subsequent course performance across disciplines and independent of LM status. Notably, while LM students performed worse in the initial lecture course, LM status resulted in neither worse performance in inquiry-based laboratory courses nor in worse performance in subsequent courses in the science gateway course sequence. Thus, this study suggests that interventions intended to support LM students in college science should target the initial courses in the corresponding science gateway course sequences.

IntroductionIn 2019, 4.6% of US-MD students self-identified as students with disabilities (SWD); many of these students will require accommodations on the USMLE Step-1 examination. Given the high-stakes nature of Step-1 for medical school advancement and residency match, SWD denied accommodations on Step-1 face considerable consequences. To date no study has investigated the rate of accommodation denial and its impact on medical school operations.MethodsTo investigate the rate of accommodation denial and evaluate whether Step-1 accommodation denial impacts medical school operations, a 10-question survey was sent to Student Affairs Deans and disability resource professionals at all fully-accredited US-MD granting programs. Two open-ended questions were analyzed using qualitative content analysis.ResultsSeventy-three of the 141 schools responded (52%). In the 2018-2019 academic year, 276 students from 73 schools applied for Step-1 accommodations. Of these, 144 (52%) were denied. Of those denied, 74/144 (51%) were delayed entry into the next phase of curriculum and 110/144 (76%) took the Step-1 exam unaccommodated. Of the 110 who took Step-1 without accommodations, 35/110 (32%) failed the exam, and 4/110 (3%) withdrew or were dismissed following exam failure. Schools reported varied investments of time and financial support for students denied accommodations, with most schools investing less than 20 hours (67%) and less than $1,000.00 (69%). Open-responses revealed details regarding the impact of denial on schools and students including frustration with process; financial and human resources allocation; delay in student progression; lack of resourcing and expertise; and emotional and financial burdens on students.DiscussionStep-1 accommodation denial has non-trivial financial, operational, and career impacts on medical schools and students alike. The cause of accommodation denial in this population requires further exploration.

The use of renal biopsy through laparoscopy is increasingly present both in human and veterinary medicine. However, both techniques require skill and training to make the operator capable to do it. The learning curve allows the quantitative and qualitative assessment of the number of attempts and minimum time for the surgical procedure. The objective included establish the learning curve for laparoscopy-guided kidney biopsy procedures in dog and pig corpses. Six dogs and six pigs corpses weighing less than 10 kg were used for this study. All corpses underwent kidney biopsy performed through laparoscopy. Twenty-four operators, two per animal, performed 20 renal biopsies each (10 for each kidney), with 480 collection-procedures in total. Duration and difficulty of the procedure and the biopsy sample quality were evaluated and statistical analysis was performed using a mixed regression model with a random effect of individuals and multivariate analysis of data. There were 91.5% of the samples that were adequate for evaluation. There was no significant difference in the number of glomeruli or cortex percentage considering the attempts in either species, demonstrating the operators ability since first collection. Swine samples showed higher amounts of renal cortex than canine samples. The procedure duration was shorter as more attempts were performed in dogs and pigs. From the fourth repetition, the professional reached a plateau for the variable related to collection, and from the second, the professional presented uniform duration for sample storage. Operators of the swine model acquired more agility than the dog ones. The variable difficulty decreased as more repetitions were performed, reaching a plateau in the sixth attempt. Seven renal biopsies laparoscopy-guided are required for an operator to be considered capable to perform the procedure in the referred species included. The learning curve for image-guided kidney biopsy procedures improves the implementation of this technique and benefits patients that undergo this procedure.

Maternal and neonatal mortality in Bihar, India was far higher than the aspirational levels set out by the Sustainable Development Goals. Provider training programs have been implemented in many low-resource settings to improve obstetric and neonatal outcomes. This longitudinal investigation assessed diagnoses and management of postpartum hemorrhage (PPH), hypertensive disorders of pregnancy, birth asphyxia (BA), and low birth weight (LBW), as part of the CARE's AMANAT program in 22 District Hospitals in Bihar, between 2015 and 2017. Physicians and nurse mentors conducted clinical instruction, simulations and teamwork and communication activities, infrastructure and management support, and data collection for 6 consecutive months. Analysis of diagnosis included 11,259 non-referred and management included 11,800 total (non-referred and referred) admissions that were observed. Data were analyzed using the chi-square test for trend. PPH was diagnosed in 3.7% with no significant trend but diagnosis of hypertensive disorders increased from 1.0% to 1.7%, (ptrend = 0.04), over the 6 months. BA was diagnosed in 5.8% with no significant trend but LBW diagnoses increased from 11% to 16% (ptrend

The importance of research ethics (RE) training has led academic and funding institutions to require that students, trainees, and faculty obtain such training at various stages of their careers. Despite the increasing awareness of the value RE education offers, this training requirement is absent in Jordan. We aimed to assess RE education offerings of pharmacy master programs in Jordan and compare with the top-ranked pharmacy graduate programs globally. Therefore, a list of universities that offer research-based pharmacy master programs was created. Each program was evaluated for the inclusion of RE education. A qualitative content analysis approach based on inductive reasoning and latent analysis was followed to analyze the data. Results of the study showed a lack of appropriate RE education for graduate-level pharmacy programs in Jordan with only 40% of the programs partially discuss selected topics related to RE. Regarding pharmacy graduate programs globally, 10% offer a standalone RE course, 40% offer some discussions related to RE, another 10% do not offer RE education in any form, and the remaining 40% of the programs were difficult to assess due to lack of sufficient information available online. Based on the findings of this study, training in RE is tends to be lacking in pharmacy graduate programs in Jordan and globally, with a greater lack in Jordan than globally. There is a need to incorporate formal RE education into programs that do not offer this type of instruction. Programs that formally touch on some aspects of RE need to expand the scope of topics to include more RE-related themes. Integrating a standalone RE course into pharmacy graduate programs is highly encouraged.

Distance learning in response to the COVID-19 pandemic presented tremendous challenges for many families. Parents were expected to support children's learning, often while also working from home. Students with Attention Deficit Hyperactivity Disorder (ADHD) are at particularly high risk for setbacks due to difficulties with organization and increased risk of not participating in scheduled online learning. This paper explores how smartwatch technology, including timing notifications, can support children with ADHD during distance learning due to COVID-19. We implemented a 6-week pilot study of a Digital Health Intervention (DHI) with ten families. The DHI included a smartwatch and a smartphone. Google calendars were synchronized across devices to guide children through daily schedules. After the sixth week, we conducted parent interviews to understand the use of smartwatches and the impact on children's functioning, and we collected physiological data directly from the smartwatch. Our results demonstrated that children successfully adopted the use of the smartwatch, and parents believed the intervention was helpful, especially in supporting the development of organizational skills in their children. Overall, we illustrate how even simple DHIs, such as using smartwatches to promote daily organization and task completion, have the potential to support children and families, particularly during periods of distance learning. We include practical suggestions to help professionals teach children with ADHD to use smartwatches to improve organization and task completion, especially as it applies to supporting remote instruction.

The present study aimed to examine effects of motivational and social cognition constructs on children's leisure-time physical activity participation alongside constructs representing implicit processes using an extended trans-contextual model. The study adopted a correlational prospective design. Secondary-school students (N = 502) completed self-report measures of perceived autonomy support from physical education (PE) teachers, autonomous motivation in PE and leisure-time contexts, and social cognition constructs (attitudes, subjective norms, perceived behavioral control), intentions, trait self-control, habits, and past behavior in a leisure-time physical activity context. Five weeks later, students (N = 298) self-reported their leisure-time physical activity participation. Bayesian path analyses supported two key premises of the model: perceived autonomy support was related to autonomous motivation in PE, and autonomous motivation in PE was related to autonomous motivation in leisure time. Indirect effects indicated that both forms of autonomous motivation were related to social cognition constructs and intentions. However, intention was not related to leisure-time physical activity participation, so model variables reflecting motivational processes did not account for substantive variance in physical activity participation. Self-control, attitudes, and past behavior were direct predictors of intentions and leisure-time physical activity participation. There were indirect effects of autonomous motivation in leisure time on intentions and physical activity participation mediated by self-control. Specifying informative priors for key model relations using Bayesian analysis yielded greater precision for some model effects. Findings raise some questions on the predictive validity of constructs from the original trans-contextual model in the current sample, but highlight the value of extending the model to incorporate additional constructs representing non-conscious processes.

BackgroundThe misdiagnosis of non-malarial fever in sub-Saharan Africa has contributed to the significant burden of pediatric pneumonia and the inappropriate use of antibiotics in this region. This study aims to assess the impact of 1) portable pulse oximeters and 2) Integrated Management of Childhood Illness (IMCI) continued education training on the diagnosis and treatment of non-malarial fever amongst pediatric patients being treated by the Global AIDS Interfaith Alliance (GAIA) in rural Malawi.MethodsThis study involved a logbook review to compare treatment patterns between five GAIA mobile clinics in Mulanje, Malawi during April-June 2019. An intervention study design was employed with four study groups: 1) 2016 control, 2) 2019 control, 3) IMCI-only, and 4) IMCI and pulse oximeter. A total of 3,504 patient logbook records were included based on these inclusion criteria: age under five years, febrile, malaria-negative, and treated during the dry season. A qualitative questionnaire was distributed to the participating GAIA providers. Fisher's Exact Testing and odds ratios were calculated to compare the prescriptive practices between each study group and reported with 95% confidence intervals.ResultsThe pre- and post-exam scores for the providers who participated in the IMCI training showed an increase in content knowledge and understanding (p0.001). However, provider responses to the qualitative questionnaires indicated alternative benefits of the training including improved illness classification and increased provider confidence.ConclusionClinics that implemented both the IMCI course and pulse oximeters exhibited a significant decrease in antibiotic prescription rates, thus highlighting the potential of this tool in combatting antibiotic overconsumption in low-resource settings. Enhanced detection of hypoxia in pediatric patients was regarded by clinicians as helpful for identifying pneumonia cases. GAIA staff appreciated the IMCI continued education training, however it did not appear to significantly impact antibiotic prescription rates and/or pneumonia diagnosis.

It is well-documented that the representation of women and racial/ethnic minorities diminishes at higher levels of academia, particularly in science, technology, engineering, and math (STEM). Sense of belonging-the extent to which an individual believes they are accepted, valued, and included in a community-is often emphasized as an important predictor of retention throughout academia. While literature addressing undergraduate sense of belonging is abundant, there has been little investigation of sense of belonging in graduate communities. Because graduate training is required to generate new scientific leaders, it is important to understand and address sense of belonging at the graduate level-paying explicit attention to devising strategies that can be used to increase representation at higher levels of academia. Here, a visual narrative survey and item response modeling are used to quantify sense of belonging among graduate students, postdoctoral researchers, and faculty within the Department of Chemistry at the University of California, Berkeley. Results suggest that graduate students, postdoctoral researchers, and faculty all experience impostor phenomenon. Respondents struggle most with maintaining positive self-perceptions of their productivity, capabilities as a scientist, and success-particularly in comparison to their peers. Communicating about science with peers, talking about teaching hurdles, and engaging in mentoring relationships also contribute significantly to sense of belonging. Faculty members have the highest sense of belonging, while senior graduate students and postdoctoral researchers are least likely to feel a sense of belonging. Additionally, graduate students and postdoctoral researchers who identify as underrepresented, as well as those who submit manuscripts for publication less than their peers, are less likely to feel a sense of belonging. This is the first study to generate a quantitative, nuanced understanding of sense of belonging within the entire graduate academic community of an R1 STEM department. We envision that these methods can be implemented within any research-focused academic unit to better understand the challenges facing community members and identify factors to address in promoting positive culture change. Furthermore, these methods and results should provide a foundation for devising interventions that academic stakeholders can use to directly improve graduate education.

PurposeThis study sought to assess the performance of the Fitbit Charge HR, a consumer-level multi-sensor activity tracker, to measure physical activity and sleep in children.Methods59 healthy boys and girls aged 9-11 years old wore a Fitbit Charge HR, and accuracy of physical activity measures were evaluated relative to research-grade measures taken during a combination of 14 standardized laboratory- and field-based assessments of sitting, stationary cycling, treadmill walking or jogging, stair walking, outdoor walking, and agility drills. Accuracy of sleep measures were evaluated relative to polysomnography (PSG) in 26 boys and girls during an at-home unattended PSG overnight recording. The primary analyses included assessment of the agreement (biases) between measures using the Bland-Altman method, and epoch-by-epoch (EBE) analyses on a minute-by-minute basis.ResultsFitbit Charge HR underestimated steps (~11.8 steps per minute), heart rate (~3.58 bpm), and metabolic equivalents (~0.55 METs per minute) and overestimated energy expenditure (~0.34 kcal per minute) relative to research-grade measures (p< 0.05). The device showed an overall accuracy of 84.8% for classifying moderate and vigorous physical activity (MVPA) and sedentary and light physical activity (SLPA) (sensitivity MVPA: 85.4%; specificity SLPA: 83.1%). Mean estimates of bias for measuring total sleep time, wake after sleep onset, and heart rate during sleep were 14 min, 9 min, and 1.06 bpm, respectively, with 95.8% sensitivity in classifying sleep and 56.3% specificity in classifying wake epochs.ConclusionsFitbit Charge HR had adequate sensitivity in classifying moderate and vigorous intensity physical activity and sleep, but had limitations in detecting wake, and was more accurate in detecting heart rate during sleep than during exercise, in healthy children. Further research is needed to understand potential challenges and limitations of these consumer devices.

The advancement of underrepresented minority and women PhD students to elite postdoctoral and faculty positions in the STEM fields continues to lag that of majority males, despite decades of efforts to mitigate bias and increase opportunities for students from diverse backgrounds. In 2015, the National Science Foundation Alliance for Graduate Education and the Professoriate (NSF AGEP) California Alliance (Berkeley, Caltech, Stanford, UCLA) conducted a wide-ranging survey of graduate students across the mathematical, physical, engineering, and computer sciences in order to identify levers to improve the success of PhD students, and, in time, improve diversity in STEM leadership positions, especially the professoriate. The survey data were interpreted via path analysis, a method that identifies significant relationships, both direct and indirect, among various factors and outcomes of interest. We investigated two important outcomes: publication rates, which largely determine a new PhD students competitiveness in the academic marketplace, and subjective well-being. Women and minority students who perceived that they were well-prepared for their graduate courses and accepted by their colleagues (faculty and fellow students), and who experienced well-articulated and structured PhD programs, were most likely to publish at rates comparable to their male majority peers. Women PhD students experienced significantly higher levels of distress than their male peers, both majority and minority, while both women and minority student distress levels were mitigated by clearly-articulated expectations, perceiving that they were well-prepared for graduate level courses, and feeling accepted by their colleagues. It is unclear whether higher levels of distress in women students is related directly to their experiences in their STEM PhD programs. The findings suggest that mitigating factors that negatively affect diversity should not, in principle, require the investment of large resources, but rather requires attention to the local culture and structure of individual STEM PhD programs.

ObjectivesIndependently, physical activity (PA), sedentary behavior (SB), and sleep are related to the development and progression of chronic diseases. Less is known about how rest-activity behaviors cluster within individuals and how rest-activity behavior profiles relate to health. In this study we aimed to investigate if adult women cluster into profiles based on how they accumulate rest-activity behavior (including accelerometer-measured PA, SB, and sleep), and if participant characteristics and health outcomes differ by profile membership.MethodsA convenience sample of 372 women (mean age 55.38 + 10.16) were recruited from four US cities. Participants wore ActiGraph GT3X+ accelerometers on the hip and wrist for a week. Total daily minutes in moderate-to-vigorous PA (MVPA) and percentage of wear-time spent in SB was estimated from the hip device. Total sleep time (hours/minutes) and sleep efficiency (% of in bed time asleep) were estimated from the wrist device. Latent profile analysis (LPA) was performed to identify clusters of participants based on accumulation of the four rest-activity variables. Adjusted ANOVAs were conducted to explore differences in demographic characteristics and health outcomes across profiles.ResultsRest-activity variables clustered to form five behavior profiles: Moderately Active Poor Sleepers (7%), Highly Actives (9%), Inactives (41%), Moderately Actives (28%), and Actives (15%). The Moderately Active Poor Sleepers (profile 1) had the lowest proportion of whites (35% vs 78-91%, p < .001) and college graduates (28% vs 68-90%, p = .004). Health outcomes did not vary significantly across all rest-activity profiles.ConclusionsIn this sample, women clustered within daily rest-activity behavior profiles. Identifying 24-hour behavior profiles can inform intervention population targets and innovative behavioral goals of multiple health behavior interventions.

BackgroundIn the state of Bihar, India a multi-faceted quality improvement nurse-mentoring program was implemented to improve provider skills in normal and complicated deliveries. The objective of this analysis was to examine changes in diagnosis and management of postpartum hemorrhage (PPH) of the mother and intrapartum asphyxia of the infant in primary care facilities in Bihar, during the program.MethodsDuring the program, mentor pairs visited each facility for one week, covering four facilities over a four-week period and returned for subsequent week-long visits once every month for seven to nine consecutive months. Between- and within-facility comparisons were made using a quasi-experimental and a longitudinal design over time, respectively, to measure change due to the intervention. The proportions of PPH and intrapartum asphyxia among all births as well as the proportions of PPH and intrapartum asphyxia cases that were effectively managed were examined. Zero-inflated negative binomial models and marginal structural methodology were used to assess change in diagnosis and management of complications after accounting for clustering of deliveries within facilities as well as time varying confounding.ResultsThis analysis included 55,938 deliveries from 320 facilities. About 2% of all deliveries, were complicated with PPH and 3% with intrapartum asphyxia. Between-facility comparisons across phases demonstrated diagnosis was always higher in the final week of intervention (PPH: 2.5-5.4%, intrapartum asphyxia: 4.2-5.6%) relative to the first week (PPH: 1.2-2.1%, intrapartum asphyxia: 0.7-3.3%). Within-facility comparisons showed PPH diagnosis increased from week 1 through 5 (from 1.6% to 4.4%), after which it decreased through week 7 (3.1%). A similar trend was observed for intrapartum asphyxia. For both outcomes, the proportion of diagnosed cases where selected evidence-based practices were used for management either remained stable or increased over time.ConclusionsThe nurse-mentoring program appears to have built providers' capacity to identify PPH and intrapartum asphyxia cases but diagnosis levels are still not on par with levels observed in Southeast Asia and globally.

We describe the development and validation of a new instrument, the Classroom Discourse Observation Protocol (CDOP), which quantifies teacher discourse moves (TDMs) from observational data in undergraduate STEM classrooms. TDMs can be conceptualized as epistemic tools that can mediate classroom discussions. Through an inductive-deductive coding process, we identified commonly occurring TDMs among a group of biology instructors (n = 13, 37 class session) teaching in Active Learning Environments. We describe the CDOP coding scheme and its associated matrix that allows observers to reliably characterize TDMs in 2-min time intervals over the course of a class period. We present the protocol, discuss how it differs from existing classroom observation protocols, and describe the process by which it was developed and validated. Also, we show how this protocol is able to discriminate the discursive practices of instructors teaching in undergraduate STEM learning environments with sample qualitative and quantitative results that illustrate its utility for assessing and improving STEM instructional practices.

OBJECTIVE:To investigate junior secondary school students' experiences and perspectives of in-school and out-of-school sport-safety, with a particular focus on the meaning and content that they applied to the motivational and social cognitive factors of sport injury prevention. DESIGN:Focus-group interview. METHOD:Participants were 128 junior secondary school students (Form 1 to Form 3) aged between 12 and 16 years from two secondary schools. We organised focus-group interviews by class (group size = six to nine students). Seventeen groups completed semi-structured interviews regarding their experience, beliefs, and motives for injury prevention in-school and out-of-school. We analysed data by thematic content analysis using a typological approach. RESULTS:Higher order themes (N = 7) including in-school and out-of-school motives and social cognitive factors and associated lower-order themes (N = 16), emerged from the analysis corresponding to constructs from trans-contextual model tenets. CONCLUSIONS:The current study is the first qualitative study to explore junior secondary school students' experience and perspectives on sport injury prevention, using trans-contextual model as a framework for investigation. The findings contribute to a better understanding on their motivational and social cognitive factors in adopting sport injury prevention. The content of the theme behavior also indicated the inadequacy of students' knowledge of effective sport injury prevention techniques, and underscored the importance of sport safety education.

A growing body of evidence has shown that active learning has a considerable advantage over traditional lecture for student learning in undergraduate STEM classes, but there have been few large-scale studies to identify the specific types of activities that have the greatest impact on learning. We therefore undertook a large-scale, curriculum-wide study to investigate the effects of time spent on a variety of classroom activities on learning gains. We quantified classroom practices and related these to student learning, assessed using diagnostic tests written by over 3700 students, across 31 undergraduate biology classes at a research-intensive university in the Pacific Northwest. The most significant positive predictor of learning gains was the use of group work, supporting the findings of previous studies. Strikingly, we found that the addition of worksheets as an active learning tool for in-class group activities had the strongest impact on diagnostic test scores. This particular low-tech activity promotes student collaboration, develops problem solving skills, and can be used to inform the instructor about what students are struggling with, thus providing opportunities for valuable and timely feedback. Overall, our results indicate that group activities with low barriers to entry, such as worksheets, can result in significant learning gains in undergraduate science.

Massive Open Online Courses (MOOCs) have the potential to democratize education by providing learners with access to high-quality free online courses. However, evidence supporting this democratization across countries is limited. We explored the question of MOOC democratization by conducting cross-national comparisons of gender differences in the enrollment in and completion of science, technology, engineering, and mathematics (STEM) MOOCs. We found that while females were less likely than males to enroll in STEM MOOCs, they were equally likely to complete them. Further, a higher probability to enroll in STEM MOOCs and smaller gender gaps in STEM MOOC enrollment and completion were found in less gender-equal and less economically developed countries.

We present a rationale for, and results from, the pilot of a direct individual-to-institution remittance system in the context of school fee payment in rural Benin. Data confirm that school fees act as an impediment to educational attainment, and in very rural poor settings such as northern Benin, students often depend on extended family and kinship networks to pay fees. But existing remittance options are costly, in terms of fees, time, and risk. We pilot a new technology bundle in a single public high school in northeastern Benin, and evaluate its effectiveness. Here we describe the technical and institutional implementation of the project, as well as our findings from the first year of operation. We discuss takeaways and implications for scale-up.

With the nationwide emphasis on improving outcomes for STEM undergraduates, it is important that we not only focus on modifying classroom instruction, but also provide students with the tools to maximize their independent learning time. There has been considerable work in laboratory settings examining two beneficial practices for enhancing learning: spacing and self-testing. In the current study, we examine biology students' study practices, particularly in the context of these two behaviors. We specifically investigate whether a light-touch study skills intervention focused on encouraging spacing and self-testing practices impacted their utilization. Based on pre- and post-course surveys, we found that students report utilizing both beneficial and ineffective study practices and confirm that usage of spacing and self-testing correlates with a higher course grade. We also found that students in the section of the course which received the study skills intervention were more likely to report continued use or adoption of spacing and self-testing compared to students in control sections without the intervention. Surprisingly, we found that underrepresented minorities (URMs) under-utilize self-testing, and that our intervention helped to partially ameliorate this gap. Additionally, we found that URMs who reported self-testing earned similar course grades compared to non-URMs who also self-tested, but that there was a much larger drop in performance for URMs who did not self-test relative to non-URMs who also did not self-test. Overall, we would encourage instructors to dedicate class time towards discussing the merits of beneficial study practices, especially for students that have historically underperformed in STEM disciplines.

The development and application of concepts is a critical component of cognition. Although concepts can be formed on the basis of simple perceptual or semantic features, conceptual representations can also capitalize on similarities across feature relationships. By representing these types of higher-order relationships, concepts can simplify the learning problem and facilitate decisions. Despite this, little is known about the neural mechanisms that support the construction and deployment of these kinds of higher-order concepts during learning. To address this question, we combined a carefully designed associative learning task with computational model-based functional magnetic resonance imaging (fMRI). Participants were scanned as they learned and made decisions about sixteen pairs of cues and associated outcomes. Associations were structured such that individual cues shared feature relationships, operationalized as shared patterns of cue pair-outcome associations. In order to capture the large number of possible conceptual representational structures that participants might employ and to evaluate how conceptual representations are used during learning, we leveraged a well-specified Bayesian computational model of category learning [1]. Behavioral and model-based results revealed that participants who displayed a tendency to link experiences in memory benefitted from faster learning rates, suggesting that the use of the conceptual structure in the task facilitated decisions about cue pair-outcome associations. Model-based fMRI analyses revealed that trial-by-trial integration of cue information into higher-order conceptual representations was supported by an anterior temporal (AT) network of regions previously implicated in representing complex conjunctions of features and meaning-based information.

The Chinese government has established definitive goals to reach a "carbon peak" by 2030 and achieve "carbon neutrality" by 2060. Investigating the attainment of these emission reduction objectives while simultaneously fostering regional economic growth and enhancing living standards holds critical importance. This study examines the link between higher education and carbon intensity across China's thirty provincial-level administrative regions, employing fixed effects models on provincial panel data spanning 2001-2020. The findings, validated through robustness tests and a mediation effect model, elucidate the mechanisms by which higher education influences carbon intensity. Notably, the results reveal that enhancing higher education markedly lowers carbon intensity; specifically, a 1% increase in the logarithmic transformation of per capita investment in higher education in a province decreases its carbon intensity by 0.219%. Additionally, higher education's output similarly contributes to reductions in carbon intensity. The influence of higher education on reducing carbon intensity is particularly pronounced in the central and western regions of China. Moreover, higher education facilitates the reduction of carbon intensity through mechanisms such as promoting environmental consciousness, advancing industrial structure, and encouraging technological innovation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yuan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

ImportanceNew dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME).ObjectiveTo examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME.DesignWe tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different "hooks" (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and message number to calculate rate ratios. To understand how physicians interact with CME content on social media, we also conducted interviews with 10 physicians.SettingThe National Physicians Alliance (NPA) membership.ParticipantsNPA e-mail recipients, Facebook followers and friends, and Twitter followers.Main outcomes and measuresClicks to the NPA's CME landing site.ResultsOn average, 4,544 recipients received each message. Messages generated a total of 592 clicks to the landing site, for a rate of 5.4 clicks per 1000 recipients exposed. There were 5.4 clicks from e-mail, 11.9 clicks from Facebook, 5.5 clicks from paid Facebook, and 6.9 clicks from Twitter to the landing site for 1000 physicians exposed to each of 4 selected CME modules. A Facebook post generated 2.3x as many clicks to the landing site as did an e-mail after controlling for participant exposure, hook type and CME topic (p

Attending school is a multifaceted experience. Students are not only exposed to new knowledge but are also immersed in a structured environment in which they need to respond flexibly in accordance with changing task goals, keep relevant information in mind, and constantly tackle novel problems. To quantify the cumulative effect of this experience, we examined retrospectively and prospectively, the relationships between educational attainment and both cognitive performance and learning. We analyzed data from 196,388 subscribers to an online cognitive training program. These subscribers, ages 15-60, had completed eight behavioral assessments of executive functioning and reasoning at least once. Controlling for multiple demographic and engagement variables, we found that higher levels of education predicted better performance across the full age range, and modulated performance in some cognitive domains more than others (e.g., reasoning vs. processing speed). Differences were moderate for Bachelor's degree vs. High School (d = 0.51), and large between Ph.D. vs. Some High School (d = 0.80). Further, the ages of peak cognitive performance for each educational category closely followed the typical range of ages at graduation. This result is consistent with a cumulative effect of recent educational experiences, as well as a decrement in performance as completion of schooling becomes more distant. To begin to characterize the directionality of the relationship between educational attainment and cognitive performance, we conducted a prospective longitudinal analysis. For a subset of 69,202 subscribers who had completed 100 days of cognitive training, we tested whether the degree of novel learning was associated with their level of education. Higher educational attainment predicted bigger gains, but the differences were small (d = 0.04-0.37). Altogether, these results point to the long-lasting trace of an effect of prior cognitive challenges but suggest that new learning opportunities can reduce performance gaps related to one's educational history.

Social support is associated with positive health outcomes, and research has demonstrated that the presence, or even just a reminder, of a social-support figure can reduce psychological and physiological responses to threats. However, the mechanisms underlying this effect are unclear, and no previous work has examined the impact of social support on basic fear learning processes, which have implications for threat responding. This study examined whether social support inhibits the formation of fear associations. After conducting a fear-conditioning procedure in which social-support stimuli were paired with conditional stimuli during fear acquisition, we found that the threat of shock was not associated with conditional stimuli paired with images of social-support figures, but was associated with stimuli paired with images of strangers. These findings indicate that social support prevents the formation of fear associations, reducing the amount of learned fears people acquire as they navigate the world, consequently reducing threat-related stress.

To achieve faculty status, graduating doctoral students have to substantially outperform their peers, given the competitive nature of the academic job market. In an ideal, meritocratic world, factors such as prestige of degree-granting university ought not to overly influence hiring decisions. However, it has recently been reported that top-ranked universities produced about 2-6 times more faculty than did universities that were ranked lower [1], which the authors claim suggests the use of un-meritocratic factors in the hiring process: how could students from top-ranked universities be six times more productive than their peers from lower-ranked universities? Here we present a signal detection model, supported by computer simulation and simple proof-of-concept example data from psychology departments in the U.S., to demonstrate that substantially higher rates of faculty production need not require substantially (and unrealistically) higher levels of student productivity. Instead, a high hiring threshold due to keen competition is sufficient to cause small differences in average student productivity between universities to result in manifold differences in placement rates. Under this framework, the previously reported results are compatible with a purely meritocratic system. Whereas these results do not necessarily mean that the actual faculty hiring market is purely meritocratic, they highlight the difficulty in empirically demonstrating that it is not so.

We report a design study that assessed the feasibility of Enacted Reading Comprehension (ERC), an intervention designed to teach 3rd and 4th grade students (n = 40 and 25, respectively) to use gestures to understand an increasingly abstract set of texts. Students were taught to use gestures to understand the idea of "opposing forces" in a concrete setting-the forces at play as tectonic plates move past each other-and then taught to use the gestures to understand opposing forces in more abstract situations. For example, students were taught to use gestures to understand the opposing sides of an argument, and to understand the internal conflicts that arise as individuals are faced with moral dilemmas. The results of our design study suggest that ERC has promise as a method for introducing students to the idea of using gesture to understand text content, and to employ this strategy in a range of reading contexts.

BackgroundA department's learning climate is known to contribute to the quality of postgraduate medical education and, as such, to the quality of patient care provided by residents. However, it is unclear how the learning climate is perceived over time.ObjectivesThis study investigated whether the learning climate perceptions of residents changed over time.MethodsThe context for this study was residency training in the Netherlands. Between January 2012 and December 2014, residents from 223 training programs in 39 hospitals filled out the web-based Dutch Residency Educational Climate Test (D-RECT) to evaluate their clinical department's learning climate. Residents had to fill out 35 validated questions using a five point Likert-scale. We analyzed data using generalized linear mixed (growth) models.ResultsOverall, 3982 D-RECT evaluations were available to investigate our aim. The overall mean D-RECT score was 3.9 (SD = 0.3). The growth model showed an increase in D-RECT scores over time (b = 0.03; 95% CI: 0.01-0.06; p < 0.05).ConclusionsThe observed increase in D-RECT scores implied that residents perceived an improvement in the learning climate over time. Future research could focus on factors that facilitate or hinder learning climate improvement, and investigate the roles that hospital governing committees play in safeguarding and improving the learning climate.

Equal rights to rent and purchase affects the supply of compulsory education resources. How to promote the balanced compulsory education resources supply in the context of equal rights to rent and purchase is currently a hot issue amongst government and society. To achieve such balance, conducting research in the context of equal rights to rent and purchase becomes crucial. However, existing research has yet to provide sufficient explanations for the differentiated paths for realizing the balanced compulsory education resources supply in practice. This study uses 31 cities in China as case samples and jointly applies fuzzy-set qualitative comparative analysis and the 'technology-organization-environment' (TOE) framework. The findings are summarized as follows. Firstly, the balanced compulsory education resources supply in the context of equal rights to rent and purchase is affected by six key technological, organizational, and environmental factors. Namely, data co-construction and sharing, technological infrastructure, attention allocation, government information disclosure, policy support for equal rights to rent and purchase, and level of urban economic development. Secondly, the linkage matching of technological, organizational and environmental conditions forms diversified configurations that drive the balanced compulsory education resources supply in the context of equal rights to rent and purchase. These configurations include the 'organization' driving model, 'technology-environment' driving model, 'technology-organization-environment' driving model, and 'technology-organization' driving model. Finally, eastern, central and western China are driven by different configuration paths. Amongst them, eastern China has relatively good basic conditions at the technological, organizational and environmental levels. The combination of different conditions can drive the balanced compulsory education resources supply in a 'different paths lead to the same destination' manner. Although the development in central China is somewhat restricted, the radiation and impetus from eastern China, in combination with the different conditions in central China, can drive the balanced compulsory education resources supply. Western China shows no advantages at the technological, organizational and environmental levels. Faced with restrictions in organizational and environmental conditions, the government in western China should develop the necessary technological conditions to drive the balanced compulsory education resources supply., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lou, Li. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The U.S. currently enjoys a position among the world's foremost innovative and scientifically advanced economies but the emergence of new economic powerhouses like China and India threatens to disrupt the global distribution of innovation and economic competitiveness. Among U.S. policy makers, the promotion of advanced education, particularly in the STEM (Science, Technology, Engineering and Mathematics) fields, has become a key strategy for ensuring the U.S.'s position as an innovative economic leader. Since approximately one third of science and engineering post-graduate students in the U.S. are foreign born, the future of the U.S. STEM educational system is intimately tied to issues of global competitiveness and American immigration policy. This study utilizes a combination of national education data, a survey of foreign-born STEM graduate students, and in-depth interviews of a sub-set of those students to explain how a combination of scientists' and engineers' educational decisions, as well as their experience in school, can predict a students' career path and geographical location, which can affect the long-term innovation environment in their home and destination country. This study highlights the fact that the increasing global competitiveness in STEM education and the complex, restrictive nature of U.S. immigration policies are contributing to an environment where the American STEM system may no longer be able to comfortably remain the premier destination for the world's top international students.

BackgroundTo understand teaching performance of individual faculty, the climate in which residents' learning takes place, the learning climate, may be important. There is emerging evidence that specific climates do predict specific outcomes. Until now, the effect of learning climate on the performance of the individual faculty who actually do the teaching was unknown.ObjectivesTHIS STUDY: (i) tested the hypothesis that a positive learning climate was associated with better teaching performance of individual faculty as evaluated by residents, and (ii) explored which dimensions of learning climate were associated with faculty's teaching performance.Methods and materialsWe conducted two cross-sectional questionnaire surveys amongst residents from 45 residency training programs and multiple specialties in 17 hospitals in the Netherlands. Residents evaluated the teaching performance of individual faculty using the robust System for Evaluating Teaching Qualities (SETQ) and evaluated the learning climate of residency programs using the Dutch Residency Educational Climate Test (D-RECT). The validated D-RECT questionnaire consisted of 11 subscales of learning climate. Main outcome measure was faculty's overall teaching (SETQ) score. We used multivariable adjusted linear mixed models to estimate the separate associations of overall learning climate and each of its subscales with faculty's teaching performance.ResultsIn total 451 residents completed 3569 SETQ evaluations of 502 faculty. Residents also evaluated the learning climate of 45 residency programs in 17 hospitals in the Netherlands. Overall learning climate was positively associated with faculty's teaching performance (regression coefficient 0.54, 95% confidence interval: 0.37 to 0.71; P

ObjectiveMedical schools struggle with large classes, which might interfere with the effectiveness of learning within small groups due to students being unfamiliar to fellow students. The aim of this study was to assess the effects of making a large class seem small on the students' collaborative learning processes.DesignA randomised controlled intervention study was undertaken to make a large class seem small, without the need to reduce the number of students enrolling in the medical programme. The class was divided into subsets: two small subsets (n=50) as the intervention groups; a control group (n=102) was mixed with the remaining students (the non-randomised group n∼100) to create one large subset.SettingThe undergraduate curriculum of the Maastricht Medical School, applying the Problem-Based Learning principles. In this learning context, students learn mainly in tutorial groups, composed randomly from a large class every 6-10 weeks.InterventionThe formal group learning activities were organised within the subsets. Students from the intervention groups met frequently within the formal groups, in contrast to the students from the large subset who hardly enrolled with the same students in formal activities.Main outcome measuresThree outcome measures assessed students' group learning processes over time: learning within formally organised small groups, learning with other students in the informal context and perceptions of the intervention.ResultsFormal group learning processes were perceived more positive in the intervention groups from the second study year on, with a mean increase of β=0.48. Informal group learning activities occurred almost exclusively within the subsets as defined by the intervention from the first week involved in the medical curriculum (E-I indexes>-0.69). Interviews tapped mainly positive effects and negligible negative side effects of the intervention.ConclusionBetter group learning processes can be achieved in large medical schools by making large classes seem small.

BackgroundGirl education is believed to be the best means of reducing girl child marriage (marriage 20%) of girl child marriage- Bangladesh, India, Nepal and Pakistan.MethodsCross-sectional time series analyses were conducted on Demographic and Health Surveys (DHS) from 1991 to 2011 in the four focal nations. Analyses were restricted to ever-married women aged 20-24 years. Multinomial logistic regression models were used to assess the effect of highest level of education received (none, primary, secondary or higher) on age at marriage (

BackgroundWorldwide, attending physicians train residents to become competent providers of patient care. To assess adequate training, attending physicians are increasingly evaluated on their teaching performance. Research suggests that personality traits affect teaching performance, consistent with studied effects of personality traits on job performance and academic performance in medicine. However, up till date, research in clinical teaching practice did not use quantitative methods and did not account for specialty differences. We empirically studied the relationship of attending physicians' personality traits with their teaching performance across surgical and non-surgical specialties.MethodWe conducted a survey across surgical and non-surgical specialties in eighteen medical centers in the Netherlands. Residents evaluated attending physicians' overall teaching performance, as well as the specific domains learning climate, professional attitude, communication, evaluation, and feedback, using the validated 21-item System for Evaluation of Teaching Qualities (SETQ). Attending physicians self-evaluated their personality traits on a 5-point scale using the validated 10-item Big Five Inventory (BFI), yielding the Five Factor model: extraversion, conscientiousness, neuroticism, agreeableness and openness.ResultsOverall, 622 (77%) attending physicians and 549 (68%) residents participated. Extraversion positively related to overall teaching performance (regression coefficient, B: 0.05, 95% CI: 0.01 to 0.10, P = 0.02). Openness was negatively associated with scores on feedback for surgical specialties only (B: -0.10, 95% CI: -0.15 to -0.05, P

Research impact is an important measure of the effective transmission and ongoing contribution of research beyond the scope of initial research publication outputs; however, determining what constitutes 'high-for-impact' research can be difficult for specific fields of study. This review of the Australian Research Council's Engagement and Impact Assessment 2018 analyses high-for-impact case studies submitted in the fields of Education (n = 17) and Studies in Human Society (n = 11) with the aim of understanding and explicating how high impact research has been evidenced in these fields. The review was guided by three research questions that concern the identification of the key characteristics of high-for-impact case studies, their reported impacts, and the evidence researchers cite to support claims of impact. The review highlights an important limitation in how impact is defined and understood by researchers, particularly cultural and social impact. Half of the analysed case studies involved international engagement, with minimal partner collaboration in the global south and countries in the Indo-Pacific, despite the region's strategic geo-political importance for Australia. Our findings draw into question the distribution of funding to universities and where investment might best be made for the highest potential return on research impact. Another key finding is that reported impacts across the domains of economy, society, culture, national security, public service, health, environment and quality of life offer little satisfactory evidence of impact, despite affording valuable insights into the nature of impact claimed. Accordingly, we conclude that to enhance the value of research and demonstrate impact in Education and Social Sciences, improved impact literacy is required among researchers. We assert that a better understanding of what constitutes impact and how it can be evidenced will support more impactful research designs. Wider adoption of the holistic anthropological definition of culture, which integrates values, practices and products, would enhance impact case studies by expanding their focus to include the broader cultural changes that underpin sustained social change. While the ARC engagement and impact agenda is a step in the right direction, improving the value of research for society will require a radical reconceptualisation of research and its funding, well beyond the current assessment framework. The Lowitja Institute's research-for-impact framework [1] is proposed as an alternative approach to research priority-setting based on explicit evidence gap analysis., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Jefferson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

BackgroundUndernutrition is an important risk factor for childhood mortality, and remains a major problem facing many developing countries. Millennium Development Goal 1 calls for a reduction in underweight children, implemented through a variety of interventions. To adequately judge the impact of these interventions, it is important to know the reproducibility of the main indicators for undernutrition. In this study, we trained individuals from rural communities in Ethiopia in anthropometry techniques and measured intra- and inter-observer reliability.Methods and findingsWe trained 6 individuals without prior anthropometry experience to perform weight, height, and middle upper arm circumference (MUAC) measurements. Two anthropometry teams were dispatched to 18 communities in rural Ethiopia and measurements performed on all consenting pre-school children. Anthropometry teams performed a second independent measurement on a convenience sample of children in order to assess intra-anthropometrist reliability. Both teams measured the same children in 2 villages to assess inter-anthropometrist reliability. We calculated several metrics of measurement reproducibility, including the technical error of measurement (TEM) and relative TEM. In total, anthropometry teams performed measurements on 606 pre-school children, 84 of which had repeat measurements performed by the same team, and 89 of which had measurements performed by both teams. Intra-anthropometrist TEM (and relative TEM) were 0.35 cm (0.35%) for height, 0.05 kg (0.39%) for weight, and 0.18 cm (1.27%) for MUAC. Corresponding values for inter-anthropometrist reliability were 0.67 cm (0.75%) for height, 0.09 kg (0.79%) for weight, and 0.22 kg (1.53%) for MUAC. Inter-anthropometrist measurement error was greater for smaller children than for larger children.ConclusionMeasurements of height and weight were more reproducible than measurements of MUAC and measurements of larger children were more reliable than those for smaller children. Community-drawn anthropometrists can provide reliable measurements that could be used to assess the impact of interventions for childhood undernutrition.

BackgroundThe importance of effective clinical teaching for the quality of future patient care is globally understood. Due to recent changes in graduate medical education, new tools are needed to provide faculty with reliable and individualized feedback on their teaching qualities. This study validates two instruments underlying the System for Evaluation of Teaching Qualities (SETQ) aimed at measuring and improving the teaching qualities of obstetrics and gynecology faculty.Methods and findingsThis cross-sectional multi-center questionnaire study was set in seven general teaching hospitals and two academic medical centers in the Netherlands. Seventy-seven residents and 114 faculty were invited to complete the SETQ instruments in the duration of one month from September 2008 to September 2009. To assess reliability and validity of the instruments, we used exploratory factor analysis, inter-item correlation, reliability coefficient alpha and inter-scale correlations. We also compared composite scales from factor analysis to global ratings. Finally, the number of residents' evaluations needed per faculty for reliable assessments was calculated. A total of 613 evaluations were completed by 66 residents (85.7% response rate). 99 faculty (86.8% response rate) participated in self-evaluation. Factor analysis yielded five scales with high reliability (Cronbach's alpha for residents' and faculty): learning climate (0.86 and 0.75), professional attitude (0.89 and 0.81), communication of learning goals (0.89 and 0.82), evaluation of residents (0.87 and 0.79) and feedback (0.87 and 0.86). Item-total, inter-scale and scale-global rating correlation coefficients were significant (P

Working memory impairments are frequent in Attention Deficit/Hyperactivity Disorder (ADHD) and create problems along numerous functional dimensions. The present study utilized the Visual Serial Addition Task (VSAT) and functional magnetic resonance imaging (fMRI) to explore working memory processes in thirteen typically developing (TD) control and thirteen children with ADHD, Combined type. Analysis of Variance (ANOVA) was used to examine both main effects and interactions. Working memory-specific activity was found in TD children in the bilateral prefrontal cortex. In contrast the within-group map in ADHD did not reveal any working-memory specific regions. Main effects of condition suggested that the right middle frontal gyrus (BA6) and the right precuneus were engaged by both groups during working memory processing. Group differences were driven by significantly greater, non-working memory-specific, activation in the ADHD relative to TD group in the bilateral insula extending into basal ganglia and the medial prefrontal cortex. A region of interest analysis revealed a region in left middle frontal gyrus that was more active during working memory in TD controls. Thus, only the TD group appeared to display working memory-modulated brain activation. In conclusion, children with ADHD demonstrated reduced working memory task specific brain activation in comparison to their peers. These data suggest inefficiency in functional recruitment by individuals with ADHD represented by a poor match between task demands and appropriate levels of brain activity.

ContextMedical educational reform includes enhancing role modelling of clinical teachers. This requires faculty being aware of their role model status and performance. We developed the System for Evaluation of Teaching Qualities (SETQ) to generate individualized feedback on previously defined teaching qualities and role model status for faculty in (non) academic hospitals.Objectives(i) To examine whether teaching qualities of faculty were associated with their being seen as a specialist role model by residents, and (ii) to investigate whether those associations differed across residency years and specialties.Methods & materialsCross-sectional questionnaire survey amongst 549 Residents of 36 teaching programs in 15 hospitals in the Netherlands. The main outcome measure was faculty being seen as specialist role models by residents. Statistical analyses included (i) Pearson's correlation coefficients and (ii) multivariable logistic generalized estimating equations to assess the (adjusted) associations between each of five teaching qualities and 'being seen as a role model'.Results407 residents completed a total of 4123 evaluations of 662 faculty. All teaching qualities were positively correlated with 'being seen as a role model' with correlation coefficients ranging from 0.49 for 'evaluation of residents' to 0.64 for 'learning climate' (P

Fertility in Ghana has declined steadily since 1980, however, a slight increase was observed between 2008 and 2014. While several factors may account for this pattern, research on the contribution of type of union is limited. This study examined differentials in the fertility of women in different types of union. Secondary data from 6,285 (weighted) ever-married women aged 15–49 years were analysed using compare means, t-test, analysis of variance, Poisson and binary logistic regression analyses. The findings indicate that, independent of other factors, fertility among remarried women is higher compared to first-time married women but this does not hold true when other factors are controlled for. Additionally, there was no significant difference in the fertility of remarried women who were in union and women who were in union in a first-time marriage. However, compared to remarried women who were currently in a union, fertility was significantly lower among remarried women who were not currently in union (β = -0.121, p<0.01) and women who have been married only once but were not currently in union (β = -0.212, p<0.001). Further analysis revealed that remarried women were significantly more likely to desire more children and less likely to use any method of contraception compared to first-time married women. There is the need for further research to better understand the fertility needs of remarried women. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine differences in perceived popularity and social preference of bullying roles and class norms. In total, 1,339 students (48% girls) participated: 674 primary school (M = 10.41 years, SD = 0.49) and 685 secondary school students (M = 12.67 years, SD = 0.80). Peer nominations and perceptions of class norms were collected. The results showed the highest perceived popularity among aggressors and defenders, except in anti-bullying primary school classes, where aggressors had low levels of popularity. In pro-bullying secondary school classes school, female victims had the lowest popularity levels. These findings suggest that class norms and personal variables as gender and school levels are important to understand bullying roles. Practical implications are discussed to guide teachers and practitioners according to the importance to adapt antibullying programs to the characteristics of the group in each school level and gender. [ABSTRACT FROM AUTHOR]

Recent research shows that preschool children born to opioid-dependent mothers are at increased risk for cognitive, psychomotor, attention, and social-emotional adjustment problems. But very little is known about their school-age functioning, particularly their educational achievement. This analysis examined the educational outcomes of a regional cohort of 100 prenatally methadone-exposed children who were prospectively studied from birth to age 9.5 years alongside a comparison group of 110 randomly identified non-exposed children born between 2003 and 2008. At age 9.5, as part of a comprehensive neurodevelopmental evaluation, children's teachers rated their achievement across the school curriculum, and children completed the Woodcock Johnson-III Tests of Achievement (WJ-III). Detailed information about the birth mother's social background, pregnancy substance use, and mental health was also collected during pregnancy/at term. Infant clinical data were collected after birth. Methadone-exposed children performed less well than non-exposed children across seven school curriculum areas rated by teachers (ps ≤.001), performed less well than non-exposed children on all reading and mathematics subtests of the WJ-III, and had higher rates of any educational delay on the WJ-III (57% vs. 15%), OR = 7.47 (3.71–15.02). Results were similar when children with severe intellectual impairment were excluded. After adjusting for confounding factors, methadone-exposed children had increased odds of educational delay, but this was only marginally significant (OR = 3.62, [1.01–13.01], p = .049). Maternal educational attainment level (OR = 0.69, [0.50–0.89], p = .006), and maternal benzodiazepine use during pregnancy (OR = 2.70 [1.03–7.12], p = .044) were also associated with later educational risk. Findings suggest that children born to opioid-dependent women enrolled in methadone maintenance are at high risk of educational delay by age 9.5 years. Children's academic difficulties appeared to reflect the effects of both adverse prenatal exposures and postnatal social risk. [ABSTRACT FROM AUTHOR]

Introduction: Women's reproductive health decision-making is indispensable for improving their reproductive health and achieving Sustainable Development Goal three. This study explored the association between reproductive health decision-making capacity and unintended pregnancy among women in Ghana. Materials and methods: We used data from the 2014 version of the Ghana Demographic and Health Survey. The unit of analysis for this study was pregnant women at the time of the survey (679). Bivariate and multivariable analyses were conducted using Pearson chi-square tests and binary logistic regression respectively. Results: We found that women who had the capacity to make reproductive health decision [AOR = 0.61; CI = 0.51–0.89] were less likely to experience unintended pregnancies, compared to those who did not have the capacity. Age was found to have a statistically significant influence on unintended pregnancy, with women aged 25–29 years [AOR = 0.29; CI = 0.13–0.63], 30–34 years [AOR = 0.18; CI = 0.08–0.45], and 35–39 years [AOR = 0.26; CI = 0.10–0.68] being less likely to experience unintended pregnancy compared to those aged 15–19 years. Women with primary level of education were more likely to have unintended pregnancies, compared to those with no education [AOR = 2.07; CI = 1.12–3.84]. Conclusion: This study has filled the gap in the already existing literature on the association between reproductive health decision making capacity and unintended pregnancy in Ghana and has created a room for specific interventions geared towards reducing unintended pregnancies, especially among women who are not capable of making reproductive health decisions, women aged 15–19 years, those with primary education, Traditionalists and unmarried women. [ABSTRACT FROM AUTHOR]

Engineering remains the least gender diverse of the science, technology, engineering and mathematics fields. Chemical engineering (ChE) and electrical engineering (EE) are exemplars of relatively high and low gender diversity, respectively. Here, we investigate departmental, institutional, and regional factors associated with gender diversity among BS graduates within the US, 2010–2016. For both fields, gender diversity was significantly higher at private institutions (p < 1x10-6) and at historically black institutions (p < 1x10-5). No significant association was observed with gender diversity among tenure-track faculty, PhD-granting status, and variations in departmental name beyond the standard “chemical engineering” or “electrical engineering”. Gender diversity among EE graduates was significantly decreased (p = 8x10-5) when a distinct degree in computer engineering was available; no such association was observed between ChE gender diversity and the presence of biology-associated degrees. States with a highly gender diverse ChE workforce had a significantly higher degree of gender diversity among BS graduates (p = 3x10-5), but a significant association was not observed for EE. State variation in funding of support services for K-12 pupils significantly impacted gender diversity of graduates in both fields (p < 1x10-3), particularly in regards to instructional staff support (p < 5x10-4). Nationwide, gender diversity could not be concluded to be either significantly increasing or significantly decreasing for either field. [ABSTRACT FROM AUTHOR]

Objectives: The effect of age on intimate partner violence (IPV) against women has received little attention. The objective of this study is to analyze the prevalence, risk factors and health impact of current IPV in different life stages. Methods: We analyzed a sub-sample of 8,935 ever-partnered women aged 16 years and older from the Spanish Macrosurvey on Gender Violence of 2014. Main outcomes: current physical/ sexual IPV and current psychological-only IPV. The impact of IPV on health was analyzed using the variables self-perceived health, mental health and activity limitations. Risk factors were assessed using the prevalence ratio (PR) from Poisson regression models with robust variance. Analyses were stratified by age (young people, adults, and elderly people). Results: Abuse in childhood increases the likelihood of IPV in any life stage. A higher education level decreases the probability of physical/sexual IPV across all ages. Unemployment increases the probability of IPV in adult women (physical/sexual-IPV, PR:1.7; psychological-IPV, PR:1.3). Being an immigrant increases the likelihood of physical/sexual IPV in adult women (PRwomen:1.91). Women exposed to current physical/sexual IPV have a greater likelihood of reporting poor self-perceived health (PRyoungpeople:2.59; PRadults:1.68; PRelderly:1.28), poor mental health (PRyoungpeople:3.10; PRadults:2.61; PRedlerly:2.17) and activity limitations (PRyoungpeople:2.44; PRadults:1.98). For psychological IPV only, there is an increase in the probability of poor self-perceived health (PRadults:1.37; PRelderly:1.19), poor mental health (PRyoungpeople:2.24; PRadults:2.16; PRelderly:1.69), and activity limitations (PRadults:1.30; PRelderly:1.18). Conclusions: We found both common factors and differential factors when looking at IPV by age group. This shows the need to link gender violence prevention with the social circumstances of the population across different life stages. [ABSTRACT FROM AUTHOR]

Background: Malnutrition among children is one of the most pressing health concerns middle- and low-income countries face today, particularly those in Sub-Saharan Africa and South Asia. Early-life malnutrition has been shown to affect long-term health and income. One hypothesized channel linking early-life malnutrition and long-term outcomes is cognitive development. However, there is limited empirical evidence on the relationship between nutritional status and cognitive achievement in middle childhood. Study design: As part of the South India Community Health Study (SICHS), we collected educational attainment and anthropometric data from 1,194 children in rural Vellore district of Tamil Nadu, India, and assessed their math and reading skills. We analyzed the relationship between continuous and binary anthropometric measures of nutritional status and three measures of cognitive achievement (reading, math, and grade level), adjusting for potential confounders, using a regression framework. Results: Lower height-for-age and weight-for-age and their corresponding binary measures (stunting, underweight) were associated with lower reading scores, lower math scores, and lower grade level, with the exception of the association between weight-for-age and reading, which was marginally significant. A stunted child had one-third of a grade disadvantage compared to a non-stunted counterpart, whereas an underweight child had one-fourth of a grade disadvantage compared to a non-underweight counterpart. Lower BMI-for-age was associated with grade level and marginally associated with lower math scores, and its binary measure (thinness) was marginally associated with lower math scores. Conclusions: Acute and chronic malnutrition in middle childhood were negatively associated with math scores, reading scores, and educational attainment. Our study provides new evidence that cognitive achievement during middle childhood could be an important mechanism underlying the association between early-life malnutrition and long-term wellbeing. [ABSTRACT FROM AUTHOR]

Background: Little has been documented about partner violence among adolescent girls and young women (AGYW) who are out of school, a factor associated with HIV acquisition. To understand areas for prioritising HIV prevention intervention efforts, we explored the prevalence and correlates of partner violence among out of school AGYW in Shinyanga, Tanzania. Methods: A cross-sectional analysis of data from AGYW aged 15–23 years recruited in a cluster randomised trial conducted between October and December 2017 was used to examine correlates of partner violence. Data were collected through an Audio Computer-Assisted Self-interview. Multivariate logistic regression analysis was used to evaluate the association. Results: 2276 (75.5%) AGYW were sexually active. Of these, 816 (35.9%) reported having experienced violence from partners in the last six months. After adjusting for other covariates, being formerly married (AOR = 1.55, 95% CI:1.02, 2.37), having children (AOR = 1.79, 95% CI:1.47, 2.16), anxiety and depression symptoms (AOR = 3.27, 95%CI: 2.15, 4.96), having engaged in sex work in the past six months (AOR = 1.92, 95% CI: 1.45, 2.53) and economic deprivation (AOR = 1.61, 95% CI: 1.34,1.92) were significantly associated with partner violence. Conclusions: Almost one in three sexually active AGYW had experienced partner violence in the 6 months preceding the survey. The findings underscore the need for future research to focus on understanding the reasons and dynamics underlying high level of partner violence among AGYW. Furthermore, there is a need for implementing intervention programs that aim to reduce economic deprivation among AGYWs and address social norms and structures perpetuating violence against AGYW. Trial registration: ClinicalTrials.gov—ID . [ABSTRACT FROM AUTHOR]

Introduction: Use of tobacco and its products are the single most preventable cause of death in the world. The objective of this study was to determine the prevalence of current tobacco use and identify associated factors among Rwandans aged 15–34 years. Methods: This study involved secondary analysis of existing data from the nationally representative WHO STEPwise approach to Surveillance of non-communicable diseases (STEPS) conducted in 2013 to explore the prevalence of tobacco use and its associated factors in Rwanda. Data of 3,900 youth participants (15–34 years old) who had been selected using multistage cluster sampling during the survey was analyzed. The prevalence of current smoking along with socio-demographic characteristics of the sample were determined and multivariable logistic regression was employed to identify independent factors associated with current tobacco use. Results: The prevalence (weighted) of current tobacco use (all forms) was 8% (95%CI: 7.08–9.01). The prevalence was found to be significantly higher among males, young adults aged 24–34, youth with primary school education or less, those from Southern province, people with income (work in public, private organizations and self-employed) and young married adults. However, geographical location i.e. urban (7%) and rural (8%) settings did not affect prevalence of tobacco use. Factors that were found to be associated with current tobacco use through the multivariate analysis included being male, aged 25 years and above, having an income, and residing in Eastern, Kigali City and Southern Province compared to Western province. Conclusion: The association between smoking and socio-demographic characteristics among Rwandan youth identified in this study provides an opportunity for policy makers to tailor future tobacco control policies, and implement coordinated, high-impact interventions to prevent initiation of tobacco use among the youth. [ABSTRACT FROM AUTHOR]