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BACKGROUND: A longstanding gap in the reproductive health field has been the availability of a screening instrument that can reliably predict a persons likelihood of becoming pregnant. The Desire to Avoid Pregnancy Scale is a new measure; understanding its sensitivity and specificity as a screening tool for pregnancy as well as its predictive ability and how this varies by socio-demographic factors is important to inform its implementation. METHODS: This analysis was conducted on a cohort of 994 non-pregnant participants recruited in October 2018 and followed up for one year. The cohort was recruited using social media as well as advertisements in a university, school, abortion clinic and outreach sexual health service. Almost 90% of eligible participants completed follow-up at 12 months; those lost to follow-up were not significantly different on key socio-demographic factors. We used baseline DAP score and a binary variable of whether participants experienced pregnancy during the study to assess the sensitivity, specificity, area under the ROC curve (AUROC) and positive and negative predictive values (PPV and NPV) of the DAP at a range of cut-points. We also examined how the predictive ability of the DAP varied according to socio-demographic factors and by the time frame considered (e.g., pregnancy within 3, 6, 9 and 12 months). RESULTS: At a cut-point of 2 on the 0-4 range of the DAP scale, the DAP had a sensitivity of 0.78, a specificity of 0.81 and an excellent AUROC of 0.87. In this sample the cumulative incidence of pregnancy was 16% (95%CI 13%, 18%) making the PPV 43% and the NPV 95% at this cut-point. The DAP score was the factor most strongly associated with pregnancy, even after age and number of children were taken into account. The association between baseline DAP score and pregnancy did not differ across time frames. CONCLUSIONS: This is the first study to assess the DAP scale as a screening tool and shows that its predictive ability is superior to the limited pre-existing pregnancy prediction tools. Based on our findings, the DAP could be used with a cut-point selected according to the purpose.

BACKGROUND: Clinicians and women of reproductive age would benefit from a reliable way to identify who is likely to become pregnant in the next year, in order to direct health advice. The 14-item Desire to Avoid Pregnancy (DAP) scale is predictive of pregnancy; this paper compares it with other ways of assessing pregnancy preferences to shortlist options for clinical implementation. METHODS: A cohort of 994 UK women of reproductive age completed the DAP and other questions about pregnancy preferences, including the Attitude towards Potential Pregnancy Scale (APPS), at baseline and reported on pregnancies quarterly for a year. For each question, DAP item and combinations of DAP items, we examined the predictive ability, sensitivity, specificity, area under the receiver operating curve (AUROC), and positive and negative predictive values. RESULTS: The AUROCs and predictive ability of the APPS and DAP single items were weaker than the full DAP, though all except one had acceptable AUROCs (>0.7). The most predictive individual DAP item was It would be a good thing for me if I became pregnant in the next 3 months, where women who strongly agreed had a 66.7% chance of pregnancy within 12 months and the AUROC was acceptable (0.77). CONCLUSION: We recommend exploring the acceptability to women and healthcare professionals of asking a single DAP item (It would be a good thing for me if I became pregnant in the next 3 months), possibly in combination with additional DAP items. This will help to guide service provision to support reproductive preferences.

INTRODUCTION & RESEARCH OBJECTIVES: The COVID-19 pandemic significantly disrupted daily travel. This paper contrasts 51 US cities responses, namely street reallocation criteria and messaging related to physical activity (PA) and active transportation (AT) during the early months of the pandemic. This study can be utilized by cities for aiding in the creation of locally responsive policies that acknowledge and remedy a lack of safe active transportation. METHODS: A content analysis review was conducted of city orders and documents related to PA or AT for the largest city by population in all 50 US states and the District of Columbia. Authoritative documents issued from each citys public health declaration (ca. March 2020) to September 2020 were reviewed. The study obtained documents from two crowdsourced datasets and municipal websites. Descriptive statistics were used to compare policies and strategies, with a focus on reallocation of street space. RESULTS: A total of 631 documents were coded. Considerable variation existed in city responses to COVID-19 that impacted PA and AT. Most cities stay-at-home orders explicitly permitted outdoor PA (63%) and many encouraged PA (47%). As the pandemic continued, 23 cities (45%) had pilot programs that reallocated street space for non-motorized road users to recreate and travel. Most cities explicitly mentioned a rationale for the programs (e.g., to provide space for exercise (96%) and to alleviate crowding or provide safe AT routes (57%)). Cities used public feedback to guide placement decisions (35%) and several welcomed public input to adjust initial actions. Geographic equity was a criterion in 35% of programs and 57% considered inadequately sized infrastructure in decision-making. CONCLUSIONS: If cities want to emphasize AT and the health of their citizens, safe access to dedicated infrastructure needs to be prioritized. More than half of study cities did not instate new programs within the first 6 months of the pandemic. Cities should study peer responses and innovations to inform and create locally responsive policies that can acknowledge and remedy a lack of safe AT.

The introductory communication course has a history of producing meaningful scholarship that shapes teaching and learning at institutions of higher education around the world. The scope of this research is broad and, as such, calls for a meta-synthesis of trends in and avenues for future research. This project examines published work from the past decade--2010 through 2019--in key outlets that regularly publish introductory course-focused research ("The Basic Communication Course Annual," "Communication Education," "Communication Teacher," "The Journal of Communication Pedagogy"). This analysis of 98 articles revealed that publications tend to focus on three primary areas: (1) students and instructors; (2) the structure of the course; and (3) assessment--while calling for future research to "replicate" past studies. Based on this meta-synthesis, we propose directions for future scholarship that will continue to impact teaching and learning practices beyond replication.

OBJECTIVES: To evaluate the psychometric performance, including predictive validity, of a UK version of the Desire to Avoid Pregnancy (DAP) scale. DESIGN: Prospective cohort study for psychometric evaluation. SETTING: UK. PARTICIPANTS: Women in the UK aged 15 years to menopause, who were not pregnant at the time of recruitment in October 2018, were eligible. 994 women completed the baseline survey and 90.2% of women eligible for the 12-month survey participated. PRIMARY AND SECONDARY OUTCOME MEASURES: The DAP scale was assessed according to key measurement properties of validity (construct (structural and hypothesis testing) and criterion (predictive)), reliability (internal consistency using Cronbachs alpha and test-retest using intraclass correlation coefficients, ICC) and differential item functioning. Item response and classical test theory methods were used. RESULTS: The scale was acceptable, understandable and showed good targeting with the full range of scores captured. Construct validity was demonstrated on hypothesis testing, with odds of contraceptive use increasing threefold with each increasing DAP point (range: 0-4). Eighty per cent of women with the lowest DAP score became pregnant within 12 months, compared with

This paper explores students' experiences with communication centers and offers recommendations for new and expanding communication centers. We combine empirical research conducted on student reflection forms with our own insight as tutors, instructors, and directors and with existing literature to offer considerations for enhancing the services offered by communication centers. We propose communication centers consider the purposes for and outcomes of students' visits, as well as what attributes of the tutoring and tutors students appreciate. Reasons for visiting the communication center included to receive help with content and structure, delivery, and sources and visual aids. Students reported getting assistance with drafting, delivery, supporting, and debriefing their presentations. The approaches to tutoring students appreciated included guided learning, clarification of course materials, and identification of both their strengths and weaknesses. Tutor characteristics appreciated by students were their prior teaching experience, good listening skills, creativity, and demeanor.

Media play an important role in young people's lives as an agent of socialization, both generally and with regard to mathematics. To understand the mathematics-related messages disseminated to young people via popular media, we analyzed portrayals of mathematics and mathematicians in over 40 media examples (television shows, movies, websites, video games, and books). Notably, the selection of media was based on elementary students' responses to a questionnaire about their media favourites, thus enabling an analysis of the messages to which students are exposed during typical media use. While there were differences in the portrayals across the media types, the messages disseminated consistently related to the invisibility of mathematics, narrow views of mathematics, and stereotypical portrayals of mathematicians. Such messages are problematic as they can influence young people's views of mathematics and mathematicians, as well as of themselves as mathematics learners.

The numeracy capabilities of pre-service teachers are a recent focus in the Australian educational system. In this article, we discuss findings from an analysis of data from the Literacy and Numeracy Test for Initial Teacher Education Students (LANTITE), which is administered by the Australian Council for Educational Research. In our analysis, we considered numeracy test data from 20 students from one Australian university: those who achieved the 10 highest and the 10 lowest overall numeracy scores in 2016 at this university on their first attempt of the test. We found that these groups clearly have particular characteristics that were linked to their success or failure on the numeracy test. We discuss programs and resources that the university has made available for students in preparation for the LANTITE and provide additional suggestions to support such students going forward.

BackgroundSocioeconomic disadvantage is a strong determinant of adverse outcomes in patients with heart failure. However, the contribution of community-level economic distress to adverse outcomes in heart failure may differ across races and ethnicities.MethodsPatients of self-reported Black, White, and Hispanic race and ethnicity hospitalized with heart failure between 2014 and 2019 were identified from the Medicare MedPAR Part A 100% Files. We used patient-level residential ZIP code to quantify community-level economic distress on the basis of the Distressed Community Index (quintile 5: economically distressed versus quintiles 1-4: nondistressed). The association of continuous and categorical measures (distressed versus nondistressed) of Distressed Community Index with 30-day, 6-month, and 1-year risk-adjusted mortality, readmission burden, and home time were assessed separately by race and ethnicity groups.ResultsThe study included 1 611 586 White (13.2% economically distressed), 205 840 Black (50.6% economically distressed), and 89 199 Hispanic (27.3% economically distressed) patients. Among White patients, living in economically distressed (versus nondistressed) communities was significantly associated with a higher risk of adverse outcomes at 30-day and 1-year follow-up. Among Black and Hispanic patients, the risk of adverse outcomes associated with living in distressed versus nondistressed communities was not meaningfully different at 30 days and became more prominent by 1-year follow-up. Similarly, in the restricted cubic spline analysis, a stronger and more graded association was observed between Distressed Community Index score and risk of adverse outcomes in White patients (versus Black and Hispanic patients). Furthermore, the association between community-level economic distress and risk of adverse outcomes for Black patients differed in rural versus urban areas. Living in economically distressed communities was significantly associated with a higher risk of mortality and lower home time at 1-year follow-up in rural areas but not urban areas.ConclusionsThe association between community-level economic distress and risk of adverse outcomes differs across race and ethnic groups, with a stronger association noted in White patients at short- and long-term follow-up. Among Black patients, the association of community-level economic distress with a higher risk of adverse outcomes is less evident in the short term and is more robust and significant in the long-term follow-up and rural areas.

In 2015, a new Master of Teaching coursework unit, Numeracy for Learners and Teachers, was introduced at Monash University in Melbourne, Australia. The drivers for the establishment of the unit were the Australian Institute for Teaching and School Leadership numeracy standards for graduate teachers and the inclusion of numeracy as a general capability in the Australian Curriculum. In this article, we describe the content and organisation of the unit. An evaluation was conducted with students in each of the years 2015-2017. Data included pre- and post-unit surveys and interviews. Findings indicated that students had fairly good numeracy skills on entry to the unit, and that as a consequence of studying the unit, their understanding of the relationship between numeracy and mathematics improved, as did their confidence to incorporate numeracy into their teaching across the curriculum.

Observational studies conducted in several countries including Qatar (1) and the United Kingdom (2) have demonstrated that SARS-CoV-2 vaccination provides protection against symptomatic infection, hospitalization, and death. The role of [...]

In order to investigate pre-service teachers (PSTs') understandings of the terms mathematics and numeracy, the authors conducted a study at one Australian university. The PSTs were enrolled in a mandatory unit about numeracy across the curriculum, in which both teachers' and students' numeracy capabilities were considered. The study took place from 2015 to 2019. Participants completed questionnaires before starting the unit (pre-unit questionnaire) and at the end of the unit (post-unit questionnaire), so that the authors could discern if their views had changed as a result of completing the unit. In this article, the authors report the findings from their analysis of the questionnaire data from PSTs completing primary (Foundation to Year 6) teaching qualifications.

PURPOSE Practice facilitation is an evidence-informed implementation strategy to support quality improvement (QI) and aid practices in aligning with best evidence. Few studies, particularly of this size and scope, identify strategies that contribute to facilitator effectiveness. METHODS We conducted a sequential mixed methods study, analyzing data from EvidenceNOW, a large-scale QI initiative. Seven regional cooperatives employed 162 facilitators to work with 1,630 small or medium-sized primary care practices. Main analyses were based on facilitators who worked with at least 4 practices. Facilitators were defined as more effective if at least 75% of their practices improved on at least 1 outcome measure-aspirin use, blood pressure control, smoking cessation counseling (ABS), or practice change capacity, measured using Change Process Capability Questionnaire-from baseline to follow-up. Facilitators were defined as less effective if less than 50% of their practices improved on these outcomes. Using an immersion crystallization and comparative approach, we analyzed observational and interview data to identify strategies associated with more effective facilitators. RESULTS Practices working with more effective facilitators had a 3.6% greater change in the mean percentage of patients meeting the composite ABS measure compared with practices working with less effective facilitators (P CONCLUSIONS Facilitation strategies that differentiate more and less effective facilitators have implications for enhancing facilitator development and training, and can assist all facilitators to more effectively support practice changes. Key words: practice facilitation; quality improvement; large-scale initiative; capacity building; implementation facilitation; organizational change; organizational innovation, INTRODUCTION Practice facilitators are trained individuals who build medical practices' capacity to make meaningful operational changes aligned with current evidence. (1,2) Facilitators provide education, motivation, accountability, and guidance on organizational [...]