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Differentiated instruction (DI) is an educational praxis that is built on the premise that all students can be engaged in learning and achieve positive academic outcomes. Previous research in secondary schools has shown promise in the success of DI practices and outlines the importance of sustained professional development (PD) for teachers. There is, however, little research on DI within senior‐secondary classrooms in the Australian context. This research is part of a larger study which recruited 12 participants from three schools across two states in Australia, and aimed to investigate teachers' perceptions of school leadership and support in implementing DI in their classrooms as well as awareness of relevant policies. Findings indicated that when teachers were aware of policies involving DI, they tended to describe policies relating to special education. This suggests that DI is viewed by these teachers as an approach for students with additional needs rather than seen as a whole class philosophy. Similarly, the results indicated that when teachers said that leadership supported them in using DI, this support was commonly reported as isolated professional development in supporting students with additional needs. Discrepancies around awareness of DI policies were also found between teachers at the same school, with those in leadership roles indicating that requirements to utilise DI were embedded in their general teaching and learning policy. Implications for future practice and policy are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Vaginal surgery has a superior outcome profile compared with other surgical routes, yet skills are declining because of low case volumes. Graduating residents' confidence and preparedness for vaginal surgery has plummeted in the past decade. The objective of the present study was to investigate whether procedure‐specific simulation skills, vs usual training, result in improved operative competence. Material and methods: We completed a randomized controlled trial of didactic and procedural training via low fidelity vaginal surgery models for anterior repair, posterior repair (PR), vaginal hysterectomy (VH), recruiting novice gynecology residents at three academic centers. We evaluated performance via global rating scale (GRS) in the real operating room and for corresponding procedures by attending surgeon blinded to group. Prespecified secondary outcomes included procedural steps knowledge, overall performance, satisfaction, self‐confidence and intraoperative parameters. A priori sample size estimated 50 residents (20% absolute difference in GRS score, 25% SD, 80% power, alpha 0.05). Clinicaltrials.gov: Registration no. NCT05887570. Results: We randomized 83 residents to intervention or control and 55 completed the trial (2011–23). Baseline characteristics were similar, except for more fourth‐year control residents. After adjustment of confounders (age, level, baseline knowledge), GRS scores showed significant differences overall (mean difference 8.2; 95% confidence interval [CI]: 0.2–16.1; p = 0.044) and for VH (mean difference 12.0; 95% CI: 1.8–22.3; p = 0.02). The intervention group had significantly higher procedural steps knowledge and self‐confidence for VH and/or PR (p < 0.05, adjusted analysis). Estimated blood loss, operative time and complications were similar between groups. Conclusions: Compared to usual training, procedure‐specific didactic and low fidelity simulation modules for vaginal surgery resulted in significant improvements in operative performance and several other skill parameters. [ABSTRACT FROM AUTHOR]

Differentiated instruction (DI) is a pedagogical framework to which all students can be engaged in their learning and achieve academically in their schooling. While DI is for all students, there is little research in DI for students with learning difficulties, in senior‐secondary schools in Australia. This research formed part of a larger study, which recruited 12 participants across two Australian states, to investigate how teachers in senior‐secondary schooling, differentiate for students with learning difficulties. Findings indicated that when students had labelled learning difficulties as recognised by other professionals, teachers expressed being able to differentiate more easily with greater self‐efficacy, as compared with differentiating for students who teachers themselves considered were experiencing difficulties in their learning but had no label assigned to them. Teachers voiced that learning difficulties was a broad concept, with each teacher defining learning difficulties differently. This suggests that with the broad nature of learning difficulties, teachers may struggle to differentiate accordingly, leading to lower self‐efficacy beliefs. While labelled learning difficulties provide guidance for differentiating, this may also see teachers differentiating based on preconceived ideas and for students with special needs, rather than individual students' current understanding. Implications for future practice are discussed. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide evidence-based guidance on the management of a positive human papilloma virus (HPV) test and to provide guidance around screening and HPV testing for specific patient populations. The guideline was developed by a working group in collaboration with the Gynecologic Oncology Society of Canada (GOC), Society of Colposcopists of Canada (SCC), and the Canadian Partnership Against Cancer. The literature informing these guidelines was obtained through a systematic review of relevant literature by a multi-step search process led by an information specialist. The literature was reviewed up to July 2021 with manual searches of relevant national guidelines and more recent publications. The quality of the evidence and strength of recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The intended users of this guideline include primary care providers, gynecologists, colposcopists, screening programs, and healthcare facilities. The implementation of the recommendations will ensure an optimum implementation of HPV testing with a focus on the management of positive results. Recommendations for appropriate care for underserved and marginalized groups are made. [ABSTRACT FROM AUTHOR]

Passive acoustic monitoring (PAM) is a cost‐effective method for monitoring cetacean populations compared with techniques such as aerial and ship‐based surveys. The Cetacean POrpoise Detector (C‐POD) has become an integral tool in monitoring programs globally for over a decade, providing standardized metrics of occurrence that can be compared across time and space. However, the phasing out of C‐PODs following the development of the new Full waveform capture POD (F‐POD) with increased sensitivity, improved train detection, and reduced false‐positive rates represents an important methodological change in data collection, particularly when being introduced into existing monitoring programs. Here, we compare the performance of the C‐POD with that of its successor, the F‐POD, co‐deployed in a field setting for 15 months, to monitor harbor porpoise (Phocoena phocoena). While similar temporal trends in detections were found for both devices, the C‐POD detected only 58% of the detection‐positive minutes (DPM), recorded by the F‐POD. Differences in detection rates were not consistent through time making it difficult to apply a correction factor or directly compare results obtained from the two PODs. Generalized additive models (GAMs) were used to test whether these differences in detection rates would have an effect on analyses of temporal patterns and environmental drivers of occurrence. No differences were found in seasonal patterns or the environmental correlates of porpoise occurrence (month, diel period, temperature, environmental noise, and tide). However, the C‐POD failed to detect sufficient foraging rates to identify temporal patterns in foraging behavior, which were shown by the F‐POD. Our results suggest that the switch to F‐PODs will have little effect on determining broad‐scale seasonal patterns of occurrence but may improve our understanding of fine‐scale behaviors such as foraging. We highlight how care must be taken interpreting F‐POD results as indicative of increased occurrence when used in time‐series analysis. [ABSTRACT FROM AUTHOR]

There is a paucity of research around Differentiated Instruction (DI) in Australian senior secondary education even though this approach has been shown to have the potential to cater for diverse learning needs in inclusive classrooms in other school contexts. Investigating how DI is understood and implemented by teachers in a senior secondary context will allow for a deeper insight into, and possible improvement in, teachers' knowledge and use of the DI approach. This qualitative study focussed on how four teachers from one school viewed DI and how they employed and documented DI practices in their senior secondary classrooms when catering for the needs of diverse learners. The teachers noted positive outcomes such as happy students and a sense of fulfilment for the teacher, as well as enablers for implementing DI effectively, including teacher collaboration and reflection. Challenges to effectively implementing DI were mentioned, such as a lack of time and large class sizes. [ABSTRACT FROM AUTHOR]

For odontocetes, passive acoustic monitoring (PAM) can be used to differentiate between occurrence and foraging through analysis of click characteristics. Feeding buzzes and navigation/searching echolocation clicks of harbor porpoise (Phocoena phocoena) were differentiated within C‐POD data from northwest Ireland between 2009 and 2017. The spatiotemporal distribution of foraging behavior was investigated using generalized additive modelling, at multiple temporal scales. Both the presence/absence of buzzes and foraging intensity (defined by buzz:click ratios) were determined. Feeding buzzes were identified in one third of porpoise positive hours, ranging from 15% in summer, to 40% in autumn, highlighting seasonal variation irrespective of porpoise occurrence. Complex interannual variation in foraging behavior was also shown across the time series. A strong nocturnal peak in foraging intensity was observed. We found increased porpoise foraging with dolphin species detections within the same hour, and a negative impact of construction activities, involving both impulsive and broadband noise. Results highlight the value of long‐term acoustic time series, by quantifying variation, and show that extracting foraging behavior from occurrence data can help to unravel habitat use patterns, responses to disturbance, and seasonal changes in behavior. Understanding when and how a species uses an area can better inform marine spatial planning and help mitigate anthropogenic impacts. [ABSTRACT FROM AUTHOR]

Differentiated instruction is a proactive teaching model and philosophy with demonstrated potential to cater for diverse learners and create inclusive classrooms. There is little research, however, into the implementation of this approach in the senior secondary classroom. Teachers' implementation of differentiated instruction has been shown to be linked to teacher attitudes and self‐efficacy in other settings. This study investigated the impact of teachers' self‐efficacy and attitudes towards the implementation of differentiated instruction in the senior secondary context across two Australian states with a total of five participating teachers. The A (Affective) B (Behaviour) C (Cognitive) model was employed to define teacher attitudes from interviews concerning differentiated instruction. Findings indicated that teacher knowledge was a major factor influencing differentiation, in addition to attitude and self‐efficacy. The discourse analysis demonstrated that teachers held a greater knowledge of differentiation strategies than the concepts that underpin the differentiated instruction framework. Additionally, time constraints and feelings of failure in implementing differentiation strategies impacted teacher attitudes. Teacher knowledge, attitude and self‐efficacy were interrelated and impacted on teachers' implementation of differentiated instruction in the senior secondary classroom. Implications for professional development to address student needs through differentiated instruction in the inclusive senior secondary classroom teacher are discussed. [ABSTRACT FROM AUTHOR]

Healthy sexual practices should be integrated into gender-affirming health care. People with reproductive potential should be offered counseling on contraception, emergency contraception, abortion, fertility, fertility preservation, and antenatal, intrapartum, and postpartum care. Use of gender-affirming hormones, including testosterone, estrogen, estrogen blockers, progestins, and gonadotropin-releasing hormone agonists, cannot be relied upon for contraception. Patients should be informed that an absence of bleeding does not equate to an absence of ovulation. Many contraceptive options, including combined hormonal contraception (pill, patch, ring) and progestinonly methods (pill, depot medroxyprogesterone acetate), can be provided without the need for an internal examination. Patients should be supported in deciding if intrauterine device placement is conducted in the office or operating room (with procedural sedation, general anesthesia). [ABSTRACT FROM AUTHOR]

Congenital adrenal hyperplasia (CAH) encompasses a range of autosomal recessive inherited enzyme deficiencies that impact cortisol biosynthesis pathways. Although reported as a rare and lifelong disorder, it holds chronic health risks for individuals that can influence menstruation. The purpose of this environmental scan and integrative literature review was to identify health information pertinent to CAH and menstruation in order to inform health providers, increase patient education, and promote menstrual wellbeing. Analysis identified that while information about menses is reported, information about menstrual irregularities and their management in adolescents and women with CAH is uncertain. Furthermore, there is insufficient good quality research and knowledge on CAH and menstruation to inform health providers in their practice with this population. The need for individuals with CAH to access evidence-informed information is constrained by the state of current understanding and limitations in knowledge translation. The importance of having trustworthy and safe spaces in which to ask questions and draw on ethically sound, language appropriate, and evidence-informed material is paramount in supporting women's confidence and wellbeing across their lifetime. We encourage the building of stronger relationships between researchers, health providers, support groups and individuals to improve knowledge translation and dissemination regarding CAH and menstruation. [ABSTRACT FROM AUTHOR]

Although pregnancy and abortion rates have declined in adolescents, unintended pregnancies remain unacceptably high in this age group. The use of highly effective methods of contraception is one of the pillars of unintended pregnancy prevention and requires a shared decision making process within a rights based framework. Adolescents are eligible to use any method of contraception and long-acting reversible contraceptives, which are "forgettable" and highly effective, may be particularly suited for many adolescents. Contraceptive methods may have additional non-contraceptive benefits that address other needs or concerns of the adolescent. Dual method use should be encouraged among adolescents for the prevention of both unintended pregnancies and sexually transmitted infections. Health care providers have an important role to play in ensuring that adolescents have access to high quality and non-judgmental reproductive health care services and contraceptive methods in adolescent-friendly settings that recognize the unique biopsychosocial needs of the adolescent. [ABSTRACT FROM AUTHOR]

Most adolescents will experience discomfort during menstruation. Due to normalization of dysmenorrhea, there is delay to diagnosis and treatment. Non-steroidal anti-inflammatories are a first line treatment. Adolescents can safely be offered menstrual suppression with combined hormonal contraception, and progestin-only options. When the above are ineffective, gonadotropin releasing hormone agonists with add back treatment can be considered. Transabdominal ultrasound is indicated when first line treatments do not improve symptoms. Endometriosis should be considered in adolescents who experience ongoing pain despite medical treatment. If laparoscopy is performed and endometriosis visualized, it should be treated with either excision or ablation. Women with endometriosis should be counselled on menstrual suppression until fertility is desired. Management of chronic pain requires the involvement of a multi-disciplinary team. [ABSTRACT FROM AUTHOR]

Although pregnancy and abortion rates have declined in adolescents, unintended pregnancies remain unacceptably high in this age group. The use of highly effective methods of contraception is one of the pillars of unintended pregnancy prevention and requires a shared decision making process within a rights based framework. Adolescents are eligible to use any method of contraception and long-acting reversible contraceptives, which are "forgettable" and highly effective, may be particularly suited for many adolescents. Contraceptive methods may have additional non-contraceptive benefits that address other needs or concerns of the adolescent. Dual method use should be encouraged among adolescents for the prevention of both unintended pregnancies and sexually transmitted infections. Health care providers have an important role to play in ensuring that adolescents have access to high quality and non-judgmental reproductive health care services and contraceptive methods in adolescent-friendly settings that recognize the unique biopsychosocial needs of the adolescent. [ABSTRACT FROM AUTHOR]

Most adolescents will experience discomfort during menstruation. Due to normalization of dysmenorrhea, there is delay to diagnosis and treatment. Non-steroidal anti-inflammatories are a first line treatment. Adolescents can safely be offered menstrual suppression with combined hormonal contraception, and progestin-only options. When the above are ineffective, gonadotropin releasing hormone agonists with add back treatment can be considered. Transabdominal ultrasound is indicated when first line treatments do not improve symptoms. Endometriosis should be considered in adolescents who experience ongoing pain despite medical treatment. If laparoscopy is performed and endometriosis visualized, it should be treated with either excision or ablation. Women with endometriosis should be counselled on menstrual suppression until fertility is desired. Management of chronic pain requires the involvement of a multidisciplinary team. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Self-confidence is the belief in one's ability to perform and can be enhanced by training. Surgical education should aim to optimize trainee confidence. We designed three procedure-specific competency-based modules to teach vaginal hysterectomy (VH), anterior (AR) and posterior repair (PR) to novice gynecology residents. We hypothesized each module would improve self-confidence and satisfaction during index procedure performance in the operating room.Methods: This was an ancillary analysis of a larger randomized-controlled trial of gynecologic educational interventions. Residents at three Canadian universities were included if they had previously performed fewer than five index procedures independently. Intervention residents received educational modules; controls engaged in self-directed learning. All residents performed one or more of the three surgeries and filled out a validated Self-Confidence Scale and a Satisfaction Scale. Scores were compared between groups. Correlations were sought between self-confidence and various variables.Results: Forty-six residents at three Canadian universities were randomized (21 intervention, 25 control). Most residents had never performed the index procedure. Overall, self-confidence was significantly higher (p = 0.021) in the intervention group for VH, but not for AR and PR (p = 0.94 and p = 0.12, respectively). Compared with controls, self-confidence was also significantly higher in intervention residents who had never performed VH (p = 0.026) or PR (p = 0.027) and in first and second year intervention residents. There was a positive correlation between self-confidence and satisfaction.Conclusions: Surgical modules improved self-confidence preferentially in the most junior residents and for more complicated procedures. The wide self-confidence ranges observed suggest that optimization should be an important goal for surgical educators. [ABSTRACT FROM AUTHOR]

Introduction: Sex variations comprise a heterogeneous group of medical conditions. These include congenital adrenal hyperplasia (CAH), androgen insensitivity syndrome, Turner syndrome, and more, reportedly affecting approximately two percent of the population. These conditions can involve lifelong management. However, no research has examined the experiences nor the healthcare practices used with these individuals in their transitions through healthcare in Canada. Further, the majority of research on healthcare transitions from other countries focuses on the pediatric to adult care transfer, despite transitions taking place across the lifespan. Aims Objectives Theory or Methods: Firstly, we aimed to investigate the current context of care for individuals with sex variations through an environmental scan of the current care pathways and guidelines for transition used by health providers. This included a search of 13 Canadian Children's Hospital websites, a survey sent to providers, and freedom of information requests submitted to these hospitals. Secondly, we sought to learn from the experiences of individuals with sex variations and their families in transitioning through care, along with their providers' understandings of transition for this group. Thus, we conducted engagement sessions in BC and Ontario applying a community-participatory learning approach Highlights or Results or Key Findings Through the environmental scan, we found no hospital-specific resources used by healthcare providers for guiding care transitions for individuals with sex variations. Our engagement sessions consisted of in-person focus groups and virtual interviews with individuals from Ontario and British Columbia. We also included secondary data from a small BC study with women with CAH. Altogether, data from 17 individuals (15 with sex variations and two caregivers) was included. Interviews highlighted three important themes: (1) transition is a lifespan activity - individuals faced different healthcare challenges that required transition as they aged, (2) the building of personal agency, and (3) wellness promotion and healing in this population. An additional output from the study included the co-development of a small advisory group of adults identifying with sex variations, involved in work around health education and consultation. Conclusions: Canadian care guidelines for managing transition with sex variations are lacking. For individuals with sex variations there is little information to support individual health literacy and selfmanagement. There exists an opportunity for these individuals and their providers to begin building a visible network that can inform care delivery and policy. Implications for applicability/transferability sustainability and limitations: A limitation of this study was failure to adopt inclusive terminology at study conception (e.g., our website domain, dsdtransition.ca). We learnt that intersex or sex variation is preferred by the community. We encourage use of inclusive terminology in healthcare and the co-development of transition guidelines with Canadians with sex variations [ABSTRACT FROM AUTHOR]

The original concept of a subculture of learning support in secondary schools developed from a study of ' Support Teachers, Learning Difficulties' in New South Wales, Australia. The study examined the influence of school culture on the service delivery model used by these support teachers in three case studies, one of which is reported in this article. Both research and policy recommend consultation and co-teaching with a minimum of withdrawal of students with learning difficulties for intensive instruction. To employ the recommended service delivery model it was found that support teachers need to be immersed in a subculture of learning support within the school, which involves interacting with others who share similar values and beliefs about the education of students with learning difficulties. If such a subculture does not exist the support teacher must play a major role in its development. The use of the recommended service delivery model will enhance the education provided for students with learning difficulties. [ABSTRACT FROM AUTHOR]