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BackgroundAsylum seekers, refugees, and immigrants experience a number of risk factors for mental health problems. However, in comparison to the host population, these populations are less likely to use mental health services. Digital mental health approaches have been shown to be effective in improving well-being for the general population. Thus, they may provide an effective and culturally appropriate strategy to bridge the treatment gap for these populations vulnerable to mental health risks. ObjectiveThis paper aims to provide the background and rationale for conducting a scoping review on digital mental health resources for asylum seekers, refugees, and immigrants. It also provides an outline of the methods and analyses, which will be used to answer the following questions. What are the available digital mental health resources for asylum seekers, refugees, and immigrants? Are they effective, feasible, appropriate, and accepted by the population? What are the knowledge gaps in the field? MethodsThe scoping review methodology will follow 5 phases: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the results. Searches will be conducted in the following databases: EBSCOhost databases (CINAHL Plus with Full Text, MEDLINE with Full Text, APA PsycArticles, Psychology and Behavioral Sciences Collection, and APA PsycInfo), PubMed, and Scopus. Additionally, OpenGrey, Mednar, and Eldis will be searched for gray literature. All primary studies and gray literature in English concerning the use of information and communication technology to deliver services addressing mental health issues for asylum seekers, refugees, and immigrants will be included. ResultsThis scoping review will provide an overview of the available digital mental health resources for asylum seekers, refugees, and immigrants and describe the implementation outcomes of feasibility, acceptability, and appropriateness of such approaches for those populations. Potential gaps in the field will also be identified. ConclusionsAs of February 2020, there were no scoping reviews, which assessed the effectiveness, feasibility, acceptability, and appropriateness of the available digital mental health resources for asylum seekers, refugees, and immigrants. This review will provide an extensive coverage on a promising and innovative intervention for such populations. It will give insight into the range of approaches, their effectiveness, and progress in their implementation. It will also provide valuable information for health practitioners, policy makers, and researchers working with the population. International Registered Report Identifier (IRRID)PRR1-10.2196/19031

BackgroundIn Australia, there is growing use of technology supported knowledge translation (KT) strategies such as social media and mobile apps in health promotion and in Indigenous health. However, little is known about how individuals use technologies and the evidence base for the impact of these health interventions on health behavior change is meager. ObjectiveThe objective of our study was to examine how Facebook is used to promote health messages to Indigenous people and discuss how KT can support planning and implementing health messages to ensure chosen strategies are fit for the purpose and achieve impact. MethodsA desktop audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people using Facebook was conducted. ResultsOur audit identified 13 out of 21 eligible campaigns that used Facebook. Facebook pages with the highest number of likes (more than 5000) were linked to a website and to other social media applications and demonstrated stickiness characteristics by posting frequently (triggers and unexpected), recruiting sporting or public personalities to promote campaigns (social currency and public), recruiting Indigenous people from the local region (stories and emotion), and sharing stories and experiences based on real-life events (credible and practical value). ConclusionsKT planning may support campaigns to identify and select KT strategies that are best suited and well-aligned to the campaign’s goals, messages, and target audiences. KT planning can also help mitigate unforeseen and expected risks, reduce unwarranted costs and expenses, achieve goals, and limit the peer pressure of using strategies that may not be fit for purpose. One of the main challenges in using KT systems and processes involves coming to an adequate conceptualization of the KT process itself.

BackgroundHealth promotion organizations are increasingly embracing social media technologies to engage end users in a more interactive way and to widely disseminate their messages with the aim of improving health outcomes. However, such technologies are still in their early stages of development and, thus, evidence of their efficacy is limited. ObjectiveThe study aimed to provide a current overview of the evidence surrounding consumer-use social media and mobile software apps for health promotion interventions, with a particular focus on the Australian context and on health promotion targeted toward an Indigenous audience. Specifically, our research questions were: (1) What is the peer-reviewed evidence of benefit for social media and mobile technologies used in health promotion, intervention, self-management, and health service delivery, with regard to smoking cessation, sexual health, and otitis media? and (2) What social media and mobile software have been used in Indigenous-focused health promotion interventions in Australia with respect to smoking cessation, sexual health, or otitis media, and what is the evidence of their effectiveness and benefit? MethodsWe conducted a scoping study of peer-reviewed evidence for the effectiveness of social media and mobile technologies in health promotion (globally) with respect to smoking cessation, sexual health, and otitis media. A scoping review was also conducted for Australian uses of social media to reach Indigenous Australians and mobile apps produced by Australian health bodies, again with respect to these three areas. ResultsThe review identified 17 intervention studies and seven systematic reviews that met inclusion criteria, which showed limited evidence of benefit from these interventions. We also found five Australian projects with significant social media health components targeting the Indigenous Australian population for health promotion purposes, and four mobile software apps that met inclusion criteria. No evidence of benefit was found for these projects. ConclusionsAlthough social media technologies have the unique capacity to reach Indigenous Australians as well as other underserved populations because of their wide and instant disseminability, evidence of their capacity to do so is limited. Current interventions are neither evidence-based nor widely adopted. Health promotion organizations need to gain a more thorough understanding of their technologies, who engages with them, why they engage with them, and how, in order to be able to create successful social media projects.

A healthcare workforce that demonstrates cultural competence and humility while reflecting the diversity of the surrounding community has the potential to significantly benefit the patient population it serves. In this context and given numerous societal influences and the events of 2020, the leadership of the Department of Emergency Medicine at Albany Medical Center recognized the need to promote diversity, equity, and inclusion (DEI) in multiple areas. These included premedical education, medical education, postgraduate medical education, faculty development, staff satisfaction, and patient care. The department formed a DEI taskforce that developed an ongoing, multipronged, interdisciplinary approach to address these important aspects of our work and clinical environment with the goals of improving staff wellbeing, reducing burnout, and promoting the health of our community. Our experience is shared here to illustrate how a small, dedicated team can implement a variety of DEI initiatives quickly and with relatively little cost at a large academic medical center.

Previous stable isotope research on Middle-to-Late Holocene (6600 cal BP-present) hunter-gatherers of Central California has documented significant regional variation in human paleodiets between the San Francisco Bay Area and Central Valley. In general, this geographically-patterned dietary variation tracks greater consumption of marine food resources in the Bay Area and greater consumption of freshwater and terrestrial food resources in the Central Valley. Using stable carbon and nitrogen isotope analysis of bone collagen, stable carbon isotopes of bone bioapatite, and a large series of AMS dates (5420-2975 cal BP), we examine human paleodiets in 238 burials from CA-CCO-548 (Marsh Creek), located near the Sacramento-San Joaquin Delta, in Central California. Isotopic results support archaeofaunal and paleobotanical findings regarding the dietary importance of terrestrial C3-resources (e.g., artiodactyls, small seeds, acorns) and freshwater fish. The results further indicate that marine resources were of minor importance and could have been acquired from brackish areas near the mouth of the San Francisco Bay estuary located 9 km away or through trade. Although carbon and nitrogen isotopes of bone collagen suggest continuity in the sources of dietary protein over time. Carbon isotopes of bone bioapatite demonstrate a significant temporal shift toward greater consumption of C3 plant resources, such as acorns and small seeds, consistent with resource intensification models. The paleodiet of the CA-CCO-548 population is similar to contemporaneous groups located to the south and northwest, but is distinct from groups within the Delta and San Francisco Bay Area.

Supporting social interactions and positive peer relationships is an important element of comprehensive secondary education and transition programming. For many adolescents with autism spectrum disorders (ASDs), such social connections may be fairly limited apart from intentional programming. We examined the efficacy and social validity of peer network interventions as an avenue for promoting social interactions and social skills for two high school students with ASD. The introduction of peer networks was accompanied by substantial increases in peer interactions for both students. Adult facilitators, peer partners, and students with ASD each considered the intervention to be acceptable and feasible to implement. We offer recommendations for designing social-focused interventions for adolescents with ASD and highlight future research directions.

Research on governance often assumes that governance requires combinations of hierarchical, market and network co-ordination. However, governance versatility – understood as the existence of a repertoire of different modes of coordination – is not a characteristic of all instances of governance. The aim of this paper is to offer a more thorough analysis by exploring existing levels of governance versatility and how these are influenced by institutional profiles. Our comparative study of primary care performance across six jurisdictions suggests that higher levels of governance versatility can be shaped by very different institutional profiles. Our analysis raises important questions for future studies of governance versatility. [ABSTRACT FROM AUTHOR]

The notion of teacher leadership is implicit in official documentation in the South African education system post 1994, which emphasises a move towards a more shared and participatory approach to the practice of leadership and management in schools. The concept of teacher leadership is embedded in a distributed leadership theoretical framing which emphasises that leadership need not be located only in the position of the principal but can be stretched over a range of people who work at different levels in a school. We report on a study in which the perceptions of teachers' on their understanding and experiences of teacher leadership were explored. The study adopted a survey approach and utilised closed questionnaires to gather data from 1,055 post level-one teachers across a range of schools of diverse contexts in KwaZulu-Natal. We found that while teachers supported the notion of shared leadership and believed they were equipped to lead, their leadership was largely restricted to their classrooms. There was some evidence of teacher leadership amongst teacher colleagues in certain curricular and extra-curricular activities. However, teacher leadership in relation to school-wide and community issues was almost non-existent. We signal two problematics regarding the leadership of school teachers and consider the implication of these for the distribution of leadership, and therefore change, in schools.

Background: Crusted scabies is a debilitating dermatological condition. Although still relatively rare in the urban areas of Australia, rates of crusted scabies in remote Aboriginal communities in the Northern Territory (NT) are reported to be among the highest in the world. Objective: To estimate the health system costs associated with diagnosing, treating and managing crusted scabies. Methods: A disease pathway model was developed to identify the major phases of managing crusted scabies. In recognition of the higher resource use required to treat more severe cases, the pathway differentiates between crusted scabies severity grades. The disease pathway model was populated with data from a clinical audit of 42 crusted scabies patients diagnosed in the Top-End of Australia's Northern Territory between July 1, 2016 and May 1, 2018. These data were combined with standard Australian unit costs to calculate the expected costs per patient over a 12-month period, as well as the overall population cost for treating crusted scabies. Findings: The expected health care cost per patient diagnosed with crusted scabies is $35,418 Australian dollars (AUD) (95% CI: $27,000 to $43,800), resulting in an overall cost of $1,558,392AUD (95% CI: $1,188,000 to $1,927,200) for managing all patients diagnosed in the Northern Territory in a given year (2018). By far, the biggest component of the health care costs falls on the hospital system. Discussion: This is the first cost-of-illness analysis for treating crusted scabies. Such analysis will be of value to policy makers and researchers by informing future evaluations of crusted scabies prevention programs and resource allocation decisions. Further research is needed on the wider costs of crusted scabies including non-financial impacts such as the loss in quality of life as well as the burden of care and loss of well-being for patients, families and communities. Author summary: Crusted scabies is characterised by thick skin crusting and fissuring and can lead to serious secondary infections and death from complications. Rates of crusted scabies in remote Aboriginal communities in the Northern Territory (NT) are among the highest in the world. Efforts are on the way in Australia to prevent, if not eliminate, crusted scabies. We use data from a clinical audit of 42 patients diagnosed with crusted scabies in the Top-End of the NT to estimate the health system costs associated with diagnosing, treating and managing crusted scabies for patients and their households. This cost of illness study can provide a valuable starting point for policy makers and evaluators in estimating the potential economic impact of crusted scabies prevention programs on health care service use and costs. [ABSTRACT FROM AUTHOR]

This paper draws on systems thinking and selected case studies to explore how 'prac‐ademic' partnerships can create impact in real‐world settings. The paper argues that knowledge co‐generation partnerships are sub‐systems of the complex systems in which research is being undertaken and that governance arrangements are central to enabling partners to work together more effectively to achieve research impact. Reflecting on two successful knowledge co‐generation case examples, three distinct areas are identified that need to be understood from a systems perspective to enable future success. These are the importance of (1) developing a clear framing and shared purpose; (2) developing flexibility in contracting that enables new deliverables to emerge; and (3) the project team comprising bilingual team members who understand the contextual demands of both academia and practice. These elements will facilitate the co‐generation of knowledge through prac‐ademic partnerships and become a path to creating research impact. The paper draws on systems thinking and selected case studies to explore how academic/practitioner ('prac‐ademic') partnerships can create research impact.Knowledge co‐generation partnerships are sub‐systems of the complex systems in which research is being undertaken.Governance arrangements are central to enabling partners to work together more effectively to achieve research impact. In particular the following are important:developing a shared purpose for the partnership (not a shared view of the problem)developing flexibility in contracting that enables new deliverables to emergethe project team comprising bilingual team members. [ABSTRACT FROM AUTHOR]

Background: Crusted scabies is endemic in some remote Aboriginal communities in the Northern Territory (NT) of Australia and carries a high mortality risk. Improvement in active case detection (ACD) for crusted scabies is hampered by a lack of evidence about best practice. We therefore conducted a systematic review of ACD methods for leprosy, a condition with similar ACD requirements, to consider how findings could be informative to crusted scabies detection. Methods and principle findings: We conducted systematic searches in MEDLINE, CINAHL, Scopus and the Cochrane Database for Systematic Reviews for studies published since 1999 that reported at least one comparison rate (detection or prevalence rate) against which the yield of the ACD method could be assessed. The search yielded 15 eligible studies from 511. Study heterogeneity precluded meta-analysis. Contact tracing and community screening of marginalised ethnic groups yielded the highest new case detection rates. Rapid community screening campaigns, and those using less experienced screening personnel, were associated with lower suspect confirmation rates. There is insufficient data to assess whether ACD campaigns improve treatment outcomes or disease control. Conclusion: This review demonstrates the importance of ACD campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases. The potential benefit of ACD for crusted scabies is not quantified, however, lessons from leprosy suggest value in follow-up with previously identified cases and their close contacts to support for scabies control and to reduce the likelihood of reinfection in the crusted scabies case. Skilled screening personnel and appropriate community engagement strategies are needed to maximise screening uptake. More research is needed to assess ACD cost effectiveness, impact on disease control, and to explore ACD methods capable of capturing the homeless and highly mobile who may be missed in household centric models. Author summary: Crusted scabies is a severely debilitating skin disease with potentially fatal consequences that is endemic in some remote Aboriginal communities in the Northern Territory (NT) of Australia. Early detection is essential to maximise the chance of recovery and help prevent transmission of scabies to others. There is little knowledge about how to actively detect crusted scabies, so we sought relevant knowledge about a disease with many similarities: leprosy. The review demonstrates the importance of ACD campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases. Lessons for crusted scabies in the NT include the importance of skilled screening personnel and appropriate community engagement strategies to maximise screening uptake. More research is needed to assess ACD cost effectiveness, impact on disease control, and to explore ACD methods capable of capturing the homeless and highly mobile who may be missed in household centric models. [ABSTRACT FROM AUTHOR]

It is widely acknowledged that 'good policy' should be informed by the people it most directly affects. However, learning from people with lived experiences in the criminal justice sector, such as people who have served time in prison, has received little attention. This article discusses the significance of and challenges related to capturing the voices of people who are currently serving time or have served time in prison. We argue that formalising the perspectives of these individuals into policymaking through co-design processes may be an important method for enhancing program responses to rising incarceration and reincarceration rates. [ABSTRACT FROM AUTHOR]

Abstract Background Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1) explore the factors associated with variation in clinical performance; 2) examine specific strategies that have been effective in improving primary care clinical performance; and 3) work with health service staff, management and policy makers to enhance the effective implementation of successful strategies. Methods/Design The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria) over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management. Discussion By linking researchers directly to users of research (service providers, managers and policy makers), the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary health care and fostering effective and efficient exchange and use of data and information among service providers and policy makers to achieve evidence-based resource allocation, service planning, system development, and improvements of service delivery and Indigenous health outcomes.

Abstract Background Experimentation with continuous quality improvement (CQI) processes is well underway in Indigenous Australian primary health care. To date, little research into how health organizations take up, support, and embed these complex innovations is available on which services can draw to inform implementation. In this paper, we examine the practices and processes in the policy and organisational contexts, and aim to explore the ways in which they interact to support and/or hinder services' participation in a large scale Indigenous primary health care CQI program. Methods We took a theory-driven approach, drawing on literature on the theory and effectiveness of CQI systems and the Greenhalgh diffusion of innovation framework. Data included routinely collected regional and service profile data; uptake of tools and progress through the first CQI cycle, and data collected quarterly from hub coordinators on their perceptions of barriers and enablers. A total of 48 interviews were also conducted with key people involved in the development, dissemination, and implementation of the Audit and Best Practice for Chronic Disease (ABCD) project. We compiled the various data, conducted thematic analyses, and developed an in-depth narrative account of the processes of uptake and diffusion into services. Results Uptake of CQI was a complex and messy process that happened in fits and starts, was often characterised by conflicts and tensions, and was iterative, reactive, and transformational. Despite initial enthusiasm, the mixed successes during the first cycle were associated with the interaction of features of the environment, the service, the quality improvement process, and the stakeholders, which operated to produce a set of circumstances that either inhibited or enabled the process of change. Organisations had different levels of capacity to mobilize resources that could shift the balance toward supporting implementation. Different forms of leadership and organisational linkages were critical to success. The Greenhalgh framework provided a useful starting point for investigation, but we believe it is more a descriptive than explanatory model. As such, it has limitations in the extent to which it could assist us in understanding the interactions of the practices and processes that we observed at different levels of the system. Summary Taking up CQI involved engaging multiple stakeholders in new relationships that could support services to construct shared meaning and purpose, operationalise key concepts and tools, and develop and embed new practices into services systems and routines. Promoting quality improvement requires a system approach and organization-wide commitment. At the organization level, a formal high-level mandate, leadership at all levels, and resources to support implementation are needed. At the broader system level, governance arrangements that can fulfil a number of policy objectives related to articulating the linkages between CQI and other aspects of the regulatory, financing, and performance frameworks within the health system would help define a role and vision for quality improvement.

Abstract Background Type 2 diabetes is rapidly growing as a proportion of the disease burden in Australia as elsewhere. This study addresses the cost effectiveness of an integrated approach to assisting general practitioners (GPs) with diabetes management. This approach uses a centralized database of clinical data of an Australian Division of General Practice (a network of GPs) to co-ordinate care according to national guidelines. Methods Long term outcomes for patients in the program were derived using clinical parameters after 5 years of program participation, and the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model, to project outcomes for 40 years from the time of diagnosis and from 5 years post-diagnosis. Cost information was obtained from a range of sources. While program costs are directly available, and costs of complications can be estimated from the UKPDS model, other costs are estimated by comparing costs in the Division with average costs across the state or the nation. The outcome and cost measures are used derive incremental cost-effectiveness ratios. Results The clinical data show that the program is effective in the short term, with improvement or no statistical difference in most clinical measures over 5 years. Average HbA1c levels increased by less than expected over the 5 year period. While the program is estimated to generate treatment cost savings, overall net costs are positive. However, the program led to projected improvements in expected life years and Quality Adjusted Life Expectancy (QALE), with incremental cost effectiveness ratios of $A8,106 per life-year saved and $A9,730 per year of QALE gained. Conclusions The combination of an established model of diabetes progression and generally available data has provided an opportunity to establish robust methods of testing the cost effectiveness of a program for which a formal control group was not available. Based on this methodology, integrated health care delivery provided by a network of GPs improved health outcomes of type 2 diabetics with acceptable cost effectiveness, which suggests that similar outcomes may be obtained elsewhere.

Abstract Background A growing body of international literature points to the importance of a system approach to improve the quality of care in primary health care settings. Continuous Quality Improvement (CQI) concepts and techniques provide a theoretically coherent and practical way for primary care organisations to identify, address, and overcome the barriers to improvements. The Audit and Best Practice for Chronic Disease (ABCD) study, a CQI-based quality improvement project conducted in Australia's Northern Territory, has demonstrated significant improvements in primary care service systems, in the quality of clinical service delivery and in patient outcomes related to chronic illness care. The aims of the extension phase of this study are to examine factors that influence uptake and sustainability of this type of CQI activity in a variety of Indigenous primary health care organisations in Australia, and to assess the impact of collaborative CQI approaches on prevention and management of chronic illness and health outcomes in Indigenous communities. Methods/design The study will be conducted in 40–50 Indigenous community health centres from 4 States/Territories (Northern Territory, Western Australia, New South Wales and Queensland) over a five year period. The project will adopt a participatory, quality improvement approach that features annual cycles of: 1) organisational system assessment and audits of clinical records; 2) feedback to and interpretation of results with participating health centre staff; 3) action planning and goal setting by health centre staff to achieve system changes; and 4) implementation of strategies for change. System assessment will be carried out using a System Assessment Tool and in-depth interviews of key informants. Clinical audit tools include two essential tools that focus on diabetes care audit and preventive service audit, and several optional tools focusing on audits of hypertension, heart disease, renal disease, primary mental health care and health promotion. The project will be carried out in a form of collaborative characterised by a sequence of annual learning cycles with action periods for CQI activities between each learning cycle. Key outcome measures include uptake and integration of CQI activities into routine service activity, state of system development, delivery of evidence-based services, intermediate patient outcomes (e.g. blood pressure and glucose control), and health outcomes (complications, hospitalisations and mortality). Conclusion The ABCD Extension project will contribute directly to the evidence base on effectiveness of collaborative CQI approaches on prevention and management of chronic disease in Australia's Indigenous communities, and to inform the operational and policy environments that are required to incorporate CQI activities into routine practice.

Intermediated markets are relatively new market channels that have the potential to expand local and regional food systems while increasing the viability of small- and medium-sized farms. The intermediated channels comprise a short supply chain linking farmers with consumers through the use of intermediary such as a distributor or supermarket. In many instances, these supply chains embed social or environmental values, such as supporting local farming. In this paper, we examine the current state of knowledge about the intermediated market channel. The first source of knowledge consists of data from federal and private sources. Next, we review a selection of the published literature focusing on farmer use of intermediated market channels in the USA. The main intermediated channels include direct to institutions, such as schools and hospitals; food hubs; and direct to retail. The paper finishes by raising questions about future of intermediated markets, based on the findings of the literature review and data. [ABSTRACT FROM AUTHOR]

Background: Scabies is a common dermatological condition, affecting more than 130 million people at any time. To evaluate and/or predict the effectiveness and cost-effectiveness of scabies interventions, disease transmission modelling can be used. Objective: To review published scabies models and data to inform the design of a comprehensive scabies transmission modelling framework to evaluate the cost-effectiveness of scabies interventions. Methods: Systematic literature search in PubMed, Medline, Embase, CINAHL, and the Cochrane Library identified scabies studies published since the year 2000. Selected papers included modelling studies and studies on the life cycle of scabies mites, patient quality of life and resource use. Reference lists of reviews were used to identify any papers missed through the search strategy. Strengths and limitations of identified scabies models were evaluated and used to design a modelling framework. Potential model inputs were identified and discussed. Findings: Four scabies models were published: a Markov decision tree, two compartmental models, and an agent-based, network-dependent Monte Carlo model. None of the models specifically addressed crusted scabies, which is associated with high morbidity, mortality, and increased transmission. There is a lack of reliable, comprehensive information about scabies biology and the impact this disease has on patients and society. Discussion: Clinicians and health economists working in the field of scabies are encouraged to use the current review to inform disease transmission modelling and economic evaluations on interventions against scabies. [ABSTRACT FROM AUTHOR]

Variation in human breastfeeding and weaning practices is subject to changing social pressures and norms, as well as individual agency. This paper presents a case study from the Yukisma Mound (CA‐SCL‐38), a prehistoric site in the San Francisco Bay Area, which was used as a ceremonial and cemetery space by the ancestral Ohlone Indians between 780 and 230 cal years bp. Stable carbon and nitrogen isotope values from bone collagen of 201 individuals, including 26 subadults, are analysed. The Weaning Age Reconstruction with Nitrogen isotope analysis package in R is used to model expected δ15N values of infant bone collagen, against which measured δ15N values reveal individual variation in weaning practices. Infants from this burial sample were exclusively breastfed until approximately 0.8 years (maximum density estimation (MDE), marginal probability = 0.0456), and completely weaned by around 4.4 years (MDE, marginal probability =.0409). Range of variation in adult diets is used as a baseline of comparison, in addition to mean δ15N values of adult females, to better consider supplementary food options, and to avoid the assumption of a homogeneous maternal diet. Comparison with weaning data from contemporaneous regional sites, drawn from studies using tooth dentin of individuals who survived childhood, reveals that introduction of complementary foods and cessation of breastfeeding occurred somewhat later at the Yukisma Mound. This contrast suggests prolonged supplementation with breastmilk for children who expressed nutritional stress or disease. Variation in weaning trajectories is further interpreted using δ13C values to identify individuals with elevated δ15N values due to supplementation with high trophic level foods (e.g., freshwater fish and marine foods). Changes in weaning practices are demonstrated by comparison of this sample to ethnohistoric accounts of the Ohlone. This study provides an example of collaborative research with descendent populations and of making the most of available materials. [ABSTRACT FROM AUTHOR]

A rapidly expanding interest in quality in the Aboriginal-community-controlled health sector has led to widespread uptake of accreditation using more than one set of standards, a proliferation of continuous quality improvement programs and the introduction of key performance indicators. As yet, there has been no overarching logic that shows how they relate to each other, with consequent confusion within and outside the sector. We map the three approaches to the Framework for Performance Assessment in Primary Health Care, demonstrating their key differences and complementarity. There needs to be greater attention in both policy and practice to the purposes and alignment of the three approaches if they are to embed a system-wide focus that supports quality improvement at the service level. [ABSTRACT FROM AUTHOR]

Monitoring patient experience is essential for stimulating innovation in health care and improving quality and accountability. Internationally, standardised approaches are used to collect patient experience information, but in Australian primary health care (PHC), little is known about which patient experience surveys are used and which aspects of experience they measure. This prevents routine inclusion of patient experience data in quality improvement or system performance measurement. A scoping review was undertaken to identify relevant surveys. Data on survey availability, psychometric properties, target population, method and frequency of administration were extracted. Survey items were mapped against six dimensions of patient experience described internationally. Ninety-five surveys were identified; 34 were developed for use in Australia. Surveys vary in content, size, aspects of experience measured and methods of administration. The quality of data collected and the extent to which it is used in quality improvement is unclear. Collection of patient experience data in Australian PHC is not well developed or standardised and there are few publicly available instruments. There is a need to clearly identify the purposes for which data are to be used and to develop an integrated approach that articulates these collections with other quality and performance data. Some options are discussed. [ABSTRACT FROM AUTHOR]

The aim of this systematic review was to assess evidence of the impact of commissioning on health service use, quality, outcomes and value for money and to consider findings in the Australian context. Systematic searches of the literature identified 444 papers and, after exclusions, 36 were subject to full review. The commissioning cycle (planning, contracting, monitoring) formed a framework for analysis and impacts were assessed at individual, subpopulation and population levels. Little evidence of the effectiveness of commissioning at any level was available and observed impacts were highly context-dependent. There was insufficient evidence to identify a preferred model. Lack of skills and capacity were cited as major barriers to the implementation of commissioning. Successful commissioning requires a clear policy framework of national and regional priorities that define agreed targets for commissioning agencies. Engagement of consumers and providers, especially physicians, was considered to be critically important but is time consuming and has proven difficult to sustain. Adequate information on the cost, volume and quality of healthcare services is critically important for setting priorities, and for contracting and monitoring performance. Lack of information resulted in serious problems. High-quality nationally standardised performance measures and data requirements need to be built into contracts and ongoing monitoring and evaluation. In Australia, there is significant work to be done in areas of policy and governance, funding systems and incentives, patient enrolment or registration, information systems, individual and organisational capacity, community engagement and experience in commissioning. [ABSTRACT FROM AUTHOR]

Background: There is good evidence that coordination can have beneficial impacts on patient care and outcomes but the mechanisms by which coordination is to be achieved are poorly understood and rarely identified in relevant policies. One approach suggests that continuity of information is a key element but research is yet to provide guidance on how to optimise coordination through improving continuity in healthcare settings. Discussion: In this paper we report on the development of a conceptual framework of information continuity in care coordination. We drew on evidence from systematic reviews of coordination and empirical studies on information use in integrated care models to develop the framework. It identifies the architecture, processes and scope of practices that evidence suggests is required to support information continuity in a population based approach to care coordination. Summary: The framework offers value to policy makers and practitioners as a map that identifies the multi-level elements of an integrated system capable of driving better coordination. Testing of the framework in different settings could aid our understanding of information continuity as a mechanism for linking coordination strategies that operate at different levels of the health system and enable synthesis of findings for informing policy and practice. [ABSTRACT FROM AUTHOR]

Supporting social interactions and positive peer relationships is an important element of comprehensive secondary education and transition programming. For many adolescents with autism spectrum disorders (ASDs), such social connections may be fairly limited apart from intentional programming. We examined the efficacy and social validity of peer network interventions as an avenue for promoting social interactions and social skills for two high school students with ASD. The introduction of peer networks was accompanied by substantial increases in peer interactions for both students. Adult facilitators, peer partners, and students with ASD each considered the intervention to be acceptable and feasible to implement. We offer recommendations for designing social-focused interventions for adolescents with ASD and highlight future research directions. [ABSTRACT FROM AUTHOR]

From the early 1980s until recently, the University of British Columbia Faculty of Dentistry had employed the Cana-dian Dental Association (CDA) Structured Interview in its Phase 2 admissions process (with those applicants invited for inter-views). While this structured interview had demonstrated reliability and validity, the Faculty of Dentistry came to believe that a multiple interview process using scenarios would help it better identify applicants who would match its mission. After a literature review that investigated such interview protocols as unstructured, semi-structured, computerized, and telephone formats, a mul-tiple interview format was chosen. This format was seen as an emerging trend, with evidence that it has been deemed fairer by applicants, more reliable by interviewers, more difficult for applicants to provide set answers for the scenarios, and not to require as many interviewers as other formats. This article describes the process undertaken to implement a customized multiple inter-view format for admissions and reports these outcomes of the process: a smoothly running multiple interview; effective training protocols for staff, interviewers, and applicants; and reports from successful applicants and interviewers that they felt the multiple interview was a more reliable and fairer recruiting tool than other models. [ABSTRACT FROM AUTHOR]

Background: Coordination of care is considered a key component of patient-centered health care systems, but is rarely defined or operationalised in health care policy. Continuity, an aspect of coordination, is the patient's experience of care over time, and is often described in terms of three dimensions: information, relational and management continuity. With the current health policy focus on both the use of information technology and care coordination, this study aimed to 1) explore how information continuity supports coordination and 2) investigate conditions required to support information continuity. Methods: Four diverse Australian primary health care initiatives were purposively selected for inclusion in the study. Each has improved coordination as an aim or fundamental principle. Each organization was asked to identify practitioners, managers and decision makers who could provide insight into the use of information for care coordination to participate in the study. Using in-depth semi-structured interviews, we explored four questions covering the scope and use of information, the influence of governance, data ownership and confidentiality and the influence of financial incentives and quality improvement on information continuity and coordination. Data were thematically analyzed using NVivo 8. Results: The overall picture that emerged across all four cases was that whilst accessibility and continuity of information underpin effective care, they are not sufficient for coordination of care for complex conditions. Shared information reduced unnecessary repetition and provided health professionals with the opportunity to access records of care from other providers, but participants described their role in coordination in terms of the active involvement of a person in care rather than the passive availability of information. Complex issues regarding data ownership and confidentiality often hampered information sharing. Successful coordination in each case was associated with responsiveness to local rather than system level factors. Conclusions: The availability of information is not sufficient to ensure continuity for the patient or coordination from the systems perspective. Policy directed at information continuity must give consideration to the broader 'fit' with management and relational continuity and provide a broad base that allows for local responsiveness in order for coordination of care to be achieved. [ABSTRACT FROM AUTHOR]

Online learning communities are entering the realm of web-based learning as a means of reflective collaborative learning. The purpose of this article is to describe the formation of an online learning community using a community of inquiry (COI) conceptual framework. Operative clinical simulation dental students at the University of British Columbia in Canada have been involved in an online COI for the past five years. This descriptive article presents an overview of the experiences involved in developing this COI and provides a conceptual framework for an online COI. [ABSTRACT FROM AUTHOR]

As technology becomes more prevalent in our lives, any professional's practice and lifelong learning becomes more dependent on it. At the University of British Columbia, Faculty of Dentistry it was noticed that some very experienced and accomplished dentists teaching on a part-time basis were becoming increasingly uncomfortable in the Faculty's high tech clinic. This has resulted in a disconnect between these clinical instructors and the dental students. We designed a continuing education course for dentists incorporating technology acceptance theory and adult learning theory with the aim of showing them how the technology could work for them. An iClicker survey administered throughout the course determined that this approach had allowed these dentists to move forward with their use of technology. [ABSTRACT FROM AUTHOR]

Our research exercise consisted of a survey conducted on 52 second year dental students to consider approaches for measuring the effectiveness of applying cognitive learning theories for teaching using technology. We did this in an effort to enhance the learning of millennial students' using their modes of communication preferences. The Cognitive Load, Multimedia and Visual Learning Theories were employed, and student preference was tested to determine the importance of the three theories in PowerPoint presentations (PPP) with respect to millennial student preference. Results, as expected, revealed students did not value PPP slides containing text without images. Given the relatively small sample size and the selected group of students in the present study, future studies should consider students from other disciplines and from different generations before generalizations can be made. [ABSTRACT FROM AUTHOR]

Breast-feeding and weaning are a part of childhood in all human populations, but the exact timing of these milestones varies between groups. As infants incorporate the nutrients from breast milk into their growing bones, chemical evidence is captured in the form of higher stable nitrogen (δ15N) isotope values. This study interprets δ15N values in the bone collagen of children (n = 24) buried at the Yukisma Mound (CA-SCL-38), in Santa Clara County, California. Radiocarbon dates for this site span 2200-250 B.P., but primarily fall during the Late period (740-230 B.P.). In the one probable mother-infant pair available for study, a 2.9 per mil enrichment of δ15N values was observed, consistent with the expected trophic level enrichment of breast-feeding infants. δ15N values of children under seven years old suggest the introduction of weaning foods between 1.5 and 2 years of age, and cessation of breast-feeding by 3 to 3.5 years of age. These results differ from the practices reported in the ethnohistoric literature. This paper includes photos of human remains, taken during excavation at CA-SCL-38 by Ohlone Family Consulting Services, the CRM arm of the Muwekma Ohlone Tribe (which also served as the Most Likely Descendant tribal group for this project). The images were provided to the authors by the tribe, and specific permission was granted to include them in this publication [ABSTRACT FROM AUTHOR]