Enjoyable Aspects Research Articles

The laughter effect: Enhancing cross-cultural learning and cohesiveness in a virtual environment

This practice report investigates the role of humor in enhancing cross-cultural learning and group cohesion in virtual education settings. Most collaborative international learning training focuses on structuring content, co-teaching, and managing coursework for specific outcomes (Rubin & Guth, 2015). Beyond including time for icebreakers for students to become acclimated with each other, often much of the rest of the experience emphasizes task completion; this serious focus may contribute to discomfort and reduced engagement among diverse students. After witnessing this our first year working together in a collaborative online international learning experience connecting North American students with those from Muslim-majority countries, we explored how modeling and creating opportunities for shared laughter in synchronous group exercises might better promote a relaxed and engaging learning environment. Our findings, derived from qualitative feedback and quantitative surveys, demonstrate that humor enhances group cohesion and cultural exploration. Students reported increased comfort, enjoyment, and willingness to engage and humor-driven activities consistently rated as the most impactful and enjoyable aspects of the course.

Kuliner “Timlo Solo” sebagai Bahan Ajar BIPA dalam Upaya Internasionalisasi Bahasa Indonesia

This article discusses the important role of teaching the Indonesian language for Foreign Speakers (BIPA) in supporting the internationalization of the language of Indonesia, with a focus on the use of the culinary material "Timlo Solo" in learning BIPA at Yale University. Through a qualitative method with a literature study approach, the study reviews the history, variation, way of making, culinary location, and role in Timlo Solo's local culinarian culture. The results of the study show that the use of Timlo solo's cooking lessons helps foreign students understand not only language, but also the cultural context, social life, and norms in Indonesia. By using culinary as a teaching material, BIPA students can gain a deeper understanding of Indonesian cultural diversity. In addition, the culinary integration in BIPA learning enriches the learning experience with practical and enjoyable aspects. In the context of the internationalization of the Indonesian language, the use of Timlo Solo’s culinary lessons at Yale University is a significant step in broadening the understanding and appreciation of Indonesia’s culture among foreign students.

Evaluation of a Simulation Based Training Course for Non-Consultant Hospital Doctors (NCHDS) in Psychiatry

IntroductionSimulation-based training (Sim) is an established method of teaching in medical education and can help bridge the gap between medical theory and clinical practice. While sim is well-established in medical and surgical specialties, it is less well developed in psychiatry. Psychiatric emergencies often occur out of hours when there are fewer senior staff available on-site. Sim offers a safe setting for development of essential clinical skills with carefully delivered feedback.Sim can be high-cost involving specialized simulation facilities, especially when utilising high-fidelity equipment. Even lower-fidelity techniques requiring standardized patients (SPs) require funding for actors and this can be a barrier to utilising Sim.ObjectivesWe piloted a Sim course to NCHDs working in psychiatry in a tertiary university hospital with the aim of improving trainee skills and confidence in managing psychiatric emergencies on-call including risk assessment, involuntary admission and acute behavioural disturbance. A low-fidelity approach was taken with minimal use of SPs.MethodsA sim handbook developed by Irish Centre for Applied Patient Safety and Simulation (ICAPSS) was used for reference in developing the simulation modules. Three modules were delivered in a structured manner over three hours; involuntary admission, risk assessment and management of acute behavioural disturbance. Each module involved the simulation exercise (20 minutes) followed by debrief (20 minutes). The facilitated debrief involved open discussion and prompted reflective learning. Anonymous, paper-based questionnaires were used to collect feedback on participants’ experience of the training.ResultsThere were 12 attendees and ten participants completed the feedback. All participants (100%, n=10) agreed or strongly agreed that sim helped them to learn and all agreed that the topics covered were relevant to their clinical role. All participants (100%, n=10), indicated that they enjoyed the workshop. Eighty percent (n=8) agreed or strongly agreed that they would like to do more sim-based workshops. The supportive environment and debrief sessions were reported as the most enjoyable aspects of the workshop.ConclusionsParticipants unanimously agreed that the training was useful to them in their clinical roles and helped them to learn. Sim was effective in teaching high risk complex psychiatric cases to psychiatry NCHDs and consideration should be given to expand this teaching method within postgraduate psychiatry training in Ireland.Disclosure of InterestNone Declared

Cancer Center Staff Satisfaction: Descriptive Results of a Canadian Study.

Caring for cancer patients is generally considered very rewarding work, but it can also be stressful and demanding. Therefore, it is important for oncology healthcare professionals to feel satisfied with their work environment in order to provide the best care possible. An ethics-approved 61-item staff satisfaction survey was developed in-house to gain insights regarding workplace satisfaction among all staff at The Ottawa Hospital Cancer Center. Descriptive statistics were used to analyze the responses. A total of 478 individuals completed the online survey, with 75.1% women, 23.2% men, and 1.7% preferring not to say. This represented the vast majority (>75%) of cancer center staff. The approximate breakdown according to healthcare professional type was as follows: 21% nurses, 20% radiation therapists, 18% physicians, 13% clerical staff, and 28% other types of staff. Almost all (97.4%) generally enjoyed their work, with 60% stating "very much" and 37.4% stating "a little bit", and 93.3% found working with cancer patients rewarding. The overall satisfaction level at work was high, with 30.1% reporting "very satisfied" and 54.2% "somewhat satisfied". However, in terms of their work being stressful, 18.6% stated it was "very much" and 62.1% "a little bit". Also, in terms of their workload, 61.3% stated it was "very busy" and 10% stated it was "excessively busy". The most enjoyable aspects of work were listed as interactions with colleagues, interactions with patients, and learning new things. The least enjoyable aspects of work were excessive workload, a perceived unsupportive work environment, and technology problems. Levels of satisfaction and stress at work varied according to role at the cancer center. Most cancer center staff seem to enjoy their work and find it rewarding. However, the work environment can be challenging and stressful. Areas for improvement include managing workloads, ensuring staff feel supported, and improving the user-friendliness of technology.

A pilot randomized controlled trial of a mind-body resiliency program for fear of cancer recurrence: Qualitative findings.

503 Background: Up to 70% of cancer survivors have elevated fear of cancer recurrence (FCR). Behavioral approaches are promising for managing FCR but lack testing in a scalable, synchronous, remotely-delivered, group format. This NCCIH-funded pilot RCT tested an adapted mind-body resiliency program (IN FOCUS) in comparison to a usual care control (UC; referral to virtual, cancer support groups). Methods: Adult survivors of any non-metastatic cancer (N=64) were recruited from two Boston-area academic medical centers (July 2021-March 2022). Inclusion criteria included primary treatment, elevated FCR (FCR Inventory severity≥16), English fluency, no undertreated serious mental illness, and access to Zoom. Survivors were randomized (1:1) to either 8 sessions of IN FOCUS or UC. Individual exit interviews were conducted virtually with high rates of completion (91% IN FOCUS, 94% UC). Open-ended questions probed survivors on study enjoyableness, convenience, helpfulness, odds of future skill use, satisfaction, and FCR. Interviews were recorded, transcribed, and analyzed using hybrid deductive/inductive coding by three coders (MM, ET, DH) with a senior coder (GY) for resolving discrepancies. Themes were iteratively collapsed and expanded through consensus. Results: Survivors randomized to IN FOCUS found group delivery (i.e., hearing insights from others, sharing similar cancer experiences) and learning a variety of new skills (i.e., positive psychology such as appreciations and humor, relaxation/breathing, CBT and health behaviors) as the most enjoyable and helpful aspects. Some survivors voiced challenges with scheduling, limited time for group discussion, and length of sessions. Homework was helpful yet challenging for survivors to implement independently. Virtual delivery and electronic materials were identified as most convenient, but some wished the manual was less dense and printed as a hard copy. Survivors valued the group facilitator’s rapport, empathy, and group diversity in terms of cancer diagnosis, but desired more diversity in age, race, and gender. IN FOCUS survivors described reductions in FCR, primarily attributed to cognitive (i.e., self-efficacy, changed perspective) and health behavior changes. However, several IN FOCUS survivors reported having no change in FCR, due to needing more time to incorporate skills or recent health events. UC survivors described benefits from reading study surveys, which prompted survivors to reflect on their psychosocial functioning, and coping skills. Conclusions: The IN FOCUS intervention and study materials were well-received and participants appreciated the integration of a variety of skills, in particular positive psychology followed by relaxation, CBT, and health behavior skills. Findings will guide future optimization and efficacy testing with heterogenous cancer survivors with FCR. Clinical trial information: NCT04876599 .

How teaching modality affects Foreign Language Enjoyment: a comparison of in-person and online English as a Foreign Language classes

Abstract The sudden shift to online foreign language (FL) learning due to the pandemic offered researchers the unique possibility to explore the role of learner emotions in different teaching modalities. This mixed methods paper investigates differences in 437 English as a foreign language (EFL) students’ levels of FL enjoyment (FLE) in pre-pandemic in-person EFL classes and their online classes after the switch to emergency remote teaching (ERT) based on a convergent research design. Statistical analysis of quantitative data gathered with a web survey showed a significant drop in learners’ FLE in ERT, based on a 9-item scale. The sharpest drop was observed for the scales’ subdimensions Personal and Social Enjoyment while Teacher appreciation decreased less. Qualitative content analysis of 21 in-depth interviews revealed that enjoyable aspects were mentioned more frequently for ERT than for in-person classes. The nature of FLE was found to shift with teaching modality: FLE was linked to rich social interactions in in-person classes, while it was linked to the convenience and comfort of working from home and an increase in learner autonomy in ERT. Additionally, learners reported that despite the physical isolation, they managed to establish good social connections in ERT classes. This shows that FLE can flourish in challenging circumstances. Its intensity might differ from in-person classes but it feeds generally on similar nutrients, namely interesting learning materials, friendly and professional teachers and stimulating interactions with peers in order to develop social bonds.

Being Present and Meaningful Engagement for Aged Care Residents Living With Dementia: A Mixed-Methods Evaluation of Australian Care Worker's Experiences.

Meaningful engagement is essential for aged care residents living with dementia. Our knowledge pertaining to caring presence for residents living with dementia is limited. This study aims to understand care workers' experiences of providing care to residents, the challenges they face in being present with residents and support that enable them to be more present and provide person-centered care. A mixed-methods approach using surveys and semi-structured interviews with care workers from three Australian residential aged care homes was adopted. Surveys were analyzed using descriptive statistics. Open-ended survey responses and interviews were analyzed using thematic analysis. Twenty-six care workers completed surveys and a subset (n = 8) participated in interviews. Survey participants were largely positive about their role and reported that they loved caring for and making a difference in the lives of residents. Three themes emerged from interviews: (a) trust, connection, and the complexities of maintaining engagement; (b) time as gift and challenge; (c) organizational culture, structure and resources, and enabling carer presence. Care workers in our study expressed their desire to be present with residents and stated that enablers such as meaningfully engaging with residents was one of the most enjoyable aspects of their work. Barriers such as staff shortages, competing demands of the role, and time-related impediments to being present were reported. Addressing challenges to being present with residents living with dementia is key to help avoiding poor care practices and resident outcomes.

Facebooking in the Classroom: Using Fb Vocabulary and Discourse Structure in L2 Teaching in the Philippines

In this study we explored Facebooking as a novel strategy in language teaching that utilizes Facebook vocabulary and discourse structure. Grounded in the Interaction Hypothesis of Second Language Acquisition and drawing on Vygotsky's Social Constructivist Theory (Vygotski, 1986), we employed a qualitative design to examine the effectiveness of this strategy. In the study, we used a questionnaire and observations to get the necessary data and employed interviews to validate the data from the teacher-participant and student-respondents. The results unveiled that incorporating Facebook vocabulary, including "post," "comment," "share," "tag," "wall," "timeline," "poke," "administrator," "offline," "online," and "loading", led to a notable increase at student participation level and facilitated the development of their spoken discourse. The familiarity and enjoyment associated with using Facebook contributed to students' active engagement in the classroom. The Facebook discourse structure can be applied effectively in language teaching, aligning it with the instructional components provided by the Department of Education. The recommendation of this study is that L2 teachers and material developers incorporate familiar and enjoyable aspects of Facebook in their teaching to create a dynamic and engaging classroom environment that promotes active student involvement. While this study acknowledges its limitations, future research should explore other age groups and different topics within the English classroom. Additionally, incorporating a quantitative design can further validate the findings presented in this study. Overall, integrating Facebook vocabulary and discourse structure offers a fresh perspective in the field of language teaching.

Measuring the Impact of Ease of Use, Usefulness, Attitude, and Enjoyment toward Intention to Play PUBG Mobile

The impact of ease of use, usefulness, attitude, and enjoyment toward intention to play PUBG Mobile as it relates to Indonesians, is explicitly examined in this study’s examination of the mobile gaming era because of the pandemic. This paper investigates the factors that influence an individual’s intention to play PUBG Mobile and the outcome of those factors towards its individuals, as well as the effects of knowledge about gaming behavior to its users. The study’s recommendations are to increase the intention to play mobile games so that the need for enjoyable aspects and the need for outside assistance become more apparent. Through an online survey, 223 individuals provided information for this study. The survey asked for responses from people who had played a mobile game, particularly Player Unknown Battle Ground Mobile version (PUBGM), millennials or members of Generation Z having enrolled in college and who previously had resided in Indonesia, had at least played PUBG Mobile in the past, and had played it more than one year. In this work, statistical analysis is carried out. The outcome demonstrates that perceived ease of use, usefulness, attitude, and perceived enjoyment have an impact toward Intention to play PUBG Mobile. This study closes a gap in the literature by concentrating on the behavioral intention to play PUBG through the playful-consumption experiences of a well-known online multiplayer game.

Expanding Nursing Faculty Development Through a Fitness Initiative

Background: Prioritizing fitness in the workplace can aid in promoting a more contemporary view of faculty development. As a result, a workplace fitness initiative was developed in a Southern college of nursing to address the physical activity of faculty and staff during work hours and to promote a more contemporary view of faculty development. Aim: This study examined perceptions of the fitness initiative and explored opportunities for improvement. Methods: Faculty and staff completed a survey about the fitness initiative including perceptions of workplace fitness, motivation to join, most enjoyable aspects of the fitness initiative, and opportunities for improvement. Data were analyzed using descriptive statistics, and qualitative responses were coded and analyzed using thematic content analysis. Results: One hundred percent of survey respondents (n = 35) believed in the importance of workplace fitness. Four themes were identified related to the perception of workplace fitness: workplace fitness can increase self-reported movement and productivity and support personal goals. Survey respondents also appreciated the comradery, connection, and team-building that the initiative created. However, time was a barrier to engagement. Conclusion: As nurses are urged to model health-promoting behaviors, a college fitness initiative should be considered for encouraging and normalizing workplace fitness and promoting a more contemporary view of faculty development that focuses on factors outside the traditional faculty role. Our fitness initiative demonstrated that such programs are feasible, well-accepted, promote fitness in physical or virtual workplaces, and help to build connection and comradery among faculty and staff.

Qualitative Evaluation of A Comprehensive Online Wellness Program Among People with Spinal Cord Injury

<h3>Research Objectives</h3> To investigate the perceptions of people with SCI who participated in an eight-week, group-based telewellness program (MENTOR – Mindfulness, Exercise, and Nutrition To Optimize Resilience). <h3>Design</h3> This was a retrospective, qualitative program evaluation conducted via telephone interviews. <h3>Setting</h3> Participants who completed MENTOR were contacted via telephone to participate in a program evaluation interview. Participants were located in several cities across the U.S. <h3>Participants</h3> 14 individuals with SCI who completed a free, home-based telewellness program. Eligibility criteria included: 1) 18 to 70 years of age; 2) internet access; and 3) ability to access the program materials independently. <h3>Interventions</h3> The entire MENTOR program was conducted remotely and included no in-person interactions. Several months after completing MENTOR, participants were contacted via telephone to participate in a program evaluation interview. The interview lasted no longer than 30 minutes and included approximately 10 questions. The questions were semi-structured and asked participants about their overall thoughts of the program, likes/dislikes, potential benefits, and general questions pertaining to the 3 core components of the program (exercise, mindfulness, and nutrition). <h3>Main Outcome Measures</h3> Inductive thematic analysis was used to analyze qualitative data. Codes were generated iteratively across each transcription. In consideration of the small sample size of the study, the coders aimed to generate a small number of rich themes with only one code level per theme to enhance the likelihood of saturation. <h3>Results</h3> Qualitative analysis yielded 5 themes: 1) MENTOR provided an intimate online community for personal growth through peer support; 2) socialization, relationship building, and the program's holistic nature were enjoyable aspects of MENTOR; 3) tailored approaches from knowledgeable, personable coaches contributed to high program quality; 4) program components facilitated maintenance of health decision-making behaviors; and 5) improved psychological wellbeing related to the mindfulness classes. <h3>Conclusions</h3> MENTOR appears to benefit the physical and mental health of people with SCI. As a government-sponsored program, there is significant opportunity to continue building from these preliminary findings in future iterations of the program. <h3>Author(s) Disclosures</h3> The authors report no conflicts of interest.

The importance of children and young person involvement in scoping the need for a paediatric glucocorticoid-associated patient reported outcome measure

BackgroundFor many children and young people (CYP) with paediatric rheumatic conditions, glucocorticoid medications and their associated side-effects have a substantial impact on disease experience. Whilst there are physician-rated measures of glucocorticoid toxicity, no parallel patient reported measure has been developed to date for CYP with rheumatic disease. This manuscript describes a series of public patient involvement (PPI) events to inform the development of a future paediatric glucocorticoid-associated patient reported outcome measure (PROM).MethodsOne large group PPI event was advertised to CYP with experience of glucocorticoid medication use and their parents through clinicians, charities and existing PPI groups. This featured education on the team’s research into glucocorticoid medication and interactive polls/structured discussion to help participants share their experiences. Further engagement was sought for PPI group work to co-develop future glucocorticoid studies, including development of a glucocorticoid associated PROM. Quantitative and qualitative feedback was collected from online questionnaires. The initiative was held virtually due to the Covid-19 pandemic.ResultsNine families (n = 15) including 6 CYP joined the large group PPI event. Online pre-attendance and post-attendance questionnaires showed improvement in mean self-reported confidence [1 = not at all confident, 5 = very confident] in the following: what steroid medications are (pre = 3.9, post = 4.8), steroid side effects (pre = 3.8, post = 4.6), patient-reported outcome measures (pre = 2.0, post = 4.5), available research on steroids (pre = 2.2, post = 3.5). Five families (n = 7) were involved in a monthly PPI group who worked alongside the research team to identify priorities in glucocorticoid research, produce age-appropriate study materials, identify barriers to study participation (e.g. accessibility & convenience) and recommend appropriate modalities for dissemination. The participants found discussing shared experiences and learning about research to be the most enjoyable aspects of the initiative.ConclusionsThis PPI initiative provided a valuable forum for families, including young children, to share their perspectives. Here, the authors explore the effective use of PPI in a virtual setting and provide a unique case study for the involvement of CYP in PROM development. The monthly PPI group also identified a need for the development of a new PROM related to glucocorticoid medication use and provided unique insights into how such a study could be structured.

P125 Online Nutrition Curriculum Improves Middle School Students’ Food, Nutrition, and Physical Activity Practices

<h3>Objective</h3> To evaluate the improvement in nutrition, food safety, food resource management, and physical activity practices among youth participating in an online nutrition education series. <h3>Use of Theory or Research</h3> Previous evaluation studies of the goal-oriented EatFit curriculum demonstrated positive behavior change outcomes when delivered in person. Pivoting to remote programming due to the COVID-19 pandemic presented an opportunity to evaluate the effectiveness of an online version of the curriculum. <h3>Target Audience</h3> Middle school students enrolled in the Expanded Food and Nutrition Education Program (EFNEP) in Contra Costa County, California <h3>Program Description</h3> During FFY21, a nutrition educator implemented an online version of the EatFit curriculum. Six lessons were adapted for remote delivery and included activities focused on MyPlate, the nutrition facts label, hydration, fast food, physical activity, and goal setting. Students worked to accomplish their eating and fitness goals each week. The engaging video lessons were delivered asynchronously through a learning management system. To interact with the students the nutrition educator provided each class with a live Zoom introductory and review session. <h3>Evaluation Methods</h3> Students completed an online version of the EFNEP 6th-8th grade pre-post Nutrition Education Survey and provided responses to an open-ended question about the online lessons. Pre-post analyses were completed using the Web-Based Nutrition Education Evaluation and Reporting System (WebNEERS). <h3>Results</h3> In total, 855 students received the online lessons, and 284 students completed the pre-post surveys. The majority of students identified as Hispanic. Differences in the pre-to-post scores indicated improvement in desired behaviors: 88% of students improved their diet quality, 51% improved food safety practices, 49% improved food resource management practices, and 71% improved physical activity practices. Students described specific behaviors they adopted and enjoyable aspects of the online lessons. <h3>Conclusions</h3> The online goal-oriented EatFit lessons provided middle school students with the knowledge and skills to improve their nutrition, food safety, food resource management, and physical activity practices and is an alternative delivery method to consider in post-pandemic programming. <h3>Funding</h3> NIFA

Using socially distanced and online simulation training to improve the confidence of junior doctors in psychiatry.

The authors designed and delivered simulation training to improve the confidence and competence of junior doctors beginning work in psychiatry. Junior doctors completed various simulated psychiatry scenarios while receiving personalised feedback and teaching from their peers in online or socially distanced settings. Learners rated their confidence in psychiatry skills pre- and post-session, and Wilcoxon signed-rank tests were conducted to detect statistically significant differences. Qualitative feedback was analysed thematically. Twenty-one junior doctors attended the training. There were statistically significant (P < 0.05) improvements in trainee confidence across all psychiatry skills tested. The most enjoyable aspects of the session included its 'interactivity', relevance to clinical practice, and 'realistic' and 'interesting' simulated scenarios. Near-peer simulation teaching, delivered both in person and online, is effective at improving junior doctors' confidence in psychiatry. Delivering this training during placement induction could help to ensure adequate preparation of, and support for, new doctors.

121 The Rapid Infuser Challenge: Applying Gamification to Improve Performance

Major haemorrhage causes systemic shock with resultant coagulopathy. The Belmont Rapid Infuser© (BRI) is one example of a rapid infuser device to deliver intravenous fluids and blood products to patients as part of emergency resuscitation. We are a simulation team based in a busy trauma unit and anecdotally our staff did not feel confident in using our BRI.We aimed to quantify how confident our nursing staff were in using the BRI, before and after delivering a simulated patient scenario asking them to transfuse blood products using the BRI. We also aimed to quantify whether a simulated scenario could reduce the time taken to use the BRI. We aimed to create an enjoyable environment and use aspects of gamificationA self-evaluation questionnaire was circulated to establish pre-scenario confidence. Candidates observed a demonstration of the set-up and use of the BRI. Candidates were read a scenario brief and asked to use the BRI to infuse 500 ml of simulated blood product at 200 ml/minute. Once they had completed the scenario, their time was recorded, they were asked to again self-evaluate their confidence and were invited to attend again at a later date to ‘compete’ against their previous time.Pre-scenario data confirmed what was suspected; there was a wide variation in confidence in using the BRI across the sample. Early data suggest that the simulation was able to significantly increase staff confidence in safely using the BRI and repeated attempts led to a significant reduction in time to safely transfuse.Positive participant feedback included recommendations for further hands-on deliberate practice. We hope the training can be expanded to also include members of the medical team. Further research is needed to explore the use of gamification to support simulation-based medical education within urgent care.

Low-Income, Older African Americans' Engagement in and Perceptions of a Smartphone-Based Ecological Momentary Assessment Study of Physical Activity and Sedentary Behavior.

Background and ObjectivesSmartphone-based ecological momentary assessment (EMA) methods can provide novel insights into modeling and predicting activity-related behaviors, yet many racial and ethnic minority groups report barriers to participating in mobile health research. We aim to (a) report on strategies used to successfully recruit and retain minority older adults in a smartphone-based physical activity and sedentary behavior EMA study and (b) report on participants’ perceptions of study acceptability.Research Design and MethodsResearchers partnered with trusted individuals and community organizations serving older adults to facilitate recruitment for an 8-day EMA study of minority older adults’ physical activity and sedentary behavior. Additional strategies such as having experienced, culturally competent team members and available technical support were employed to further recruitment and retention efforts. A poststudy questionnaire assessed participants’ perceptions of study acceptability.ResultsIn total, 123 minority older adults were recruited, 102 met inclusion criteria, 91 completed the study, and 89 completed the poststudy questionnaire. The sample consisted of predominantly low-income African American women with an average age of 70 years. Responses to open-ended questions revealed that the most enjoyable aspects of study participation were the ability to learn more about themselves, contribute to science and/or their community, engage in a new activity, and receive financial compensation. Participants reported the least enjoyable aspects of the study included the frequency of EMA questionnaires, apprehension of missing EMA questionnaires, carrying the smartphone, and difficulty wearing the accelerometer. Most participants (97%) expressed interest in being contacted for future studies.Discussion and ImplicationsLow-income, older African Americans reported positive perceptions of a smartphone-based EMA study of physical activity and sedentary behavior. Findings suggest that applying demonstrated strategies to engage this population in technology-based health research can enhance recruitment and retention efforts; however, it is unclear which strategies are most effective in reducing participation barriers.

Who killed food tourism? Unaware cannibalism in online conversations about traveling in Italy

PurposeA food tourism destination can fully exploit its competitiveness if food-related attributes are consistently highlighted both in its promotion and in user-generated content. However, in the context of food tourism research, a possible image incongruence has not yet been studied. Tourism destination image incongruence occurs when different travel information sources reflect inconsistent representations of a destination's attributes. This study addresses this gap, focusing on Italian food and wine as drivers to attract visitors. This study examines whether food-related attributes are present in online travel-related conversations and are perceived differently by people with and without knowledge about the destination.Design/methodology/approachContent analysis based on a Bayesian machine-learning technique utilizing Leximancer software was applied to analyze questions and answers posted on TripAdvisor forums by potential and past visitors of four destinations in Italy (Naples, Florence, Parma and Ferrara). Questions and answers expressed by people with different knowledge in Italian and English were analyzed separately to gain deeper understanding.FindingsContrary to expectations, food-related themes were almost completely absent in the conversations analyzed, with only a few exceptions in Italian question sections. This situation depicts a sort of “cannibalism”, in the sense that the centrality of food-related attributes is engulfed by other, less sensorial, enjoyable and memorable aspects of the travel experience.Research limitations/implicationsAnalysis suggests that hype may exist in food tourism promotion related to destination image incongruence. However, while based on a large volume of conversations, the analysis covers only four Italian cities.Practical implicationsDestination management organizations (DMOs) should develop their strategy and communication considering internal and external elements: their marketing targets on one side and the local culture and attractions' perceptions on the other. Standard marketing processes (segmenting, targeting, positioning) and theories should be put in place. The application of standard marketing dynamics and studies should push the DMOs to understand that the internally perceived cultural values of the touristic destinations could not be known or joint univocally by the global external customers and that a local promotional activity should start with branding and not commercial activities.Originality/valueThis is the first study to suggest the existence of hype in food tourism promotion of Italian destinations and to provide evidence supporting this argument.

Coding Challenges in Common Pediatric Sports Surgeries of the Knee

Coding and billing for procedures is necessary but possibly the least enjoyable aspects of performing surgery. Additionally, proper documentation is crucial to support procedural coding and billing. Unfortunately, these are also areas in which orthopaedic surgeons receive the least consistent training, which can lead to enormous variability in how different surgeons code and bill for the same procedure. Pediatric sports medicine is a relatively younger subspecialty within pediatric orthopaedics and as such, techniques and approaches to surgery continue to evolve. As a result, many of the procedures performed may not have well established—or indeed any—corresponding CPT codes.&#x0D; This article presents case scenarios for common knee pathologies often treated surgically by pediatric orthopaedic surgeons. The intent is to clarify some discrepancies in coding for these procedures and aid the surgeon in proper billing. It is important to note that the following scenarios are hypothetical and therefore ultimate code selection should always reflect the operative report documentation.

Melody Ding: connecting physical activity and public health

As a lead author of the new Lancet Series on physical activity, Melody Ding emphasises the broader context of her work in this field. “My main research area of physical activity is interlinked with many other areas of public health, such as diet and environmental health; this helps me better understand physical activity. I am constantly learning from my mentors, colleagues, and students, one of the most enjoyable aspects of my job”, says Ding, who is Associate Professor in the School of Public Health at the University of Sydney, Australia.

Clinician experiences using standardised language assessments via telehealth

Purpose: Telehealth is rapidly becoming an essential part of speech-language pathologists’ core business, and yet the experiences and opinions of community-based therapists in using telehealth remain relatively unknown. This paper describes a recent study in which speech-language pathologists were provided with access to a formal language assessment within a telehealth platform and asked to provide feedback about their experiences. Method: Twenty-seven speech-language pathologists in paediatric practice were recruited via callouts on social media, community contacts and professional networks. The participants were provided access to a telehealth platform with a built-in formal language assessment and asked to use the assessment with their own caseload as clinically indicated and provide feedback after each assessment. Questionnaire data was collected via an online survey system and contained questions about each assessment including the most enjoyable and most difficult aspects of the assessment and their overall experience of the platform. Result: More than 100 assessments were completed during the 3-month trial, with clinicians reporting that on most occasions, video and audio quality was adequate or more than adequate, and that interactions with their child clients were effective. Qualitative data indicated that technical difficulties were a drawback to the assessments, but that ease of use of the assessment, the added functionality of using the assessment within the telehealth platform and factors including general benefits of telehealth, particularly that of being able to continue to provide services when face-to-face work was not possible were seen as positive elements. Conclusion: This study adds clinicians’ voices to the research into telehealth, indicating that the assessment within the telehealth platform was generally easy to use, and provided an unexpected depth of insight and connection for clinicians and their clients. Future research may consider the voices of other stakeholders in telehealth interactions, including parents and child clients.