Factorial Analysis Of Covariance Research Articles

Balance abilities in high dynamic-sport athletes with different maximal voluntary contraction

Background: Previous studies have shown that muscle force control during submaximal isometric contractions is associated with the ability of dynamic balance to a greater extent than static balance in healthy adults. However, the effect of maximal voluntary contraction (MVC) on balance abilities of athletes with high dynamicsport, which are most popular in Thailand, needs to be addressed. Objective: To determine static and balance abilities of high dynamic-sport athletes at different levels of MVC. Materials and methods: Three groups of high dynamic-sport athletes at different levels of maximal voluntary contraction (MVC), were voluntarily recruited using a sports matrix classification. Outcome measures comprised the Balance Error Scoring System (BESS) and the Star Excursion Balance Test (SEBT). Correlations between BESS and SEBT and confounding variables comprised of performance time of the Mcgill core endurance tests (Core), single-leg sit-to-stand (STS) test, and flexibility were investigated using Pearson’s correlation. After controlling for Core and STS, a factorial analysis of covariance (ANCOVA) was used to determine group differences in SEBT and BESS variables. Results: Athletes with high- and low- MVC had significantly different reaching distances in all SEBT directions (all, p<0.05). Significant differences between the high- and the moderate- MVC groups were observed in anterior and lateral directions (p<0.05). A significant difference between the moderate- and the low MVC groups was found in the medial direction (p<0.05). After controlling for Core and STS, the observed group differences disappeared, except in the posterolateral reaching distance between the high- and the low-MVC groups (p<0.05). A significant difference between the high- and the low-MVC groups was only observed in the total foam BESS scores with tandem stance (p<0.05) and then disappeared after adjusting for Core and STS (all, p>0.05). Conclusion: The observed differences in all SEBT directions among groups and the difference in the total BESS scores between the high- and the low- MVC, which were observed only in challenged conditions i.e., tandem-foam stance, suggested that dynamic, but not static balance performance of athletes with high dynamicsport appears to be associated with the magnitude of MVC. Core and STS, but not flexibility, are considered significant contributions to their balance performance.

The role of education level on changes in endorsement of medication treatment and perceived public stigma towards psychosis in Hong Kong: comparison of three population-based surveys between 2009 and 2018

ObjectiveThis study aimed to investigate the changes in perceived public stigma (PPS) towards psychosis, and endorsement of medication treatment between 2009 to 2018 in the Hong Kong Chinese population.The role of education level on the changes in PPS and endorsement of medication treatment for psychosis was also examined.MethodsTelephone survey of the general population was conducted in 2009, 2014, and 2018. PPS was assessed using the revised Link’s Perceived Discrimination-Devaluation Scale. Endorsement of medication was measured using an item asking if individuals with psychosis requires medication to manage their symptoms. Education level was separated into three categories (primary, secondary, and tertiary) for analysis. Factorial analysis of covariance was used to examine the main effects of survey year, education and endorsement of medication on stigma, and the interaction between survey year and education level, and survey year and endorsement of medication on PPS.Results1016, 1018, and 1514 respondents completed the surveys in 2009, 2014, and 2018, respectively. PPS was found to be stable across the three public surveys. Endorsement of medication treatment was associated with higher PPS. An interaction effect between survey year and education level onPPS was observed. PPS was significantly lower and fewer respondents endorsed medication treatment in 2018 in the tertiary education group than in previous years.ConclusionCurrent findings suggest that a targeted approach may be required for different education groups when developing anti-stigma public campaigns. Inclusion of other aspects of knowledge about psychosis may also be useful in reduction of PPS.

‘Tracking Together’—Simultaneous Use Of Human And Dog Activity Trackers: A Factorial Randomized Controlled Trial

PURPOSE: Human activity trackers have been shown to increase daily steps and physical activity intensity. Dog activity trackers may increase the owner’s awareness of their dog’s well-being, resulting in increased dog walking behavior, which may increase the owner’s physical activity. This study examines the impact of the simultaneous use of activity trackers by humans and their dogs on the physical activity of humans. METHODS: Fifty dog owners were randomized into one of four groups. Each group consisted of dog-human duos, in which both, human-only, dog-only, or neither were given an activity tracker to use for eight weeks. All human subjects wore a waist mounted accelerometer that quantified physical activity at two timepoints: one week prior to randomization and eight weeks after randomization. Commercial activity trackers were used during the eight-week session for tracking human and dog activity remotely. A factorial analysis of covariance was used to compare daily average sedentary, low, light, moderate, and vigorous physical activity across the four groups from pre to post. RESULTS: Change in daily average sedentary, low, light, moderate, and vigorous physical activity from fifty dog owners were analyzed (Control n = 13, Human Activity Tracker (HAT) n = 14, Dog Activity Tracker (DAT) n = 12, HAT + DAT n = 11). There was a significant main effect of HAT on change in average daily light physical activity (Avg Light PA) minutes. No HAT compared to HAT significantly increased Avg Light PA (30.83 ± 14.87 minutes/day, p = 0.04). There was a marginally significant effect of HAT on change in average daily sedentary physical activity minutes (Avg Sed PA). No HAT compared to HAT decreased Avg Sed PA (-43.8 ± 23.76 minutes/day, p = 0.07). There were no other significant changes in average daily physical activity categories. CONCLUSIONS: Simultaneous use of activity trackers did not change physical activity for this small, self-selected sample. The pandemic may have already increased dog walking for this sample, they may already have well-established dog-walking routines, or they may not have continuously worn trackers. Future studies should also explore behavioral interventions that utilize DAT for improving dog-walking behavior and other dog-engaged activities among dog-owners that positively impact health of both species.

Evaluating level of specificity and discrepancy of normative referents for condom promotion

Objective: College students are among the age-group most affected by sexually transmitted infections, yet few evidence-based interventions have proved effective in increasing college student condom use. The goal of this study was to determine which combination of referent proximity and width of discrepancy between perceived and actual norms within a normative feedback intervention produced the greatest motivation to increase condom use among US college students. Design: A 2 (proximity) × 2 (width of discrepancy) × 2 (gender) randomised-factorial experiment was conducted. Setting: Sexually active college students ( N = 212; 50.5% female; 70.4% White) were recruited via Amazon Mechanical Turk, an online labour market. Method: Participants were randomised, stratified by gender, to one of four sham feedback conditions: proximal referent wide discrepancy, proximal referent narrow discrepancy, distal referent wide discrepancy and distal referent narrow discrepancy. Following delivery of the feedback, participants completed measures assessing their willingness to change their condom use. Results: A three-way factorial analysis of covariance revealed a significant interaction between referent proximity and width of discrepancy ( F = 7.88, p = .005, [Formula: see text]), such that the effect of proximity on willingness to use condoms was greater in the narrow, compared with wide, discrepancy condition. Conclusion: Findings from this study indicate that it may be beneficial to assess students’ perceptions of their peers’ sexual behaviour before selecting the reference group to include within normative feedback. This is the first study to demonstrate that the importance of selecting referents within normative feedback may be dependent on the accuracy of students’ perceptions.

Effectiveness of pediatric learning modules in enhancing competencies among nurses in a specialized unit.

The global shortage of highly competent nurses has forced healthcare organizations to adapt to various strategies, including rotating nurses to different units, impacting their competency levels. To equip nurses with the needed competencies, the researchers developed the pediatric learning modules and conducted this study to analyze their effectiveness. Researchers employed purposive and random sampling to identify study participants, and utilized a mixed-method design, including Solomon Four Group Design and a narrative approach. A researcher-made evaluation questionnaire, competency checklists, and guide questions for a written narrative were used to collect data. Descriptive statistics and factorial analysis of covariance were utilized for data analysis. The outcomes revealed that demographic variables have no effect on knowledge and competence (p > 0.05). It was also discovered that exposure to learning modules enhanced the competence levels of nurses who were inexperienced in the pediatric setting (F = 41.183, df = 1, p = 0.000). Furthermore, results revealed that enhancing knowledge and competencies is not wholly dependent on well-structured educational sessions and training modules, but is also influenced by other factors, including time allocation for module delivery, protected time to practice, and the opportunity to apply new skills in the clinical area.

Malnourished lung cancer patients have poor baseline functional capacity but show greatest improvements with multimodal prehabilitation.

The objective is to characterize the presence of malnutrition, examine the association between malnutrition and baseline functional capacity (FC), and the extent to which patients benefit from preoperative multimodal prehabilitation in patients undergoing lung resection for cancer. Data from 162 participants enrolled in multimodal prehabilitation or control before lung cancer surgery were analyzed. Malnutrition was measured using the Patient-Generated Subjective Global Assessment (PG-SGA) according to triage levels: low-nutrition-risk (PG-SGA 0-3), moderate-nutrition-risk (4-8) and high-nutrition-risk (≥9). Baseline differences in FC, measured by the 6-minute walk test (6MWT), were compared. Factorial analysis of covariance (ANCOVA) was conducted to examine the effect of nutrition status and intervention on mean change in 6MWT preoperatively. 51.2% patients were considered low-nutrition-risk, 37.7% moderate-nutrition-risk, and 11.1% high-nutrition-risk. Low-nutrition-risk patients had significantly higher 6MWT at baseline (mean of 484 m [standard deviation (SD) = 88]) compared with moderate-nutrition-risk (432 m [SD = 107], P = .005) and high-nutrition-risk groups (416 m [SD = 90], P = .022). The adjusted mean change in 6MWT between prehabilitation vs control was 18.1 (95% confidence interval, 3.8 to 32.3) vs 5.6 m (-14.1 to 25.4) in low-nutrition-risk (P = .309), 28.5 (11 to 46) vs -4 m (-31.3 to 23.4) in moderate-nutrition-risk (P = .053), and 58.9 (16.7 to 101.2) vs -39.7 m (-80.2 to 0.826) in high-nutrition-risk group (P = .001). Lung cancer patients at high-nutrition-risk awaiting surgery had significantly lower baseline FC compared with low-nutrition-risk patients but experienced significant improvements in preoperative FC upon receiving multimodal prehabilitation.

Sustainable Education, Emotional Intelligence and Mother–Child Reading Competencies within Multiple Mediation Models

The influence of the family on the education of children is indisputable, and the mother plays a fundamental role as a direct influence on the educational process of children, especially on their reading competence. Systematically, the role of education has been delegated to the teacher when, even in academic aspects, the values of a society influence the education of the new generations. A sustainable society goes through a sustainable education, instilling values from a well-developed emotional intelligence. The objective of this study is to establish for first time the existence of relationships among reading habits, sex, and mother′s emotional intelligence regarding the reading comprehension of children. Participants included 521 adolescent baccalaureates aged between 16 and 17 years old, who attended three public baccalaureate schools in the province of Málaga and four public high schools in the province of Granada, all located in areas of medium socio-cultural context. Mediation and factorial analysis of covariance (ANCOVA) analyses were performed. The results show that girls with higher emotional intelligence and whose mothers have higher reading habits obtain higher reading competence.

Assessment of nosocomial infection, hand hygiene and medical waste trainings for caregivers and cleaning staff in the university hospital

Aim: The training and practices taken by the cleaning staff and the caregivers working at the hospital about prevention of nosocomial infections, approach to medical waste and hand hygiene are important in terms of both patient and staff health. It is aimed to assess the efficiency of previous training information given to the cleaning staff and caregivers working in a university hospital about nosocomial infections and the ways of prevention of these infections and efficiency of the last training given by reorganizing the same topics in this study. Methods: The number of trainings taken about the same topic by participants of the study was listed and the pre-test, interactive training, and then the final test were applied. Chi-square test, McNemar test, T-test, factorial covariance analysis and Pearson correlation analysis were used in the analysis of the data. p 0.05). Conclusion: In our study, we found that there was no significant relationship between the number of trainings on prevention of nosocomial infections and the number of questions correctly known in the pre-test suggested us to review the trainings given and also the necessity of observing the employees in units about these subjects.

Korean mothers' alcohol consumption trajectories from childbirth to 6years postpartum and children's executive function difficulties at first grade.

This study aims to identify Korean mothers' alcohol consumption trajectories during early parenthood (from birth to 6years postpartum) and to examine associations between these trajectories and their children's executive function difficulties at first grade (age 7). Participants were 1010 mothers and their children, a subset of the Panel Study of Korean Children. Mothers' postpartum alcohol consumption trajectories were identified using growth mixture modeling. Children's executive function difficulties by the trajectories were examined using factorial analysis of covariance. Korean mothers' alcohol consumption trajectories during early parenthood were heterogeneous. Mothers developed one of four alcohol consumption patterns: stable low use (49.9%), increasing use (25.0%), chronic modest use (18.3%), and chronic high use (6.8%). Children's executive function difficulties as evaluated by first grade teachers differed by mothers' postpartum alcohol consumption trajectories. Children of chronic high users displayed more difficulties in planning-organization, behavioral control, and attention-concentration than did children of the other groups of mothers. Mothers' chronic and excessive postpartum alcohol consumption during early parenthood can be a significant risk factor for difficulties in children's early executive function development. Early screening for mothers with unhealthy alcohol consumption habits is critical. Special attention and support should be afforded to their children's development and school adjustment.

Antenatal Training with Music and Maternal Talk Concurrently May Reduce Autistic-Like Behaviors at around 3 Years of Age

Antenatal training through music and maternal talk to the unborn fetus is a topic of general interest for parents-to-be in China, but we still lack a comprehensive assessment of their effects on the development of autistic-like behaviors during early childhood. During 2014–2016, 34,749 parents of children around the age of 3 years who were enrolled at kindergarten in the Longhua district of Shenzhen participated in this study. Self-administered questionnaires regarding demographics, antenatal music training, and maternal talk to the fetus during pregnancy were completed by the children’s primary caregivers. Autistic-like behaviors were assessed using the Autism Behavioral Checklist. Tobit regression analyses revealed that antenatal music training and maternal talk to the fetus was associated with a reduction in autistic-like behaviors in children, with a dose-dependent relationship. Furthermore, factorial analysis of covariance indicated a significant interaction effect between antenatal music training and maternal talk to the fetus on the autistic-like behaviors and found that children who often experienced antenatal music training and maternal talk concurrently had the lowest risk of autistic-like behaviors, while children who were never exposed to maternal talk and only sometimes experienced antenatal music training had the highest risk. Our results suggest that antenatal training through both music and maternal talk to the unborn fetus might reduce the risk of children’s autistic-like behaviors at around 3 years of age.

Charter Schools and Mathematics Achievement in the State of Georgia

This study uses hierarchical linear modeling (HLM) and factorial analysis of covariance (ANCOVA) to investigate the relationship between a school’s charter status and Math achievement. After accounting for school gender and ethnicity effects, charter school status is associated with Math achievement. Specifically, the initial status of Math achievement varies depending on ethnicity and gender, but the growth rate does not. Furthermore, district characteristics help to explain the charter school effect on Math achievement. Charter schools outperform traditional public schools when they receive an average amount of instructional funds. To this end, the charter gap in Math achievement decreases over time in districts that spend on instruction and have a substantial amount of minorities. When compared to traditional public schools with similar characteristics, charter schools with high percentages of Black students and/or low percentages of females outperformed their matched traditional public school counterparts.

Exploring Determinants of Country of Origin and Product Category on Perceived Value and Satisfaction: Comparison Analysis of the Newly Emerging vs. Developed Country

While the sustainable growth of newly emerging economics is increasing, how customers perceive the product made in the newly emerging country remains an important consideration. The purpose of this study is to investigate determinants of the country of origin effects by comparing perception on made in the newly emerging and developed country. Study 1 and Study 2 examined determinants of the country of origin effects by considering the moderating role of the product categories based on i) utilitarian vs. hedonic and ii) the perceived degree of the risk. Study 1 applied the perceived acquisition value (PAV) and the perceived transaction value (PTV) to measure the country of origin effects, while Study 2 investigated the effects of the country of origin on customer satisfaction by controlling the effects of a covariate of attitude. This study applied empirical analyses that utilize the factorial Multivariate Analysis of Variance (factorial MANOVA) for study 1and factorial Analysis of Covariance (factorial ANCOVA) for study 2. This study proposes a policy recommendation regarding which product categories should the manufacturing industries of those countries focus in effort to ensure the sustained growth of their economies. This study also provides a managerial implication in that the policy makers of these countries should investigate in minimizing the display of the country of origin information on these products to benefit from greater value added from manufacturing products from such categories, given the intersection between the products without country of origin information and the products from a developed country in study 2 indicating that the undetermined order of consumer satisfaction resulting from the country of origin effects.

Effect of Plant Characteristics on Picking Efficiency of the Wild Blueberry Harvester

Abstract. Wild blueberry is a high value cash crop in northeastern North America. In the last two decades, improved management practices have changed crop characteristics. Currently, the wild blueberry industry is facing increased harvesting losses (15%-25%) due to changes in crop conditions. This study was designed to examine the effect of plant characteristics on picking efficiency of the wild blueberry harvester. Four wild blueberry fields were selected in Nova Scotia and New Brunswick, Atlantic Provinces of Canada. Plant height (PH) and plant density (PD) were classified into four different categories, i.e., tall plant - low plant density, tall plant - high plant density, short plant - low plant density, and short plant - high plant density, and stem thickness (ST) was used as a covariate. Nine yield plots (0.9 x 3 m) for each combination of PH and PD were selected randomly at each experimental field. The PH, PD, and ST were recorded manually from each selected plot. Factorial experiments with four replications were designed to identify the combined effect of ground speed (1.2, 1.6, and 2.0 km h-1) and header revolutions (26, 28, and 30 rpm) on berry losses at each category of PH and PD. Berry losses were collected from each plot within the selected fields. Factorial analysis of covariance (ANCOVA) using general linear model (GLM) procedure showed that the interaction of ground speed and header rpm was significant (p = 0.05) in each category of plant characteristics. Results of multiple means comparison showed that the lower ground speed and header rpm resulted in significantly lower losses when compared with higher ground speed and header rpm. The study findings also suggested a suitable combination of ground speed and header rpm for each class of plant characteristics to minimize the berry losses during harvesting.

Gray and white matter trajectories in patients with bipolar disorder.

Findings on brain structural abnormalities in patients with bipolar disorder (BP) are inconsistent and little is known about age-related evolution of these changes. We employed a cross-sectional, case-control study to compare structural age-related brain trajectories in patients with BP and healthy control subjects (HC) over a period of approximately 50 years. The primary aim was to understand whether white (WM) and gray matter (GM) abnormalities are present from the beginning of the illness and how they change over time. Seventy-eight patients with BP and 78 HC matched for age, gender, and educational level underwent a high-resolution structural magnetic resonance imaging protocol. A voxel-based morphometry (VBM) analysis was used to capture GM and WM differences between subjects with BP and HC. Factorial analysis of covariance was used to compare brain volume alterations at different ages between the groups. We found an age-related atrophy in GM and WM volumes both in patients with BP and HC. A main effect of diagnosis emerged in the posterior cingulate cortex bilaterally, in the right thalamus, in the cerebellum bilaterally, and in the left posterior limb of the internal capsule. No interaction between diagnosis and age emerged, indicating that the volumes of these areas were permanently reduced in subjects with BP throughout the entire age range under investigation. Brain alterations in patients with BP are present from the beginning of the illness and remain stable over time. All the affected areas are involved in mood and psychomotor control process. This suggests a possible neurodevelopmental involvement in the mechanism of BP.

Long-Term Effect of an Interdisciplinary Supportive Care Intervention for Lung Cancer Survivors After Surgical Procedures

Surgical procedures provide the best chance for cure and long-term survival in non-small cell cancer (NSCLC). Persistent symptoms after surgical procedures are common, and they can negatively affect health-related quality of life (HRQOL). The purpose of this study was to examine the long-term effect of an interdisciplinary supportive care intervention to improve HRQOL, psychological distress, and symptoms in lung cancer survivors who were treated surgically. Patients undergoing curative intent resection for NSCLC were enrolled in a prospective sequential design whereby the control group was accrued first, followed by the intervention group. Patients in the intervention group were assessed and presented by nurses at weekly interdisciplinary care meetings before surgical procedures, and received four educational sessions (physical, psychological, social, and spiritual well-being) after surgical procedures. Appropriate symptom management, social work, rehabilitation, and spiritual support interventions were coordinated by the study nurse. In both groups, HRQOL, psychological distress, and symptom severity were assessed at baseline and at 6, 12, 24, 36, and 52 weeks with the use of surveys that included the validated Functional Assessment of Cancer Therapy-Lung (FACT-L), Lung Cancer Subscale (LCS), and Distress Thermometer. Mean survey scores were analyzed with factorial analysis of covariance at 12 months. A total of 71 survivors (control= 33; intervention= 38) were accrued. No difference was found in age, baseline performance status, or stage of disease between groups. Patients in the intervention group had significantly less distress (mean, 1.0 versus 4.0; range, 0 to 10; p < 0.001) and more favorable mean FACT-L scores (126.1 versus 98.7; range, 0 to 140; p < 0.001) and LCS scores (29.4 versus 23.6; range, 0 to 32; p < 0.001) at 12 months. The mean scores of all categories of questions in FACT-L (physical, social/family, emotional, and functional well-being) were considerably more favorable in the intervention group at 12 months. An interdisciplinary supportive care intervention improves psychological distress and HRQOL at 12 months after lung cancer surgical procedures. This study has important implications in improving HRQOL of lung cancer survivors after surgical procedures. Further study is warranted on incorporating the interdisciplinary personalized interventions used in this study into clinical practice for lung cancer survivors.

Legacy effects of no‐analogue disturbances alter plant community diversity and composition in semi‐arid sagebrush steppe

AbstractQuestions(i) What role does the type of managed disturbance play in structuring sagebrush steppe plant communities? (ii) How does the composition of post‐disturbance plant communities change with time since disturbance? (iii) Does plant community diversity change over time following managed disturbance?LocationField study within the sagebrush steppe ecosystem. Rich County, Utah, USA.MethodsWe developed a chronosequence spanning up to 50 yrs post‐treatment to study sagebrush steppe vegetation dynamics. Direct ordination was used to examine plant community composition by managed disturbance type and time since disturbance, and factorial analysis of covariance was used to examine diversity dynamics following disturbance. Indicator species values were calculated in order to identify characteristic species for each disturbance type.ResultsPlant communities experienced a shift toward distinct community composition for each of the three managed disturbance types, and gave no indication of returning to untreated community composition or diversity. Small post‐disturbance increases in the number of non‐native grass species were observed in the treatments relative to reference, with native forb species making the largest contribution to altered composition. On fire‐ and chemically‐treated sites the proportional native forb species richness increased over time since disturbance, while the proportional contribution of non‐native forbs to total species richness decreased. For all three treatment types, native grasses contributed less on average to total richness than on reference sites, while non‐native grasses made up a higher proportion of total richness.ConclusionsCommon shrubland management techniques have legacy effects on the composition and diversity of sagebrush steppe plant communities, and no‐analogue disturbances, such as chemical or mechanical treatments, have more pronounced legacy effects than treatments similar to natural disturbance regimes (fire). This study informs a broader understanding of how management actions affect natural systems by highlighting the importance of long‐term management legacies as drivers of plant community structure and function.

Childhood adversities, urbanisation and depressive symptoms among middle-aged and older adults: evidence from a national survey in China

ABSTRACTThe trajectory of modern China, namely from dire poverty and communist fever to economic boom and marketisation under an authoritarian regime, makes the country a unique social laboratory for examining how social environment affects human development of individuals. This study investigated the correlation between childhood adversity and depressive symptoms of Chinese middle-aged and older adults, as well as how urbanisation moderates the correlation. A sub-sample (N = 14,681) of the baseline of the China Health and Retirement Longitudinal Study was analysed. Seven variables were used in the latent class analysis to establish a childhood adversity typology. Three urbanisation statuses were identified according to theHukou(household registration system) status and neighbourhood type: non-urbanised, semi-urbanised and fully urbanised. The correlation between childhood adversity and depressive symptoms and the moderation of urbanization on the correlation were assessed with factorial analysis of covariance. Three latent classes for childhood adversities were identified: ‘normal childhood class', ‘low childhood socio-economic status and health class' and ‘traumatic childhood class'. The class membership was significantly correlated with depressive symptoms (p = 0.015), and the urbanisation status, also significantly affecting depressive symptoms (p = 0.05), had significant moderating effect on the correlation (p = 0.002). It is suggested that more social inclusive policies need to be adopted in order to guarantee the equal distribution of wellbeing led by urbanisation.

Pediatric emergency medicine asynchronous e-learning: a multicenter randomized controlled Solomon four-group study.

Asynchronous e-learning allows for targeted teaching, particularly advantageous when bedside and didactic education is insufficient. An asynchronous e-learning curriculum has not been studied across multiple centers in the context of a clinical rotation. We hypothesize that an asynchronous e-learning curriculum during the pediatric emergency medicine (EM) rotation improves medical knowledge among residents and students across multiple participating centers. Trainees on pediatric EM rotations at four large pediatric centers from 2012 to 2013 were randomized in a Solomon four-group design. The experimental arms received an asynchronous e-learning curriculum consisting of nine Web-based, interactive, peer-reviewed Flash/HTML5 modules. Postrotation testing and in-training examination (ITE) scores quantified improvements in knowledge. A 2 × 2 analysis of covariance (ANCOVA) tested interaction and main effects, and Pearson's correlation tested associations between module usage, scores, and ITE scores. A total of 256 of 458 participants completed all study elements; 104 had access to asynchronous e-learning modules, and 152 were controls who used the current education standards. No pretest sensitization was found (p = 0.75). Use of asynchronous e-learning modules was associated with an improvement in posttest scores (p < 0.001), from a mean score of 18.45 (95% confidence interval [CI] = 17.92 to 18.98) to 21.30 (95% CI = 20.69 to 21.91), a large effect (partial η(2) = 0.19). Posttest scores correlated with ITE scores (r(2) = 0.14, p < 0.001) among pediatric residents. Asynchronous e-learning is an effective educational tool to improve knowledge in a clinical rotation. Web-based asynchronous e-learning is a promising modality to standardize education among multiple institutions with common curricula, particularly in clinical rotations where scheduling difficulties, seasonality, and variable experiences limit in-hospital learning.

Biological Impacts of the Port Complex of Suape on Benthic Reef Communities (Pernambuco–Brazil)

ABSTRACT Costa, D.L.; Santos, A.M.; da Silva, A.F.; Padilha, R.M.; Nogueira, V.O.; Wanderlei, E.B.; Belanger, D.; Gomes, P.B., and Perez, C.D., 2014. Biological impacts of the port complex of Suape on benthic reef communities (Pernambuco–Brazil). The construction of Suape's port in 1979 divided a natural reef line into two reefs (Suape and Muro Alto) and generated changes in the hydrodynamics along the coast of Pernambuco State, Brazil. We compared the composition of the macrobenthic communities on the two reefs to determine how they were affected by the construction of the port. Two seasonal collections were made along each reef utilizing the band transect, totalizing 144 transects. Of 47 taxa found, 11 were exclusive to Suape and two to Muro Alto. The Suape reef demonstrated the greatest richness (F1,126 = 54.634, p < 0.001) and a significantly different faunal composition (analysis of similarity: r = 0.534, p < 0.001). Analyses (three-way, full factorial analysis of covariance) indicated that the reef ...

Cultural Competency in Medical Education: Demographic Differences Associated With Medical Student Communication Styles and Clinical Clerkship Feedback

We tested the significance of associations among students' demographics, communication styles, and feedback received during clerkships. US medical students who completed at least one required clinical clerkship were invited between April and July 2006 to complete an anonymous, online survey inquiring about demographics, communication styles (assertiveness and reticence), feedback (positive and negative), and clerkship grades. The effects of self-identified race/ethnicity, gender, and generation (immigrant, first- or second-generation American) and their 2-way interactions on assertiveness, reticence, total positive and total negative feedback comments were tested using factorial analysis of covariance, controlling for age, clerkship grades, and mother's and father's education; pairwise comparisons used simple contrasts. Two-sided P values < .05 were considered significant. Medical students from 105 schools responded (N = 2395: 55% women; 57% white). Men reported more assertiveness than women (P = .001). Reticence (P < .001) and total positive comments (P = .006) differed by race/ethnicity; in pairwise contrasts, black, East Asian, and Native American/ Alaskan students reported greater reticence than white students (P < .001), and white students reported receiving more positive comments than black, and South and East Asian students. Race/ethnicity-by-generation (P = .022) and gender-by-generation (P = .025) interaction effects were observed for total negative comments; white first-generation Americans reported receiving the fewest and male immigrants reported receiving the most negative comments. Demographic differences in students' communication styles and feedback they received highlight a need for cultural competency training to improve medical student-teacher interactions, analogous to training currently advocated to improve physician-patient interactions.