Free Responses Research Articles

P03-10 I miss a normal life. It's gone on so long': A qualitative interpretation of youth's perceptions of a third national COVID-19 lockdown on their well-being and physical activity

BackgroundYouth have experienced unprecedented restrictions during the COVID-19 pandemic. It is important to ascertain youth's perceptions of how the lockdown restrictions have impacted their well-being. Given the varying restrictions imposed in different countries, exploring the impact relative to the specific restrictions is imperative. This study investigated youth's views on the impact of a third national lockdown on their well-being and physical activity.MethodsFollowing informed parental consent, youth aged 8-18 years attending state schools in Wales, UK, were invited to complete an online questionnaire using an individualised link sent to the email addresses provided by parents (January 2021). A total of 4,259 survey links were issued. The questionnaire included questions on children's physical activity, mental well-being and experience of COVID-19. This study reports on free text responses from an optional two-part open-ended question on their experience during restrictions employed to manage the COVID-19 pandemic in Wales. The questions were (a) How does lockdown make you feel?, followed by (b) Why do you feel this way?. Flexible thematic analysis was employed to analyse the data and identify themes and sub-themes.ResultsValid responses were received from 1,681 youth (11.8±2.3 years; 50% girls). Most participants expressed only a negative emotional response to their lockdown experience. Whilst there were no overall sex differences in the responses, age differences were observed. Specifically, the 12-13 year-old age group reported the lowest number of negative responses, compared to 8-9 year-olds who reported the highest. Six distinct negative emotional responses were identified: sadness, anger, worry, loneliness, boredom, laziness. Nevertheless, a small cohort of participants identified positive emotional responses that focused on being happy. Mixed emotions were also reported by participants which were most prevalent amongst 16-18 year-olds and least reported in 10-11 year-olds. Finally, the inability to participate in team sports was reported negatively, however, some youth reported the additional time facilitated greater participation in exercise.ConclusionsThe predominance of negative emotions highlights the significant and potentially long-lasting impact the lockdowns have had on youth's mental well-being. In addition, the findings evidence that youth associated sport participation with their mental health. Furthermore, the age differences identified highlight that youth's developmental stage, both emotionally and societally, should be considered in the recovery response to improve and reduce further deterioration in youth's mental health. This evidence should be considered when ministers evaluate the wider evidence to inform future restrictions required to manage the exit from COVID-19 and other future pandemics.

Standard setting Very Short Answer Questions (VSAQs) relative to Single Best Answer Questions (SBAQs): does having access to the answers make a difference?

BackgroundWe investigated whether question format and access to the correct answers affect the pass mark set by standard-setters on written examinations.MethodsTrained educators used the Angoff method to standard set two 50-item tests with identical vignettes, one in a single best answer question (SBAQ) format (with five answer options) and the other in a very short answer question (VSAQ) format (requiring free text responses). Half the participants had access to the correct answers and half did not. The data for each group were analysed to determine if the question format or having access to the answers affected the pass mark set.ResultsA lower pass mark was set for the VSAQ test than the SBAQ test by the standard setters who had access to the answers (median difference of 13.85 percentage points, Z = -2.82, p = 0.002). Comparable pass marks were set for the SBAQ test by standard setters with and without access to the correct answers (60.65% and 60.90% respectively). A lower pass mark was set for the VSAQ test when participants had access to the correct answers (difference in medians -13.75 percentage points, Z = 2.46, p = 0.014).ConclusionsWhen given access to the potential correct answers, standard setters appear to appreciate the increased difficulty of VSAQs compared to SBAQs.

Utility of a Device Briefing Tool to Improve Surgical Safety

IntroductionClear communication around surgical device use is crucial to patient safety. We evaluated the utility of the Device Briefing Tool (DBT) as an adjunct to the Surgical Safety Checklist. MethodsA nonrandomized, controlled pilot of the DBT was conducted with surgical teams at an academic referral center. Intervention departments used the DBT in all cases involving a surgical device for 10 wk. Utility, relative advantage, and implementation effectiveness were evaluated via surveys. Trained observers assessed adherence and team performance using the Oxford NOTECHS system. ResultsOf 113 individuals surveyed, 91 responded. Most respondents rated the DBT as moderately to extremely useful. Utility was greatest for complex devices (89%) and new devices (88%). Advantages included insight into the team's familiarity with devices (70%) and improved teamwork and communication (68%). Users found it unrealistic to review all device instructional materials (54%). Free text responses suggested that the DBT heightened awareness of deficiencies in device familiarity and training but lacked a clear mechanism to correct them. DBT adherence was 82%. NOTECHS scores in intervention departments improved over the course of the study but did not significantly differ from comparator departments. ConclusionsThe DBT was rated highly by both surgeons and nurses. Adherence was high and we found no evidence of “checklist fatigue.” Centers interested in implementing the DBT should focus on devices that are complex or new to any surgical team member. Guidance for correcting deficiencies identified by the DBT will be provided in future iterations of the tool.

Barriers and enablers of weight management after breast cancer: a thematic analysis of free text survey responses using the COM-B model

BackgroundWeight gain is common after breast cancer. The aim of this study was to identify and describe the barriers to and enablers of successful weight management for women with breast cancer.MethodsThis was a combined inductive and deductive framework analysis of free text responses to an anonymous cross-sectional survey on weight after breast cancer. Women were recruited mainly through the Breast Cancer Network Australia Review and Survey Group. We applied deductive thematic analysis to free text responses to questions on barriers, enablers, research priorities, and one open-ended question at the end of the survey using the Capability, Opportunity, Motivation and Behaviour (COM-B) model as a framework. Subthemes that arose from the inductive analysis were mapped onto the COM-B model framework. Findings were used to identify behaviour change intervention functions.ResultsOne hundred thirty-three women provided free text responses. Most women were of Caucasian origin and had been diagnosed with non-metastatic breast cancer, with a mean age of 59.1 years. Women's physical capability to adopt and sustain healthy lifestyle habits was significantly affected by treatment effects and physical illness, and some lacked psychological capability to self-regulate the face of stress and other triggers. Limited time and finances, and the social impact of undergoing cancer treatment affected the ability to control their diet. Frustration and futility around weight management were prominent. However, some women were confident in their abilities to self-regulate and self-monitor lifestyle behaviours, described support from friends and health professionals as enablers, and welcomed the physical and psychological benefits of being active in the context of embracing transformation and self-care after cancer.ConclusionWomen need specific advice and support from peers, friends and families and health professionals. There is a substantial gap in provision of supportive care to enable women to adopt and sustain healthy lifestyles. Environmental restructuring (including financial support), incentivization (creating an expectation of looking and feeling better), persuasion and coercion (aiming to prevent recurrence), and equipping women with specific knowledge and skills, would also facilitate optimal lifestyle behaviours and weight management.

COVID-19 vaccination uptake in 441 socially and ethnically diverse pregnant women.

To explore COVID-19 vaccination uptake, facilitators and barriers in ethnically-diverse pregnant women. An anonymous quality improvement questionnaire survey exploring COVID-19 vaccination uptake, causes of vaccine hesitancy and trusted sources of information among pregnant women in two acute district general hospitals in England (Berkshire and Surrey) between 1.9.21 and 28.2.22. 441 pregnant women attending routine antenatal clinic appointments. Consented pregnant women completed the survey either electronically using a QR code or on paper. Descriptive data were summarised and free text responses were thematically analysed. 441 pregnant women, mean age 32 years (range 17-44), completed the survey. Twenty-six percent were from ethnic minority groups, and 31% had a co-morbid health condition. Most respondents (66.2%) had been vaccinated against COVID-19 with at least one dose (White British 71.9%, Asian 67.9%, White-other 63.6%, Black 33%). The most common reasons for not being vaccinated were concerns about effects on the unborn baby and future pregnancies, anxiety about possible adverse impact on the mother, not enough known about the vaccine, and lack of trust in vaccines. Comments included: "I'd rather not risk injecting the unknown into my body", and "I don't trust it." Although 23% used social media for information on COVID-19 vaccination, the most trusted sources were the patient's GP and midwife (43%) and official health-related websites such as NHS (39%). A third of these pregnant women had not been vaccinated against COVID-19. Trusted health professionals like midwives and GPs could have a crucial role in increasing vaccination uptake.

초등학교 과학 원격수업에 대한 학생들의 교육 요구와 인식 조사

Objectives The purpose of this study was to identify the priority of educational needs by analyzing the importance and the present implementation level and students' perceptions that affects elementary school science distance learning. Methods For this purpose, a survey was conducted targeting 5th and 6th grade students of 4 elementary schools located in B city. This questionnaire consisted of 11 items on a 5-step Likert scale for educational needs and 6 items of choice and free responses for perceptions of elementary school students for science distance learning. A total of 182 responses were analyzed using SPSS 18.0, excluding 38 data that responded unreliable or omitted responses out of 220 responses. Results As a result, the students’ educational needs of science distance learning in elementary school were prioritized in the students' concentration, participation, and understanding of the learning content, as well as interactions between students and teachers and between students and other students. In addition, as a result of the current status of distance learning based on students' perceptions of elementary school science distance classes, students wanted real-time interactive science distance classes, self-participating classes, and comments and real-time feedback of teachers' feedback. Conclusions This study intends to provide a basis for improving science distance learning classes and for proposing the design of training or education programs on strategies for improving teachers' classes of science distance learning in elementary school.

Group Concept Mapping Conceptualizes High-Quality Care for Long-Stay Pediatric Intensive Care Unit Patients and Families

To describe and conceptualize high-quality care for long-stay pediatric intensive care unit (PICU) patients using group concept mapping (GCM). We convened an expert panel to elucidate domains of high-quality care for this growing patient population for which transitory care models fail to meet their needs. Thirty-one healthcare professionals and 7 parents of patients with previous prolonged PICU hospitalizations comprised a diverse, interprofessional multidisciplinary panel. Participants completed the prompt "For PICU patients and families experiencing prolonged lengths of stay, high quality care from the medical team includes ______", with unlimited free text responses. Responses were synthesized into individual statements, then panelists sorted them by idea similarity and rated them by perceived importance. Statement analysis using GCM software through GroupWisdom generated nonoverlapping clusters representing domains of high-quality care. Participants submitted 265 prompt responses representing 313 unique ideas, resulting in 78 final statements for sorting and rating. The resultant cluster map best representing the data contained 8 domains: (1) Family-Centered Care and Shared Decision Making, (2) Humanizing the Patient, (3) Clinician Supports and Resources, (4) Multidisciplinary Coordination of Care, (5) Family Well-Being, (6) Anticipatory Guidance and Care Planning, (7) Communication, and (8) Continuity of Care. GCM empowered a panel of healthcare professionals and parents to explicitly describe and conceptualize high-quality care for patients and families experiencing prolonged PICU stays. This information will aid the effort to address shortcomings of transitory PICU care models.

An interactive smartphone application for trainees in Radiation Oncology: "The Rad Onc Handbook"

1The app is well structured and easy to use. 2The app content is relevant to radiation oncology. 3The audio lessons enhanced my learning. 4The quizzes and cases enhanced my learning. 5My overall knowledge in radiation oncology has increased. 6I would recommend this application to a colleague. 25 participants completed the survey on the advanced learning module. 70% of all survey participants ""agree"" or ""strongly agree"" to the five statements listed below: 1The module was well structured. 2The module is relevant to radiation oncology. 3The module was an appropriate level of complexity. 4My overall knowledge about breast cancers has increased. 5I would recommend this module to a colleague. Overall, the application and advanced learning modules were well received and the trainees express a desire for other advanced learning modules in the free text responses. This free smartphone application provides an easily accessible resource for self-directed learning in radiation oncology. Initial feedback was very favourable and recommended use of this innovative learning resource among a wider group of trainees. In response to trainee feedback, future work will focus on the development of additional modules, incorporating interactive virtual patient cases, in other tumour sites. As web-based learning continues to become increasingly popular, this application can be a useful educational resource for medical trainees." Background Radiation oncology (RO) textbooks and primary references are often complex, technically advanced, and inaccessible to medical trainees. To address this, we designed a free, interactive smartphone application, to introduce trainees to the basics of RO. Methods We created and implemented an Apple iOS smartphone application with RO content, targeted for medical trainees. The beta version is free for download via the TestFlight application (https://testflight.apple.com/join/4A6qXjq2). The application incorporates both introductory topics relevant to radiation oncology and advanced, site-specific modules, that focus on the different tumour sites and their management. Content includes written text, audio lectures, interactive quizzes, and clinical cases. Two questionnaires were implemented to elicit feedback; one for application design and the other a knowledge-quiz for an advanced learning module on breast cancers. Both contain quantitative 5-point Likert-scale questions and one qualitative freeform text question seeking suggestions for improvement. Results There have been over 70 unique downloads of the application. 40 participants completed the survey on application design. Over 80% have selected ""agree"" or ""strongly agree"" to the six statements listed below: Radiation oncology (RO) textbooks and primary references are often complex, technically advanced, and inaccessible to medical trainees. To address this, we designed a free, interactive smartphone application, to introduce trainees to the basics of RO. We created and implemented an Apple iOS smartphone application with RO content, targeted for medical trainees. The beta version is free for download via the TestFlight application (https://testflight.apple.com/join/4A6qXjq2). The application incorporates both introductory topics relevant to radiation oncology and advanced, site-specific modules, that focus on the different tumour sites and their management. Content includes written text, audio lectures, interactive quizzes, and clinical cases. Two questionnaires were implemented to elicit feedback; one for application design and the other a knowledge-quiz for an advanced learning module on breast cancers. Both contain quantitative 5-point Likert-scale questions and one qualitative freeform text question seeking suggestions for improvement. There have been over 70 unique downloads of the application. 40 participants completed the survey on application design. Over 80% have selected ""agree"" or ""strongly agree"" to the six statements listed below:

Small-Scale Dynamic Behavior of Embedded Beams Under Moving Force in Complex Environments

Forced and free dynamic responses of nanobeams resting on a three-parameter foundation subjected to a moving force in magneto-hygro-thermal conditions are investigated based on the nonlocal strain gradient theory. Also, a detailed parametric study is conducted to identify the impact of slender ratio, axial and distributed tangential loads on the vibration characteristics and dynamic phenomena of the small-scale system. Comparative studies with existing results in the literature are performed to ensure the accuracy of the presented model and solution approach. Analytical and numerical methods are implemented to detect the effects of foundation coefficients, environmental conditions, geometrical and scale parameters on the dynamic amplification factor, critical moving force velocity, cancellation, and maximum free response mechanisms of the system. The outcomes revealed that the critical moving force velocity is enhanced by ascending the slender ratio, elastic, and shear moduli of the foundation. It is found that when the damping factor is considered for the foundation, it is feasible to prevent the occurrence of the cancellation phenomenon. Also, it is concluded that by fine-tuning scale parameters and environmental conditions, unwanted vibration of the system can be suppressed. The attained results of this study can be helpful in the vibration control of nanoscale actuators, switches, and resonators.

Stressors, manifestations and course of COVID-19 related distress among public sector nurses and midwives during the COVID-19 pandemic first year in Tasmania, Australia.

Impacts of the COVID-19 pandemic on the mental health of healthcare workers has been established, linking workplace factors with high levels of stress, anxiety, depression, insomnia and burnout. Less established is how COVID-19 affects both work, home and social life of nurses and midwives concurrently. This study describes the prevalence and severity of anxiety, depression, post-traumatic stress disorder (PTSD) and insomnia and examines their associations with stressors within the work, home and social environment, among nurses and midwives. A longitudinal, mixed-methods, online survey explored the psychological health of public sector nurses and midwives during the COVID-19 pandemic first year. Surveys were conducted in April (initial) and June 2020 (3-month), and April 2021 (12-month) and consisted of psychological tests including the Patient Health Questionnaire, General Anxiety Disorder, Insomnia Severity Index, and the Impact of Events Scale-Revised; workplace and lifestyle questions, together with free-text comments. The relative strengths of the associations between predictor and outcome variables were estimated using repeated measures ordered logistic regression, and free text responses were themed. Data show diagnostic levels of anxiety (23%, 18%, 21%) at surveys one, two and three respectively, depression (26%, 23% and 28%), PTSD (16%, 12% and 10%) and insomnia (19%, 19% and 21%). The strongest predictors of psychological distress were current home and family stress and poor clinical team support. Factors which will help preserve the mental health of nurses and midwives include strong workplace culture, reducing occupational risk, clear communication processes, and supporting stable and functional relationships at home. The COVID-19 pandemic has increased the visibility of mental distress on nurses and midwives and established they are pivotal to healthcare. The health service has a duty-of-care for the welfare of nurses and midwives who have entered this psychologically taxing profession to future proof service delivery and safeguard its service-response capacity.

Clinicians’ perceptions of virtual reality for firesetting

PurposeVirtual reality (VR) is a novel technology that could be used in the assessment and/or treatment of deliberate firesetting. This study aims to develop an understanding of clinicians’ views of VR for deliberate firesetting, to identify areas where VR could potentially add value to current practice and any particular barriers to using VR in this context.Design/methodology/approachThrough an online survey, 73 clinicians rated their agreement with nine potential benefits of using VR for firesetting and 11 potential barriers to using it. They also provided free text responses detailing the greatest perceived potential benefit and the greatest perceived barrier. Factors related to intent to use VR for firesetting in the future were explored.FindingsClinicians perceived the ability to safely expose clients to fire-related stimuli to be highly beneficial. However, clinicians were concerned about the possibility of re-traumatisation and logistic barriers. Previous experience of using VR with individuals who have set fires was significantly related to using it in the future.Practical implicationsFurther research establishing the feasibility and effectiveness of using VR with individuals who have set fires may help alleviate clinicians’ concerns. Increasing opportunities for clinicians to experience a firesetting VR programme may widen the implementation of firesetting VR.Originality/valuePrevious research has only focused on clinicians’ perceptions of VR in the general field of forensic mental health and has failed to consider offence-specific applications.

Challenges imposed by the COVID-19 pandemic on the Obstetrics and Gynecology residency program: a mixed-methods Swedish survey in the COPE Staff cohort study

BackgroundTo outline how the training program and work situation of residents in Obstetrics and Gynecology (OB-GYN) was affected by the pandemic and to illuminate how residents experienced these changes.MethodsAs part of the COVID-19 in Pregnancy and Early Childhood Staff (COPE Staff) cohort study, between January and May 2021, all participating residents were invited to answer a 28-question online Resident Survey focusing on their specialist education, work situation and experiences during the COVID-19 pandemic. Descriptive statistics were given in percentages for categorical variables and means and standard deviations (SD) for continuous variables. Univariate comparative analyses were performed with the use of the Pearson’s Chi-2-test for dichotomous data. The association between residents’ worry about the quality and length of their specialist training, with extra clinical hours and transfer to other healthcare institutions were assessed by multivariate logistic regression. Free text responses were analyzed by content analysis.ResultsOf the 162 participating OB-GYN residents, 69% expressed concern that the pandemic would have a negative impact on their training. Ninety-five (95%) reported cancellation/postponement of educational activities, 70% performed fewer surgeries and 27% had been transferred to other healthcare institutions where about half reported having gained more general knowledge as a physician. Working extra clinical hours was reported by 69% (7.4 ± 5.3 hours per week) and 14% had considered changing their profession due to the pandemic. Senior residents, compared to junior residents, more often experienced cancelled/postponed clinical rotations (30% vs 15%, P=0.02) and reported performing fewer surgeries (P=0.02). The qualitative analysis highlighted the lack of surgical procedural training as a major concern for residents.ConclusionThe COVID-19 pandemic has strongly impacted the training program and work situation of OB-GYN residents in Sweden. Residents were concerned over the negative impact of the pandemic on their training program and senior residents reported more missed educational opportunities as compared to junior residents. Program directors, head of institutions and clinical supervisors can use the problem areas pinpointed by this study to support residents and compensate for missed educational opportunities. While hands-on-training and operating time cannot be compensated for, the authors hope that the findings of the study can help develop new strategies to minimize the negative impact of the current and future pandemics on resident education and work situation.

Texting Lost-to-follow-up PrEP Patients from a San Francisco Sexual Health Clinic

It is critical to understand what happens when PrEP patients are lost-to-follow-up (LTFU) and, where appropriate, attempt to re-engage them in care with the goal of preventing future human immunodeficiency virus (HIV) acquisition. We evaluated the benefits and limitations of using text-based outreach to re-engage with LTFU PrEP patients and offer re-initiation of PrEP care. Using text-messaging, we surveyed San Francisco City Clinic patients who started PrEP from January 2015 to October 2019 and were LTFU by October 1, 2020. Our goals were to better understand (1) whether our patients remained on PrEP through another provider or source, (2) why patients choose to discontinue PrEP, and (3) whether text-based outreach could successfully re-engage such patients in care. Multiple-choice survey questions were analyzed quantitatively to determine the proportion of respondents selecting each option; free-text responses were analyzed qualitatively using an inductive approach to identify any additional recurring themes. Of 846 eligible survey recipients, 130 responded (overall response rate 15.4%). Forty-two respondents (32.3%) were still on PrEP through another provider while 88 (67.7%) were not. Common reasons for stopping PrEP included: COVID-19–related changes in sex life (32.3% of responses), concerns regarding side effects (17.7%), and the need to take a daily pill (8.3%). Free text responses revealed additional concerns regarding risk compensation. While 32 participants agreed to be contacted by City clinic staff for PrEP counseling, only 6 were reached by phone and none of the six subsequently restarted PrEP. We learned that text messaging is a possible approach to survey certain PrEP program participants to determine who is truly LTFU and off PrEP, and to better understand reasons for PrEP discontinuation. While such information could prove valuable as programs seek to address barriers to PrEP retention, efforts to improve acceptability and increase response rates would be necessary. We were less successful in re-engaging LTFU patients in PrEP care, suggesting that text-messaging may not be the optimal strategy for this purpose.

Assessment of the General Public’s Understanding of Rapidly Produced Earthquake Information Products ShakeMap and PAGER

Abstract Public engagement through outreach is a key mechanism for learning about science and to communicate societal impacts of government-funded science. However, outreach effectiveness could be limited if approaches are not evidenced based. Partnerships with cognitive scientists who study fundamental learning processes suggest helping people learn how earthquakes happen would improve understanding of hazards and motivation for preparedness. We used a seismology–cognitive science partnership to evaluate understanding by nongeoscientists of widely viewed U.S. Geological Survey (USGS) ShakeMap and Prompt Assessment of Global Earthquakes for Response (PAGER) products originally developed for technical use. After discussions with USGS staff, we constructed 13 free response questions probing understanding of these products, including the graph literacy scale (GLS) for comparison. Through Zoom interviews of 101 participants, we found poor performance (28% correct) on the PAGER and ShakeMap questions despite good performance (76% correct) on the GLS. When coding free responses, we identified an average of 12.4 misconceptions per participant, approximately 1 per question. Five misconceptions were observed in over half the participants, including how the reports are constructed and used in real time, treating reports using modeling or simulations as containing only direct observations, and difficulty interpreting probabilities. The performance and misconceptions led us to develop a revised PAGER with scatter plots to visualize fatality and damage probabilities among other simplifications. We used a multiple-choice survey to assess understanding using the original and new visualizations with another 100 participants. We found significant improvement: 49% correct when seeing the revised visualization first, compared with 36% when seeing the original visualization first. Finally, we surveyed 147 participants on whether they could distinguish expert-defined shaking and damage descriptors for three macroseismic terms (moderate, strong, and severe). Participants struggled, choosing greater consequences than intended for lower intensity terms. Overall, our findings suggest that the key aspects of these earthquake information products are poorly understood by nongeoscientists in aseismic regions, but adjustments can improve effectiveness.

Adolescent experience of radically open dialectical behaviour therapy: a qualitative study

BackgroundRadically Open Dialectical Behaviour Therapy (RO DBT) is a novel transdiagnostic treatment that targets ‘maladaptive overcontrol’; a transdiagnostic cluster of traits associated with excessive emotional and behavioural inhibitory control. Outcomes are promising for adults with a range of psychiatric disorders. No study to date has explored the adolescent experience of RO DBT.MethodsOf the 25 eligible adolescents who received RO DBT between March 2015 and April 2017, 15 (14–17 years) consented and completed a semi-structured interview about their experience of treatment within 1 month of discharge. Interviews were recorded and then transcribed manually. Free text responses were analysed using reflexive thematic analysis.ResultsThe majority (n = 13) had a primary diagnosis of anorexia nervosa, although comorbidity was the norm, with 80.0% having two or more predicted comorbid psychiatric diagnoses. All had received some prior psychological treatment. Four themes were identified from analysis of transcripts: 1) Broadening Horizons, 2) Building Connections, 3) Flexibility, 4) Information Overload. Generally, RO DBT was perceived as helpful in both content and process. The focus on social and broader well-being, rather than specific mental health symptoms, was considered beneficial by many. Adolescents appreciated the group-based format of skills classes and reported benefiting from learning and practicing skills each week. The fourth theme, Information Overload, highlighted that for some, the amount of content felt overwhelming and that it was hard to remember and digest all the information, suggesting that adaptations, or simplifications, may be required to ensure accessibility for adolescents.ConclusionsRO DBT is perceived as a relevant and beneficial new treatment for adolescents with maladaptive overcontrol. The broad treatment focus is perceived as unique and of particular benefit. It is reported to help with general and social functioning and foster cognitive and behavioural flexibility. Nevertheless, the amount and complexity of material was felt to be very large by some and may suggest the need for modified adolescent-specific materials.

Staff and patient experience of the implementation and delivery of a virtual health care home monitoring service for COVID-19 in Melbourne, Australia

BackgroundProvision of virtual health care (VHC) home monitoring for patients who are experiencing mild to moderate COVID-19 illness is emerging as a central strategy for reducing pressure on acute health systems. Understanding the enablers and challenges in implementation and delivery of these programs is important for future implementation and re-design. The aim of this study was to explore the perspectives of staff involved with the implementation and delivery, and the experience of patients managed by, a VHC monitoring service in Melbourne, Australia during the COVID-19 pandemic.MethodsA descriptive qualitative approach informed by naturalist inquiry was used. Staff interviews were analysed using the Consolidated Framework for Implementation Research (CFIR). Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses as they related to the CFIR. Finally, data from the interviews and patient experience were triangulated to see if patient experience validated data from staff interviews.ResultsAll 15 staff were interviewed, and 271 patients were surveyed (42%). A total of four final overarching themes emerged: service implementation enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths. 19 subthemes aligned with 18 CFIR constructs from staff and patient data.ConclusionRapid implementation was enabled through shared resources, dividing implementation tasks between senior personnel, engaging furloughed healthcare staff in design and delivery, and having a flexible approach that allowed for ongoing improvements. Benefits for patients included early identification of COVID-19 deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges were the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.

Porosity dependent torsional vibrations of restrained FG nanotubes using modified couple stress theory

In the present study, size-dependent static and free torsional vibration responses of functionally graded porous nanotubes are examined using Fourier sine series and Stokes’ transformation for the first time. The boundary conditions of functionally graded porous nano-sized tubes are defined by the two elastic torsional springs at the both ends. A power law rule is utilized to describe the distribution of functionally graded material and this distribution is considered through the radius of nanotube. The governing equations of the mechanical response of porous nanotubes with elastic boundary conditions and subjected to torsion are accomplished via the modified couple stress theory. The purpose of the presented work is to construct an eigen value solution including the small scale parameter based on the modified couple stress theory, torsional spring coefficients representing the boundaries of the porous nanotubes, functionally graded index caused by power law rule and porosity volume fraction.

On the flexoelectric effect on size-dependent static and free vibration responses of functionally graded piezo-flexoelectric cylindrical shells

The flexoelectric effect depends on the strain gradient, which naturally appears in intelligent structures at micro and nano scales. Therefore, the flexoelectric phenomenon significantly affects electro-mechanical behavior of structures in these scales. In this study, the first-order shear deformation theory and the reformulated flexoelectric theory are applied to derive coupling equations of motion for a size-dependent static and dynamic responses of multilayered composite shell with simply supported and clamped edges. Constitutive equations are defined based on assumption that the internal energy function depends not only on strains and polarization tensors but also on strains and polarization gradient tensors. The piezo-flexoelectric structure is made of an isotropic functionally graded core and two orthotropic layers. Reynolds transport theorem and variational Hamilton principle are used to derive equations of motion expressed by forces and displacements, and corresponding boundary conditions. In order to check the correctness of the formulation, and solution of the problem obtained by Galerkin method, static and free vibrations analyses of macro-/micro-/nanoshell are investigated. Diagrams of deflection and electrical potential variations of the structure under the load are obtained for the direct flexoelectric effect. Additionally, the influence of various parameters, e.g., geometric properties, size effect, power-law index, and flexoelectric layer thickness, on the deflection, potential function, and natural frequency of the microshell have been investigated. The numerical results and discussion present that above parameters significantly affect a mechanical behavior of the microshell under consideration.

COVID‐19 and CPN attendance on ward rounds

COVID‐19 and CPN attendance on ward rounds

Residents Are Coming: A Faculty Development Curriculum to Prepare a Community Site For New Learners.

This curriculum is designed for emergency medicine attendings in varying years of community practice to prepare them for Emergency Medicine (EM) residents. 15 months. Emergency medicine is a growing field with new residencies approved every year. A strong, competent cadre of clinical educators is essential to the success of any residency, and new programs have the challenge of developing their clinical faculty into outstanding teachers. There is minimal literature guidance for navigating this transition. Our site is a community tertiary care center in the process of applying for an EM residency. We focus on our experience designing a faculty development curriculum to accommodate the needs of a diverse group of physicians in all stages of their careers. We will demonstrate that a curriculum satisfying all stakeholders can easily be implemented in a way that allows for robust participation without excessive additional administrative burden. Our goal is to prepare community-based EM attendings to be outstanding educators to future residents by augmenting their knowledge of current educational practice and adult learning theory, literature review, and biostatistics. The educational strategies used in this curriculum included lectures, guided discussion, small group discussion, and asynchronous learning. This curriculum was implemented in the Geisinger Wyoming Valley Medical center targeted at staff physicians. This educational study was deemed exempt by the institutional review board (IRB). We electronically collected retrospective survey data using a 5-point Likert scale as well as free text responses. The primary measure was agreement with the statement, "Faculty development time makes me feel more prepared to be a clinical educator." We also surveyed whether this was felt to be an appropriate use of time, self-reported growth in key educational and biostatistical domains, and likeliness to change practice based on the material. Responses collected from core faculty after the sessions indicated a uniformly positive review of the series itself with the primary outcome receiving a 4.6 rating on a 5-point Likert scale (strong agreement). Faculty reported that these brief sessions improved the quality of the departmental staff meetings (average rating 4.7/5). Journal club sessions were rated as positive (4.7/5) and attendees self-reported growth in statistical literacy and security in clinical practice. We demonstrated successful implementation of a faculty development curriculum that was favorably assessed by all key stakeholders. Faculty self-reported growth in all educational and clinical domains evaluated. It was successfully implemented without substantially increasing the time burden for physicians with robust clinical and administrative schedules. We feel this is generalizable to other sites seeking to start an EM residency and is useful for sites with existing residencies to efficiently deliver content to junior faculty. Emergency medicine, faculty development, journal club, virtual learning.