Iterative Sessions Research Articles

Co-creating innovative and accepted legume-based dishes for school canteens with adolescents in a low socioeconomic area

The promotion of sustainable diets, that valorise and give stage to plant-based foods, is beneficial for both human and environmental health. Adolescence is crucial to support healthy and sustainable eating. Despite this, adolescents remain an understudied group, especially those with a lower economic status. This study aimed to develop innovative, sustainable and healthy legume-based dishes for school canteens through co-creation with adolescents in a low socioeconomic status area with high immigration rate.Nineteen adolescents and four chefs participated in iterative sessions of focus group discussions using a combination of methods (Jobs-To-Be-Done, free association tasks, SCAMPER (Substitute-Combine-Adapt-Modify-Purpose-Eliminate-Rearrange) technique) to identify ideas of new legume-based dishes. Subsequently, 91 adolescents rated their willingness-to-try 28 dish concepts based on these ideas. Six concepts were selected and translated into prototypes that underwent further evaluation by 138 adolescents who assessed their liking, sensory and emotional responses.Results showed that all dishes were well-received, with lower acceptance among high-neophobic adolescents, yet none of the selected dishes were rejected. Exploring individual differences in liking identified two clusters with different hedonic patterns. Emotional characterization of dishes showed those that elicit positive emotional responses high in arousal and novelty in all adolescents, independently from food neophobia, increasing their likelihood of acceptance.The study shows that co-creation with adolescents, in combination with understanding individual differences, are promising strategies to develop innovative, healthy and well-received legume-based dishes for school canteens.

Developing tailor-made plant-based dishes with adolescents for school canteens

Abstract School interventions can have a significant impact on promoting plant-based (PB) diets, which can benefit both health and environmental sustainability. This co-creation and repeated exposure study was conducted in a high school and is divided into 3 parts, a) Co-creation with adolescents (aged 12-16) and chefs to develop innovative PB dishes, b) Global profile (liking, sensory properties, emotions) of the new dishes, c) Repeated exposure for 6 weeks. Using a combination of techniques, 25 adolescents and four chefs took part in iterative sessions of focus group discussions to identify ideas for new PB dishes. Interviews were conducted with 17 adolescents who tasted the five most-liked dishes, using the EmoSemio approach to define a global profile questionnaire. This was then used with 147 adolescents that were characterised for taste responsiveness and food neophobia, to study their liking, sensory/emotional responses to the dishes. The most promising dish was chosen and a 6-week exposure experiment was conducted with 60 adolescents. Results indicate that all five dishes were accepted (mean liking=54.6/100). Taste responsiveness and neophobia were significantly associated with the dish liking, with students who were less responsive to taste and more neophobic liking the dishes less (p < 0.0001). Individual differences were further explored through preference mapping combined with hierarchical clustering. Four clusters with distinct hedonic patterns were identified, with two dishes, different in terms of sensory properties, being accepted by all clusters. One of the two induced positive emotions higher in arousal and novelty and appeared the most viable for school canteen use. Liking and positive emotional responses for the selected dish remained stable during a 6-week repeated exposure experiment, unlike a control dish with a plain taste. Co-creation with adolescents and chefs was effective for developing innovative and accepted PB dishes for school canteens. Key messages • Co-creating with adolescents and chefs and understanding individual differences are promising strategies for developing innovative and well-received PB dishes for sustainable school meals. • Segmenting for psychological traits and taste responsiveness and evaluating the Global Profile of healthy PB dishes in terms of sensory/emotional profile is essential in developing tailor-made dishes.

Participant-guided development of bilingual genomic educational infographics for Electronic Medical Records and Genomics Phase IV study.

Developing targeted, culturally competent educational materials is critical for participant understanding of engagement in a large genomic study that uses computational pipelines to produce genome-informed risk assessments. Guided by the Smerecnik framework that theorizes understanding of multifactorial genetic disease through 3 knowledge types, we developed English and Spanish infographics for individuals enrolled in the Electronic Medical Records and Genomics Network. Infographics were developed to explain concepts in lay language and visualizations. We conducted iterative sessions using a modified "think-aloud" process with 10 participants (6 English, 4 Spanish-speaking) to explore comprehension of and attitudes towards the infographics. We found that all but one participant had "awareness knowledge" of genetic disease risk factors upon viewing the infographics. Many participants had difficulty with "how-to" knowledge of applying genetic risk factors to specific monogenic and polygenic risks. Participant attitudes towards the iteratively-refined infographics indicated that design saturation was reached. There were several elements that contributed to the participants' comprehension (or misunderstanding) of the infographics. Visualization and iconography techniques best resonated with those who could draw on prior experiences or knowledge and were absent in those without. Limited graphicacy interfered with the understanding of absolute and relative risks when presented in graph format. Notably, narrative and storytelling theory that informed the creation of a vignette infographic was most accessible to all participants. Engagement with the intended audience who can identify strengths and points for improvement of the intervention is necessary to the development of effective infographics.

Multiple perspectives of stakeholders towards young learners’ language assessment in an international school in Malaysia

The issue of assessment in Malaysian international schools has rarely been explored. This qualitative study focuses on the views of three groups of stakeholders regarding the English language assessment of young learners in one such school. Primary-age children, their parents, and their teachers were interviewed online in iterative sessions for their experiences and views on language assessment as it was practised in the school. Thematic analysis of the data revealed how the children suffered from test anxiety; they believed the exams were difficult; and the teachers were seen as strict examiners. The parents agreed that the exams were unfairly difficult; they complained about a lack of transparency and feedback, besides excessive test frequency. The teachers believed they assessed both formatively and summatively; however, administratively their formative assessment results formed no part in students’ final assessment reports. The assessment practices in this case, and likely more widely in Malaysia, need reconsideration and point to a broad paradox.

Healthcare provider and patient perspectives on access to and management of atrial fibrillation in the Northern Province, Sri Lanka: a rapid evaluation of barriers and facilitators to care

BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia that affects 60 million people worldwide. Limited evidence on AF management exists from low- and middle-income countries and none from Sri Lanka. We aimed to investigate the existing AF care pathway and patients’ perception on AF management to identify barriers and enablers for optimal AF care in Northern Province, Sri Lanka.MethodsA rapid evaluation was undertaken with use of qualitative methods. Local healthcare providers (HCPs) mapped the intended pathway of care for AF patients which was then explored and annotated through 12 iterative sessions with additional HCPs. Topics of inefficiencies identified from the finalised map were used to guide focus group discussions (FGDs) with AF patients. AF patients who were attending the anticoagulation clinic at the only tertiary hospital in Northern Province were recruited and invited to participate using purposive sampling. The topic guide was developed in collaboration with local clinicians and qualitative experts. FGDs were conducted in the native Tamil language and all sessions were recorded, transcribed verbatim and thematically analysed using a deductive approach.ResultsThe mapped pathway revealed inefficiencies in referral, diagnosis and ongoing management. These were explored through three FGDs conducted with 25 AF patients aged 25 to 70 years. Two key themes that contributed to and resulted in delays in accessing care and ongoing management were health seeking behaviours and atomistic healthcare structures. Four cross-cutting sub-themes identified were decision making, paternalistic approach to care, cost impacts and lifestyle impacts. These are discussed across 10 unique categories with consideration of the local context.ConclusionsStrengthening primary healthcare services, improving public health literacy regarding AF and building patient autonomy whilst understanding the importance of their daily life and family involvement may be advantageous in tackling the inefficiencies in the current AF care pathway in Sri Lanka.

VIPCare: Understanding the support needed to create affective interactions between new caregivers and residents with dementia.

IntroductionIn this paper, we study the support needed by professional caregivers of those with dementia, and present a first step toward development of VIPCare, a novel application with the goal of assisting new caregivers at care-centres in interacting with residents with dementia.MethodsA mixed-methods study including two questionnaires, two focus groups, and seven co-design sessions with 17 professional caregivers was conducted to (a) understand caregivers’ challenges/approaches used to reduce negative interactions with persons with dementia, (b) identify the existing gaps in supporting information for improving such interactions, and (c) co-design the user interface of an application that aims to help improve interactions between a new professional caregiver and persons with dementia. A pre-questionnaire assessed knowledge of smartphones and attitude toward technology. A post-questionnaire provided an initial evaluation of the designed user interface.ResultsFocus groups emphasized the importance of role-playing learned through trial and error. The layout/content of the application was then designed in four iterative paper-prototyping sessions with professional caregivers. An iOS/Android-based application was developed accordingly and was modified/improved in three iterative sessions. The initial results supported efficiency of VIPCare and suggested a low task load index.ConclusionsWe presented a first step toward understanding caregiver needs and developing an application that can help reduce negative interactions between professional caregivers and those with dementia.

Co-designing a remote rehabilitation tool for Parkinson\u2019s disease: exploratory values and challenges

BackgroundImpaired motor function is one of the early symptoms shown in patients with Parkinson Disease (PD). For this reason, rehabilitative interventions have been used for many years to improve motor and non-motor symptoms. Among them, the use of music therapy has shown benefits in helping to overcome some of the most common motor dysfunction. Addressing the challenge of providing access to this type of therapy, this document presents the collaborative design process to develop a remote training support tool for PD based on music therapy.MethodsA qualitative study with creative co-design methods was used in which different groups of healthcare professionals, patients, and relatives participated in six iterative sessions. Workshops were designed and structured to incrementally discover requirements and needs and validate the proposed prototype ideas.ResultsThe study provided key aspects that were used for the development and validation of the proposed prototypes for the remote music-based training support tool for PD. Up to 20 factors that had a positive and/or negative influence on patient access to training were detected. These factors were classified into three common themes: daily activities and independence, participation in treatment and barriers to daily treatment, and self-management and personalization of information and telecommunication technologies (ICT).ConclusionsThis paper shows the results of a collaborative design process aimed at identifying the different factors, relevant to patients with PD, to improve their access to remote ICT-based training therapy and their expectations regarding alternative therapies, such as music. The participatory design methods and the iterative model used helped overcome many of the traditionally barriers that this type of technological support solutions usually have, facilitating the future participation.

Perspectives on Conducting Research in Indian Country.

Certain research principles, framed within an indigenous context, are helpful guideposts to practice ethical, relevant, and sensitive inquiries. It is essential to further adapt research approaches based on the unique geographical, sociopolitical, and cultural attributes of partnering tribal communities. These adaptations are largely shaped by trial and error. The purpose of this article is to offer the prospective novice nurse researcher lessons that we learned when entering Indian country to conduct research for the first time. As indigenous and nonindigenous researchers, we are not seeking to set down a methodology but rather offer a list of processes, environments, timelines, and barriers that we never learned in didactic, seminar, clinical, practicum, or any other academic setting. We organized a set of memories and thoughts through a series of semistructured iterative sessions specific to our first encounters as researchers in Indian country. We compiled our written responses and field notes from our dialogue, interpreted these data, and organized them into themes. We have reported what we felt would be the most surprising, frequent, or important information to note. We identified three overarching themes in our collective experience: orientation and negotiation, situating ourselves and our work, and navigating our way. Subthemes included perceiving ourselves as outsiders, negotiating distance and time realities, relying on the goodness of gatekeepers, shaping research questions per community priorities, honing our cross-cultural and intercultural communication skills, discovering the many layers of tribal approval processes, and developing sensibilities and intuition. Our previous experiences as novices leading research projects in Indian country have produced unique sensibilities that may serve to guide nurse researchers who seek to partner with tribal communities.

Similarity corpus on microbial transcriptional regulation

BackgroundThe ability to express the same meaning in different ways is a well-known property of natural language. This amazing property is the source of major difficulties in natural language processing. Given the constant increase in published literature, its curation and information extraction would strongly benefit from efficient automatic processes, for which corpora of sentences evaluated by experts are a valuable resource.ResultsGiven our interest in applying such approaches to the benefit of curation of the biomedical literature, specifically that about gene regulation in microbial organisms, we decided to build a corpus with graded textual similarity evaluated by curators and that was designed specifically oriented to our purposes. Based on the predefined statistical power of future analyses, we defined features of the design, including sampling, selection criteria, balance, and size, among others. A non-fully crossed study design was applied. Each pair of sentences was evaluated by 3 annotators from a total of 7; the scale used in the semantic similarity assessment task within the Semantic Evaluation workshop (SEMEVAL) was adapted to our goals in four successive iterative sessions with clear improvements in the agreed guidelines and interrater reliability results. Alternatives for such a corpus evaluation have been widely discussed.ConclusionsTo the best of our knowledge, this is the first similarity corpus—a dataset of pairs of sentences for which human experts rate the semantic similarity of each pair—in this domain of knowledge. We have initiated its incorporation in our research towards high-throughput curation strategies based on natural language processing.

Support values through the eyes of the patient: An exploratory study into long-term support of persons with refractory epilepsy

A significant group of persons affected by refractory epilepsy require a wide range of long-term support from professionals as well as informal support givers. To enhance person-centeredness, it is important to know which patient values are associated with long-term support.An Internet survey produced a total of 1176 statements from 289 persons with epilepsy for analysis. Statements were expressed in the respondent's own words and were related to positive experiences (704) as well as possible areas of improvement (472) regarding the support received in the past six months. Thematic summaries of the survey results were presented to four focus groups of persons with epilepsy and proxies with a request to formulate the most important patient values which should be observed in long-term support. In iterative sessions with a panel of epilepsy experts, a framework of twelve value domains was formulated, organized in four major value clusters.An example of how these value domains can be operationalized for use in practice is next presented as a checklist to help evaluate the support patients with long-term support needs actually receive. Correspondingly, two sets of reflective questions were formulated for informal and professional support givers for the purpose of evaluating and improving person-centeredness in their support practices.

Using quality improvement to promote implementation and increase well child visits in home visiting

A key goal of home visiting is to connect children with medical homes through anticipatory guidance regarding recommended well child care (WCC). Substantial barriers to WCC among low socioeconomic families can limit achievement of this outcome. Quality improvement strategies have been widely adopted in healthcare but only recently implemented in home visiting to achieve program outcomes. The objective of this initiative was to increase the percentage of infants enrolled in home visiting who completed at least 3 recommended WCC visits in the first 6 months of life within a large, multi-model program comprised of 11 sites. A series of 33 quality improvement cycles were conducted at 3 sites involving 18 home visitors and 139 families with infants in the target age range. These were deployed sequentially, and changes within and across sites were monitored using trend charts over time. Adopted strategies were then implemented program-wide. Initiatives focused on staff training in WCC recommendations, data collection processes, monthly family tracking reports, and enhanced communication with primary care offices. Data were shared in iterative sessions to identify methods for improving adherence. Wide baseline variability across sites was observed, with the percentage of infants with recommended care ranging from 35% to 83%. Over the project timeline, the percentage of infants receiving at least 3 WCC visits in the first 6 months increased from 58% to 86%. Quality improvement within home visiting can be used to improve WCC adherence and provides an example of maximizing implementation of home visiting interventions.

User-Centered Design of a Controller-Free Game for Hand Rehabilitation.

The purpose of this study was to develop and test a hand therapy game using the Microsoft (Redmond, WA) Kinect(®) sensor with a customized videogame. Using the Microsoft Kinect sensor as an input device, a customized game for hand rehabilitation was developed that required players to perform various gestures to accomplish a virtual cooking task. Over the course of two iterative sessions, 11 participants with different levels of wrist, hand, and finger injuries interacted with the game in a single session, and user perspectives and feedback were obtained via a questionnaire and semistructured interviews. Participants reported high levels of enjoyment, specifically related to the challenging nature of the game and the visuals. Participant feedback from the first iterative round of testing was incorporated to produce a second prototype for the second round of testing. Additionally, participants expressed the desire to have the game adapt and be customized to their unique hand therapy needs. The game tested in this study has the potential to be a unique and cutting edge method for the delivery of hand rehabilitation for a diverse population.

Pain Management for Persons Living With HIV Disease: Experience With Interprofessional Education in Nigeria.

Pain management (PM) has not been routinely incorporated into HIV/AIDS care and treatment in resource-constrained settings. We describe training for multidisciplinary teams tasked with integrating care management into HIV clinics to address pain for persons living with HIV in Nigeria. Education on PM was provided to mixed-disciplinary teams including didactic and iterative sessions following home and hospital visits. Participants identified challenges and performed group problem solving. HIV trainers identified barriers to introducing PM reflecting views of the patient, providers, culture, and the health environment. Implementation strategies included (1) building upon existing relationships; (2) preliminary advocacy; (3) attention to staff needs; and (4) structured data review. Implementing PM in Nigerian HIV clinics requires recognition of cultural beliefs.

Round-Table Group Optimization for Sequencing Problems

In this paper, a round-table group optimization (RTGO) algorithm is presented. RTGO is a simple meta-heuristic framework using the insights of research on group creativity. In a cooperative group, the agents work in iterative sessions to search innovative ideas in a common problem landscape. Each agent has one base idea stored in its individual memory, and one social idea fed by a round-table group support mechanism in each session. The idea combination and improvement processes are respectively realized by using a recombination search (XS) strategy and a local search (LS) strategy, to build on the base and social ideas. RTGO is then implemented for solving two difficult sequencing problems, i.e., the flowshop scheduling problem and the quadratic assignment problem. The domain-specific LS strategies are adopted from existing algorithms, whereas a general XS class, called socially biased combination (SBX), is realized in a modular form. The performance of RTGO is then evaluated on commonly-used benchmark datasets. Good performance on different problems can be achieved by RTGO using appropriate SBX operators. Furthermore, RTGO is able to outperform some existing methods, including methods using the same LS strategies.

P5-S3.01 Developing a multi-pronged quality improvement (QI) strategy to increase Chlamydia trachomatis (CT) retesting rates: building a framework for success

BackgroundCT reinfection is common and linked with adverse reproductive sequelae. Despite strengthened national recommendations and clinician education efforts in California (CA), retesting rates remain low. Our objective was to use...

Improving Early Literacy Promotion: A Quality-Improvement Project for Reach Out and Read

The Reach Out and Read (ROR) program promotes early literacy as part of pediatric primary care through the distribution of children's books and anticipatory guidance during early childhood. To improve the rates of age-appropriate book-giving during well-child care and the delivery of ROR-recommended anticipatory guidance in 6 pediatric clinics. Three quality-improvement cycles were completed at each site. Practice-level data were shared with participants in iterative sessions to identify methods for improving care. A provider-training DVD was used to promote these ROR activities. Over the course of the project, the median rate of book-giving increased from 97% to 99% and for anticipatory guidance remained at 89%. Providers reported significantly improved ROR-related skills, particularly self-efficacy for modeling reading aloud and for using children's books to assess development. Baseline adherence to the ROR program is high, possibly because of the ease of implementation. Quality improvement for ROR is feasible and may be easier to implement for book distribution than anticipatory guidance, although providers reported improved anticipatory-guidance skills. Future quality-improvement efforts should continue to address giving books and anticipatory guidance, both of which are integral to the ROR model.