Lessons Learned Research Articles

Humor Effectiveness in L2 Classrooms: The Case of Rural School EFL Students

This study aimed to measure types, levels, and perceptions towards the application of humor as a supporting material in EFL classrooms. One hundred and thirteen rural school EFL students were involved as the participants of this mixed-methods study. As for quantitative results, humor was revealed to have positive influence on EFL students’ learning development by facilitating the lesson and encouraging learning enthusiasm. Although some aspects of L2 humor were not believed to be helpful, other aspects such as modelling English use and usage and authentic materials proved that such L2 humor was advantageous. Meanwhile, interview results showed that L2 humor was considered paramount that it helped to progress English learning, improve learning strategies, and increase motivation. The combination between both results prove that L2 humor is not only entertaining, but also prospective for those who expect a more realistic or knowledgeable material that does not cause stress or anxiety in learning English, particularly in a rural context. In addition, this study was limited on quantitative and qualitative perceptions, but it did not attempt to implement L2 humor through an action research.

Opportunities and challenges of promoting integrated care through digitalisation–Learning lessons from large-scale national programmes in England

There is a growing global interest in integrating health and care through digitalisation. However, many ambitious digitalisation initiatives in the healthcare sector fail to achieve their intended outcomes. One contributing factor is the failure to apply lessons learned from past endeavours. We here leverage the experiences gained from large-scale digitalisation efforts within the National Health Service (NHS) in England to distil valuable insights for strategic decision-makers who are embarking on the development and implementation of initiatives aimed at integrating health and social care through digitalisation. While not exhaustive, our compilation of eight key lessons serves as a foundational resource to inform such initiatives, seeking ultimately to contribute to realising maximum benefits for health and care organisations and service users.

Educational Intervention to Increase COVID-19 Vaccine Uptake in Rural Patients with Chronic Diseases: Lessons Learned from An Innovative Academic-Community Partnership.

The pandemic has disproportionately impacted rural communities with a higher burden of chronic disease and COVID-19 infection. West Virginia is a rural state with a high rate of diabetes, hypertension, and COPD, which are known risk factors for severe COVID-19 and long COVID. Yet, there is a significant hesitancy regarding COVID-19 vaccination uptake in the state. The purpose of this study was to use an educational intervention to increase vaccine knowledge and vaccine acceptance in rural patients with chronic disease(s) in West Virginia. This project used an academic-community partnership comprised of researchers, practitioners, community organizations, community-engaged partners, and patient stakeholders to increase COVID-19 health literacy and increase vaccine acceptance among rural West Virginians with chronic conditions. A quasi-experimental study design was used to deliver an educational intervention by trained Health Navigators using short videos to increase COVID-19 health literacy and address participants' vaccine concerns. Eligibility included adults (18 years and older) who have at least one chronic condition. A statewide community advisory board (CAB) guided the development of the educational training curriculum and implementation strategies. An adapted version of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework guided the development of the intervention. Health Navigators (n = 45) delivered the educational intervention in their local communities between November 2022 and October 2023 (project implementation is still ongoing). Intervention fidelity checks, an adaptable script, and a flow chart allowed tailoring of brief videos to address participants' specific COVID-19 questions and vaccine concerns. A validated online survey, monitored by an online Research Electronic Data Capture (REDCap) database, assessed participants' knowledge, perceived susceptibility, and vaccine intention. Health Navigators delivered the intervention to 1368 West Virginians in 52 counties (59.2% women; 61.8% without a college degree). Participants reported living with an average of 2.1 ± 1.4 chronic conditions. The mean age was 43.5 ± 18.8 years. The majority of participants (81.2%) had received the primary vaccination series, and 63.1% had at least one booster. However, 18% were unvaccinated or did not complete the primary COVID-19 vaccine series. Discussions to improve vaccine literacy focused on how the vaccine was so quickly developed and protects against variants, addressing concerns related to the safety, short- and long-term side effects, and importance of vaccine uptake for immunocompromised individuals. Participants with higher concerns were more likely to be unvaccinated and to have not completed their primary series or boosters (p < 0.001). However, the educational intervention improved the willingness of individuals who were either unvaccinated or did not complete their primary vaccine series to get vaccinated (11.4%). Our findings highlight the importance of vaccine literacy in increasing vaccination rates among rural patients with chronic diseases. Using the EPIS framework allowed us to reflect upon the challenges, ensure resilience during changing local contexts, and plan and implement a promising, cost-effective intervention in rural areas. This study provides insights into the need for tailored educational interventions based on disease status, which has implications for public health and patient care in rural and underserved communities. Academic-community partnerships can be useful for successful knowledge transfer for vaccine acceptance to reduce rural health disparities.

Implementing an Organized Colorectal Cancer Screening Program: Lessons Learned From an Academic–Community Practice

IntroductionThe effectiveness of mailed fecal immunochemical test (FIT) outreach might be enhanced through an organized colorectal cancer (CRC) screening program, yet published real-world experiences are limited. We synthesized the process of implementing a CRC screening program which used mailed FIT outreach in a large integrated academic-community practice. Materials and MethodsData from a pilot mailed FIT program were shared with healthcare system leadership which inspired the creation of a cross-institutional organized CRC Screening Program. In partnership with a centralized Population Health Team and Primary Care, we defined: 1) the institutional approach to CRC screening, 2) the target population and method for screening, 3) the team responsible for implementation, 4) the healthcare team responsible for decisions and care, 5) a quality assurance structure, and 6) a method for identifying cancer occurrence. ResultsThe Fred Hutch/UW Medicine Population Health CRC Screening Program began in September 2021. The workflow for mailed FIT outreach included a mailed postcard, a MyChart message from the patient's primary care provider (PCP), a FIT kit with a letter signed by the PCP and program director, and up to three bi-weekly reminders. Patients without a colonoscopy 3 months after an abnormal FIT result received navigation through the program. In the first program year, we identified 9,719 patients eligible for outreach and in an intention to treat analysis, 32% of patients completed CRC screening by FIT or colonoscopy. ConclusionsReal-world experiences detailing how to implement organized CRC screening programs might increase adoption. In our experience, broadly disseminating pilot data, early institutional support, robust data management and strong cross-departmental relationships were critical to successfully implementing a CRC screening program that benefits all patients.

Establishing a Multi-disciplinary Adult Oncology Unit at Muhimbili National Hospital: Lessons Learned, Challenges, and Opportunities Amidst Tanzania's Growing Cancer Burden

In light of the escalating cancer burden in Tanzania, Muhimbili National Hospital (MNH) embarked on a transformative initiative, utilizing the Capability, Opportunity, Motivation (COM-B) framework to meticulously design an implementation strategy. This collaborative effort yielded a dedicated chemotherapy ward, an expanded workforce, and ongoing professional development programs. The success of MNH's Adult Oncology Unit highlights the critical significance of adaptability, stakeholder engagement, and an unwavering commitment to meet the rising demand for cancer care in resource-constrained environments.

Stories of QRIO and PINO, and Beyond: Lessons Learned from Small Humanoid Projects From R&amp;D to Business

In 1997, Sony announced AIBO, a fully autonomous small quadruped robot for home entertainment, and in 1999 the company began selling it as a consumer product. Soon after development, two small humanoid robots were announced. One was QRIO by Sony, which is about 60[Formula: see text]cm height body with dynamical bipedal walking and whole-body cooperative control. The other was PINO by the ERATO Kitano Symbiotic Systems Project, which is about 70[Formula: see text]cm height body, Open HW/SW with inexpensive off-the-shelf component. In this paper, we revisit the two humanoids and nearly 20-year-old technologies, and discuss what were done 20 years ago, what have been achieved and what challenges are ahead.

Engaging Participants Through Hybrid Community-Centered Approaches: Lessons Learned During the COVID CommUNITY Public Health Research Program.

Community-centered research studies can improve trust, cultural appropriateness, and accurate findings through meaningful, in-depth engagement with participants. During the COVID-19 pandemic, researchers shifted to implement pandemic-specific guidelines on top of already existing safety practices; these adjustments gave insight into bettering the structure of forthcoming research studies. At the Population Health Research Institute (PHRI)/McMaster University, the COVID CommUNITY study staff took field notes from their experience at the Ontario (ON) and British Columbia (BC) sites navigating an observational prospective cohort study during the pandemic. These field notes are outlined below to provide insight into culturally responsive, trust-centered, and communication-focused strategies used to improve hybrid research. A significant challenge the team overcame was obtaining blood sample collections by executing socially distanced sample collections outside of participants' homes, coined "Porch Pickups." Data collection was made more accessible through phone surveys and frequent virtual contact. To enhance recruitment strategies for sub-communities of the South Asian population, staff focused on cultural interests and "gift-exchange" incentives. Cultural awareness was prioritized through correct name pronunciation, conducting data collection in participant preferred languages, and using flexible approaches to data collection. These strategies were developed through weekly team meetings where improvement strategies were discussed, and concerns were addressed in real-time.

Students as Creators of Instructional Videos: Best Practices and Lessons Learned

Students as Creators of Instructional Videos: Best Practices and Lessons Learned

Preparing for data collection: the mock interview as a researcher’s training tool

ABSTRACT Background The research interview is a valuable tool for collecting data in qualitative studies. All education researchers, whether novice or experienced, need to prepare carefully when planning to conduct interviews. Thus, how best to assist newer researchers to acquire interviewing skills for the purpose of collecting research data remains an important question. Mock, or ‘practice’, interviews can offer opportunities for such researchers to become more familiar with the methodological processes involved in interviewing, so that they can start to build necessary skills prior to carrying out interviews in the field. Purpose Set in the context of nursing education, the research sought to describe the use of an online mock interview protocol as a researcher’s training tool and consider key lessons learnt from this process. Method In this qualitative study, seven purposively selected participants from a university in Australia were involved in a mock interview process. A video conferencing platform was utilised as an online environment for the interviews. Findings Analysis of the procedure indicated the ways in which carrying out the mock interviews supported the researcher’s preparation for qualitative interviewing and facilitated the development of good practice for conducting interviews in a virtual environment. Processes included undertaking a rigorous training needs analysis, optimising technical preparedness for the mock interviews, and practising how to ask interview questions in a suitable way. The experience involved learning lessons around self-evaluation, mental readiness, retrieving rich data and troubleshooting technical issues. Conclusion The research highlights the extent to which successful interviewing depends on the quality of pre-interview preparation on the part of the researcher. Conducting mock interviews prior to online qualitative research could help support less experienced researchers in areas of research including nursing education. Integration of mock interview protocols into curricula for educational research purposes could help provide research students with opportunities to strengthen their skills.

Using Clinical Decision Support Systems to Decrease Intravenous Acetaminophen Use: Implementation and Lessons Learned.

Clinical decision support systems (CDSS) can enhance medical decision-making by providing targeted information to providers. While they have the potential to improve quality of care and reduce costs, they are not universally effective and can lead to unintended harm. To describe the implementation of an unsuccessful interruptive CDSS that aimed to promote appropriate use of intravenous (IV) acetaminophen at an academic pediatric hospital, with an emphasis on lessons learned. Quality improvement methodology was used to study the effect of an interruptive CDSS, which set a mandatory expiry time of 24 hours for all IV acetaminophen orders. This CDSS was implemented on April 5, 2021. The primary outcome measure was number of IV acetaminophen administrations per 1,000 patient days, measured pre- and postimplementation. Process measures were the number of IV acetaminophen orders placed per 1,000 patient days. Balancing measures were collected via survey data and included provider and nursing acceptability and unintended consequences of the CDSS. There was no special cause variation in hospital-wide IV acetaminophen administrations and orders after CDSS implementation, nor when the CDSS was removed. A total of 88 participants completed the survey. Nearly half (40/88) of respondents reported negative issues with the CDSS, with the majority stating that this affected patient care (39/40). Respondents cited delays in patient care and reduced efficiency as the most common negative effects. This study underscores the significance of monitoring CDSS implementations and including end user acceptability as an outcome measure. Teams should be prepared to modify or remove CDSS that do not achieve their intended goal or are associated with low end user acceptability. CDSS holds promise for improving clinical practice, but careful implementation and ongoing evaluation are crucial for maximizing their benefits and minimizing potential harm.

Space ‘Tourism’: a Framework for Ensuring ‘Safe and Orderly Development’ Lessons Learnt from the U.S. and Aviation

In August 2023, following its successful mission, Virgin Galactic announced the intention to provide scheduled services into space. Yet, this paper sets out to present evidence to argue that, from an international (U.N.) perspective, there has been a lack of activity to establish safeguards and to ensure a fit for purpose governance and oversight mechanism is in place for this new and growing sector—space tourism. The research is undertaken by way of a comparison law/policy analysis which factors in key historic events across both aviation and space. The main focus is given to the developments and approach of the U.S. The research finds that there remains a number of areas where clarity and advancement is needed both nationally (U.S.) and internationally; and that, without suitable governance and frameworks being established—safety is compromised, and equitability is not ensured for space tourists. It is advocated that there are clear lessons to be learnt from aviation developments and practices and that one solution would be a governance and oversight system as has been established by the International Civil Aviation Organization (ICAO).

HTA community perspectives on the use of patient preference information: lessons learned from a survey with members of HTA bodies.

This research sought to assess whether and how patient preference (PP) data are currently used within health technology assessment (HTA) bodies and affiliated organizations involved in technology/drug appraisals and assessments. An exploratory survey was developed by the PP Project Subcommittee of the HTA International Patient and Citizen Involvement Interest Group to gain insight into the use, impact, and role of PP data in HTA, as well as the perceived barriers to its incorporation. Forty members of HTA bodies and affiliated organizations from twelve countries completed the online survey. PP data were reported to be formally considered as part of the HTA evidence review process by 82.5 percent of the respondents, while 39.4 percent reported that most of the appraisals and assessments within their organization in the past year had submitted PP data. The leading reason for why PP data were not submitted in most assessments was time/resource constraints followed by lack of clarity on PP data impact. Participants reported that PP data had a moderate level of influence on the deliberative process and outcome of the decision, but a higher level of influence on the decision's quality. Most (81.8 percent) felt patient advocacy groups should be primarily responsible for generating and submitting this type of evidence. Insights from the survey confirm the use of PP data in HTA but reveal barriers to its broader and more meaningful integration. Encouragingly, participants believe obstacles can be overcome, paving the way for a second phase of research involving in-depth collaborative workshops with HTA representatives.

ElliQ, an AI-Driven Social Robot to Alleviate Loneliness: Progress and Lessons Learned.

Loneliness is a significant issue in older adults and can increase the risk of morbidity and mortality. To present the development of ElliQ, a proactive, AI-driven social robot with multiple social and health coaching functions specifically designed to address loneliness and support older people. ElliQ, a consumer robot with a friendly appearance, uses voice, sounds, light, and buttons through a touch screen to facilitate conversation, music, video calls, well-being assessments, stress reduction, cognitive games, and health reminders. The robot was deployed by 15 government agencies in the USA. Initial experience suggests it is not only highly engaging for older people but may be able to improve their quality of life and reduce loneliness. In addition, the development of a weekly report that patients can share with their clinicians to allow better integration into routine care is described. This paper describes the development and real-world implementation of this product innovation and discusses challenges encountered and future directions.

Robotic-Assisted Microsurgery: Lessons Learned from 50 Consecutive Cases

Robotic-Assisted Microsurgery: Lessons Learned from 50 Consecutive Cases

Implementing Community Antimicrobial Stewardship Model in Nigeria: Lessons Learned from AMS Outpatient Setting among Community Pharmacists/Patent and Proprietary Medicine

Antimicrobial resistance (AMR) is a growing global concern primarily driven by the overuse and inappropriate utilization of antimicrobials. In Nigeria, AMR is exacerbated by the routine sale of prescription-only medicines, including antimicrobials, without proper monitoring. The National Action Plan for Antimicrobial Resistance (2017-2022) highlighted widespread inappropriate antibiotic use, with significant proportions obtained without prescriptions. Antimicrobial stewardship (AMS) in outpatient settings is a novel concept in Nigeria. This interventional study sought to contribute to the reduction of inappropriate antibiotic dispensing and use in community/outpatient settings in Nigeria, focusing on enhancing the skills and capacity of improved rational antibiotic therapy among community pharmacists and Patent and Proprietary Medicine Vendors (PPMVs), with the sole aim of improving patient health outcomes. The CAMS interventional study involves education, quality improvement capacity building, patient empowerment, and a multifaceted AMS strategy. Results from the CFID’s CAMS model indicated a significant improvement in the rational dispensing and use of antimicrobials within the intervention group, emphasizing the effectiveness of CAMS. Notable variations in post-visit actions between the intervention and monitoring groups further support the positive impact of the intervention. Variation in attitudes towards sharing of antibiotic to friends and relatives was reduced among the intervention group, offering clear understanding into the potential impact of CFID AMS outpatient setting (CAMS) intervention. The study’s conclusion underscores the pivotal role of implementing AMS in outpatient and community settings such as the CAMS interventional model in improving antibiotic-related practices in both urban and rural communities in Nigeria, emphasizing its relevance and impact.

Understanding Multilevel Factors Related to Retention Among the Direct Care Workforce: Incorporating Lessons Learned in Considering Innovative Interventions.

This article explores how broad, contextual factors may be influential in the retention of direct care workers (DCWs; i.e., entry-level caregivers) who provide vital support to patients in healthcare settings. We reflect on lessons learned from an evaluation of a multisite intervention to improve retention among DCWs employed primarily in hospital settings at three health systems. We evaluated a multitiered program for entry-level caregivers that included a risk assessment, a 4-day curriculum, and follow-up sessions, as well as workforce coaching at the three health systems. As part of our evaluation, we collected data on roughly 3,000 DCWs from the three health systems; the information included hiring date, any transfer date, and any termination date for each new DCW, as well as demographic information, position characteristics, and termination status and reasons for any termination. In addition, we collected information about organizational characteristics, including staffing and number of employees. We also conducted interviews with 56 DCWs and 21 staff members who implemented a retention program across each of the three health systems and remotely conducted virtual observations of the curriculum sessions at each system. Although the program we evaluated focused on individual-level factors that may affect retention, our findings revealed other broader, contextual challenges faced by DCWs that they said would have an impact on their willingness to stay in their positions. These challenges included (1) job-related factors including limited compensation, aspects of the job itself, and the inability to advance in one's position; (2) health system challenges including the mission, policies, staffing, and organizational culture; and (3) external factors including federal policies and the ongoing COVID-19 pandemic. As the direct care workforce continues to grow, interventions to improve retention should consider the interconnectedness of these multilevel factors rather than solely individual-level factors. In addition, further research is needed to rigorously evaluate any potential intervention and consider how such an approach can target DCWs in hospital-based settings who are most affected by the multilevel challenges identified. Finally, any intervention to improve retention must be also aligned to ensure equity, especially in this population of low-wage DCWs, many of whom are marginalized women and individuals of color.

Continuous Integration and Delivery in Open Source Development and Pattern Publishing: Lessons Learned With Tool Setup and Pipeline Evolution

Continuous Integration and Delivery in Open Source Development and Pattern Publishing: Lessons Learned With Tool Setup and Pipeline Evolution

Simultaneous submission of seven CTSA proposals: UM1, K12, R25, T32-predoctoral, T32-postdoctoral, and RC2: strategies, evaluation, and lessons learned.

Translation is the process of turning observations in the research laboratory, clinic, and community into interventions that improve people's health. The Clinical and Translational Science Awards (CTSA) program is a National Center for Advancing Translational Sciences (NCATS) initiative to advance translational science and research. Currently, 64 "CTSA hubs" exist across the nation. Since 2006, the Houston-based Center for Clinical Translational Sciences (CCTS) has assembled a well-integrated, high-impact hub in Texas that includes six partner institutions within the state, encompassing ∼23,000 sq. miles and over 16 million residents. To achieve the NCATS goal of "more treatments for all people more quickly," the CCTS promotes diversity and inclusion by integrating underrepresented populations into clinical studies, workforce training, and career development. In May 2023, we submitted the UM1 application and six "companion" proposals: K12, R25, T32-Predoctoral, T32-Postdoctoral, and RC2 (two applications). In October 2023, we received priority scores for the UM1 (22), K12 (25), T32-Predoctoral (20), and T32-Postdoctoral (23), which historically fall within the NCATS funding range. This report describes the grant preparation and submission approach, coupled with data from an internal survey designed to assimilate feedback from principal investigators, writers, reviewers, and administrative specialists. Herein, we share the challenges faced, the approaches developed, and the lessons learned.

Assessing the Sustainability Impact of Improving Secondary Steel Production: Lessons Learned from an Italian Plant

Abstract This work presents a sustainability assessment approach to evaluate technological innovations in secondary steel production making use of Electric Arc Furnace (EAF) technology. The assessment covers the environmental, social, and economic dimensions of sustainability by combining different tools (Life Cycle Assessment and Analytic Hierarchy Process), and also provides an integrated assessment of the overall sustainability. The approach, which can also be used to support decision-making, has been applied to a real case study of a steel plant located in Northern Italy. In the case study, environmental sustainability is positively impacted mainly by increased metal yield and reduced furnace energy consumption. The greatest social sustainability benefits are mainly related to improved ergonomic and safety conditions for workers (reduced demand for physical effort, manual handling and repetitiveness, and lower risk of accidents), as a consequence of the introduction of Industry 4.0 technologies. Regarding economic sustainability, a positive impact related to reduced cycle time, increased metal yield and quality yield, reduced maintenance and quality control costs was observed. The integrated assessment of the overall sustainability has proven to be a viable approach to manage trade-offs between the different dimensions of sustainability.

Green Video Compression for Metaverse: Lessons Learned from VP9 and HEVC

Green Video Compression for Metaverse: Lessons Learned from VP9 and HEVC