Nonacademic Settings Research Articles

Alternatives for testing of context-aware software systems in non-academic settings: results from a Rapid Review

Context-awareness challenges the engineering of contemporary software systems and jeopardizes their testing. The variation of context represents a relevant behavior that deepens the limitations of available software testing practices and technologies. However, such software systems are mainstream. Therefore, researchers in non-academic settings also face challenges when developing and testing contemporary software systems. To understand how researchers deal with the variation of context when testing context-aware software systems developed in non-academic settings. To undertake a secondary study ( Rapid Review ) to uncover the necessary evidence from primary sources describing the testing of context-aware software systems outside academia. The current testing initiatives in non-academic settings aim to generate or improve test suites that can deal with the context variation and the sheer volume of test input possibilities. They mostly rely on modeling the systems' dynamic behavior and increasing computing resources to generate test inputs to achieve this. We found no evidence of test results aiming at managing context variation through the testing lifecycle process. So far, the identified testing initiatives and strategies are not ready for mainstream adoption. They are all domain-specific, and while the ideas and approaches can be reproduced in distinct settings, the technologies are to be re-engineered and tailored to the context-awareness of contemporary software systems in different problem domains. Further and joint investigations in academia and experiences in non-academic settings can evolve the body of knowledge regarding the testing of contemporary software systems in the field.

Social Media and the Quest for Equity and Diversity in Oncology: On Safe Spaces and the Concept of the Public Physician.

Despite their increased enrollment into medical school, women still face systemic barriers in medicine, whether in an academic or nonacademic setting. Those from Under-Represented Minority (URM) groups face similar issues, which may affect their desire to enter, pursue, and/or maintain a career in medicine. Social media provides unique opportunities for peer-to-peer support among members of URM communities and for amplification of their voices calling for social justice-here defined as a redistribution of power and the quest for equity in access to opportunities, including access to mentorship, professional development, and timely promotion in academic rank. These issues are relevant to oncologists especially as we strive for diversity, equity, and inclusion and to ensure that our patients have equal access to care, regardless of their circumstances. In this article, we review current literature that highlights issues faced by women and historically URM groups in medicine, particularly in oncology. We also discuss the physician's role as a social justice advocate and the concept of the public physician.

INVESTIGATING CAUSES OF CULTURE SHOCK EXPERIENCED BY INTERNATIONAL STUDENTS

This study aims to investigate the causes of culture shock experienced by international students of Indonesia who study abroad as well as how is the culture shock and how to cope with it. This study employed qualitative research. The research subjects comprised ten international students who study in three different countries; eight in China, one in Australia and one in Netherland. They were selected utilizing purposive sampling techniques and collected through a semi-structured interview. The results of this research showed there are three main conditions of culture shock experienced by international students, that categorized in three dimension of culture shock; affect, behaviour and cognitions. Moreover, it was found that there were several causes of culture shock revealed in academic and non-academic settings. The causes of culture shock in academic settings indicated affecting students GPA score, like language barriers and learning process. While in non-academic settings the culture shock experienced by the international students cause by food, seasons and weather, payment system and people behavior in their host country. Also, the subjects showed the way to cope with culture shock using their own coping strategy and it was revealed that having pre-departure orientation helped students cope with culture shock.

The Use of Nitric Oxide as a Rescue Modality for Severe Adult Acute Respiratory Distress Syndrome Patients, Including COVID-19, in Critical Care Rotor Transport: A Retrospective Community Outcome Study

ObjectiveSevere acute respiratory distress syndrome (ARDS) mortality increases in smaller outlying facilities, and patients (especially those diagnosed with coronavirus disease 2019 [COVID-19]) are often “stuck” at these facilities. These patients are on maximal ventilator settings and are often in the prone position. Our purpose was to show that with the use of inhaled nitric oxide (iNO), a “community-based” rotor wing critical care transport (CCT) team can safely, consistently, and effectively transport these extremely precarious patients to the tertiary care that is needed. MethodsThis was a retrospective database review of 50 patients (39 patients with COVID-19) transported between 2017 and 2021 in whom iNO was brought to the bedside and initiated by the rotor wing critical care transport team. The review included patient demographics, vital signs, and ventilator settings from the sending hospital, in-flight, and the receiving hospital. We reviewed the transition from transport to venovenous extracorporeal membrane oxygenation (if applicable), hospital disposition, and length of stay from the receiving hospital side. Concerning the actual transport, we reviewed the mode of transport, the sending facility size, and the distances covered. ResultsUpon arrival at the sending facilities, we found severely ill patients with almost half (46%) in the prone position or recently transitioned from a prone position within the last 2 hours. Eighty-six percent were pharmaceutically paralyzed, and 44% were in shock. There was a younger and heavier predominance with an average age of 44 years and an average weight of 103 kg. Thirty-nine patients were diagnosed with COVID-19. The other 11 had a mix of non–COVID-19 ARDS, pulmonary embolism, and pulmonary edema. The patients presented from 27 different community hospitals. Forty-four percent were from small referring hospitals that had less than 200 beds. Twenty-eight patients were transported by a Bell 407 helicopter, 18 with an Airbus H135 helicopter, and 4 by ground ambulance. Forty-one percent of patients were transported within 25 miles, and 4 patients were transferred from > 100 miles away. All 50 patients were safely transported without significant deterioration or significant pulmonary pressure increases. Thirty-seven patients were placed on venovenous extracorporeal membrane oxygenation (34 of those patients cannulated within 2 hours of arrival). The overall mortality rate was 27%, and the COVID-19 mortality rate was 24%. ConclusioniNO retrieval for severe ARDS can be safely and effectively completed within the COVID-19 population and the nonacademic community setting using helicopters prevalent in the global air medical industry (Bell 407 and Airbus H135).

Neoadjuvant versus adjuvant chemotherapy for resectable metastatic colon cancer in non-academic and academic programs.

e15607 Background: Approximately 21% of colon cancer patients have synchronous metastatic disease at presentation. Liver is by far the most common site of metastasis. For resectable and borderline resectable metastatic lesions after conversion to surgical resection, five-year survival ranges between 40-70%. Overall survival advantage of chemotherapy before and after metastasectomy of liver or lung lesion is not clear. We here compare the differential effect of neoadjuvant versus adjuvant chemotherapy on overall survival of patients who received resection of both primary and metastatic lesions in non-academic and academic settings from the National Cancer Database (NCDB). Methods: Adults 20 years or older with primary colon cancer and single organ metastatic disease either in the liver or lung at diagnosis between 2010-2015 were identified. All patients had received surgery to the primary site, resection of the distant site and chemotherapy within 1 year of diagnosis. Patients were categorized into 2 cohorts based on whether they received chemotherapy in the pre-operative/peri-operative setting (neoadjuvant chemotherapy –NAC) or post-operative setting (adjuvant chemotherapy AC). Descriptive analysis, Kaplan-Meier plots, Log-Rank tests, and Cox-regression models for multivariate survival analyses were performed. To assess uncertainty of estimates, a sensitivity analysis was also performed based on the intention to treat principle by including additional surgery only and chemotherapy only cases. Results: A total of 3,038 colon cancer patients with liver or lung metastases were identified between 2010-2015. A larger majority of patients (n = 2387, 78.6%) received AC. The percentage of patients receiving NAC had steadily increased from 2010-2015 from 12.29% to 28.31%. The supermajority of metastases was in the liver. On multivariate analysis, patients who received NAC had an overall survival advantage (HR 0.661; 95% CI 0.534-0.879; P = 0.0001) in the non-academic setting whereas no advantage is seen in the patients treated in the academic settings (HR 0.994; 95% CI 0.831-1.189; P < 0.9484). The median overall survival for patients receiving NAC and AC was 47.24 months and 38.08 months respectively. Clinical factors associated with overall survival advantages in NAC patients treated in non-academic programs included age 20-49 years; low-income (< $38,000/year) status; CEA value of > 30; right sided colon primary; low T status and liver metastasis among others. The survival advantage of NAC over AC is associated with more clean resection margin and fewer regional lymph node involvement after surgery. Conclusions: Metastatic colon cancer with single organ liver or lung lesions benefits from neoadjuvant chemotherapy especially in non-academic settings based on our analysis of the NCDB database. The overall survival advantage in this setting has not been shown before.

Creating a Learning Health System for Improving Diagnostic Safety: Pragmatic Insights from US Health Care Organizations.

To identify challenges and pragmatic strategies for improving diagnostic safety at an organizational level using concepts from learning health systems METHODS: We interviewed 32 safety leaders across the USA on how their organizations approach diagnostic safety. Participants were recruited through email and represented geographically diverse academic and non-academic settings. The interview included questions on culture of reporting and learning from diagnostic errors; data gathering and analysis activities; diagnostic training and educational activities; and engagement of clinical leadership, staff, patients, and families in diagnostic safety activities. We conducted an inductive content analysis of interview transcripts and two reviewers coded all data. Of 32 participants, 12 reported having a specific program to address diagnostic errors. Multiple barriers to implement diagnostic safety activities emerged: serious concerns about psychological safety associated with diagnostic error; lack of infrastructure for measurement, monitoring, and improvement activities related to diagnosis; lack of leadership investment, which was often diverted to competing priorities related to publicly reported measures or other incentives; and lack of dedicated teams to work on diagnostic safety. Participants provided several strategies to overcome barriers including adapting trigger tools to identify safety events, engaging patients in diagnostic safety, and appointing dedicated diagnostic safety champions. Several foundational building blocks related to learning health systems could inform organizational efforts to reduce diagnostic error. Promoting an organizational culture specific to diagnostic safety, using science and informatics to improve measurement and analysis, leadership incentives to build institutional capacity to address diagnostic errors, and patient engagement in diagnostic safety activities can enable progress.

Variation in survival rates among patients with angiosarcoma based on demographic and socioeconomic factors in academic versus non-academic settings: An NCDB analysis.

e23537 Background: Angiosarcomas are malignancies of endothelial-cell origin representing 2% of soft-tissue sarcomas. Although the number of cases of angiosarcoma continues to rise, the prognosis is generally poor and treatment options remain limited. Due to the rarity of angiosarcoma and limited available literature, this study is intended to analyze the impact of demographic and socioeconomic factors on patients’ survival rates in academic versus non-academic settings. Methods: We performed a retrospective analysis of 5,544 patients diagnosed with angiosarcoma from the National Cancer Database (NCDB) between 2004-2017. Patients were stratified by facility type and compared via Kaplan-Meier analysis, log-rank test, chi-square analyses, and ANOVA. Additionally, a cox proportional hazards multivariate regression model was used. The following demographic factors were examined: age, sex, reported race and ethnicity, mean survival rates utilizing the Charlson Comorbidity Index, facility type where patients received treatments, and treatment modalities. Furthermore, the assumption of proportionality was tested for each variable. Data was analyzed using Statistical Analysis Software (SAS). Results: Higher rates of death were seen in those of male sex, African American race, increased age (> 72), and increasing Charlson-Deyo scores. There was an increased risk of death for older African American males with non-zero Charlson-Deyo scores. Additionally, patients from areas of increased income had decreased rates of death. After adjusting for most variables, patients who were treated at academic facilities had an 8.5% decreased risk of death compared with patients treated at non-academic facilities (95% CI: 1.5% to 15.0%; P = 0.019). Conclusions: Our study results indicate that certain demographic and socioeconomic factors may be linked to poorer survival outcomes in patients with angiosarcoma. Further investigation of socioeconomic barriers and prognostic factors for angiosarcoma may help to identify populations at risk for poor treatment outcomes and guide disease management.

Trends and factors affecting approach choice to pulmonary resection.

The development of an advanced robotic platform in 2014 led to increased adoption of minimally invasive (MI) approaches in thoracic surgery. Due to dataset reporting lag, a comprehensive assessment of trends in thoracic approaches has not been analyzed to date. We queried the National Cancer Database (NCDB) for patients with Stage I-III who underwent lung resection from 2010 to 2018. Most published NCDB analyses on lung cancer using pre-2015 data. Overall treatment trends were analyzed, with geographic, institutional, and socioeconomic characteristics evaluated for approach. There were 162 335 lung resections, and 131 958 were anatomic. Robotic resection saw a steady increase through 2012 but plateaued in 2013-2014. From 2015 to 2018, another increase correlated with the release of a new platform. Video-assisted thoracoscopic surgery lung resection plateaued in 2014 and decreased in 2018. Open resection steadily decreased. Tumors requiring neoadjuvant radiation had an increase in MI approach with corresponding decreases in the open. On multivariable analysis, African-American race, low volume, Medicaid insurance, and nonacademic setting were associated with a lower likelihood of MI surgery. The open approach has decreased since 2010. More than 65% of anatomic resections are now performed inMI. As this trend will continue, it is important that all patients are afforded the opportunity of the least invasive approach.

Characteristics of Female Sexual Health Programs and Providers in the United States.

BackgroundFemale sexual dysfunction is a prevalent condition affecting 12% of women, yet few academic centers in the US have female sexual medicine programs.AimTo characterize female sexual health programs in the United States, services offered, and training of female sexual health providers.MethodsWe performed an internet search to identify female sexual health programs and clinics in the US. From each programs’ website we abstracted the location, clinic setting (academic vs private), training of providers, and whether the clinic provided investigational services (ie, PRP injections, laser/radiofrequency therapy). We categorized clinics as specialized in sexual medicine, specialized with a focus on cancer patients, general, aesthetics-focused, general & aesthetic, or specialized & aesthetic. We used Chi-square and Fisher's exact test to evaluate association between practice setting and provision of investigational therapies with a Bonferroni-adjusted critical P-value of 0.017.OutcomesOur outcomes were the number of clinics in each setting, in each category, and each state, as well as the number of providers by training type.ResultsWe identified 235 female sexual medicine programs in the United States. Seventeen percent were in the academic setting. Clinics in the non-academic setting were significantly (α = 0.017) more likely to offer PRP injections (0% vs 47%, P < .001), laser/radiofrequency therapy (14% vs 56%, P < .0001), and shockwave therapy (0% vs 14%, P = .011). Among all clinics, 22% provided specialized care, 2% provided care for cancer patients, 29% were more general clinics that advertised female sexual healthcare, 23% were aesthetics-focused, 22% were general practices that provided aesthetics services, and 2% were specialized clinics that offered aesthetics services. 81% of aesthetics-focused clinics advertised PRP injections. Seven states had no clinics and 26 states lacked a clinic specializing in female sexual health. The most frequent providers were OB/Gyns (40%), nurse practitioners (22%), urologists (13%), and physicians assistants (10%).Clinical ImplicationsThe geographic distribution of clinics and pervasiveness of clinics offering investigational services for female sexual dysfunction may be a barrier for patients seeking care.LimitationsAs a result of our internet search methodology, we likely did not capture all clinics providing female sexual health services. Further, the accuracy of our data depends on the level of detail provided on each clinics’ website.ConclusionOnline search identified few clinics providing female sexual healthcare in academic medicine: development of such clinics could benefit patients by improving access to evidence-based care and promoting training of future providers.Elizabeth E. Stanley and Rachel J. Pope, Characteristics of Female Sexual Health Programs and Providers in the United States. Sex Med 2022;10:100524.

Root Canal Treatment Survival Analysis in National Dental PBRN Practices

Few studies have examined the longevity of endodontically treated teeth in nonacademic clinical settings where most of the population receives its care. This study aimed to quantify the longevity of teeth treated endodontically in general dentistry practices and test the hypothesis that longevity significantly differed by the patient’s age, gender, dental insurance, geographic region, and placement of a crown and/or other restoration soon after root canal treatment (RCT). This retrospective study used deidentified data of patients who underwent RCT of permanent teeth through October 2015 in 99 general dentistry practices in the National Dental Practice-Based Research Network (Network). The data set included 46,702 patients and 71,283 RCT permanent teeth. The Kaplan–Meier (product limit) estimator was performed to estimate survival rate after the first RCT performed on a specific tooth. The Cox proportional hazards model was done to account for patient- and tooth-specific covariates. The overall median survival time was 11.1 y; 26% of RCT teeth survived beyond 20 y. Tooth type, presence of dental insurance any time during dental care, placement of crown and/or receiving a filling soon after RCT, and Network region were significant predictors of survival time (P < 0.0001). Gender and age were not statistically significant predictors in univariable analysis, but in multivariable analyses, gender was significant after accounting for other variables. This study of Network practices geographically distributed across the United States observed shorter longevity of endodontically treated permanent teeth than in previous community-based studies. Also, having a crown placed following an RCT was associated with 5.3 y longer median survival time. Teeth that received a filling soon after the RCT before the crown was placed had a median survival time of 20.1 y compared to RCT teeth with only a crown (11.4 y), only a filling (11.2 y), or no filling and no crown (6.5 y).

Digital Migration Practices and the Everyday

AbstractThis special issue explores the role that digital technology plays in the lives of migrants. It does so by paying close attention to governmental and supranational organizations as well as to subjective and affective dimensions of the everyday. Digital migration practices emerge as complex negotiations in the digital media sphere between infrastructural bias and agential opportunities, contesting racial practices as well as enabling digitally mediated bonds of solidarity and intimacy. The issue offers nuanced critical perspectives ranging from surveillance capitalism, extractive humanitarianism, datafication, and border regimes to choreographies of care and intimacy in transnational settings, among other aspects. Renowned international scholars reflect on these issues from different vantage points. The closing forum section provides state-of-the-art commentaries on digital diaspora, affect and belonging, voice and visibility in the digital media sphere, queer migrant interventions in non-academic settings, and datafication and media infrastructures in “deep time.”

An IRIS Registry-Based Assessment of Primary Open-Angle Glaucoma Practice Patterns in Academic Versus Nonacademic Settings

To compare patient demographic data; level of severity; and clinical, diagnostic, and surgical practice patterns in patients with primary open-angle glaucoma (POAG) in an academic setting vs nonacademic setting using the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight). A retrospective cohort study of IRIS Registry data that included patients with POAG who were seen between January 2016 and December 2019 and had at least 1 year of follow-up. Of 3 707 084 distinct eyes with POAG, 3% (109 920) were included in the academic subcohort and 97% (3 597 164) were included in the nonacademic subcohort. Among the findings of greatest note (P < .0001 for all comparisons) were a higher proportion of eyes of Black patients, a higher proportion of eyes with level 3 severity, and a higher mean cup-to-disc ratio in eyes in the academic setting. The relative frequency of gonioscopy, pachymetry, and visual field testing in conjunction with new patient visits was also notably higher in the academic setting. For glaucoma surgical procedures, the greatest proportional differences in relative frequency were seen for tube shunt procedures (2.55-fold higher in the academic setting), iStent and Hydrus procedures (2.52-fold higher in the nonacademic setting), and endoscopic cyclophotocoagulation (5.80-fold higher in the nonacademic setting). Based on IRIS Registry data, notable differences appear to exist with regard to ethnoracial groups, glaucoma severity, and diagnostic and surgical practice patterns in academic vs nonacademic settings. By understanding these differences, potential opportunities exist in the development of educational programs related to clinical and surgical glaucoma care.

Virtually Bridging the Safety Gap between the Lecture Hall and the Research Laboratory

Laboratory safety has received heightened attention due to a series of devastatingly tragic accidents in both academic and nonacademic settings. Consequently, chemistry departments at various academic institutions now offer some form of formal training in laboratory safety for entering graduate students. Although the extent of this training varies widely among institutions, it typically includes an online assessment and/or minimal in-person classroom instruction. However, a significant gap exists between a lecture hall setting and the complex environment that comprises an advanced research laboratory. We’ve adapted the technological advances in virtual and augmented reality to bridge this gap. A set of 360° virtual reality lab experiences, highlighting safety infractions, have been created for a variety of subdiscipline-distinct (medicinal, organic, inorganic, physical, drug screening) laboratory settings. Notable features include the accurate depiction of the visual complexity associated with research settings, the opportunity for the trainee to explore multiple laboratories in a self-paced fashion, and immediate feedback with respect to the identification of safety hazards. The VR Lab Safety modules were very well received by first year graduate students, with greater than 85% of the respondents describing the VR experience as engaging and memorable, as a good supplement to safety reading material, and as providing real world examples that are otherwise difficult to visualize.

Evaluation of the “Positive Parent”, a Spanish web-based program to promote positive parenting in a Personal Learning Environment

Introduction. The increasing use of online parenting resources offers the opportunity to improve the parenting role through Personal Learning Environments (PLEs). However, there is no evidence concerning the effectiveness of the learning process that takes place in a PLE space. Method. We evaluated the “Positive Parent” program through the self-assignment of: (a) 143 Spanish-speaking parents to the program modules, following a fixed learning itinerary based on the experiential methodology (Program Group), and (b) 139 parents to complementary multimedia material, following a self-guided, flexible learning itinerary (Visitor Group). For the first goal, both groups were automatically monitored for their pre-posttest completion of the Positive Parenting Scale, resulting in significant improvements in Family involvement, Affection and recognition for the child, Family communication and stress management, and Shared activities in the Program Group only. For the second goal, the Program Group was automatically monitored for Connection time, Connection duration, and Program duration, as well as level of engagement in Forum participation, Diary use, and Making a commitment. Results. Latent Profile Analysis (LPA) was used to identify patterns of pre-post changes in positive parenting, showing moderate to high improvements in three out of four profiles, that is, for 87.4% of the parents. There was a significant relation between the participants’ decisions in the PLE space and profile membership, with higher engagement in forums, diary use, and making a commitment linked with greater improvements in positive parenting. Discussion and Conclusion. Given the use of spontaneous enrolment and self-assignment of participants to the program and visitor conditions, we cannot rule out the possibility that individual differences in unknown factors (i.e., motivation) may have affected the results for program effectiveness. However, we provide evidence that the significant improvements in all dimensions of positive parenting were limited to the Program Group, as indicated by the significant group x time interactions, despite the Visitor Group’s exposure to equivalent multimedia materials. For the first time, this evaluation reveals some of the relevant implementation conditions related to the effectiveness of PLEs in non-academic settings. The Positive Parent program provides Spanish-speaking parents with an innovative and successful learning experience to enhance positive parenting that may ultimately promote positive child development and family wellbeing.

Opportunities for Excellence in Interventional Radiology Training: A Qualitative Study.

The training experience in interventional radiology (IR) residency programs varies widely across the country. The introduction of an IR training pathway has provided the impetus for the specialty to better define outstanding IR education and for programs to rethink how their curricula prepare IR trainees for real-world practice. Although ACGME competencies define several training components that are necessary for independent practice, few quantitative or qualitative studies have explored current perceptions on what constitutes optimal IR training. Our goal was to qualitatively explore program training features deemed most important to adequately prepare IR physicians for practice and assess whether there were differences in perception between academic and nonacademic practices. Semistructured interviews were conducted with 71 IR attending physicians, trainees, and support staff across the United States. All interviews were performed over the telephone by a single researcher for consistency and systematically coded by two independent coders for common themes. Frequency and prevalence of themes and facilitating features were analyzed. The most frequently perceived facilitating features included longitudinal patient care experience, practice-building education, interspecialty collaboration exposure, broad case mix, clinical decision-making exposure, diagnostic radiology training, procedural skills training, and graduated autonomy. Comparing nonacademic versus academic practice settings, significantly more nonacademic IR attending physicians expressed practice-building education (prevalence 72% versus 42%, frequency 2.2 versus 0.7, P < .01) as an important training experience. An understanding of perceived facilitating features for optimal IR trainee preparation, including potentially different needs between academic and nonacademic practices, can help programs prepare their trainees for a successful transition into practice.

Cardio-Oncology Care Delivered in the Non-academic Environment.

It is a fact that the field of Cardio-Oncology is growing rapidly throughout the USA and abroad. Cancer and heart disease continue to be the leading causes of death in the USA, and oncologic therapies are evolving to the point that cancer survivors are increasing yearly, some living long enough to develop cardiovascular disease, and others living with sequelae from their cancer therapy. The financial burdens to the healthcare system continue to present barriers for the delivery of healthcare, especially for patients with heart disease and cancer as chronic diseases. Collaboration between cardiologists and oncologists is paramount to ensure timely cancer care while minimizing cardiotoxicity. The field of Cardio-Oncology is the perfect model for the current management of these patients, positioned to break down silos, avoid delays in cancer care, and treating potential short- and long-term sequela of cancer therapy in a cost-efficient manner. While cardio-oncology programs initially sprang from the academic and defined cancer centers, it is rapidly growing in the nonacademic settings. This paper explores reasons that occurred and explores some of the unique aspects to cancer care and cardio-oncology delivery in the nonacademic setting. The ultimate goal is to achieve the best cancer care with the least degree of disruption to therapy that also minimizes cardiotoxicity, lowering costs, and improving outcomes for patients.

Othering: When Malaysians are Mocked for ‘Speaking London’

Malaysia is a multicultural society. There are over 130 languages spoken by various ethnicities in the country. The official language is Malay, and it is emphasised as a medium of teaching and learning and a language of knowledge. English continues to be the dominant language in the country's trade and industrial sector. Both languages are taught at primary, secondary and tertiary levels to equip learners for future undertakings. To advance in proficiency, English language users are encouraged to practice the language in non-academic settings. However, studies show that using English openly poses a specific challenge to its users. Speakers report experiencing instances of 'othering' when they use English. 'Othering' happens when speakers of a different language feel ostracised by members of their ethnic group due to prejudiced mentality. It can hinder their progress in English language proficiency by building resentment and insinuating betrayal against their own cultural identity. However, language attitude is shifting. More Malaysians recognise the importance of English in academia and business. This study explores the effects of ‘othering' on language learning and cultural identity and how a change in attitude toward English may help to minimise instances of othering. This paper presents findings from data collected and analysed through a semi-systematic review of published literature. The discussion focuses on how a shift in attitude about English might serve to eliminate cases of othering against English users in Malaysian.

Burnout Among Nephrologists in the United States: A Survey Study

Rationale & ObjectiveBurnout decreases job satisfaction and leads to poor patient outcomes but remains underinvestigated in nephrology. We explored the prevalence and determinants of burnout among a sample of nephrologists.Study DesignCross-sectional.Setting & ParticipantsThe nephrologists were approached via the American Medical Association Physicians Masterfile, National Kidney Foundation listserv, email, and social media between April and August 2019. The predictors were demographics and practice characteristics. The outcome was burnout, defined as responding “once a week” or more on either 1 of the 2 validated measures of emotional exhaustion and depersonalization or both.Analytical ApproachParticipant characteristics were tabulated. Responses were compared using χ2 tests. Multivariable logistic regression was used to estimate the odds ratios (ORs) of burnout for risk factors. Free text responses were thematically analyzed.ResultsAbout half of 457 respondents were 40-59 years old (n=225; 49.2%), and the respondents were more predominantly men (n=296; 64.8%), US medical graduates (n=285; 62.4%), and in academic practice (n=286; 62.6%). Overall, 106 (23.2%) reported burnout. The most commonly reported primary drivers of burnout were the number of hours worked (n=27; 25.5%) and electronic health record requirements (n=26; 24.5%). Caring for ≤25 versus 26-75 patients per week (OR, 0.34; 95% confidence interval [95% CI], 0.15-0.77), practicing in academic versus nonacademic settings (OR, 0.33; 95% CI, 0.21-0.54), and spending time on other responsibilities versus patient care (OR, 0.32; 95% CI, 0.17-0.61) were each independently associated with nearly 70% lower odds of burnout after adjusting for age, sex, race, and international medical graduate status. The free text responses emphasized disinterested health care systems and dissatisfaction with remuneration as the drivers of burnout.LimitationsInability to precisely capture response rate.ConclusionsNearly one-quarter of the nephrologists in our sample reported burnout. Future studies should qualitatively investigate how the care setting, time spent on electronic medical records, and hours of clinical care drive burnout and explore other system-level drivers of burnout in nephrology.

Foreign Language Acquisition Anxiety and Project-Based Learning in Collaborative L2 Instruction: A Case Study

This article discusses the experiences of an instructor-student collaboration in combining English as a Second Language instruction with a project-based model. It provides information about a year-long period of instruction that made use of extensive collaboration in language instruction for the creation of business documents geared to a specific purpose. The article suggests that such a project-based and collaborative approach to Foreign Language Learning might be useful in alleviating foreign language learning anxiety for advanced speakers of a second language. Additionally, the article discusses instruction performed via the Zoom platform. The use of platforms such as Zoom, or Skype, are becoming more ubiquitous as an instructional trend that pre-dates recent public health concerns, and this technology is discussed here in terms of the opportunities for collaborative learning and feedback it offers in a discipline that is still favors traditional face-to-face instruction. Although the experiences described here occurred in a non-academic setting with an instructor-student dyad, we suggest that it may be useful in academic settings with additional students and fewer collaborative opportunities to create highly specific objectives.

Understanding the Experiences of Mauritian Students at Institutions of Higher Education Overseas

Each year, a significant number of students from the Indian Ocean island of Mauritius seek higher education opportunities abroad. Yet, limited research exists on these students’ expectations, preferences, and experiences in their academic and non-academic university settings overseas. This quantitative study investigates the experiences of Mauritian degree-seeking students at universities in Australia and the United Kingdom, which have been two of their most preferred destination countries for Mauritian international students over the years. It specifically examines associations between overall university satisfaction and various aspects of the student experience in the arrival, learning, living, and support services environment. Analyses from this research reveal that a number of satisfaction variables were important to students, namely the opportunity to make friends on campus, the availability of social activities and facilities, internet access and IT support, and chaplaincy or multi-faith provision. Implications for international educators, university administrators, and guidance counselors are discussed.