Participants In Study Group Research Articles

Evaluation of Factors Affecting Epiretinal Membrane Surgery Outcomes.

Objectives:The aim of this study was to evaluate several factors affecting the outcome of epiretinal membrane (ERM) surgery.Methods:The data of a total of 41 eyes of 40 patients (20 female, 20 male) who underwent pars plana vitrectomy (PPV) and epiretinal membrane (ERM) peeling with/without internal limiting membrane (ILM) peeling between November 2001 and October 2005 at Beyoğlu Eye Training and Research Hospital with a minimum follow-up of 6 months were included in this retrospective study. The patients’ best corrected visual acuity (BCVA; Snellen) and the biomicroscopic, funduscopic, and optical coherence tomography (OCT) findings measured preoperatively and at month 1,3,6, and a final visit were recorded. The surgical technique (partial 25-gauge vs 20-gauge), ILM peeling, intraoperative dyes, and the etiology of the ERM were evaluated as separate factors in the surgical outcome. Intraoperative, peroperative, and postoperative complications were assessed and compared.Results:The mean age of the study group participants was 63.56±14.96 years. The mean BCVA had increased from 0.28±0.149 to 0.35±0.24 Snellen lines (p=0.028) at the 6-month visit. In all, 18 of 41 eyes (43.9%) had gained ≥2 Snellen lines at the final visit. Cataract progression was detected in 17 cases (54.8%) of phakic eyes. The incidence of ERM recurrence was significantly greater in the ILM Intact group (37% vs 0%) than in the ILM Peeled group (p=0.009). There was no significant difference in anatomical or functional outcome between the partial 25-gauge and 20-gauge PPV techniques.Conclusion:ILM peeling significantly reduced ERM recurrence. Follow-up observations indicated that cataract progression was the primary factor limiting visual gain.

Short- and Long-Term Impacts of Engagement Experiences with Faculty and Peers at Community Colleges.

This study uses nationally representative longitudinal data and propensity score modeling to evaluate the effects of first-year engagement experiences at community college-including social and academic contact with faculty and participation in study groups and clubs-on achievement, persistence, degree attainment, and vertical transfer. Speaking with faculty about academic matters improved short- and long-term outcomes, while engaging in study groups and clubs improved early outcomes, with less sizeable long-term impacts. The findings highlight the need for continued inquiry into community college engagement using longitudinal data with detailed engagement and outcome measures to determine best practices.

Validity and Reliability of the Turkish SingingVoice Handicap Index-10

To evaluate the validity and reliability of the Turkish version of the Singing Voice Handicap Index-10 (SVHI-10). Cross-sectional study. Two hundred singers consisting of a control group (n = 136) without voice complaints and a study group (n = 64) diagnosed with a voice disorder served as participants. To detect test-retest reliability, 97 participants (representing a portion of both the control and study group participants) completed the index twice with a minimum of a one-week interval between each completion. Internal consistency was confirmed using Cronbach's alpha coefficient. To complete a clinical validity assessment, scores from the control group participants were compared with scores from the study group participants. To determine content validity, the correlation between the SVHI-10 and the participants' perceptions of singing voice complaints was researched. The sensitivity and specificity of the SVHI-10/Turkish version were calculated using a receiver operating characteristic curve analysis. Cronbach's alpha coefficient, which was equal to 0.91, proved to have excellent internal consistency. Item-total correlations were found in the range of 0.55 to 0.76. The mean SVHI-10/Turkish score for the control group was 8.14 ± 5.4, whereas this value was significantly higher in the study group (20.54 ± 6.9, P < 0.001). The Pearson product-moment correlation test indicated that the Turkish SVHI-10 is a reliable tool (r = 0.90, n = 97, P < 0.001). The area under curve of the Turkish SVHI-10 was 0.95. The optimal cut-off point was found to be 11.5, with a sensitivity of 95.8% and a specificity of 83.2%. The Turkish version of the SVHI-10 has proven to be a reliable and valid instrument for evaluating the self-perception of a singer in relation to voice problems. It can also be used as a quick screening tool because a score on the SVHI-10 higher than 11.5 is indicative of an abnormal singer's perceived voice handicap.

Effectiveness of instructional intervention upon multipara women’s practices to control stress incontinence

Objective(s): to determine the effectiveness of instruction intervention upon multipara women's practices tocontrol stress incontinence.Methodology: A quasi-experimental study was carried out from (2nd) April, 2010 to 15th June, 2010. Nonprobability(purposive sample) of (60) multiparous women was selected from Baghdad Teaching Hospital and AlElwiaMaternity Teaching Hospital in Baghdad city, the sample was divided into two groups (30) women wereconsidered as a study group, and another (30) were considered as the control group. An instructional interventionwas applied on the study group, while the intervention was not applied on control group. A questionnaire wasresolve as a tool of data collection to suit the purpose of the study. A pilot study was carried out to test thereliability and validity of the questionnaire for the period from 10th of March. - 30 March. 2010. Data wereanalyzed through the application of descriptive statistical data analysis approach (frequency, percentage, mean ofscores) and inferential statistical data analysis approach (correlation coefficient, and chi- square).Result: The results of the study revealed that the study group participants had benefited from the implementationof instructional intervention and dramatic change had occurred in their practices to control stress urinaryincontinence. The study concluded that the majority of mothers had adequately met their needs control stressurinary incontinence-pelvic floor and perineum muscles exercise, and lifestyle change.Recommendation: The study recommended that the instructional intervention can be presented to all multiparapregnant mothers who are attending to the primary health care centers; moreover, an instructional interventionmight be implemented in the hospital for multipara women to increase their knowledge about stress urinaryincontinence. The study also recommended that the nurse must take the role for teaching multiparous women theprinciples of control SUI while they perform such procedure for them during postpartum period.

Effectiveness of Nursing Management Education Program upon the Nurse Managers' Knowledge about Planning in Baghdad City Hospitals

Objective: To determine the effectiveness of the Nursing Management Education Program upon the NurseManagers' Knowledge about planning in Nursing Management at Baghdad City Hospitals.Methodology: A Quasi-experimental study in which a purposive "non-probability" sample of (50) NurseManagers was selected from Baghdad City Hospitals. These Managers were divided into two equal groups of(25) Nurse Managers for each (study and control ones). A questionnaire was developed as a tool for datacollection. A pilot study was carried out to test the reliability of the questionnaire for the period from April 2nd toJune 20th 2007. The pre-post test approach was applied to the study and control groups as mean for the quasiexperimentaldesign when the education program was implemented in the period from October 1st 2007 toFebruary 1st 2008. Data were analyzed through the application of the descriptive data analysis approach(frequency, percentage, mean) and inferential data analysis approach (T-test).Results: The study results revealed that the study group participants made use of the implementation of nursingmanagement program and a change had occurred to their knowledge about planning in nursing management. Thestudy concludes that the nursing management education program can be considered an effective mean for theimprovement of the nurse managers' knowledge about planning in nursing management.Recommendations: The study recommends that the nursing management education program can be presented toall nurse managers with respect to planning in nursing management.

Synchronized Pedaling with Martial Arts Improves Quality of Life of Women with Breast Cancer.

Physical exercise improves the physical condition of women who have been undergone surgery for breast cancer. This study evaluated the effect of a new martial arts program that combined aerobic endurance and muscle strength exercises on improving upper limb function and aerobic performance of women who have undergone breast cancer surgery. Fifty-three women who had previously undergone breast cancer surgery with axillary lymph node dissection, radiotherapy and/or chemotherapy participated in the twelve-week program. Participants were randomly assigned to two groups; a study group (28 participants) in which participants carried out a synchronized pedaling with martial arts routine of 2 sessions per week, and a control group (22 participants) who received usual care. Study group participants demonstrated a significant increase in right hand and quadriceps strength, maximum oxygen consumption, max power-to-weight ratio, muscle mass percentage and a decrease in fat mass percentage (p≤0.05). A controlled training system like synchronized pedaling with martial arts, which combines aerobic and strength exercises, appears suitable for improving the muscle strength and aerobic capacity of these breast cancer participants.

Psychological Effects of the SRS-22 on Girls With Adolescent Idiopathic Scoliosis

Study DesignProspective, randomized control study. ObjectivesTo determine whether the SRS-22r (SRS-22) has a negative effect on the body image of females with adolescent idiopathic scoliosis (AIS) using the Body Appreciation Scale (BAS). SummaryThe SRS-22 is a validated questionnaire designed by the Scoliosis Research Society (SRS) to assess outcomes of scoliosis patients. Parents and nursing staff have expressed concern that the questionnaire may incite body image concerns when administered to teenagers with AIS. MethodsFemale AIS patients were prospectively enrolled and randomly assigned to the study or control group. Patients were being observed, braced, or planning operative intervention. Patients in the study group were administered the SRS-22, followed by the BAS. Patients in the control group were administered only the BAS. The BAS is scored from 13 to 65, with higher scores indicating a more positive body image. Results45 females were enrolled and assigned to study group (n = 24, SRS-22+BAS) or control group (n = 21, BAS only). There were no differences between the groups in age (p = .55) or Cobb angle (p = .21). There were no differences in overall BAS scores between study (mean = 55.9, range 31–65) and control group participants (mean = 54.2, range 42–64, p = .56). SRS-22 questions and BAS scores had multiple correlations. A higher BAS score is associated with the following SRS-22 questions: being a happy person in the last 6 months, feeling calm and peaceful during the past 6 months, and feeling attractive with one’s current back condition. A lower BAS score is associated with the following SRS-22 questions: being down in the dumps, feeling downhearted and blue, and feeling that one’s back condition affects personal relationships. ConclusionSimilar BAS scores were observed between the study and control group. Despite concerns regarding the potential negative impact of the SRS-22, taking the questionnaire was not observed to negatively affect patients’ body image. Level of EvidenceLevel II.

Investigation of the Effectiveness of a Holistic Vocal Training Program Designed to Preserve Theatre Students’ Vocal Health and Increase Their Vocal Performances; A Prospective Research Study

ObjectiveThe main purpose of this study is to investigate the effectiveness of a 12-week holistic vocal training program designed for theatre students. MethodsThe participants included 10 female and 8 male students, who were third- and fourth-year students of a state conservatory theatre department. Participants randomly selected from among those who were between the ages of 18–30 years, had no history of voice disorders, and had no systemic and neurological disorders. The study group (n = 9) was involved in the vocal training program. The control group (n = 9) has not received any training. During the program, 12 sessions of lectures and voice exercises were given to all participants of the study group for a period of 12 weeks. The sessions were planned to last for a duration of 30–45 minutes. Participants’ knowledge of vocal health was assessed using a questionnaire that was developed in the present study and a multidimensional voice assessment protocol including acoustic analyses and audio-perceptual evaluation has been applied. ResultsWithin-group comparisons indicated a significant increase in the study group participants’ knowledge of vocal hygiene after training (P = 0.011). Similarly, the study group outperformed the control group in the vocal mechanism knowledge (P = 0.027). Multidimensional Voice Profile findings revealed that vocal qualities of the control group deteriorated, whereas no alterations were found in the study group. Audio-perceptual analysis conducted through the Consensus Auditory-Perceptual Evaluation of Voice did not introduce significant changes in the control group in overall severity and roughness parameters, these values were found significantly improved for the study group. ConclusionIt can be concluded that the Holistic Vocal Training Program designed in the present study is effective for preserving theatre students’ vocal health and voice quality. It is important for future studies to search the long-term effects.

Variance-mediated multifractal analysis of group participation in chasing a single dangerous prey

Complexity of group participation in chasing a single dangerous prey is usually influenced by many factors such as the group size, the physiological fitness of predator, the hunting tactics and the running speed of prey. The group members may take diversified roles and switch their roles in the process of group hunting. In this paper, we study group participation in lions’ pride hunting by using a minimal cheating–pursuing model formulated in discrete-time random walks. Predator’s switching between cheating state and pursuing state is determined by a preset probability transition matrix which is regarded to be a product of the combination of various factors that influence group participation. The physiological constraints of lions require that the measurement of complexity of group participation must be built for short time series. On the basis of 300 simulated time steps, numerical results show that our model reasonably reflects the common expectation that the pride groups tightly in chasing a single slow prey while in chasing a single fast prey it groups loosely. We compute the distance between the group center and the center of the concerted pursuing for the quantification of group participation. Complexity embedded in short time series of these quantities is measured via a new method named variance-mediated multifractal analysis. This method is based on the partition function which is the weighted sum of probability measures of qth power. The short time series is divided into non-overlapping windows where the sample variance of each window is used to build the normalized probability measure. A strategy, “one-point indent for local past”, is designed to weigh the probability measures. The singularity spectrum exhibits more multifractality in the simulated group participation in chasing a fast prey and far less such in chasing a slow one, showing the potential applications of this method in studying short process of group hunting.

Relationship Between Psychiatric Morbidity and Substance Dependence in Patients with Borderline Personality Disorder

Purposes of this study were empirical research of prevalence of psychiatric morbidity (PM) in male prisoners suffering from borderline personality disorder (BPD) and also relations between PM and pattern of substance dependence (SD). This cross-sectional study was done at a prison hospital with total sample size of 712 participants (study = 306, control = 306). The study period was 20 months. All participants were male prisoner ≥ 18 years of age suffering from BPD. Participants in study group met an additional criterion of having SD. Results indicate that there was no difference between two groups in terms of socio-demographic variables like age, educational status, and occupation. Among study participants those suffering from PM had earlier onset of substance use, both use and dependence for longer duration and more sever consumption pattern than those without PM. Majority of them had onset of PM after onset of SD. Substance using BPD prisoners had higher (68.6%) prevalence of PM especially generalized anxiety disorder (GAD) (24.2%), adjustment disorder (12.7%), and major depressive disorder (MDD)/recurrent depressive disorder (RDD) (11.1%). Among study participants, 118 (56.9%) participants with PM used three or more than three psychoactive substances against 20(20.3%) in those without PM. The results suggest that a higher burden of PM exists in substance using BPD population than those without PM and occurrence of PM in turn leads to earlier onset and increased severity of SD in this population.

The effect of maternal exercise program on fetal growth in pre-eclampsia: a prospective, randomized controlled clinical trial

Background Pre-eclampsia affects 2–8% of all pregnancies globally and the condition is estimated to account for 10–15% of maternal deaths worldwide. Preterm birth accounts for 15% of pre-eclampsia disorders. Pre-eclampsia-associated morbidities and mortality can also lead to intrauterine growth restriction and death ‏. So a maternal exercise program has been recommended to prevent and/or decrease pre-eclampsia complications for both the mother and the fetus. Objective The aim of this study was to assess the effect of maternal exercise program on fetal growth in pre-eclampsia. Patients and methods Thirty pregnant women who suffered from pre-eclampsia were selected from the inpatient Clinic of Mansoura University Hospitals; they were at 27th week of gestation. The participants were randomly assigned into two groups (control and study). The participants in the study group received a designed maternal exercise program. The outcome measure was fetal growth. Results Fetal growth measures were significantly higher in the study group compared with the control group (P Conclusion It was concluded that the maternal exercise program improved fetal growth in pre-eclampsia.

An international perspective on knowledge in teaching mathematics

This article provides an overview of the Special Issue of the Journal of Mathematical Behavior: An international perspective on the knowledge in teaching mathematics, with a focus on the primary and elementary levels. The work originated with presentations given at the International Congress on Mathematics Education (ICME) 13 in Hamburg, Germany, in the Summer of 2016. The papers were solicited from the participants in Topic Study Group (TSG) 45: Knowledge In/For Teaching Mathematics at Primary Level. A primary goal for TSG 45 was to advance theories about the teacher content knowledge and pedagogical content knowledge required for focusing instruction on building mathematical understanding and promoting student reasoning. This Special Issue emphasizes the role that teachers play in supporting that development. A significant corpus of research has identified major factors influencing how students build mathematical ideas and construct pathways of reasoning. However, our current understanding is that what is lacking is a conceptual framework that identifies and integrates factors regarding teachers’ roles in supporting students’ mathematical learning; and also, identifying the set of conditions and resources that optimally support that learning. We address this area of inquiry by organizing this overview article into the following sections: Cognitive perspectives; pedagogical perspectives; attending to students’ reasoning; language, communication and dialogue perspectives; and finally, we conclude with research-based implications for teaching practice and teacher professional learning.

Intervention provided by family doctors improves loneliness status for people who lost their only child

Objective To investigate the intervention of family doctor management system on the loneliness in people who lost their only child. Methods Sixty two residents who lost their only child in Shanghai Xujiahui district were enrolled in the study from December 2015 to June 2016. The participants were randomly divided into study group and control group with 31 cases in each group; the participants in study group were signed by family doctors and the psychological intervention was provided, those in control group had no intervention, the participants were followed up for 6 months, the psychological status was evaluated with UCLA loneliness scale in two groups. Results There were no significant differences in UCLA scores (63.26±7.17 vs. 60.03±7.59, t=1.709, P>0.05) and in the severity of loneliness (mild 0/30 vs. 1/31, moderate 9/30 vs. 11/31, severe 21/30 vs. 19/31, χ2=1.284, P>0.05) between study and control groups before the intervention. There were significant differences in UCLA scores (63.26±7.17 vs. 40.13±5.61, t=15.631, P 0.05) and in the severity of loneliness (mild 1/31 vs. 0/31, moderate 11/31 vs. 14/31, severe 19/31 vs. 17/30, χ2=1.471, P>0.05) in control group after 6-month follow-up. The UCLA scores (40.13±5.61 vs. 59.64±6.90, t=12.086, P<0.05) and the severity of loneliness (mild 17/30 vs. 0/31, moderate 13/30 vs. 14/31, severe 0/30 vs.17/31, χ2=34.030, P<0.05) in study group were significantly lower than those in control group after intervention. Conclusion The family doctor management system can improve the loneliness and mental health status of people who lost the only child, to reduce the risk of mental illness and the family and social burden. Key words: Loneliness; Family doctor; Lost the only child

Dental knowledge and dental service utilization: A 2-year follow-up study.

To investigate associations of dental knowledge with dental service utilization over 2years in South Australians aged 45-54years. In 2004-2005, a random sample of 2469 adults aged 45-54years from Adelaide, South Australia, who were selected from the Australian electoral roll was surveyed. The outcome variables were the numbers of visits and dental services received over 2years. Data were analysed using log-binomial and Poisson regression. Statistical significance was determined at P<.05. The response rates were 43.8% in the study group (n=879) and 50.7% in the comparison group (n=107). Oral examinations were conducted on 709 persons (81% of study group participants). Dental services data were collected from approximately 60% of participants at the end of years 1 and 2. After adjusting for sex, education, health card status, toothbrushing and inadequate dentition, higher caries knowledge and periodontal knowledge scores were associated with higher percentages of persons making dental visits (prevalence ratio, 95% CI: 1.2, 1.1-1.3 and 1.1, 1.0-1.3), and lower rates of extraction (rate ratio, 95% CI: 0.2, 0.1-0.4 and 0.4, 0.3-0.7) and endodontic services (0.5, 0.3-0.9 and 0.5, 0.3-0.7). Higher caries knowledge was associated with lower rates of fillings (0.8, 0.7-0.9) and denture services (0.1, 0.0-0.6), while higher periodontal knowledge was associated with higher numbers of visits (1.3, 1.2-1.5), and prophylaxis services (1.4, 1.1-1.8) and crowns (1.7, 1.1-2.5). South Australians aged 45-54years with higher dental knowledge had lower rates of invasive treatment over 2years. These findings warrant policy initiatives that highlight the importance of dental knowledge in improving oral health.

Impact of first-year mathematics study groups on the retention and graduation of engineering students

ABSTRACTMany interventions have been proposed to improve the retention and graduation rates of engineering students. One such intervention is to use study groups for first-year college students; such groups provide a structured environment in which the students can learn course material from each other outside of class and can provide the students with a sense of community. In this paper, we report on the impacts fostered by study groups in first-year mathematics courses on the odds of retaining and graduating engineering students. Students who participated in the study groups are compared to students of similar academic preparation who did not participate in such groups. It is found that student participation in study groups is significantly associated with the higher odds of being retained in engineering studies through the first 3 years of college. The results reported here are not as certain for the effect of study group participation on 5-year graduation odds for engineering students and some possible reasons for this are discussed.

Echocardiographic assessment of children participating in regular sports training.

OBJECTIVE:The aim of the present study was to determine the effects of a well-controlled endurance training program on cardiac functions and structures in healthy children and to define whether training hours per week and type of sports affect the training-induced cardiovascular response.METHODS:Echocardiographic recordings were obtained in 126 children who systematically participated in sports training for at least 1 year (study group), and the results were compared with the values obtained in 62 normal children who did not actively engage in any sports activity (control group). The two groups were comparable for age, sex, and body mass index. Study group participants were divided into two groups according to the duration of physical activity (training hours per week, <8 h and >8 h) and five groups according to the cardiovascular demand of sports type. Clinical examination, resting electrocardiogram, two-dimensional, M-mode, and Doppler echocardiography were obtained in all participants.RESULTS:Left ventricle wall dimensions, left atrial diameters, and aortic measurements were significantly higher in the study group. The mean mitral E/A ratio was also significantly higher in the training group than in untrained subjects (p<0.001). Echocardiographic measurements were similar between different sports type participants in the study group. However, aortic root diameter, left atrial diameter, and left ventricle posterior wall diastolic thickness were higher in children training >8 h/week than in children training <8 h/week in the study group.CONCLUSION:The present study showed that the echocardiographic parameters of children participating in regular sports training activities statistically significantly exceeded the parameters of untrained controls. These parameters were mostly dependent on the duration of training hours per week.

Effect of 12 weeks of slow breathing exercise practice on anthropometric parameters in healthy volunteers

Background: Regular practice of slow breathing technique shows improvement in the cardiorespiratory functions. The previous studies have reported that it is well known to decrease the effect of stress which, in turn, improves the physical and mental health of an individual. Aims and Objectives: This study aims to assess the effect of 12 weeks of slow breathing exercise practice on anthropometric parameters in healthy volunteers. Materials and Methods: A total of 59 young, healthy volunteers of both genders participated in this study. The subjects were allocated to the study group (n = 29) and control group (n = 30) based on simple random technique. Slow breathing exercise training was given to the study group for 20 minutes daily in two sessions for 12 weeks. Height, weight, body mass index (BMI), waist circumference, hip circumference, and waist/hip ratio were recorded at the start of the study and after 12 weeks in both the groups. Longitudinal changes in both the groups were compared by Student’s paired t-test. Comparison between the study group and control group was done by Student’s unpaired t-test. The statistical analysis was carried out at 5% level of significance and P < 0.05 was considered as statistically significant. Results: The average age of the study group and control group participants was 19.9 ± 1.8 years and 19.2 ± 1.9 years, respectively. BMI was significantly decreased in the study group from 21.75 ± 4.14 to 19.51 ± 3.95 (P 0.05) which was not statistically significant. Conclusion: Results of our study indicate that 12 weeks of slow breathing exercise training improve the anthropometric parameters in the study group. This indicates that regular, long-term slow breathing exercise training helps in weight reduction among the obese population.

Effect of Oral Insulin on Prevention of Diabetes in Relatives of Patients With Type 1 Diabetes

Type 1 diabetes requires major lifestyle changes and carries increased morbidity and mortality. Prevention or delay of diabetes would have major clinical effect. To determine whether oral insulin delays onset of type 1 diabetes in autoantibody-positive relatives of patients with type 1 diabetes. Between March 2, 2007, and December 21, 2015, relatives with at least 2 autoantibodies, including insulin autoantibodies and normal glucose tolerance, were enrolled in Canada, the United States, Australia, New Zealand, the United Kingdom, Italy, Sweden, Finland, and Germany. The main study group (n = 389) had first-phase insulin release on an intravenous glucose tolerance test that was higher than the threshold. The 55 patients in the secondary stratum 1 had an identical antibody profile as the main study group except they had first-phase insulin release that was lower than the threshold. Secondary strata 2 (n = 114) and strata 3 (n = 3) had different autoantibody profiles and first-phase insulin release threshold combinations. Follow-up continued through December 31, 2016. Randomization to receive 7.5 mg/d of oral insulin (n = 283) or placebo (n = 277), including participants in the main study group who received oral insulin (n = 203) or placebo (n = 186). The primary outcome was time to diabetes in the main study group. Significance was based on a 1-sided threshold of .05, and 1-sided 95% CIs are reported. Of a total of 560 randomized participants (median enrollment age, 8.2 years; interquartile range [IQR], 5.7-12.1 years; 170 boys [60%]; 90.7% white non-Hispanic; 57.6% with a sibling with type 1 diabetes), 550 completed the trial including 389 participants (median age, 8.4 years; 245 boys [63%]), 382 (96%) in the main study group. During a median follow-up of 2.7 years (IQR, 1.5-4.6 years) in the main study group, diabetes was diagnosed in 58 participants (28.5%) in the oral insulin group and 62 (33%) in the placebo group. Time to diabetes was not significantly different between the 2 groups (hazard ratio [HR], 0.87; 95% CI, 0-1.2; P = .21). In secondary stratum 1 (n = 55), diabetes was diagnosed in 13 participants (48.1%) in the oral insulin group and in 19 participants (70.3%) in the placebo group. The time to diabetes was significantly longer with oral insulin (HR, 0.45; 95% CI, 0-0.82; P = .006). The HR for time to diabetes for the between-group comparisons for the 116 participants in the other secondary stratum was 1.03 (95% CI, 0-2.11; P = .53) and for the entire cohort of 560 participants was 0.83 (95% CI, 0-1.07; P = .11), which were not significantly different. The most common adverse event was infection (n = 254), with 134 events in the oral insulin group and 120 events in the placebo group, but no significant study-related adverse events occurred. Among autoantibody-positive relatives of patients with type 1 diabetes, oral insulin at a dose of 7.5 mg/d, compared with placebo, did not delay or prevent the development of type 1 diabetes over 2.7 years. These findings do not support oral insulin as used in this study for diabetes prevention. clinicaltrials.gov Identifier: NCT00419562.

Assessing an Intervention Focused on Enhancing Interpersonal Communication Skills and Humor: A Multi-Method Quasi-Experiential Study Among Medical Students

ABSTRACTTeaching and applying interpersonal communication skills (ICS) and humor in medicine is challenging. The present study assessed an innovative course focused on enhancing ICS and humor based on the Four Habits Model and theater concepts. Medical students enrolled in the course (the study group) were assessed pre- and post-intervention, as well as compared with their peers (the control group) using quantitative methods to measure attitudes, self-efficacy, and behaviors. Qualitative methods were used to learn about students’ change in perceptions related to ICS and humor following the course, as well as their experiences of developing these skills during the course. Post-intervention study group participants scored significantly higher on all ICS measurements and on humor behavior compared with pre-intervention, and significantly higher on all humor measurements compared with control group participants. Interviews indicated students’ increased understanding and difficulties in learning these skills. Analyses showed how framing humor as one possible ICS and focusing on specific parts of the medical encounter can promote patient-centered care.

Effectiveness of Immersive Virtual Reality in Surgical Training—A Randomized Control Trial

Surgical training methods are evolving with the technological advancements, including the application of virtual reality (VR) and augmented reality. However, 28 to 40% of novice residents are not confident in performing a major surgical procedure. VR surgery, an immersive VR (iVR) experience, was developed using Oculus Rift and Leap Motion devices (Leap Motion, Inc, San Francisco, CA) to address this challenge. Our iVR is a multisensory, holistic surgical training application that demonstrates a maxillofacial surgical technique, the Le Fort I osteotomy. The main objective of the present study was to evaluate the effect of using VR surgery on the self-confidence and knowledge of surgical residents. A multisite, single-blind, parallel, randomized controlled trial (RCT) was performed. The participants were novice surgical residents with limited experience in performing the Le Fort I osteotomy. The primary outcome measures were the self-assessment scores of trainee confidence using a Likert scale and an objective assessment of the cognitive skills. Ninety-five residents from 7 dental schools were included in the RCT. The participants were randomly divided into a study group of 51 residents and a control group of 44. Participants in the study group used the VR surgery application on an Oculus Rift with Leap Motion device. The control group participants used similar content in a standard PowerPoint presentation on a laptop. Repeated measures multivariate analysis of variance was applied to the data to assess the overall effect of the intervention on the confidence of the residents. The study group participants showed significantly greater perceived self-confidence levels compared with those in the control group (P=.034; α=0.05). Novices in the first year of their training showed the greatest improvement in their confidence compared with those in their second and third year. iVR experiences improve the knowledge and self-confidence of the surgical residents.