Probing Questions Research Articles

Adapting the Cultural Formulation Interview for the Military.

U.S. military service members, veterans, and their families increasingly seek care from providers with limited knowledge of military culture. The 16-item core DSM-5 Cultural Formulation Interview (CFI) was designed to integrate cultural factors into assessment and treatment of mental disorders. Although the CFI was designed for use with all patients, it is unknown whether the CFI adequately assesses military culture. The authors describe a methodology to determine the need for specific CFI versions and how to create a version for use with persons affiliated with the military. Published articles on cultural competence in the military were systematically reviewed. Cultural domains were abstracted from each article, inductively coded, and hierarchically organized for assessment against the core CFI. A military CFI was created with additional implementation instructions, questions, and probes when the core CFI was inadequate for eliciting relevant cultural domains. Sixty-three articles were included. Coding revealed 22 military culture domains, of which only five would be elicited in the core CFI without additional guidance. Twelve of 16 questions in the core CFI required additional instructions, five benefited from question edits, and 10 needed additional probing questions. On the basis of these results, the authors crafted a military version of the CFI for service members, veterans, and their families. The military CFI for clinicians assesses aspects of military culture that are not comprehensively evaluated through the core CFI. The development process described in this article may inform the creation of other versions when the core CFI does not comprehensively assess cultural needs for specific populations.

Knowledge-Base in ELT Education: A Narrative-Driven Discussion

Knowledge and experience, mediated by reflection, are essential components in teacher education and development programs. This paper discusses core elements that have guided ELT education in the last years and analyzes the case of five English language teacher educators who –in the Colombian context—reflect on their own pedagogical practices through narrative. I guide the discussion by four probing questions that generate a reflective overview of English language teachers’ knowledge-base, identity construction, and decision-making when it comes to localizing knowledge. This reflection uncovers teacher educators’ gains and challenges as it becomes input for those others who are at different stages of their teaching career.

Experiences regarding internship among Bachelor of Science in nursing students in Peshawar: A qualitative study.

To explore the experiences of new nursing graduates during their internship in a tertiary care setting. The qualitative phenomenological descriptive study was conducted from September2020 to May2021 at three private hospitals of Peshawar, Pakistan, namely the Kuwait Teaching Hospital, the Mercy Teaching Hospital and the Prime Teaching Hospital. New nursing graduates of either gender were enrolled. Data was collected through semi-structured interviews using an interview guide and probing questions. Data was analysed using the 6-step Braun and Clarke method. Of the 11 subjects, 6(54.5%) were males and 5(45.5%) were females. Data led to the generation of four main themes; challenges, coping strategies, improved knowledge, and need for improvement in internship programme. The participants said certain types of individuals and organisational challenges affected them both personally and socially in their daily routines. Coping strategies varied among the subjects. New nursing graduates faced both individual and organisational challenges which is a matter of concern. Policies and their proper implementation should be planned to counter such challenges.

Contemporary Women's Post-Apocalyptic Fiction

Contemporary Women's Post-Apocalyptic Fiction

Medication reconciliation—is it possible to speed up without compromising quality? A before–after study in the emergency department

ObjectiveThe aim of this study was to investigate whether it was possible to decrease the time used for medication reconciliation (MR) in the emergency department without compromising quality. A more...

Environmental Risk Factors for Childhood Acute Lymphoblastic Leukemia: An Umbrella Review.

Simple SummaryLeukemia is the most common type of cancer among children worldwide. The aim of this umbrella review was to provide an evidence-based summary of epidemiological studies on environmental risk factors and the risk of childhood acute lymphoblastic leukemia (ALL), by exposure window. Second aim was to assess the prevalence in the German population which determines the relevance on population level. Only low doses of ionizing radiation in early childhood and maternal exposure to general pesticides during pregnancy showed convincing evidence of an association with childhood ALL. Other risk factors vary in level of association. The results of this umbrella review should be interpreted with caution; as the evidence are mostly from case-control studies, where selection and recall bias are potential concerns.Leukemia is the most common type of cancer among children and adolescents worldwide. The aim of this umbrella review was (1) to provide a synthesis of the environmental risk factors for the onset of childhood acute lymphoblastic leukemia (ALL) by exposure window, (2) evaluate their strength of evidence and magnitude of risk, and as an example (3) estimate the prevalence in the German population, which determines the relevance at the population level. Relevant systematic reviews and pooled analyses were identified and retrieved through PubMed, Web of Science databases and lists of references. Only two risk factors (low doses of ionizing radiation in early childhood and general pesticide exposure during maternal preconception/pregnancy) were convincingly associated with childhood ALL. Other risk factors including extremely low frequency electromagnetic field (ELF-MF), living in proximity to nuclear facilities, petroleum, benzene, solvent, and domestic paint exposure during early childhood, all showed some level of evidence of association. Maternal consumption of coffee (high consumption/>2 cups/day) and cola (high consumption) during pregnancy, paternal smoking during the pregnancy of the index child, maternal intake of fertility treatment, high birth weight (≥4000 g) and caesarean delivery were also found to have some level of evidence of association. Maternal folic acid and vitamins intake, breastfeeding (≥6 months) and day-care attendance, were inversely associated with childhood ALL with some evidence. The results of this umbrella review should be interpreted with caution; as the evidence stems almost exclusively from case-control studies, where selection and recall bias are potential concerns, and whether the empirically observed association reflect causal relationships remains an open question. Hence, improved exposure assessment methods including accurate and reliable measurement, probing questions and better interview techniques are required to establish causative risk factors of childhood leukemia, which is needed for the ultimate goal of primary prevention.

Key informant perspectives about telephonic comprehensive medication review services in the United States

BackgroundComprehensive medication reviews (CMRs) are provided by providers such as pharmacists to eligible beneficiaries. Although CMRs have been shown to provide value to patients, little is known about the service uniformity, quality, and content of CMRs. ObjectiveThis study aimed to characterize the current state of CMR services from diverse stakeholder perspectives and describe variation in responses to content and delivery of telephonic CMR services. MethodsSemistructured interviews were conducted with 10 key informants. The interview guide contained 6 key questions with additional probing questions. Transcripts were analyzed using the inductive saturation model and phenomenological approach to code emergent themes, which were iteratively refined until saturation was achieved. ResultsKey informants included CMR payers (n = 3), providers (n = 5), and standards-setting organizations (n = 2). Ten themes about CMRs emerged from qualitative analysis: (1) definition, (2) organizational goals, (3) content, (4) eligibility, (5) frequency, (6) acceptance and completion, (7) process and personnel, (8) quality assurance, (9) preparation, and (10) future directions. CMR content descriptions were consistent across perspectives. Key informants described scenarios appropriate for expanded CMR eligibility criteria, although none were consistently reported. Providers emphasized patient CMR acceptance rates whereas payers and standard-setting organizations emphasized completion rates. Completion rates and adherence to Centers for Medicare and Medicaid Services standards were characterized as core organizational goals (n = 8), whereas patient satisfaction was less frequently identified (n = 4). A lack of incentive for CMR providers to follow-up with patients was a barrier to expanded services. Overall, key informants were dissatisfied with the CMR completion rate measure and would prefer measures focused on service quality and outcomes. ConclusionsCMR services largely met perceived guidelines, with variation in value-added services. Key informants desired adoption of an actionable measure that is focused on quality rather than completion rate. To inform a quality measure, future research should analyze completed CMRs to determine the extent of variation in content and delivery.

“We Have to Build Trust”: Intimate Partner Violence Risk Assessment with Immigrant and Refugee Survivors

Abstract Intimate partner violence (IPV) research highlights unique immigration-related risk factors, abusive tactics, and barriers to seeking help. With the aim of developing practice-informed guidance, data from nine focus groups (N = 57) were analyzed thematically to examine practitioners’ experiences and approaches to risk assessment with survivors of IPV who are immigrants and refugees. Participants noted the importance of fostering relationships and trust in client disclosure and assessment of risk. Participants highlighted using a conversation-based approach; carefully chosen words; and open-ended, indirect, and probing questions to help clients feel at ease and generate information regarding risk. Additionally, practitioners emphasized the importance of conducting risk assessment and client education in concert with safety and service planning. However, safety and service planning must account for variations in context and language, as well as social pressures to keep families together. The adaptation of risk assessments to reflect immigrant experiences is a critical step forward. Nevertheless, listening to practitioners with expertise serving immigrant and refugee IPV survivors and developing additional guidance on how to use risk assessment tools and engage survivors are paramount to expanding relevant and responsive domestic violence services for diverse groups.

Missing appointments by patients on antiretroviral therapy: Professional nurses' perspective.

BackgroundMissed appointments for medicine pick-ups are regarded as a predictor of poor adherence, and should trigger immediate questions about issues that may affect follow-up visits to healthcare settings.ObjectivesThe study explored and described professional nurses’ perspectives about the factors that contribute to missing appointments by people living with Human Immunodeficiency Virus (PLWHIV) on antiretroviral therapy (ART) at Mopani and Vhembe district in Limpopo Province.MethodA qualitative explorative contextual approach was used for the study. Non-probability, purposive sampling was used to select 14 professional nurses who met the inclusion criteria. Data were collected through face-to-face unstructured interviews. One central question was asked and probing questions were based on the participants’ responses to the central question. Thematic analysis of the findings was carried out. Trustworthiness was ensured through intercoder agreement, audio recording, triangulation, bracketing, and member checking. Required permission, approval, and ethical clearance were also ensured.ResultsOrganisational health system and management of the healthcare facility were found to be the barriers that negatively impacted on the ability of the PLWHIV on ART to maintain clinic visits appointments. Lack of patient involvement, stereotyped appointment dates selection, poor patient-provider relationships, errors of recording appointment dates and long waiting times came up as sub-themes derived from the main theme.ConclusionThe results suggest that there is a need to increase and improve mutual trust in patient-provider relationships, improve nurses working conditions, develop proper booking systems and reduce clinic waiting hours.

Distance Learning with Virtual Case-Based Collaborative Learning: Adaptation and Acceptability of Clinical Cases from an American Academic Medical Center for Education at an African Medical School

We aimed to determine whether a Case-Based Collaborative Learning (CBCL) curriculum, developed from the clinical experience of U.S.-based clinicians in collaboration with Rwandan medical faculty, is acceptable, feasible to implement, and effective as a virtual educational tool for medical students in a resource-limited, global health setting. In this CBCL distance learning education, students were actively engaged and understood the case material and asked probing and insightful questions. Course evaluations showed that 106 of the 120 total student responses (88.3%) said that the difficulty level was “about right”, while only 11/120 (9.2%) said it was “too easy” and 3/120 (2.5%) said it was “too hard” providing evidence that even though the cases were largely based on clinical encounters at an American academic medical center, they are understandable, and at the appropriate level of difficulty for Rwanda-based medical students. Qualitative analysis from student comments found the CBCL method most helpful for students to develop diagnostic frameworks, and the practice of clinical reasoning using CBCL was engaging and interactive. This method of a virtual, international CBCL approach, was feasible, effective, and acceptable for students. A large majority of students found the sessions to be of appropriate difficulty and engaging. From the global health and inter-cultural exchange perspective, this collaboration demonstrates feasibility and acceptability of international partnerships. Using virtual, video conferencing technology, similar future collaborations can improve capacity building in lower-resource settings.

Implementation of the Al-Quran and Science Integration Approach at the Asajaya Regional Middle School

Integration of Al-Quran and Science (PIQS) was introduced as a hub for enriching students' monotheism elements and playing a role in implementing the Higher Level Thinking Skills (KBAT) element. This study aims to identify the effectiveness of the PIQS approach on the achievement of KBAT and student perceptions in the field of faith. This study was carried out in four high schools in the Asajaya area, and a total of 80 second-year students were sampled for the study. This study uses a quasi-experimental design (Quasi-Experimental Design). The instruments used are pre-test and post-test, which consist of 10 subjective questions to measure students' KBAT in the field of faith. In addition, probing questions were used to measure students' perceptions of the approach used between the control and experimental groups. A total of 40 students in the control group were taught using conventional methods, while 40 students in the experimental group were exposed to the PIQS approach. Data collection for pre and post exams was analyzed using the Statistical Package for the Social Science (SPSS) version 23.0 program. The study results were analyzed using an independent sample t-test to see if there was a significant difference in students' minimum KBAT achievement between the experimental group and the control group in the pre and post exams based on two different approaches in learning the field of faith. The study results show that the minimum post-test achievement for the treatment group is 29.22 higher than the control group, which is 21.57, and the difference between the two is 7.65 points. The investigation results also show that the minimum perception of the PIQS approach is high, which is 44.25, compared to the minimum perception of the traditional approach of 37.25. This study implies that it allows students to understand and explore the field of faith more clearly and can indirectly increase students' KBAT levels.

Imaging Mass Spectrometry (IMS) for drug discovery and development survey: Results on methods, applications and regulatory compliance

Imaging mass spectrometry (IMS) is increasingly used for drug discovery and development to understand target enagement, tissue distribution, drug toxicity, and disease mechanisms, etc. However, this is still a relatively new technique that requires further development validation before it will be an acceptable technique to support regulated development of new drugs. Thus, best practices will need to be established to build more confidence and gain wider acceptance by the scientific community, pharmaceutical industry, and regulatory authorities. The Imaging Mass Spectrometry Society (IMSS) and the Japan Association for Imaging Mass Spectrometry (JAIMS) have conducted a thorough survey to gather information on the current state of IMS and to identify key issues. The survey was sent to researchers or managers in the position who are currently using IMS techniques in support of their drug discovery and development efforts and/or who plan to use such tools as best practices are established. The survey probes questions related to details regarding technical aspects of IMS, which includes data acquisition, data analysis and quantitation, data integrity, reporting, applications, and regulatory concerns. This international survey was conducted online through the Survey Monkey (https://www.surveymonkey.com) in both English and Japanese from September 14 through September 30, 2020.

RNA regulation in immunity.

RNA regulation in immunity.

Facilitators and barriers to getting obstructive sleep apnea diagnosed: perspectives from patients and their partners.

Obstructive sleep apnea (OSA) is a prevalent and debilitating condition that is significantly underdiagnosed. The majority of adults sleep with someone-a partner. Partners can play a significant role in the patient's OSA diagnosis. The goal of this work is to describe facilitators and barriers to OSA diagnosis as discussed by patients with OSA and their partners. This was a qualitative secondary analysis with results drawn from 20 dyadic interviews, conducted 1 couple at a time, in 20 newly diagnosed adult patients with OSA and their partners. Qualitative interview data were analyzed using conventional content analysis. Facilitators of OSA diagnosis were partners pushing patients to seek care, patients actively seeking care, and care providers identifying the patient's risk of OSA. Barriers to OSA diagnosis were patients' lack of serious attention to symptoms, patients' negative perceptual framing of diagnosis and treatment of OSA, and poor coordination of health care services. We recommend engaging partners in the OSA diagnosis and developing educational and behavioral interventions to raise public awareness about OSA. It is important to educate clinicians on atypical presentations of OSA. Further investigation is needed to evaluate the impact of health care services on OSA diagnosis. Ye L, Li W, Willis DG. Facilitators and barriers to getting obstructive sleep apnea diagnosed: perspectives from patients and their partners. J Clin Sleep Med. 2022;18(3):835-841.

Questioning and answering strategies in Malaysian criminal proceedings

Questioning and answering strategies in Malaysian criminal proceedings

The river of postnatal psychosis: A qualitative study of women's experiences and meanings

ObjectiveThis paper reports findings from a study about women's experience of postpartum psychosis which affects 1-2 women in 1000 in the first four to six weeks following childbirth. Previous research reports many women are relucent to disclose symptoms of mental ill health to healthcare professionals, although they are most likely to discuss symptoms and concerns with a health professional known to them. DesignA qualitative interpretive study using semi-structured interviews. ParticipantsTen women in Australia who had recovered from postpartum psychosis in the last ten years were interviewed. Data analysisData were analysed thematically by three researchers to enhance trustworthiness. ResultsThe women described their overall experience as traumatic and described what they saw as contributing factors such as a previous history of mental illness or a significant life event that was present before or during pregnancy; the women described how they made meaning of the symptoms they experienced, such as a lack of sleep or changes in their thoughts or behaviours; and the difficulties they experienced during recovery. The women also identified novel ways to support themselves and each other as they recovered. Conclusion and implications for practiceMidwives require further education to recognise the symptoms of postpartum psychosis, to ask further probing questions to identify postpartum psychosis in its early stages and to support women as they recover from this illness.

Outcomes in breast cancer from the patient perspective: Development of an innovative, user-centered platform for collection and reporting of patient-reported data.

188 Background: Transition towards a patient-centered healthcare model has been recognized as an important step towards improving the quality and coordination of breast cancer care. Although evidence suggests that patient self-reporting of quality of life improves clinical care, there are significant barriers to successful collection and use of patient-reported data (PRD) including a lack of a technology designed to fully engage patients and providers, limited electronic health record (EHR) integration, and suboptimal clinical implementation strategies. To address this, our team developed imPROVE, an innovative and customizable patient-reported data (PRD) collection platform consisting of a patient web-application and a clinician portal. Methods: This study was performed as a quality improvement initiative at Dana-Farber Cancer Institute (DFCI) and Brigham and Women’s Hospital (BWH). Multiple perspectives were sought from key stakeholders to ensure that the content and design of the platform target the needs of the end-users and garners the latest in technological advances. Development and testing were performed using best practices in user-centered design and agile development, and iterative programming sprints followed by stakeholder feedback and testing. Content was evaluated using probing questions about relevance, comprehensiveness, and clarity. Design was assessed through feedback about the look and feel of the platform and its usability. Results: A multidisciplinary team of 28 stakeholders in the field of breast cancer care, patient-reported outcomes research and value-based healthcare was assembled. Recurring group meetings (n = 8), individual patient interviews (n = 23), and two focus groups with the DF/HCC Breast Cancer Advocacy Group, were conducted. The resultant application is a hybrid mHealth application that is supported by iOS and Android and is comprised of five screens (myCare, myStory, myResources, myCommunity, myNotes). Patients are provided written and graphical displays of their PRD as well as tailored resources that are customized depending on their type and stage of treatment. The clinician portal is comprised of an overview table listing all patients enrolled for each individual clinician, as well as individual patient profiles demonstrating demographic, clinical, and outcomes data. Conclusions: imPROVE has the potential to create a paradigm shift in the delivery of care for breast cancer patients. Next steps will include implementation of imPROVE within the breast oncology and plastic surgery services at DFCI and BWH.

The acquisition of wh-questions: Beyond structural economy and input frequency

ABSTRACT We present in this article corpus analyses, two experiments, and a preliminary English-French comparison on children’s acquisition of wh-in-situ. Our examination of 10,000 wh-questions from CHILDES reveals that the reported empirical picture of wh-question acquisition in English is incomplete: A type of wh-in-situ, probe questions (PQs), has been left out from most discussions despite its presence in child-directed speech. Unlike wh-in-situ echo questions (EQs), PQs are used to request new information, and parents frequently use PQs and fronted information-seeking questions in alternation. The fact that PQs share the pragmatic space with fronted wh-questions while involving fewer syntactic operations and exhibiting lower input frequency allows us to test both structure-based and frequency-based theories of syntax acquisition. Our comprehension task with 3;06–5;06-year-olds confirms that children accept and understand PQs as information seeking. On the other hand, results from a production task show a strong avoidance of wh-in-situ, which is in line with reported elicited data from French-speaking children. We reason that a structural economy-based approach alone is not sufficient to account for children’s disfavor of wh-in-situ. Depending on the input frequency and consistency, as well as the number of variants licensed by the grammar of a given language, children may treat part of the input as uninformative and initially only learn from higher-frequent, more regularized input. Their intake is thus selective.

Formative Assessment in Online Distance Learning Modality through the Lens of Mathematics and Science Teachers

Formative assessment provides ongoing feedback to monitor student learning and improve teachers’ instruction. But the COVID-19 pandemic has changed the mode of learning delivery and has affected formative assessment. Hence, the researchers explored the practices, challenges, and adaptive strategies of Mathematics and Science Senior High school teachers on formative assessment of students’ learning in an online distance learning modality. Narrative inquiry research design was used in which eight teachers and six students who were chosen through convenience sampling were subjected to in-depth interview. The audio-recorded interviews were transcribed and underwent coding, categorizing, and thematizing. Results revealed that teachers employ practices that allow them to provide immediate feedback, utilize online assessment tools, probe questions, encourage students’ active participation, and align learning competencies with formative assessment. However, they encounter challenges that affect students’ learning such as lack of motivation, unavailability of internet/data connection and gadgets, low digital literacy skills, minimal peer assistance, and authenticity of formative assessment results. But they adapt strategies to address these challenges through designing differentiated assessment, showing empathy, reinventing pedagogical goals through meaningful online tools, promoting student-centered learning, and providing consistent means of communication. Findings implied that teachers use various online formative assessment practices similar to what they do in face-to-face classes. Challenges are evident in the entirety of instruction. However, teachers are dynamic in improving their practices. An action plan consisting of activities, objectives, and description is hereby proposed to improve the online formative assessment practices of mathematics and science teachers to enhance students’ learning.

HOW MERITOCRACY FUELS INEQUALITY—PART II Reply to Critics

HOW MERITOCRACY FUELS INEQUALITY—PART II Reply to Critics