Proficiency In Use Research Articles

Physicians’ Perspectives on Using Direct Observation to Assess Non-English Language Proficiency for Clinical Practice: A Qualitative Study

BackgroundCommunication barriers are known to adversely affect patient safety. Yet few health systems assess and track physician non-English language proficiency for use in clinical settings. Barriers to current assessments (usually simulated clinician oral proficiency interviews) include time constraints and lack of interactivity. This study's objective was to investigate physician perspectives on using direct clinical observation as an alternative form of assessment of their non-English language skills. MethodsThe authors conducted semistructured interviews with 11 fully and partially bilingual primary care physicians (general internists) from a large academic health system to understand physician perspectives on using direct observation as an alternative form of assessing non-English proficiency for use in clinical practice. Two researchers independently and iteratively coded transcripts using thematic analysis with constant comparison to identify themes. ResultsParticipants, mostly women (n = 9; 81.8%), reported varying levels of proficiency in Cantonese, Mandarin, Russian, or Spanish. Participants expressed three main themes: (1) benefits of direct observation, including familiar setting, relevant content, and convenience; (2) disadvantages, including discomfort, potential embarrassment, and limitations of observing a single encounter; and (3) suggestions to enhance use of direct observation tools, such as observing multiple encounters, and use of remote observation. ConclusionTo ensure high-quality language-concordant care, health systems must assess physicians’ non-English language proficiency. If validated tools can be developed and disseminated in clinical practice, direct observation may be an acceptable option.

Preliminary assessment of a robotic system for overground gait in children with cerebral palsy

PurposeCerebral palsy is one of the leading causes of chronic disability in children. The current pilot study investigated (1) whether an exoskeleton system enables physiological gait patterns and (2) whether the system is user-friendly enough to envision its use in a clinical setting.Design/methodology/approachParticipants included a convenience sample of six children with cerebral palsy. Following informed consent, study volunteers underwent baseline assessments, participated in eight sessions during which they used the exoskeleton system with the objective of achieving proficiency in use of the system, and underwent an end-of-study assessment of walking. Satisfaction and usability questionnaires were given to the family/caregiver.FindingsAll participants achieved a more regular gait pattern and improved their 6-Minute Walk Test scores. Overall satisfaction and usability were rated as good.Practical implicationsThe exoskeleton system enabled physiological gait patterns, and the system was user-friendly enough to envision its use in a clinical setting.Originality/valueThere is potential for guiding treatment plans for individuals with cerebral palsy.

A Study on the Factors Influencing the Sustainable Development of Education in the Context of COVID-19: Tencent Conference Online Platform

The difficulties of offline education caused by the COVID-19 epidemic are attracting increasing public attention. Although international research on online education platforms is gradually deepening, the research on the influencing factors of Chinese users’ participation in these platforms shows different results due to regional differences. Therefore, this study adopts the technology acceptance model (TAM) as the basis to build the index system of influencing factors for the Tencent conference online education platform. The questionnaire design covered five dimensions, including external environment, platform satisfaction, and continuous use intention. An online questionnaire survey was conducted on participants in some regions of China, 320 questionnaires were distributed, and 297 valid questionnaires were collected. The data were analyzed by SPSS 26.0, and the results of Cronbach’s coefficient of 0.939 and a KMO value of 0.941 were obtained. The weight value, entropy value, and importance ranking of the factors were determined by combining hierarchical analysis and the entropy weighting method. First, the perceived ease of use is the most critical factor influencing the users’ use of online delivery platforms. Second, freedom from geographical time difference, the ease of operation, system perfection, and proficiency in use greatly influenced the participants’ use of the online lecture platform. Third, the study group suggested that the platform should be optimized in terms of convenience, stability, and freedom from geographical time difference, and provide reasonable references and lessons for future educational efforts.

Demystifying the Digital Divide: Disparities in Telerehabilitation Readiness Among Older Adults in the United States

ObjectiveTo estimate readiness of older rehabilitation users in the United States to participate in video-based telerehabilitation and assess disparities in readiness among racial and ethnic minoritized populations, socioeconomically disadvantaged populations, and rural-dwelling older adults. DesignRetrospective cohort study using nationally representative survey data from the National Health and Aging Trends Study from 2015 and 2020. Survey-weighted regression models, accounting for complex survey design, were used to generate estimates of readiness and evaluate disparities across racial and ethnic, socioeconomic, and geographic subgroups. Odds ratios (OR) and 95% confidence intervals (CIs) were estimated for each comparison. SettingHome or community rehabilitation environments. ParticipantsA cohort of 5274 home or community-based rehabilitation users aged 70 years or older (N=5274), representing a weighted 33,576,313 older adults in the United States. InterventionsNot applicable. Main Outcome Measure(s)Video-based telerehabilitation readiness was defined consistent with prior work; unreadiness was defined as lacking ownership of internet-enabled devices, limited proficiency of use, or living with severe cognitive, visual, or hearing impairment. Telerehabilitation readiness was categorized as “Ready” or “Unready”. ResultsApproximately 2 in 3 older rehabilitation users were categorized as ready to participate in video-based rehabilitation. Significantly lower rates of readiness were observed among those living in rural areas (OR=0.75, 95% CI: 0.60-0.94), financially strained individuals (OR=0.37, 95% CI: 0.26-0.53), and among individuals identifying as Black or Hispanic (as compared with non-Hispanic White older adults: Non-Hispanic Black [OR=0.23, 95% CI: 0.18-0.30]; Hispanic [OR=0.17, 95% CI: 0.11, 0.27]). ConclusionsOur findings highlight significant disparities in the readiness to uptake video-based telerehabilitation. Policy and practice interventions to address telerehabilitation readiness should focus not only on improving broadband access but also on technology ownership and training to ensure equitable adoption in populations with lower baseline readiness.

Tipping the analytical scales, investigating the use of frequentist equivalence analyses in psychology: a scoping review

Psychological researchers may be interested in demonstrating that sets of scores are equivalent, as opposed to different. If this is true, use of equivalence analyses (equivalence and non-inferiority testing) are appropriate. However, the use of such tests has been found to be inconsistent and incorrect in other research fields (Lange and Freitag 2005). This study aimed to review the use of equivalence analyses in the psychological literature to identify issues in the selection, application, and execution of these tests. To achieve this a systematic search through several databases was conducted to identify psychological research from 1999 to the 2020 that utilized equivalence analyses. Test selection, choice of equivalence margin, equivalence margin justification and motivation, and data assessment practices for 122 studies were examined. The findings indicate wide variability in the reporting of equivalence analyses. Results suggest there is a lack of agreement amongst researchers as to what constitutes a meaningless difference. Additionally, explications of this meaninglessness (i.e., justifications of equivalence margins) are often vague, inconsistent, or inappropriate. This scoping review indicates that the proficiency of use of these statistical approaches is low in psychology. Authors should be motivated to explicate all aspects of their selected equivalence analysis and demonstrate careful consideration has been afforded to the equivalence margin specification with a clear justification. Additionally, there is also a burden of responsibility on journals and reviewers to identify sub-par reporting habits and request refinement in the communication of statistical protocols in peer-reviewed research.

Contextualizing EFL Learners’ Proficiency in Using English Collocations

Proficiency in using a foreign language cannot be separated from mastery of collocation in the target language. Although several previous studies have explored collocations in various forms of oral communication; however, few studies have investigated the context of collocation use and proficiency in collocation use by EFL learners. This study aims to describe the English collocation competence and collocational mistakes of Indonesian (EFL) students. A total number of 50 students from an English education department in Medan, Indonesia, served as the subjects. The research instrument was a 50-item Simple Completion Test that the researchers created themselves. It assessed students' understanding of four different lexical collocations: pure idioms, figurative idioms, free combinations, and restricted collocations. The findings showed that pure idioms were the most difficult for these students, while free combinations posed the fewest number of a challenge. Student performance on restricted collocations and figurative idioms were roughly equal. The student's inconsistent responses often showed a lack of proficiency with English collocations. It is concluded that poor first language transfer is to blame for the collocational errors made by EFL learners. The greatest way to get more proficient at using collocation while avoiding errors that have been identified thus far is to utilize it as frequently as feasible in English.

Outcomes of Mayo Clinic reBoot camps for postimplementation training in the electronic health record.

ObjectiveAfter a new electronic health record (EHR) was implemented at Mayo Clinic, a training program called reBoot Camp was created to enhance ongoing education in response to needs identified by physician leaders.Materials and MethodsA reBoot camp focused on EHR topics pertinent to ambulatory care was offered from April 2018 through June 2020. There were 37 2-day sessions and 43 1-day sessions, with 673 unique participants. To evaluate outcomes of the reBoot camp, we used survey data to study baseline, immediate, and long-term perceptions of program satisfaction and self-assessed skills with the EHR. The study was conducted among practitioners at a large ambulatory practice network based in several states. Data were collected from April 2018 through January 2021. We analyzed automatically collected metadata and scores that evaluated the amount of personalization and proficiency of use.ResultsConfidence in skills increased by 13.5 points for general EHR use and was significant in 5 subdomains of use (13–18 point improvement). This degree of user confidence was maintained at the 6-month reassessment. The outcomes of configuration and proficiency scores also improved significantly.DiscussionOngoing education regarding EHR tools is necessary to support continued use of technology. This study was novel because of the amount and breadth of data collected, diversity of user participation, and validation that improvements were maintained over time.ConclusionsParticipating in a reBoot camp significantly improved user confidence in each domain of the EHR and demonstrated use of best-practice tools. Users maintained gains at the 6-month evaluation phase.

The Role of Literature in Achieving Proficiency in Language Use: The Case of ESL

It has been observed that many users of English in Nigeria do not possess the required level of competence in the language despite its second language status, with its attendant high functional load. This paper seeks to discover the role of literature in achieving proficiency in the use of the English language. To this end, it is targeted at exploring literature in English as a veritable resource in achieving the required proficiency among Nigerian users of English as a second language. The study population consists of final year students of the Department of English language and Literature of Nnamdi Azikiwe University Awka in Nigeria. Questionnaires and participant observations were adopted as the instruments for data collection. It was discovered that students who have more exposure to literary works are more proficient in using the English language. It, therefore, concluded that making students read literary works, listen, dramatize, and recite them will acquaint them with the comprehensible input they need to achieve the requisite competence in the language.

Demographic and Psychographic Factors of Social Isolation During the COVID-19 Pandemic: The Importance of Technology Confidence.

The COVID-19 pandemic presents an unprecedented situation in which physical distancing and “stay at home” orders have increased the pressures for social isolation. Critically, certain demographic factors have been linked to increased feelings of isolation and loneliness. These at-risk groups for social isolation may be disproportionately affected by the changes and restrictions that have been implemented to prevent viral spread. In our analysis, we sought to evaluate if perceived feelings of social isolation, during the COVID-19 pandemic, was related to demographic and technology-related psychographic characteristics. Older adults across Canada were surveyed about their demographic background, their feelings concerning confidence and proficiency in technology use, and how frequently they have felt isolated during the pandemic. In total 927 responses from Canadians over 65 years old, of varying demographic characteristics were collected. Our data shows that many older adults are feeling isolated “Often” or “Some of the time” in 2020, regardless of most demographic factors that have been previously associated with increased isolation risk. However, feelings of proficiency in using technology was an important factor affecting feelings of isolation. Given that technology proficiency is a modifiable factor, and remained significant after adjustment for demographic factors, future efforts to reduce social isolation should consider training programs for older adults to improve technology confidence, especially in an increasingly digital world.

676 Age is only a number: Treatment modality preferences in a randomized controlled trial of CBTI in older adults

Abstract Introduction Use of telemedicine platforms for conducting CBTI has the potential to reach more patients than in person treatment alone. While CBTI has been shown to be effective in older adults, questions about proficiency with technology and preference for treatment modality have not been addressed. Methods Baseline data from participants in the RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING) study were used. Analyses compared CBTI treatment modality preference (in person, online [video platform], no preference) across the following variables: insomnia severity (Insomnia Severity Index; ISI), depression (Geriatric Depression Scale; GDS), cognitive functioning (telephone-based cognitive screen) and internet proficiency (IP; assessing comfort with and frequency of internet use). Data collected prior to the pandemic-shut down (March 2020) were utilized for the primary analysis of treatment preference; n=71, mean age = 62.5 (SD = 8.1); 64.8% female; treatment preferences: in person (33.8%), no preference (25.4%), online (40.8%). A secondary analysis compared IP data from participants with baseline data from pre-pandemic (Nov 2019-Feb 2020, n=71), early pandemic (March-June 2020, n=28), and late pandemic (the most recent four months of enrollment, July 2020-Nov 2020, n=40) periods. Results Pre-pandemic, age was not significantly associated with treatment modality preference, nor any baseline clinical characteristics or demographic variables (p’s >.01). Only ‘comfort’ and ‘comfort+frequency’ scores from the internet proficiency measure differed significantly between treatment preference groups (p’s<.002). Post-hoc analyses revealed the online group had significantly higher comfort and comfort+frequency scores than the in person group (p’s<. 003). Comparing data from pre-pandemic, early pandemic, and late pandemic, frequency of internet use and comfort+frequency with internet use differed across groups (p’s <.004). Post-hoc comparisons revealed frequency of internet use scores were higher in the late pandemic compared to pre-pandemic (p=.003). Conclusion These findings suggest that comfort using technology, but not age or clinical characteristics, is associated with treatment modality preference for patients with insomnia who are enrolled in a technology-based clinical trial of CBTI. As proficiency in use of technology increases, for example, during and following the pandemic, one can expect that telemedicine will be an increasingly viable approach to providing CBTI among older adults. Support (if any) 1R01AG057500

Access to smart devices and utilization of online health resources among older cardiac rehabilitation participants.

BACKGROUNDNewer models of cardiac rehabilitation (CR) delivery are promising but depend upon patient participation and ability to use technological media including Internet and smart devices.AIMTo explore the availability of smart devices, current utilization and proficiency of use among older CR program attendees.METHODSStudy participants were enrolled from four CR programs in Omaha, Nebraska United States and completed a questionnaire of 28 items.RESULTSOf 376 participants approached, 169 responded (45%). Mean age was 71.1 (SD ± 10) years. Demographics were 73.5% males, 89.7% Caucasians, 52% with college degree and 56.9%, with income of 40K$ or more. Smart device ownership was 84.5%; desktop computer was the most preferred device. Average Internet use was 1.9 h/d (SD ± 1.7); 54.3% of participants indicating for general usage but only 18.4% pursued health-related purposes. Utilization of other health information modalities was low, 29.8% used mobile health applications and 12.5% used wearable devices. Of all participants, 72% reported no barriers to using Internet. Education and income were associated positively with measures of utilization and with less perceived barriers.CONCLUSIONAmong an older group of subjects attending CR, most have access to smart devices and do not perceive significant barriers to Internet use. Nonetheless, there was low utilization of health-related resources suggesting a need for targeted education in this patient population.

Older Adults' Live Demonstration of Electronic Personal Health Record Use: Factors Mediating Initial Proficiency.

Adoption of electronic personal health records by older adults offers multiple advantages to healthcare and is being encouraged by federal agencies and health associations. However, obstacles have limited older adults' rates of adoption to approximately 10%. This study examined the initial proficiency of older adults at entering 21 standard health elements into an electronic personal health record. Entry completeness, accuracy, elapsed time, and help requests were measured. A combination of standard technology adoption model and older adult characteristics accounted for 52% of variability in proficiency at entering electronic personal health record data. Automatic linear modeling identified three variables as primarily related to proficiency with electronic personal health record use: age, computer competency, and mental status. Interventions to increase electronic personal health record adoption and proficiency of use will require the consideration of variables specific to older adults, and may best focus on younger seniors with good mental status and computer competency. Efforts for older seniors with decreased mental status might better center on delegation to a primary caregiver.

Towards automatic assessment of spontaneous spoken English

With increasing global demand for learning English as a second language, there has been considerable interest in methods of automatic assessment of spoken language proficiency for use in interactive electronic learning tools as well as for grading candidates for formal qualifications. This paper presents an automatic system to address the assessment of spontaneous spoken language. Prompts or questions requiring spontaneous speech responses elicit more natural speech which better reflects a learner’s proficiency level than read speech. In addition to the challenges of highly variable non-native, learner, speech and noisy real-world recording conditions, this requires any automatic system to handle disfluent, non-grammatical, spontaneous speech with the underlying text unknown. To handle these, a strong deep learning based speech recognition system is applied in combination with a Gaussian Process (GP) grader. A range of features derived from the audio using the recognition hypothesis are investigated for their efficacy in the automatic grader. The proposed system is shown to predict grades at a similar level to the original examiner graders on real candidate entries. Interpolation with the examiner grades further boosts performance. The ability to reject poorly estimated grades is also important and measures are proposed to evaluate the performance of rejection schemes. The GP variance is used to decide which automatic grades should be rejected. Back-off to an expert grader for the least confident grades gives gains.

Pediatric Emergency Medicine Physicians' Use of Point-of-care Ultrasound and Barriers to Implementation: A Regional Pilot Study.

Point-of-care ultrasound (POCUS) has been identified as a critical skill for pediatric emergency medicine (PEM) physicians. The purpose of this study was to profile the current status of PEM POCUS in pediatric emergency departments (EDs). An electronic survey was distributed to PEM fellows and attending physicians at four major pediatric academic health centers. The 24-item questionnaire covered professional demographics, POCUS experience and proficiency, and barriers to the use of POCUS in pediatric EDs. We used descriptive and inferential statistics to profile respondent's PEM POCUS experience and proficiency and Rasch analysis to evaluate barriers to implementation. Our return rate was 92.8% (128/138). Respondents were attending physicians (68%) and fellows (28%). Most completed pediatric residencies prior to PEM fellowship (83.6%). Almost all had some form of ultrasound education (113/128, 88.3%). Approximately half (46.9%) completed a formal ultrasound curriculum. More than half (53.2%) said their ultrasound education was pediatric-specific. Most participants (67%) rated their POCUS proficiency low (Levels 1-2), while rating proficiency in other professional competencies (procedures 52%, emergency stabilization 70%) high (Levels 4-5). There were statistically significant differences in POCUS proficiency between those with formal versus informal ultrasound education (p < 0.001) and those from pediatric versus emergency medicine residencies (p < 0.05). Participants identified both personal barriers discomfort with POCUS skills (76.7%), insufficient educational time to learn POCUS (65%), and negative impact of POCUS on efficiency (58.5%)-and institutional barriers to the use of ultrasound-consultants will not use ultrasound findings from the ED (60%); insufficient mentoring (64.7%), and POCUS not being a departmental priority (57%). While POCUS utilization continues to grow in PEM, significant barriers to full implementation still persist. One significant barrier relates to the need for dedicated time to learn and practice POCUS to achieve sufficient levels of proficiency for use in practice.

Speech comprehension in realistic classrooms: Effects of room acoustics and foreign accent

The current classroom acoustics standard (ANSI S12.60) recommends that core learning spaces shall not exceed reverberation time (RT) of 0.6 second and background noise level (BNL) of 35 dBA, based on speech intelligibility performance mainly by the native English-speaking population. This paper presents two studies on the effects of RT and BNL on more realistic classroom learning experiences. How do native and non-native English-speaking listeners perform on speech comprehension tasks under adverse acoustic conditions, if the English speech is produced by talkers whose native language is English (Study 1) versus Mandarin Chinese (Study 2)? Speech comprehension materials were played back in a listening chamber to individual listeners: native and non-native English-speaking in Study 1; native English, native Mandarin Chinese, and other non-native English-speaking in Study 2. Each listener was screened for baseline English proficiency for use as a covariate in the statistical analysis. Participants completed dual tasks simultaneously (speech comprehension and adaptive dot-tracing) under 15 different acoustic conditions, comprised of three BNL conditions (RC-30, 40, and 50) and five RT scenarios (0.4–1.2 s). Results do show distinct differences between the listening groups. [Work supported by a UNL Durham School Seed Grant and the Paul S. Veneklasen Research Foundation.]

Ranking the Criteria of Quality Evaluation for Intellectual Information on Internet

Recent past has witnessed the fast use of the information and communication technology in the ever developing field of education. Enormous information is brought to the classroom for easy access by the learner anywhere in the world. Learners of today are distinguished by their proficiency in use of technology to know about assessment and successful management of informational opportunities. Critical analysis of existing education scenario emphasizes the introduction of major thrust areas as Information Communication Technology, literacy, organization of curriculum, and others. This is to elevate the standard of education and disseminate the information in shortest time with use of online and offline resources through internet. These are for professional growth, teaching support materials and other classroom related activities. The research work and true knowledge of topics calls for the need to evaluate the information provided on the internet. The present paper caters to this need, especially in context to intellectual information available on the internet. The research work in this paper is accomplished by selecting a system of quality criteria and defining in terms of internet usage for intellectual purpose. Several questions are designed to assess each criterion and as a result an instrument is developed and validated in the form of a questionnaire. The quality criteria taken into consideration are as Content, Objective reasoning, Scope, Authority; these are further classified into indicators for easy assessment. The collected data has been tabulated and analysed to rank the criteria as per their preference for quality assessment of the intellectual information available on the internet. The results indicate that authority is the most preferred criteria while objective reasoning is the least preferred one as per their calculated mean values.

Using a specialized blowgun dart to obtain genetic samples from mammals

AbstractWe developed a blunt, sticky blowgun dart to collect genetic samples from mammals, and used the technique on the variegated squirrel (Sciurus variegatoides) in June and July 2010. Blowgun and darts cost &lt;US$30. The blowgun had an effective range of &gt;40 m. Total sampling success was 88%. The blowgun enabled a rapid method of sample collection that reduced animal stress and the expenses associated with trapping. Developing proficiency in use of the blowgun can be challenging but is overcome with practice. It is difficult to use the blowgun method during heavy rain or high winds. © 2012 The Wildlife Society.

Understanding the management of electronic test result notifications in the outpatient setting

BackgroundNotifying clinicians about abnormal test results through electronic health record (EHR) -based "alert" notifications may not always lead to timely follow-up of patients. We sought to understand barriers, facilitators, and potential interventions for safe and effective management of abnormal test result delivery via electronic alerts.MethodsWe conducted a qualitative study consisting of six 6-8 member focus groups (N = 44) at two large, geographically dispersed Veterans Affairs facilities. Participants included full-time primary care providers, and personnel representing diagnostic services (radiology, laboratory) and information technology. We asked participants to discuss barriers, facilitators, and suggestions for improving timely management and follow-up of abnormal test result notifications and encouraged them to consider technological issues, as well as broader, human-factor-related aspects of EHR use such as organizational, personnel, and workflow.ResultsProviders reported receiving a large number of alerts containing information unrelated to abnormal test results, many of which were believed to be unnecessary. Some providers also reported lacking proficiency in use of certain EHR features that would enable them to manage alerts more efficiently. Suggestions for improvement included improving display and tracking processes for critical alerts in the EHR, redesigning clinical workflow, and streamlining policies and procedures related to test result notification.ConclusionProviders perceive several challenges for fail-safe electronic communication and tracking of abnormal test results. A multi-dimensional approach that addresses technology as well as the many non-technological factors we elicited is essential to design interventions to reduce missed test results in EHRs.

Validation of a Verbal Assessment Tool of English Proficiency for Use in the Health Care Setting

Validation of a Verbal Assessment Tool of English Proficiency for Use in the Health Care Setting

Factors associated with female condom use among HIV-seropositive women.

Female condoms are an effective option for preventing sexually transmitted diseases (STDs), including HIV transmission. Little is known, however, about female condom use in women living with HIV/AIDS. Ninety HIV-positive women completed measures of demographic characteristics, exposure and use of female condoms, attitudes toward female and male condoms, sexual behaviours, and substance use. Most women (77%) had been exposed to female condoms, however only 30% reported lifetime use, 16% reported recent use, and only 6% of the sample used female condoms as much or more than they used male condoms. The only factors consistently associated with female condom use were positive attitudes toward female condoms. Women who recently used female condoms were also more likely to have multiple male sex partners and reported fewer unprotected intercourse occasions. Female condoms are therefore used by a small number of HIV-infected women, particularly those with more than one male sex partner. Female condom use may be enhanced by removing barriers to their use, increasing cooperation of male partners, and enhancing proficiency of use.