Summative Approach Research Articles

A new approach to measuring the synergy in a syndemic: Revisiting the SAVA syndemic among urban MSM in the United States

ABSTRACT Syndemic theory hypothesises that observed clusters of diseases are the result of harmful social conditions. Critiques of syndemics present the theory as ambiguous and lacking empirical evidence. Syndemics are evidenced through qualitative assessments drawing on observations, epidemiology, and biomedical evidence to explain bio-bio and bio-social interactions. Quantitative syndemic studies commonly apply a summative approach, whereby the outcome is a result of the cumulative effect of the individual elements. More recently, quantitative studies apply analyses to assess mechanical interactions among conditions. This paper applies a synergy factor analysis to measure synergy – the enhancement of the effect of one element on the effect of the others. Data from the canonical quantitative syndemic analysis study was reanalysed to assess synergy among the elements of the SAVA syndemic (substance ab/use, violence, HIV/AIDS). Contrary to original study findings, which applied a summative approach, no synergy was measured. Synergistic interactions were confirmed among a subset of the study population; the effects of substance ab/use and violence on HIV were more than two times greater in White MSM than the predicted joint effect (SF = 2·32, 95%CI 1·02–5·11, p = 0·044), indicating synergy. Synergy factor analysis presents an accessible tool to measure syndemic interactions and facilitate timely global health responses.

Medical Student Experience and Outcomes, as Well as Preceptor Experience, with Rapid Conversion of a Preclinical Medical School Course to a Remote-Based Learning Format in the Setting of the COVID-19 Pandemic

ObjectivesTo assess student outcomes and experiences, as well as preceptor experiences, after emergently converting a preclinical medical school renal course to a remote setting during the COVID-19 pandemic.MethodsFirst-year medical student examination scores and responses to Likert-scale questions on end-of-course evaluations from the 2018–2019 (traditional) and 2019–2020 (remote) academic years were compared. Free-text responses from students and preceptors were analyzed using a qualitative summative approach to extract major themes in perceptions of remote learning.ResultsMean student scores on course examinations did not significantly differ between the traditional and remote settings (p = 0.23 and 0.84 respectively). Quantitative analysis of student evaluations revealed no significant difference across all items in mean Likert-scale responses. Student and preceptor free-text responses identified course leader engagement and responsiveness as essential to the success of remote-based learning. Optimal group size and online etiquette are areas that require attention.ConclusionsDespite rapid conversion of a preclinical medical school renal course to a remote-based format in the setting of the COVID-19 pandemic, student scores and evaluations remain positive and largely unchanged.

Identifying the content and context of pain within paediatric rheumatology healthcare professional curricula in the UK: a summative content analysis

BackgroundThe curriculum for professionals working in paediatric rheumatology should include pain but it is unclear to what extent this currently occurs. The aim of this study was to identify pain-related curriculum content and the context in which pain is presented in educational and training documentation for healthcare professionals in this clinical speciality.MethodsCore curricula documents from UK based professional organisations were identified in partnership with healthcare professionals. Documents were analysed using a summative content analysis approach. Key pain terms were quantified and weighted frequencies were used to explore narrative pain themes. Latent content was interpreted qualitatively to explore the context within which pain terms were positioned.ResultsNine curriculum documents were identified and analysed from doctors, nurses, physiotherapists and occupational therapists specialising in paediatric rheumatology. Pain themes represented a mean percentage of 1.51% of text across all documents. Pain was rarely presented in the context of both inflammatory and non-inflammatory condition types despite being a common feature of each. Musculoskeletal pain was portrayed simply as a ‘somatic’ symptom, rather than as a complex phenomenon involving biological and psychosocial processes. Content around the assessment and management of pain was vague and inexplicit.ConclusionCurrent educational and training documentation in paediatric rheumatology do not include core pain topics. Curricula for these healthcare professionals would benefit from updates in contemporary pain theories and examples of in-context, evidence-based pain practices. This should be a priority starting point for optimising patient pain care in paediatric musculoskeletal healthcare.

A PHENOMENOLOGICAL CONTENT ANALYSIS OF PSYCHOLOGICAL FLEXIBILITY IN PRIVATE UNIVERSITY STUDENTS OF LAHORE

Psychological flexibility is an emerging phenomenon worldwide. It has been shown that an adequate level of psychological flexibility supports with adjustment of an individual in a present situation. In European cultures, psychological flexibility has been associated with successful outcomes and adaptive behaviors for stress management. The phenomenology of a variable differs in different populations; the scarcity of an indigenous psychological flexibility scale for university students in Pakistani society drew this research study towards an exploration of the variable among Pakistani students. The purpose of the study is to comprehend the perceptions of university students about psychological flexibility. The experiences were collected in the form of written transcripts from 73 university students from two private universities in Lahore. Participants were recruited through convenience sampling. A qualitative summative content analysis approach was used to interpret the results of the data. A research question was formulated for data collection and codes were found using an operationalized definition from the literature review. Four major themes were identified through the data analysis of the university students' phenomenology exploration about psychological flexibility. The key findings that were highlighted through the content analysis were discussed based on the pre-determined codes in the operational definition of psychological flexibility. The study provides direction to future researchers while working on the level of psychological flexibility in clinical and non-clinical practices.

Children\u2019s Imaginaries of Robots for Playing With

Children with severe motor impairment due to cerebral palsy have difficulties engaging in play, although they want to play games that typically developing children play. The barriers imposed by motor impairments against engaging in play can be addressed through the use of robots. We aim to identify how children, who have extensive experience of play, imagine what a robot is and what features would make a robot good to play with. Using a qualitative description design, 19 children from urban and rural settings participated in focus groups to draw and talk about the robots they would like to exist. The data were coded and analyzed using a summative approach to content analysis. The findings revealed that the children imagined that a good robot to play with is one that has an anthropomorphic appearance, is tough and strong, has controls, and that is able to move, grab, speak, and play popular children’s games. In particular, the girls imagined that robots should be able to express positive emotions towards children. Age, gender, culture, and the physical environment in which the children lived influenced what they expected to find in a robot for playing with and how they imagined child–robot interactions.

A holistic life cycle sustainability evaluation of a building project

The current approach to life cycle sustainability assessment (LCSA) is based on a triple-bottom line (TBL) framework, which has recognised limitations due to its predominantly quantitative and reductive summative approach. The increased understanding and importance of an integrative approach for incorporating qualitative sustainability considerations into life cycle choices for the built environment sectors have led this investigation towards a more holistic paradigm. The purpose of this paper is two-fold. Firstly, to introduce a conceptual method and application process for life cycle sustainability evaluation (LCSE) based on Integral Theory (IT). Secondly, to illustrate the application of LCSE with a case study as a potential advancement to the traditional Life Cycle Sustainability Assessment (LCSA) methodology. This work is centred around a sequence of methodological stages: (1) literature review, (2) action research with stakeholder groups, and (3) illustrative case study application. It was found that the key effectiveness of the LCSE approach lies in providing an expansive paradigm for sustainability evaluation and delivering a template for identifying missing perspectives or variables in a project. In particular, LCSE achieves increased integration of qualitative sustainability aspects in buildings and has potential to stimulate better long-term built environment outcomes in our cities and communities.

STEAM views from a need: the case of the chewing gum and pH sensopill (Miradas STEAM desde la necesidad: el caso de la sensopíldora chicles y pH)

ABSTRACT The integrated STEAM approach arises when a contextualized problem’s resolution requires different contributions (views) from each discipline. In this descriptive article we discuss the views needed from chemistry, technology, design skills, mathematical modelling and the artistic support necessary for constructing a scientific model that explains the pH of the mouth when chewing gum. To do this, we focus on describing the implementation of a short sequence of video-recorded inquiry-based contextualized activities (didactic innovation) in two classrooms with students in their third year of compulsory secondary education (14–15 years old). The scenes taken from the analysis of the implementation videos support the proposal of the connections needed in the STEAM contributions. The difficulties encountered from each discipline and the resolutions we propose shed light on how well-selected problems make STEAM views necessary, thus avoiding the usual summative multidisciplinary approach.

Changing an industry: leading equality in the investment and savings industry

Purpose The purpose of this paper is to explore the impact of the Diversity Project, a cross company initiative that has been applied in the investment and savings profession to accelerate progress towards a more inclusive culture across the industry. This is with a view to providing a template for other industries considering impactful change. Design/methodology/approach This paper considers the approach taken by the investment and savings industry to drive change towards a more inclusive culture by using a summative content analysis approach. The authors framework this application using Sustainable Development Goal 10 (reduced inequalities) to increase relevance and contribution beyond this context. Findings The Diversity Project demonstrates numerous examples of driving change within the investment and savings industry by galvanising cross company support for events, publications, charters and action. These experiences will provide policymakers and practitioners in other industrial sectors insight to achieve similar change. Originality/value The Diversity Project established in 2016 has gained significant traction in the investment and savings industry through membership of 70 firms and 30 partner firms, supporting 18 cross company diversity and inclusion work streams focussed on developing collaborative and cohesive action plans.

Instructional design with the ICE approach in academic libraries: A framework that integrates assessing, learning, and teaching

One-shot instruction in academic libraries is a librarian-controlled bibliographic instruction that responds to the point of information need for subject-related courses. The assessment of teaching effectiveness tends to take a summative approach, which provides an answer to what students learned but does not address how they learned. This column theoretically explores the framework of Ideas-Connections-Extensions (ICE) in library instruction and the classroom setting, which demonstrates learning outcomes and explores the learning journey, and integrates assessment, learning, and teaching through collaborative efforts by academic librarians and classroom faculty.

Swedish occupational therapists’ considerations for leaving their profession: Outcomes from a national survey

Background Occupational therapists are an essential healthcare profession and play a vital role in rehabilitating patients in the activities of daily life. Nevertheless, many occupational therapists in Sweden are leaving the profession and this jeopardises occupational therapy services. Objective To explore factors that cause occupational therapists to seriously consider leaving their profession. Material and methods As part of a larger national study of Swedish occupational therapists’ health and work environment, qualitative content analysis with a summative approach was applied to explore the reasons for considering leaving their profession among 1279 Swedish occupational therapists. Results Three themes emerged: (1) facing work environment deficiencies, (2) pursuing own development and (3) Personal factors and external constraints. The largest category, belonging to theme 1, was stress and high work pressure given 344 times as a reason to consider leaving the profession. Conclusions and significance This article provides new and important insights on the reasons why occupational therapists may seriously consider leaving their profession. The results are significant for managers and employing organizations to consider in order to prevent a shortage of occupational therapy services.

Teachers’ Use of Descriptive Assessment in Primary School Mathematics Education in Iran

In many countries, assessment and curriculum reforms came into being in recent decades. In Iran, an important educational assessment reform took place called Descriptive Assessment (DA). In this reform, the focus of student assessment was moved from a more summative approach of providing grades and deciding about promotion to the next grade to a more formative approach of providing descriptive feedback aimed at improving student learning. In this study, we evaluated how seven fourth-grade mathematics teachers used the principles of DA. Data were collected by a questionnaire on assessment practices and beliefs, lesson observations, and interviews. Although the teachers varied in how they assess their students, in general their assessment practice is by and large in line with the DA guidelines. Nevertheless, in some respects we found differences. When assessing their students, the teachers essentially do not check the students’ strategies and when preparing the report cards, they still use final exams because they do not sufficiently trust the assessments methods suggested by DA. The guideline to use assessment results for adapting instruction is also not genuinely put into action. The article is concluded by discussing dilemmas the teachers may encounter when implementing DA.

A mapping of facilitators and barriers to evidence-based management in health systems: a scoping review study

BackgroundHealthcare settings are complex, and the decision-making process is usually complicated, too. Precise use of best evidence from different sources for increasing the desired outcomes is the result of EBM. Therefore, this study aimed to map the potential facilitators and barriers to EBM in health systems to help the healthcare managers to better implement EBM in their organizations.MethodsThe present study was a scoping review (SR) conducted in 2020 based on the integration of the frameworks presented by Arksey and O’Malley (2005) and Levac et al. (2010) considering the Joanna Briggs Institute guideline (2015). These frameworks consist of 6 steps. After finalizing the search strategy, 7 databases were searched, and the PRISMA-ScR was used to manage the retrieval and inclusion of the evidence. Microsoft Excel 2013 was used to extract the data, and the graphic description was presented. The summative analysis approach was used applying MAXQDA10.ResultsAccording to the systematic search, 4815 studies were retrieved after eliminating duplicates and unrelated articles, 49 articles remained to extract EBM facilitators and barriers. Six main aspects attitude toward EBM, external factors, contextual factors, resources, policies and procedures, and research capacity and data availability were summarized as EBM facilitators. The barriers to EBM were similarly summarized as attitude toward EBM, external factors, contextual factors, policies and procedures, limited resources, and research capacity and data availability. The streamgraphs describe that the international attention to the sub-aspects of facilitators and barriers of EBM has been increased since 2011.ConclusionsThe importance of decision-making regarding complex health systems, especially in terms of resource constraints and uncertainty conditions, requires EBM in the health system as much as possible. Identifying the factors that facilitate the use of evidence, as well as its barriers to management and decision-making in the organization, can play an important role in making systematic and reliable decisions that can be defended by the officials and ultimately lead to greater savings in organization resources and prevent them from being wasted.

A Review on: Can Developing Ecotourism is a Panacea for the Betrayed Lake Hashenge and its Environs, Tigray-Ethiopia?

The main aim of this review is to divulge the major ecotourism resources of Lake Hashenge and its environs and the challenges these resources are facing with. The paper has made use of a summative approach of content analysis methods in reviewing the published and unpublished literatures. The review indicates that though Lake Hashenge and its environs are endowed with several ecotourism attractions like natural, cultural, archaeological and historical resources, these resources are threatened with great anthropogenic factors as well as natural enigmas. Hence, developing ecotourism in the area is a timely issue to solve these anthropogenic and natural problems of the area.

Evaluation of health information systems with ISO 9241-10 standard: A systematic review and meta-analysis

This study aimed to summarize available data about health information system evaluation using the ISO 9241–110 (previously 9241–10) standard. A systematic review of literature from January 2000 to November 2020 was conducted in PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar as well as two Iranian national databases, Scientific Information Database and Magiran. Pooled estimates were calculated using random-effects meta-analysis. Data analyses were conducted using Stata version 14. From total of 179 studies subjected to initial screening, fifteen studies were eligible to enter the meta-analysis. The pooled mean estimates of the health information systems' overall scores (3.11; 95% confidence interval [CI], 2.82–3.41), suitability for individualization (3.82; 95% CI, 2.59–3.04), and controllability (3.82; 95% CI, 2.91–3.47) commonly had better performance compared with other dimensions. High heterogeneity was seen among the seven dimensions ( I 2 ≥ 98.6%, p < .001). According to the viewpoints of HIS users, suitability for individualization (3.82; 95% CI, 2.59–3.04) and controllability (3.82; 95% CI, 2.91–3.47) had better performance compared with other dimensions, and the results of the subgroup meta-analysis confirmed this difference ( z = 4.75, p < .001). For each dimension, Egger's and Begg's tests showed no publication bias ( p > .1). Most of the studies used the ISO 9241-110 standard as a summative assessment for evaluation of the usability of the HIS and results indicated the relative success of the evaluated systems based on this standard. • ISO 9241 part 10 is a valid standard for formative and summative evaluation of health information systems. • Most of the studies that have used the ISO9241 part 10 have focused on hospital information systems. • Few evaluations have been conducted using the formative version of ISO 9241 part 10. • Most of the evaluation studies have used the summative approach of the ISO 9241 part 10. • Because of the importance, it is suggested that researchers consider formative approaches.

Considerations for Implementation of an Ankle-Foot Orthosis to Improve Mobility in Peripheral Artery Disease

ObjectiveTo explore the perceptions of wearing an ankle-foot orthosis (AFO) in patients with peripheral artery disease (PAD) who did and did not adopt the AFO intervention. This follows a clinical trial of the effectiveness of an AFO in improving walking distances for patients with PAD-related claudication. DesignA randomized crossover trial of standard of care and an AFO for 3 months. Semistructured interviews were conducted 1.5 months into the AFO intervention to understand acceptability, demand, implementation, and practicality. Data were analyzed using a summative content analysis approach. SettingVascular surgery clinic and biomechanics research laboratory. ParticipantsPatients (N=15; male, 100%; age, 71.9±.6.7y; body mass index [calculated as weight in kilograms divided by height in meters squared], 29.0±.5.5; ankle brachial index: AFO intervention withdrawal, 0.543; AFO intervention completion, 0.740) with claudication completed the study, and 6 withdrew prior to intervention completion. InterventionsA certified orthotist fit participants with an AFO that was worn for 3 months. Main Outcome MeasuresQualitative analysis of the semistructured interviews. ResultsKey differences were reported between AFO intervention completion and AFO intervention withdrawal. Six of 14 of AFO intervention completion participants described their initial reactions to the AFO as negative vs 3 of 6 AFO intervention withdrawal participants. Only 5 of 15 AFO intervention completion participants reported minimal use of the AFO compared with 5 of 6 AFO intervention withdrawal participants. The AFO intervention withdrawal group reported higher levels of physical discomfort with the use of the AFO (4/6 vs 7/15) and preexisting health issues becoming a barrier to the use of the AFO (3/6 vs 5/15). Positive aspects reported included ease in standing and walking for AFO intervention withdrawal (4/6) and AFO intervention completion groups (13/15) as well as walking straighter and longer with less pain for AFO intervention withdrawal (3/6) and AFO intervention completion groups (9/15). ConclusionsPatients withdrawing prior to completion of AFO intervention tended to have more negative perceptions, more comorbidities, and more physical discomfort than those completing the intervention. Both groups reported positive aspects of the AFO. Implementation studies are needed to address barriers to AFO adoption.

¿Podemos vivir con el gigante? La máquina epistemológica universitaria: reflexiones y propuestas sobre la tecnología académica

&#x0D; &#x0D; &#x0D; En la actualidad, hay un profundo y extendido malestar entre la comunidad académica por la presión psicológica y laboral que las universidades ejercen sobre los investigadores al exigir la publicación ininterrumpida de artículos de investigación. En este artículo presento varios indicios de esta crisis, la cual afecta en particular a quienes habitan ecologías académicas. En primer lugar, argumento la necesidad de entender la situación como expresión de tecnologías y dispositivos moldeados por ideologías que generan subjetividades, mecanismos de exclusión, estigmatización y remplazo. En segundo, examino dos respuestas ante la crisis de la publicación académica enmarcadas en el movimiento de des- aceleración (Slow). Por último, después de explicitar algunos de los supuestos de la máquina epistemológica universitaria, propongo completar el proyecto de Ulmer y el equipo de Mountz con dos sugerencias. Por un lado, extiendo una invitación a reflexionar sobre y con los estudiantes, como medida para reconducir la teleología universitaria. Por el otro, sugiero adoptar la ontogogía como dispositivo de resistencia ante el embate de las exigencias de la máquina. El punto de partida del texto es antidicotonegativo pues explora un enfoque sumativo, más que una perspectiva agónica. En otras palabras, propongo dos herramientas adicionales que se pueden poner a prueba para contribuir en la solución de la crisis universitaria.&#x0D; &#x0D; &#x0D;

Evaluation of one-month foundation course for the first year undergraduate students at a Medical College in Puducherry, India.

Introduction: Medical Council of India has revised the undergraduate medical curriculum by introducing “Competency-based Medical Education” which emphasizes the foundation course of one-month duration. This period is said to be essential for students to get acclimatized to the new college environment. The present study evaluated the first one-month foundation course from students and faculty members’ point of view.Methods: The present study was program evaluation. The study participants were all 150 first year medical students joining the college and preclinical department faculty in the academic year, 2019-20. The foundation program was pre-planned and implemented as per the Medical Council of India guidelines. The program was evaluated using a pre-designed questionnaire where the items were aligned with the research question and inputs were obtained from all faculty members. Kirkpatrick framework level 1 was used for evaluation. Feedback was received from the faculty members by force field analysis and from student’s using a five-point Likert scale. A summative approach to the qualitative content analysis was done to identify certain themes from the text data and infer meaning for the force field analysis obtained from the faculty. Considering the high rating for most of the sessions, we arbitrarily considered values above 75% to reflect good consensus and below 75% to reflect poor consensus. Consensus measure expressed in percentage was obtained for each item. The quantitative data were analyzed using open Epi info version 7.0.Results: The consensus scores ranged from 73.7 to 83.3 percent. The sessions on learning styles, student support system, self-directed learning, communication skills, medical ethics, soft skills, and orientation to health systems in India reflected good consensus, indicating that these sessions were well received by the students. Other sessions like stress management, interpersonal skills, presentation skills, email writing and ethics for mobile usage reflected poor consensus, implying the need for further improvement. As per the faculty perception, good coordination, teamwork, and proper planning at interdepartmental and intradepartmental levels were the key features for the successful implementation of the course.Conclusion: Overall, the sessions in the foundation course were well received by the students. As felt by both students and faculty, more interactive sessions need to be incorporated. The major strength of the course was the skill module, visit to special school, and field visit to the community and primary health center. The findings will help us to improve our next year foundation program to meet the purpose of the Foundation course.

Exploring multidimensional operationalizations of precarious employment in Swedish register data - a typological approach and a summative score approach.

Objectives:This study aimed to explore multidimensional operationalizations of precarious employment (PE) in Swedish register data using two approaches: (i) a typological approach and (ii) a dimensional, summative scale approach. It also examined the distribution of sociodemographic and occupational characteristics of precarious employees in Sweden.Method:Register data was retrieved on individuals and their employers in the Swedish workforce. Five items corresponding to three dimensions of PE were operationalized: contractual relationship insecurity, contractual temporariness, multiple jobs/sectors, income level, and lack of unionization. First, latent class analysis was applied and a typology of six employment types emerged. Second, a summative scale was constructed by scoring all PE-items.Results:Three types of PE were found using the typological approach, which were characterized by direct employment, solo self-employment and multiple job holding, respectively. The summative scale score ranged between -10 and +2 (average: -1.8). Particularly poor scores were seen for solo self-employed, multiple job holders/multiple sectors, and low income. Female gender, young age, low education and foreign origin were prone to precariousness. PE was more frequent among certain economic sectors and occupations.Conclusions:Using an existing register of labor market data, two operationalizations of PE were constructed and rendered promising for exposure assessment. Hence, the operationalizations could be of interest for countries with similar data structure. Both approaches highlighted precarious combinations of employment conditions and pointed towards the existence of a wide continuum of precariousness on the labor market. Etiological studies and research assessing trends over time are needed to validate these findings.

Older Adults' Perspectives on Fall Risk: Linking Results to the ICF.

The aim of this study is to establish the perceptions of older adults in the South African context regarding falls and to link these perceptions to the International Classification of Functioning, Disability and Health (ICF). Data were analyzed by a summative, conventional, and deductive approach. The analysis indicated that the Body Function and Structure codes were most frequently used during the discussions, but the contextual analysis of the most frequently used categories indicated that Activities and Participation were the participants' main focus. The main focus of fall assessment in older adults should therefore be on Activities and Participation, as this can assist them in decreasing their fall risk, irrespective of whether they had a previous fall. Contrary to the majority of current literature on falls, this study included both participants who had fallen and those who hadn't, resulting in richer data and themes gathered from the focus groups.

Holistically speaking: A content analysis of spiritual interventions to inform the development of culturally relevant interventions for African American women living with HIV

Psychosocial interventions are a key component to improved quality of life for women living with HIV. Spirit-level interventions are shown to buffer psychosocial distress experienced by HIV positive persons. This article will review published spiritually-oriented interventions and compare, contrast, and critique the various components, sample, and intervention methods. Using a summative approach to content analysis, this article will offer the applicability and replicability of these interventions as a basis for increasing treatment options for co-morbid African American women.