Text Response Research Articles

Influence of acculturation and professional socialization on student teachers' beliefs about teaching physical education

The purpose of this study was to examine the influence of student teachers’ (ST's) acculturation and professional socialization on their beliefs about teaching PE. Specifically, ST's beliefs about teaching PE and how ST's acculturation and professional socialization influence ST's beliefs were investigated. For this study, occupational socialization theory was employed as a theoretical framework to examine student teachers’ beliefs. Thirteen STs participated in this study and data collection was undertaken during their final teaching practicum. Text descriptions were analysed and collected with the intention of gaining an overall grasp of STs’ beliefs. All the text response data were analysed inductively in a step-wise approach. The results of this study suggested that STs’ beliefs about PE teaching are influenced by how they view the purpose of PE lessons and their experiences with the level of student engagement during such lessons. It was also concluded that STs continue to believe that it is important for PE to provide students with enjoyment and the opportunity to socialise and acquire positive values. Insights were also observed that clarified the impact of classroom atmosphere on student engagement level and attitudes during PE lessons in influencing ST's pedagogical practices. While the study is situated in the Japanese context, findings from this study have useful international relevance.

Acceptance, Intent, Hesitance, and Attitudes Towards SAR-CoV-2 Vaccines Among Healthcare Workers in Michigan, USA.

Healthcare workers (HCWs) are critical infrastructure workers for whom COVID-19 vaccination was prioritized. It is believed that healthcare workers would have little or no hesitancy to take the COVID-19 vaccines given the risks of the pandemic to them, their families, and their patients. The study aims to understand the acceptance and attitudes toward COVID-19 vaccines among the HCWs in Michigan. A cross-sectional survey was fielded from January 11, 2021, through February 28, 2021. We obtained a representative sample of HCWs at MidMichigan Health. The participants were approximately 1500 clinical and non-clinical HCWs. COVID-19 vaccination acceptance and the intent to be vaccinated were measured with a questionnaire. HCWs indicating hesitance were asked to enter their reasons for hesitance as a free text response. A total of 1,467 HCWs responded to the survey. Overall, 62% indicated they had received both shots; 19.7% reported that they had received the first shot and would take the second; 2.3% noted that they were yet to receive the vaccine but would take both shots; 0.4% reported that they had received the first shot but would not take the second; 5.7% noted that they were unsure; and 9.9% indicated they did not intend to take the vaccine. Factors associated with vaccine hesitance included being female, younger age, having administrative staff or other health workers, having a larger household size, and having received no vaccines in the past year. Vaccine hesitancy concerns included safety, efficacy, antivaccine beliefs, the need for additional information, and a lack of trust. This survey revealed that 16% of HCWs in central and northern Michigan were hesitant about COVID-19 vaccines. Vaccine education is needed to increase the acceptance of COVID-19 vaccines among HCWs.

Description of patient questions received by clinical pharmacists in the Nudge Study.

The Nudge Study is a patient level-randomized trial testing different text message medication refill reminders sent to patients assigned to 4 arms: (1) usual care, (2) generic text, (3) optimized text, and (4) optimized text plus chatbot. This report describes the frequency and types of patient questions sent to clinical pharmacists (CPs) following text reminders. Patients were enrolled from Denver Health and Hospital Authority (DHHA) and Veterans Affairs Eastern Colorado Health Care System (VA ECHCS) from October 1, 2019, through May 30, 2021. Included patients responded to at least 1 text or interactive voice response (IVR) message. Patients were dichotomized as those who posed at least 1 question to a CP and those who posed no questions. Of the 6,325 patients enrolled in an intervention arm, 3,323 (52.5%) responded to at least 1 text or IVR message, and among those responding, 305 (9.2%) responded with a pharmacist question. Patient factors associated with submitting a CP question included age (45-74 years), enrollment from DHHA, and receipt of the optimized text or optimized text plus chatbot message versus the generic text. Questions to CP were in the following categories: medication related (48.2%), refill logistics (38.4%), cost (9.2%), and other (17.7%). In a text messaging intervention focused on medication refills, there were few questions directed to the CP. Patients assigned to receive optimized texts were more likely to have questions. We hypothesize that this may suggest greater patient engagement regarding their condition, resulting in more questions.

Metadial: A Meta-learning Approach for Arabic Dialogue Generation

Dialogue generation is the automatic generation of a text response, given a user’s input. Dialogue generation for low-resource languages has been a challenging tasks for researchers. However, the advancements in deep learning models have made developing conversational agents that perform the tasks of dialogue generation not only possible, but also effective and helpful in many applications spanning a variety of domains. Nevertheless, work on conversational bots for low-resource languages such as the Arabic language is still limited due to various challenges, including the language structure, vocabulary, and the scarcity of its data resources. Meta-learning has been introduced before in the natural language processing (NLP) realm and showed significant improvements in many tasks; however, it has rarely been used in natural language generation (NLG) tasks and never in Arabic NLG. In this work, we propose a meta-learning approach for Arabic dialogue generation for fast adaptation on low-resource domains, namely, Arabic. We start by using existing pre-trained models; we then meta-learn the initial parameters on high-resource dataset before finetuning the parameters on the target tasks. We prove that the proposed model that employs meta-learning techniques improves generalization and enables fast adaptation of the transformer model on low-resource NLG tasks. We report gains in the BLEU-4 and improvements in Semantic textual Similarity (STS) metrics when compared to the existing state-of-the-art approach. We also do a further study on the effectiveness of the meta-learning algorithms on the response generation of the models.

Accuracy of Information and References Using ChatGPT-3 for Retrieval of Clinical Radiological Information.

Purpose: To assess the accuracy of answers provided by ChatGPT-3 when prompted with questions from the daily routine of radiologists and to evaluate the text response when ChatGPT-3 was prompted to provide references for a given answer. Methods: ChatGPT-3 (San Francisco, OpenAI) is an artificial intelligence chatbot based on a large language model (LLM) that has been designed to generate human-like text. A total of 88 questions were submitted to ChatGPT-3 using textual prompt. These 88 questions were equally dispersed across 8 subspecialty areas of radiology. The responses provided by ChatGPT-3 were assessed for correctness by cross-checking them with peer-reviewed, PubMed-listed references. In addition, the references provided by ChatGPT-3 were evaluated for authenticity. Results: A total of 59 of 88 responses (67%) to radiological questions were correct, while 29 responses (33%) had errors. Out of 343 references provided, only 124 references (36.2%) were available through internet search, while 219 references (63.8%) appeared to be generated by ChatGPT-3. When examining the 124 identified references, only 47 references (37.9%) were considered to provide enough background to correctly answer 24 questions (37.5%). Conclusion: In this pilot study, ChatGPT-3 provided correct responses to questions from the daily clinical routine of radiologists in only about two thirds, while the remainder of responses contained errors. The majority of provided references were not found and only a minority of the provided references contained the correct information to answer the question. Caution is advised when using ChatGPT-3 to retrieve radiological information.

MP62-13 THE PATIENT'S VOICE AT SCALE: UNDERSTANDING WHY PATIENTS ARE NOT SEXUALLY ACTIVE POST RADICAL PROSTATECTOMY THROUGH QUALITATIVE CODING OF RESPONSES ON A PATIENT REPORTED OUTCOME INSTRUMENT

You have accessJournal of UrologyCME1 Apr 2023MP62-13 THE PATIENT'S VOICE AT SCALE: UNDERSTANDING WHY PATIENTS ARE NOT SEXUALLY ACTIVE POST RADICAL PROSTATECTOMY THROUGH QUALITATIVE CODING OF RESPONSES ON A PATIENT REPORTED OUTCOME INSTRUMENT Mahmoud Hijazi, David Gandham, Alice Semerjian, Thomas Maatman, Mohammad Jafri, Kenneth Kernen, James Peabody, Arvin George, Kevin Ginsburg, and Andrew Krumm Mahmoud HijaziMahmoud Hijazi More articles by this author , David GandhamDavid Gandham More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Thomas MaatmanThomas Maatman More articles by this author , Mohammad JafriMohammad Jafri More articles by this author , Kenneth KernenKenneth Kernen More articles by this author , James PeabodyJames Peabody More articles by this author , Arvin GeorgeArvin George More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , and Andrew KrummAndrew Krumm More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While Patient reported outcome measures (PROMs) can capture the patient perspective at scale, that perspective is often constrained by available survey items. To amplify the patient′s voice as communicated through a PROM, free text, or open response, items may provide a more nuanced rendering of what a patient is experiencing. The objective of this abstract is to understand in qualitative terms, why patients are not sexually active pre- and post-radical prostatectomy. METHODS: Survey responses from the Michigan Urological Surgery Improvement Collaborative prostate cancer disease registry were collected pre-treatment and at 3-, 6-, 12-, and 24-months post-surgery. Written responses to the question “Why are you not sexually active?” beyond were independently analyzed and iteratively refined into higher-level codes. For the same question, patients could select 8 other options (“Lack of a willing partner”, “Lack of interest,” “Lack of confidence,” “No ejaculate,” “No erection,” “Urine leak during intercourse”, “Pain/discomfort during intercourse”, and "Not applicable"); a free-response option was provided next to the “Other” option. Prevalence of codes was examined after two independent raters reached agreement on code definitions. RESULTS: Between 1/2018 and 12/2021, 24,568 PROMs were collected, and 20,268 patients responded to the sexual activity question. Approximately 7% of patients provided a text response: 1,448 unique patients submitted 1,875 written responses. Table 1 summarizes the identified codes and the percent of overall responses with each code. The three most common codes were complications (e.g., treatment-specific change in anatomy of function), partner (e.g., own health and interest), and structural issues (e.g., lack of time). Other factors that patients identified included comorbidities and explicit choices not to be sexually active. CONCLUSIONS: Written responses provide a glimpse into a more nuanced view of post-treatment sexual activity that can be used to not only develop a more robust understanding of patients but also develop survey items that better capture patient concerns and hesitancies. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e866 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mahmoud Hijazi More articles by this author David Gandham More articles by this author Alice Semerjian More articles by this author Thomas Maatman More articles by this author Mohammad Jafri More articles by this author Kenneth Kernen More articles by this author James Peabody More articles by this author Arvin George More articles by this author Kevin Ginsburg More articles by this author Andrew Krumm More articles by this author Expand All Advertisement PDF downloadLoading ...

Perspectives of Dermatology Program Directors on the Impact of Step 1 Pass/Fail.

The shift of Step 1 to Pass/Fail has generated several questions and concerns about obtaining residency positions among allopathic and osteopathic students alike. Determining the perspectives of Dermatology Program Directors in regards to post-Step 1 Pass/Fail is critical for students to better prepare for matching into dermatology. After receiving Institutional Review Board (IRB) exemption status, the program directors were chosen from 144 Accreditation Council for Graduate Medical Education (ACGME) and 27 American Osteopathic Association (AOA) Dermatology programs using contact information from their respective online website databases. An eight-item survey was constructed on a three-point Likert scale, one free text response, and four demographic questions. The anonymous survey was sent out over the course of three weeks with weekly individualized reminder requests for participation. A total of 54.54% of responders had "Letters of Recommendation" in their top 3. Forty-five percentof responders had "Completed Audition Rotation at Program" in their top 3. And, 38.09% of responders had "USMLE Step 2 CK Scores" in their top 3. Approximately 50% of responders agreed that all medical students will have more difficulty matching dermatology. Based on the survey study, Dermatology program directors want to focus more on letters of recommendation, audition rotations, and Step 2 CK scores. Because each field seems to prioritize different aspects of an application, students should attempt to gain as much exposure to different fields such as through research and shadowing to narrow down their ideal specialties. Consequently, the student will have more time to tailor their applications to what residency admissions are looking for.

Examiner perceptions of the MRCGP recorded consultation assessment for general practice licensing during COVID-19: cross-sectional study

BackgroundThe Recorded Consultation Assessment (RCA) was developed rapidly during the COVID-19 pandemic to replace the Clinical Skills Assessment (CSA) for UK general practice licensing. Our aim was to evaluate examiner perceptions of the RCA.MethodsWe employed a cross-sectional design using a questionnaire survey of RCA examiners with attitudinal (relating to examiners thoughts and perceptions of the RCA) and free text response options. We conducted statistical descriptive and factor analysis of quantitative data with qualitative thematic analysis of free text responses.ResultsOverall, 182 of 260 (70%) examiners completed the questionnaire. Responders felt that consultations submitted were representative of the work of a typical GP during the pandemic and provided a good sample across the curriculum. They were also generally positive about the logistic, advisory and other support provided as well as the digital platform. Despite responders generally agreeing there was sufficient information available in video or audio consultations to judge candidates’ data gathering, clinical management, and interpersonal skills, they were less confident about their ability to make judgments of candidates’ performance compared with the CSA. The qualitative analysis of free text responses detailed the problems of case selection and content, explained examiners’ difficulties when making judgments, and detailed the generally positive views about support, training and information technology. Responders also provided helpful recommendations for improving the assessment.ConclusionThe RCA was considered by examiners to be feasible and broadly acceptable, although they experienced challenges from candidate case selection, case content and judgments leading to suggested areas for improvement.

Analysis of ChatGPT Tool to Assess the Potential of its Utility for Academic Writing in Biomedical Domain

Background: ChatGPT (Generative Pre-trained Transformer) is an artificial intelligence chatbot which is designed to generate detailed text response and/or articulate answers to any query. Widespread concerns are expressed that such tools can be misused for academic writing. Hence this study was designed to test the utility and merit of ChatGPT for academic writing in biomedical sciences. Materials and Methods: five randomly selected quey topics were input into ChatGPT for a response. The ChatGPT response time, quality of the content and reliability were assessed. The ChatGPT response was transferred into a word file and the file was checked for originality using the Urkund software. Results: The response rate by ChatGPT was observed to be very quick i.e., less than 2 min to give a 300-500 words text output. Although the content of the response were systematic, precise and original, it lacked quality and depth of academic writing. Several shortcomings such as word count, referencing errors and lack of academic merit were observed. Conclusion: Despite its significant limitations, ChatGPT has enormous potential as training and upskilling resource for academic writing, which rather than replacing biological intelligence will help in refining it if used appropriately under academic mentoring.

Reading the lockdown: responding to covid poetry

ABSTRACT During 2020, sales of books increased as readers found more time to engage with fiction and return to books that provided comfort and a sense of escapism. The Covid-19 pandemic also provided the space for a new genre, “covid fiction”, to emerge. This article examines the sub-genre of “covid poetry” by integrating text and reader response data analysis to examine the representation of the pandemic experience in Michele Witthaus’ poem “The new shape of fear”. Analysis of the data reveals that participants interpret and discuss the poem by drawing on foregrounded language features in the text, reflecting on their own pandemic experiences and demonstrating empathy with the experiences of others. These findings demonstrate that covid poetry may have particular interpretative effects that are geared towards self- and other-understanding. Overall, the article sets out some first steps towards examining the stylistic characteristics and interpretative effects of this emerging and important genre.

Predication of Writing Originality Based on Computational Linguistics.

Existing assessment methods of writing originality have been criticized for depending heavily on subjective scoring methods. This study attempted to investigate the use of topic analysis and semantic networks in assessing writing originality. Written material was collected from a Chinese language test administered to eighth-grade students. Two steps were performed: 1. Latent topics of essays in each writing task were identified, and essays on the same topic were treated as a refined reference group, within which an essay was to be evaluated; 2. A group of features was developed, including four categories, i.e., path distance, semantic differences, centrality, and similarity of the network drawn from each text response, which were used to quantify the differences among essays. The results show that writing originality scoring is not only related to the intrinsic characteristics of the text, but is also affected by the reference group in which it is to be evaluated. This study proves that computational linguistic features can be a predictor of originality in Chinese writing. Each feature type of the four categories can predict originality, although the effect varies across various topics. Furthermore, the feature analysis provided evidence and insights to human raters for originality scoring.

Initial Development and Validation of the Plant Awareness Disparity Index.

Plant awareness disparity (PAD, formerly plant blindness) is the idea that students tend not to notice or appreciate the plants in their environment. This phenomenon often leads to naïve points of view, such as plants are not important or do not do anything for humans. There are four components of PAD: attitude (not liking plants), attention (not noticing plants), knowledge (not understanding the importance of plants), and relative interest (finding animals more interesting than plants). Many interventions have been suggested to prevent PAD, but without an instrument shown to demonstrate valid inferences to measure PAD, it is difficult to tell whether these interventions are successful or not. We have developed and validated the Plant Awareness Disparity Index (PAD-I) to measure PAD and its four components in undergraduate biology students. The study population was 74.32% female and 69.08% white, indicating that the need for further analysis is necessary if this instrument is to be used in a more diverse student population. We collected validity evidence based upon text content, response processes, and internal structure. Our findings demonstrate that our instrument generates reliable inferences regarding PAD with a Cronbach's alpha of 0.884 and a six-factor structure that aligns conceptually with the four components of PAD.

Pediatricians’ Disclosure and Documentation of Sickle Cell Trait Found on Newborn Screening: Barriers and Possible Implementation Strategies

Introduction All states in the US require hemoglobinopathy testing as part of the newborn screen (NBS) which incidentally identifies individuals with sickle cell trait (SCT). Each state has its own protocol for disclosure of SCT results to families (i.e., via primary care provider (PCP), public health nurse, direct mailing to family) with no standards for documentation in the electronic health record (EHR). Our past work showed that SCT is documented 53% of the expected rate within our EHR. Though gaps in documentation may not equate to lack of disclosure, such gaps demonstrate a risk for inadequate counseling and loss of data with transitions of care. Further, the majority of individuals with SCT are Black or Hispanic. Failure to disclose SCT may contribute to inequities in healthcare and hamper informed reproductive decision making. Objective To identify barriers and facilitators to PCPs’ documentation and disclosure of SCT. Methods A cross sectional survey of outpatient PCPs at 43 pediatric offices within a pediatric health system in Delaware, Pennsylvania, and Florida was conducted. Using Likert scales, rating scales, and free text response, the survey assessed PCP practices surrounding NBS results, attitudes toward SCT disclosure and documentation, and ranking of implementation strategies from the "Expert Recommendations for Implementing Change” project intended to increase SCT documentation and disclosure. Recruitment and survey administration was via REDCap. Lunch was provided to offices with >75% participation. Free text items were analyzed using qualitative methods. Descriptive statistics were used for other items. The study was approved by the IRB. ResultsParticipants: Seventy-eight PCPs from 43 practices completed surveys (51% recruitment rate). Fourteen offices received lunch incentives. PCPs worked in their offices a mean of 7.1 years (SD 6.8y). Most (76%) identified as female and White (66%), with 17% Asian, 4% Black, and 12% Hispanic. Practice locations varied in percentages of patients insured by Medicaid (3-76%) or who identify as Black (2-91%). NBS Results: Most PCPs had a process for reviewing NBS results with ~1/3 actively seeking results (i.e., log into a separate portal). The majority "always” checked a NBS during infancy but "never/occasionally” checked for an older new patient, before sports participation, or transition to adult medicine. All PCPs endorsed the importance for families and PCPs to know about hemoglobin traits but 14% thought a family may not want to know and 30% thought a family may have trouble understanding results. Nearly half (45%) thought a non-PCP should discuss results. SCT: Almost all participants routinely discuss SCT during infancy. 16% routinely discuss it with adolescents and 56% "rarely/never” discuss SCT before transition to adult medicine. 10% "rarely/never” discuss inheritance patterns, but nearly one third "rarely/never” discuss possible medical complications and reproductive planning options. PCPs had varying confidence levels for several tasks (Table). Barriers: In free text questions, PCPs identified barriers to discussing SCT (during infancy or adolescence) including PCP knowledge/comfort, adequate time, NBS availability, lack of "good” handouts, and family health literacy. Additional barriers included believing adolescents are not interested. Potential Interventions: The highest ranked interventions to help increase the documentation and discussion of SCT included having a designated person to review the NBS, prompts within the EHR and templates for documentation, NBS program providing disclosure, longer appointment slots, educational sessions to increase PCP knowledge/comfort, and educational materials for families. Least helpful rated interventions included chart audits, incentives, leadership/society endorsements, or simulated discussions. Conclusions Despite PCPs recognizing the importance of discussing SCT, they rarely do so outside of infancy and have varying degrees of confidence in doing so. PCPs recognized several system-based (i.e. time, EHR prompts) and personal barriers (i.e. confidence, knowledge) to discussing SCT. They expressed preferences for a range of potential implementation strategies. Real world studies are needed to determine whether strategies designed to address these barriers increase discussion and documentation of SCT across childhood and enhance care equity. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Can Sri Lankan Australians Recognise Depression? The Influence of Acculturation, Age and Experiences with Depression on Recognition.

Mental health literacy is an important determinant of mental health help-seeking and is associated with improved mental health. There is evidence that mental health literacy may be lower amongst some migrant communities in Australia. The present study conducted the first cross-sectional survey of mental health literacy in Sri Lankan Australians between April and October 2020. Participants (N = 404) were presented with a culturally-tailored vignette describing an individual with symptoms of major depressive disorder, with correct recognition determined by the coding of an open text response to the question 'what's wrong with Mr Silva?'. Binomial linear regression modelling was conducted to identify predictors of the correct recognition of depression. Approximately 74% of participants recognised the presented symptoms as depression, though multiple other labels were also used by the respondents. The results also suggested that younger age and having a prior diagnosis of depression were significant predictors of recognising depression in the vignette. In the first study of Sri Lankan migrants' mental health literacy in an Australian context, the rates of depression recognition were comparable to those found in the general Australian population. Further research is urgently required to replicate and extend the present findings and ultimately support the development of tailored interventions aimed at improving mental health literacy across the diverse Sri Lankan Australian community.

Sociodemographic factors affecting paediatric surgical training in Malaysia: Gender matters

BackgroundA shortage of specialist paediatric surgeons in Malaysia led to establishment of a national postgraduate training programme in 2004. We aimed to identify sociodemographic factors impacting training experience, and to define pressure points during training to inform targeted trainee support strategies. MethodsWe conducted an anonymized online survey in June 2021 on all programme graduates. Participants were asked for sociodemographic data, both current and during training. Likert scale responses were required for questions regarding adequacy of support received for family, health and personal issues during training. A free text response question soliciting suggestions for programme improvement was included. Data are reported as median (range). Chi-square/Fisher's exact tests for categorical variables and Mann-Whitney U tests for continuous variables were used, with p<0.05 significance. ResultsOf 53 eligible participants, 52 (98%) responded, 24 (46%) were female. Marital status was similar between genders at entry, but female trainees were more likely to be unmarried on exit (p = 0.001), and less likely to have children while training (p = 0.017). Of the 6 female and 18 male trainees who had children while training, women were more likely to take parental leave (p = 0.01). The majority felt advice given regarding parental leave and managing training while having children were poor. In thematic analysis of free text answers, lack of hands-on experience was the most common concern. ConclusionFactors related to marriage and parenthood significantly associate with gender amongst trainees in Malaysia despite both genders being well represented. Concerns regarding adequacy of hands-on training highlight the need for educational innovations such as simulation models. Level of studyLevel III.

Do reasons for undergoing bariatric surgery influence weight loss and health-related quality of life?-A Swedish mixed method study.

BackgroundA wish for improved health or avoidance of ill health is often given as reason for wanting to undergo bariatric surgery. How such reasons relate to postoperative outcome is unclear.ObjectiveThe aim was to explore Swedish patients’ reasons for undergoing bariatric surgery. Also, we wanted to analyze if there were sex and age differences and associations with weight loss and health-related quality of life (HRQoL).SettingsThis was a single-center study conducted at a university hospital.MethodData on 688 patients (528 women and 160 men) including a free text response was analyzed inductively and deductively using predefined statements and was merged with data from the Scandinavian Obesity Surgery Registry. All data was analyzed using descriptive and analytic statistics.ResultThe most common reason for undergoing bariatric surgery was pain in different body parts. A wish for an improved medical condition was reported by most patients (59%, n = 408), followed by physical limitations making daily life difficult (42%, n = 288). Men and women reported similar reasons. Younger patients were more distressed about physical appearance (p = 0.001) and older patients wanted to improve their medical condition (p = 0.013). Health-related quality of life improved irrespective of reasons for undergoing surgery.ConclusionThe most reported reasons for undergoing bariatric surgery were a wish for improved medical condition and to make daily life easier. Factors associated with the decision for surgery showed that there were few sex differences, but age seemed to be a factor. The HRQoL trajectory showed improvement regardless of reasons for undergoing surgery.

Transportation barriers to care among frequent health care users during the COVID pandemic

BackgroundTransportation problems are known barriers to health care and can result in late arrivals and delayed or missed care. Groups already prone to greater social and economic disadvantage, including low-income individuals and people with chronic conditions, encounter more transportation barriers and experience greater negative health care consequences. Addressing transportation barriers is important not only for mitigating adverse health care outcomes among patients, but also for avoiding additional costs to the health care system. In this study, we investigate transportation barriers to accessing health care services during the COVID-19 pandemic among high-frequency health care users.MethodsA web-based survey was administered to North Carolina residents aged 18 and older in the UNC Health system who were enrolled in Medicaid or Medicare and had at least six outpatient medical appointments in the past year. 323 complete responses were analyzed to investigate the prevalence of reporting transportation barriers that resulted in having arrived late to, delayed, or missed care, as well as relationships between demographic and other independent variables and transportation barriers. Qualitative analyses were performed on text response data to explain transportation barriers.ResultsApproximately 1 in 3 respondents experienced transportation barriers to health care between June 2020 and June 2021. Multivariate logistic regressions indicate individuals aged 18–64, people with disabilities, and people without a household vehicle were significantly more likely to encounter transportation barriers. Costs of traveling for medical appointments and a lack of driver or car availability emerged as major transportation barriers; however, respondents explained that barriers were often complex, involving circumstantial problems related to one’s ability to access and pay for transportation as well as to personal health.ConclusionsTo address transportation barriers, we recommend more coordination between transportation and health professionals and the implementation of programs that expand access to and improve patient awareness of health care mobility services. We also recommend transportation and health entities direct resources to address transportation barriers equitably, as barriers disproportionately burden younger adults under age 65 enrolled in public insurance programs.

“O.I. Wish Orthopaedic Surgeons Had Better Strategies to Help with …” Results of a Patient- and Parent-Based Survey

Purpose: Osteogenesis Imperfecta (OI) is a rare genetic disorder caused by a mutation in type I collagen, characterized by bone fragility and deformity. Current treatment methods aim to decrease fracture rates and improve bone density and mobility. Recent orthopaedic surgery research has focused primarily on fracture fixation and outcomes of intramedullary rodding procedures. While surgical techniques continue to evolve, recent trends are focusing on patient-reported outcomes measures (PROMs). Methods: The authors created a 12-question survey in conjunction with the OI Foundation (OIF). The survey was titled, “O.I. Wish Orthopaedic Surgeons Had Better Strategies to Help with . . .” and sought to gather information regarding the aspects of orthopaedic care OI patients and families would most like to see improved. The survey was electronically administrated to members of the OIF and the OI Federation Europe (OIFE). 341 individuals completed the survey. The final question of the survey indicated, “Please include any comments you would like to pass along.” To report on the responses for this question, the answers were grouped into themes. Results: Many of the survey questions we asked were related to childhood orthopaedic surgical interventions. However, 75% of the respondents who answered the age question (254/335) were adults. Regarding surgical intervention for long bones, 16% of respondents recall that they have been told that they could not have surgery because they were too young. Of the 16%, 37.8% were told that &lt;5 years was too young, 13.4% &lt;4 years was too young, and 48.8% &lt;3 years of age was too young for surgical intervention for fractures or deformity. Nearly 22% of respondents were told that their bones were too small to have intramedullary fixation. For the free text response, the most frequent comments were to focus future research on OI adults (14.9%), focus on pain management (11.8%), and focus on improving rodding surgery techniques (11.3%). Conclusion: The information collected helps reveal trends of the typical orthopaedic advice patients and families with OI are receiving. The patient and family responses help elucidate the topics requiring focus for the improvement of OI orthopaedic care. Patient concerns and insights most powerfully drive the research questions we should ask to advance the orthopaedic care of OI patients. Significance: This survey highlights variability in OI treatment for patients of all ages. The responses guide future OI research with a focus on patient-reported areas for improvement of care.

Establishing national stakeholder priorities for quality improvement in pediatric trauma care: Consensus results using a modified Delphi process.

Quality improvement efforts within pediatric trauma centers (PTCs) are robust, but the majority of children do not receive initial postinjury care at PTCs. Disparities in access to quality trauma care remain, particularly for children who initially access the trauma system outside of a PTC. The purpose of this project was to identify unmet needs for injured children within the pediatric emergency care system and to determine national priorities for quality improvement across the continuum of pediatric trauma care. A panel of delegates representing patients and families, prehospital providers, federal funding partners, nurses, and physicians was recruited from 10 national stakeholder organizations. Potential targets were identified using an initial stakeholder meeting followed by a free text response survey. Free text items were coded and condensed as themes and then ranked by the panel using a modified Delphi approach to determine consensus priorities. Items not achieving >35% prioritization on a given iteration were dropped from subsequent iterations. Consensus was defined as 75% of members designating an item as a top-four priority. Nineteen themes were identified as potential targets for QI initiatives. Four iterations of panel ranking were used to achieve consensus, with four priorities identified: (1) creation of a toolkit and standard provider training for pediatric trauma triage, shock recognition, and early recognition for need to transfer to higher level of care; (2) development of minimum standards for pediatric trauma resuscitation and stabilization capability in nonpediatric centers; (3) facilitating creation of local nursing and physician champions for pediatric trauma; and (4) development and dissemination of best-practice guidelines to improve imaging practices for injured children. System-level quality improvement priorities for pediatric trauma care should focus resources on developing and implementing minimum pediatric standards for injury care, frontline provider training, stabilization protocols, imaging guidelines, and local pediatric champions. Therapeutic/Care Management; Level IV.

R Markdown as a dynamic interface for teaching: Modules from math and biology classrooms

Advancing technologies, including interactive tools, are changing classroom pedagogy across academia. Here, we discuss the R Markdown interface, which allows for the creation of partial or complete interactive classroom modules for courses using the R programming language. R Markdown files mix sections of R code with formatted text, including LaTeX, which are rendered together to form complete reports and documents. These features allow instructors to create classroom modules that guide students through concepts, while providing areas for coding and text response by students. Students can also learn to create their own reports for more independent assignments. After presenting the features and uses of R Markdown to enhance teaching and learning, we present examples of materials from two courses. In a Computational Modeling course for math students, we used R Markdown to guide students through exploring mathematical models to understand the principle of herd immunity. In a Data Visualization and Communication course for biology students, we used R Markdown for teaching the fundamentals of R programming and graphing, and for students to learn to create reproducible data investigations. Through these examples, we demonstrate the benefits of R Markdown as a dynamic teaching and learning tool.