Trained Observers Research Articles

The Influence of Hybrid Comprehensive Telerehabilitation on Anxiety in Heart Failure Patients: The TELEREH-HF Randomized Clinical Trial.

Telerehabilitation for heart failure (HF) patients is beneficial for physical functioning, prognosis, and psychological status. The study aimed at evaluating the influence of hybrid comprehensive telerehabilitation (HCTR) on the level of anxiety in comparison to usual care (UC). The TELEREH-HF study was a multicenter prospective RCT in 850 clinically stable HF participants. Patients underwent clinical examinations, including the assessment of anxiety, at entry and after the 9-week training program (HCTR) or observation (UC). The State-Trait Anxiety Inventory (STAI) was used. 20.3% HCTR and 20.1% UC patients reported high level of anxiety as a state at baseline, with higher STAI results in younger participants (< 63 y.o.) (p = .048 for HCTR; p = .026 for UC). At both stages of the study, patients with lower level of physical capacity (measured by a peak VO2) had shown significantly higher level of anxiety. There were no significant changes in anxiety levels during the 9-week observation for the entire study population, although there were different patterns of change in anxiety (both trait and state) in younger and older groups,with the decrease in younger patients, and the increase-in the older group.Trial registry number NCT02523560 (Clinical Trials.gov), date of registration: August 14, 2015.

Restraint use within vehicles transporting child occupants in Dubai, United Arab Emirates: An observational study

ObjectiveThis observation study aimed to describe the frequency and type of restraint use for child occupants within private motor vehicles in the emirate of Dubai in the United Arab Emirates (UAE). MethodsAn overt, on-road observation study was conducted by trained observers who recorded the restraint use of the occupants while travelling in private motor vehicles with at least one child aged approximately ten years and younger in Dubai. ResultsOverall, 2000 vehicles were observed transporting 2940 child occupants estimated to be aged 10 years and younger. Over one-half of the drivers were observed to be using their seatbelt (60.0%) and over one-half of front-seat passengers were observed to be using their seatbelt (53.3%). One-half of the observed child occupants were unrestrained (51.7%), and a further 8.3 percent were seated unrestrained on an adult's lap. Based on the seating position and restraint type within the vehicle, child restraint use was classified into appropriate, seatbelt and inappropriate use, and the results showed that more than one-half of the child occupants were inappropriately restrained (59.9%). There was a significant relationship between the driver's seatbelt use and inappropriate restraint use for at least one child occupant in the vehicle (χ2 (1) = 75.450, p < 0.001). Unrestrained drivers were more likely to have at least one inappropriately restrained child in their vehicle (28.4%) than to have all children appropriately restrained (8.8%). ConclusionsDespite the introduction of child restraint system (CRS) legislation in 2017 that mandated the use of CRS for child occupants aged four years and younger while travelling in a private motor vehicle in the UAE, this study observed a high proportion of unrestrained or inappropriately restrained child occupants than expected. These findings highlight an urgent need for greater enforcement of this legislation and awareness programs about the significant injury risks for unrestrained or inappropriately restrained child occupants in the UAE.

CHANGES IN FRACTAL DIMENSION OF THIN AND THICK BLOOD VESSELS FROM RETINAL FUNDUS IMAGES FOR DIFFERENT STAGES IN DIABETIC RETINOPATHY

Retinal vasculature feature extraction plays a critical role in the diagnosis and treatment of systemic conditions, particularly in the cases of diabetic retinopathy (DR). This research introduces an algorithm that utilizes segmented blood vessels in retinal images to identify and differentiate five stages of DR, including mild, moderate, severe and proliferative. The algorithm effectively extracts retinal blood vessels by integrating morphological operators and matched filters, yielding a more precise output. The algorithm’s performance is evaluated using the database IDRiD, demonstrating precision and sensitivity scores comparable to those of a trained observer. A box-counting method was incorporated to measure the fractal dimension (FD) of DR-segmented vessel images at various stages to enhance the accuracy of DR staging. The FD analysis was applied to both thick and thin segments of the blood vessels, enabling the assessment of accuracy, sensitivity and specificity. The results indicate that the algorithm successfully identifies the different stages of DR with an accuracy of 93.65% for the mild stage, of 93.33% for the moderate and severe stages and of 92.71% for proliferative DR compared to the images without DR. The study reveals that the variation in FD between the thick and thin vessel components can be an effective biomarker for identifying the different stages of DR, contributing to a better understanding of disease progression. By combining morphological operators, matched filters and fractal dimension analysis, this research presents a promising approach for specialists involved in diagnosing and treating DR, eventually leading to improved patient care and consequences.

Within-Subject Principal Component Analysis of External Training Load and Intensity Measures in Youth Soccer Training.

Marynowicz, J, Lango, M, Horna, D, Kikut, K, Konefał, M, Chmura, P, and Andrzejewski, M. Within-participant principal component analysis of external training load and intensity measures in youth soccer training. J Strength Cond Res 37(12): 2411-2416, 2023-The aim of this study was to identify which combination of external training load (EL) and external intensity (EI) metrics during youth soccer training sessions captured similar or unique information. Data were collected from 18 youth soccer players during an 18-week in-season competition period using a 10-Hz global positioning system, rating of perceived exertion (RPE), and session-RPE (sRPE). External training load measures included total distance (TD, in meters), PlayerLoad (PL, in arbitrary units), high-speed running distance (HSR, in meters), and number of accelerations (ACC, n). All EL metrics were also divided by session duration (minutes) to obtain EI values. A total of 804 training observations were undertaken (43 ± 17 sessions per player). The analysis was performed by use of the principal component analysis technique. The first principal component (PC) captured 49-70% and 68-89% of the total variance in EI and EL, respectively. The findings show that from the 5 EI metrics, most of the information can be explained by either TD per minute or PL per minute, with a loading from 0.87 to 0.98 and from 0.76 to 0.95, respectively. The majority of EL information can be explained by PL (loading: 0.93-0.98), TD (loading: 0.95-0.99), ACC (loading: 0.71-0.91), or sRPE (loading: 0.70-0.93). The second PC for EL metrics is most strongly correlated with HSR, with loadings from 0.53 to 0.84. The results suggest that the majority of the information contained in the EL variables can be captured in 1 PC without losing much information. The findings suggest that stakeholders who intend to provide a fast and holistic view of EL information in a daily training environment should report TD, PL, ACC, or sRPE plus HSR to coaching staff as a metrics that provides additional unique information.

Remaking the ‘angry Narcanned subject’: Affording new subject positions through take-home naloxone training

Naloxone is a medication used to reverse opioid overdose. Alongside its lifesaving effects, it also has a reputation for producing distress, aggression and occasionally violence upon administration. This article analyses how take-home naloxone (THN) training initiatives address naloxone's reputation for producing aggression and conflict, and how new subject positions emerge in the context of this training. While the role of naloxone in producing aggression has been discussed in a range of research, this work emphasises that such conflict is neither inevitable nor even likely because it is contingent on several other issues such as administration practices. Building on this scholarship, we work with Bruno Latour's theorisation of technological ‘affordances’ to analyse THN as a socially co-produced technology that, rather than either determining or neutrally communicating actions and effects, ‘affords’ possibilities, capacities and subjects. Analysing data drawn from observations of THN training in Victoria, Australia, and in-depth interviews with training participants, we argue that the issue of conflict upon revival affords a subject position we term the ‘angry Narcanned subject’. This subject, we note, has come to hold a powerful position in understandings of naloxone, not least because it tends to accord with stereotypes of antisocial drug users. From here, we argue that a much of THN training is focused on challenging and reframing naloxone's reputation for conflict and questioning related subject positions, especially that of the angry Narcanned subject. We argue that this process of challenging and reframing affords two new subject positions for consumers: the ‘capable administrator’ and the ‘calmer revivee’. We conclude that while THN training affords multiple, potentially positive, subject positions, unless these initiatives are accompanied by broader interventions such as decriminalisation campaigns, they may inadvertently responsibilise people who consume opioids for addressing overdose and erase the role of prohibition, criminalisation and stigmatisation in producing overdose events.

A note on dairy cow behavior when measuring enteric methane emissions with the GreenFeed emission monitoring system in tiestalls

Changes in the environment or novel procedures can result in altered cow behavior during data collection; training is often recommended to ensure accurate data is being recorded. Currently, little is known regarding the habituation of dairy cows during methane emission testing with the GreenFeed emission monitoring system (C-Lock Inc., Rapid City, SD), or how behavior relates to enteric methane emission measurements. Methane emissions were estimated from a total of 202 Holstein dairy cows (120–150 d in milk) housed in tiestalls as part of a larger project. Cows were tested on d 0 (training day) and d 1–5 (test day) for approximately 10 min, during which behavior was recorded by a trained observer. While cows spent more time with their head outside of the machine on the training day (d 0) than during the test days (d 1–5), the opposite pattern was observed for the number of leg movements. No differences in estimated methane production were found over the different days, though it was negatively correlated with both behaviors. These results highlight the importance of habituation of dairy cows to the GreenFeed system for methane measurements to minimize changes to cow behavior under tiestall conditions, whereas the methane emissions themselves are less affected. However, further research is needed to determine the impact of cow behavior on the reliability and repeatability of methane emission measurements as it may introduce bias in genetic evaluations for methane efficiency.

Investigating permafrost carbon dynamics in Alaska with artificial intelligence

Positive feedbacks between permafrost degradation and the release of soil carbon into the atmosphere impact land–atmosphere interactions, disrupt the global carbon cycle, and accelerate climate change. The widespread distribution of thawing permafrost is causing a cascade of geophysical and biochemical disturbances with global impacts. Currently, few earth system models account for permafrost carbon feedback (PCF) mechanisms. This research study integrates artificial intelligence (AI) tools and information derived from field-scale surveys across the tundra and boreal landscapes in Alaska. We identify and interpret the permafrost carbon cycling links and feedback sensitivities with GeoCryoAI, a hybridized multimodal deep learning (DL) architecture of stacked convolutionally layered, memory-encoded recurrent neural networks (NN). This framework integrates in-situ measurements and flux tower observations for teacher forcing and model training. Preliminary experiments to quantify, validate, and forecast permafrost degradation and carbon efflux across Alaska demonstrate the fidelity of this data-driven architecture. More specifically, GeoCryoAI logs the ecological memory and effectively learns covariate dynamics while demonstrating an aptitude to simulate and forecast PCF dynamics—active layer thickness (ALT), carbon dioxide flux (CO2), and methane flux (CH4)—with high precision and minimal loss (i.e. ALTRMSE: 1.327 cm [1969–2022]; CO2 RMSE: 0.697 µmolCO2m−2s−1 [2003–2021]; CH4 RMSE: 0.715 nmolCH4m−2s−1 [2011–2022]). ALT variability is a sensitive harbinger of change, a unique signal characterizing the PCF, and our model is the first characterization of these dynamics across space and time.

Transforming Team Performance Through Reimplementation of the Surgical Safety Checklist

Patient safety interventions, like the World Health Organization Surgical Safety Checklist, require effective implementation strategies to achieve meaningful results. Institutions with underperforming checklists require evidence-based guidance for reimplementing these practices to maximize their impact on patient safety. To assess the ability of a comprehensive system of safety checklist reimplementation to change behavior, enhance safety culture, and improve outcomes for surgical patients. This prospective type 2 hybrid implementation-effectiveness study took place at 2 large academic referral centers in Singapore. All operations performed at either hospital were eligible for observation. Surveys were distributed to all operating room staff. The study team developed a comprehensive surgical safety checklist reimplementation package based on the Exploration, Preparation, Implementation, Sustainment framework. Best practices from implementation science and human factors engineering were combined to redesign the checklist. The revised instrument was reimplemented in November 2021. Implementation outcomes included penetration and fidelity. The primary effectiveness outcome was team performance, assessed by trained observers using the Oxford Non-Technical Skills (NOTECH) system before and after reimplementation. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used to assess safety culture and observers tracked device-related interruptions (DRIs). Patient safety events, near-miss events, 30-day mortality, and serious complications were tracked for exploratory analyses. Observers captured 252 cases (161 baseline and 91 end point). Penetration of the checklist was excellent at both time points, but there were significant improvements in all measures of fidelity after reimplementation. Mean NOTECHS scores increased from 37.1 to 42.4 points (4.3 point adjusted increase; 95% CI, 2.9-5.7; P < .001). DRIs decreased by 86.5% (95% CI, -22.1% to -97.8%; P = .03). Significant improvements were noted in 9 of 12 composite areas on culture of safety surveys. Exploratory analyses suggested reductions in patient safety events, mortality, and serious complications. Comprehensive reimplementation of an established checklist intervention can meaningfully improve team behavior, safety culture, patient safety, and patient outcomes. Future efforts will expand the reach of this system by testing a structured guidebook coupled with light-touch implementation guidance in a variety of settings.

Exploring Innovative Teaching Strategies of the Singapore English Language Curriculum: A Learning Experience of Lesson Study

The innovative teaching strategies employed within the context of Singapore's educational framework have been judiciously applied to enhance and enrich the English Language Curriculum. These have been strategically integrated into the pedagogical landscape of English language education. By infusing the English Language Curriculum with these innovative teaching strategies, educators and learners alike have been afforded a dynamic and progressive educational experience that transcends traditional paradigms. This study was conducted in a lesson study. The conducted Lesson Study unfolded across a meticulously orchestrated tripartite framework encompassing distinct research stages: training, instructional planning, and lesson observation. Initially, the data were subjected to a process of "open coding," as per the methodological tenets. Subsequently, a process of categorical organization ensued, wherein the data were systematically sorted into discrete categories. The finding showed that The intricate interplay between lesson study and curriculum innovation has unfolded as a symphonic harmonization that bridges the theoretical constructs of education with the practical realm of pedagogical implementation, immersing itself deeply within the crucible of the classroom.

The effect of repeated transcranial magnetic stimulation combined with cognitive rehabilitation training on post-stroke cognitive impairment.

The aim of this study was to explore the effect of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive rehabilitation training on post-stroke cognitive impairment (PSCI). We retrospectively reviewed clinical data from 119 patients with PSCI admitted to our hospital from December 2021 to April 2023, of which 58 received pure cognitive rehabilitation training (control group) and 61 received rTMS combined with cognitive rehabilitation training (observation group). We calculated measures of cognitive function rehabilitation, daily living activity abilities, latency and amplitude of P300 wave of evoked potential, and serum biochemical index levels before and after the intervention in the two groups. After the intervention, the scores of the Montreal Cognitive Assessment (MoCA) scale and Rivermead behavioral memory test (RBMT) had improved in the two groups. Also, the Modified Barthel Index (MBI) scores of the two groups increased after the intervention. The P300 wave latencies in both groups decreased and their amplitudes increased after the intervention. The levels of serum neurotrophin-3 (NT-3) and brain-derived neurotrophic factor (BDNF) in the two groups were higher, and the levels of brain glial fibrillary acidic protein (GFAP) were lower after the intervention. All these improvements were more marked in the observation group than in the control group (all p<0.05). Compared with simple cognitive rehabilitation training, the training combined with rTMS was more effective at restoring cognitive function, improving daily living activity abilities, and improving the treatment outcome of patients with PSCI.

6 Back-To-Drive Project. Assessment of Fitness-To-Drive in Older and Cognitively Impaired Adult Drivers: Adaptation of the on-Road Driving Observation Schedule to Simulation-Based Environments

Objective:Cognitive, motor and sensory deficits associated with aging, and with some neurological conditions such as acquired brain injury, may lead to severe driving performance impairment. While rehabilitation and driver assistance technologies may improve driving performance, the assessment of the actual fitness-to-drive of these people is challenging. Office-based neuropsychological/physical tests are considered insufficient to understand one’s ability to drive. The gold standard is the on-road assessment with dual control cars, superior in ecological validity, but expensive, stressful, and potentially unsafe. Valid, more cost-effective solutions for a safer, more accurate, standardized assessment of fitness-to-drive are currently needed. Modern and sensorized driving simulators offer key advantages, such as the possibility of exposing drivers to several relevant driving scenarios, including hazard situations, and of assessing their driving performance without being physically at risk. However, the extraction and direct interpretation of existing simulator-produced data may require specialized data processing skills or simulation expertise. To overcome this, we have developed an easy-to-use, pencil-and-paper observational instrument. The Sim-DOS is an adaptation of the widely used instrument to assess “natural driving”, the Driving Observation Schedule (DOS; Vlahodimitrakou et al., 2013).Participants and Methods:Via expert consensus, DOS targeted behaviors were adapted to a simulated-based environment (signaling, observation of environment, speed regulation, slow or unsafe reaction, distance interpretation, vehicle/lane positioning), and the Sim-DOS scores calculation (based on errors while doing such behaviors) was adapted from DOS to include hazard situations (HS, 0-100) and free driving (FD, 0-°°) scores. The instrument was then piloted with a sample of 35 older adults, along with the collection of simulator-produced data on number of harsh events and driving speed. Participants drove two consecutive 20-minutes long scenarios, with low and high traffic density (LTD, HTD). In each scenario, there were periods with and without potentially hazard situations.Results:Assessments were performed by two independent trained observers, producing substantial inter-rater reliability (intra-class correlation coefficients above 0.94). Participants (70.7±4.1 years old, 60% male, 46.1±6.7 years of driving experience) were mostly regular drivers (74%). However, psychomotor skills of the majority were compromised, with only one participant being above the 80th percentile in the reaction times test of the national mandatory driving assessment. When exposed to hazard situations, most of the participants (94.1%) did not perform well, independently of traffic density, with average Sim-DOS-HS scores of 87.1±9.7 (out of 100, t-values&gt;7.3, p-values&lt;.05).Compared to LTD scenarios, in HTD scenarios participants drove less smoothly (HTD:0.97±1.24 vs. LTD:0.33±0.58 of harsh events, Z=3.1, p&lt;.05). However, they also drove slower (HTD:82.41±27.43 vs. LTD:103.55±14.61 km/h, t=5.2, p&lt;.05), improving their ability to manage hazard situations, and therefore producing higher than expected Sim-DOS scores (HTD:87.05±10.28). During free driving, participants performed worse under LTD conditions (Sim-DOS-FD scores: HTD:11.68±6.20 vs. LTD:14.40±9.58, t=2.15, p&lt;.05) as they drove at higher speed (HTD:85.01±24.28 vs. LTD:104.70±11.94 km/h, t=5.8, p&lt;.05), although they did it more smoothly (HTD:1.94±3.74 vs. LTD:0.45±0.74 harsh events, Z=2.65, p&lt;.05).Conclusions:Our study provides a validated driving assessment tool for use in driving simulators that will allow a safer, more ecologic, holistic and informative evaluation of the fitness-to-drive of older adults and neurological patients.

Basic competency for Elementary School teachers in teaching music

Competence is a skill that everyone must possess to complete various tasks. With constantly evolving work challenges, competencies must always follow the dynamics of the development of job challenges. This study revealed the phenomenon of the profession of a class teacher in elementary school education, which has significant challenges in the teaching and learning process and is a big concern for the government. Therefore, understanding the phenomenon of teachers as an educator profession is very important in understanding how to design and increase the professional competence of classroom teachers in musical instruments, such as recorders. The research will focus on the class teacher who teaches the art of music through recorders at the elementary school in the field of art knowledge, particularly the music arts. This study explores the problems of how classroom teachers achieve essential competencies to teach music knowledge. The data collected results from observations of classroom teacher training on music art learning organized in collaboration between Yamaha Education and the Ministry of Education and Culture in 2022. In training to improve the competence of class teachers, many need to be revealed and need solutions. So, this study aims to design various things that can improve the competence of elementary school class teachers in providing knowledge of music art. This study's data collection and analysis method uses a qualitative tradition through a case study approach for elementary school teachers. Keywords: teacher competence, elementary school, music arts, recorder

PSIII-2 Comparison of Continuous Monitoring and Scan Sampling for Monitoring Postural Changes in Sows Housed in Gestation Crates

Abstract Continuous monitoring of the behavior of sows is the most accurate approach of measurement but is laborious. Scan sampling, which involves monitoring behavior at fixed intervals, can reduce labor requirements compared with continuous monitoring. However, the accuracy of scan sampling compared with continuous monitoring needs to be established. The objective of this study was to compare 2 sampling methods (continuous monitoring vs. scan sampling) for monitoring postural changes in individually housed sows after weaning. The study was carried out as a within-subject longitudinal study using 99 multiparous sows that were monitored over an 11-day period following weaning. Sows were housed in individual stalls and were checked daily for standing reflex from day 3 to 7 post-weaning. Video recording of the sows was carried out throughout the study period. The postures recorded were lying, standing, sitting, and active (standing + sitting). All recording of postures was carried out by a single trained observer. For the continuous monitoring, video recordings were observed continuously and the exact time and duration that sows exhibited each posture over the study period was recorded. The scan sampling method involved pausing the video recordings at 5 min intervals and recording the posture of the sow at each time. Postures recorded from the scan sampling were reported as the number of observations of each posture as a percentage of the total number of observations. Postures recorded from the continuous monitoring were reported as the time spent in each posture as a percentage of the total time. A repeated-measures analysis was carried out using PROC GLIMMIX of SAS; the model included the fixed effects of study day, sampling method, and the interaction. There was no difference (P &amp;gt; 0.05) between sampling methods for any of the postures on any study day or for the overall study period (Table 1). In conclusion, these results suggest that scan sampling at 5-minute intervals gives similar results to continuous monitoring for measuring the posture of newly weaned sows housed in individual crates. Further research is needed to define the maximum interval for scan sampling that maintains the accuracy of monitoring sow posture.

The influence of clinical experience on reliable evaluation of pharyngeal and laryngeal lesions: comparison of high-definition laryngoscopy using narrow band imaging with fibre-optic laryngoscopy.

Fibre-optic laryngoscopy is still widely used in daily clinical practice; however, high-definition laryngoscopy using narrow band imaging could be more reliable in characterising pharyngeal and laryngeal lesions. Endoscopic videos were assessed in a tertiary referral hospital by 12 observers with different levels of clinical experience. Thirty pairs of high-definition laryngoscopy with narrow band imaging and fibre-optic laryngoscopy videos were judged twice, with an interval of two to four weeks, in a random order. Inter- and intra-observer reliability, sensitivity and specificity were calculated in terms of detecting a malignant lesion and a specific histological entity, for beginners, trained observers and experts. Using high-definition laryngoscopy with narrow band imaging, inter-observer reliability for detecting malignant lesions increased from moderate to substantial in trained observers and experts (high-definition laryngoscopy with narrow band imaging κ = 0.66 and κ = 0.77 vs fibre-optic laryngoscopy κ = 0.51 and κ = 0.56, for trained observers and experts respectively) and sensitivity increased by 16 per cent. Inter-observer reliability increased with the level of clinical experience, especially when using high-definition laryngoscopy with narrow band imaging.

Effect of audio and virtual reality distraction on the dental anxiety of children with mild intellectual disability.

Intellectual disability, is a neurodevelopmental disorder that typically manifests early in childhood and consists of both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. It can be categorized into mild, moderate, severe, and profound based on its severity. Cognitive impairment may be observed predominantly in children with intellectual disabilities. Marked deficits in areas of learning, planning, communication, social participation, and personal independence in children with mild intellectual disabilities make behavior guidance and communication a challenge during dental treatments. The aim was to evaluate and compare the use of two different distraction tools, audio, and virtual reality (VR) on the dental anxiety of children with mild intellectual disability during dental treatment. Twenty children diagnosed with mild intellectual disability were equally divided into two groups. A cross-over study design consisting of two appointments 1 month apart was employed. In the first appointment, audio and VR distractions were provided to participants in Groups 1 and 2, respectively, and the distraction tools provided to the participants were interchanged in the second appointment. A trained observer recorded physiological parameters (pulse rate and oxygen saturation) and observational parameters (Venham's anxiety rating scale) during both appointments at three-time intervals. Statistical intra-group and inter-group comparison analyses were performed using Friedman's and Mann-Whitney U tests. A decrease in pulse, increase in oxygen saturation levels, and a decrease in Venham's Anxiety Rating Scores (statistically significant p<.05 / highly significant p<.01) was observed on introducing the distraction techniques in Groups 1 and 2 in both appointments. A statistically non-significant difference (p>.05) in physiological and observational parameters was observed between Groups 1 and 2 in both appointments. Audio and VR distraction techniques can be employed for behavior guidance in children with mild intellectual disability during restorative dental procedures.

Moving beyond skills acquisition: a multiple case study of situated learning in a league for children with disabilities.

In the last few decades, there has been a movement from individualistic and mechanistic notions of learning to approaches that turn attention to the significance of the context of learning. While these approaches have been utilized to point out the significance of the environment for skill acquisition, they have primarily been oriented towards performance-oriented milieus. Inspired by the theory of situated learning in "communities of practice" (CoP), the aim of the study is to analyze learning processes among members (participants, coaches, parents, etc.) of a diverse sporting community. The article is based on a multiple-case study of a Danish handball community named Lykkeliga (Happy League) that within a few years has attracted more than a thousand children with a remarkable diverse range of age, gender, diagnosis, and disabilities. The data collection included participant observation of training and tournament situations in two clubs over a 3-month period, along with informal interviews. The thematic analysis reveals a range of legitimate ways of participating for members of Happy League clubs, including sitting on the bench and even dating during practice. In sum, our case study sheds light on how situated learning in sporting communities may be directed towards inclusion and expansive understanding of what it means to be a sport participant.

SAT116 Utilizing User-centered Design And Usability And Skills Testing For Remote Diabetes Survival Skills Training

Abstract Disclosure: S.J. Freeman: None. B. Radonski: None. L. Lecka: Employee; Self; Doximity. Stock Owner; Self; Doximity. K. Davis: None. G. Prince: None. K. Carthy: None. J.J. Seley: Speaker; Self; Lifescan Diabetes Institute. J. Song: None. J. Lee: None. S.C. Bailey: Consulting Fee; Self; Merck, Lundbeck, Sanofi-Aventis, Pfizer, Inc., Luto, University of Westminster, Gilead. Grant Recipient; Self; Merck, Eli Lilly &amp; Company, Pfizer, Inc., Lundbeck, Gordon and Betty Moore Foundation, National Institutes of Health, Gilead. R. Khorzad: None. D. Gatchell: None. B. Ankenman: None. D.R. Lewis: Grant Recipient; Self; Pfizer, Inc., Spencer Foundation, National Institutes of Health. J. Holl: None. A. Wallia: Consulting Fee; Self; Eli Lilly &amp; Company. Grant Recipient; Self; Novo Nordisk. Research Investigator; Self; UnitedHealth Group, Eli Lilly &amp; Company. Patient-centered approaches for teaching diabetes mellitus (DM) survival skills are essential. Furthermore, in the peri-COVID era, interventions also need to be amenable to remote care delivery. User-Centered design (UCD) including usability testing is a key strategy to optimize adoption and engagement of interventions. We developed a Diabetes Survival Skills Toolkit (website, paper guide, and a physical Kit with simulation supplies) using UCD (&amp;gt; 50 sessions), followed by administration of system usability surveys (SUS) (scored as unacceptable, acceptable, or excellent) and, in a subset, additional skills testing. Skills testing included simulated blood glucose checks and insulin administration, conducted by 2 trained observers. Forty-three participants with no prior history of DM were recruited between 01/2021-07/2022 to independently learn survival skills using different Toolkit components [website only (N=11), Kit + paper guide (N=28), and Kit + website (N=4)]. Purposive sampling for age and highest education level resulted in 33% being ≥ 65 years and 35% having &amp;lt; 4-year degree. Overall, SUS scores were deemed excellent (N=15/43 [35%]) or acceptable (N=20/43 [47%]). Unacceptable scores were noted in 8/43 (19%) [4 website only (all &amp;gt; 4-year degree) and 4 Kit + paper guide (3 of 4 &amp;gt; 65 years, all &amp;lt; 4-year degree)]. Use of the website alone resulted in a higher rate of unacceptable SUS scores (37%) compared to use of the Kit with either the paper guide or website (13%). SUS-score category was not associated with age (82% acceptable/excellent among &amp;lt;45 years, 86% among 45-64 years, and 79% among &amp;gt;=65 years; Fishers’ p=1.00) nor highest education level (80% acceptable/excellent among &amp;lt;4-year degree and 82% among &amp;gt;=4-year degree; Fisher’s p=0.69). Participants who completed skills testing (N= 28 Kit + paper guide, 4 Kit + website), regardless of their SUS score, all correctly demonstrated the ability to inject insulin with simulation supplies. However, 4/32 (13%) (all SUS scores acceptable/excellent) were unable to navigate all steps independently and 9/32 (28%) (2 SUS unacceptable) did not use the recommended instructional pathway. All 4 participants (3 with &amp;gt; age 65 and &amp;lt; 4-year degree) who completed skills testing but had unacceptable SUS scores still correctly demonstrated the ability to measure blood glucose and inject insulin. In conclusion, a Survival Skills Toolkit, resulted in excellent rates of successful survival skills performance when tested with laypersons of diverse ages and education levels. Subjective usability (SUS scores) did differ among users of different Toolkit components; however, they did not align with actual skill performance. Design preferences and usability tests as well as subsequent skills testing are critical to optimally design tools for diabetes survival skills training. Presentation: Saturday, June 17, 2023

SAT377 Revisiting The Utility Of Simplified Ferriman-Gallway Score (Sfg) To Predict Hirsutism In Brazilian Women

Abstract Disclosure: T.F. Oliveira: None. T. Oliveira: None. K.L. da Penha: None. D.C. Santana: None. A.L. Rocha: None. F.M. Reis: None. M.O. Premaor: None. A. Candido: None. F.V. Comim: None. Hirsutism is a common condition in women, being a hallmark of polycystic ovary syndrome (PCOS). Currently, the unique way to determine hirsutism is through the modified Ferriman Gallway score (mFG) based on the analysis of nine body areas. Establishing the mFG score also requires a trained observer, a well-lit room, and time to perform a satisfactory examination. Due to these requirements, alternatives have been proposed. Our study investigated the performance of the simplified Ferriman-Gallwey (sFG) hair growth scoring system, as proposed by Cook et al. (2011). sFG includes only three areas of mFG (cheek, upper and lower abdomen) identifying hirsutism when the score is equal or superior to 3. Since the presence of hirsutism depends on the ethnical background, we explored the performance of sFG to predict the diagnosis of hirsutism in Brazilian women. This study was approved by the local ethics committee. Women at reproductive age were recruited from the Endocrine and Gynecologic outpatient clinics. Clinical and anthropometric data were obtained; two independent observers performed the modified FG score. Hirsutism was defined as mFG &amp;gt; 6 for South Americans [the criteria suggested by the Endocrine Society (ES)] or mFG &amp;gt; 4 [European Society of Human Reproduction and Embryology (ESHRE)]. Overall, 199 women were evaluated. The (mean + SEM) for age was 33.7 + 0.7 years, BMI 29.8 + 0.5 kg/m2, Abdominal circumference 92.4 + 1.2 cm, total mFG score 2.8 + 0.2. The frequency of ethnic background was 20.8% for whites, 28.7% for blacks, 47.8% for multiracial, and 2.7% for others (e.g., indigenous). The prevalence of the established diagnosis of PCOS was 24.6%. When inquired, 50% of the group (n=98) complained of excessive hair growth. Our results confirmed by multiple linear regression (Adjusted R2=0.986; p&amp;lt;0.001) that the best five predictors for mFG score were the upper abdomen, cheek, lower abdomen, thorax, and upper lip. When using the criteria of ES (mFG &amp;gt; 6) (n=147), the sensibility and CI of sFG was 76.9%, (95% CI =56.4-91.0%), and the specificity 95.0%, (95%CI =89.5-98.2%) with an accuracy of 91.8% (95% CI= 86.2 – 95.7%). The positive predictive value (PPV) was 76.9%, and the negative predictive value (NPV) was 95.0%. Using the criteria for diagnosing hirsutism by ESHRE (mFG &amp;gt; 4) (n=188), the sensibility and CI of sFG was lower 55.6%, (95% CI 40.0-70.4%), and the specificity higher, 97.2% (95%CI 93.0-99.2%) with an accuracy of 87.2% (95% CI 81.6 – 91.6%). The PPV was 86.2% and the NPV of 87.4%. Our results in South American women replicated those reported in the largest study performed in a predominant white ethnicity (approximately 70%) in the US. From our point of view, as a screening or as a substitutive tool, the sFG below three can exclude hirsutism with a reasonable negative prediction; nevertheless, more studies need to be performed in the clinical setting. Presentation Date: Saturday, June 17, 2023

A curvilinear association between therapists' use of discourse particles and therapist empathy in psychotherapy.

This study investigates the relationships between therapists' use of discourse particles and therapist empathy. Discourse particles, commonly found in non-English languages, are verbal elements that constitute metacommunication by encoding speakers' emotions and attitudes, which are typically expressed by nonverbal behaviors (e.g., intonation, tone, facial expression, nodding). We hypothesize an inverted U-shaped curvilinear relationship between therapists' use of discourse particles and therapist empathy, given the notion that an optimal level of therapists' emotion in psychotherapy can facilitate clients' inner experiencing and self-expression. Four psychotherapy sessions each from 39 therapist-client dyads were analyzed. After each session, therapist empathy was rated by trained observers using the Therapist Empathy Scale (TES) and by clients using the Barrett-Lennard Relationship Inventory (BLRI). Multilevel modeling shows that both the person-level negative quadratic term and positive linear term for therapists' usage of discourse particles are significant in predicting mean TES with large effect sizes. The same predictors do not yield significant results in predicting mean BLRI but they trend in similar directions of associations with medium effect sizes. Our results suggest the optimal usage of discourse particles by therapists is around 20.3% (out of all utterances). The nonsignificant results in BLRI may be attributed to the relatively small sample size of our data and the noncommunication orientation of the client-rated measure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Learning Curves Prediction for a Transformers-Based Model

One of the main challenges when training or fine-tuning a machine learning model concerns the number of observations necessary to achieve satisfactory performance. While, in general, more training observations result in a better-performing model, collecting more data can be time-consuming, expensive, or even impossible. For this reason, investigating the relationship between the dataset's size and the performance of a machine learning model is fundamental to deciding, with a certain likelihood, the minimum number of observations that are necessary to ensure a satisfactory-performing model is obtained as a result of the training process. The learning curve represents the relationship between the dataset’s size and the performance of the model and is especially useful when choosing a model for a specific task or planning the annotation work of a dataset. Thus, the purpose of this paper is to find the functions that best fit the learning curves of a Transformers-based model (LayoutLM) when fine-tuned to extract information from invoices. Two new datasets of invoices are made available for such a task. Combined with a third dataset already available online, 22 sub-datasets are defined, and their learning curves are plotted based on cross-validation results. The functions are fit using a non-linear least squares technique. The results show that both a bi-asymptotic and a Morgan-Mercer-Flodin function fit the learning curves extremely well. Also, an empirical relation is presented to predict the learning curve from a single parameter that may be easily obtained in the early stage of the annotation process. Doi: 10.28991/ESJ-2023-07-05-03 Full Text: PDF