Using Computer Vision to Annotate Video-Recoded Direct Observation of Physical Behavior

Direct observation is a ground-truth measure for physical behavior, but the high cost limits widespread use. The purpose of this study was to develop and test machine learning methods to recognize aspects of physical behavior and location from videos of human movement: Adults (N = 26, aged 18-59 y) were recorded in their natural environment for two, 2- to 3-h sessions. Trained research assistants annotated videos using commercially available software including the following taxonomies: (1) sedentary versus non-sedentary (two classes); (2) activity type (four classes: sedentary, walking, running, and mixed movement); and (3) activity intensity (four classes: sedentary, light, moderate, and vigorous). Four machine learning approaches were trained and evaluated for each taxonomy. Models were trained on 80% of the videos, validated on 10%, and final accuracy is reported on the remaining 10% of the videos not used in training. Overall accuracy was as follows: 87.4% for Taxonomy 1, 63.1% for Taxonomy 2, and 68.6% for Taxonomy 3. This study shows it is possible to use computer vision to annotate aspects of physical behavior, speeding up the time and reducing labor required for direct observation. Future research should test these machine learning models on larger, independent datasets and take advantage of analysis of video fragments, rather than individual still images.

Factors Associated with Children's Physical Activity During Youth Soccer Practices

Purpose: To identify practice and social contextual factors that associate with physical activity (PA) levels of children during their participation in a youth soccer program. Methods: Twenty-seven youth soccer teams serving children ages 6-11 years participated. Research staff directly observed and recorded PA intensity and practice and social contextual factors using momentary time-sampling procedures. Each team was observed for 1 practice, during which approximately 6 children were each observed for twenty 30-s observation blocks (10-s observation, 20-s recording). In total, children were observed for 3,102 intervals. Multilevel logistic regression analyses were conducted to describe associations between PA intensity and practice and social contexts. Interaction terms were introduced into the models to determine if the associations differed across girls-only, boys-only, and coed teams. Results: A total of 158 children were observed across the 27 teams. Children were more likely to engage in moderate or vigorous PA while performing fitness (Odds Ratio [OR], 9.9, 95% CI = 5.34-18.04), game (OR, 4.0, 95% CI = 2.88-5.66), warm-up (OR, 2.8, 95% CI = 1.85-4.11), and drill (OR, 1.9, 95% CI = 1.41-2.67) activities compared to tactic/instructional activities. The associations between PA intensity levels and practice and social contexts did not differ across girls-only, boys-only, and coed teams. Conclusions: Fitness activities and full-team game play were associated with higher PA intensity levels during children's participation in youth soccer practices. Youth sport practice protocols can be modified to increase children's physical activity.

Direct observation of spreading precursor liquids in a corner

Precursor liquid is a nanoscale liquid creeping ahead of the macroscopic edge of spreading liquids, whose behaviors tightly correlate with the three-phase reaction efficiency and patterning accuracy. However, the important spatial-temporal characteristic of the precursor liquid still remains obscure because its real-time spreading process has not been directly observed. Here, we report that the spreading ionic liquid precursors in a silicon corner can be directly captured on video using in situ scanning electron microscopy. In situ spreading videos show that the precursor liquid spreads linearly over time ([Formula: see text]) rather than obeying the classic Lucas-Washburn law ([Formula: see text]) and possesses a characteristic width of ∼250-310 nm. Theoretical analyses and molecular dynamics simulations demonstrate that the unique behaviors of precursor liquids originate from the competing effect of van der Waals force and surface energy. These findings provide avenues for directly observing liquid/solid interfacial phenomena on a microscopic level.

Evaluating Modes of Observations Using Hierarchical Signal Detection Rater Models

Scoring of performance can be based on different modes of observation, which can include live and videotaped observations. Although live observations have been the traditional format of measuring examinee performance in education and in healthcare, videotaped observations provide educators and testing agencies the promise of unbiased and standardized evaluations, offering practical solutions to limitations of real-time scoring. This study proposes a measurement model taking into account different modes of observation, using an extension of the hierarchical rater model based on signal detection theory (HRM-SDT). A hierarchical rater model is motivated by the nested structure of scores assigned by raters - scores assigned by raters become indicators of performance quality, which in turn become indicators of examinee ability. This study extends the hierarchical structure of the scoring process to include modes of observation, which serves as an intermediary level between the latent categorical indicator of performance quality and examinee ability, forming a three-level HRM-SDT. Analyses based on real-world data showed differences in the quality of scores from live observations and videotaped recordings. Compared to the traditional HRM-SDT, the overall model fit improved when including modes of observation. Simulations using different sample sizes and conditions provide implications for uses of this model.

Commentary: Best practices and processes for assessment of autism spectrum disorder - the intended role of standardized diagnostic instruments

Development of standardized diagnostic instruments has facilitated the systematic characterization of individuals with autism spectrum disorders (ASD) in clinical and research settings. However, overemphasis on scores from specific instruments has significantly detracted from the original purpose of these tools. Rather than provide a definitive "answer," or even a confirmation of diagnosis, standardized diagnostic instruments were designed to aid clinicians in the process of gathering information about social communication, play, and repetitive and sensory behaviors relevant to diagnosis and treatment planning. Importantly, many autism diagnostic instruments are not validated for certain patient populations, including those with severe vision, hearing, motor, and/or cognitive impairments, and they cannot be administered via a translator. In addition, certain circumstances, such as the need to wear personal protective equipment (PPE), or behavioral factors (e.g., selective mutism) may interfere with standardized administration or scoring procedures, rendering scores invalid. Thus, understanding the uses and limitations of specific tools within specific clinical or research populations, as well as similarities or differences between these populations and the instrument validation samples, is paramount. Accordingly, payers and other systems must not mandate the use of specific tools in cases when their use would be inappropriate. To ensure equitable access to appropriate assessment and treatment services, it is imperative that diagnosticians be trained in best practice methods for the assessment of autism, including if, how, and when to appropriately employ standardized diagnostic instruments.

Real-time monitoring of polyacrylamide gel electrophoresis by the shadowgraph technique

Polyacrylamide gel electrophoresis (PAGE) with sodium dodecyl sulphate (SDS) and Coomassie brilliant blue (CBB) staining is widely used in protein research and requires time for electrophoresis, staining and destaining. Because the protein bands electrophoresed in the gel are invisible in most cases, the results cannot be observed until the whole process is complete. In this study, shadowgraph was applied to detect biomolecules such as proteins during electrophoresis. A simple optical system and camera-enabled real-time monitoring of migration and separation of individual protein bands in polyacrylamide gels without staining. The visibility was high enough that it was possible to visualize substances other than proteins, such as DNA. This method provides protein profiles instantly in the early stage of electrophoresis. The elimination of the staining and destaining steps will help save researchers' time. The method is also environmentally friendly and will help reduce the generation of waste solutions containing synthetic dyes.

Implementation of the SIMPL (Society for Improving Medical Professional Learning) performance assessment tool in the emergency department: A pilot study

Background

Feedback and assessment are difficult to provide in the emergency department (ED) setting despite their critical importance for competency-based education, and traditional end-of-shift evaluations (ESEs) alone may be inadequate. The SIMPL (Society for Improving Medical Professional Learning) mobile application has been successfully implemented and studied in the operative setting for surgical training programs as a point-of-care tool that incorporates three assessment scales in addition to dictated feedback. SIMPL may represent a viable tool for enhancing workplace-based feedback and assessment in emergency medicine (EM).

Methods

We implemented SIMPL at a 4-year EM residency program during a pilot study from March to June 2021 for observable activities such as medical resuscitations and related procedures. Faculty and residents underwent formal rater training prior to launch and were asked to complete surveys regarding the SIMPL app's content, usability, and future directions at the end of the pilot.

Results

A total of 36/58 (62%) of faculty completed at least one evaluation, for a total of 190 evaluations and an average of three evaluations per faculty. Faculty initiated 130/190 (68%) and residents initiated 60/190 (32%) evaluations. Ninety-one percent included dictated feedback. A total of 45/54 (83%) residents received at least one evaluation, with an average of 3.5 evaluations per resident. Residents generally agreed that SIMPL increased the quality of feedback received and that they valued dictated feedback. Residents generally did not value the numerical feedback provided from SIMPL. Relative to the residents, faculty overall responded more positively toward SIMPL. The pilot generated several suggestions to inform the optimization of the next version of SIMPL for EM training programs.

Conclusions

The SIMPL app, originally developed for use in surgical training programs, can be implemented for use in EM residency programs, has positive support from faculty, and may provide important adjunct information beyond current ESEs.

A Systematic Review Examining Contributors to Misestimation of Food and Beverage Intake Based on Short-Term Self-Report Dietary Assessment Instruments Administered to Adults

Error in self-reported food and beverage intake affects the accuracy of dietary intake data. Systematically synthesizing available data on contributors to error within and between food groups has not been conducted but may help inform error mitigation strategies. In this review we aimed to systematically identify, quantify, and compare contributors to error in estimated intake of foods and beverages, based on short-term self-report dietary assessment instruments, such as 24-h dietary recalls and dietary records. Seven research databases were searched for studies including self-reported dietary assessment and a comparator measure of observed intake (e.g., direct observation or controlled feeding studies) in healthy adults up until December 2021. Two reviewers independently screened and extracted data from included studies, recording quantitative data on omissions, intrusions, misclassifications, and/or portion misestimations. Risk of bias was assessed using the QualSyst tool. A narrative synthesis focused on patterns of error within and between food groups. Of 2328 articles identified, 29 met inclusion criteria and were included, corresponding to 2964 participants across 15 countries. Most frequently reported contributors to error were omissions and portion size misestimations of food/beverage items. Although few consistent patterns were seen in omission of consumed items, beverages were omitted less frequently (0-32% of the time), whereas vegetables (2-85%) and condiments (1-80%) were omitted more frequently than other items. Both under- and overestimation of portion size was seen for most single food/beverage items within study samples and most food groups. Studies considered and reported error in different ways, impeding the interpretation of how error contributors interact to impact overall misestimation. We recommend that future studies report 1) all error contributors for each food/beverage item evaluated (i.e., omission, intrusion, misclassification, and portion misestimation), and 2) measures of variation of the error. The protocol of this review was registered in PROSPERO as CRD42020202752 (https://www.crd.york.ac.uk/prospero/).

Examining Processes of Care Redesign: Direct Observation of Group Well-Child Care

We sought to describe processes of psychosocial screening and discussion with immigrant Latino families in the context of group well-child care. We conducted longitudinal direct observations of the 1-, 2-, 4-, and 6-month visits of 7 group well-child care cohorts at an academic pediatric clinic using unstructured observations of visit and group processes as well as structured observations to code facilitators' behavior. A range of psychosocial and social determinants of health topics were incorporated into discussions. In general, providers skillfully navigated group discussions, but inconsistently introduced the visit purpose. Asking participants to define psychosocial terms (eg, stress) and conversations about managing fussy infants were effective strategies to engage families in psychosocial discussions (eg, about postpartum depression). Some challenges with workflow were identified. Strategies to enhance screening and discussion of psychosocial topics may benefit from adaptation to maximize the effectiveness of this care mechanism.

A Systematic Review of Direct Assessments to Evaluate Psychotropic Medication Effects for Children With Disabilities

To evaluate effects of psychotropic medication for children with disabilities, direct assessments may offer a valuable supplement to caregiver reports. Relative to indirect assessment, direct measures of behavior can increase objectivity and sensitivity, and some have potential to isolate distinct behavioral and learning processes. We conducted a systematic, narrative literature review to identify and describe the types and qualities of direct assessment methods that have been used to evaluate effects of non-stimulant psychotropic medication for children with disabilities. We identified 50 studies and 78 direct assessments, which we organized and described using seven assessment categories. Only one study met all three direct assessment quality indicators. We use our descriptive results to highlight research trends and gaps that warrant further study.

Seasonality in daily movement patterns of mandrills revealed by combining direct tracking and camera traps

Movement is a fundamental characteristic of animals, but challenging to measure noninvasively. Noninvasive methods for measuring travel have different weaknesses, so multiple techniques need to be applied multiple techniques for reliable inferences. We used two methods, direct tracking and camera trapping, to examine the variation in time and seasonal differences in movement rates of mandrills (Mandrillus sphinx), an elusive primate that lives in large groups in central Africa. In a 400-km2 rainforest area in Moukalaba-Doudou National Park, Gabon, we tracked unidentified groups 46 times from 2009 to 2013. We systematically placed 157 terrestrial camera traps in the same area from 2012 to 2014 and recorded groups 309 times. Generalized additive mixed models (GAMMs) of the tracking data indicated that the group travel speed varied with time and season. In the fruiting season, the movement rate fluctuated with time in a bimodal pattern, whereas in the nonfruiting season, it increased monotonously with time. The predicted day range was longer in the fruiting season (6.98 km) than in the nonfruiting season (6.06 km). These seasonal differences suggest responses to changes in food resources and temperature. Camera-trap detection rates showed similar temporal and seasonal patterns to the tracking data, allowing us to generalize our findings to the population level. Moreover, cameras never detected mandrills at night, and we observed that they slept high in trees and hardly moved until the next morning, all suggesting their strict avoidance of nighttime movement. This study demonstrated the significance of the multiple-method approach in drawing robust conclusions on temporal patterns of animal movement.

Direct observation in a large-scale randomized trial of parent training in children with autism spectrum disorder and disruptive behavior

A direct observation strategy (Standardized Observation Analogue Procedure, SOAP) was used in a large-scale randomized trial of parent training versus parent education in young children with autism spectrum disorder (ASD) and disruptive behavior. The 16-minute SOAP, modified from an earlier version of this same measure, included parentchild interaction to assess child behavior in a clinical laboratory setting. Despite study entry criteria for all child participants requiring moderate levels of disruptive behavior in this project, 126 of 168 children with complete SOAP data at baseline showed no disruptive behavior on this measure. Although the primary purpose of the study was to determine whether the SOAP could detect differences between the two conditions (i.e.,parent training (PT) and parent education (PE)), baseline observation data was not consistent with parent ratings at baseline or subsequent follow up visits, leaving little room to demonstrate improvement with this observation measure. This and the challenging, time-consuming and resource intensive effort involved in using such a measure in a large randomized scale trial, raises fundamental questions about the validity of the SOAP as an outcome measure in such a study. Further consideration related to the feasibility and practicality of using direct observation as a primary measure in larger scale efforts overall are also discussed.

What happens under the flag of direct observation, and how that matters: A qualitative study in general practice residency

INTRODUCTION

In competency-based medical education, direct observation (DO) of residents' skills is scarce, notwithstanding its undisputed importance for credible feedback and assessment. A growing body of research is investigating this discrepancy. Strikingly, in this research, DO as a concrete educational activity tends to remain vague. In this study, we concretised DO of technical skills in postgraduate longitudinal training relationships.

METHODS

Informed by constructivist grounded theory, we performed a focus group study among general practice residents. We asked residents about their experiences with different manifestations of DO of technical skills. A framework describing different DO patterns with their varied impact on learning and the training relationship was constructed and refined until theoretical sufficiency was reached.

RESULTS

The dominant DO pattern was ad hoc, one-way DO. Importantly, in this pattern, various unpredictable, and sometimes unwanted, scenarios could occur. Residents hesitated to discuss unwanted scenarios with their supervisors, sometimes instead refraining from future requests for DO or even for help. Planned bi-directional DO sessions, though seldom practiced, contributed much to collaborative learning in a psychologically safe training relationship.

DISCUSSION AND CONCLUSION

Patterns matter in DO. Residents and supervisors should be made aware of this and educated in maintaining an open dialogue on how to use DO for the benefit of learning and the training relationship.

Effect of barcode technology on medication preparation safety: a quasi-experimental study

BACKGROUND

Medication errors are a common problem in hospitals and a major driver of adverse patient outcomes. Barcode verification technology is a promising strategy to help ensure safe medication preparation practices.

OBJECTIVES

The objectives of this study were (i) to assess the effects of a barcode-assisted medication preparation and administration system regarding the rate of medication preparation errors and (ii) to compare the time spent on medication preparation tasks by medical staff.

METHODS

A quasi-experimental study with a pre-post design was conducted, from August 2017 to July 2018, in two mixed medical/surgical units of a tertiary teaching hospital. The primary aim was to assess the effects of a barcode-based electronically assisted medication preparation and administration system linked to the hospital's electronic medication administration record regarding the rate of medication preparation errors and time-based staff performance. Data were collected using direct observation. Adjusted and unadjusted logistic models were used for error frequencies and linear regression models for time performance.

RESULTS

5932 instances of medication selection and dosing during 79 medication preparation procedures were observed. The overall medication preparation error incidence decreased from 9.9% at baseline to 4.5% at post-intervention, corresponding to a relative risk reduction of 54.5% (P < 0.001). However, the adjusted effect by registered nurses (RNs) and nurses' work experience of total medication preparation errors showed only borderline significance (odds ratio [OR] 0.64, P = 0.051). For adjusted error-specific analyses, significant error reductions were found in wrong medication errors (OR 0.38, P < 0.010) and wrong dosage errors (OR 0.12, P = 0.004). Wrong patient, wrong form and ambiguous dispenser errors did not occur at post-intervention. Errors of omission (OR 1.53, P = 0.17), additional doses (OR 0.63, P = 0.64) and wrong dispenser boxes (OR 0.51, P = 0.11) did not change significantly. The time necessary to prepare medications for a 24-h period also decreased significantly-from 30.2 min to 17.2 min (beta = -6.5, P = 0.047), while mean preparation time per individual medication dose fell from 24.3 s to 15.1 s (beta = -5.0, P = 0.002).

CONCLUSION

Use of the new barcode technology significantly reduced the rate of some medication preparation errors in our sample. Moreover, the time necessary for medication preparation, both per 24-h period and per single-medication dose, was significantly reduced.

A Qualitative Analysis of Outpatient Medication Use in Community Settings: Observed Safety Vulnerabilities and Recommendations for Improved Patient Safety

OBJECTIVE

The aim of the study was to analyze diverse patients' experiences throughout the medication use process to inform the development of overarching interventions that support safe medication use in community settings.

METHODS

Using a qualitative observational approach, we conducted approximately 18 hours of direct observation of the medication use process across multiple settings for a sample of vulnerable, high-risk patients. Observers recorded detailed field notes during the observations. To enrich the observational findings, we also conducted six semistructured interviews with medication safety experts representing a diversity of perspectives. Barriers and facilitators to safe medication use were identified based on inductive coding of the data.

RESULTS

A variety of safety vulnerabilities plague all stages of the medication use process and many of the well-established evidence-based interventions aimed at improving the safety of medication use at key stages of the process have not been widely implemented in community settings observed in this study. Key safety vulnerabilities identified include: limited English proficiency, low health literacy, lack of clinician continuity, incomplete medication reconciliation and counseling, unsafe medication storage and disposal habits, and conflicting healthcare agendas with caregivers.

CONCLUSIONS

Our findings underscore a need for overarching, comprehensive interventions that span the entire process of medication use, including integrated communication systems between clinicians, pharmacies, and patients, and a "patient navigator" program that assists patients in navigating the entire medication-taking process. Collective ownership of the medication management system and mutual motivation for devising collaborative solutions is needed among key sectors.

Development of the systematic observation of COVID-19 mitigation (SOCOM): Assessing face covering and distancing in schools

INTRODUCTION

During the COVID-19 pandemic, some K-12 schools resumed in-person classes with varying degrees of mitigation plans in the fall 2020. Physical distancing and face coverings can minimize SARS-CoV-2 spread, the virus that causes COVID-19. However, no research has focused on adherence to mitigation strategies during school days. Thus, we sought to develop a systematic observation protocol to capture COVID-19 mitigation strategy adherence in school environments: The Systematic Observation of COVID-19 Mitigation (SOCOM).

METHODS

We extended previously validated and internationally used tools to develop the SOCOM training and implementation protocols to assess physical-distancing and face-covering behaviors. SOCOM was tested in diverse indoor and outdoor settings (classrooms, lunchrooms, physical education [PE], and recess) among diverse schools (elementary, secondary, and special needs).

RESULTS

For the unique metrics of physical-distancing and face-covering behaviors, areas with less activity and a maximum of 10-15 students were more favorable for accurately capturing data. Overall proportion of agreement was high for physical distancing (90.9%), face covering (88.6%), activity type (89.2%), and physical activity level (87.9%). Agreement was lowest during active recess, PE, and observation areas with ≥20 students.

CONCLUSIONS

Millions of children throughout the USA are likely to return to school in the months ahead. SOCOM is a relatively inexpensive research tool that can be implemented by schools to determine mitigation strategy adherence and to assess protocols that allow students return to school safely and slow the spread of COVID-19.

Patient Education for Kidney Failure Treatment: A Mixed-Methods Study

RATIONALE & OBJECTIVE

Education programs are needed for people with advanced chronic kidney disease to understand kidney failure treatment options and participate in shared decision-making (SDM). Little is known about the content and accessibility of current education programs or whether they support SDM.

STUDY DESIGN

Stakeholder-engaged, mixed-methods design incorporating qualitative observations and interviews, and a quantitative content analysis of slide presentations.

SETTING & PARTICIPANTS

Four sites located in Boston, Chicago, Portland (Maine), and San Diego.

ANALYTICAL APPROACH

Thematic analysis based on the Ottawa Framework (observations and interviews) and descriptive statistical analysis (slide presentations).

RESULTS

Data were collected from observations of 9 education sessions, 5 semistructured interviews with educators, and 133 educational slide presentations. Sites offered group classes or one-on-one sessions. Development, quality, and accuracy of educational materials varied widely. Educators emphasized dialysis (often in-center hemodialysis), with little mention of conservative management. Educators reported patients were often referred too late to education sessions and that some patients become overwhelmed if they learn of the implications of kidney failure in a group setting. Commonly, sessions were general and did not provide opportunities for tailored information most supportive of SDM. Few nephrologists were involved in education sessions or aware of the educational content. Content gaps included prognosis, decision support, mental health and cognition, advance care planning, cost, and diet. Slide presentations used did not consistently reflect best practices related to health literacy.

LIMITATIONS

Findings may not be broadly generalizable.

CONCLUSIONS

Education sessions focused on kidney failure treatment options do not consistently follow best practices related to health literacy or for supporting SDM. To facilitate SDM, the establishment of expectations for kidney failure treatment options should be clearly defined and integrated into the clinical workflow. Addressing content gaps, health literacy, and communication with nephrologists is necessary to improve patient education in the setting of advanced chronic kidney disease.

Directly Observed Physical Activity of Year 1 Children during School Class Time: A Cross-Sectional Study

Providing physical activity opportunities to children throughout the school day may be beneficial for children’s health and learning. Existing practices regarding the frequency, type and context of physical activity opportunities being provided to children in the early years of primary school remains largely unknown. The aim of this study was to observe Year 1 children’s physical activity and its contexts during school class time and identify opportunities to incorporate additional activity. A cross-sectional study was conducted with 34 Year 1 children (20 boys, 14 girls; mean age = 6.36 ± 0.34 years) from one primary school in Queensland, Australia. A modified version of the Observational System for Recording Physical Activity in Children—Elementary School was used to assess children’s physical activity and its contexts during class time. Observational data were collected over a four-week period. The frequencies (and percentages) of intervals of children’s activity observed in sedentary, light and moderate-to-vigorous intensities during different instructional and social contexts and physical settings were recorded and calculated. Pearson’s chi-square test of association was conducted to evaluate whether social context (group composition) was related to incidental physical activity. A total of 5305 observation intervals (i.e., 5 s observation interval followed by a 25 s recording interval) were available for analysis (~44 h of observation). Year 1 children were sedentary for the majority (86%) of observed intervals during school class time. Children spent limited time performing light (12% of intervals) and moderate-to-vigorous physical activity (2% of intervals). Organised physical activity observed during class time included physical education/school sport (5.9% of intervals) and classroom-based physical activity (2.8% of intervals). When children completed activities in small groups, they were significantly more likely to engage in incidental physical activity than when they completed activities as a whole class (χ² = 94.73 p < 0.001). Incorporating movement into academic lessons or during transitions between lessons and classrooms may encourage children to be more active. Incidental physical activity may also be promoted through small group activities. Schools should ideally be encouraged and supported to employ a whole-of-school approach to physical activity promotion, which includes identifying and implementing opportunities for children to be active during class time.

Teaching Rapid Assessment Skills in Triage for the Emergency Medicine Clerkship

BACKGROUND

Rapidly assessing an undifferentiated patient and developing a gestalt for "sick vs. not sick" is a core component of emergency medicine (EM). Developing this skill requires clinical experience and pattern recognition, which can be difficult to attain during a typical EM clerkship.

OBJECTIVE

We developed a novel approach to teaching medical students rapid assessment skills in the emergency department (ED) by implementing a teaching shift in triage.

METHODS

Fourth-year medical students in our EM clerkship in fall 2019 were scheduled one shift in triage with a dedicated teaching attending. The students evaluated patients under direct supervision, discussed their immediate differential diagnosis, and proposed an initial workup. The attending gave real-time feedback using a standardized direct observation tool. Students completed an electronic pre and post survey (5-point Likert scale) to assess their comfort level in the following areas: performing a rapid triage assessment, determining "sick vs. not sick", performing a focused physical examination, developing a targeted differential diagnosis, and ordering an initial diagnostic workup.

RESULTS

Twenty-one students participated in the triage shifts. There was a significant improvement in self-assessed comfort with performing a rapid triage assessment, mean pre 2.76 and post 4.43 (p < 0.0001). There were also significant improvements in the four other survey areas (p < 0.004 or less).

CONCLUSIONS

A teaching shift in triage can increase medical students' self-assessed rapid assessment skills for patients in the ED. Benefits to the teaching attending included the opportunity to perform direct observation, give real-time feedback, and identify real-time teaching moments.

Days Needed to Characterize the Healthfulness of a Typical Dinner Meal in Direct Observational Research: Mixed Methods Study

BACKGROUND

Prior research around the home meal environment has demonstrated that family meals are associated with positive health outcomes for children and adolescents. Researchers have begun using direct observational methods to understand key aspects of family meals such as meal healthfulness and family meal frequency to explain the protective nature of family meals. Direct observational research, however, can be resource intensive and also burdensome for participants. Information about the number of days needed to sufficiently characterize typical meal healthfulness using direct observational research methods is needed.

OBJECTIVE

The current study aimed to produce guidance about the number of meals necessary to approximate typical meal healthfulness at the family dinner meal occasion in a direct observational, mixed methods study of the home food environment.

METHODS

Families were recruited between 2012-2013 from primary care clinics in the Minneapolis-St Paul metropolitan area (N=120). A total of 800 meals were collected as part of the Family Meals LIVE! mixed methods study. The Healthfulness of Meal Index was used to evaluate meal dietary healthfulness of foods served at 8 family meal occasions. Participating families were provided an iPad (Apple Inc) and asked to video-record 8 consecutive days of family dinner meals with a minimum of two weekend meals. After the meal, families completed a meal screener, which is a self-reported, open-ended measure of the foods served at the meal.

RESULTS

Weekend and weekday meals differed in their measurement of meal healthfulness, indicating that at least one weekday and one weekend day are necessary to approximate meal healthfulness. Single-day measurement mischaracterized the strength of the relationship between the quality of what was served and intake by almost 50%, and 3 to 4 observation days were sufficient to characterize typical weekly meal healthfulness (r=0.94; P<.001).

CONCLUSIONS

Relatively few direct observational days of family meals data appear to be needed to approximate the healthfulness of meals across 1 week. Specifically, 1 weekday and 1 weekend observation are needed, including a total of 3 to 4 days of direct observational meal data. These findings may inform future direct observational study designs to reduce both research costs and participant burden in assessing features of the meal environment.

Direct Observation of the Light-Induced Exfoliation of Molybdenum Disulfide Sheets in Water Medium

Single and a few atomic-layer molybdenum disulfide (MoS₂) is a promising material in the fields of hydrogen generation, battery, supercapacitor, and environmental protection, owing to the outstanding electronic, optical, and catalytic properties. Although many approaches have been developed for exfoliation of MoS₂ sheets, it is still essential to develop simple, convenient, and environmental friendly exfoliation methods. More importantly, the microscopic exfoliation process and the mechanism are still not clear, limiting a deeper understanding of the exfoliation. Herein, we develop a convenient and clean method for exfoliation of the 2H phase MoS₂ (2H-MoS₂) deposited on an indium tin oxide (ITO) surface. Importantly, the exfoliation process is observed directly and continuously under an optical microscope to reveal the detailed exfoliation process and mechanism. As illustrated, the light illumination triggers the exfoliation of the 2H-MoS₂ sheets, and the presence of water is essential in this exfoliation process. The light intensity and wavelength, humidity, and bias all affect the exfoliation process obviously. The exfoliation is caused by the vaporization of the water molecules intercalated in 2H-MoS₂ interlayers. By using this method, 2H-MoS₂ nanosheets with different thicknesses are prepared on the ITO substrate, and microscopic catalysis mapping of the exfoliated sheets is demonstrated with single-molecule fluorescence microscopy, revealing that the prepared thin-layer 2H-MoS₂ nanosheets show improved electrocatalysis activity (roughly 20 times). Our work will not only help deepen the understanding of exfoliation process of two-dimensional nanosheets but also provide an effective tool for the in situ study of various properties of the exfoliated sheets.

Cultural socialization in childhood: Analysis of parent-child conversations with a direct observation measure

Cultural factors influence the development of all children. Yet, current knowledge of explicit cultural socialization processes in childhood remains limited, mainly by failing to incorporate the experiences of young children. To address this critical gap, the authors introduce the OMERS-Peds task, an observational measurement designed to systematically identify and compare the content of cultural messages passed down from caregivers to offspring during early school age years. The OMERS-Peds was administered to mothers and children (n = 275) from three diverse racial/ethnic backgrounds (African American (n = 153), Hispanic (n = 61), and non-Hispanic White (n = 61)) within the longitudinal Multidimensional Assessment of Preschoolers (MAPS) Study. The OMERS-Peds coding system was used to rate how strongly families endorsed 5 key constructs: family culture, religion, identity, ethnicity, and race. A series of χ2 statistic tests were used to compare scores across racial/ethnic backgrounds, and within families (between children and their mothers). Analyses revealed that in the cultural socialization conversations occurring in early childhood, parents and children prioritize talking about their family's culture and religion. Independent of their racial/ethnic backgrounds, mothers and children seldom discussed race and ethnicity. Contrary to research with older children, differences were mainly identified within families, rather than across racial/ethnic groups. Findings support the need to include children's perspectives in the assessments of cultural socialization, as opposed to relying primarily on parent reports, and highlight the importance of having an observational methodology that allows researchers to examine parent-child bidirectional interactions during early school age years in a systematic manner. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Building a Shared Mental Model of Competence Across the Continuum: Trainee Perceptions of Subinternships for Residency Preparation

INTRODUCTION

Toward a vision of competency-based medical education (CBME) spanning the undergraduate to graduate medical education (GME) continuum, University of Minnesota Medical School (UMMS) developed the Subinternship in Critical Care (SICC) offered across specialties and sites. Explicit course objectives and assessments focus on internship preparedness, emphasizing direct observation of handovers (Core Entrustable Professional Activity, "EPA," 8) and cross-cover duties (EPA 10).

METHODS

To evaluate students' perceptions of the SICC's and other clerkships' effectiveness toward internship preparedness, all 2016 and 2017 UMMS graduates in GME training (n = 440) were surveyed regarding skill development and assessment among Core EPAs 1, 4, 6, 8, 9, 10. Analysis included descriptive statistics plus chi-squared and Kappa agreement tests.

RESULTS

Respondents (n = 147, response rate 33%) rated the SICC as a rotation during which they gained most competence among EPAs both more (#4, 57% rated important; #8, 75%; #10, 70%) and less explicit (#6, 53%; #9, 69%) per rotation objectives. Assessments of EPA 8 (80% rated important) and 10 (76%) were frequently perceived as important toward residency preparedness. Agreement between importance of EPA development and assessment was moderate (Kappa = 0.40-0.59, all surveyed EPAs).

CONCLUSIONS

Graduates' perceptions support the SICC's educational utility and assessments. Based on this and other insight from the SICC, the authors propose implications toward collectively envisioning the continuum of physician competency.

Using a Sociogram to Characterize Communication During an Interprofessional Team Huddle

PURPOSE

The complexity of modern medicine requires high-performance teamwork to ensure quality care. Teams rely on communication patterns that are replicable and efficient. The purpose of this observational study was to characterize communication dynamics among interprofessional team members during a team huddle. The study aimed to (a) characterize communication within structured huddles on an inpatient medicine unit by evaluating who talked and to whom and what types of communication took place during each interaction and (b) explore participants' perceptions of the huddles.

MATERIALS AND METHODS

We used a sociogram to diagram direct observations of the structure and patterns of group interaction. Through the sociogram, we documented the flow and frequency of team members information exchange, questions, and requests. We conducted two follow-up focus groups-one with residents and one with nurses.

RESULTS

The most frequent type of interaction observed was information exchange: nurse to resident (28.3%) and resident to nurse (47%). Both residents and nurses asked questions: nurse to resident (7.4%) and resident to nurse (14.2%). Nurses made more requests of residents (2.8%) than vice versa (0.3%). Four themes emerged from focus group analysis, including the huddle promotes (1) a better-informed team, (2) relationship building, (3) communication process efficiencies, and (4) logistical challenges.

CONCLUSION

Sociograms can serve as a novel tool to characterize what actually happens during information exchange at the point of care and identify the nature of communication among team members. Daily huddles among team members involved in the frontline of patient care provides an opportunity to share information, requests, and questions and update shared mental models to meet team objectives.

Overcoming the Challenges of Direct Observation and Feedback Programs: A Qualitative Exploration of Resident and Faculty Experiences

Problem: Prior studies have reported significant negative attitudes amongst both faculty and residents toward direct observation and feedback. Numerous contributing factors have been identified, including insufficient time for direct observation and feedback, poorly understood purpose, inadequate training, disbelief in the formative intent, inauthentic resident-patient clinical interactions, undermining of resident autonomy, lack of trust between the faculty-resident dyad, and low-quality feedback information that lacks credibility. Strategies are urgently needed to overcome these challenges and more effectively engage faculty and residents in direct observation and feedback. Otherwise, the primary goals of supporting both formative and summative assessment will not be realized and the viability of competency-based medical education will be threatened. Intervention: Toward this end, recent studies have recommended numerous strategies to overcome these barriers: protected time for direct observation and feedback; ongoing faculty and resident training on goals and bidirectional, co-constructed feedback; repeated direct observations and feedback within a longitudinal resident-supervisor relationship; utilization of assessment tools with evidence for validity; and monitoring for engagement. Given the complexity of the problem, it is likely that bundling multiple strategies together will be necessary to overcome the challenges. The Direct Observation Structured Feedback Program (DOSFP) incorporated many of the recommended features, including protected time for direct observation and feedback within longitudinal faculty-resident relationships. Using a qualitative thematic approach the authors conducted semi-structured interviews, during February and March, 2019, with 10 supervisors and ten residents. Participants were asked to reflect on their experiences. Interview guide questions explored key themes from the literature on direct observation and feedback. Transcripts were anonymized. Two authors independently and iteratively coded the transcripts. Coding was theory-driven and differences were discussed until consensus was reached. The authors then explored the relationships between the codes and used a semantic approach to construct themes. Context: The DOSFP was implemented in a psychiatry continuity clinic for second and third year residents. Impact: Faculty and residents were aligned around the goals. They both perceived the DOSFP as focused on growth rather than judgment even though residents understood that the feedback had both formative and summative purposes. The DOSFP facilitated educational alliances characterized by trust and respect. With repeated practice within a longitudinal relationship, trainees dropped the performance orientation and described their interactions with patients as authentic. Residents generally perceived the feedback as credible, described feedback quality as high, and valued the two-way conversation. However, when receiving feedback with which they did not agree, residents demurred or, at most, would ask a clarifying question, but then internally discounted the feedback. Lessons Learned: Direct observation and structured feedback programs that bundle recent recommendations may overcome many of the challenges identified by previous research. Yet, residents discounted disagreeable feedback, illustrating a significant limitation and the need for other strategies that help residents reconcile conflict between external data and one's self-appraisal.

Direct Observation of Relaxation of Aqueous Shake-Gel Consisting of Silica Nanoparticles and Polyethylene Oxide

Controlling the rheological property of suspensions consisting of colloidal particles and polymers is necessary in industry. Especially, gels induced by shear (shake-gel) are interesting phenomena in rheological field. To gain insight into the shake-gel phenomena of the aqueous suspensions of silica nanoparticles and poly(ethylene oxide) (PEO) and its temporal change, we observed the state transition and measured the viscosity of the silica-PEO suspensions. Our results showed that PEO dose, pH, and molecular weight of PEO influence the state of suspension greatly, and revealed the differences of the suspension states, namely, cloudy, permanent gel, shake-gel, and high viscosity sol. We found that the relaxation time from shake-gel to flowable sol increases to the maximum and decreases again with increasing PEO dose. Shake-gels at pH 8.4 relaxed more slowly than at pH 9.4, and shake-gel did not form at pH above 10 in most of cases, indicating high pH inhibits the formation of shake-gels. PEO of molecular weight of 1000 and 4000 kDa easily bonds more silica nanoparticles by bridging and results in the formation of gels with more stable polymer networks. PEO of molecular weight of 1000 and 4000 kDa also led to longer relaxation time of the silica-PEO suspensions from gel to sol.

Are health workers reduced to being drug dispensers of antiretroviral treatment? A randomized cross-sectional assessment of the quality of health care for HIV patients in northern Uganda

High quality of care (QoC) for antiretroviral treatment (ART) is essential to prevent treatment failure. Uganda, as many sub-Saharan African countries, increased access to ART by decentralizing provision to districts. However, little is known whether this rapid scale-up maintained high-quality clinical services. We assess the quality of ART in the Acholi and Lango sub-regions of northern Uganda to identify whether the technical quality of critical ART sub-system needs improvement. We conducted a randomized cross-sectional survey among health facilities (HF) in Acholi (n = 11) and Lango (n = 10). Applying lot quality assurance sampling principles with a rapid health facility assessment tool, we assessed ART services vis-à-vis national treatment guidelines using 37 indicators. We interviewed health workers (n = 21) using structured questionnaires, directly observed clinical consultations (n = 126) and assessed HF infrastructure, human resources, medical supplies and patient records in each health facility (n = 21). The district QoC performance standard was 80% of HF had to comply with each guideline. Neither sub-region complied with treatment guidelines. No HF displayed adequate: patient monitoring, physical examination, training, supervision and regular monitoring of patients' immunology. The full range of first and second line antiretroviral (ARV) medication was not available in Acholi while Lango had sufficient stocks. Clinicians dispensed available ARVs without benefit of physical examination or immunological monitoring. Patients reported compliance with drug use (>80%). Patients' knowledge of preventing HIV/AIDS transmission concentrated on condom use; otherwise it was poor. The poor ART QoC in northern Uganda raises major questions about ART quality although ARVs were dispensed. Poor clinical care renders patients' reports of treatment compliance as insufficient evidence that it takes place. Further studies need to test patients' immunological status and QoC in more regions of Uganda and elsewhere in sub-Saharan Africa to identify topical and geographical areas which are priorities for improving HIV care.

Being There: The Importance of Direct Observation in Resident Assessment

There are many methods to assess resident competency. In this report the author describes an experience that strongly suggests the superiority of direct observation compared to other methods. Literature comparing direct observation to other methods is cited. In addition ways to create time for direct observation and how to promote wider use of direct observation are discussed.

Oil Deposition on Polymer Brush-Coated NF Membranes

Membrane-based processes are attractive for treating oily wastewaters. However, membrane fouling due to the deposition of oil droplets on the membrane surface compromises performance. Here, real-time observation of the deposition of oil droplets by direct confocal microscopy was conducted. Experiments were conducted in dead-end and crossflow modes. Base NF 270 nanofiltration membranes as well as membranes modified by grafting poly(N-isopropylacrylamide) chains from the membrane surface using atom transfer radical polymerization were investigated. By using feed streams containing low and high NaCl concentrations, the grafted polymer chains could be induced to switch conformation from a hydrated to a dehydrated state, as the lower critical solution temperature for the grafted polymer chains moved above and below the room temperature, respectively. For the modified membrane, it was shown that switching conformation of the grafted polymer chains led to the partial release of adsorbed oil. The results also indicate that, unlike particles such as polystyrene beads, adsorption of oil droplets can lead to coalescence of the adsorbed oil droplets on the membrane surface. The results provide further evidence of the importance of membrane properties, feed solution characteristics, and operating mode and conditions on membrane fouling.

Direct Observation of Filling Process and Porosity Prediction in High Pressure Die Casting

Although numerical simulation accuracy makes progress rapidly, it is in an insufficient phase because of complicated phenomena of the filling process and difficulty of experimental verification in high pressure die casting (HPDC), especially in thin-wall complex die-castings. Therefore, in this paper, a flow visualization experiment is conducted, and the porosity at different locations is predicted under three different fast shot velocities. The differences in flow pattern between the actual filling process and the numerical simulation are compared. It shows that the flow visualization experiment can directly observe the actual and real-time filling process and could be an effective experimental verification method for the accuracy of the flow simulation model in HPDC. Moreover, significant differences start to appear in the flow pattern between the actual experiment and the Anycasting solution after the fragment or atomization formation. Finally, the fast shot velocity would determine the position at which the back flow meets the incoming flow. The junction of two streams of fluid would create more porosity than the other location. There is a transition in flow patterns due to drag crisis under high fast shot velocity around two staggered cylinders, which resulted in the porosity relationship also changing from R1 < R3 < R2 (0.88 m/s) to R1 < R2 < R3 (1.59 and 2.34 m/s).

Utilizing a Board Game to Measure Family/Parenting Factors and Childhood Obesity Risk

OBJECTIVE

To describe a direct observational approach (ie, interactive family board game) to measure familyfunctioning and parenting behaviors of relevance to child weight and weight-related behaviors and to examine family functioning and parenting factors from multiple family dyads (eg, siblings, parent-child) and their associations with child weight and weight-related behaviors.

DESIGN

Cross-sectional, mixed-methods study.

SETTING

Two home visits were conducted with families 10days apart with a 7-day observational period between home visits.

PARTICIPANTS

Children (n = 150) aged 5-7years and their families from 1 of 6 racial and ethnic or immigrant and refugee groups, including African American, Hispanic, Hmong, Native American, Somali, and white, participated in the Family Matters study between 2014 and 2016.

MAIN OUTCOME MEASURE

Child weight status and weight-related behaviors (ie, diet quality, physical activity).

ANALYSIS

Adjusted logistic and linear regression models with robust SEs were used in analysis.

RESULTS

Higher family functioning scores across the majority of family dyads were significantly associated with lower child weight status (P < .05). In addition, some family functioning scores were associated with child diet and physical activity, but not consistently. Parenting behavior scores were inconsistently associated with child weight and weight-related outcomes.

CONCLUSIONS AND IMPLICATIONS

Results suggest that the interactive family board game task is a direct observational approach that researchers can use with family members to measure family functioning and parenting behaviors related to childhood obesity. Future interventions may want to consider including multiple family members in both measurement and intervention development to target childhood obesity.

The Family Mealtime Observation Study (FaMOS): Exploring the Role of Family Functioning in the Association between Mothers' and Fathers' Food Parenting Practices and Children's Nutrition Risk

This cross-sectional study explores associations between mothers’ and fathers’ food parenting practices and children’s nutrition risk, while examining whether family functioning modifies or confounds the association. Home observations assessed parents’ food parenting practices during dinnertime (n = 73 families with preschoolers). Children’s nutrition risk was calculated using NutriSTEP^®. Linear regression models examined associations between food parenting practices and NutriSTEP^® scores. An interaction term (family functioning × food parenting practice) explored effect modification; models were adjusted for family functioning to explore confounding. Among mothers, more frequent physical food restriction was associated with higher nutrition risk in their children (β = 0.40 NutriSTEP^® points, 95% Confidence Interval (CI) = 2.30, 7.58) and among both mothers and fathers, positive comments about the target child’s food were associated with lower nutrition risk (mothers: β = −0.31 NutriSTEP^® points, 95% CI = −0.54, −0.08; fathers: β = −0.27 NutriSTEP^® points, 95% CI = −0.75, −0.01) in models adjusted for parent education and child Body Mass Index (BMI) z-score. Family functioning did not modify these associations and they remained significant after adjustment for family functioning. Helping parents to use positive encouragement rather than restriction may help to reduce their children’s nutrition risk.

Teaching methods used by internal medicine residents on rounds: what works?

BACKGROUND

The specific teaching methods used by internal medicine residents on walk rounds are unknown.

OBJECTIVES

1) To characterize in real time the specific teaching methods used by internal medicine residents on rounds and 2) to identify attributes of successful resident teaching on rounds.

MATERIALS AND METHODS

We conducted a prospective mixed-methods study on inpatient medical services at a single academic medical center from September 2016 to January 2017. Participants were internal medicine residents (postgraduate year [PGY]-1, PGY-2, and PGY-3) and attending physicians. Teachers were PGY-2 and PGY-3 residents, and learners were PGY-1 residents. Residents' teaching on rounds was observed and characterized according to resident demographics, specific teaching methods, and length of time. Participants completed a survey with Likert scale and free-text questions.

RESULTS AND CONCLUSION

Among 136 surveys across 28 separate teaching encounters, we noted that PGY-3 residents' teaching was rated significantly better than PGY-2 residents' teaching. Teaching lasting >1 minute was rated significantly better than teaching lasting <1 minute. Free-text responses emphasized the value of immediate clinical relevance, citing published evidence, conciseness, clarity, and pertinence to the patient. Our findings may help guide internal medicine residents aiming to teach better on rounds and inform further research into specific resident teaching methods.

Student Practice Opportunities in Core Mathematics Instruction: Exploring for a Goldilocks Effect for Kindergartners With Mathematics Difficulties

Opportunities for practice play a critical role in learning complex behaviors. In the context of explicit mathematics instruction, practice facilitates systematic opportunities for students with mathematics difficulties (MD) to learn new mathematics content and apply such knowledge and skills to novel mathematics problems. This study explored whether there is an optimal amount of student practice that teachers should provide in core mathematics instruction to maximize the mathematics achievement of kindergarten students with MD, a so called "Goldilocks effect," as opposed to simply "more is better." Results from observation data collected in a large-scale efficacy trial supported the latter rather than the former. Specifically, we found that three individual practice opportunities for every explicit teacher demonstration of mathematical content was associated with increased mathematics achievement for students with MD relative to fewer practice opportunities. Implications for facilitating frequent student practice opportunities during core mathematics instruction and designing professional development for teachers who work with students with MD are discussed.

Evaluating motion detection to score sleep disturbance for children: A translational approach to developing a measurement system

Information obtained via direct observation of children's sleep disturbance throughout the night in their home can guide the assessment and treatment process, but watching live or via recorded video might be impractical in terms of time expenditures. In Experiment 1, we assessed the accuracy and reliability of a motion-detection camera with human motor movements. In Experiment 2, we tested the system's generality by using it to obtain in-home measures of sleep disturbance for three children with autism spectrum disorder and compared the accuracy to a continuous measurement system. We also measured scoring efficiency and assessed parents' acceptability of the camera. Results provide preliminary support for motion detection in measuring sleep disturbance, but further evaluation of motion detection to improve accuracy is warranted.

Application of the Scale for the Assessment of Feeding Interaction (SVIA) to Children With Autism Spectrum Disorder

Background and Objectives: Feeding problems occur more frequently among children with Autism spectrum disorder (ASD). The aim of this study was to analyse eating difficulties of ASD children through the direct observation of the caregiver-child co-regulation system. Methods: We compared 60 ASD children with a control group of 50 typically developing Italian children on the Scale for the Assessment of Feeding Interaction (SVIA). The Brief Autism Mealtime Behaviour Inventory (BAMBI) was used to define the presence of an eating disorder. Results: The ASD group showed higher scores on all dimensions of the SVIA compared to the control group. The SVIA and the BAMBI showed significant correlations. In a second step, the ASD sample was divided into two subgroups, children with and without feeding difficulties. The comparison between the ASD subgroups with the control group on the SVIA scales showed significant differences on all dimensions. Finally, significant differences emerged between the two ASD subgroups in three SVIA dimensions. Conclusion: These data suggest the importance of direct observation of feeding in the assessment of children with ASD. The SVIA seems to be able to point out some feeding difficulties in these subjects and to discriminate ASD with and without an eating disorder. Critical aspects of the application of SVIA to autistic children are discussed.

Authoritative parent feeding style is associated with better child dietary quality at dinner among low-income minority families

Background

Parent feeding styles have been linked to child weight status across multiple studies. However, to our knowledge, the link between feeding styles and children's dietary quality, a more proximal outcome, has not been investigated.

Objective

The purpose of this study was to examine the relation between parent feeding styles and dietary quality of Head Start preschoolers' dinner meals.

Design

The amount of food served and consumed by children was measured by using a standardized digital photography method during 3 in-home dinner observations of low-income minority families in Houston, Texas. Trained dietitians entered food served and consumed into the Nutrient Data System for Research 2009 for nutrient analysis. Overall dietary quality of the food served and consumed at dinner was evaluated by using the Healthy Eating Index 2010 (HEI-2010). Parent feeding style was assessed with the use of the Caregiver's Feeding Style Questionnaire (CFSQ). On the basis of a parent's level of demandingness and responsiveness to his or her child during feeding, the CFSQ categorizes parent feeding into 4 styles: authoritative (high demandingness and high responsiveness), authoritarian (high demandingness and low responsiveness), indulgent (low demandingness and high responsiveness), or uninvolved (low demandingness and low responsiveness).

Results

For the overall sample, the mean ± SD HEI score for dinner served was 44.2 ± 8.4, and the mean ± SD HEI score for dinner consumed was 43.4 ± 7.0. In the fully adjusted model, ANCOVA indicated that the authoritative parent feeding style was associated with significantly higher child dietary quality compared with the authoritarian feeding style (mean ± SEE HEI consumed-authoritative 45.5 ± 0.9; authoritarian: 41.9 ± 0.7; P = 0.001).

Conclusions

Parent feeding style contributes to the overall dietary quality of children, and among low-income minority preschoolers an authoritative feeding style was associated with the highest dietary quality of the 4 feeding styles. Interventions to promote feeding practices that contribute to authoritative feeding are needed to improve the dietary quality of preschool children at dinner. This trial was registered at https://clinicaltrials.gov as NCT02696278.

Evaluation of the accuracy, reliability, efficiency, and acceptability of fast forwarding to score problem behavior

Technological advances have allowed professionals to obtain extended recordings of caregiver-client interactions in natural settings, but scoring recorded video at normal speed to identify instances of low-rate problem behavior is impractical in terms of scoring time. Fast forwarding is a continuous measurement system in which all seconds of an observation are viewed at a speed faster than normal. In Study 1, we evaluated whether three groups of five observers could discriminate problem behavior at three fast-forwarding speeds across 10-min observations. We analyzed the efficiency of using fast forwarding compared to continuous scoring, and interobserver agreement across the fast-forwarding speeds. In Study 2, we compared the accuracy, efficiency, and social acceptability of fast forwarding (3.5x) and momentary time sampling (3.5 s) across 90-min observations. Results support the use of 3.5x fast forwarding as a viable measurement system of improving the practicality of scoring problem behavior from video.

Use of Objective Measures to Estimate Sedentary Time in Youth

The purpose of the study was to conduct a comprehensive evaluation of the ActiGraph GT3X+ (AG) and activPAL (AP) for assessing time spent in sedentary behaviors (SB) in youth using structured and free-living activities. Forty-four participants (mean±SD; age, 12.7±0.8 yrs) completed up to 8 structured activities and approximately 2-hrs of free-living activity while wearing an AG (right hip) and AP (right thigh). A Cosmed K4b² was used for measured energy expenditure (MET_y; activity VO₂ divided by resting VO₂). Direct observation was used during the structured activities. SB time was estimated using the inclinometer function of the AP and AG, and count thresholds with AG (<75 vector magnitude (VM) counts/10-s, < 25 vertical axis (VA) counts/10-s, and <50, 100, 150, and 200 VA counts/min). For the structured activities, the AG inclinometer and AP correctly classified supine rest about 45% of the time, seated activities 54.6% and 65.1% of the time, respectively, and walking and running >96% of the time. For the free-living measurement, the VA <25 counts/10-s has the lowest RMSE (20.6 min), while the VM <75 counts/10-s had the lowest MAPE (69.2%). The AG inclinometer was within 0.2 minutes of measured time, but had the highest MAPE (107.1%). The AP was within 1.6 minutes of measured time, but had the highest RMSE (28.5 minutes). Compared to measured SB time, the VA <25 counts/10-s and VM <75 counts/10-s provided the most precise estimates of SB during free-living activity. Further refinement is needed to improve the AP and AG posture estimates.

Physical Activity and Outdoor Play of Children in Public Playgrounds-Do Gender and Social Environment Matter?

Background: Few studies have delved into the relationship of the social environment with children’s physical activity and outdoor play in public playgrounds by considering gender differences. The aim of the present study was to examine gender differences and the relationship of the social environment with children’s physical activity and outdoor play in public playgrounds. Methods: A quantitative, observational study was conducted at ten playgrounds in one district of a middle-sized town in Germany. The social environment, physical activity levels, and outdoor play were measured using a modified version of the System for Observing Play and Leisure Activity in Youth. Results: In total, 266 observations of children (117 girls/149 boys) between four and 12 years old were used in this analysis. Significant gender differences were found in relation to activity types, but not in moderate-to-vigorous physical activity (MVPA). The presence of active children was the main explanatory variable for MVPA. In the models stratified by gender, the presence of opposite-sex children was a significant negative predictor of MVPA in girls but not in boys. Conclusions: The presence of active children contributes to children’s physical activity levels in public playgrounds. Girls’ physical activity seems to be suppressed in the presence of boys.

'Nurse specialling': Direct nursing observation in the emergency department compared to other wards of an urban teaching hospital in Sydney

OBJECTIVE

This study examined the patterns of direct observation of patients by nursing staff ('nurse specials') and compared those required for mental health/drug health (MH/DH)-related presentations to other patient groups in different care settings.

METHODS

A retrospective review of nurse special shifts requested during the 2014 calendar year at an urban teaching hospital.

RESULTS

Hospital-wide 14,021 8-hour nursing shifts were ordered for special observation of patients, an average of 39 per day. Of these, 30% were requested for MH/DH-related presentations, with the majority (70%) required for medically unstable patients. However, of the 1917 shifts required in the emergency department, 1841 (96%) were for MH/DH presentations compared to 76 (4%) for patients with unrelated medical conditions (odds ratio 98.2; 95% confidence interval 77.71-124.06, P<0.0001).

CONCLUSIONS

In contrast to the rest of the hospital, emergency department-based nurse special requests were significantly more likely to be for MH/DH presentations. This figure represents a considerable staff and financial burden and may be reduced by diversion or more rapid transfer of such presentations to an appropriate inpatient ward.

Using caregiver report on the impact of challenging behavior exhibited by children with autism spectrum disorder to guide treatment development and outcomes

Objectives: Evaluations of treatments using applied behavior analysis (ABA) for challenging behavior have relied mostly on direct behavioral observation. While observation is crucial, qualitative information can also be beneficial. In this study, we describe methods for using qualitative information in ABA treatments for challenging behavior. Method: Three participants were undergoing treatment for challenging behavior. Information was collected through caregiver interviews at the start and end of the admission. Directed content analysis identified themes in the interviews and we compared treatment outcomes using qualitative and quantitative measures. Results: Three themes emerged: description, frequency, and impact of the behavior. Quantitative and qualitative measures both suggested successful interventions for two participants. For the third, direct observation suggested treatment was effective while caregiver report did not. Conclusion: Incorporation of qualitative information into outcomes allowed for a more comprehensive view of treatment success and guided assessment and treatment decisions. Treatments based on applied behavior analysis (ABA) are commonly studied for the treatment of challenging behavior, but these studies rely mostly on direct behavioral observation. While observation is crucial, qualitative information is also useful in ensuring meaningful results. In this study, we describe a method of collecting, analyzing, and using qualitative information collected from caregivers and compare qualitative to quantitative outcomes.

In Situ Observation of Carbon Dioxide Capture on Pseudo-Liquid Eutectic Mixture-Promoted Magnesium Oxide

Eutectic mixtures of alkali nitrates are known to increase the sorption capacity and kinetics of MgO-based sorbents. Underlying principles and mechanisms for CO₂ capture on such sorbents have already been established; however, real-time observation of the system was not yet accomplished. In this work, we present the direct-observation of the CO₂ capture phenomenon on a KNO₃-LiNO₃ eutectic mixture (EM)-promoted MgO sample, denoted as KLM, via in situ transmission electron microscopy (in situ TEM). Results revealed that the pseudoliquid EM undergoes structural rearrangement as MgCO₃ evolves from the surface of MgO, resulting in surface roughening and evolution of cloudy structures that stay finely distributed after regeneration. From this, we propose a nucleation and structural rearrangement scheme for MgCO₃ and EM, which involves the rearrangement of bulk EM to evenly distributed EM clusters due to MgCO₃ saturation as adsorption proceeds. We also conducted studies on the interface between EM over solid MgO and MgCO₃ formed during sorption, which further clarifies the interaction between MgO and EM. This study provides better insight into the sorption and regeneration mechanism, as well as the structural rearrangements involved in EM-promoted sorbents by basing not only on intrinsic evolutions but also on real-time observation of the system as a whole.

Oral Contact Events and Caregiver Hand Hygiene: Implications for Fecal-Oral Exposure to Enteric Pathogens among Infants 3-9 Months Living in Informal, Peri-Urban Communities in Kisumu, Kenya

Childhood diarrhea is one of the leading causes of morbidity and mortality in children under five in low and middle-income countries, second only to respiratory illness. The mouthing behavior that is common in children exposes them to fecal-orally transmitted pathogens that can result in diarrhea; however, there is a need for further evidence on specific exposure routes. This study describes the frequency and diversity of two important routes of enteric pathogen exposure among infants 3-9 months of age: infant oral contact behavior and caregiver handwashing behavior. Data were collected through structured observations of 25 index infants for the oral contact data and 25 households for the caregiver handwashing data in a peri-urban setting in Kisumu (Obunga), Kenya. Breast was the most common type of oral contact event with an average of 3.00 per observation period and 0.5 events per hour. This was followed by a range of physical objects with an average of 2.49 per observation and 0.4 events per hour. The "infant's own hands" was the third most common oral contact, with an average of 2.16 events per hour, and 0.4 oral contact events per hour. Food and liquids were the 4th and 5th most common oral contact events with an average of 1.64 food contacts and 0.52 liquid oral contact events per observation period. Feeding events, including breastfeeding, were the most commonly observed key juncture-71% of total junctures observed were caregivers feeding children. This was followed by child cleaning (23%), caregiver toilet uses at (4%), and lastly food preparation at 2%. HWWS was observed only once before a feeding event (1%), twice after cleaning a child (9%), and twice after caregiver toilet use (40%). The combined implication of data from observing oral contact behavior in children and hand hygiene of caregivers suggests that caregiver hand hygiene prior to feeding events and after cleaning a child are priority interventions.

Piloting Direct Observation of Procedural Skills in Dental Education in India

Context:

Direct observation of procedural skills (DOPS) and corrective feedback are one of the most important tools to promote skill learning. Authentic and pedagogically effective feedback can come out only when based on direct observation of the learners' performance. Use of DOPS, particularly in dental education in India is very uncommon.

Aims:

To pilot DOPS on undergraduate dental students in the specialty of periodontia.

Materials and Methods:

The faculty was oriented to the concept and use of this modality during a 1 h session, which included a video demonstration. The generic DOPS recording format with modifications was used for periodontal procedures. A total of 42 procedures (including 7, 30, and 5 of low, average, and high difficulty, respectively) performed by 15 students were observed by four faculty members. Feedback was provided to the students regarding the procedure and how to overcome shortcomings if any.

Results:

Faculty was comfortable observing and providing feedback (3.95/5.0) and found this mode feasible and nonintrusive in their clinical and teaching schedule. Students expressed satisfaction and acceptance of this modality (4.19/5.0), felt that it would help them in learning skills better (4.01/5.0) and 83% wanted it to be extended to other clinical areas, preferably from the beginning of their clinical postings.

Conclusion:

DOPS can be incorporated in the in-training assessment of undergraduate dental students and seems to have a good feasibility and acceptability. Faculty training in observation and providing feedback will enhance its utility.

The Hawthorne effect in direct observation research with physicians and patients

RATIONALE, AIMS, AND OBJECTIVES

This study examines the degree to which a "Hawthorne effect" alters outpatient-visit content.

METHODS

Trained research nurses directly observed 4454 visits to 138 family physicians. Multiple data sources were used to examine the Hawthorne effect including differences in medical record documentation for observed visits and the prior visit by the same patient, time use during visits on the first versus the second observation day of each physician, and report by the patient, physician, and observer of the effect of observation.

RESULTS

Visits on the first versus the second observation day were longer by an average of 1 minute (P < .001); there were time-use differences for 4 of 20 behaviour categories evaluated. No effect of the observer on the interaction was reported by 74% of patients and 55% of physicians. Most of those that reported an affect indicated it was slight. Patients with non-White race, lower-educational level, and poorer health were more likely to report being affected by the observer.

CONCLUSIONS

In a study that was designed to minimize the Hawthorne effect, the presence of an observer had little effect on most patient-physician visits but appeared to at least slightly effect a subgroup of vulnerable patients.

A novel resident-as-teacher curriculum: the role of experiential learning and coaching

This article was migrated. The article was marked as recommended. Background: Canadian family medicine residency programs have the challenge of training in a wide breadth of topics and competencies within a two-year program, including training residents to be effective teachers. There has been a gap in knowledge with regards to the most effective method to train residents to teach. We developed, implemented, and evaluated a novel multi-level resident-as-teacher (RAT) coaching curriculum to provide training and authentic experiences for family medicine residents in teaching medical students. Methods: A curriculum centred around multi-level coaching was designed where family medicine faculty members directly observed and provided feedback to family medicine residents teaching small group clinical skills to first and second year medical students. Family medicine residents received didactic training on how to provide effective feedback to students and manage small group dynamics, after reviewing the learning objectives that students were to achieve. This was followed by the authentic small group teaching experiences. A survey was sent out by email to all residents and faculty members who had participated in the RAT curriculum at the end of the 2013-2014 and 2014-2015 academic years. Quantitative survey data were analyzed using descriptive statistics (frequencies, percentages, correlation coefficients (Spearman's rho)). Qualitative analysis was completed through thematic analysis of respondents' written comments to open-ended survey questions. Results: 80% of 127 residents strongly agreed (26%) or agreed (54%) that the RAT program effectively developed their teaching skills. 57% either strongly agreed (17%) or agreed (40%) that the direct observation and feedback from faculty coaches helped to improve their teaching skills. There was a significant positive correlation between residents' perceptions of the usefulness of the feedback from faculty coaches and residents' perceptions of the overall RAT program's effectiveness in developing their teaching skills (r=0.42; p=0.001). Qualitative analysis revealed that residents perceived the RAT program to have solidified their own knowledge base for the content covered in the sessions. Residents also perceived a benefit of near-peer teaching for the medical students and an elevated family physicians' profile as teachers. They found the active learning experience increased their self-awareness of their teaching skills. Time away from clinical rotations and preparation time were derived as a potential drawback of the program. All faculty coaches agreed or strongly agreed that the RAT curriculum improved the teaching skills of family medicine residents. Thematic analysis of the faculty coaches' comments revealed that participating as coaches allowed for their own professional development in that their feedback and coaching skills improved. Conclusions: Our experiences and program evaluation of a novel multi-level resident-as-teacher coaching curriculum show that direct observation with feedback of authentic teaching activities is highly valued, and appears to be effective in developing resident teaching skills while fostering interest in future teaching.

Contacts of healthcare workers, patients and visitors in general wards in Singapore

To characterize contacts in general wards, a prospective survey of healthcare workers (HCWs), patients and visitors was conducted using self-reported diary, direct observation and telephone interviews. Nurses, doctors and assorted HCWs reported a median of 14, 18 and 15 contact persons over one work shift, respectively. Within 1 h, we observed 3·5 episodes with 25·6 min of cumulative contact time for nurses, 2·9 episodes and 22·1 min for doctors and 5·0 episodes with 44·3 min for assorted-HCWs. In interactions with patients, nurses had multiple brief episodes of contact; doctors had fewer episodes and less cumulative contact time; assorted-HCWs had fewer contact episodes of longer durations (than for nurses and doctors). Assortative mixing occurred amongst HCWs: those of the same HCW type were the next most frequent class of contact after patients. Over 24-h, patients contacted 14 persons with 23 episodes and 314·5 min of contact time. Patient-to-patient contact episodes were rare, but a maximum of five were documented from one patient participant. 22·9% of visitors reported contact with patients other than the one they visited. Our study revealed differences in the characteristics of contacts among different HCW types and potential transmission routes from patients to others within the ward environment.