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Antibody responses require the proliferative expansion of B cells controlled by affinity-dependent signals. Yet, proliferative bursts are heterogeneous, varying between 0 and 8 divisions in response to the same stimulus. NFκB cRel is activated in response to immune stimulation in B cells and is genetically required for proliferation. Here, we asked whether proliferative heterogeneity is controlled by natural variations in cRel abundance. We developed a fluorescent reporter mTFP1-cRel for the direct observation of cRel in live proliferating B cells. We found that cRel is heterogeneously distributed among naïve B cells, which are enriched for high expressors in a heavy-tailed distribution. We found that high cRel expressors show faster activation of the proliferative program, but do not sustain it well, with population expansion decaying earlier. With a mathematical model of the molecular network, we showed that cRel heterogeneity arises from balancing positive feedback by autoregulation and negative feedback by its inhibitor IκBε, confirmed by mouse knockouts. Using live-cell fluorescence microscopy, we showed that increased cRel primes B cells for early proliferation via higher basal expression of the cell cycle driver cMyc. However, peak cMyc induction amplitude is constrained by incoherent feedforward regulation, decoding the fold change of cRel activity to terminate the proliferative burst. This results in a complex nonlinear, nonmonotonic relationship between cRel expression and the extent of proliferation. These findings emphasize the importance of direct observational studies to complement gene knockout results and to learn about quantitative relationships between biological processes and their key regulators in the context of natural variations.

Mesoporous materials find widespread applications due to their high specific surface area, contributing to enhanced performance. Scanning electron microscopy (SEM) observation of mesoporous materials provides valuable insights into their mesostructures. However, direct observation of the outermost surfaces, which often dictate material properties, remains challenging, especially for highly insulating and fragile compounds. In this study, utilizing SEM observation with ultra‐low‐voltage acceleration directed by Gemini column is proposed to achieve direct surface imaging of mesoporous organic materials with highly insulating and fragile characteristics. By observing mesostructured polymers obtained through a soft‐templating method without washing, stuffed pores are identified allowing the differentiation of micelle templates and polymer walls. Moreover, leveraging SEM measurements, a polymerization mechanism is proposed for dopamine on the polymer micelles adhered to the graphene oxide nanosheets. These findings demonstrate the potential of SEM measurements with ultra‐low accelerating voltage in facilitating surface observations of polymer‐derived nanomaterials characterized by high insulating properties and a fragile framework. [ABSTRACT FROM AUTHOR]

Kush S Patel,1 Ronald J Anderson,1,* Carolyn B Becker,1,* William C Taylor,1,* Anne F Liu,1,* Anubodh S Varshney,2,* Nadaa B Ali,1,* Barbara J Nath,3,* Stephen R Pelletier,4 Helen M Shields,1 Nora Y Osman1 1Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA; 2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA; 3Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; 4Office of Medical Education, Harvard Medical School, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Helen M Shields, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA, 02115, USA, Tel +1 617 678 6077, Fax +1 617 525 8740, Email hmshields@bwh.harvard.eduPurpose: Coaching is a well-described means of providing real-time, actionable feedback to learners. We aimed to determine whether dual coaching from faculty physicians and real inpatients led to an improvement in history-taking skills of clerkship medical students.Patients and Methods: Expert faculty physicians (on Zoom) directly observed 13 clerkship medical students as they obtained a history from 26 real, hospitalized inpatients (in person), after which students received immediate feedback from both the physician and the patient. De-identified audio-video recordings of all interviews were scored by independent judges using a previously validated clinical rating tool to assess for improvement in history-taking skills between the two interviews. Finally, all participants completed a survey with Likert scale questions and free-text prompts.Results: Students’ history-taking skills – specifically in the domains of communication, medical knowledge and professional conduct – on the validated rating tool, as evaluated by the independent judges, did not significantly improve between their first and second patient interviews. However, students rated the dual coaching as overwhelmingly positive (average score of 1.43, with 1 being Excellent and 5 being Poor), with many appreciating the specificity and timeliness of the feedback. Patients also rated the experience very highly (average score of 1.23, with 1 being Excellent and 5 being Poor), noting that they gained new insights into medical training.Conclusion: Students value receiving immediate and specific feedback and real patients enjoy participating in the feedback process. Dual physician-patient coaching is a unique way to incorporate more direct observation into undergraduate medical education curricula.Keywords: direct observation, immediate feedback, medical student education, real patients, virtual teaching

Antibody responses require the proliferative expansion of B cells controlled by affinity-dependent signals. Yet, proliferative bursts are heterogeneous, varying between 0 and 8 divisions in response to the same stimulus. NFκB cRel is activated in response to immune stimulation in B cells and is genetically required for proliferation. Here, we asked whether proliferative heterogeneity is controlled by natural variations in cRel abundance. We developed a fluorescent reporter mTFP1-cRel for the direct observation of cRel in live proliferating B cells. We found that cRel is heterogeneously distributed among naïve B cells, which are enriched for high expressors in a heavy-tailed distribution. We found that high cRel expressors show faster activation of the proliferative program, but do not sustain it well, with population expansion decaying earlier. With a mathematical model of the molecular network, we showed that cRel heterogeneity arises from balancing positive feedback by autoregulation and negative feedback by its inhibitor IKBG, confirmed by mouse knockouts. Using live-cell fluorescence microscopy, we showed that increased cRel primes B cells for early proliferation via higher basal expression of the cell cycle driver cMyc. However, peak cMyc induction amplitude is constrained by incoherent feedforward regulation, decoding the fold change of cRel activity to terminate the proliferative burst. This results in a complex nonlinear, nonmonotonic relationship between cRel expression and the extent of proliferation. These findings emphasize the importance of direct observational studies to complement gene knockout results and to learn about quantitative relationships between biological processes and their key regulators in the context of natural variations. [ABSTRACT FROM AUTHOR]

Abstract Mesoporous materials find widespread applications due to their high specific surface area, contributing to enhanced performance. Scanning electron microscopy (SEM) observation of mesoporous materials provides valuable insights into their mesostructures. However, direct observation of the outermost surfaces, which often dictate material properties, remains challenging, especially for highly insulating and fragile compounds. In this study, utilizing SEM observation with ultra‐low‐voltage acceleration directed by Gemini column is proposed to achieve direct surface imaging of mesoporous organic materials with highly insulating and fragile characteristics. By observing mesostructured polymers obtained through a soft‐templating method without washing, stuffed pores are identified allowing the differentiation of micelle templates and polymer walls. Moreover, leveraging SEM measurements, a polymerization mechanism is proposed for dopamine on the polymer micelles adhered to the graphene oxide nanosheets. These findings demonstrate the potential of SEM measurements with ultra‐low accelerating voltage in facilitating surface observations of polymer‐derived nanomaterials characterized by high insulating properties and a fragile framework.

Junior faculty are often called upon to deliver high-stakes large-group presentations. Training in the skills needed to do this effectively is often lacking. We devised a 1.25 h coaching program. The coach analyzed a practice run of the presentation using a locally developed assessment tool. Areas covered included public speaking skills, promoting learner understanding and retention, creating a dynamic learning climate, and optimal use of slides. COVID-19 necessitated a switch to virtual coaching, and we studied the impact of virtual vs. in-person coaching. We added two additional coaches and studied the transferability of the coaching component. There was high uptake of the offered coaching. Participant surveys showed improved comfort levels with large-group presentations; had a sense that their presentation skills had improved; showed an increased likelihood of volunteering for future speaking opportunities; and were likely to recommend the program. Comparisons between virtual and in-person coaching showed no statistical difference, and there was little difference between the original coach and the subsequent two coaches. Qualitative assessments revealed broad areas in which faculty felt the program had been most impactful. The coaching program was well-received and resulted in concrete positive changes in presenter behavior. Conducting the coaching in a virtual manner may increase the feasibility of the intervention, as would expanding the coach pool.

Abstract Backgrounds Social skills are frequently impaired in neurodevelopmental disorders and genetic conditions, including 22q11.2 deletion syndrome (22q11DS) and autism spectrum disorders (ASD). Although often assessed with questionnaires, direct assessment provides a more valid estimate of the constructs. Role-plays (i.e., simulates situational settings) therefore appear to be an appropriate indicator of social skills in daily life. Methods This co-registered study involved 53 individuals with 22q11DS, 34 individuals with ASD, and 64 typically developing (TD) peers aged 12–30 years. All participants were assessed with role-plays as well as parent-reported questionnaires and clinical interviews focusing on social skills, functioning and anxiety. Results Both clinical groups showed impaired social skills compared to TD, but distinct social profiles emerged between the groups. Individuals with 22q11DS displayed higher social appropriateness and clarity of speech but weaker general argumentation and negotiation skills, with the opposite pattern observed in participants with ASD. No association was found between social skills measured by direct observation and caregiver reports. Social anxiety, although higher in clinical groups than in TD, was not associated with role-plays. Conclusions This study highlights the need to train social skills through tailored interventions to target the specific difficulties of each clinical population. It also highlights the importance of combining measures as they do not necessarily provide the same outcome.

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. [ABSTRACT FROM AUTHOR]

Backgrounds: Social skills are frequently impaired in neurodevelopmental disorders and genetic conditions, including 22q11.2 deletion syndrome (22q11DS) and autism spectrum disorders (ASD). Although often assessed with questionnaires, direct assessment provides a more valid estimate of the constructs. Role-plays (i.e., simulates situational settings) therefore appear to be an appropriate indicator of social skills in daily life. Methods: This co-registered study involved 53 individuals with 22q11DS, 34 individuals with ASD, and 64 typically developing (TD) peers aged 12–30 years. All participants were assessed with role-plays as well as parent-reported questionnaires and clinical interviews focusing on social skills, functioning and anxiety. Results: Both clinical groups showed impaired social skills compared to TD, but distinct social profiles emerged between the groups. Individuals with 22q11DS displayed higher social appropriateness and clarity of speech but weaker general argumentation and negotiation skills, with the opposite pattern observed in participants with ASD. No association was found between social skills measured by direct observation and caregiver reports. Social anxiety, although higher in clinical groups than in TD, was not associated with role-plays. Conclusions: This study highlights the need to train social skills through tailored interventions to target the specific difficulties of each clinical population. It also highlights the importance of combining measures as they do not necessarily provide the same outcome. [ABSTRACT FROM AUTHOR]

While membrane separation has proven to be an outstanding method for separating oil in water (O/W) emulsions containing droplets smaller than 20 µm, it is severely limited due to fouling. Much research has been aimed at understanding the mechanism behind membrane fouling, particularly for ultrafiltration (UF) membranes. Interestingly, studies pointed out that the emulsifier, namely surfactant, is the main source of fouling in nanofiltration and reverse osmosis, while in the case of UF, oil is generally regarded as the main source of fouling. Herein, we study the fouling of UF membranes during separation of O/W emulsions stabilized by surfactants, with the explicit goal of determining the relative impact of the oil and surfactant present on fouling severity and dynamics. Results obtained from flux decline measurements, complimented by visualization using confocal microscopy, show that oil causes irreversible fouling to a certain extent, however, surfactant fouling dominates the observed membrane performance. The degree of fouling and flux recovery appears to be closely related to the properties the surfactant, namely charge and molecular weight, as has been observed in the past but attributed to the oil-membrane interactions, mediated by the surfactant. Further, to visualize the fouling mechanisms, direct observation via a confocal microscope set-up is used to capture real-time images of the membrane surface, which reveal that surface coverage of oil is not directly related to flux decline during the separation process. Our results suggest that membrane flux decline and fouling is dominated by membrane-surfactant interactions, the exact nature of which is a topic for future extensions of this work.

Abstract Background In the United States, the number of state policies mandating recess in schools has rapidly increased over the past decade; however, few policies specify recess frequency. Informed by an ecological model of physical activity (PA) policy, this study examined and compared total amounts and intensity of PA expended during recess among children attending schools in compliance with Arizona recess policy ARS§ 15–118 mandating 2 + daily recess periods versus not. Methods PA during recess was measured among grade three children (ages 8–10) in four randomly selected elementary schools (two complying averaging 30 daily recess minutes; two non-complying averaging 15 daily recess minutes) in Maricopa County, Arizona. Group-level PA was assessed by direct observation using the System for Observing Play and Leisure (137 observations). A subset of students (N = 134) from all schools wore ActiGraph GT3X + devices during recess to measure individual PA. General linear mixed effects models were used to analyze the impact of recess frequency on group and individual PA during recess. Results Students attending complying schools spent significantly greater proportions of time in moderate-to-vigorous PA (MVPA) based on direct observation (5%) and accelerometry (15%) and less time being sedentary based on accelerometry (14%) during recess. Across the school day, this would equate to 5.1 more MVPA minutes based on systematic direct observation and 9.5 more MVPA minutes based on accelerometry, and 4.1 less minutes being sedentary based on accelerometry if students received two daily 15-minute recess periods compared to one. Conclusions Students attending elementary schools implementing 2 + recesses, in accordance with state policy, demonstrated greater MVPA and less sedentary time, providing preliminary evidence that recess frequency is associated with greater PA intensity among children during recess. Schools that adhere to state-level PA policies may provide a more supportive environment for PA, resulting in increased movement among students. Specifying recess frequency should be considered in statewide recess policy.

Background: In the United States, the number of state policies mandating recess in schools has rapidly increased over the past decade; however, few policies specify recess frequency. Informed by an ecological model of physical activity (PA) policy, this study examined and compared total amounts and intensity of PA expended during recess among children attending schools in compliance with Arizona recess policy ARS§ 15–118 mandating 2 + daily recess periods versus not. Methods: PA during recess was measured among grade three children (ages 8–10) in four randomly selected elementary schools (two complying averaging 30 daily recess minutes; two non-complying averaging 15 daily recess minutes) in Maricopa County, Arizona. Group-level PA was assessed by direct observation using the System for Observing Play and Leisure (137 observations). A subset of students (N = 134) from all schools wore ActiGraph GT3X + devices during recess to measure individual PA. General linear mixed effects models were used to analyze the impact of recess frequency on group and individual PA during recess. Results: Students attending complying schools spent significantly greater proportions of time in moderate-to-vigorous PA (MVPA) based on direct observation (5%) and accelerometry (15%) and less time being sedentary based on accelerometry (14%) during recess. Across the school day, this would equate to 5.1 more MVPA minutes based on systematic direct observation and 9.5 more MVPA minutes based on accelerometry, and 4.1 less minutes being sedentary based on accelerometry if students received two daily 15-minute recess periods compared to one. Conclusions: Students attending elementary schools implementing 2 + recesses, in accordance with state policy, demonstrated greater MVPA and less sedentary time, providing preliminary evidence that recess frequency is associated with greater PA intensity among children during recess. Schools that adhere to state-level PA policies may provide a more supportive environment for PA, resulting in increased movement among students. Specifying recess frequency should be considered in statewide recess policy. [ABSTRACT FROM AUTHOR]

BackgroundMicroscale environmental features are usually evaluated using direct on-street observations. This study assessed inter-rater reliability of the Microscale Audit of Pedestrian Streetscapes, Global version (MAPS-Global), in an international context, comparing on-street with more efficient online observation methods in five countries with varying levels of walkability.MethodsData were collected along likely walking routes of study participants, from residential starting points toward commercial clusters in Melbourne (Australia), Ghent (Belgium), Curitiba (Brazil), Hong Kong (China), and Valencia (Spain). In-person on the street and online using Google Street View audits were carried out by two independent trained raters in each city. The final sample included 349 routes, 1228 street segments, 799 crossings, and 16 cul-de-sacs. Inter-rater reliability analyses were performed using Kappa statistics or Intraclass Correlation Coefficients (ICC).ResultsOverall mean assessment times were the same for on-street and online evaluations (22 ± 12 min). Only a few subscales had Kappa or ICC values

This study was intended to exploit the possibility of using the quick gelation of alcogel that is induced by adding catalytic imidazole into a silicate-oligomer-based solution. For this purpose, the experimental viability of the direct observation of the gelation behavior was actually examined. The silicate oligomer, derived from tetraethyl orthosilicate hydrolyzed under an acidic condition (pH ~ 5), was used as the quickly gelling mother solution. The capability of the oligomer solution to form a non-flowable matter in only a few seconds when triggered by the addition of the catalytic solution of imidazole is promising, for example, for stabilizing a sandy ground surface, due to its simplicity. From the practical viewpoint, how long the gelation could take (=gel time) is a crucial parameter when the choice of an appropriate gelling chemical species needs to be made. Thus, this study focused its interest on as simple an experimental method as possible for evaluating the gel time of the gelling systems that actually underwent instantaneous gelation. The silicate oligomer solution was an appropriate material both in its quick gelling behavior and environmental friendliness. For such quick gelation, rheological approaches are not applicable for detecting the boundary in the mechanical properties that delineate the regime of "gel". In this study, instead, direct observation was employed to capture the short interval during which the gelation was completed. The silicate-oligomer-based gelling solution was observed to lose its flowability within only 0.2 s, as it was seen to come off the bottom of the shaken cylinder at 5 Hz. For a more quantitative estimation, the same gelling solution was observed by high-speed motion picture. The high-speed motion picture could clearly capture the instantaneous gelation as a sudden arrest of the flow. The sub-millisecond direct observation of the gelation behavior revealed that the timescale of the instantaneous termination of the flow was as quick as 1 ms in order of magnitude. Such instantaneous gelation in the sub-millisecond-order timescale could not be forecasted from the observable megascopic gelation, which appeared to last from 102 ms to 103 ms in our naked-eye observation. The noteworthy gap between the timescale of the naked-eye-observed gelation and that of the true gel time at a localized spot determined by the high-speed motion picture should be noted to avoid excess agitation, which can result in total collapse into gel fragments of the just solidifying or already solidified gel under strong deformational influence by mechanical agitation, for example. [ABSTRACT FROM AUTHOR]

Background: Direct observation is important, yet medical residents are rarely observed. We implemented and evaluated a direct observation program in resident clinics to increase the frequency of observation and feedback and improve perceptions about direct observation. Methods: We assigned faculty as observers in our resident clinics between June 2019 and February 2020. We surveyed residents and faculty before and after the program. Faculty completed a form for each observation performed. We analyzed surveys to examine changes in barriers, frequency and type of observations and feedback, and attitudes toward observation. The analytical sample included 38 and 37 pre- and postresident surveys, respectively, and 20 and 25 pre- and postfaculty surveys, respectively. Results: Resident survey response rates were 32.3% (40/124) pre- and 30.7% (39/127) postintervention. Most residents (76% [pre], 86% [post], P = 0.258) reported being observed in at least one of the four areas: history, examination, counseling, or wrap-up. We received observation tracking forms on 68% of eligible residents. Observed history taking increased from 30% to 79% after the program (P = 0.0010). Survey response rates for faculty were 64.7% (22/34) pre- and 67.5% (25/37) postintervention. Fewer faculty reported time (80% [pre], 52% [post], P = 0.051) and competing demands (65% [pre], 52% [post], P = 0.380) as barriers postintervention. Fewer faculty postintervention viewed observation as a valuable teaching tool (100% [pre], 79% [post], P = 0.0534). All faculty who did not view observation as valuable were the least experienced. Discussion: Assigning faculty as observers can increase observation, especially in history taking, though data suggest an increase in negative perceptions of observation by faculty. [ABSTRACT FROM AUTHOR]

ObjectiveThe 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.MethodsUsing 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.ResultsA 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.ConclusionsOur 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.

IntroductionDuring 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).MethodsWe 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).ResultsFor 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.ConclusionsMillions 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.

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.

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 (⁠|${\rm{\Delta }}L\ \sim\ {\rm{\Delta }}T$|⁠) rather than obeying the classic Lucas–Washburn law (⁠|$l\ \sim\ {t}^{1/2}$|⁠) 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. [ABSTRACT FROM AUTHOR]

Good access and appropriate use of Water, Sanitation and Hygiene (WASH) is important in the control, elimination and eradication of a number of neglected tropical diseases (NTDs). Poor WASH access and use may explain continued high trachoma prevalence in Nabilatuk district, Uganda. This study aimed to investigate the level of WASH access and use through different WASH data collection methods and the triangulation of their results. A mixed-methods cross-sectional study was conducted in 30 households in Nabilatuk district, from 10 households in each of three nomadic villages. The data collection methods used were: (1) direct observations of routine WASH behaviours; (2) structured quantitative household questionnaires; (3) demonstrations of specific WASH behaviours. With regards to access, observations indicated less WASH access and use compared with questionnaire responses: the questionnaire indicated all households had access to an improved water source, but 70% had a >30-min round-trip, and no households had access to an improved latrine, whereas some observations indicated longer water collection times. In terms of behaviour, there were also differences between the data collection methods, with demonstrations revealing knowledge of good practice, such as thorough handwashing, but this was not routinely observed in the observations. Further systematic investigation of barriers to appropriate WASH access and use in the local context is needed, as is the development of feasible, valid and reliable WASH access and use assessment methods for use in national NTD programmes. [ABSTRACT FROM AUTHOR]

PurposeTo test the validity of the Ecological Video Identification of Physical Activity (EVIP) computer vision algorithms for automated video-based ecological assessment of physical activity in settings such as parks and schoolyards.MethodsTwenty-seven hours of video were collected from stationary overhead video cameras across 22 visits in nine sites capturing organized activities. Each person in the setting wore an accelerometer, and each second was classified as moderate-to-vigorous physical activity or sedentary/light activity. Data with 57,987 s were used to train and test computer vision algorithms for estimating the total number of people in the video and number of people active (in moderate-to-vigorous physical activity) each second. In the testing data set (38,658 s), video-based System for Observing Play and Recreation in Communities (SOPARC) observations were conducted every 5 min (130 observations). Concordance correlation coefficients (CCC) and mean absolute errors (MAE) assessed agreement between (1) EVIP and ground truth (people counts+accelerometry) and (2) SOPARC observation and ground truth. Site and scene-level correlates of error were investigated.ResultsAgreement between EVIP and ground truth was high for number of people in the scene (CCC = 0.88; MAE = 2.70) and moderate for number of people active (CCC = 0.55; MAE = 2.57). The EVIP error was uncorrelated with camera placement, presence of obstructions or shadows, and setting type. For both number in scene and number active, EVIP outperformed SOPARC observations in estimating ground truth values (CCC were larger by 0.11-0.12 and MAE smaller by 41%-48%).ConclusionsComputer vision algorithms are promising for automated assessment of setting-based physical activity. Such tools would require less manpower than human observation, produce more and potentially more accurate data, and allow for ongoing monitoring and feedback to inform interventions.

Khapra beetle, Trogoderma granarium Evert (Coleoptera: Dermestidae) is the most important stored pest and was first discovered in Jakarta grain storages in 1972. Since then, quarantine procedures have been massively carried out to prevent khapra beetles to spread in Indonesia. In 2009, Indonesia has been declared as free area from Khapra beetle. However, Indonesia still import grain from non-Khapra beetle free countries and supervision must be carried out continuously to prevent Khapra beetle reinfestation. This survey was conducted at warehouses in five areas of Jakarta, Tangerang, and Bekasi from October 2016 to February 2017 with high risk due to its role as one of the main entry ports and storage of imported grains. Observation was done using probe sampling, direct observation and traps with attractant. Results showed that several insects were found from imported seeds in the surveyed area, but no Khapra beetles were found. It showed that non-Khapra free countries have implemented the required Sanitary Phytosanitary. In addition, it implies that survey methods using attractant traps could complement the probe sampling methods and direct observation that are currently used.

الملخص: أهداف البحث: أخطاء إعطاء الدواء هي من بين أكثر أنواع الأخطاء الدوائية شيوعا وأهمية في جميع أنحاء العالم. هدفت هذه الدراسة إلى تقييم انتشار أخطاء إعطاء الدواء وأنواعها وشدتها، وتحديد العوامل المرتبطة بحدوث مثل هذه الأخطاء. طرق البحث: أجريت هذه الدراسة المقطعية على مدى ثلاثة أشهر في جناح الطب الباطني في مستشفى تعليمي ثلاثي في الأردن. خلال فترة الدراسة، تمت ملاحظة ما مجموعه 13 ممرضة أثناء تحضير الأدوية وإعطائها باستخدام طريقة الملاحظة المقنعة المباشرة. تمت مقارنة جميع الملاحظات المسجلة المتعلقة بالتحضير والإدارة مع أوامر الطبيب في سجل الأدوية لتحديد أي أخطاء محتملة. النتائج: لوحظ ما مجموعه 1012 فرصة للأخطاء، وتم تحديد 910 خطأ في إعطاء الأدوية. من بين هذه الأخطاء البالغ عددها 910، كانت أخطاء الالتزام هي النوع الأكثر شيوعا (العدد 364 ، 35.9٪)، يليها تحضير دواء غير صحيح (العدد 247، 24.4٪). لم يسفر أي من أخطاء إعطاء الأدوية عن ضرر جسيم للمرضى أو ساهم في البقاء في المستشفى لفترات طويلة. كانت الأدوية المضادة للميكروبات (العدد 210 ، 23.0٪) هي الفئة الأكثر شيوعا المرتبطة بـأخطاء إعطاء الأدوية، تليها أدوية أمراض القلب والأوعية الدموية (العدد 157 ، 17.2٪). أظهرت النتائج أن حدوث أخطاء إعطاء الأدوية كان أعلى بشكل ملحوظ في الأدوية غير الوريدية مقارنة بالأدوية الوريدية (القيمة الاحتمالية أقل من 0.001). الاستنتاجات: كشفت هذه الدراسة عن وجود معدل مرتفع من أخطاء إعطاء الأدوية. على الرغم من أن جميع الأخطاء التي تم تحديدها لم تسبب أي ضرر للمرضى، إلا أن الأخطاء كانت موجودة دائما. يوصى بشدة بحملات التوعية والتثقيف المستمرة للممرضين والممرضات حول أهمية الإدارة السليمة والآمنة للأدوية. Abstract: Objectives: Medication administration errors (MAEs) are the most common and significant type of medication errors worldwide. This study aims to assess the prevalence, types, and severity of MAEs. Furthermore, this study attempts to determine the factors associated with the occurrence of MAEs. Method: This cross-sectional study was conducted over a three-month interval in the internal medicine ward of a tertiary teaching hospital in Jordan. During the study period, 13 nurses were observed while they were preparing and administering medications using a direct disguised observation method. All the recorded observations about the preparation and administration were compared with the physician's orders in the medications' records to identify any possible MAEs. Results: Having observed a total of 1,012 opportunities for errors, 910 MAEs were identified. Among these 910 errors, adherence errors were found to be the most frequent type (n = 364, 35.9%), followed by incorrect drug preparation (n = 247, 24.4%). None of the MAEs revealed any serious harm to patients or contributed to prolonged hospitalization. Antimicrobial drugs (n = 210, 23.0%) was the most common class associated with MAEs, followed by the class of cardiovascular (n = 157, 17.2%) medicines. Results have shown that the occurrence of MAEs was significantly higher in the non-intravenous medications in comparison to the intravenous medications (p-value < 0.001). Conclusion: While this study revealed a high rate of MAEs, all the identified errors did not cause harm to the patients. Continuous awareness and education campaigns targeting the nurses about the importance of proper and safe drug administration are highly recommended.

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. [ABSTRACT FROM AUTHOR]

Direct observation of postgraduate medical trainees with actual patients by clinical faculty has traditionally been a standard tool to assess knowledge and skills in clinical subjects. By assessing and providing feedback to medical trainees performing a medical interview, physical examination, or counselling patients, faculty can facilitate budding physicians to have successful practice of medicine in their future. Despite the advances in clinical skills evaluation, direct observation has been a most popular and time tested method. However, observation of postgraduate medical students by faculty is very subjective and unfortunately often sporadic and non-standardized. Substantial amount of literature identifies several threats to its construct validity as an assessment tool. Although many tried to demonstrate methods to minimize those threats, there are many lacunae that remain inherent to direct observation method. Hence the need of the time is to relook at the observation as an assessment tool, instead of discarding the whole as inappropriate one. The authors initially made an effort to analyse the problems in present settings in India. After an extensive literature search authors advocate few additions and modifications to the existing system. Thus the present study not only highlights the pitfalls in the direct observation method but also suggests solutions for the problem.

Abstract Background Clinical education across the professions is challenged by a lack of recognition for faculty and pressure for patient throughput and revenue generation. These pressures may reduce direct observation of patient care provided by students, a requirement for both billing student-involved services and assessing competence. These same pressures may also limit opportunities for interprofessional education and collaboration. Methods An interprofessional group of faculty collaborated in a sequential quality improvement project to identify the best patients and physical location for a student teaching clinic. Patient chief complaint, use of resources, length of stay, estimated severity of illness and student participation and evaluation of the clinic was tracked. Results Clinic Optimization and Patient Care: Five hundred and thirty-two emergency department (ED) patients were seen in the first 19 months of the clinic. A clinic located near the ED allowed for patients with higher emergency severity index and greater utilization of imaging. Patients had similar or lower lengths of stay and higher satisfaction than patients who remained in the ED (p

Abstract Background Hand hygiene using alcoholic hand rub solution is essential for the prevention of surgical site infections. There are several opportunities for hygienic hand disinfection (termed “hand hygiene” in the following) during immediate pre-, intra- and postoperative orthopedic patient care. However, the level of hand hygiene compliance among surgical and anesthesia staff in this context is unclear. Therefore, we conducted an observational study in operating theatres of an orthopedic university clinic in northern Germany during July and August 2020. Methods One trained person directly and comprehensively observed hand hygiene compliance of surgical and anesthesia staff according to the WHO “My 5 moments for hand hygiene” model (WHO-5). In addition to cross-tabulations with Chi2 tests, multiple logistic regression models were used to study associations between occupational group, medical specialty, and compliance (both overall and for each WHO-5 indication). Models were adjusted for hand hygiene opportunities being associated with female or male healthcare workers, being located within or outside the operation room, and occurring in adult or pediatric surgery. Results In total, 1145 hand hygiene opportunities during 16 surgeries were observed. The overall compliance was 40.8% (95% CI 37.9–43.6%), with a larger difference between surgical versus anesthesia staff (28.4% vs. 46.1%, p

Feeding behaviour plays a significant role in promoting good animal health and welfare. It is also reflective of the quality and quantity of available feed. In fact, grazing livestock do not select their feed randomly, rather their behaviour is influenced by the texture, taste, and smell of each pasture species. Although taste agents are often used to modify feed intake for captive livestock, the effect on the feeding behaviour of grazing livestock has not yet been extensively evaluated in native grasslands. To address this gap in knowledge, herein, we sprayed three types of taste agents—salty (SA), sweet (SW), and bitter (BT)—on alpine meadows to investigate their effect on the grazing behaviour of yaks (Bos Grunniens) on the Qinghai-Tibetan Plateau (QTP). Behavioural observations showed that grazing was concentrated primarily in the morning and afternoon, while ruminating/resting peaked at noon; however, the diurnal behavioural patterns of grazing yaks were not affected by the taste agents. Application of the SA agent significantly increased the yaks’ grazing time, bites per minute, bites per step, time per feeding station, and steps per feeding station, while significantly reducing walking time, steps per minute, and number of feeding stations per minute. Meanwhile, application of the SW agent significantly increased the yaks’ time per feeding station, however, significantly reduced the steps per minute and number of feeding stations per minute. In contrast, the BT agent significantly increased the yaks’ walking time, steps per minute, and number of feeding stations per minute, while significantly reducing grazing time, bites per minute, bites per step, and time per feeding station. Application of the SA agent also significantly increased the intake of favoured, edible, and inedible forage, while the SW agent improved inedible forage intake, however, had a more subtle effect on favoured and edible forage intake. Meanwhile, the BT agent had an inhibitory effect on grazing intake. Hence, the structural equation model suggested that taste agents may directly or indirectly influence grazing behaviour by regulating feeding behaviour. Our findings provide a theoretical basis for using taste agents in grasslands to control the grazing behaviour of livestock and provide a method to promote the stability of grassland communities, while mitigating the degradation of grasslands in the QTP.

Objective: To provide health research teams with a practical, methodologically rigorous guide on how to conduct direct observation. Methods: Synthesis of authors’ observation-based teaching and research experiences in social sciences and health services research. Results: This article serves as a guide for making key decisions in studies involving direct observation. Study development begins with determining if observation methods are warranted or feasible. Deciding what and how to observe entails reviewing literature and defining what abstract, theoretically informed concepts look like in practice. Data collection tools help systematically record phenomena of interest. Interdisciplinary teams--that include relevant community members-- increase relevance, rigor and reliability, distribute work, and facilitate scheduling. Piloting systematizes data collection across the team and proactively addresses issues. Conclusion: Observation can elucidate phenomena germane to healthcare research questions by adding unique insights. Careful selection and sampling are critical to rigor. Phenomena like taboo behaviors or rare events are difficult to capture. A thoughtful protocol can preempt Institutional Review Board concerns. Innovation: This novel guide provides a practical adaptation of traditional approaches to observation to meet contemporary healthcare research teams’ needs.

Background Medication administration errors are frequent and cause significant harm globally. However, only a few data are available on their prevalence, nature, and severity in developing countries, particularly in Brazil. This study attempts to determine the incidence, nature, and factors associated with medication administration errors observed in a university hospital. Methods This was a prospective observational study, conducted in a clinical and surgical unit of a University Hospital in Brazil. Two previously trained professionals directly observed medication preparation and administration for 15 days, 24 h a day, in February 2020. The type of error, the category of the medication involved, according to the anatomical therapeutic chemical classification system, and associated risk factors were analyzed. Multivariate logistic regression was adopted to identify factors associated with errors. Results The administration of 561 drug doses was observed. The mean total medication administration error rate was 36.2% (95% confidence interval 32.3–40.2). The main factors associated with time errors were interruptions. Regarding technique errors, the primary factors observed were the route of administration, interruptions, and workload. Conclusions Here, we identified a high total medication administration error rate, the most frequent being technique, wrong time, dose, and omission errors. The factors associated with errors were interruptions, route of administration and workload, which agrees well with the results of other national and international studies.

BackgroundAn online version of the Microscale Audit of Pedestrian Streetscapes (Abbreviated) tool was adapted to virtually audit built environment features supportive of physical activity. The current study assessed inter-rater reliability of MAPS Online between in-person raters and online raters unfamiliar with the regions.MethodsIn-person and online audits were conducted for a total of 120 quarter-mile routes (60 per site) in Phoenix, AZ and San Diego, CA. Routes in each city included 40 residential origins stratified by walkability and SES, and 20 commercial centers. In-person audits were conducted by raters residing in their region. Online audits were conducted by raters in the alternate location using Google Maps (Aerial and Street View) images. The MAPS Abbreviated Online tool consisted of four sections: overall route, street segments, crossings and cul-de-sacs. Items within each section were grouped into subscales, and inter-rater reliability (ICCs) was assessed for subscales at multiple levels of aggregation.ResultsOnline and in-person audits showed excellent agreement for overall positive microscale (ICC = 0.86, 95% CI [0.80, 0.90]) and grand scores (ICC = 0.93, 95% CI [0.89, 0.95]). Substantial to near-perfect agreement was found for 21 of 30 (70%) subscales, valence, and subsection scores, with ICCs ranging from 0.62, 95% CI [0.50, 0.72] to 0.95, 95% CI [0.93, 0.97]. Lowest agreement was found for the aesthetics and social characteristics scores, with ICCs ranging from 0.07, 95% CI [-0.12, 0.24] to 0.27, 95% CI [0.10, 0.43].ConclusionsResults support use of the MAPS Abbreviated Online tool to reliably assess microscale neighborhood features that support physical activity and may be used by raters residing in different geographic regions and unfamiliar with the audit areas.

Hand hygiene (HH) compliance among health-care workers has not satisfactorily improved despite multiple educative approaches. Between October 2019 and February 2020, we performed a self-evaluation test and a direct observation for the compliance of the 5 Moments for Hand Hygiene program advocated by the World Health Organization at two Japanese hospitals. Average percentages of self-evaluated HH compliance were as follows: (i) 76.9% for "Before touching a patient," (ii) 85.8% for "Before clean/aseptic procedures," (iii) 95.9% for "After body fluid exposure/risk," (iv) 84.0% for "After touching a patient," and (v) 69.2% for "After touching patient surroundings." On the other hand, actual HH compliance was 11.7% for "Before touching a patient" and 18.0% for "After touching a patient or patient surroundings." The present study demonstrated a big gap between self-evaluation and actual HH compliance among nurses working at hospitals, indicating the need of further providing the education in infection prevention. [ABSTRACT FROM AUTHOR]

Pedestrian safety on crosswalks is extremely vital in Poland since 2015, when the first study on road users’ behaviour on driver–pedestrian encounters in areas of zebra crosswalks were conducted. The second study was carried out in 2018 and its results are published in this article for the first time. The results of the project helped lead to changes in pedestrians’ safety regulations in Poland, increasing the safety of pedestrians in areas of crossing. Since June, the 1st, 2021, drivers of oncoming cars approaching a zebra crossing are obliged to stop to allow pedestrians approaching from the sidewalk to cross the zebra crossing. Data to assess pedestrian safety presented in this article combine a new approach that is a combination of different diagnostic techniques: a surrogate safety measure (non- accident-based indicators) and the traditional approach: statistical analysis. As a result of the study, the most frequent categories of interactions between drivers and pedestrians and pedestrians itself were characterized on crossing facilities. Videos recording pedestrians’ and drivers’ behaviours, and vehicle speed measurements at pedestrian crossings from 2018 allow to assess the safety of 7 000 pedestrians during behaviour observation in on- site fields: on all crossing facilities, except with light signalization, 55% of pedestrians had to stop and wait at the sidewalks to cross, before an oncoming car. Only 45% of drivers approaching not signalised zebra crossings gave way to pedestrians. Pedestrians aged 60+ entering the road on marked crossings without traffic light waited longer to cross than younger. In residential areas with high traffic volume more drivers stopped at non signalised crossings and gave way to pedestrians. At low speed of vehicle in urban areas pedestrians felt safer and were ready to enter the crossing; their behaviour was more predictable. Results showed dangerous pedestrian behaviours on signal-regulated crossing facilities who failed to obey the traffic lights (7% of red-light crossings). 8% of observed pedestrians crossed the street outside designated pedestrian crossings. Video-recorded speed measurements of over 32 000 vehicles on-site study fields of pedestrian crossings showed that the speed of vehicles was higher than permitted. This article presents the newest characteristics of traffic and pedestrian’ behavior at crossings together with measurements of pedestrians’ speed and loss of pedestrians’ time on different road cross sections in Poland in 2018.

Background: Medication administration errors are frequent and cause significant harm globally. However, only a few data are available on their prevalence, nature, and severity in developing countries, particularly in Brazil. This study attempts to determine the incidence, nature, and factors associated with medication administration errors observed in a university hospital. Methods: This was a prospective observational study, conducted in a clinical and surgical unit of a University Hospital in Brazil. Two previously trained professionals directly observed medication preparation and administration for 15 days, 24 h a day, in February 2020. The type of error, the category of the medication involved, according to the anatomical therapeutic chemical classification system, and associated risk factors were analyzed. Multivariate logistic regression was adopted to identify factors associated with errors. Results: The administration of 561 drug doses was observed. The mean total medication administration error rate was 36.2% (95% confidence interval 32.3–40.2). The main factors associated with time errors were interruptions. Regarding technique errors, the primary factors observed were the route of administration, interruptions, and workload. Conclusions: Here, we identified a high total medication administration error rate, the most frequent being technique, wrong time, dose, and omission errors. The factors associated with errors were interruptions, route of administration and workload, which agrees well with the results of other national and international studies. [ABSTRACT FROM AUTHOR]

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IntroductionDirect observation of clinical skills is a key assessment strategy in competency-based medical education. The guidelines presented in this paper synthesize the literature on direct observation of clinical skills. The goal is to provide a practical list of Do's, Don'ts and Don't Knows about direct observation for supervisors who teach learners in the clinical setting and for educational leaders who are responsible for clinical training programs.MethodsWe built consensus through an iterative approach in which each author, based on their medical education and research knowledge and expertise, independently developed a list of Do's, Don'ts, and Don't Knows about direct observation of clinical skills. Lists were compiled, discussed and revised. We then sought and compiled evidence to support each guideline and determine the strength of each guideline.ResultsA final set of 33 Do's, Don'ts and Don't Knows is presented along with a summary of evidence for each guideline. Guidelines focus on two groups: individual supervisors and the educational leaders responsible for clinical training programs. Guidelines address recommendations for how to focus direct observation, select an assessment tool, promote high quality assessments, conduct rater training, and create a learning culture conducive to direct observation.ConclusionsHigh frequency, high quality direct observation of clinical skills can be challenging. These guidelines offer important evidence-based Do's and Don'ts that can help improve the frequency and quality of direct observation. Improving direct observation requires focus not just on individual supervisors and their learners, but also on the organizations and cultures in which they work and train. Additional research to address the Don't Knows can help educators realize the full potential of direct observation in competency-based education.

PurposeMacroscale built environment factors (e.g., street connectivity) are correlated with physical activity. Less-studied but more modifiable microscale elements (e.g., sidewalks) may also influence physical activity, but shorter audit measures of microscale elements are needed to promote wider use. This study evaluated the relation of an abbreviated 54-item streetscape audit tool with multiple measures of physical activity in four age groups.MethodsWe developed a 54-item version from the original 120-item Microscale Audit of Pedestrian Streetscapes (MAPS). Audits were conducted on 0.25-0.45 mile routes from participant residences toward the nearest nonresidential destination for children (N=758), adolescents (N=897), younger adults (N=1,655), and older adults (N=367). Active transport and leisure physical activity were measured with surveys, and objective physical activity was measured with accelerometers. Items to retain from original MAPS were selected primarily by correlations with physical activity. Mixed linear regression analyses were conducted for MAPS-Abbreviated summary scores, adjusting for demographics, participant clustering, and macroscale walkability.ResultsMAPS-Abbreviated and original MAPS total scores correlated r=.94 The MAPS-Abbreviated tool was related similarly to physical activity outcomes as the original MAPS. Destinations and land use, streetscape and walking path characteristics, and overall total scores were significantly related to active transport in all age groups. Street crossing characteristics were related to active transport in children and older adults. Aesthetics and social characteristics were related to leisure physical activity in children and younger adults, and cul-de-sacs were related with physical activity in youth. Total scores were related to accelerometer-measured physical activity in children and older adults.ConclusionMAPS-Abbreviated is a validated observational measure for use in research. The length and related cost of implementation has been cited as a barrier to use of microscale instruments, so availability of this shorter validated measure could lead to more widespread use of streetscape audits in health research.

Increasing coverage of evidence-based maternal, neonatal, child, reproductive health and nutrition (MNCRHN) programs in low- and middle-income countries has coincided with dramatic improvements in health despite variable quality of implementation. Comprehensive evaluation to inform program improvement requires standardized but adaptable tools, which the Real Accountability, Data Analysis for Results (RADAR) project has developed. To inform selection of tools and methods packages (‘packages’) to measure program quality of care (QoC), we documented experiences testing the packages, which were developed and adapted based on global and local expertise, and pre- and pilot-testing. We conducted cross-sectional studies in 2018–2019 on the quality of 1) integrated community case management, 2) counseling on maternal, infant, and young child feeding, 3) intrapartum care, and 4) family planning counseling in Mali, Mozambique, Tanzania, and Malawi. Herein we describe package performance and highlight experiences that inform their selection and use. Direct observation packages provided high-quality, immediately applicable results but they required specialized expertise, in-person collection, adequate patient volume, reasonable wait times, and unambiguously ‘correct’ provision of care. General satisfaction questions from exit interview packages produced unvaryingly positive responses despite variable observed quality of care. Variation increased when questions were more targeted, but findings on caregiver and client’s recall of recommendations were more actionable. When interactive, clinical vignettes can capture knowledge of clinical care. But for conditions that can be simulated, like provision of family planning counseling, we could capture provider practice from simulated clients. Clinicians could more easily demonstrate tactile aspects of intrapartum care using observed structured clinical examinations, but this method required storage and transport of the required mannequins. Based on our findings we recommend ten questions upon which evaluators can base package selection. Findings from these packages inform programs and, in the context of comprehensive program evaluation enable us to link programs with impact.

Abstract Background Microscale environmental features are usually evaluated using direct on-street observations. This study assessed inter-rater reliability of the Microscale Audit of Pedestrian Streetscapes, Global version (MAPS-Global), in an international context, comparing on-street with more efficient online observation methods in five countries with varying levels of walkability. Methods Data were collected along likely walking routes of study participants, from residential starting points toward commercial clusters in Melbourne (Australia), Ghent (Belgium), Curitiba (Brazil), Hong Kong (China), and Valencia (Spain). In-person on the street and online using Google Street View audits were carried out by two independent trained raters in each city. The final sample included 349 routes, 1228 street segments, 799 crossings, and 16 cul-de-sacs. Inter-rater reliability analyses were performed using Kappa statistics or Intraclass Correlation Coefficients (ICC). Results Overall mean assessment times were the same for on-street and online evaluations (22 ± 12 min). Only a few subscales had Kappa or ICC values

Purpose: To compare the video observation of procedural skills (VOPS) method with the direct observation of procedural skills (DOPS) method in the assessment of senior residents' performance utilizing the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric for phacoemulsification (ICO-OSCAR; phaco). Methods: This is a prospective comparative study conducted at a university-affiliated hospital. Six ophthalmology residents of postgraduate year 4 participated. Their performance in phacoemulsification was rated via DOPS and later in a masked manner through VOPS by a single faculty assessor. Results: Seventy-one surgeries were evaluated. There were no statistically significant differences between the scores of VOPS and DOPS regarding all ICO-OSCAR indices except “instrument insertion into the eye” in which DOPS had higher scores (P = 0.035). A significant correlation was observed in total scores of “task-specific” (r = 0.64, P < 0.001) and “global” (r = 0.38, P = 0.003) indices between VOPS and DOPS while some subscales did not show a correlation between the two methods of assessment. The Bland-Altman analysis demonstrated that nearly all data points of total “task-specific” and “global” scores fell within the 95% limits of agreement ([-5.84, 6.87] and [-4.78, 4.86], respectively). Conclusion: This study demonstrated that VOPS holds promise for a general rating of residents' performance.

Background: Hand hygiene using alcoholic hand rub solution is essential for the prevention of surgical site infections. There are several opportunities for hygienic hand disinfection (termed "hand hygiene" in the following) during immediate pre-, intra- and postoperative orthopedic patient care. However, the level of hand hygiene compliance among surgical and anesthesia staff in this context is unclear. Therefore, we conducted an observational study in operating theatres of an orthopedic university clinic in northern Germany during July and August 2020. Methods: One trained person directly and comprehensively observed hand hygiene compliance of surgical and anesthesia staff according to the WHO "My 5 moments for hand hygiene" model (WHO-5). In addition to cross-tabulations with Chi2 tests, multiple logistic regression models were used to study associations between occupational group, medical specialty, and compliance (both overall and for each WHO-5 indication). Models were adjusted for hand hygiene opportunities being associated with female or male healthcare workers, being located within or outside the operation room, and occurring in adult or pediatric surgery. Results: In total, 1145 hand hygiene opportunities during 16 surgeries were observed. The overall compliance was 40.8% (95% CI 37.9–43.6%), with a larger difference between surgical versus anesthesia staff (28.4% vs. 46.1%, p < 0.001) than between physicians versus nurses (38.5% vs. 42.9%, p = 0.13). Adjusting for sex, place of observation, and adult versus pediatric operation theatre, logistic regression analyses revealed a significant interaction between medical specialty and occupational group (p < 0.001). In particular, the odds for compliance were higher for anesthesiologists (47.9%) than for surgeons (19.6%) (OR = 4.8, 95% CI 3.0–7.6). In addition, compliance was higher in pediatric surgery (OR = 1.9, 95% CI 1.4–2.6). In general, WHO-5-stratified results were in line with these overall patterns. Conclusions: Hygienic hand disinfection compliance was approximately 41%. Notably, surgeons performed worse than anesthesiologists did. These results indicate that hand hygiene compliance in orthopedic surgery needs to be improved. Tailored interventions promise to be an appropriate way to address each occupational group's specific needs. [ABSTRACT FROM AUTHOR]

Background: Clinical education across the professions is challenged by a lack of recognition for faculty and pressure for patient throughput and revenue generation. These pressures may reduce direct observation of patient care provided by students, a requirement for both billing student-involved services and assessing competence. These same pressures may also limit opportunities for interprofessional education and collaboration. Methods: An interprofessional group of faculty collaborated in a sequential quality improvement project to identify the best patients and physical location for a student teaching clinic. Patient chief complaint, use of resources, length of stay, estimated severity of illness and student participation and evaluation of the clinic was tracked. Results: Clinic Optimization and Patient Care: Five hundred and thirty-two emergency department (ED) patients were seen in the first 19 months of the clinic. A clinic located near the ED allowed for patients with higher emergency severity index and greater utilization of imaging. Patients had similar or lower lengths of stay and higher satisfaction than patients who remained in the ED (p < 0.0001). In the second clinic location, from October 2016–June 2019, 644 patients were seen with a total of 667 concerns; the most common concern was musculoskeletal (50.1%). Student Interprofessional Experience: A total of 991 students participated in the clinic: 68.3% (n = 677) medical students, 10.1% (n = 100) physician assistant students, 9.7% (n = 96) undergraduate nursing students, 9.1% (n = 90) physical therapy students, and 2.8% (n = 28) nurse practitioner students. The majority (74.5%, n = 738) of student participants worked with students from other professions. More than 90% of students reported that faculty set a positive learning environment respectful of students. However, 20% of students reported that faculty could improve provision of constructive feedback. Direct Observation: Direct observation of core entrustable professional activities for medical students was possible. Senior medical students were more likely to be observed generating a differential diagnosis or management plan than first year medical students. Conclusions: Creation of a DOCENT clinic in the emergency department provided opportunities for interprofessional education and observation of student clinical skills, enriching student experience without compromising patient care. [ABSTRACT FROM AUTHOR]

Increasing coverage of evidence-based maternal, neonatal, child, reproductive health and nutrition (MNCRHN) programs in low- and middle-income countries has coincided with dramatic improvements in health despite variable quality of implementation. Comprehensive evaluation to inform program improvement requires standardized but adaptable tools, which the Real Accountability, Data Analysis for Results (RADAR) project has developed. To inform selection of tools and methods packages ('packages') to measure program quality of care (QoC), we documented experiences testing the packages, which were developed and adapted based on global and local expertise, and pre- and pilot-testing. We conducted cross-sectional studies in 2018–2019 on the quality of 1) integrated community case management, 2) counseling on maternal, infant, and young child feeding, 3) intrapartum care, and 4) family planning counseling in Mali, Mozambique, Tanzania, and Malawi. Herein we describe package performance and highlight experiences that inform their selection and use. Direct observation packages provided high-quality, immediately applicable results but they required specialized expertise, in-person collection, adequate patient volume, reasonable wait times, and unambiguously 'correct' provision of care. General satisfaction questions from exit interview packages produced unvaryingly positive responses despite variable observed quality of care. Variation increased when questions were more targeted, but findings on caregiver and client's recall of recommendations were more actionable. When interactive, clinical vignettes can capture knowledge of clinical care. But for conditions that can be simulated, like provision of family planning counseling, we could capture provider practice from simulated clients. Clinicians could more easily demonstrate tactile aspects of intrapartum care using observed structured clinical examinations, but this method required storage and transport of the required mannequins. Based on our findings we recommend ten questions upon which evaluators can base package selection. Findings from these packages inform programs and, in the context of comprehensive program evaluation enable us to link programs with impact. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Lisa Royse,1 Nathanial Nolan,2 Kimberly Hoffman3 1Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, MO, USA; 2Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA; 3Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, USACorrespondence: Lisa RoyseDepartment of Orthopaedic Surgery, University of Missouri School of Medicine, 1100 Virginia Ave, Columbia, MO 65212, USATel +1 573-882-6965Fax +1 573-882-1760Email roysel@health.missouri.eduPurpose: 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.Keywords: interprofessional communication, direct observation, information exchange, sociogram

Abstract Background Improving the neighborhood environment may help address chronic disease and mortality. To identify neighborhood features that are predictors of health, objective assessments of the environment are used. Multiple studies have reported on cross-sectional assessments of health-related neighborhood features using direct observation. As study designs expand to better understand causation and predictors of change, there is a need to test whether direct observation methods are adequate for longitudinal assessment. To our knowledge, this is the first study to report on the reliability of repeated measurements of the neighborhood environment, and their stability, over time. Methods The Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH) study conducted longitudinal assessments in two low-income, African American neighborhoods at three waves (years 2012, 2015, 2017). The PHRESH audit tool is a modification of earlier validated tools, with an emphasis on environment features relevant for physical activity, sleep, and obesogenic behaviors. Trained data-collector pairs conducted direct observations of a 25% sample of street segments in each neighborhood. At each wave, we audited a sub-sample of street segments twice and assessed reliability using percentage inter-observer agreement and krippendorf’s alpha statistics. Stability of these items was assessed as exhibiting moderate or high agreement at every time point. Results Across waves, a majority (81%) of the items consistently demonstrated moderate to high agreement except for items such as public/communal space, amount of shade, sidewalk features, number of traffic lanes, garden/flower bed/planter, art/statue/monument, amount of trash, and physical disorder. The list of items with poor agreement includes features that are easy to miss (e.g. flower bed/planter), hard to assess from outside (e.g. public/communal space), or may change quickly (e.g. amount of trash). Conclusion In this paper, we have described implementation methods, reliability results and lessons learned to inform future studies of change. We found the use of consistent methods allowed us to conduct reliable, replicable longitudinal assessments of the environment. Items that did not exhibit stability are less useful for detecting real change over time. Overall, the PHRESH direct observation tool is an effective and practical instrument to detect change in the neighborhood environment.

Abstract Background Direct observation is necessary for specific and actionable feedback, however clinicians often struggle to integrate observation into their practice. Remotely audio-monitoring trainees for periods of time may improve the quality of written feedback given to them and may be a minimally disruptive task for a consultant to perform in a busy clinic. Methods Volunteer faculty used a wireless audio receiver during the second half of students’ oncology rotations to listen to encounters during clinic in real time. They then gave written feedback as per usual practice, as did faculty who did not use the listening-in intervention. Feedback was de-identified and rated, using a rubric, as strong/medium/weak according to consensus of 2/3 rating investigators. Results Monitoring faculty indicated that audio monitoring made the feedback process easier and increased confidence in 95% of encounters. Most students (19/21 respondents) felt monitoring contributed positively to their learning and included more useful comments. 101 written evaluations were completed by 7 monitoring and 19 non-monitoring faculty. 22/23 (96%) of feedback after monitoring was rated as high quality, compared to 16/37 (43%) (p