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Objective: Describe young children's beverage intake in early care and education (ECE) settings between 2008 and 2020 across multiple states in the US., Methods: Multivariable-adjusted, age-stratified estimates of beverage consumption among children aged 12-60 months (n = 4,457) in ECE centers and homes (n = 846)., Results: During any given day in ECE, younger children had a 79.7% per-meal probability of consuming milk, 8.9% water, 19.8% 100% juice, and 3.2% sugar-sweetened beverages (SSBs), and a per-meal mean intake of 1.5 oz milk, 1.7 oz water, 2.2 oz 100% juice, and 2.9 oz SSBs. Older children had an 87.2% probability of consuming milk, 0.6% water, 2.9% 100% juice, and 4.2% SSBs, and a mean intake of 4.2 oz milk, 2.3 oz water, 3.6 oz 100% juice, and 5.9 oz SSBs., Conclusions and Implications: There is room to improve beverage intake in ECE, with a focus on increasing water and decreasing juice and SSB consumption. These results may justify policies to limit or prohibit juice consumption in ECE., Competing Interests: CONFLICT OF INTEREST DISCLOSURE The authors have not stated any conflicts of interest., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

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

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 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.

Environmental change and growing anthropogenic pressure on water resources is increasing the duration and intensity of drying events in streams in many geographical locations. Favourable sediment characteristics (e.g. high porosity and low fine sediment load within the substrate matrix) may facilitate benthic macroinvertebrate use of subsurface sediments in response to drying. However, the influence of sedimentary characteristics on the use and subsequent recovery of macroinvertebrates from initial vertical migration into, survival during unfavourable conditions within, and subsequent re‐emergence from subsurface sediments have not been directly observed.Transparent mesocosm tanks were used to directly observe the vertical movement and subsequent re‐emergence of Gammarus pulex from subsurface sediments in response to increasing dry period (1, 7, or 21 days) and fine sediment load (0.5–1 mm particle diameter used for light and heavy sediment treatment) and following rehydration and resumption of flowing conditions.Increasing volumes of fine sediment addition limited the ability of G. pulex to access subsurface sediment in response to drying and re‐emerge following rehydration. The longest dry period (21 days) reduced the ability of G. pulex to re‐emerge from the subsurface sediments following rehydration and flow resumption.Increasing fine sediment load negatively affects taxa using subsurface sediments as a refuge. Increased fine sediment deposition has the potential to reduce both access to the sub‐surface and re‐emergence once surface flow resumes.As many rivers are beginning to dry out, or are showing prolonged drying due to global warming, it is increasingly important that river management reduces the input of fine sediment into rivers and increase sediment porosity of riverbeds to facilitate access into the subsurface refuge by benthic fauna. [ABSTRACT FROM AUTHOR]

Surveys constitute the main method of studying elite behavior. A concern with survey data is that they reflect what elites report they do - not what elites actually do. Alternative, process-oriented approaches such as direct observation can help to address this concern. Examining elected representatives' engagement in debates concerning service provision in the local councils of Albania, I show that observation data - opposed to survey data - portray a picture that is less positively biased towards men and less divided along male and female domains of representation. Findings underscore the importance of using measures that tap into how the behavior of political elites unfolds in practice. [ABSTRACT FROM AUTHOR]

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.

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.

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.

Background: Recess and physical education time continue to diminish, creating a need for additional physical activity opportunities within the school environment. The use of school gardens as a teaching tool in elementary science and math classes has the potential to increase the proportion of time spent active throughout the school day. Methods: Teachers from 4 elementary schools agreed to teach 1 math or science lesson per week in the school garden. Student physical activity time was measured with ActiGraph GT3X accelerometers on 3 garden days and 3 no-garden days at each school. Direct observation was used to quantify the specific garden-related tasks during class. The proportion of time spent active and sedentary was compared on garden and nogarden days. Results: Seventy-four children wore accelerometers, and 75 were observed (86% participation). Children spent a significantly larger proportion of time active on garden days than no-garden days at 3 of the 4 schools. The proportion of time spent sedentary and active differed significantly across the 4 schools. Conclusions: Teaching lessons in the school garden may increase children's physical activity and decrease sedentary time throughout the school day and may be a strategy to promote both health and learning. [ABSTRACT FROM AUTHOR]

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]

Most vulture species worldwide are in decline and of conservation concern. Despite the growing attention to vultures, relatively few studies have focused on their breeding behaviour. Understanding all aspects of a species' behaviour and its behavioural needs could help to inform conservation efforts. Behavioural studies can be enhanced with the use of an ethogram that clearly defines and describes distinct behaviours. We present the first ethogram detailing the nesting and breeding behaviours of the Critically Endangered Hooded Vulture Necrosyrtes monachus, compiled from over 400 000 nest camera photographs and from hours of direct personal observations at nests in north-eastern South Africa. We describe 28 behaviours that Hooded Vultures exhibited in and around their nests, and these fell into five discrete categories: Movement, Resting, Body Care, Social, and Nesting. We also present 34 camera trap images depicting behaviours from within each category, and discuss the uses and limitations of behaviour-recording technologies. Many of these behavioural elements may be common across vulture species, and so this ethogram may be a useful starting point for other researchers studying vultures globally. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine if student engagement in physical activity, lesson context/content, teacher involvement, and teacher interaction during Physical Education and Game course in elementary school changed as a function of teacher sex and years of teaching experience. Method: A convenience sample of classroom teachers from Şanlıurfa, Turkey, took part in the study. A direct observation tool, the System for Observing Fitness Instruction Time, was used to collect the data. Results: Although small differences were observed regarding sex and teaching experience for some subcategories of observation, the results showed that the students were standing, the context/content of the lesson was a game play, the teachers were observing the students, and they did not promote in-class and out-of-class physical activity during the greatest percentage of 4th grade Physical Education and Game lessons. Conclusion: It has been concluded that the practices that will support the physical activity and physical fitness levels of the students in the Physical Education and Game classes taught by the classroom teachers are found to be insufficient. [ABSTRACT FROM AUTHOR]

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The monitoring of pedestrian activity is challenging, primarily because its traffic levels are typically lower and more variable than those of motorized vehicles. Compared with other on-the-ground observation tools, unmanned aerial vehicles (UAVs) could be suitable for counting and mapping pedestrians in a reliable and efficient way. Thus, this study establishes and tests a new method of pedestrian observation using UAVs. The results show that UAV observations demonstrate high levels of interrater reliability (intraclass correlation coefficient = 0.99) and equivalence reliability (Cronbach's α =.97 with on-the-ground counts and.73 with Google Street View). Practical implications of the new tool are discussed. [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 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.

This study examined the generalizability and dependability of observational estimates of middle and high school teachers' use of praise and reprimands. Frequency of behavior-specific praise, general praise, and total reprimands were collected across 67, 20-min observations that took place during class-wide instruction in general education classrooms. Generalizability theory was used to determine the number of observations needed to obtain dependable estimates of teacher behavior. Behavior-specific praise rates were consistently low. General praise rates were slightly higher and reprimand rates were notably higher and slightly more variable. Total reprimands had the strongest generalizability results and general praise had the weakest. Behavior-specific praise reached an acceptable level of dependability after 15 min, whereas general praise required a 35-min observation, and reprimand only required 5 min. Implications and future directions are discussed. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the preliminary reliability and predictive and incremental validity of a novel system of coding observational assessments of children's coping behavior during a laboratory stress task using the Responses to Stress theoretical framework. Specifically, this study tested whether observations of child coping predicted child adjustment (i.e., internalizing problems, externalizing problems, and coping efficacy) overtime in middle childhood. Methods: Child coping was observed in a community, pilot sample of children (N = 65, M age = 9.06) during a difficult star‐tracing task. At baseline and six‐month follow‐up, children reported on their responses to stress and coping efficacy and parents reported on children's internalizing and externalizing problems. Results: The Coping Coding System was highly reliable and predicted unique variance in child adjustment over time. Longer duration of engagement coping predicted greater coping efficacy and internalizing problems over time. The direction of association between disengagement coping and internalizing and externalizing problems depended on whether the disengaged behavior involved verbalizations. Conclusions: Coping observations in the context of a challenge task contributed to individual differences in children's psychological adjustment, above and beyond child self‐report of coping. [ABSTRACT FROM AUTHOR]

PhenomenonEnsuring that future physicians are competent to practice medicine is necessary for high quality patient care and safety. The shift toward competency-based education has placed renewed emphasis on direct observation via workplace-based assessments in authentic patient care contexts. Despite this interest and multiple studies focused on improving direct observation, challenges regarding the objectivity of this assessment approach remain underexplored and unresolved. Approach: We conducted a literature review of direct observation in authentic patient contexts by systematically searching databases PubMed, Embase, Web of Science, and ERIC. Included studies comprised original research conducted in the patient care context with authentic patients, either as a live encounter or a video recording of an actual encounter, which focused on factors affecting the direct observation of undergraduate medical education (UME) or graduate medical education (GME) trainees. Because the patient care context adds factors that contribute to the cognitive load of the learner and of the clinician-observer we focused our question on such contexts, which are most useful in judgments about advancement to the next level of training or practice. We excluded articles or published abstracts not conducted in the patient care context (e.g., OSCEs) or those involving simulation, allied health professionals, or non-UME/GME trainees. We also excluded studies focused on end-of-rotation evaluations and in-training evaluation reports. We extracted key data from the studies and used Activity Theory as a lens to identify factors affecting these observations and the interactions between them. Activity Theory provides a framework to understand and analyze complex human activities, the systems in which people work, and the interactions or tensions between multiple associated factors. Findings: Nineteen articles were included in the analysis; 13 involved GME learners and 6 UME learners. Of the 19, six studies were set in the operating room and four in the Emergency department. Using Activity Theory, we discovered that while numerous studies focus on rater and tool influences, very few study the impact of social elements. These are the rules that govern how the activity happens, the environment and members of the community involved in the activity and how completion of the activity is divided up among the members of the community. Insights: Viewing direct observation via workplace-based assessment through the lens of Activity Theory may enable educators to implement curricular changes to improve direct observation of assessment. Activity Theory may allow researchers to design studies to focus on the identified underexplored interactions and influences in relation to direct observation. [ABSTRACT FROM AUTHOR]

The sustained-release formulations consist of many components, such as the active pharmaceutical ingredient, excipient, binder, lubricant, and polymer, leading to the complex dissolution process. The objective of this study is the elucidation of the rate-determining step in the dissolution process by direct optical observation. The composite particles of hydroxypropyl methylcellulose (HPMC) and brilliant blue FCF (model drug) were prepared, and the direct observation of the dissolution process and image analysis were conducted. The decrease in particle size and the penetration of solvent into the particles during the dissolution process had little impact on the sustained-release performance. On the other hand, the diffusion rate of the model drug in the HPMC gel strongly depended on the type of HPMC, suggesting that the rate-determining step in the dissolution process of the sustained-release formulations using HPMC would be the drug diffusion process in the polymer gel in the particles. [ABSTRACT FROM AUTHOR]

Health service psychology (HSP) graduate programs are shifting from knowledge- to competency-based assessments of trainees' psychotherapy skills. This study used Generalizability Theory to test the dependability of psychotherapy competence assessments based on video observation of trainees. A 10-item rating form was developed from a collection of forms used by graduate programs (n = 102) in counseling and clinical psychology, and a review of the common factors research literature. This form was then used by 11 licensed psychologists to rate eight graduate trainees while viewing 129, approximately 5-min video clips from their psychotherapy sessions with clients (n = 22) at a graduate program's training clinic. Generalizability analyses were used to forecast how the number of raters and clients, and length of observation time impact the dependability of ratings in various rating designs. Raters were the primary source of error variance in ratings, with rater main effects (leniency bias) and dyadic effects (rater-target interactions) contributing 24% and 7% of variance, respectively. Variance due to segments (video clips) was also substantial, suggesting that therapist performance varies within the same counseling session. Generalizability coefficients (G) were highest for crossed rating designs and reached maximum levels (G > .50) after four raters watched each therapist working with three clients and observed 15 min per dyad. These findings suggest that expert raters show consensus in ratings even without rater training and only limited direct observation. Future research should investigate the validity of competence ratings as predictors of outcome. [ABSTRACT FROM AUTHOR]

Preschool children spend most of their day in the indoor classroom, but it is unknown which learning centers or activity types are associated with physical activity (PA) or if children even use learning centers for their intended purpose (e.g., block play in the block center). The present study aimed to describe activity types in which children participate within classroom locations and to compare location- versus activity type-based approaches to characterizing children's classroom PA. Preschoolers' (N = 50) classroom location and activity type were video-coded and matched with PA level (measured as accelerometer vector magnitude in counts/s) for one indoor free-play period. Multiple activities occurred within each location (median = 6.5), with the predominant activity type accounting for 40.7 (sociodramatic play in group location) to 88.4 (manipulative play in sensory location) percent of time in that location. Children spent the most time in the group location (17.9%) and the sociodramatic activity type (19.9%). PA varied by location and activity type with the loft location (37.3 counts/s) and gross motor activity type (46.3 counts/s) promoting the highest PA levels. Activity types elicited varying PA levels depending on location (e.g., block activity in block vs. group location: 22.8 vs. 43.9 counts/s). Children do not always participate in the type of activity for which a space was designed but this can facilitate PA. Activity type- and location-based approaches to characterizing children's play and PA are not interchangeable but these approaches may provide additive information about classroom behavior, which is a methodological consideration for future studies. [ABSTRACT FROM AUTHOR]

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. [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

Abstract Introduction Learners may subconsciously change their behavior once they know they are being observed, and this Hawthorne effect should be considered when designing assessments of learner behavior. While there is a growing body of literature to suggest direct observation is the ideal standard for formative assessment, the best method to directly observe learners is unknown. We explored scheduled and unscheduled methods of direct observation among internal medicine residents in the outpatient continuity clinic to advance the understanding of both observation methods. Methods We conducted a thematic analysis of faculty and internal medicine residents in an outpatient clinic setting. A semi-structured interview guide for focus group sessions was created. Focus groups were used to explore the internal medicine resident and core teaching faculty perceptions of the scheduled and unscheduled direct observation methods in the outpatient clinc. An experienced qualitative research interviewer external to the internal medicine residency was moderating the sessions. Eight peer focus groups were held. Abstraction of themes from focus group transcripts identified resident and faculty perceptions of the different observation methods. Results Focus groups had 14 resident participants and 14 faculty participants. Unscheduled observations were felt to be more authentic than scheduled observations since residents perceived their behavior to be unmodified. Unscheduled observations allowed for increased numbers of observations per resident, which permitted more frequent formative assessments. Residents and faculty preferred remote video observation compared to in-room observation. Participants found direct observation a useful learning tool for high-yield, specific feedback. Conclusions Unscheduled remote direct observation captures authentic clinical encounters while minimizing learner behavior modification. An unscheduled observation approach results in more frequent formative assessment and therefore in more instances of valuable feedback compared to scheduled observations. These findings can help guide the best practice approaches to direct clinical observation in order to enhance residents learning and experience.

Background: "One-minute preceptor" (OMP) is a well-established educational technique; however, primary literature on OMP lacks a tool to assess behavioral change after delivery of curricula.Primary aim of this pilot study was to design a checklist for direct observation of teachers using OMP on general medicine rounds and obtain inter-rater reliability evidence for the checklist. Methods: This study pilots an internally designed 6-item checklist to assess change in directly observed behavior. We describe the process of developing the checklist and training the observers. We calculated a percent agreement and Cohen's kappa to assess inter-rater reliability. Results: Raters had a high percent agreement ranging from 0.8 to 0.9 for each step of OMP. Cohen's kappa ranged from 0.49 to 0.77 for the five OMP steps. The highest kappa obtained was for getting a commitment (κ = 0.77) step, whereas the lowest agreement was for correcting mistakes (κ = 0.49). Conclusion: We showed a percent agreement ≥0.8 and moderate agreement based on Cohen's kappa with most steps of OMP on our checklist. A reliable OMP checklist is an important step in further improving the assessment and feedback of resident teaching skills on general medicine wards. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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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]

The present study aimed to identify a way for educators to improve the accuracy of their praise and reprimand reflections to ultimately improve their ability to set, monitor, and evaluate their use of praise and reprimand. To do this, teachers' natural use of praise and reprimand (in the absence of intervention) were compared with their perceived use. A 20-min direct observation was collected from 66 middle and high school teachers to obtain praise and reprimand rates. Following the observation, teachers reported their perceived use of praise and reprimand. A t test and analysis of variance (ANOVA) were used to determine differences between praise and reprimand types. Correlations were used to determine the relation between perceived and actual praise and reprimand use. Statistical results indicated teachers used more general praise (GP) than behavior-specific praise and more mild reprimand than any other reprimand type. Teachers' actual and perceived use of GP were positively correlated, as were teachers' actual and perceived use of mild, gestural, and total reprimand. Furthermore, teachers with a greater difference between their actual and perceived praise also had a greater difference between their actual and perceived reprimand use. Future research and implications of these findings are discussed. [ABSTRACT FROM AUTHOR]