Critical reflections on formal teaching observations

Formal teaching observations not only have an essential role in the visibility of teaching and learning but also allow for constructive, critical feedback for improvement. In both nursing and teaching, there is an emphasis on the need for efficient, regular reflective practice; this not to identify negative aspects but to transform professional practice. This article provides a personal insight into formal teaching observations, and themes arising from them of motivation, the teacher's voice, the use of abbreviations and acronyms and the use of exemplars, using a critical reflective approach.

How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study

BACKGROUND

Medication-related problems are an important cause of emergency department (ED) visits, and medication errors are reported in up to 60% of ED patients. Procedures such as medication reconciliation and medication review can identify and prevent medication-related problems and medication errors. However, this work is often time-consuming. In EDs without pharmacists, medication reconciliation is the physician's responsibility, in addition to the primary assignments of examining and diagnosing the patient. The aim of this study was to identify how much time ED physicians spend on medication-related tasks when no pharmacists are present in the EDs.

METHODS

An observational time-and-motion study of physicians in three EDs in Northern Norway was conducted using Work Observation Method by Activity Timing (WOMBAT) to collect and time-stamp data. Observations were conducted in predefined two-hour observation sessions with a 1:1 relationship between observer and participant, during Monday to Friday between 8 am and 8 pm, from November 2020 to October 2021.

RESULTS

In total, 386 h of observations were collected during 225 observation sessions. A total of 8.7% of the physicians' work time was spent on medication-related tasks, of which most time was spent on oral communication about medications with other physicians (3.0%) and medication-related documentation (3.2%). Physicians spent 2.2 min per hour on medication reconciliation tasks, which includes retrieving medication-related information directly from the patient, reading/retrieving written medication-related information, and medication-related documentation. Physicians spent 85.6% of the observed time on non-medication-related clinical or administrative tasks, and the remaining time was spent standby or moving between tasks.

CONCLUSION

In three Norwegian EDs, physicians spent 8.7% of their work time on medication-related tasks, and 85.6% on other clinical or administrative tasks. Physicians spent 2.2 min per hour on tasks related to medication reconciliation. We worry that patient safety related tasks in the EDs receive little attention. Allocating dedicated resources like pharmacists to contribute with medication-related tasks could benefit both physicians and patients.

Direct observations of X-rays produced by upward positive lightning

X-rays have been observed in natural downward cloud-to-ground lightning for over 20 years and in rocket-triggered lightning for slightly less. In both cases, this energetic radiation has been detected during the stepped and dart leader phases of downward negative flashes. More recently, X-rays have also been reported during the dart leader phase of upward negative flashes. In this study, we present the observations of four upward positive lightning flashes from the Säntis Tower (2.5 km ASL) in Switzerland. These consist of the simultaneous records of electric current passing through the tower, and electric field strength and X-ray flux 20 m from the tower base. One of the flashes was captured by a high-speed camera operating at 24,000 frames per second, stills from which are also presented. We detected X-rays during the initial phase of upward negative leader propagation, which can be associated with the leader-stepping process from electric field and current waveforms. To the best of our knowledge, this is the first time that such measurements are reported in the literature. The obtained time-synchronised data confirm that the X-ray emissions detected are associated with the initial steps of the upward negative leader. The frequency and energy of X-ray pulses appear to decrease as functions of time, with pulses disappearing altogether within the first millisecond of the leader initiation. X-ray emission also appears to be correlated with the maximum current-derivative and the electric field change of leader steps, consistent with cold electron runaway. These observations contribute to improving our understanding of upward lightning, which is a primary source of damage to tall structures such as wind turbines and telecommunications towers, as well as aircraft during takeoff and landing.

Riding practices of e-bike riders after the implementation of electric bike management regulations: An observational study in Hangzhou, China

Objective

This study aimed to understand the riding behaviors of electric bike (e-bike) users in Hangzhou after the "Regulations of Zhejiang Province on the Administration of Electric Bicycles".

Methods

The study consisted of two parts, including a questionnaire survey of local e-bike users in Shangcheng District and Jiande County in Hangzhou City, and a cross-sectional observational study of 16 intersections.

Results

A total of 789 e-bike riders participated in the questionnaire survey, and the riding behavior of 99,407 e-bike users was observed. The main purpose of using e-bike was work and daily life, 46.0% of them used e-bikes more than 5 days a week, and 58.5% used e-bikes for less than 30 min each time. A vast majority (81.7%) of e-bike riders believe that the implementation of Zhejiang Regulations has significantly improved the safety level of e-bike riding in the region. The field survey found that the correct rates of helmet wearing by e-bike riders and passengers were 78.83% and 42.27%. The main violations were invalid/non-helmet wearing (21.17%), followed by carrying passengers and running red lights (7.94% and 4.26%). The rates of invalid/non-helmet wearing and running red lights were significantly higher during non-morning rush hour, weekends, and roads without separate non-motorized vehicle lanes than in other conditions (all P < 0.05). Additionally, sunny days and crossroads were risk factors for passenger-carrying and invalid/non-helmet wearing compared to rainy/cloudy days and T-intersections.

Conclusions

The phenomenon that e-bike users' correct practice lags far behind the awareness of various violations has shown some improvement. To further enhance safety measures for e-bike riders, it is necessary to promote education, improve infrastructure, and strengthen law enforcement, in support of the "Zhejiang Regulations" and behavioral interventions.

Aerosols heat up the Himalayan climate

The impact of aerosols, especially the absorbing aerosols, in the Himalayan region is important for climate. We closely examine ground-based high-quality observations of aerosol characteristics including radiative forcing from several locations in the Indo-Gangetic Plain (IGP), the Himalayan foothills and the Tibetan Plateau, relatively poorly studied regions with several sensitive ecosystems of global importance, as well as highly vulnerable large populations. This paper presents a state-of-the-art treatment of the warming that arises from these particles, using a combination of new measurements and modeling techniques. This is a first-time analysis of its kind, including ground-based observations, satellite data, and model simulations, which reveals that the aerosol radiative forcing efficiency (ARFE) in the atmosphere is clearly high over the IGP and the Himalayan foothills (80-135 Wm-2 per unit aerosol optical depth (AOD)), with values being greater at higher elevations. AOD is >0.30 and single scattering albedo (SSA) is ∼0.90 throughout the year over this region. The mean ARFE is 2-4 times higher here than over other polluted sites in South and East Asia, owing to higher AOD and aerosol absorption (i.e., lower SSA). Further, the observed annual mean aerosol-induced atmospheric heating rates (0.5-0.8 Kelvin/day), which are significantly higher than previously reported values for the region, imply that the aerosols alone could account for >50 % of the total warming (aerosols + greenhouse gases) of the lower atmosphere and surface over this region. We demonstrate that the current state-of-the-art models used in climate assessments significantly underestimate aerosol-induced heating, efficiency and warming over the Hindu Kush - Himalaya - Tibetan Plateau (HKHTP) region, indicating a need for a more realistic representation of aerosol properties, especially of black carbon and other aerosols. The significant, regionally coherent aerosol-induced warming that we observe in the high altitudes of the region, is a significant factor contributing to increasing air temperature, observed accelerated retreat of the glaciers, and changes in the hydrological cycle and precipitation patterns over this region. Thus, aerosols are heating up the Himalayan climate, and will remain a key factor driving climate change over the region.

Mothers' perceptions and experiences of caring for sick newborns in Newborn Care Units in public hospitals in Eastern Uganda: a qualitative study

INTRODUCTION

Mothers' participation in the care of their sick newborns in Newborn Care Units (NCUs) has been linked to several advantages including earlier discharge, fewer complications, better mother-baby bonding, and an easier transition to home after discharge. This study aimed to understand mothers' perceptions and experiences while participating in the care of their sick newborns in the NCUs to inform interventions promoting mothers' participation in public health facilities in Uganda.

METHODS

We conducted an exploratory qualitative study comprised of 18 in-depth interviews with mothers caring for their newborns in two NCUs at a Regional Referral and General hospital in Eastern Uganda between April and May 2022. The interviews were audio-recorded and then transcribed. For analysis, we used a thematic analysis approach.

RESULTS

The fear of losing their baby was an overarching theme that underlay mothers' perceptions, actions, and experiences in the NCU. Mothers' confidence in the care provided to their babies was based on their baby's outcomes. For example, when mothers saw almost immediate improvement after treatment, they felt more confident in the care than when this was not the case. Furthermore, mothers considered it essential that health care providers responded quickly in an emergency. Moreover, they expressed concerns about a lack of control over their personal space in the crowded NCU. Additionally, caring for babies in these settings is physically and financially taxing, with mothers requiring the combined efforts of family members to help them cope.

CONCLUSION

This study shows that for mothers of sick newborns in the NCU, the baby's survival is the first concern and the basis of mothers' confidence in the quality of care provided. Efforts to improve parental participation in NCUs must focus on lowering the costs incurred by families in caring for a baby in the NCU, addressing privacy and space concerns, leveraging the family's role, and avoiding compromising the quality of care in the process of participation.

How popularity goal and popularity status are related to observed and peer-nominated aggressive and prosocial behaviors in elementary school students

Whereas previous research with secondary school students has demonstrated that popularity goals and actual popularity status are related to peer-reported aggression, it is unclear whether this is already the case in the upper grades of elementary school. The current study extends previous research by assessing elementary school students, focusing on both aggressive and prosocial behaviors, and importantly by observing aggressive and prosocial behaviors in cooperative and competitive small-group settings. Participants were 173 Dutch fifth- and sixth-grade students (58.2% girls; M_age = 11.11 years, SD = 0.72), who self-reported popularity goals and nominated peers for popularity, aggressive behavior, and prosocial behavior. Participants' behavior in a cooperative task and a competitive task, completed in groups of 4, was observed. Results show that popularity goal was related to high levels of aggression according to peers (only for boys) and to low levels of prosocial behavior across reporters and settings. Actual popularity status was related to high levels of strategic aggression across reporters and settings and additional high levels of strategic prosocial behavior in a cooperative setting. Thus, the current study demonstrates that popularity goal is already related to social behavior in elementary school and that desired and actual popularity are not only predictive of the behavior as perceived by peers but also predictive of observed behaviors during group interactions.

Searching for a Solar Source of Magnetic-Field Switchbacks in Parker Solar Probe's First Encounter

Parker Solar Probe observations show ubiquitous magnetic-field reversals closer to the Sun, often referred to as "switchbacks". The switchbacks have been observed before in the solar wind near 1 AU and beyond, but their occurrence was historically rare. PSP measurements below ∼ 0.2 AU show that switchbacks are, however, the most prominent structures in the "young" solar wind. In this work, we analyze remote-sensing observations of a small equatorial coronal hole to which PSP was connected during the perihelion of Encounter 1. We investigate whether some of the switchbacks captured during the encounter were of coronal origin by correlating common switchback in situ signatures with remote observations of their expected coronal footpoint. We find strong evidence that timescales present in the corona are relevant to the outflowing, switchback-filled solar wind, as illustrated by strong linear correlation. We also determine that spatial analysis of the observed region is optimal, as the implied average solar-wind speed more closely matches that observed by PSP at the time. We observe that hemispherical structures are strongly correlated with the radial proton velocity and the mass flux in the solar wind. The above findings suggest that a subpopulation of the switchbacks are seeded at the corona and travel into interplanetary space.

Submerged aquatic vegetation: Overview of monitoring techniques used for the identification and determination of spatial distribution in European coastal waters

Coastal waters are highly productive and diverse ecosystems, often dominated by marine submerged aquatic vegetation (SAV) and strongly affected by a range of human pressures. Due to their important ecosystem functions, for decades, both researchers and managers have investigated changes in SAV abundance and growth dynamics to understand linkages to human perturbations. In European coastal waters, monitoring of marine SAV communities traditionally combines diver observations and/or video recordings to determine, for example, spatial coverage and species composition. While these techniques provide very useful data, they are rather time consuming, labor-intensive, and limited in their spatial coverage. In this study, we compare traditional and emerging remote sensing technologies used to monitor marine SAV, which include satellite and occupied aircraft operations, aerial drones, and acoustics. We introduce these techniques and identify their main strengths and limitations. Finally, we provide recommendations for researchers and managers to choose the appropriate techniques for future surveys and monitoring programs. Integr Environ Assess Manag 2022;18:892-908. © 2021 SETAC.

Insights into recent aerosol trends over Asia from observations and CMIP6 simulations

Aerosols continue to contribute the largest uncertainty in climate change. Over Asia, a global aerosol hotspot, spatial patterns of aerosol emissions are changing mainly because of changes in anthropogenic emissions, producing a dipole in atmospheric aerosol loading between East (decrease in emissions) and South Asia (increase in emissions). The resultant aerosol radiative effects are expected to be different as compared to the last decades of the 20^th century because of this emerging Asian aerosol dipole. The projection and assessments of radiative and climate impacts of aerosols rely on simulating accurately the aerosol properties, thus, making it imperative that current climate models involved in climate assessments including the Intergovernmental Panel on Climate Change Assessment Reports, simulate well the magnitude and trends in changing aerosol properties. For the first time, in this study we analyze trends in aerosol properties over Asia from satellite and ground-based observations, and simulations from climate models in Coupled Model Intercomparison Project Phase 6 (CMIP6) experiment with state-of-the-art treatment of aerosol chemistry, physics and meteorology. The results reveal large inter-model differences in model estimates, and discrepancies between model simulations and observations as most models are not able to capture the recent observed magnitudes and trends in aerosol optical depth (AOD) and single scattering albedo (SSA) over Asia. The absolute and the relative (percent) trends (positive and/or negative) in AOD are significantly higher than the trends in SSA. The aerosol-induced effective radiative forcing within the atmosphere simulated with three CMIP6 models show a positive (increasing) trend over Asia. A positive trend in atmospheric heating due to aerosols in model simulations is consistent with model simulated trends in AOD (positive) and SSA (negative). These results on model-observations comparison need to be taken into account while examining the projected/expected future climate impacts due to aerosols, and potential value of various mitigation measures, in particular on regional and decadal climate change in Asia which is largely uncertain. MAIN FINDING: Our analysis of satellite and ground-based observations, and simulations from climate models in CMIP6 experiment with state-of-the-art treatment of aerosol chemistry, physics and meteorology reveal large difference in model calculations, and most models are not able to capture the recent observed trends in aerosol optical depth and single scattering albedo over Asia during 2000-2018.

Unravelling spatio-temporal patterns of suspended microplastic concentration in the Natura 2000 Guadalquivir estuary (SW Spain): Observations and model simulations

Microplastics (MPs) patterns in a weakly-stratified estuary were investigated using a combined approach of observations and modeling. The study was conducted in the Guadalquivir River Estuary, which is of high environmental value, yet significantly altered by human activities. The study aims to contribute to understanding and quantifying the land-ocean transport of MPs. Mean concentrations of MPs in the estuary were 0.041itemsm^-3, with maximum values up to 0.20itemsm^-3, in agreement with the range reported in other estuaries. Polyethylene floating MPs were predominant. Relationships between increases in MP concentration and local rainfall events were identified in the middle estuary when there were no significant discharges from the head dam. Modeling results mimicked observations and revealed the effects of tidal straining, density-driven, and river flow-induced circulation on the net transport. Convergence of transports favors the MPs trapping in the vicinity of Doñana National Park, overlapping the location of the Estuarine Turbidity Maximum.

Evaluation of interprofessional teamwork modules implementation in an emergency department - A mixed-methods case study of implementation fidelity

BACKGROUND

The need for interprofessional collaboration has been emphasized by health organizations. This study was part of a mixed-methods evaluation of interprofessional teamwork modules implementation in an emergency department (ED), where a major intervention was didactic training of team roles and behaviours in combination with practice scenarios. The aim of the study was to evaluate the implementation of interprofessional teamwork modules from a staff perspective and focus on how implementation fidelity may be sustained.

METHODS

In this mixed-methods case study we triangulated staff data from structured observations, semi-structured interviews, and a questionnaire repeated at intervals over 5 years. A protocol of key team behaviours was used for the observations conducted in June 2016 and June 2018, 1½ and 3½ years after the initial implementation. A purposeful sample of central informants, including nursing and medical professionals and section managers, was interviewed from May to June 2018. The interview guide consisted of open-ended questions about the experiences of interprofessional teamwork modules and the implementation process. The questionnaire consisted of five statements about the perceived workload, interprofessional collaboration and patient satisfaction, where each was rated on a Likert scale.

RESULTS

Good fidelity to four out of five key team behaviours was observed during the first year. However, fidelity was sustained only for one key team behaviour after 3 years. We conducted a qualitative content analysis of 18 individual interviews. The theme Enjoying working together, but feeling less efficient emerged of the interprofessional teamwork modules, despite shorter ED stays for the patients. Negative experiences of the staff included passive team leaders and slow care teams. The theme Stimulating to create, but challenging to sustain emerged of the implementation process, where barriers were not adressed and implementation fidelity not sustained. The staff questionnaire showed that the perceived work conditions was improved in periods of high fidelity, but deteriorated to pre-implementation levels as fidelity to the key team behaviours decayed in 2018.

CONCLUSIONS

Extensive planning and successful initial implementation were not enough to sustain the key behaviour changes in the study. The use of implementation frameworks can be helpful in future projects.

Teachers as co-regulators of children's emotions: A descriptive study of teacher-child emotion dialogues in special education

BACKGROUND

The study examined how teachers and children with emotional and behavioral disturbances engage in dialogues about children's emotional experiences. Dialogues about emotions are an important strategy for teachers to co-regulate children's emotions but have remained understudied.

AIMS

This study aimed to explore whether the Autobiographical Emotional Events Dialogue (AEED) can help to assess the quality of teacher-child emotion dialogues about past emotional events and examined associations with child behavior and teacher-child relationship quality.

METHOD

The sample included 85 children and 70 teachers from special education schools serving children with emotional and behavioral disturbances. Teacher-child dialogues were videotaped and coded using the 16 rating scales of the AEED coding system (Koren-Karie, Oppenheim, Carasso, & Haimovich, 2003).

RESULTS

The scales (except child boundary dissolution) could be reliably assessed. A Principal Component Analysis yielded 4 factors: Adequate task completion (coherent dialogues and positive child task behavior), Negativity (hostility and teacher boundary dissolution), Teacher Guidance (involvement, structuring, and acceptance), and Resolution (positive closure of negative stories). Child age, verbal intelligence, prosocial behavior, and higher teacher-child relationship scores (higher closeness, lower conflict) were positively associated with the quality of the dialogues but behavior problems were not.

CONCLUSIONS AND IMPLICATIONS

The study provides first insight in teachers' scaffolding of dialogues with children about negative emotional events in special education serving children with emotional and behavioral disturbances.

What are the Marital Problems of Happy Couples? A Multimethod, Two-Sample Investigation

How couples handle marital conflict may depend on what issues they are facing, as some issues may be more difficult to resolve than others. What is unclear, however, is what issues happy couples face and how these issues may be different for couples depending on their developmental stage. To explore this possibility, the current study used both self-reports and observations drawn from two separate samples of happily married couples-one early in middle adulthood (N = 57 couples; average marital duration = 9 years) and one in older adulthood (N = 64 couples; average marital duration = 42 years). Results indicated that all issues were relatively minor, but early middle-aged couples reported more significant problems than did older couples. As to determining the most salient topic for happy couples, it depended on the spouses' gender, developmental stage, and how salience was assessed (i.e., highest rated issue vs. most discussed issue). Only moderate links were found between what happy couples said was their most serious concern and what they actually tried to resolve during observations of marital problem-solving, but there were differences in how spouses behaved based on the proportion of their time discussing certain topics. Findings suggest that more attention should be devoted to understanding what marital issues happy couples discuss and why, as doing so may reveal how couples maintain their marital happiness.

Understanding family caregivers' needs to support relatives with advanced progressive disease at home: an ethnographic study in rural Portugal

Background

Family caregivers play an important role supporting their relatives with advanced progressive disease to live at home. There is limited research to understand family caregiver needs over time, particularly outside of high-income settings. The aim of this study was to explore family caregivers’ experiences of caring for a relative living with advanced progressive disease at home, and their perceptions of met and unmet care needs over time.

Methods

An ethnographic study comprising observations and interviews. A purposive sample of 10 family caregivers and 10 relatives was recruited within a rural area in the north of Portugal. Data were collected between 2014 and 16 using serial participant observations (n = 33) and in-depth interviews (n = 11). Thematic content analysis was used to analyse the data.

Results

Five overarching themes were yielded: (1) provision of care towards independence and prevention of complications; (2) perceived and (3) unknown caregiver needs; (4) caregivers’ physical and emotional impairments; and (5) balancing limited time. An imbalance towards any one of these aspects may lead to reduced capability and performance of the family caregiver, with increased risk of complications for their relative. However, with balance, family caregivers embraced their role over time.

Conclusions

These findings enhance understanding around the needs of family caregivers, which are optimally met when professionals and family caregivers work together with a collaborative approach over time. Patients and their families should be seen as equal partners. Family-focused care would enhance nursing practice in this context and this research can inform nursing training and educational programs.

Supervisors' intention to observe clinical task performance: an exploratory study using the theory of planned behaviour during postgraduate medical training

BACKGROUND

Direct observation of clinical task performance plays a pivotal role in competency-based medical education. Although formal guidelines require supervisors to engage in direct observations, research demonstrates that trainees are infrequently observed. Supervisors may not only experience practical and socio-cultural barriers to direct observations in healthcare settings, they may also question usefulness or have low perceived self-efficacy in performing direct observations. A better understanding of how these multiple factors interact to influence supervisors' intention to perform direct observations may help us to more effectively implement the aforementioned guidelines and increase the frequency of direct observations.

METHODS

We conducted an exploratory quantitative study, using the Theory of Planned Behaviour (TPB) as our theoretical framework. In applying the TPB, we transfer a psychological theory to medical education to get insight in the influence of cognitive and emotional processes on intentions to use direct observations in workplace based learning and assessment. We developed an instrument to investigate supervisors intention to perform direct observations. The relationships between the TPB measures of our questionnaire were explored by computing bivariate correlations using Pearson's R tests. Hierarchical regression analysis was performed in order to assess the impact of the respective TPB measures as predictors on the intention to perform direct observations.

RESULTS

In our study 82 GP supervisors completed our TPB questionnaire. We found that supervisors had a positive attitude towards direct observations. Our TPB model explained 45% of the variance in supervisors' intentions to perform them. Normative beliefs and past behaviour were significant determinants of this intention.

CONCLUSION

Our study suggests that supervisors use their past experiences to form intentions to perform direct observations in a careful, thoughtful manner and, in doing so, also take the preferences of the learner and other stakeholders potentially engaged in direct observations into consideration. These findings have potential implications for research into work-based assessments and the development of training interventions to foster a shared mental model on the use of direct observations.

Front-line education by infection preventionists helps reduce Clostridioides difficile infections

When implementing the latest innovations to reduce health care-associated infections, it is important not to overlook basic infection prevention principles such as hand hygiene, isolation precautions, use of personal protective equipment, and cleaning and low-level disinfection. Like many facilities, we implemented a multifaceted approach to reduce hospital-onset Clostridioides difficile infections. In this paper, we share simple tools that we found helpful in improving infection prevention practices by addressing knowledge gaps among staff, visitors, and patients.

Lean maturity and quality in primary care

PURPOSE

The purpose of this paper is twofold: first, to describe Lean maturity in primary care using a questionnaire based on Liker's description of Lean, complemented with observations; and second, to determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines (NG). High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff.

DESIGN/METHODOLOGY/APPROACH

Data were collected using a survey based on Liker's four principles, divided into 16 items ( n=298 staff in 45 units). Complementary observations ( n=28 staff) were carried out at four units.

FINDINGS

Lean maturity varied both between and within units. The highest Lean maturity was found for "adhering to routines" and the lowest for "having a change agent at the unit." Lean maturity was positively associated with satisfaction with care and with adherence to NG to improve healthcare quality.

PRACTICAL IMPLICATIONS

Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker's principles and using the results as guidance for further development.

ORIGINALITY/VALUE

This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker's principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

An intervention to support stroke survivors and their carers in the longer term (LoTS2Care): study protocol for the process evaluation of a cluster randomised controlled feasibility trial

Background

Whilst pathways relating to the early stages of stroke care have become well established, strategies for longer-term care are less developed and longer-term outcomes remain poor for many stroke survivors. New Start, a complex intervention that includes needs identification, exploration of social networks and components of problem-solving and self-management, was designed to improve stroke survivors’ quality of life by addressing unmet needs and increasing participation. It is delivered approximately 6 months post-stroke by trained staff (facilitators). We are currently undertaking a cluster randomised feasibility trial of the New Start intervention with an embedded process evaluation, which is an important component of the design and testing of complex interventions as it provides an understanding of how interventions are delivered and function in different settings.

Methods/design

This mixed methods process evaluation will explore the degree to which New Start is implemented as intended, the impact of context on intervention delivery and the acceptability of the intervention for stroke survivors, their families and practitioners. It will include non-participant observation of facilitator training and intervention delivery. Interviews with stroke survivors, facilitators and other relevant staff (including administrators and managerial staff) will be undertaken. Qualitative data from interview transcripts, facilitator reflections and observational field notes will be analysed thematically alongside numerical data documenting intervention delivery collected as part of the trial.

Discussion

This process evaluation will identify factors that aid and impede implementation of the New Start intervention and improve understanding of this novel approach to longer-term stroke care.

Trial registration

ISRCTN Registry, ISRCTN38920246. Registered on 22 June 2016.

Googling your hand hygiene data: Using Google Forms, Google Sheets, and R to collect and automate analysis of hand hygiene compliance monitoring

BACKGROUND

Hand hygiene is one of the most important interventions in the quest to eliminate healthcare-associated infections, and rates in healthcare facilities are markedly low. Since hand hygiene observation and feedback are critical to improve adherence, we created an easy-to-use, platform-independent hand hygiene data collection process and an automated, on-demand reporting engine.

METHODS

A 3-step approach was used for this project: 1) creation of a data collection form using Google Forms, 2) transfer of data from the form to a spreadsheet using Google Spreadsheets, and 3) creation of an automated, cloud-based analytics platform for report generation using R and RStudio Shiny software.

RESULTS

A video tutorial of all steps in the creation and use of this free tool can be found on our YouTube channel: https://www.youtube.com/watch?v=uFatMR1rXqU&t. The on-demand reporting tool can be accessed at: https://crsp.louisville.edu/shiny/handhygiene.

CONCLUSIONS

This data collection and automated analytics engine provides an easy-to-use environment for evaluating hand hygiene data; it also provides rapid feedback to healthcare workers. By reducing some of the data management workload required of the infection preventionist, more focused interventions may be instituted to increase global hand hygiene rates and reduce infection.

A collection of the etiological theories, characteristics, and observations/phenomena of peptic ulcers in existing data

In this article, we compiled 13 etiological theories, 15 characteristics, and 81 observations/phenomena of peptic ulcers, reported in reproducible, peer-reviewed studies from the literature, to reflect the historical evolution of studies on peptic ulcers and to provide a multidisciplinary view of this disease. This data was collected during the systematic review of topics on peptic ulcers including genetics, etiology, epidemiology, psychology, anatomy, neurology, bacteriology, pathology, and clinical statistics. The data curated herein was extracted via application of recently published basic theories and methodologies.

Measuring feeding difficulties in toddlers with Down syndrome

Early feeding problems occur frequently across the population, but have a higher incidence in children with Down syndrome (DS). Early identification can possibly be improved with the help of a valid screening instrument based on caregiver reports. In a previous study, we investigated the concurrent validity of the Dutch version of the Montreal Children's Hospital Feeding Scale (MCH-FS, SEP in Dutch) in a sample of typically developing toddlers, and we found a correlation between the score on the instrument and observed behavior during a regular meal. The current pilot study was a replication in a sample of children with DS (aged 1; 0-3; 0) and their primary caregivers (n = 32). The results showed that children in the sample did not score higher on the SEP than children in their respective norm groups. In addition, when caregivers reported more symptoms of feeding problems on the SEP, children showed more food refusal and negative affect during the observed meal. This suggests that the screening instrument is particularly associated with negative mealtime interactions. This is in contrast with earlier results, which mainly indicated a relation with eating skills.

Global-Mode Analysis of Full-Disk Data from the Michelson Doppler Imager and the Helioseismic and Magnetic Imager

Building upon our previous work, in which we analyzed smoothed and subsampled velocity data from the Michelson Doppler Imager (MDI), we extend our analysis to unsmoothed, full-resolution MDI data. We also present results from the Helioseismic and Magnetic Imager (HMI), in both full resolution and processed to be a proxy for the low-resolution MDI data. We find that the systematic errors that we saw previously, namely peaks in both the high-latitude rotation rate and the normalized residuals of odd a -coefficients, are almost entirely absent in the two full-resolution analyses. Furthermore, we find that both systematic errors seem to depend almost entirely on how the input images are apodized, rather than on resolution or smoothing. Using the full-resolution HMI data, we confirm our previous findings regarding the effect of using asymmetric profiles on mode parameters, and also find that they occasionally result in more stable fits. We also confirm our previous findings regarding discrepancies between 360-day and 72-day analyses. We further investigate a six-month period previously seen in f -mode frequency shifts using the low-resolution datasets, this time accounting for solar-cycle dependence using magnetic-field data. Both HMI and MDI saw prominent six-month signals in the frequency shifts, but we were surprised to discover that the strongest signal at that frequency occurred in the mode coverage for the low-resolution proxy. Finally, a comparison of mode parameters from HMI and MDI shows that the frequencies and a -coefficients agree closely, encouraging the concatenation of the two datasets.

ELECTRONIC SUPPLEMENTARY MATERIAL

The online version of this article (10.1007/s11207-017-1201-5) contains supplementary material, which is available to authorized users.

Response of the Intertropical Convergence Zone to Climate Change: Location, Width, and Strength

PURPOSE OF REVIEW

The intertropical convergence zone (ITCZ) is a planetary-scale band of heavy precipitation close to the equator. Here, we consider the response of the ITCZ structure to climate change using observations, simulations, and theory. We focus on the substantial yet underappreciated projected changes in ITCZ width and strength, and highlight an emerging conceptual framework for understanding these changes.

RECENT FINDINGS

Satellite observations and reanalysis data show a narrowing and strengthening of precipitation in the ITCZ over recent decades in both the Atlantic and Pacific basins, but little change in ITCZ location. Consistent with observations, coupled climate models predict no robust change in the zonal-mean ITCZ location over the twenty-first century. However, the majority of models project a narrowing of the ITCZ and weakening mean ascent. Interestingly, changes in ITCZ width and strength are strongly anti-correlated across models.

SUMMARY

The ITCZ has narrowed over recent decades yet its location has remained approximately constant. Climate models project further narrowing and a weakening of the average ascent within the ITCZ as the climate continues to warm. Following intense work over the last ten years, the physical mechanisms controlling the ITCZ location are now well understood. The development of complementary theories for ITCZ width and strength is a current research priority. Outstanding challenges include understanding the ITCZ response to past climate changes and over land versus ocean regions, and better constraining all aspects of the ITCZ structure in model projections.

ELECTRONIC SUPPLEMENTARY MATERIAL

The online version of this article (10.1007/s40641-018-0110-5) contains supplementary material, which is available to authorized users.

An Observational View of Relationships Between Moisture Aggregation, Cloud, and Radiative Heating Profiles

Data from several coincident satellite sensors are analyzed to determine the dependence of cloud and precipitation characteristics of tropical regions on the variance in the water vapor field. Increased vapor variance is associated with decreased high cloud fraction and an enhancement of low-level radiative cooling in dry regions of the domain. The result is found across a range of sea surface temperatures and rain rates. This suggests the possibility of an enhanced low-level circulation feeding the moist convecting areas when vapor variance is large. These findings are consistent with idealized models of self-aggregation, in which the aggregation of convection is maintained by a combination of low-level radiative cooling in dry regions and mid-to-upper-level radiative warming in cloudy regions.

Mechanisms and Model Diversity of Trade-Wind Shallow Cumulus Cloud Feedbacks: A Review

Shallow cumulus clouds in the trade-wind regions are at the heart of the long standing uncertainty in climate sensitivity estimates. In current climate models, cloud feedbacks are strongly influenced by cloud-base cloud amount in the trades. Therefore, understanding the key factors controlling cloudiness near cloud-base in shallow convective regimes has emerged as an important topic of investigation. We review physical understanding of these key controlling factors and discuss the value of the different approaches that have been developed so far, based on global and high-resolution model experimentations and process-oriented analyses across a range of models and for observations. The trade-wind cloud feedbacks appear to depend on two important aspects: (1) how cloudiness near cloud-base is controlled by the local interplay between turbulent, convective and radiative processes; (2) how these processes interact with their surrounding environment and are influenced by mesoscale organization. Our synthesis of studies that have explored these aspects suggests that the large diversity of model responses is related to fundamental differences in how the processes controlling trade cumulus operate in models, notably, whether they are parameterized or resolved. In models with parameterized convection, cloudiness near cloud-base is very sensitive to the vigor of convective mixing in response to changes in environmental conditions. This is in contrast with results from high-resolution models, which suggest that cloudiness near cloud-base is nearly invariant with warming and independent of large-scale environmental changes. Uncertainties are difficult to narrow using current observations, as the trade cumulus variability and its relation to large-scale environmental factors strongly depend on the time and/or spatial scales at which the mechanisms are evaluated. New opportunities for testing physical understanding of the factors controlling shallow cumulus cloud responses using observations and high-resolution modeling on large domains are discussed.

"I passed the test!" Evidence of diagnostic misconception in the recruitment of population controls for an H3Africa genomic study in Cape Town, South Africa

Background

Advances in genetic and genomic research have introduced challenges in obtaining informed consent for research in low and middle-income settings. However, there are only few studies that have explored challenges in obtaining informed consent in genetic and genomic research in Africa and none in South Africa. To start filling this gap, we conducted an empirical study to investigate the efficacy of informed consent procedures for an H3Africa genomic study on Rheumatic Heart Disease (RHDGen) at the University of Cape Town in South Africa. The main aim of the study was to understand ethical challenges in obtaining informed consent in the RHDGen study.

Methods

We used a qualitative study methodology involving in-depth interviews and participant observations. Our study participants were RHDGen cases (patients), healthy controls and research staff involved in the recruitment of RHDGen cases and controls. In total, we conducted 32 in-depth interviews with RHDGen cases and controls, 2 in-depth interviews with research staff and 57 direct observations of the consent procedures of RHDGen cases and controls. The interviews were conducted in English, audio-recorded and transcribed verbatim. Data were analyzed using thematic content analysis. The study was conducted in 3 sites within Cape Town, South Africa.

Results

Most healthy controls joined the RHDGen study in order to be screened for rheumatic heart disease (diagnostic misconception). A majority of RHDGen cases decided to join the RHDGen study because of therapeutic misconception.

Conclusion

The ethical challenges that impacted on obtaining informed consent in the RHDGen study were complex. In this study, the main challenges were diagnostic misconception among RHDGen controls and therapeutic misconception among RHDGen cases.

Towards quantifying the glacial runoff signal in the freshwater input to Tyrolerfjord-Young Sound, NE Greenland

Terrestrial freshwater runoff strongly influences physical and biogeochemical processes at the fjord scale and can have global impacts when considered at the Greenland scale. We investigate the performance of the HIRHAM5 regional climate model over the catchments delivering freshwater to Tyrolerfjord and Young Sound by comparing to the unique Greenland Ecological Monitoring database of in situ observations from this region. Based on these findings, we estimate and discuss the fraction of runoff originating from glacierized and non-glacierized land delivered at the daily scale between 1996 and 2008. We find that glaciers contributed on average 50-80% of annual terrestrial runoff when considering different sections of Tyrolerfjord-Young Sound, but snowpack depletion on land and consequently runoff happens about one month earlier in the model than observed in the field. The temporal shift in the model is a likely explanation why summer surface salinity in the inner fjord did not correlate to modelled runoff.

Association of environmental indicators with teen alcohol use and problem behavior: Teens' observations vs. objectively-measured indicators

Most prior studies use objectively measured data (e.g., census-based indicators) to assess contextual risks. However, teens' observations might be more important for their risk behavior.

OBJECTIVES

1) determine relationships between observed and objective indicators of contextual risks 2) determine relations of observed and objective indicators with teen alcohol use and problem behavior. Teens aged 14-16 (N=170) carried GPS-enabled smartphones for one month, with locations documented. Ecological momentary assessment (EMA) measured teens' observations via texts regarding risk behaviors and environmental observations. Objective indicators of alcohol outlets and disorganization were spatially joined to EMAs based on teens' location at the time of the texts. Observed and objective disorganization, and objective indicators of alcohol outlets were related to alcohol use. Observed disorganization was related to problem behavior, while objective indicators were unrelated. Findings suggest the importance of considering teens' observations of contextual risk for understanding influences on risk behavior and suggest future directions for research and prevention strategies.

Multiple and mixed methods in formative evaluation: Is more better? Reflections from a South African study

Background

Formative programme evaluations assess intervention implementation processes, and are seen widely as a way of unlocking the ‘black box’ of any programme in order to explore and understand why a programme functions as it does. However, few critical assessments of the methods used in such evaluations are available, and there are especially few that reflect on how well the evaluation achieved its objectives. This paper describes a formative evaluation of a community-based lay health worker programme for TB and HIV/AIDS clients across three low-income communities in South Africa. It assesses each of the methods used in relation to the evaluation objectives, and offers suggestions on ways of optimising the use of multiple, mixed-methods within formative evaluations of complex health system interventions.

Methods

The evaluation’s qualitative methods comprised interviews, focus groups, observations and diary keeping. Quantitative methods included a time-and-motion study of the lay health workers’ scope of practice and a client survey. The authors conceptualised and conducted the evaluation, and through iterative discussions, assessed the methods used and their results.

Results

Overall, the evaluation highlighted programme issues and insights beyond the reach of traditional single methods evaluations. The strengths of the multiple, mixed-methods in this evaluation included a detailed description and nuanced understanding of the programme and its implementation, and triangulation of the perspectives and experiences of clients, lay health workers, and programme managers. However, the use of multiple methods needs to be carefully planned and implemented as this approach can overstretch the logistic and analytic resources of an evaluation.

Conclusions

For complex interventions, formative evaluation designs including multiple qualitative and quantitative methods hold distinct advantages over single method evaluations. However, their value is not in the number of methods used, but in how each method matches the evaluation questions and the scientific integrity with which the methods are selected and implemented.

Mutually Responsive Orientation: A novel observational assessment of mother-child mealtime interactions

Mother-child mealtime interactions during preschool years is an important but overlooked factor when evaluating the influence of parent-child relationships on child eating and weight. This paper describes the validation of the Mutually Responsive Orientation (MRO) coding system adapted for assessing parent-child interactions during food preparation and consumption situations. Home-based mealtimes of 94 mothers and their children (3.03 ± 0.75 years) were filmed at two time points, 12-months apart. Filmed dimensions of mutual mother-child responsiveness, shared positive affect, maternal control relating to food and child compliance were assessed. Objective BMI and maternal reports of parenting, feeding, child eating, diet and child temperament were also collected. Correlations, repeated measures ANOVAs and regressions were performed to examine the validity of MRO variables and their stability across both time points. Validation analysis showed the MRO coding system performed as expected: dyads with higher MRO scores expressed lower control/power assertion, lower child non-compliance, and greater committed compliance. The measure demonstrated sensitivity to specific contexts: maternal responsiveness, mother and child positive affect were higher during food consumption compared to food preparation. Coded dimensions were stable across time points, with the exception of decreases in maternal responsiveness in food consumption and child non-compliance in food preparation. MRO and maternal dimensions were correlated with maternally reported parenting and feeding measures. Maternal responsiveness (inversely) and child responsiveness (positively) were concurrently associated with child fussy eating, and child refusal was prospectively and inversely associated with child fussy eating. Findings suggest the adapted MRO coding system is a useful measure for examining observed parent-child mealtime interactions potentially implicated in preschoolers' eating and weight development.

Observable characteristics associated with alcohol intoxication within licensed entertainment venues in Australia

BACKGROUND

The aim of the current study was to assess correlates of intoxication in licensed venues in Australia.

METHODS

Covert observations of licensed venues and venue patron in night-time entertainment districts of five Australian cities were conducted. In total, 828 unique cross-sectional observations were completed across 62 bars, nightclubs, and large mainstream pubs. Venues were selected from the main entertainment district of smaller cities and the busiest entertainment districts of larger cities. Outcomes were the estimated percentage of patrons showing any signs of alcohol intoxication and the overall level of intoxication ('high' versus 'none to medium'). Seven predictors of patron intoxication were examined: hour of observation; estimated percentage of male patrons; estimated percentage of patrons <25 years old; venue crowding; presence of observable alcohol promotions; type of alcoholic beverage consumed by the majority of patrons; and, venue type.

RESULTS

Time of night (coefficient=11.71, p<.001; OR=9.61, p<.001), percentage of patrons aged <25 (coefficient=0.14, p<.001; OR=1.01, p=.031), and venue crowding (coefficient=4.40, p<.001; OR=1.39, p=.009) had significant positive associations with both signs of intoxication and high levels of intoxication. Nightclubs had a lower percentage of signs of intoxication compared to pubs (coefficient=-10.73, p=.021). Increased percentage of male patrons was associated with increased odds of high-level intoxication (OR=1.05, p=.020).

CONCLUSION

Time of night and proportion of younger patrons had a strong association with patron intoxication adding further support for the strong body of evidence that ceasing service of alcohol earlier in the evening will reduce intoxication levels.

Review on recent progress in observations, source identifications and countermeasures of PM2.5

Recently, PM2.5 (atmospheric fine particulate matter with aerodynamic diameter ≤ 2.5 μm) have received so much attention that the observations, source appointment and countermeasures of it have been widely studied due to its harmful impacts on visibility, mood (mental health), physical health, traffic safety, construction, economy and nature, as well as its complex interaction with climate. A review on the PM2.5 related research is necessary. We start with summary of chemical composition and characteristics of PM2.5 that contains both macro and micro observation results and analysis, wherein the temporal variability of concentrations of PM2.5 and major components in many recent reports is embraced. This is closely followed by an overview of source appointment, including the composition and sources of PM2.5 in different countries in the six inhabitable continents based on the best available results. Besides summarizing PM2.5 pollution countermeasures by policy, planning, technology and ideology, the World Air Day is proposed to be established to inspire and promote the crucial social action in energy-saving and emission-reduction. Some updated knowledge of the important topics (such as formation and evolution mechanisms of hazes, secondary aerosols, aerosol mass spectrometer, organic tracers, radiocarbon, emissions, solutions for air pollution problems, etc.) is also included in the present review by logically synthesizing the studies. In addition, the key research challenges and future directions are put forward. Despite our efforts, our understanding of the recent reported observations, source identifications and countermeasures of PM2.5 is limited, and subsequent efforts both of the authors and readers are needed.

The School Assessment for Environmental Typology (SAfETy): An Observational Measure of the School Environment

School safety is of great concern for prevention researchers, school officials, parents, and students, yet there are a dearth of assessments that have operationalized school safety from an organizational framework using objective tools and measures. Such a tool would be important for deriving unbiased assessments of the school environment, which in turn could be used as an evaluative tool for school violence prevention efforts. The current paper presents a framework for conceptualizing school safety consistent with Crime Prevention through Environmental Design (CPTED) model and social disorganization theory, both of which highlight the importance of context as a driver for adolescents' risk for involvement in substance use and violence. This paper describes the development of a novel observational measure, called the School Assessment for Environmental Typology (SAfETy), which applies CPTED and social disorganizational frameworks to schools to measure eight indicators of school physical and social environment (i.e., disorder, trash, graffiti/vandalism, appearance, illumination, surveillance, ownership, and positive behavioral expectations). Drawing upon data from 58 high schools, we provide preliminary data regarding the validity and reliability of the SAfETy and describe patterns of the school safety indicators. Findings demonstrate the reliability and validity of the SAfETy and are discussed with regard to the prevention of violence in schools.

Does Mother-Child Interaction Mediate the Relation Between Maternal Depressive Symptoms and Children's Mental Health Problems?

The relation between maternal depressive symptoms and children's mental health problems has been well established. However, prior studies have predominantly focused on maternal reports of children's mental health problems and on parenting behavior, as a broad and unilateral concept. This cross-sectional study examined specific observed mother-child interaction behaviors through which maternal depressive symptoms are assumed to affect children's mental health problems. We expected higher rates of maternal depressive symptoms to predict higher rates of children's mental health problems, and we expected this relation to be mediated by low maternal warmth and high maternal psychological control. The sample consisted of 111 mother-child dyads referred for treatment. The mother-child interaction behaviors were coded according to the observed mother-child interaction tasks. Children's mental health problems were assessed using both maternal reports and children's self-reports. As expected, the results showed that maternal depressive symptoms were strongly related to maternal reports of children's internalizing and externalizing mental health problems. Surprisingly, maternal depressive symptoms were unrelated to children's self-reported depressive symptoms. Furthermore, mother-child interactions did not mediate the relation between maternal depressive symptoms and child mental health problems. Maternal depressive symptoms were associated with high maternal warmth, and high psychological control was associated with high levels of mother-reported externalizing mental health problems in children. These results partially replicate previous findings but add to these by using observational methods and multi-informant data. The importance of using a multi-informant and multi-method approach in assessing children's mental health problems in clinical practice and research are discussed.

Parental modelling of eating behaviours: observational validation of the Parental Modelling of Eating Behaviours scale (PARM)

Parents are important role models for their children's eating behaviours. This study aimed to further validate the recently developed Parental Modelling of Eating Behaviours Scale (PARM) by examining the relationships between maternal self-reports on the PARM with the modelling practices exhibited by these mothers during three family mealtime observations. Relationships between observed maternal modelling and maternal reports of children's eating behaviours were also explored. Seventeen mothers with children aged between 2 and 6 years were video recorded at home on three separate occasions whilst eating a meal with their child. Mothers also completed the PARM, the Children's Eating Behaviour Questionnaire and provided demographic information about themselves and their child. Findings provided validation for all three PARM subscales, which were positively associated with their observed counterparts on the observational coding scheme (PARM-O). The results also indicate that habituation to observations did not change the feeding behaviours displayed by mothers. In addition, observed maternal modelling was significantly related to children's food responsiveness (i.e., their interest in and desire for foods), enjoyment of food, and food fussiness. This study makes three important contributions to the literature. It provides construct validation for the PARM measure and provides further observational support for maternal modelling being related to lower levels of food fussiness and higher levels of food enjoyment in their children. These findings also suggest that maternal feeding behaviours remain consistent across repeated observations of family mealtimes, providing validation for previous research which has used single observations.

The relationship between parenting, family interaction and childhood dental caries: a case-control study

The aim of this case-control study was to explore the relationship between parenting practices, parent-child interaction and childhood dental caries, using a sample of 5-8-year old children from the Netherlands. Cases were defined as children with four or more decayed, missing or filled teeth and controls were caries free. Cases (n = 28) and controls (n = 26) were recruited from a referral centre for paediatric dental care and a general dental practice, respectively. Parenting practices and parent-child interactions of the child's primary caregiver were observed using Structured Interaction Tasks and subsequently rated on seven dimensions: positive involvement, encouragement, problem-solving, discipline, monitoring, coercion and interpersonal atmosphere. All Structured Interaction Tasks were videotaped, and coded by trained and calibrated observers blind to the dental condition. Differences in parenting dimensions between cases and controls were analysed using multivariate analysis of variance, independent samples T-tests, χ(2)-tests and multiple logistic regression analyses. Controls had significantly higher scores on the dimensions positive involvement, encouragement, problem-solving and interpersonal atmosphere, compared to cases. Parents of controls were also less likely to show coercive behaviours. These associations remained statistically significant after adjustment for the mother's education level, tooth brushing frequency and the frequency of consuming sugary foods and drinks, except for coercion. There was no significant difference in discipline between cases and controls. In conclusion, this case-control study found a significant relationship between parenting practices, parent-child interaction quality and childhood dental caries. Our findings suggest that parenting practices may be an important factor to consider in caries preventive programs.

Issues of rigor and feasibility when observing the quality of program implementation: a case study

Program evaluators have paid little attention in the literature to the manner in which measuring the quality of implementation with observations requires tradeoffs between rigor (reliability and validity) and program evaluation feasibility. We present a case example of how we addressed rigor in light of feasibility concerns when developing and conducting observations for measuring the quality of implementation of a small education professional development program. We discuss the results of meta-evaluative analyses of the reliability of the quality observations, and we present conclusions about conducting observations in a rigorous and feasible manner. The results show that the feasibility constraints that we faced did not notably reduce the rigor of our methods.

Use of top tethers with forward-facing child restraints: observations and driver interviews

OBJECTIVE

Despite the safety benefits, many parents do not use top tethers with forward-facing child restraints. Detailed information was collected about why parents are not using tethers.

METHODS

The sample included 479 drivers who had forward-facing child restraints installed in passenger vehicles equipped with tether anchors. The survey was conducted primarily at shopping centers, recreation facilities, child care facilities, car seat check events, and health care facilities in mostly suburban areas surrounding Philadelphia, Washington, DC, Fredericksburg (VA), and Seattle. Drivers were surveyed about their knowledge and use of tethers and experience with child restraints. Tether use was observed to verify whether tethers were being used correctly.

RESULTS

Fifty-six percent of forward-facing child restraints were installed with the tether; 39% were installed with the tether used correctly. The tether was used with 71% of LATCH lower anchor installations and 33% of seat belt installations. Drivers who installed child restraints without tethers most often said they did not know about the tether or how to use it.

CONCLUSIONS

Although the tether use rate was slightly higher in the current research than in previous studies, many parents and caregivers still use forward-facing child restraints without attaching the tether. Because the main problem is lack of awareness of the tether or how to use it, public education should focus specifically on the safety benefits of tethers and how to use them.

PRACTICAL APPLICATIONS

Information about why caregivers fail to use top tethers is potentially useful to child restraint manufacturers, child passenger safety technicians, and others who work with parents to improve motor vehicle safety.

Understanding on-road practices of electric bike riders: an observational study in a developed city of China

Although millions of electric bikes (E-bikes) operate in China and many associated deaths and injuries have been reported, E-bikers' on-road practices are poorly characterized and few direct observational studies have been performed. This study aims to describe riding behaviors among E-bikers and to investigate factors influencing these practices to inform injury prevention. In March 2012, a cross-sectional observational study was conducted at 14 randomly selected intersections in Suzhou during a 7-day period. A pro-forma observation checklist was used to collect data on road riding practice. Adjusted Odds Ratios (OR) and 95% Confidence Intervals (CI) to assess the likelihood of specific riding practices among E-bikers were evaluated using mixed-effects logistic regression. Among 18,150 E-bikers observed, 37.6% rode E-bikes with cycling pedals, 86.0% of E-bikes were registered, 26.6% did not comply with the road rules, and 41.1% wore at least one safety item. The overall prevalence of carrying passengers, riding in a motor vehicle lane, running red lights, riding in opposite directions (i.e., facing oncoming traffic), mobile phone use, and helmet use were 12.4% (95%CI: 11.9-12.9%), 1.9% (95%CI: 1.7-2.1%), 4.8% (95%CI: 4.5-5.1%), 3.4% (95%CI: 3.1-3.7%), 0.4% (95%CI: 0.3-0.5%), and 9.0% (95%CI: 8.5-9.4%), respectively. Male E-bikers was associated with increased helmet use and riding in motor vehicle lanes, whereas riding a registered E-bike was associated with reduced likelihood of carrying passengers. This study demonstrates common road rule violations and low helmet use among E-bikers and supports the urgent need to develop additional regulations and behavioral interventions to improve safety practice among E-bikers in China.

Interventional based study to reduce child mortality in rural Uganda

BACKGROUND

Reducing child mortality is a WHO Millennium Development Goal. Child mortality rate in Uganda in 2009 was 128. In a rural hospital observations on the paediatric ward were being performed infrequently.

METHODS

Introduction of regular observation. Hourly, two hourly or 4 hourly observation on sick children. Training of nurses I interpretation of observations. The number of admissions, discharges and deaths was calculated during two six month periods and mortality rates calculated.

RESULTS

Mortality decreased from 6.9% (34 deaths from 496 admissions) to 4% (27 deaths from 706 admissions). This is statistically significant (p-value 0.023). The demographics, cause of death and length of stay remained similar in both groups.

CONCLUSIONS

The simple intervention of regular nursing observation in children with associated training of nurses has resulted in a statistically significant reduction in child mortality rates in a rural hospital in Uganda.