OU-Tulsa Research Forum 2020

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https://hdl.handle.net/11244/324958

The OU-Tulsa Research Forum 2020 was held virtually Monday, April 6 to Friday, April 10. The OU-Tulsa Research Forum is an annual event to showcase research conducted by current OU-Tulsa fellows, residents, students, or staff and University of Tulsa students. The event was presented by the OU-Tulsa Assistant Vice President for Research, the Office for Research Development and Scholarly Activity, the OU-Tulsa Schusterman Library, and the Tulsa County Medical Society

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Open Access
App-Based Longitudinal Infectious Disease Curriculum for Pediatrics Residency
(2020-04) Nguyen, Andrew; Guzman, Janitzio; Mather, Keith; Escala, Michelle
BACKGROUND: Infectious disease comprises 7% of the American Board of Pediatrics general pediatrics board exam and covers hundreds of different organisms that cause disease. Covering each of these topics all together in one presentation at our weekly academic afternoon quickly becomes overwhelming. Additionally, we understand residents have dozens of other responsibilities. Our aim was to develop a longitudinal weekly curriculum that could be replicated at other programs that would deliver the required material to all residents, allow residents to cover material quickly at their own pace, and improve Infectious Disease sub-scores on the in training exam. METHODS: Starting in summer 2019, the Pediatrics and Medicine-Pediatrics chiefs at University of Oklahoma-Tulsa School of Community Medicine have developed a longitudinal infectious disease curriculum that uses technology to aid in education. Every week, a short board-style quiz is released to the residents via Google Classroom, which gets pushed directly to the phones of our residents. Each week a different organism or group of organisms is covered, focusing on the most common organisms on the test. Google classroom allows us to attach study guides, the appropriate Red Book chapters, and YouTube videos that explain each topic, allowing for residents to review topics and answer questions at their own pace. RESULTS: We have recommended, but have not required our 24 residents to complete each assignment. Since beginning the project, 58% of our residents have completed at least 75% of the assignments with an average score of 70%. Initial participation was robust, but as the busy winter season approached, participation rates decreased. Reminder notifications, and an incentive was introduced in the winter which temporarily improved participation from 54% to 75-83%. Our academic benchmark is to measure average infectious disease In-Training Exam sub-scores per class in comparison to our baseline test in June 2018 and 2019. CONCLUSION: Educating residents on infectious disease as a year-long longitudinal curriculum has the potential to be an effective way to present material relevant to the ABP General Pediatrics exam. Providing this content as an mobile-app based curriculum allows for self-pacing and interactive content. Our first cycles have shown residents will voluntarily participate in this curriculum and the seasonal limitations of voluntary participation, with possible steps programs could take to improve participation. The extent to which this curriculum improves ITE sub-scores will be determined at the next exam this summer. We hope this information can be used by other programs wishing to implement similar curricula.
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Are There Gender Disparities in Child Maltreatment Related Criminal Court Outcomes?
(2020-04) Hendrix, Amy; Conway, Lauren; Baxter, Michael
BACKGROUND: Oklahoma’s failure to protect law, which holds non-offending caregivers who fail to report maltreatment to the same standard as perpetrators, has received increased scrutiny at the national level. This is in part due to cases such as Tondalao Hall, a mother from Oklahoma City who was sentenced to 30 years in prison for failing to report child maltreatment while the perpetrator, who was also allegedly abusing Hall, was sentenced to two years in jail with credit for time served and probation. Due to the increased focus for criminal justice reform in Oklahoma the investigators sought to evaluate gender disparities in the criminal court outcomes of child maltreatment cases investigated by a multidisciplinary team. METHODS: A cross-sectional study was conducted of defendants of 151 medically diagnosed child maltreatment cases from 2013–2014. Data included both clinical data from the University of Oklahoma Electronic Medical Record as well as publicly accessible data from the Tulsa District Attorney’s Office and Oklahoma State Courts Network. Only defendants with criminal cases prosecuted within Tulsa County were considered for analysis. Expunged cases were also excluded from analysis. To test for associations between gender and court outcomes, chi-square tests of independence were used in SPSS, version 25. RESULTS: There were a total of 138 defendants, with a slightly male majority (n=76, 55.1%). There was a significant association between gender and neglect charges (χ2(1)=3.96, p<0.046), with 46.8% of females charged with neglect vs. 30.3% of males. There was also a significant association between gender and verdict type (χ2(1)=14.35, p<0.001), with a greater percentage of females (43.5%) receiving deferred verdicts than males (15.8%). Conversely, a greater percentage of males (71.1%) received guilty verdicts than females (41.9%). Gender was also associated with incarceration being included in sentencing (χ2(1)=6.63, p<0.01), with a greater percentage of males (56.6%) receiving jail/prison time than females (35.5%). CONCLUSION: The results indicate that males within the cohort typically received higher rates of guilty verdicts, fewer deferred sentences, and harsher sentencing outcomes, such as incarceration. Notably more females than males were charged with neglect (46.8%); however, the difference between convictions for neglect by gender was not statistically significant. Further research regarding criminal court outcomes in child maltreatment cases is still needed to fully understand the impact of failure to protect laws across the entire state.
Open Access
Bariatric Surgery Outcomes in Patients with Chronic Liver Disease - Nationwide Study
(2020-04) Li, Wei; Jackson, Theresa; Fischer, Laura; Chow, Geoffrey; Royall, Nelson; Khorgami, Zhamak
BACKGROUND: Chronic liver disease (CLD) is a risk factor for surgical complications and a relative contraindication to bariatric surgery. This study evaluates early outcomes after bariatric surgery in patients with CLD with and without liver cirrhosis (LC). METHODS: In a retrospective analysis of 2012–2016 Healthcare Cost and Utilization Project-National Inpatient Sample, adult patients with obesity undergoing laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) were studied. CLD and LC were identified along with patient comorbidities. Outcomes were Long Hospital Stay (LHS) defined as ≥5 days (as a proxy of complicated course), blood product transfusion, total hospital charges, and in-hospital mortality. Binary logistic regression was used for multivariate analysis (MVA). RESULTS: 139,952 patients were analyzed (RYGB 36.6%, female 78.6%, age 44.7±12 years). CLD was listed in 17,423 (12.4%) patients, including 818 (0.6%) with LC. Non-alcoholic fatty liver disease was the most common cause of CLD. Patients with LC were more likely to be older, male, and have diabetes mellitus and hyperlipidemia. 37.7% of LC and 42.1% of non-cirrhotic CLD patients underwent RYGB. Transfusion, LHS, and total charges were higher in the LC group (Table). In-hospital mortality was higher in CLD (0.1%) and LC (<0.3%). In MVA, LC was an independent predictor of LHS (Odds Ratio (OR): 1.82, 95% CI: 1.25-2.67) but non-cirrhotic CLD was not a predictor of LHS. Subgroup MVA in CLD showed RYGB was independently associated with LHS (OR: 1.85, 95% CI: 1.53-2.25). CONCLUSION: Bariatric surgery can be performed safely in appropriately selected patients with non-cirrhotic CLD and LC. Further studies are needed to assess long-term outcomes of bariatric surgery in CLD.
Open Access
Camp Hope: Developing Hope and Resilience in Youth Exposed to Domestic Violence
(2020-04) Jackson-Stowe, Jennifer; Muilenburg-Trevino, Eva; Hellman, Chan
BACKGROUND: Camp HOPE America (www.camphopeamerica.com) is the first local, state, and national camping and mentoring initiative in the United States to focus on children exposed to domestic violence. The vision for Camp HOPE America is to break the generational cycle of family violence by offering healing and hope to children who have witnessed such violence. The purpose of this study is to evaluate the camp's effectiveness at increasing hope and resilience in youth after participating in Camp HOPE. METHODS: This study utilized pre, post and thirty day follow-up surveys from 1,127 campers at twenty-eight camp sites across fifteen states and their counselors’ observations to examine hope and resilience factors. The surveys were conducted a few days before camp, during camp, and approximately thirty days after the camp ended. To assess hope, the Children’s Hope Scale (Snyder et al., 1997) was utilized to examine the extent to which children believe they can establish pathways to their goals as well as develop and maintain the willpower to follow these pathways. On the first and last day of camp, counselors also provided assessments of 1,063 campers using the Children's Hope Scale, reworded to reflect this observational approach. Following the Camp HOPE America theme of believing in yourself, believing in others and believing in your dreams, OU's Hope Research Center created six items to assess each child's self-reported resiliency. For both hope and resilience, a six point Likert-type response format was utilized (1=none of the time; 6=all of the time). RESULTS: Hope and Resiliency scores increased from pre-camp test to at-camp test and again at the 30-day follow-up assessment. Repeated measures ANOVAS showed that the increase was statistically significant for both hope [F(2,781)=36.80; p<.001] and resilience [F (2, 769)=26.34; p<.001]. In regard to hope observed by the camp counselors, a repeated measures ANOVA was computed to examine the differences in pre-camp and at-camp test mean scores [t(1062)=-16.66; p<.001] and showed that individuals' levels of observable hope increased after participating in Camp HOPE America. CONCLUSION: The results of this study provide compelling evidence that Camp HOPE improves the hope of children exposed to domestic violence and their resilience. This study serves to evaluate the success of current camp programming and will inform future curriculum and programming for Camp HOPE America. It also serves to stimulate further interest in organizations' ability to nourish hope and resilience in children impacted by domestic violence.
Open Access
Development of Assessment Tool to Measure Soft Skills of Healthcare Providers
(2020-04) Abu Jbara, Nida'a
BACKGROUND: The objective of the study is to develop and validate an assessment tool to measure soft skills in the performance of healthcare providers during patient encounters in primary care settings. The assessment tool will address a gap in performance measurement systems of healthcare providers and patient surveys about soft skills that most influence the way service is delivered and perceived during provider-patient interactions. In this study, the Iceberg Model of Managerial Competencies was used to define the construct and develop a conceptual model of soft skills. Soft skills are commonly referred to as bedside manner. METHODS: The study implemented a mixed methods approach. The first phase used qualitative focus groups and semi-structured personal interviews to collect primary data from 62 participants from users (n=35) and providers (n=27) of healthcare services using a purposeful and snowball sampling strategies. Quantitative surveys were utilized to examine content and face validity. The first refined draft of the assessment tool was developed and obtained content and face validity through conducting qualitative focus groups and semi-structured personal interviews with six subject matter experts and a quantitative survey of 14 individuals representing users of healthcare services. Subject matter experts were recruited using purposeful sampling strategy, and users of healthcare services were recruited using availability sample from the target population. Ongoing data collection using a quantitative survey will further inform the factorial structure of the scale. RESULTS: Ten soft skills were identified as the most essential soft skills for provider-patient interaction in primary care setting. A pool of 198 items were generated from the content analysis process. The final refined draft of the assessment tool consists of 49 items rated on 6-point Likert-type scale, measuring Verbal (personal) and non-verbal communication (15 items), empathy (5 items), compassion (4 items), caring (6 items), listening (5 items), respect (4 items), friendliness (4 items), and trust (6 items). CONCLUSION: The scale obtained excellent content validity with S-CVI/Ave = .96, and S-CVI/UA = .92. Psychometric evaluation of score reliability and construct validity for the final draft of the assessment tool will be reported.
Open Access
Early Childhood Teachers' Perspectives and Needs for Professional Development
(2020-04) Evans, Samantha; Kwon, Kyong Ah; Malek, Adrien
BACKGROUND: Many early childhood programs offer various professional development opportunities in different formats for teachers (Guskey, 2003). However, the effectiveness of professional development trainings on teacher practices is often questioned (Son, Kwon, Jeon, & Hong, 2013). This could be due to trainings not being tailored to individual teachers’ characteristics, needs, and preferences. There have been few studies that examined teacher experiences with professional development trainings, their views on future training opportunities (Buell et al., 2000; Dunst & Raab, 2010) and an assessment of the teachers’ unique professional development needs. Thus, this phenomenological study examined early childhood teachers’ experiences with and needs for professional development trainings and how their views differ by their characteristics (i.e., age group they serve, level of education, teaching certification). METHODS: Forty teachers from 14 early childhood settings were interviewed for an hour and completed a survey created for the Early Childhood Educator Workforce study. They came from diverse racial (17.1% African American, 43.9% Caucasian, 12.2% Hispanic, 17.1% Native American, 9.8% Biracial) and educational backgrounds (39.1% hold bachelor's degrees or higher). Participants had a range of teaching experiences with a mean of 11 years (SD = 9.27, range of 0.7 to 41.0). Participants were purposefully selected to participate by teaching in an infant/toddler or preschool classroom in a southwestern state. InVivo coding was used for data analysis as way to gain a better understanding of the participants’ perceptions on professional development. RESULTS: Preliminary analysis using InVivo revealed 100% of participants found conferences, workshops, and coaching style trainings effective for learning. Desired content for future trainings varied by teachers’ characteristics. For example, needs for learning more about effective instructional and individualized learning strategies, including differentiating between student levels, individualized learning plans, and new activities for children, were prevalent among teachers with higher educational levels and infant and toddler teachers. How to handle challenging and difficult behaviors were the content focus for future trainings from non-bachelor's degree holding educators and non-certified teachers. Conscious discipline was identified as a desirable topic for preschool teachers. CONCLUSION: Regardless of individual characteristics, all teachers believed more curriculum related training was needed and preferred an interactive hands-on approach to learning. From these results, we suggest professional trainings may be more effective in engaging early childhood teachers if they accommodate the situation, needs, and characteristics of teachers.
Open Access
Emergency Department Utilization and Hierarchical Condition Category Risk Scores
(2020-04) Duncan, Ashten; Lesselroth, Blake; Van Cain, Melissa; Aran, Peter; Homco, Juell
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) introduced Comprehensive Primary Care Plus (CPC+) to improve the quality of primary care services nationwide. CPC+ utilization measures use a risk-adjustment model to predict utilization for different patient populations. Risk is determined using Hierarchical Condition Categories (HCCs), which are based on ICD-10 codes and patient demographics. Since patients with higher HCC scores are expected to have higher utilization rates, CMS uses these calculations to compare practices and categorize patients into “risk tiers,” which guide payments. OUSCM participates in CPC+ (Track 2). In order to track our patients’ emergency department utilization (EDU), search for patterns of use, and identify opportunities for quality improvement, we sought to determine (1) what associations exist between HCC risk tiers and patterns of EDU and (2) what patient characteristics are associated with HCC risk scores. METHODS: We analyzed cross-sectional CPC+ data for fiscal year 2018 provided by CMS. We performed multiple linear regression, Tukey’s method, and independent-samples t-tests to explore possible relationships between EDU, HCC risk score and associated risk tiers (range 1-5), and patient characteristics, such as dual-eligibility status and age. The study population included 906 Medicare-only and 1173 dual-eligible patients aged 18 years and older attributed to the OUSCM Internal Medicine (n=1122) or Family Medicine (n=957) practice. RESULTS: Our patient population had a median HCC risk score of 0.93 (CMS-reported Oklahoma median risk score = 0.74). We found that 56.4% of our patients were dual-eligible compared to the national average of 19.4%. Tukey multiple comparison test demonstrated significant differences between risk tiers and ED visits (p < .05). Dual-eligible patients had a higher average HCC risk score than Medicare-only patients (t(2072) = 8.491; p < .00001) and a higher average number of ED visits (t(2077) = 3.9577; p < .00001). Age was weakly correlated with HCC risk scores (r = .074, p = .0228). Density analysis of HCC scores by age revealed evidence of low-risk clustering for adults between 45 and 75 years of age. CONCLUSION: HCC risk tier classifications are predictive of EDU rates in our patient population. However, our overall HCC score was lower than anticipated given the complexity of our patient population. Dual-eligible status was associated with higher risk and EDU rates. However, age–typically an independent predictor of morbidity and mortality–was only weakly correlated with HCC scores, suggesting clinicians may be undercoding encounters for adults between the ages of 45 and 75 years, which decreases revenue.
Open Access
Factors Associated with Medication Adherence Among a High-Risk Hepatitis C Birth Cohort
(2020-04) Philip, Timothy; Solberg, Marie; Crosby, Kimberly; Gaskins, Janet; Wendelboe, Aaron; Frank-Pearce, Summer; Williams, Mary
BACKGROUND: Multiple studies of hepatitis C virus (HCV) reported that 75% of individuals infected with HCV were born between 1945-1965 and were previously never tested. Therefore, in 2012 the CDC published recommendations that all individuals in this birth cohort should be screened for HCV at least once. Adherence to treatment is essential to achieve a sustained virologic response (SVR) for HCV cure. Patients who do not complete the treatment are at risk of treatment failure. The Adherence to Refills and Medication Scale (ARMS) has been an effective tool for predicting adherence of medication treatment in cardiovascular disease and diabetes and identifying risk factors associated with nonadherence to treatment for these diseases. The purpose of this study is to elucidate which risk factors significantly influence the ARMS score among this birth cohort at risk for HCV to guide future HCV treatment protocol adherence. METHODS: This study recruited patients born between 1945-1965 and accessing care at the OU Physicians-Tulsa Family Medicine clinic between March-July 2019. Data was collected using a prescreening survey consisting of demographics, questions related to HCV risk factors (blood transfusions, tattoos, and intravenous drug use), depression assessed with the PHQ9 tool, and adverse childhood experiences (ACEs). IVDU, ACEs, and PHQ9 were classified into groups. Mean ARMS scores were compared using t-tests for variables with two categories and analysis of variance for variables with three or more categories. All statistical analyses were performed in SAS 9.4. RESULTS: Among the 75 participants in the study, most were women (57%) and the sample had a mean ARMS score of 16.32 (SD=3.45). About half reported depression (51%) and one-third reported four or more ACEs (33%). Mean ARMS scores were 2.983 points (95% CI: 0.70-5.26) higher among those with moderate depression (PHQ 5-14), and 2.699 points (95% CI: 0.65-4.75) higher among those with severe depression (PHQ 15-27) than those with a minimal depression (PHQ 0-4). Similarly, mean ARMS score was 2.61 points (95% CI: 0.34-4.88) higher among those with at least four ACEs compared to those with three ACEs or less. Mean ARMS scores did not differ for any other variables. CONCLUSION: This is the first study to assess the ARMS score as a predictor of medication adherence and risk factors associated with the ARMS score in this high-risk birth cohort for HCV infection. These findings indicate that depression and ACEs may be risk factors for poor medication adherence in this population.
Open Access
Factors Influencing Physician Treatment Strategies in Crotaline Snake Envenomation
(2020-04) Ramirez-Cueva, Fatima; Knowlton, Elise; Hendrix, Amy; Condren, Michelle; Woslager, Megan
BACKGROUND: Crotaline snake envenomation is a potentially serious medical condition that affects thousands of Americans each year. There continues to be variation in treatment practices by physicians in the United States despite guidelines establishing the use of antivenom and supportive care as the mainstays for treating crotaline snake envenomation. METHODS: This study sought to determine associations between physician treatment strategies, snake identification (ID), venom effects, bite location and patient presentation. A cross-sectional review of electronic medical records (EMR) for patients diagnosed with venomous snake bites from July 1, 2014 to August 31, 2019 was completed. Data collected from the EMR included: patient demographics, transfer information, length of hospital and ICU stays, snake ID, bite site, progression of local tissue effects, additional clinical and lab results, patient comorbidities and complications, and provider treatment strategy. RESULTS: Of the 83 patients who met inclusion criteria, 68 patients (81.9%) received antivenom. None of the 15 patients who were under observation (no antivenom) for treatment went to the ICU. These patients experienced the shortest hospital stays (H(2)=16.76, p<0.001). Hospital stays were longest for patients envenomated by an identified rattlesnake or cottonmouth compared to patients envenomated by an unknown snake or copperhead (H(2)=14.32, p<0.05). Rattlesnake envenomations used more vials of antivenom than copperhead envenomations (H(2)=8.76, p=0.01). In a regression model of treatment strategy, progression of local tissue effects was the only statistically significant predictor of receiving antivenom while other independent variables including snake ID, patient age, hemotoxicity, systemic symptoms, site of the snakebite, and patient comorbidities were not significant predictors. Lastly, there was a statistically significant association between treatment strategy and opioid prescription, with 77.9% of patients who received antivenom also receiving an opioid for pain management vs. 33.3% of patients under observation (no antivenom) who received opioids (Fisher Exact Probability Test, p=0.001). CONCLUSION: Envenomated patients are likely to be treated with antivenom if there was progression of local tissue effects. For patients in this study who were bitten by copperheads and unknown snakes, close observation without antivenom administration had favorable outcomes including shorter hospital stays and likely decreased hospital costs.
Open Access
High Crime Neighborhoods as a Driver for Toxic Stress Leading to Asthma
(2020-04) Paracha, Alizay; Hendrix, Amy; Hemming, Eden; Munoz, Ric; Couch, Taylor; Gent, Carmen; Homco, Juell; Schaefer, Shawn; Merrill, April
BACKGROUND: Social determinants of health and allostatic load theory suggest social environment can drive asthma diagnoses via the mechanism of toxic stress, the prolonged activation of stress response systems. While research has linked neighborhood crime to asthma, multivariate causal modeling has not been used to test toxic stress as the mechanism that links the two. The current study investigates neighborhood crime as a driver of pediatric asthma diagnoses via toxic stress. METHODS: A retrospective geospatial analysis of health and crime data was conducted. Health data was collected from the OU-Tulsa General Pediatric Clinic’s Electronic Medical Record while crime data was collected from the Tulsa Police Department. All variables were mapped geospatially using census tract as the unit of analysis. Structural equation modeling was used to test the causal model. Neighborhood crime indicators included homicide, rape, and narcotic-related offenses. Diagnoses of conduct, attention deficit, and other anxiety disorders were used in the analysis as toxic stress indicators. Asthma diagnoses were the outcome variable. To further test the model, data from 2016 was used as a calibration sample while data from 2017 was used as a validation sample. RESULTS: A full mediation model of high crime neighborhoods (n = 134) as a driver of toxic stress resulting in increased asthma diagnoses fit the 2016 data well (Χ2 = 15.6, p =.27; df = 13; RMSEA = .04 [90% CI: .00, .10]; CFI: .99; SRMR = .04). The results indicated the model accounted for 78% (R2 = .78) of the variance in asthma diagnoses. The model also provided a good fit to the 2017 data (X2= 23.6, p<.001; df= 13; RMSEA = .08 [90% CI: .02, .13]; CFI: .96; SRMR=.06). CONCLUSION: The results of the current study have important practice and research implications. While clinicians and researchers have become increasingly aware of the impact of social determinants of health, there has been little focus on improving clinical practices. Physicians interested in alleviated the burden of toxic stress and asthma should explore ways to reduce neighborhood crime at the policy level while also being aware of each of their patients’ unique circumstances in relation to where they live.
Open Access
Improving Primary Care Follow-Up After Pediatric Hospitalization
(2020-04) Kahler, Anna; Suhag, Sunaina; Stuemky, Laura; Fleming, Gabby; McIntosh, Heather; Condren, Michelle
BACKGROUND: Transitioning patient care to primary care physicians after pediatric hospitalization plays a critical role in children’s health. Follow-up appointments are an ideal time to provide education, address concerns, and arrange for continuity of care. This quality improvement (QI) study aimed to improve the percentages of primary care clinic follow-up within 7 days of hospital discharge. METHODS: Using the Plan-Do-Study-Act (PDSA) Model for Improvement, a multidisciplinary team examined pre-implementation data for patients discharged from the children’s hospital in February 2018. Electronic medical record (EMR) review was performed to determine if follow-up appointments were scheduled and attended within 7 days of discharge. Four week PDSA cycles were then completed by the medical residents, pediatric hospitalists and a care transition coordinator. Cycle 1 (n=25) involved developing an EMR-based shared patient list to identify all patients needing follow-up. In Cycle 2 (n=69), monthly standardized resident education was implemented to optimize use of the shared patient list. In Cycle 3 (n=81), a discharge appointment template was used to schedule appointments for patients discharged on weekends. RESULTS: Percent of appointments scheduled increased throughout the PDSA cycles from baseline (baseline - 60%; cycle 1 - 72%; cycle 2 - 74%; cycle 3 - 85%), as well as percent of appointments attended (baseline - 56%; cycle 1 - 56%; cycle 2 - 61%; cycle 3 - 70%) with p<0.001. Clinic follow-up was lower for patients with chronic illnesses but did improve from cycle 1 (42%) to cycle 3 (67%). The percentage of appointments scheduled for weekend discharges was not significantly different from weekday discharges, and increased from baseline over the course of the PDSA cycles. CONCLUSION: The number of follow-up appointments both scheduled and attended increased throughout the study, suggesting that the QI measures implemented were effective. Further interventions will focus on patient and system barriers to appointment attendance.
Open Access
Individual Myanmar Children's Experiences in Head Start Classrooms
(2020-04) Lim, Boo Young; Castle, Sherri
BACKGROUND: Early childhood is a crucial period for children who are dual language learners (DLLs), struggling to learn the new language as well as other skills for school readiness. In contrast to comprehensive research in ECE, there are relatively few studies conducted with DLLs, and mainly for the Latino DLLs, no other language groups. Recently, Myanmar migrants are growing rapidly and make up 25% of the total migrant population in Tulsa (NBC news, 2017). Previous studies have shown that DLL children differ in various developmental outcomes because of a myriad of factors including poverty, systemic racism, and oppression. The researchers examined the classroom experiences of Myanmar children in a Head Start program by measuring their individual language use and level of engagement then, comparing them to other racial groups. METHODS: The participants included 3- and 4-year-old children (n=1,101) in a Head Start program in Northeast OK. The measure used the Child Observational Protocol, which involved 3-second sweeps which snapshots of individual children’s behavior across a period of time in the classroom. Observers spent approximately 4 hours in the classroom on a typical morning. All children in the classroom were observed and had an average of 9 sweeps per child. The current study specifically focused on the proportion of sweeps in which a child was listening to or talking to someone else in the classroom (in any language) and the proportion of sweeps a child was observed speaking in English. Descriptive analyses were conducted using ANOVA in SPSS. RESULTS: Results indicated that children who speak Myanmar at home had fewer times observational sweeps in which they were speaking in English (15%) compared to their African American and White peers (19-20%). However, whereas Latino children were observed more frequently to be neither speaking nor listening (45% of sweeps), Myanmar children were not significantly different than their Latino peers. Instead, Myanmar children were more likely to engage in passive instruction (15%) than their African American (10%) and White (12%) peers. CONCLUSION: Our findings suggest that Myanmar children who were enrolled in a Head Start program had bit fewer opportunities to practice their language skills and are less likely to be engaged in their classroom activities. Further research is needed to see whether these outcomes are due to language proficiency, cultural aspects, or influenced by others. This information also leads to the need for further study of how teachers interact in the classroom based on the racial groups.
Open Access
An Informational Letter's Impact on Parent Perceptions and Understanding of Adolescent Confidentiality
(2020-04) Kaminski, Jake; Ramirez-Cueva, Fatima; Studebaker, Susan
BACKGROUND: Adolescence is a period of rapid emotional, behavioral, social, and physiological change in a child’s development. Evidence is conclusive that teens are more likely to engage and revisit their provider in a confidential setting. Parents frequently express hesitancy or opposition when asked to leave the room for the confidential portion of the visit. Studies have shown that while 89% of parents believe that adolescents should speak to a provider one-on-one, about 61% of parents wish to be in the exam room for the entire visit. The goal of this quality improvement project was to determine if parental perceptions and understanding of confidentiality in the adolescent visit could be improved by providing an informational letter before the clinical visit. METHODS: A letter that defined adolescent confidentiality was created and addressed to parents regarding their child(ren)’s transition to adolescent care. This letter, along with a pre- and post-letter survey, was given to parents at annual adolescent well-visits. The survey assessed attitudes and knowledge related to adolescent confidentiality. The knowledge section asked parents to define confidentiality in the adolescent context. The responses were graded as “correct,” “partially correct,” and “incorrect.” Three Plan-Do-Study-Act (PDSA) cycles were completed, revising the succinctness and clarity of the letter and the survey in between each cycle. This yielded a total of 64 responses between spring 2018 and fall 2019. RESULTS: Across all PDSA cycles, the letter was reportedly easy to read. A 60% and 17% increase in parental favorability regarding adolescent confidentiality was seen in cycles 1 and 2. Letter clarity and succinctness were not correlated with parental perceptions, indicating little association between letter “improvements” and parental perceptions. Parental understanding of confidentiality was mixed. With each cycle, there was no significant correlation between reading the letter and likelihood of choosing the most “correct” answer. However, a 25% and 100% increase in combined “slightly correct” and “correct” answers in 2 of 3 cycles was seen. There was also an average 34% decrease of “incorrect” answers across all 3 cycles. CONCLUSION: An explanatory letter may advance parents’ understanding and appreciation for adolescent autonomy; however, there is room for improvement in both areas, which will require alternative interventions.
Open Access
Perceived Organizational and Social Support as Probable Mitigators of Burnout Among Medical Trainees and Providers
(2020-04) Kaur, Rajdeep; Stiefer, Auston; Fawad, Marie; McIntosh, Heather; Kezbers, Krista; Touchet, Bryan
BACKGROUND: National trends show that employees and trainees in the medical field are susceptible to burnout. To our knowledge, no studies have been published on burnout moderators, such as perceived support and lifestyle behaviors. This study is part of a larger, longitudinal investigation examining the relationships among burnout, levels of perceived stress, levels of perceived support (social and organizational), and several lifestyle behaviors for faculty, staff, residents, fellows, and students at the OU-TU School of Community Medicine (OUSCM). METHODS: Investigators sent an email survey to every member of the OUSCM in April 2019. It included validated measures such as the Maslach Burnout Inventory (MBI), University of Delaware Survey of Perceived Organizational Support, and the Multidimensional Scale of Perceived Social Support, alongside questions about lifestyle behaviors. MBI subscores of exhaustion and cynicism were stratified in the analysis. SPSS software was used to conduct Pearson correlations among these variables. RESULTS: 318 responses were collected (35% response rate), with respondents’ demographic data representing the white (67.7%), women (78.1%), and staff (57.2%) members of the population. Among the whole sample, levels of perceived organizational support had a moderate negative correlation relative to burnout subscores of exhaustion (r=-.556, p<0.001) and cynicism (r=-.558, p<0.001). Likewise, levels of perceived social support had a weak negative correlation to exhaustion (r= -.169, p = 0.008) and cynicism (r= -.233, p<0.001). Among the disaggregated subgroups of students and faculty, moderate negative correlations were found between perceived social support and burnout subscores. Social support had a moderate negative correlation only with cynicism among students (r= -.453, p=0.006), while social support had moderate negative correlations with both exhaustion (r=-.514 p<0.001) and cynicism (-.555, p<0.001) among faculty. There were no significant relationships found between these two variables among staff members and resident physician subgroups. CONCLUSION: Because of a low response rate, our sample’s demographics may not be representative of our populations and may potentially limit generalization based on these results. However, the significant correlations found in whole sample analysis between perceived organizational and social support relative to burnout suggest that these variables may lessen the effects of burnout in our population. Moreover, subgroup analysis suggests that social support is a more important potential mitigator of burnout only in students and faculty, when compared to staff and residents. Furthermore, this finding supports that burnout levels within distinct subgroups of our population may be mitigated by different variables.
Open Access
Predictive Factors of Follow-Up in Early Lifestyle Intervention for Childhood Obesity
(2020-04) Stiefer, Auston; Rainey-Kiehl, Robin; Albin, Andrea; Hendrix, Amy; Knowlton, Elise; Ali, Lamiaa
BACKGROUND: The Early Lifestyle Intervention (ELI) Clinic is an OU Physicians Pediatrics specialty clinic dedicated to helping children achieve healthier weights via behavioral modification through a multidisciplinary team approach. Children between 2–18 years of age from North Eastern Oklahoma are eligible for ELI referral if their BMI is at the 95th percentile or above. It is estimated that 30–40% of patients never make their ELI appointments after referral. This study explored predictive factors of patient follow-up to these appointments. METHODS: A retrospective chart review of 121 pediatric patients with ELI referrals made between January 2010 and March 2018 was conducted. Patients were grouped into three categories based on follow-up status for this intervention: immediate (attended first ELI appointment made at time of referral), late (did not attend first ELI appointment but eventually saw ELI provider), and never attended an ELI appointment. Demographic, medical, and social data were extracted from each patient’s medical record, including comorbid conditions such as musculoskeletal pain and past medical interventions such as obesity counseling. Reported comorbidities and conditions in family medical histories were documented for each patient according to the organ system affected. Associations between clinical and family factors and follow-up status were evaluated using the χ2 test, Fisher exact test, 1-way analysis of variance, and Kruskal-Wallis H test in SPSS. RESULTS: The majority of patients were Hispanic (n=73, 60.3%) and male (n=65, 53.7%), with an average age of 7.81 years (+ SD, 3.82 yrs). Frequency of obesity counseling from a healthcare provider and reported musculoskeletal pain differed significantly among groups. 31% of patients with timely follow-up experienced musculoskeletal pain compared to 3% of those with no follow-up and late follow-up. In addition, patients in the timely follow-up group had the highest frequencies of obesity counseling. The organ systems-based approach of conditions in family histories showed cardiovascular disease and endocrine disorders to be present in all patient groups with no significant difference across groups. CONCLUSION: The results suggest that providers who document counseling their patients about childhood obesity more frequently prior to ELI referral can improve their patients’ follow-up rates. Additionally, musculoskeletal pain was the only comorbidity significantly associated with attending ELI clinic. This suggests that most comorbid conditions associated with childhood obesity have a limited effect on motivating parent/patient behavior to seek longitudinal intervention.
Open Access
Preservice Teachers' Use of a Translation App with Dual Language Learners
(2020-04) Ross, Raeanne; Lake, Vickie; Beisly, Amber
BACKGROUND: Many practicing teachers face challenges with effective technology integration (Keengwe & Onchwari, 2009). Teachers who do integrate technology into their educational practices understand that it is not an end-all solution, but rather a support to their current pedagogical and content practices. However, a simple question remains among current early childhood educators, how can technology be effectively used and integrated into classroom environments in order to facilitate children’s learning and development? Therefore, the purpose of this study was to explore how pre-service teachers (PSTs) integrated technology (a translation app) into their lessons and how students (or dual language learners) responded to the use of this technology. The study was guided by the following research questions:    1. How do pre-service teachers integrate Speak & Translate with dual language learners?   2. Based on PST's observations, how do dual language learners respond to the use of Speak & Translate?  METHODS: This qualitative, phenomenological research study was conducted in a teacher preparation program in the Midwest. Thirty-one female PSTs participated in the study. During their field placement experience, each PST taught 3 small group lessons with preschool children using the Speak & Translate (S&T) app. After each lesson was taught, PSTs completed a lesson reflection that was uploaded into Dedoose. Analysis included level 1 (priori coding) and level 2 (thematic coding) in order to analyze the reflections and explore PST’s use of S&T with DLLs and how DLLs responded to this experience. RESULTS: Across all lessons, S&T was utilized a total of 46 times and was primarily used to translate key vocabulary of the lesson or content of the book. PSTs also used the app to model an activity, model material use, and provide instructions and directions. The most exciting finding was the changes PST’s noticed in DLL’s body language, engagement, and motivation when they used the app in their lessons. CONCLUSION: PSTs were asked to focus on the integration of technology (S&T), which produced a lesson that met all aspects of the TPACK framework. Based on PST’s reflections, they not only experienced a shift in their own thinking and pedagogical approaches, but they also noticed a shift in DLLs’ engagement and motivation during their technology supported lessons. Findings from this study hold promising and important educational implications for pedagogical practices not only for PSTs, but also for current educators who work with DLLs.
Open Access
Queer Affirmative Practice for Medical and Social Work Students: An Introductory Module
(2020-04) Howell, Daniel; Peake, Ian; Rodriguez, Kristin; Latham, Whitney; Bragg, Jedediah; Nay, Eden; Nguyen, Tuan
BACKGROUND: Research suggests members of the sexual and gender minority (SGM) community fail to seek out medical care despite a higher prevalence of negative health outcomes, ranging from implicit bias to structural violence. In response, the OU-TU School of Community Medicine, the Anne and Henry Zarrow School of Social Work, and the Simulation Center at OU-Tulsa partnered with faculty from the OSU College of Osteopathic Medicine to design and implement a three-part education and training module promoting queer-affirmative practice among medical school and social work students. METHODS: This introductory module begins with a lecture-based overview of human sexuality that emphasizes caring for the specific healthcare and social needs of SGM populations. The initial lecture is followed by a high-fidelity simulation with standardized patient actors (SPs) to implement the practices discussed. To better provide an authentic simulation experience, special attention is taken to recruit SPs who identify as members of the LGBTQIA+ community. The simulation cases begin with a patient presenting a complaint of anxiety related to SGM status, requiring students to work collaboratively to adequately address those needs. Skills emphasized throughout the simulation include interprofessional communication, queer-affirmative practice, expressing empathy and building rapport with patients. Finally, all students engage in a debriefing process—first as pairs with their respective SPs, then as a collective group with all SPs and training facilitators. All participants (N = 24) completed a standardized pre-post educational assessment, evaluating the development of clinical skills related to SGM populations, the importance of this material to their profession, their comfort working with SGM populations, their confidence in working with SGM populations, and the importance of affirmative practice to their profession. RESULTS: A repeated measures ANOVA analyzed changes over time, both within groups (i.e., all students) and between groups (i.e., medical/social work students). Results indicated statistically significant improvements within groups on all measures (p < .05) except attitudes (a subscale of the LGBTDOCSS) (p = .382) with all significant results having large effect sizes (η2p > .2). Additionally, results indicated no statistically significant difference between groups (p > .05). In sum, the results validate the affirmative-practice module as an effective teaching method for students, regardless of discipline. CONCLUSION: The results of this study illustrate the capabilities of interdisciplinary education in the form of didactics and high-fidelity simulation to educate students on how to address the complex issues faced by SGM populations.
Open Access
Relationship Between the Second Victim Phenomenon and Occupational Burnout in Healthcare
(2020-04) Brannon, Carrie; Kisamore, Jennifer
BACKGROUND: Unexpected events or outcomes in healthcare that create considerable harm or lasting damage to a patient are called adverse patient events (Mira et al., 2015). Providers affected by such events are called “second victims.” The current study examined personal and organizational outcomes related to involvement in adverse events including psychological and physical symptoms, burnout, and employee withdrawal behaviors. METHODS: Participants were recruited through social media sites. The population of interest was healthcare providers who potentially had been involved in an adverse event. Consent to participate was given by 204 individuals of which 127 were current or former healthcare providers. The remaining 77 respondents were excluded from the study. All measures were self-report and administered online through Qualtrics. All scales demonstrated acceptable internal consistency reliability. First, burnout was measured using the Oldenburg Burnout Inventory (Demourti et al., 2003). Participants were then asked if they had experienced an adverse patient event. Individuals who affirmed having such an experience were considered second victims and remained in the study; participation from other healthcare respondents was complete at that point. Responses to items from the second victim experience and support tool developed by Burlison and colleagues (2017) were collected from the second victims. Factor analytic work and internal consistency reliability analyses resulted in three factors: “personal distress,” “organizational support,” and “withdrawal behaviors.” RESULTS: Results indicated that second victims had significantly higher rates of burnout (M=3.88, SD=.97) than did other healthcare providers (M=3.46, SD=.84), t(119)=-2.07, p<.05. Results also revealed personal distress was significantly positively correlated with both burnout (r=.56) and withdrawal behaviors (r=.56) while perceptions of organizational support were significantly negatively correlated with both burnout (r=-.46) and withdrawal behaviors (r=-.35). A mediation model tested using Hayes SPSS PROCESS macro revealed the negative relationship between organizational support and withdrawal behaviors was partially mediated by burnout. Percent mediation was 52.9%. CONCLUSION: This study has important implications for healthcare organizations. Adverse patient experiences were related to higher likelihood of provider burnout and withdrawal behaviors. Perceptions of organizational support, however, were inversely related to these outcomes. Results suggest healthcare organizations should prioritize support mechanisms for second victims to potentially mitigate undesirable employee and organizational outcomes related to adverse patient events. Due to the cross-sectional design of the study, causal relationships between involvement in adverse events and these consequences cannot be assumed however, thus, further research is suggested.
Open Access
Revisiting Unlicensed Channel Access Scheme of 5G New Radio
(2020-04) Muhammad, Siraj; Hazem, Refai
BACKGROUND: As the second phase of 5G standardization efforts encapsulated in Release 16 comes to its freeze and completion date in June 2020, aspects of some promised features and services started to crystallize. Among of which, New Radio (NR)-based access to unlicensed spectrum, commonly known as 5G NR-U. Current technical reports have identified Listen-Before-Talk (LBT) as a working assumption in the process of standardizing NR-U channel access scheme. LBT was originally developed for Licensed-Assisted Access (LAA) in release 13 of the 3GPP specifications, which was based on ETSI regulations. This research examines how next-generation wireless systems using LBT perform under vastly presumed 5G NR dense deployments, and how the coexistence landscape manifests in the homogeneous prospect rather than the widely investigated heterogeneous counterpart, e.g. with Wi-Fi. METHODS: In this work, a simulator was developed in C++ to help analyze different intra-network NR-U co-channel scenarios under saturated traffic. The simulator was validated with Markov Chain analytical model to confirm the procedures and algorithms conform to the standard delineated by the 3GPP specifications. RESULTS: Simulation results indicated inefficiency in channel utilization of homogeneous dense deployments with high priority traffic classes. For instance, the effective channel utilization drops to less than 10% when only 20 devices share the channel with traffic tagged as priority 4, e.g., voice calls. Moreover, mean delay between successful packet transmissions in aforesaid scenario turned out to be around 1 second and exponentially increasing with the number of devices sharing the channel. We demonstrated through simulations how LBT devices can be unfair when sharing the channel with others exhibiting different traffic priority classes. A video streaming device – i.e. class 3 – for example, takes away 42% of the channel when sharing it with other 7 devices browsing the internet – i.e. class 2 – leaving them with 34% of useful channel time to split. The remaining 24% of the time packets collide with each other, rendering the channel futile and reducing the overall throughput. CONCLUSION: Literature is inundated with research on cross-technology coexistence analysis. This work aims to study same-technology wireless coexistence performance and underlines the importance of improving channel access mechanisms in next-generation wireless communication.