Yoxas/statistical_literacy huggingface dataset:
The Gambia has the 12th highest maternal mortality rate in the world, with 80% of deaths resulting from avoidable causes. Unawareness of pregnancy danger signs (DS) has been shown to be a barrier to seeking obstetric care, while app-based education intervention has shown promise. We aim to assess patient awareness of DS, identify barriers to awareness, and evaluate potential for implementing smartphone-based technologies for education. A cross-sectional semi-structured survey was administered to Gambian women (n = 100) across five hospitals/health centers. Data and informed consent were collected via an online survey portal. Analysis included bivariate analysis and descriptive statistics with p < 0.05 significance level. Recall of 0-2 DS per category was classified as "low" knowledge, 3-5 as "moderate" knowledge, and 6+ as "sufficient" knowledge. Cross-category recall was quantified for overall awareness level (0-6 = "low", 7-12 = "moderate", 13+ = "sufficient". N = 28 total DS). Although 75% of participants (n = 100) self-perceived "sufficient" knowledge of DS, the average recall was only two (SD = 2, n = 11) pregnancy DS, one labor and delivery DS (SD = 1, n = 8), and one postpartum DS (SD = 1, n = 9). Twenty-one women were unable to recall any danger signs. "Low" awareness was identified in 77% of women, while 23%, and 0% of women showed "moderate" and "sufficient" overall awareness, respectively. Education level was significantly correlated with overall danger sign recall (ρ(98) = .243, p = .015) and awareness level (ρ(98) = .265, p = .008). Monthly income was significantly correlated with awareness level (ρ(97) = .311, p = .002). Smartphone ownership was reported by 76% of women, and 97% expressed interest in using app-based video (94%) or provider (93%) teaching. Women had low knowledge of obstetric danger signs, and true awareness of danger signs was remarkably lower than self-perceived knowledge. However, patients exhibited proper healthcare-seeking behavior when danger signs arose. Findings suggest that video- or messaging-based education from local healthcare providers may be effective DS educational interventions.
The gamification of learning increases student enjoyment, and motivation and engagement in learning tasks. This study investigated the effects of gamification using decision-making cards (DMCs) on diagnostic decision-making and cost using case scenarios. Thirty medical students in clinical clerkship participated and were randomly assigned to 14 small groups of 2-3 medical students each. Decision-making was gamified using DMCs with a clinical information heading and medical cost on the front, and clinical information details on the back. First, each team was provided with brief clinical information on case scenarios. Subsequently, DMCs depending on the case were distributed to each team, and team members chose cards one at a time until they reached a diagnosis of the case. The total medical cost was then scored based on the number and contents of cards drawn. Four case scenarios were conducted. The quantitative outcomes including confidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical costs were measured before and after our gamification by self-evaluation using a 7-point Likert scale. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using DMCs. Confidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical cost were significantly higher after the gamification. Furthermore, comparing the clinical case scenario tackled last with the one tackled first, the average medical cost of all cards drawn by students decreased significantly from 11,921 to 8,895 Japanese yen. In the content analysis, seven advantage categories of DMCs corresponding to clinical reasoning components were extracted (information gathering, hypothesis generation, problem representation, differential diagnosis, leading or working diagnosis, diagnostic justification, and management and treatment). Teaching medical students clinical reasoning using DMCs can improve clinical decision-making confidence and learning motivation, and reduces medical cost in clinical case scenarios. In addition, it can help students to acquire practical knowledge, deepens their understanding of clinical reasoning, and identifies several important clinical reasoning skills including diagnostic decision-making and awareness of medical costs. Gamification using DMCs can be an effective teaching method for improving medical students' diagnostic decision-making and reducing costs.
The Gaussian law reigns supreme in the information theory of analog random variables. This paper showcases a number of information theoretic results which find elegant counterparts for Cauchy distributions. New concepts such as that of equivalent pairs of probability measures and the strength of real-valued random variables are introduced here and shown to be of particular relevance to Cauchy distributions.
The General Health Questionnaire-12 (GHQ-12) is a widely used screening tool for mental health assessment however its traditional scoring methods and cutoffs may not adequately capture the mental health complexities of younger populations. This study explores GHQ-12 responses from a sample of university students. Possible differences in means scores considering gender, age, academic field and degree course were assessed through t-test or one-way ANOVA as appropriate. To deeper understanding different levels of severity and individual item impact on general distress measurement, we applied Item-Response-Theory (IRT) techniques (two-parameters logistic model). We compared students' population with a population of workers who underwent a similar psychological evaluation. A total of 3834 university students participated in the study. Results showed that a significant proportion (79%) of students reported psychological distress. Females and younger students obtained significantly higher average scores compared to others. IRT analysis found item-specific variations in mental distress levels, with more indicative items for short-term fluctuations and potential severe mental health concerns. Latent class analysis identified three distinct subgroups among students (including 20%, 37%, 43% of the participants respectively) with different levels of psychological distress severity. Comparison with a population of adults showed that students reported significantly higher scores with differences in the scale behavior. Our results highlighted the unique mental health challenges faced by students, suggesting a reevaluation of GHQ-12 applicability and cutoff scores for younger populations, emphasizing the need for accurate instruments in mental health evaluation.
The General Internal Medicine Acting Internship (GIM AI) at our school is a compulsory, one-month-long experience. Morning report-style case-based discussions were conducted on a weekly basis as part of the acting internship and were poorly attended. We sought to redesign our academic half day didactic curriculum and increase voluntary student attendance by allowing students to actively participate in determining the content of the acting internship academic half day. Prior to the beginning of the acting internship, students were sent an email survey listing seven inpatient topics to rank on a scale of 1-5 (1=not at all interested, 5=very interested). Based on student feedback, one additional topic was added: antibiotic use for common inpatient diagnoses. Topics that received the highest score were selected for topic-based sessions. A total of 32 teaching sessions were conducted over eight months. Twenty-four of these sessions were topic-based and the remainder were case-based. Student attendance at these sessions was voluntary. Case-based discussions had the lowest preference ranking (n=94, mean=2.9), while cross-cover-based discussions (n=94, mean=4.3, p=0.001) and antibiotic use (n=52, mean=4.3, p=0.001) received the highest scores. Thirty-four percent (41/120) of possible learners attended case-based discussions, while 78% (281/360) of possible learners attended topic-based sessions (p<0.001). Learners reported a statistically significant improvement in comfort level in recognizing and managing 73% of sub-topics (29 out of 41) covered in topic-based sessions. A learner-centered approach to curriculum design led to robust student engagement in our acting internship academic half day. Fourth-year students prefer specific topic-based teaching sessions over case-based, morning report-style sessions.
The General Practitioner (GP) is often the first professional contact for patients with depression. Depression care constitutes a substantial part of GPs' workload. To assess how GPs experience their patients' expectations and their own provision of depression care; further, how their depression care was associated with doctor- and practice-characteristics. A cross-sectional questionnaire study about depression care in general practice among the GPs in the Norwegian Physician Survey of 2021. Of the 221 responding GPs, 50% were female and 70% agreed to have constant time pressure due to workload. The GPs believed that patients with depression were interested in their professional assessment (87.2%) and saw them as providers of talking therapy (76,9%). Still, 77,8% of the GPs thought the patients expected a referral. Talking therapy was commonly provided (79.6%) along with consultations of more than 30 min (80.4%). The youngest age group and GPs with shorter patient lists spent more time. Most GPs (92.3%) considered their help to be of great benefit for depressed patients. However, one-fourth of the GPs did not feel competent in providing talking therapy, less frequently reported by the GPs aged 40-54 years. Talking therapy is commonly provided by GPs. However, there is a need to investigate what GP talking therapy implies, and to strengthen GP skills in this regard. Overall, the GPs experience their depression care to be useful for their patients, and do not de-prioritize this although they experience workload pressure.
The genetic diagnosis of mitochondrial disorders is complicated by its genetic and phenotypic complexity. Next generation sequencing techniques have much improved the diagnostic yield for these conditions. A cohort of individuals with multiple respiratory chain deficiencies, reported in the literature 10 years ago, had a diagnostic rate of 60% by whole exome sequencing (WES) but 40% remained undiagnosed. We aimed to identify a genetic diagnosis by reanalysis of the WES data for the undiagnosed arm of this 10-year-old cohort of patients with suspected mitochondrial disorders. The WES data was transferred and processed by the RD-Connect Genome-Phenome Analysis Platform (GPAP) using their standardized pipeline. Variant prioritisation was carried out on the RD-Connect GPAP. Singleton WES data from 14 individuals was reanalysed. We identified a possible or likely genetic diagnosis in 8 patients (8/14, 57%). The variants identified were in a combination of mitochondrial DNA (n = 1, MT-TN), nuclear encoded mitochondrial genes (n = 2, PDHA1, and SUCLA2) and nuclear genes associated with nonmitochondrial disorders (n = 5, PNPLA2, CDC40, NBAS and SLC7A7). Variants in both the NBAS and CDC40 genes were established as disease causing after the original cohort was published. We increased the diagnostic yield for the original cohort by 15% without generating any further genomic data. In the era of multiomics we highlight that reanalysis of existing WES data is a valid tool for generating additional diagnosis in patients with suspected mitochondrial disease, particularly when more time has passed to allow for new bioinformatic pipelines to emerge, for the development of new tools in variant interpretation aiding in reclassification of variants and the expansion of scientific knowledge on additional genes.
The geopolitical setting has changed significantly since the definition of UK Armed Forces General Practice was published in 2012. New operating models require medical services to provide smaller teams operating at greater reach from secondary care and logistical support. The Defence Medical Services have reorganised to meet these changing needs. Defence general practices (DGPs) are key enablers of the Defence strategic effort, both integral to deployed units, in preparing forces for deployment and managing their rehabilitation back to fitness. A formal role performance statement (RPS) has been created to guide the training and development of DGPs to meet these changing requirements. The RPS details the additional scope of practice, beyond the national GP licensing standard, in which DGPs work. In this article, we compare and contrast the RPS with the previous definition of a DGP. The resultant updated model recharacterises the extended roles into five themes of DGP built on the foundation of the Royal College of General Practitioners curriculum. This new model provides the platform on which to develop the clinical specialty over the next decade and highlights avenues for educational interventions to develop future generations of DGPs.
The Geriatric Interprofessional Team Transformation for Primary Care (GITT-PC) is a model developed to deliver optimal care to older adults in primary care. GITT-PC is an expansion of the John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) program developed at New York University and funded from 1995 to 2002 (Fulmer et al., 2004). GITT was designed to create training models that reflect the needs of the changing health care system and the challenge of caring for older adults with complex conditions (Fulmer et al., 2005). The GITT-PC model builds on the lessons learned from GITT and the development of curricula and training materials based on best practices. Implementation of GITT-PC is accomplished through systems and practices that meet the needs and preferences of patients and their families and that are implemented by teams of health professionals and community service providers. GITT-PC is focused on four core components of high-quality geriatric care: (1) health promotion and prevention, (2) chronic disease management, (3) advanced care planning, and (4) transitional care management, each component corresponding to a Medicare-reimbursable visit. Implementation of these reimbursable services enables practices to provide evidence-based geriatric care while realizing a potential significant return on investment. The GITT-PC model has evolved from an academic training program to a financially sustainable model that serves to improve the care of older adults through a systematic team transformation process that makes a clear business case for primary care (Tabbush et al., 2021). The GITT-PC training program can be implemented in primary care practices with a focus on improving or expanding delivery of annual wellness visits (AWVs) and, potentially, registered RN-led AWVs.
The German Incentives for Physical Activity in Cardiac Patients trial is a three-arm, randomised controlled trial for secondary prevention of coronary heart disease (CHD). Guidance for developing complex interventions recommends pre-trial health economic modelling. The aim of this study is to model the long-term cost-effectiveness of the incentive-based physical activity interventions in a population with CHD. A decision-analytical Markov model was developed from a health services provider perspective, following a cohort aged 65 years with a previous myocardial infarction for 25 years. Monetary and social incentives were compared relative to no incentive. Intervention effects associated with physical activity were used to determine the costs, quality-adjusted life-years (QALYs) gained, incremental cost-effectiveness and cost-utility ratios. The probability of cost-effectiveness was calculated through sensitivity analyses. The incremental QALYs gained from the monetary and social incentives, relative to control, were respectively estimated at 0.01 (95% CI 0.00 to 0.01) and 0.04 (95% CI 0.02 to 0.05). Implementation of the monetary and social incentive interventions increased the costs by €874 (95% CI €744 to €1047) and €909 (95% CI €537 to €1625). Incremental cost-utility ratios were €25 912 (95% CI €15 056 to €50 210) and €118 958 (95% CI €82 930 to €196 121) per QALY gained for the social and monetary incentive intervention, respectively. With a willingness-to-pay threshold set at €43 000/QALY, equivalent to the per-capita gross domestic product in Germany, the probability that the social and monetary incentive intervention would be seen as cost-effective was 95% and 0%, respectively. Exercise-based secondary prevention using inventive schemes may offer a cost-effective strategy to reduce the burden of CHD.
The German system of higher education and public research is characterized by a high rate of temporary contracts with short contract durations and a nearly complete absence of structured career options. About 82% of employees not holding a full professorship have fixed-term contracts, with an average contract period of 20 months. This is facilitated by a special fixed-term employment law (Wissenschaftszeitvertragsgesetz) which universities and other public research institutions have stretched to its limits. Against the background of a survey which we conducted in 2021 and whose results once more demonstrate the shortcomings of this system, we discuss alternative options in the form of model calculations. We propose a reform of employment structures and career paths that could improve not only personal working conditions but also ensure the quality of research and teaching in German academia. By quantitative comparison with the current employment situation, our model calculation demonstrates that plannable career decisions can be enabled at an early stage without changing budgets or teaching duties. We also show that the counter argument of a "congestion" of positions is not substantiated, and that young scholars will still have the opportunity to start a career in the reformed system, while the total number of employees can be kept nearly constant.
The glass ceiling in academic medicine has resulted in lower pay and fewer career advancement opportunities for women. Creating change relies on preparing early-career women for positions of leadership, but most leadership programs focus on faculty, not trainees. The present exploratory qualitative study investigates how to prepare women medical students to be leaders in academic medicine. Focus groups with medical students and faculty who identify as women were conducted at an academic medical center in the West. A total of 25 individuals (10 students and 15 faculty) participated. Recordings of focus groups were transcribed and coded using thematic analysis until saturation of themes was achieved. Codes were organized into three themes: obstacles, support systems, and self-presentation. Obstacles identified included the subthemes microaggressions, macroaggressions, a lack of female role models in leadership, and personal characteristics such as the ability to self-promote and remain resilient. Support systems included sponsorship, allyship, mentorship, networking, and gender-specific role modeling subthemes. Self-presentation involved learning behaviors for demonstrating leadership and exuding confidence, being strategic about career moves, resiliency, and navigating social norms. The key themes of obstacles, support systems, and self-presentation are targets for systemic and individualistic improvement in leadership development.
The global dissemination of Chinese martial arts (CMAs), transcends mere physical activity; it represents a cultural and philosophical journey that contributes to enhanced psychological well-being. Capturing international attention, CMAs have engendered a network of global instructors committed to their cross-cultural teaching. However, the narrative of CMAs across the globe is incomplete without understanding the psychological factors that fuel the perseverance of these international instructors. Their relentless commitment, motivated by factors beyond the cultural and geographical barriers, poses a unique question: What motivates these instructors to persist in teaching CMAs in the face of such challenges? The study aims to uncover the key motivational mechanisms that influence the perseverance of international CMAs instructors in their teaching endeavors. Employing Self-Determination Theory, 147 international CMAs instructors completed the Motivation for Teaching CMAs Scale, Perceived Belonging Scale, and Perseverance in Teaching CMAs Scale. SPSS 20.0 was utilized for conducting descriptive statistics, common method bias tests, and correlation analyses. Structural equation modeling was performed using AMOS 26.0. Autonomous Motivation positively affected perseverance in teaching CMAs (β = 0.369, b = 0.465, t = 4.232, p < 0.001). In contrast, Amotivation negatively affected perseverance (β = -0.323, b = -0.382, t = -3.561, p < 0.001). Neither Controlled Motivation nor Sense of Belonging significantly affected perseverance. The model explained 27.9% of the variance in perseverance, offering insights into the motivational mechanisms influencing international CMAs instructors. This study concludes that the perseverance of international instructors in teaching CMAs is primarily driven by overcoming amotivation and fostering autonomous motivation, rather than short-term internal or external incentives, which appear ineffective. Additionally, sense of belonging to their CMA school does not significantly influence their perseverance, potentially due to the diverse cultural backgrounds of the instructors surveyed. The findings suggest that by enhancing the recognition and acceptance of CMAs' core philosophies and values, aligning teaching practices with personal and cultural values, and fostering a profound passion for CMAs, international instructors could boost their autonomous motivation, which is crucial for their sustained commitment in promoting CMAs globally.