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OBJECTIVE: The aim of this study was to understand the influence of clinician encouragement and sociodemographic factors on whether patients access online electronic medical records (EMR). MATERIALS AND METHODS: We analyzed 3279 responses from the Health Information National Trends Survey 5 cycle 4 survey, a cross-sectional, nationally representative survey administered by the National Cancer Institute. Frequencies and weighted proportions were calculated to compare clinical encouragement and access to their online EMR. Using multivariate logistic regression, we identified factors associated with online EMR use and clinician encouragement. RESULTS: In 2020, an estimated 42% of US adults accessed their online EMR and 51% were encouraged by clinicians to access their online EMR. In multivariate regression, respondents who accessed EMR were more likely to have received clinician encouragement (odds ratio [OR], 10.3; 95% confidence interval [CI], 7.7-14.0), college education or higher (OR, 1.9; 95% CI, 1.4-2.7), history of cancer (OR, 1.5; 95% CI, 1.0-2.3), and history of chronic disease (OR, 2.3; 95% CI, 1.7-3.2). Male and Hispanic respondents were less likely to have accessed EMR than female and non-Hispanic White respondents (OR, 0.6; 95% CI, 0.5-0.8, and OR, 0.5; 95% CI, 0.3-0.8, respectively). Respondents receiving encouragement from clinicians were more likely to be female (OR, 1.7; 95% CI, 1.3-2.3), have college education (OR, 1.5; 95% CI, 1.1-2.0), history of cancer (OR, 1.8; 95% CI, 1.3-2.5), and greater income levels (OR, 1.8-3.6). DISCUSSION: Clinician encouragement of patient EMR use is strongly associated with patients accessing EMR, and there are disparities in who receives clinician encouragement related to education, income, sex, and ethnicity. CONCLUSIONS: Clinicians have an important role to ensure that all patients benefit from online EMR use.

Applying a behavior change framework to guide the design of interventions to improve respectful maternity care (RMC) could accelerate and unify the implementation and evaluation of diverse RMC interventions.

It is important to cultivate dispositions of 21st-century skills (D21S: critical thinking, complex problem solving, creativity, communication, and collaboration) in project-based science, technology, engineering, and mathematics learning (STEM-PjBL). Previous research has seldom adopted the person-oriented approach to examine STEM-PjBL program effectiveness, and knowledge regarding group differences is still lacking. To fill this gap, a person-oriented analysis was used to form groupings of students based on D21S. Three latent profiles (high-, medium-, and low-D21S) of students were identified in 6 elementary schools, and the transition probabilities were estimated for 2 class types (treatment vs. comparison) across 1 semester. Most of the students (63.4%) showed stable D21S profiles over 1 semester; however, some students (17.6%) exhibited improvement, and some (18.9%) showed declination. Additionally, the STEM-PjBL programs presented positive effects on the growth of D21S. This study further found that the D21S transitional types (i.e. declined, stable, and improved) could predict students' motivation (perceived STEM domain content mastery, self-efficacy, and task value), showing that a declined D21S also decreased academic motivation. The findings suggest that students who decline in D21S should receive attention from teachers because their perceived academic performance, competence beliefs, and values in STEM also decrease simultaneously.

To improve the quality of intrapartum care in public health facilities of Bihar, India, a statewide quality improvement program was implemented. Nurses participated in simulation sessions to improve their clinical, teamwork, and communication skills. Nurse mentors, tasked with facilitating these sessions, received training in best practices. To support the mentors in the on-going facilitation of these trainings, we developed a digital, interactive, comic series starring "Super Divya", a simulation facilitation superhero. The objective of these modules was to reinforce key concepts of simulation facilitation in a less formal and more engaging way than traditional didactic lessons. This virtual platform offers the flexibility to watch modules frequently and at preferred times. This pilot study involved 205 simulation educators who were sent one module at a time. Shortly before sending the first module, nurses completed a baseline knowledge survey, followed by brief surveys after each module to assess change in knowledge. Significant improvements in knowledge were observed across individual scores from baseline to post-survey. A majority found Super Divya modules to be acceptable and feasible to use as a learning tool. However, a few abstract concepts in the modules were not well-understood, suggesting that more needs to be done to communicate their core meaning of these concepts.

In research on math self-concept (MSC) formation, very few studies have juxtaposed the effects of math grades, math ability, school-average math grades, and school-average math ability. However, these factors are important in enabling Taiwanese senior school students to achieve proper MSC and choose a suitable academic track. Thus, the present study aimed to model the relationship of these factors with MSC. The study also examined the gender effect and school location (rurality) effect. The sample contained 1,196 10th-grade students from 31 senior high schools in Taiwan. A doubly latent multilevel linear model was adopted to account for both sampling and measurement errors. The results suggested that math grades relative to the school-average math grade are key in MSC formation. There were school location and gender effects but no significant interaction between gender and school-level math grade or ability. These effects are discussed, as are the implications in practical settings.

PURPOSE:To improve care coordination for complex cancers, it is critical to establish a more nuanced understanding of the types of providers involved. As the number of provider types increases, strategies to support cancer care coordination must adapt to a greater variety of information needs, communication styles, and treatment strategies. METHODS:We categorized providers into 11 types, using National Provider Identifier specialties. Using Medicare claims, we counted the number of unique combinations of provider types billed during preoperative, operative, and postdischarge care for colon cancer surgery and assessed how this count varies across hospitals. The study included 70,567 beneficiaries in fee-for-service Medicare A and B for 6 months before and 60 days after an admission for colectomy for colon cancer between 2008 and 2011. RESULTS:We observed 1,554 preoperative provider-type combinations, 975 operative combinations, and 1,571 postdischarge combinations. The three most common combinations in the preoperative phase were general medicine only, other medical specialists only, and general medicine and other medical specialists. In the operative phase, the three most common combinations were primary surgery, anesthesiology, and pathology; general medicine, other medical specialists, radiology, primary surgery, anesthesiology, and pathology; and other medical specialists, radiology, primary surgery, anesthesiology, and pathology. In the postdischarge phase, the three most common combinations were general medicine, general medicine and other medical specialists, and general medicine and oncology. On average, each hospital had 15 preoperative, 11 operative, and 15 postoperative combinations. High-volume, larger, teaching, urban, and noncritical access hospitals had more combinations in all phases. CONCLUSION:Many provider-type combinations are involved in colon cancer surgery care. Substantial variation exists across hospitals types, suggesting that certain hospitals need additional resources and more flexible infrastructure to coordinate care.

Background: Although many healthcare settings have since returned to pre‐pandemic levels of operation, long‐term care (LTC) facilities have experienced extended and significant changes to operations, including unprecedented levels of short staffing and facility closures, that may have a detrimental effect on resident outcomes. This study assessed the pandemic's extended effect on outcomes for LTC residents, comparing outcomes 1 and 2 years after the start of the pandemic to pre‐pandemic times, with special focus on residents with frailty and dually enrolled in Medicare and Medicaid. Methods: Using Medicare claims data from January 1, 2018, through December 31, 2022, we ran over‐dispersed Poisson models to compare the monthly adjusted rates of emergency department use, hospitalization, and mortality among LTC residents, comparing residents with and without frailty and dually enrolled and non‐dually enrolled residents. Results: Two years after the start of the pandemic, adjusted emergency department (ED) and hospitalization rates were lower and adjusted mortality rates were higher compared with pre‐pandemic years for all examined subgroups. For example, compared with 2018–2019, 2022 ED visit rates for dually enrolled residents were 0.89 times lower, hospitalization rates were 0.87 times lower, and mortality rates were 1.17 higher; 2022 ED visit rates for frail residents were 0.85 times lower, hospitalization rates were 0.83 times lower, and mortality rates were 1.21 higher. Conclusions: In 2022, emergency department and hospital utilization rates among long‐term residents were lower than pre‐pandemic levels and mortality rates were higher than pre‐pandemic levels. These findings suggest that the pandemic has had an extended impact on outcomes for LTC residents. [ABSTRACT FROM AUTHOR]

BACKGROUND:Health Information Organizations (HIOs) are third party organizations that facilitate electronic health information exchange (HIE) between providers in a geographic area. Despite benefits from HIE, HIOs have struggled to form and subsequently gain broad provider participation. We sought to assess whether market-level hospital and EHR vendor dynamics are associated with presence and level of hospital participation in HIOs. METHODS:2014 data on 4523 hospitals and their EHR vendors were aggregated to the market level. We used multivariate OLS regression to analyze the relationship between hospital and vendor dynamics and (1) probability of HIO presence and (2) percent of hospitals participating in an HIO. RESULTS:298 of 469 markets (64%) had HIO presence, and in those markets, 47% of hospitals participated in an HIO on average. In multivariate analysis, four characteristics were associated with HIO presence. Markets with more hospitals, markets with more EHR vendors, and markets with an EHR vendor-led HIE approach were more likely to have an HIO. Compared to markets with low hospital competition, markets with high hospital competition had a 25 percentage point lower probability of HIO presence. Two characteristics were associated with level of hospital HIO participation. Markets with more hospitals as well as markets with high vendor competition (compared to low competition) had lower participation. CONCLUSION:Both hospital and EHR vendor dynamics are associated with whether a market has an HIO as well as the level of hospital participation in HIOs.

This study constructed a questionnaire, named "Lifestyle Change in Regard to Problematic Internet Use (LC-PIU)," for helping school psychologists detect early indications of PIU-related lifestyle changes in university populations. Our focus is on all university students who use the Internet, not users who already show dependent symptoms. The lifestyles that we concerned include physical/social activities and dietary/sleep patterns that are notable consequences of excessive Internet use (Lam et al., 2009; Choi et al., 2009). With 708 university students recruited in 2009 (Time 1), we tested the factor structure of LC-PIU and determined the concurrent and cross-year predictive utilities with the same participants in 2010 (Time 2). The 2009-sample was randomly split into two independent subsamples for calibration and validation using exploratory and confirmatory factor analyses. The calibration and validation results, along with convergent and discriminant tests, confirmed that the LC-PIU is composed of five distinct subscales: problematic Internet use, physical activity change, social activity change, dietary pattern change, and sleep pattern change. All Time-1 LC-PIU subscores were positively correlated with depression, loneliness, and weekly Internet use at Time 1 and Time 2. Only a negative correlation was found between gender and social activity change at Time 1 and Time 2. (Contains 1 table and 1 figure.)

This research is comprised of two studies designed to explore the effects of online discussion forum aggressive messages and Internet cognitive distortion on users' negative affect and aggression. The results of study 1 revealed 69 users could perceive both disgust and hostility feelings toward aggressive messages conducted by the authors, and classify them into three levels: direct aggression, indirect aggression, and disagreement. Study 2 focused on whether three aggressive messages and Internet cognitive distortion had effects on users' negative affect and online aggression. 359 users read one of messages conducted in study 1, and then finished online questionnaires. The results indicated that there were no significant differences in aggression across interaction between aggressive messages and cognitive distortion. However, in users with high cognitive distortion there was significant reported higher aggression than users with low cognitive distortion. Though users could classify the aggressive level of messages and their negative affect be aroused during the treatment, their aggression was not evoked after reading aggressive messages. High cognitive distortion users' aggression and negative affect were triggered without reading aggressive messages. (Contains 4 tables.)

The authors conducted two studies to explore online game players' flow experiences and positive affect. Our findings indicated that online game are capable of evoking flow experiences and positive affect, and games of violent or nonviolent type may not arouse players' aggression. The players could be placed into four flow conditions: flow, boredom, anxiety, and apathy, as determined by level of perceived challenges and skills. The majority of players entered the flow condition when playing violent or non-violent online game. The path analysis results suggested that violent online games may have a significant but indirect effect on positive affect via flow experience mediation. (Contains 2 figures and 1 table.)

To deepen our understanding of those aspects of problems that cause the most difficulty for solvers, this study integrated eye-tracking with handwriting devices to investigate problem solvers' online processes while solving geometry problems. We are interested in whether the difference between successful and unsuccessful solvers can be identified by employing eye-tracking and handwriting. Sixty-two high school students were required to complete a series of geometry problems using pen tablets. Responses, including eye movement measures, wrote/drew trace, perceived cognitive load and questionnaires concerning the source of difficulties, were collected. The results suggested that the technique could enhance methods to diagnose difficulties by differentiating between successful and unsuccessful solvers. We considered mental rotation could be a primary obstacle in the integrating stage of diagram comprehension. The technique can be extensively applied in various instructional scenarios. Educational implications for problem solving are discussed.

OBJECTIVES: To assess whether hospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program for joint replacement changed their referral patterns to favor higher-quality skilled nursing facilities (SNFs). STUDY DESIGN: Retrospective observational study using 2009-2015 inpatient and outpatient claims from a 20% sample of Medicare beneficiaries undergoing joint replacement in US hospitals (N = 146,074) linked with data from Medicare's BPCI program and Nursing Home Compare. METHODS: We ran fixed effect regression models regressing BPCI participation on hospital-SNF referral patterns (number of SNF discharges, number of SNF partners, and SNF referral concentration) and SNF quality (facility inspection survey rating, patient outcome rating, staffing rating, and registered nurse staffing rating). RESULTS: We found that BPCI participation was associated with a decrease in the number of SNF referrals and no significant change in the number of SNF partners or concentration of SNF partners. BPCI participation was associated with discharge to SNFs with a higher patient outcome rating by 0.04 stars (95% CI, 0.04-0.26). BPCI participation was not associated with improvements in discharge to SNFs with a higher facility survey rating (95% CI, -0.03 to 0.11), staffing rating (95% CI, -0.07 to 0.04), or registered nurse staffing rating (95% CI, -0.09 to 0.02). CONCLUSIONS: BPCI participation was associated with lower volume of SNF referrals and small increases in the quality of SNFs to which patients were discharged, without narrowing hospital-SNF referral networks. [ABSTRACT FROM AUTHOR]

We investigate Alzheimer's disease and related dementia (ADRD) prevalence, incidence rate, and risk factors in individuals racialized as Asian and/or Asian‐American and assess sample representation. Prevalence, incidence rate, risk factors, and heterogeneity of samples were assessed. Random‐effects meta‐analysis was conducted, generating pooled estimates. Of 920 records across 14 databases, 45 studies were included. Individuals racialized as Asian and/or Asian‐American were mainly from Eastern and Southern Asia, had higher education, and constituted a smaller sample relative to non‐Hispanic white cohorts. The average prevalence was 10.9%, ranging from 0.4% to 46%. The average incidence rate was 20.03 (12.01‐33.8) per 1000 person‐years with a range of 75.19–13.59 (12.89‐14.33). Risk factors included physiological, genetic, psychological, behavioral, and social factors. This review underscores the systemic underrepresentation of individuals racialized as Asian and/or Asian‐American in ADRD research and the need for inclusive approaches accounting for culture, language, and immigration status. Highlights: There is considerable heterogeneity in the prevalence of ADRD among studies of Asian‐Americans.There is limited data on group‐specific risk factors for ADRD among Asian–Americans.The average prevalence of (ADRD) among Asian–Americans was found to be 7.4%, with a wide range from 0.5% to 46%. [ABSTRACT FROM AUTHOR]

The authors defined optimal experience as a functional state of a relatively high level of concentration, time distortion, satisfaction, and enjoyment (Csikszentmihalyi, 1992) and collected data through the Day Reconstruction Method. In three random days, 147 fifth-grade students answered questionnaires for each school event in the previous day resulting repeated data from 2,288 episodes. Several hierarchical linear models were conducted. The authors found that elementary students perceived better quality of optimal experience during break time versus classes taught by activity, seatwork or lecture methods. Unexpectedly, more optimal experience was reported in the events when students perceived themselves as having high skill but low challenge, contradictory to the original expectation of skill-challenge balance. Four additional flow conditions were more effective than primary flow condition and instructional methods in predicting optimal experience. Finally, optimal experience varied much more across event-episodes than among individuals meaning that teachers have rooms to improve students' optimal experience in elementary school days.

Preparing patients for posthospital care may improve readmission risk. Alternative payment models (APMs) incent hospitals to reduce readmissions by tying payment to outcomes. The impact of APMs on preparation for discharge is not well understood. We assessed whether patient-reported preparation for posthospital care was associated with reduced readmissions, and whether APM participation was associated with improved preparation for posthospital care. We used mixed-effects regression on retrospective (2013–2017) observational data for 2685 U.S. hospitals. We measured patient-reported preparation for posthospital care using the 3-Item Care Transition Measure and readmission using 30-day all-cause risk-adjusted readmissions from Hospital Compare. Participation in accountable care organizations (ACOs), Medical Homes, and Medicare's Bundled Payments for Care Improvement program was obtained from Medicare, the American Hospital Association's Annual Survey, and Leavitt Partner's ACO database. We found that APMs are not associated with improved preparation for posthospital care, even though it was associated with reduced readmissions (Marginal Effect: −0.012 percentage points). This may be because hospitals are not investing in patient engagement. This study has limited insight into causality and reduced generalizability among smaller, rural, and non-teaching hospitals. [ABSTRACT FROM AUTHOR]

The present study investigated the effects of providing subtitles and taking enotes on cognitive load and performance. A total of 73 English-as-a-Foreign-Language (EFL) undergraduates learned brain anatomy and cognitive functions through multimedia programs. We used a 2 (subtitle/no) x 2 (taking enotes/no) factorial design to test the following: (1) if cognitive demand would vary among different groups, and (2) if providing subtitles or taking enotes would facilitate learning. Four versions of multimedia materials had exactly the same content and differed only in the availability of subtitles or enote functions. The enote tool was designed for effective note-taking with regard to video/animation, making it possible to directly link notes to a specific scene. The results indicated that animation with subtitles groups help reduce cognitive load and increase performance. No significant differences were found in either cognitive load or post-performance for those who learned with or without taking enotes. Although previous studies suggest subtitles may lead to a split-attention effect for native learners, we found a dual-coding effect (or reverse split-attention effect) for EFL learners.