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The purpose of this study was to investigate secondary science teachers' PCK components and subcomponents that are specific to online and offline learning environment. Data collection consisted of survey, class observation, and individual interviews of twelve science teachers. This study used a theoretical framework of PCK for deductive data analysis and articulated codes and themes through the following inductive analysis. Data analysis revealed that each of PCK components showed different specificity to the online and offline learning environment. And subcomponents of each PCK component were different according to the specificity of the online and offline learning environment. Teaching orientation toward science had a specific orientation for the online learning environment, i.e., `learning science concept' and `lecture centered instruction.' Knowledge of the science curriculum had online-offline mixed learning environment specific knowledge, i.e., `reorganization of curriculum' and online learning environment specific knowledge, i.e., `development of learning goal' and `science curricular materials.' Knowledge of science teaching strategies had online learning environment specific knowledge, i.e., `topic-specific strategy', `subject-specific strategy', and `interaction strategy' and COVID-19 offline learning environment specific knowledge, i.e., `topic-specific strategy' and `interaction strategy'. Knowledge of student science understanding had online learning environment specific knowledge, i.e., `student preconception', `student learning difficulty', `student motivation and interest', and `student diversity' and COVID-19 offline learning environment specific knowledge, i.e., student learning difficulty'. Knowledge of science assessment had online-offline mixed learning environment specific knowledge and online learning environment specific knowledge, i.e., assessment contents and assessment methods for each.
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Outcomes: 1. Evaluate the effectiveness of a virtual communication workshop in comparison to prior in-person format. 2. Gauge medical students' level of emotional support during an advanced communication workshop in the virtual setting. Introduction: Medical schools rapidly adopted virtual learning in response to the COVID-19 pandemic. Many descriptions of virtual objective-structured clinical examinations (OSCE) have been published;however, there have been no studies comparing the effectiveness of in-person and virtual formats for medical students. Method(s): The investigators revised a previously conducted workshop from in-person to virtual format. The workshop is a five-station formative OSCE focused on advanced communication skills for senior medical students. After each station, examinees completed a self-assessment checklist (Communication Behavior Checklist;CBC) and received checklist-based assessments (CBC and modified Master Interview Rating Scale;mMIRS) from two same-level peers. Afterward, a faculty-led debrief was performed to review clinical cases, emotional responses, and student questions. A post-OSCE survey based on one collected after the prior in-person OSCE was distributed to students. Result(s): Eighty-three students participated in the virtual OSCE. Overall, CBC scores were lower in the virtual OSCE compared to in-person (p<0.05). There was no difference in mMIRS scores between virtual and in-person OSCE. Sixty-seven out of 83 (80.7%) students completed the post-OSCE survey. Results showed no difference between virtual and in-person OSCE in terms of educational value, whether the OSCE would change the way participants talk to patients, and preparedness to have serious conversations with patients. All 67 students somewhat or strongly agreed with feeling emotionally supported during the virtual OSCE. Discussion(s): In conclusion, a virtual OSCE on advanced communication skills was well received by students who reported similar educational value compared with a prior in-person OSCE. Students felt emotionally supported in the virtual format. While student performance related to interview process (mMIRS) was similar, scores on interview content (CBC) were significantly lower in the virtual environment compared with the prior in-person OSCE. For future virtual iterations, modifications may be necessary to ensure adequate instruction on interview content.Copyright © 2023
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Background/Purpose: The COVID-19 pandemic and associated mitigation procedures have significantly altered daily life in ways that may disproportionately affect patients with CNS tumors. This study aimed to explore differences in symptom burden and interference, mood disturbance, and health-related quality of life in the CNS tumor patient population during the COVID-19 pandemic, compared to a normative sample of pre-pandemic data. Method(s): Data from the Neuro-Oncology Branch (NOB) Natural History Study, including demographic and clinical data, as well as PROs including PROMIS Anxiety and Depression Short-Forms, EQ- 5D-3L, MDASI-Brain Tumor/Spine Tumor, and NeuroQOL-Cognition Function, were collected and compared across groups ('NOB normative sample' and 'COVID year' patients) using one-sample proportion tests. Result(s): 178 COVID year CNS tumor patients (55% male, 82% Caucasian, median age 45 years) were compared with 678 NOB normative sample patients with similar demographic and clinical characteristics. Symptom burden remained comparably high during the COVID year compared to the NOB normative sample with the most common moderate-severe symptoms being fatigue (31% vs. 35%), difficulty remembering (28% vs. 24%), drowsiness (22% vs. 25%), disturbed sleep (20% vs. 22%), and distress (20% for both). However, a significantly greater proportion of COVID year assessments endorsed moderate-severe depression on the PROMIS compared to the NOB normative sample (17% vs. 12%, p = 0.023, Cohen's h = 0.22) and moderate-severe depression/anxiety on the EQ-5D-3L was also more prevalent (53% vs. 43%, p = 0.009, Cohen's h = 0.28). There were no other significant differences in PROs between groups. Conclusions and Implications: These findings demonstrated that while objective symptom burden for CNS tumor patients was unchanged, there was an increase in depression reported during the COVID-19 pandemic. Future work should investigate potential pandemic-era interventions for screening, targeting, and improving both mood disturbance and other disease-specific symptoms to improve symptom burden and quality of life.
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Throughout the COVID-19 pandemic, there have been an increasing number of hate crimes perpetrated against Chinese and non-Chinese Asian Americans. Some hate incidents suggest that Chinese Asian Americans have been mainly targeted followed by non-Chinese Asian Americans. The present study examined the influence of victim Chinese phenotypicality (CP) and participant individual differences on COVID-19-related prejudice and discrimination. Participants were presented with a mock news story detailing a restaurant employee (varying in CP) who tested positive for COVID-19 but went to work despite warnings to quarantine and allegedly spread COVID-19 to other employees and customers. CP was manipulated through photographs embedded within the mock news story of the employee (White (control) vs. Low CP vs. High CP). After reading the news story, participants completed measures of prejudice and discrimination endorsement along with measures of individual differences. Results revealed that CP influenced prejudice and support for discrimination, but only for individuals with certain characteristics (e.g., low income). The findings highlight individual difference characteristics among perpetrators of prejudice and discrimination against Asian Americans, in addition to phenotypic variations among those who may be victims of hate related to the COVID-19 pandemic. © The Author(s) 2022.
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Throughout the COVID-19 pandemic, there have been an increasing number of hate crimes perpetrated against Chinese and non-Chinese Asian Americans. Some hate incidents suggest that Chinese Asian Americans have been mainly targeted followed by non-Chinese Asian Americans. The present study examined the influence of victim Chinese phenotypicality (CP) and participant individual differences on COVID-19-related prejudice and discrimination. Participants were presented with a mock news story detailing a restaurant employee (varying in CP) who tested positive for COVID-19 but went to work despite warnings to quarantine and allegedly spread COVID-19 to other employees and customers. CP was manipulated through photographs embedded within the mock news story of the employee (White (control) vs. Low CP vs. High CP). After reading the news story, participants completed measures of prejudice and discrimination endorsement along with measures of individual differences. Results revealed that CP influenced prejudice and support for discrimination, but only for individuals with certain characteristics (e.g., low income). The findings highlight individual difference characteristics among perpetrators of prejudice and discrimination against Asian Americans, in addition to phenotypic variations among those who may be victims of hate related to the COVID-19 pandemic.
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Background/Purpose: Since the outbreak of COVID-19 was declared a pandemic, there has been concern regarding the social isolation born from safety mandates. Literature suggests that social distancing guidelines provoke anxiety and uncertainty among children and adolescents. This study aims to evaluate the effects of pandemic guidelines on pediatric patients with craniofacial conditions (CFCs), by studying the Health-Related Quality of Life (HRQoL) in a matched sample of pediatric patients with CFCs prior to and during the COVID-19 pandemic. Methods/Description: This matched cohort study (N=88) utilized the Craniofacial Quality of Life Scale (CFC-QoL), a bilingual patient- and parent-reported outcome measure, to assess social and psychological HRQoL domains. CFC-QoL surveys were collected from CFC patients and parents prior to March 11, 2020 (pre-pandemic) and compared to a separate cohort that completed the survey after July 1, 2020, during the pandemic. The patients in each sample (n = 44) were matched by diagnosis (bilateral or unilateral cleft lip and palate, craniosynostosis, microtia or dermatologic condition), age range (7-12, 13-17, 18+) and gender. Mean scores for both patient and parent responses to each survey item within the social and psychological impact subscales were computed and compared between the matched cohorts. Results: Comparison of mean responses found significant differences between the pre-pandemic and pandemic cohorts. On the social impact subscale, patients in the pandemic sample reported that 'People tease me', 'People ask me what is wrong with my face', and 'People notice that my face is different' less often than those in the pre-pandemic sample (p = .021;p = .041;p = .038). Parents in the pandemic sample reported 'People ask my child what is wrong with their face' and 'People notice my child's face is different' less often compared to the pre-pandemic sample (p = .040;p = .020). Within the psychological subscale, patients in the pandemic sample reported feeling less worried about their future (p = .030), less anxious or scared (p = .024), and more likely to try new things (p = .039) compared to those who answered the survey pre-pandemic. The parents in the pandemic sample reported 'My child feels bad about himself/herself' less often compared to parents in the prepandemic sample (p = .038). Conclusions: This study found that a sample of patients with CFCs and their parents reported better indications of social and psychological HRQoL during the COVID-19 pandemic compared to a matched pre-pandemic cohort. Factors that might influence these findings include decreased negative social impact due to containment measures such as school closures. Additionally, enforced mask wearing in social settings may serve as a protective barrier to decrease negative attention drawn toward a child's facial differences.
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Primary brain tumor (PBT) patients experience high symptom burden and functional limitations, which may be impacted by the economic strain and mood disturbance during the COVID-19 pandemic. We assessed financial toxicity and associated patient reported outcomes (PROs) after one year of lockdown in a cohort of PBT patients. Patient and disease characteristics and PROs including FACIT-COST, MDASI-Brain Tumor, PROMISAnxiety/ Depression short forms, and EQ-5D-3L were collected from 7/2020 to 5/2021 from participants in our Natural History Study. Descriptive statistics, Pearson correlations, and independent samples t-tests evaluated PRO relationships. The cohort included 112 PBT patients: 57% male, 87% white, mean age = 47 (range 25 - 80). Majority were married (65%), completed ≥ 4-year college degree (73%), earned annual family income ≥ $50,000 (68%) and living with a high-grade glioma (72%) complicated by recurrence (51%). Using FACIT-COST, 56% reported some financial hardship due to illness with a mean FACIT-COST of 28.3 (SD = 11.3, range: 0 - 44). Half of patients reported feeling moderately to extremely anxious or depressed. Non-Whites and Hispanics as well as those not currently working reported worse financial toxicity compared to White non- Hispanics and individuals currently working (21.4 vs 29.8 and 25.7 vs 30.4, respectively). Worse financial toxicity scores strongly correlated with worse overall symptom burden (r = -0.55) and interference (r = -0.42), worse anxiety (r = -0.39) and depression scores (r = -0.44), and worse overall HRQOL scores (r = -0.33)[all p< .01]. This is the first report of FACIT-COST in PBT patients to our knowledge and demonstrates that non-White individuals living with high grade glioma who are not currently working due to their tumor reported worse financial toxicity which was strongly correlated with higher symptom burden and interference with lower HRQOL. Future studies to assess financial toxicity longitudinally and post-pandemic using the FACIT-COST are needed.
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BACKGROUND: Primary CNS tumors are associated with uncertainty likely contributing to mood disturbance that is common throughout the disease trajectory. The intersection of the COVID-19 pandemic with a CNS tumor diagnosis may further impact the anxiety/depression experienced in this population. This study assessed key anxiety/depression symptoms in patients with CNS tumors prior to and during the COVID year. METHODS: Patient reported outcomes (PROs), including the PROMIS Anxiety and Depression Short Forms and EQ-5D-3L, were collected at the time of clinical or telehealth evaluation from the COVID year (March 2020-February 2021) and were compared to assessments through February 2020 (a NOB-normative sample), reflecting what we would typically see in our regular clinic evaluations. RESULTS: The COVID sample (N = 178) was primarily White (82%), male (55%), median age of 45 (range 18-79), and KPS 3 90 (50%). The majority had high grade (70%) brain (83%) tumors with 3 1 prior recurrence (60%) and 25% were on active treatment. Visits were primarily conducted via telehealth (64%) and 20% had progression at assessment. Compared to the NOB-normative sample, patients reported significantly higher depression scores (moderate-severe, 17% vs. 12%, p < 0.05), but not anxiety (18% vs. 16%). Eleven percent reported both moderate-severe anxiety and depressive symptoms (8% pre-COVID). Overall health assessed by the EQ-5D-3L was similar to the normative sample in all dimensions, apart from impact of moderate/extreme mood disturbance, which was more prevalent in the COVID year (53% vs. 43%, p < 0.05%). CONCLUSION: Patients with CNS tumors are at risk for significant symptoms of depression and anxiety;this risk was heightened during the COVID year. Further evaluation of clinical factors associated with risk are underway. These findings highlight the need for assessments and interventions that can be administered via telehealth to address the mental health needs of this vulnerable population.
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CNS tumor patients are highly symptomatic causing interference with activity and worse quality of life. Social distancing due to the COVID-19 pandemic increased demands on the patient, caregivers, clinicians, and the health care system. The NCI's Neuro-Oncology Branch Natural History Study (NHS) systematically collected patient-reported outcomes (PROs) provide insight into how these challenges influenced symptom burden and interference during the COVID year. METHODS: Patient and disease characteristic as well as patient-reported symptoms and interference (MDASI-BT/-SP) and general health status (EQ-5D-3L) from 3/2020-2/2021) were compared to NHS normative sample collected prior to 3/2020. RESULTS: The sample (n = 178) was primarily White (82%), male (55%), median age of 45 (range 18 - 79) and KPS 3 90 (51%). The majority had high-grade (70%) brain (83%) tumors (BT) with ≥ 1 prior recurrence (60%) and 25% were on active treatment. Clinical visits were primarily conducted via telehealth (64%) and 20% of all patients were diagnosed with progression at the time of assessment. Most commonly reported moderate-severe symptoms among BT patients were fatigue (30%), difficulty remembering (28%), feeling drowsy (22%). Among spinal cord tumor patients, fatigue (39%), pain (35%) and numbness/tingling in arms/legs/trunk (35%) were most frequently reported. These symptoms were reported in similar frequencies by the normative sample. Nearly half of the COVID year sample (48%) reported moderatesevere activity-related interference. Reported problems with mobility (38%), self-care (19%), pain/discomfort (40%), and usual activities (50%) were similar in both groups except for increased mood disturbance (53%) was reported during the COVID year. CONCLUSION: These findings support CNS tumor patients remained highly symptomatic with significant impact on health-related quality of life during the COVID year. Clinicians should develop timely individual care plans to help BT patients navigate their disease course. Evaluation of risk associated with more severe symptoms and functional limitations are ongoing.
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Background: Coronavirus disease 2019 (COVID-19) has infected over 62 million people worldwide as of November 28, 2020. Emerging studies have revealed a high prevalence of gastrointestinal (GI) symptoms among patients with COVID-19, and coronavirus particles have been found in their stool. However, there are minimal data regarding the impact of COVID-19 severity on the GI system. In this study, we evaluated GI and hepatobiliary manifestations in a large number of hospitalized patients across the United States (US) with COVID-19 based on admission to the intensive care unit (ICU), a surrogate for COVID-19 severity. Methods: Seven US academic centers ed data from patients who had a positive COVID-19 test and were hospitalized. Demographics, presenting symptoms, clinical, and laboratory data were ed, as were hospitalization outcomes. Patients were stratified According to admission to the ICU (yes/no) during their hospital course. GI and hepatobiliary manifestations and outcomes were compared using the Chi-square test, and parametric laboratory values were compared using Student’s t test. Results: Of a total of 1,896 COVID-19 positive patients, 730 patients (38.5%) were admitted to the ICU (Table 1). ICU admissions were more likely to be male (64.2% vs. 52.1%;p<0.01). The most common presenting symptom was dyspnea in ICU patients (57.8%) versus cough in non-ICU patients (47.9%).The prevalence of patients reporting GI symptoms was similar between ICU and non-ICU patients (20.4% vs 21.1%;p=0.14). Compared with non-ICU patients, ICU patients had a higher prevalence of abnormal serum aspartate aminotransferase (AST) values (16.0% vs. 6.7%;p<0.01) and total bilirubin > 3 mg/dL (3.1% vs. 0.8%;p<0.01) (Table 2). There was not a significant difference in prevalence of abnormal alanine aminotransferase (ALT) values between the two groups (9.6% vs. 7.1%;p=0.13). The peak values of AST, ALT, and total bilirubin among all patients in the cohort were 3384 U/L, 1274 U/L, and 54 mg/dL, respectively. Conclusions: In a large US-based cohort of hospitalized patients with COVID-19, GI symptoms did not differ between ICU and non-ICU patients despite their high prevalence. ICU patients were more likely to have serum liver test abnormalities. In this context, further investigation is needed to clarify whether hepatobiliary dysfunction stems from direct injury from COVID-19 or an indirect effect of ICU-related multi-organ dysfunc-tion. Such insight would help guide future management to reduce the risk of and mitigate hepatic injury in these patients (Table Presented) (Table Presented)
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Background: Coronavirus disease 2019 (COVID-19) has infected over 14 million people in the United States (US) as of December 1, 2020. Recent data have shown that COVID-19 strains appear to demonstrate geographic variation, such as Asian strains predominating in the Western US and European strains predominating in the Eastern US. However, the clinical significance of this variation remains unclear. In this large, multi-center cohort study, we evaluated gastrointestinal (GI) manifestations of COVID-19 regionally and throughout the US. Methods: Patients hospitalized with a positive COVID-19 test were identified at seven US academic centers. As a surrogate for differing COVID-19 strains, patients were stratified into regions (West, Midwest, or Northeast) depending on hospital location. Demographics, presenting symptoms, laboratory data, and hospitalization outcomes were ed. Statistical comparisons were performed with Chi-square and ANOVA tests, as appropriate. Results: A total of 1896 patients were identified (Table 1). Most patients were male (56.8%), and the most prevalent race was Caucasian (40.5%). The mean age was 58.1 years (±19.1), and the mean body mass index (BMI) was 29.9 (±8.4). A third (29.2%) of patients had a known COVID-19 exposure. The mean presenting temperature was 37.3 °C, and dyspnea was the most common presenting symptom (48.2%). GI symptoms were present in 20.3% of the overall cohort (Table 2);diarrhea was most common (12.4%), followed by nausea and/or vomiting (10.3%) and abdominal pain (6.0%). Geographically, GI symptoms were significantly less common in the Western cohort (17.8%) than the Northeastern (25.6%) and Midwestern (26.7%) cohorts. GI complications (GI hemorrhage and pancreatitis) were also significantly less common in the Western cohort (1.5%, 0.2%) than the Northeastern (6.9%, 1.5%) and Midwestern (3.3%, 1.7%) cohorts. The Midwestern cohort had a higher prevalence of moderately elevated serum aspartate aminotransferase (AST;23.5% vs 8.5% in Western and 10.5% in Northeastern cohorts;p<0.01). Compared to the Northeastern and Midwestern cohorts, the Western cohort had a higher prevalence of mildly elevated serum alanine aminotransferase (ALT;20.9% and 20.9% vs 28.5%;p=0.01) and total bilirubin (6.7% and 7.0% vs 11.4%;p=0.03). The presence of GI symptoms was not associated with increased mortality (p=0.15). Conclusions: Although GI manifestations were common among patients hospitalized with COVID-19, there is significant variability in prevalence across the US. GI symptoms and complications were less common in the West than the Northeast or Midwest. Our study highlights notable geographic variations in GI manifestations of COVID-19, prompting the need for further investigation into the mechanisms of these differences. Such insight could identify strategies that mitigate GI complications of COVID-19 infection.(Table presented) Demographic and Clinical Data of Patients with COVID-19 by Geographic Region. (Table presented) Gastrointestinal Manifestations of COVID-19 in Patients by Geographic Region.
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Background: Although the use of remdesivir and systemic corticosteroids have reduced deaths from COVID-19, COVID-19 still has a high mortality rate. Aims: To know the effectiveness of the combined use of remdesivir and regdanvimab (CT-P59) in patients with severe COVID-19. Methods: From March to early May 2021, 124 severe COVID-19 patients were admitted to Ulsan University Hospital (Ulsan, Korea), and received oxygen therapy and remdesivir. Among them, 25 were administered regdanvimab before oxygen/remdesivir. We retrospectively compared the outcomes of the two groups: remdesivir alone group (n = 99 [79.8%]) vs. regdanvimab/remdesivir group (n = 25 [20.2%]). Results: The oxygen-free days at day 28 (primary outcome), defined as the number of days a patient was alive and oxygen-free for 28 days from oxygen/remdesivir start, were significantly higher in regdanvimab/remdesivir group (mean ± SD [standard deviation]: 19.36 ± 7.87 vs. 22.72 ± 3.66, P = 0.003). The association between the regdanvimab/ remdesivir group and the oxygen-free days was also significant in multivariate analysis (logistic regression), where the initial SpO2/FiO2 ratio (severity index) was adjusted. Further, in the regdanvimab/remdesivir group, the lowest SpO2/FiO2 ratio during treatment was significantly higher (mean ± SD: 237.05 ± 89.68 vs. 295.63 ± 72.74, P = 0.003), and the Kaplan-Meier Estimate of oxygen supplement days in surviving patients (at day 28) were significantly shorter (mean ± SD: 8.24 ± 7.43 vs. 5.28 ± 3.66, P (log-rank test) = 0.024). Conclusions: In severe COVID-19 patients, clinical outcomes could be improved by using regdanvimab in addition to remdesivir.
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Clinicians have commented that ‘your zip code means more than your genetic code.’ Communities such as Chicago’s Fuller Park lack key socioeconomic opportunities that are correlated with lower health literacy rates, contributing to health disparities which have further exacerbated amidst the COVID-19 pandemic. Despite making up only 30% of Chicago’s population by race, African Americans are disproportionately impacted by COVID-19, accounting for 44% of cases and 48% of deaths in Chicago. Specific risk factors such as diabetes, hypertension, coronary conditions, and old age are prominently observed in these communities, making them more vulnerable to acquiring COVID-19. The Dance PAMOJA Challenge (DPC), coordinated by the Red Clay Dance Company based in Chicago, provides free, biweekly dance classes and education on diabetes, hypertension, COVID-19, nutrition, and resilience as well as resources that can be accessed virtually on the Challenge blog, or the Resilience Portal. The challenge fosters a connection between community members and occupies trust within their network of artivists. The Pamoja Dance Cohort Study is a 12-month, prospective, open-cohort community based participatory research study, characterizing specific health outcomes among challenge participants that are associated with COVID-19 infection. The study observes the health status of DPC dancers, who are armed with information and support regarding COVID-19 fare relative to their age, zip code, ethnicity, and health status in context to COVID-19 hospitalization, death, and risk factor status. Challenge participants are assessed biweekly via a REDCap questionnaire recording their blood pressure, blood sugar level, self-evaluated COVID-19 status, and reflection of their mental resilience. Both qualitative and quantitative outcomes for DPC participants will be evaluated within this paper at the conclusion of this study. Keywords: Coronavirus (COVID-19), Dance Pamoja Challenge (DPC), Health disparities, Community-based participatory research, Resilience