Bridging the Gap: Including Patient Voices in Short-Term Medical Mission Evaluations.

BACKGROUND: Several studies have evaluated short term medical missions (STMM), but most have been from the perspective of the STMM teams providing their own suggestions [1]; few surveys have assessed the perceptions of patients who seek medical care at these STMM clinics [2]. OBJECTIVES: This project evaluates the efficiency, quality, and value of the services provided by a STMM clinic established in the community of Paraíso in Santo Domingo Norte, Dominican Republic, as perceived by the patients. Study results will allow organizers to make improvements to these clinics and will contribute to a broader understanding of the benefit and value of medical services provided by STMMs. METHODS: A mixed method, cross-sectional survey was created which consisted of 11 questions and a medication quiz. The survey questions were based on items used in prior surveys, as well as the participant responses to those surveys, and attempted to address perceived efficiency, quality, value, and effectiveness of services provided, as well as the impact on the community. FINDINGS: Two-hundred sixty-six patients were invited to complete the survey, and 117 (44%) were enrolled in the study. The majority of survey responses were positive and highlighted patients' satisfaction with provider skills and communication. Of note, many responses identified longer than anticipated wait times during two portions of the patient encounter and self-reported deferral of local care to receive care with the STMM. Additionally, although average medication quiz scores were high, average scores decreased with age. CONCLUSIONS: This study brings to light patient perceptions of services at a STMM in the community of Paraíso in Santo Domingo Norte, Dominican Republic. Survey responses highlight the importance of efforts to: minimize clinic wait time; enhance collaboration between local providers and STMMs to reduce deferral of care; and improve medication knowledge among the geriatric population.

Canonical correlation analysis of brain prefrontal activity measured by functional near infra-red spectroscopy (fNIRS) during a moral judgment task.

Individuals differ in the extent to which they make decisions in different moral dilemmas. In this study, we investigated the relationship between functional brain activities during moral decision making and psychopathic personality traits in a healthy population. We measured the hemodynamic activities of the brain by functional near-infrared spectroscopy (fNIRS). FNIRS is an evolving non-invasive neuroimaging modality which is relatively inexpensive, patient friendly and robust to subject movement. Psychopathic traits were evaluated through a self-report questionnaire called the Psychopathic Personality Inventory Revised (PPI-R). We recorded functional brain activities of 30 healthy subjects while they performed a moral judgment (MJ) task. Regularized canonical correlation analysis (R-CCA) was applied to find the relationships between activation in different regions of prefrontal cortex (PFC) and the core psychopathic traits. Our results showed a significant canonical correlation between PFC activation and PPI-R content scale (PPI-R-CS). Specifically, coldheartedness and carefree non-planfulness were the only PPI-R-CS factors that were highly correlated with PFC activation during personal (emotionally salient) MJ, while Machiavellian egocentricity, rebellious nonconformity, coldheartedness, and carefree non-planfulness were the core traits that exhibited the same dynamics as PFC activation during impersonal (more logical) MJ. Furthermore, ventromedial prefrontal cortex (vmPFC) and left lateral PFC were the most positively correlated regions with PPI-R-CS traits during personal MJ, and the right vmPFC and right lateral PFC in impersonal MJ.

The role of prefrontal cortex in a moral judgment task using functional near-infrared spectroscopy.

BACKGROUND: Understanding the neural basis of moral judgment (MJ) and human decision-making has been the subject of numerous studies because of their impact on daily life activities and social norms. Here, we aimed to investigate the neural process of MJ using functional near-infrared spectroscopy (fNIRS), a noninvasive, portable, and affordable neuroimaging modality. METHODS: We examined prefrontal cortex (PFC) activation in 33 healthy participants engaging in MJ exercises. We hypothesized that participants presented with personal (emotionally salient) and impersonal (less emotional) dilemmas would exhibit different brain activation observable through fNIRS. We also investigated the effects of utilitarian and nonutilitarian responses to MJ scenarios on PFC activation. Utilitarian responses are those that favor the greatest good while nonutilitarian responses favor moral actions. Mixed effect models were applied to model the cerebral hemodynamic changes that occurred during MJ dilemmas. RESULTS AND CONCLUSIONS: Our analysis found significant differences in PFC activation during personal versus impersonal dilemmas. Specifically, the left dorsolateral PFC was highly activated during impersonal MJ when a nonutilitarian decision was made. This is consistent with the majority of relevant fMRI studies, and demonstrates the feasibility of using fNIRS, with its portable and motion tolerant capacities, to investigate the neural basis of MJ dilemmas.

Exploring the role of task performance and learning style on prefrontal hemodynamics during a working memory task.

Existing literature outlines the quality and location of activation in the prefrontal cortex (PFC) during working memory (WM) tasks. However, the effects of individual differences on the underlying neural process of WM tasks are still unclear. In this functional near infrared spectroscopy study, we administered a visual and auditory n-back task to examine activation in the PFC while considering the influences of task performance, and preferred learning strategy (VARK score). While controlling for age, results indicated that high performance (HP) subjects (accuracy > 90%) showed task dependent lower activation compared to normal performance subjects in PFC region Specifically HP groups showed lower activation in left dorsolateral PFC (DLPFC) region during performance of auditory task whereas during visual task they showed lower activation in the right DLPFC. After accounting for learning style, we found a correlation between visual and aural VARK score and level of activation in the PFC. Subjects with higher visual VARK scores displayed lower activation during auditory task in left DLPFC, while those with higher visual scores exhibited higher activation during visual task in bilateral DLPFC. During performance of auditory task, HP subjects had higher visual VARK scores compared to NP subjects indicating an effect of learning style on the task performance and activation. The results of this study show that learning style and task performance can influence PFC activation, with applications toward neurological implications of learning style and populations with deficits in auditory or visual processing.