Association of Inventory to Measure and Assess imaGe Disturbance – Head and Neck Scores With Clinically Meaningful Body Image-Related Distress Among Head and Neck Cancer Survivors

Objective: The Inventory to Measure and Assess imaGe disturbance – Head and Neck (IMAGE-HN) is a validated patient-reported outcome measure of head and neck cancer-related body image-related distress (BID). However, the IMAGE-HN score corresponding to clinically relevant BID is unknown. The study objective is to determine the IMAGE-HN cutoff score that identifies head and neck cancer patients with clinically relevant BID.Methods: We conducted a cross-sectional study at six academic medical centers. Individuals ≥18 years old with a history of head and neck cancer treated with definitive intent were included. The primary outcome measure was the IMAGE-HN. A Receiver Operating Characteristic curve analysis was performed to identify the IMAGE-HN score that maximized sensitivity and specificity relative to a Body Image Scale score of ≥10 (which indicates clinically relevant BID in a general oncology population). To confirm the validity of the IMAGE-HN cutoff score, we compared the severity of depressive [Patient Health Questionnaire-9 (PHQ-9)] and anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7)], and quality of life [University of Washington-QOL (UW-QOL)] in patients with IMAGE-HN scores above and below the cutoff.Results: Of the 250 patients, 70.4% were male and the mean age was 62.3 years. An IMAGE-HN score of ≥22 was the optimal cutoff score relative to a Body Image Scale score of ≥10 and represents a clinically relevant level of head and neck cancer-related BID. Relative to those with an IMAGE-HN score of <22, patients with IMAGE-HN scores of ≥22 had a clinically meaningful increase in symptoms of depression (mean PHQ-9 score difference = 5.8) and anxiety (mean GAD-7 score difference = 4.1) as well as worse physical (mean UW-QOL score difference = 18.9) and social-emotional QOL (mean UW-QOL score difference = 21.5). Using an IMAGE-HN cutoff score ≥22, 28% of patients had clinically relevant BID.Conclusion: An IMAGE-HN score of ≥22 identifies patients with clinically relevant head and neck cancer-related BID. This score may be used to detect patients who could benefit from strategies to manage their distress, select patients for studies evaluating interventions to manage head and neck cancer-related BID, and improve our understanding of the underlying epidemiology of the disorder.

Prenatal Exposure to Chemical Mixtures and Cognitive Flexibility among Adolescents

Cognitive flexibility, the ability to smoothly adapt to changing circumstances, is a skill that is vital to higher-level executive functions such as problem-solving, planning, and reasoning. As it undergoes substantial development during adolescence, decrements in cognitive flexibility may not become apparent until this time. There is evidence that prenatal exposure to individual chemicals may adversely impact executive functions in children, but few studies have explored the association of co-exposure to multiple chemicals with cognitive flexibility specifically among adolescents. We investigated this association among a diverse group of adolescents living near a Superfund site in New Bedford, Massachusetts. Specifically, using Bayesian kernel machine regression (BKMR) and multivariable regression analyses, we investigated the association of biomarkers of prenatal exposure to organochlorines (DDE, HCB, PCBs) and metals (lead, manganese) with cognitive flexibility, measured with four subtests of the Delis-Kaplan Executive Function System. In BKMR models, we observed adverse joint associations of the chemical mixture with two of the four cognitive flexibility subtests. In covariate-adjusted linear regression models, a two-fold increase in cord blood Mn was associated with poorer performance on two of the subtests: Trail-Making (scaled score difference = −0.60; 95% CI: −1.16, −0.05 points) and Color-Word Interference (scaled score difference = −0.53; 95% CI: −1.08, 0.01 points). These adverse Mn-cognitive flexibility associations were supported by the results of the BKMR. There was little evidence of effect modification by sex and some evidence of effect modification by a measure of social disadvantage, particularly for the associations between HCB and cognitive flexibility. This study is among the first to provide evidence of an adverse association of prenatal exposure to a chemical mixture with cognitive flexibility in adolescence.

Effectiveness of Online Learning in Auditing Course

This study analyzes the differences in the effectiveness of several online learning in the Auditing course. The Auditing course was held in four models include 1). Without class and assignments 2). The class without giving assignments 3). The class with assignments but without discussion 4). The class with assignments and discussions. This study uses primary data obtained by questionnaires to 105 undergraduate students who have taken auditing courses at several universities in Yogyakarta Special Region. The data were analyzed by the analysis of variance and the Bonferroni test. The results showed that students' understanding of auditing courses varied between some online learning models. The highest student understanding occurred in the class with assignments and discussions. The second rank is the class without assignments is in the third level. Meanwhile, the lowest level is the online learning model without classes and assignments. However, the score difference between the class with assignments but without discussion and the class with assignments and discussions is not significant. It exhibits that the discussion of online assignments has no impact on student understanding.

Evaluation of Musculoskeletal Medicine Knowledge Among Physicians and Physical Therapists in Saudi Arabia: A Cross-Sectional Study

Background: Musculoskeletal (MSK) conditions are rapidly rising in Saudi Arabia and considered the 3rd reason for hospital visits across the country. Despite their prevalence, the adequacy of knowledge in MSK medicine has not been assessed. The purpose of this study is to assess MSK medicine knowledge amongst healthcare providers (orthopedists, primary care physicians, and physical therapists) and medical and physical therapy students and interns.Method: In this cross-sectional study, a web-based 25-question MSK test was given to licensed physical therapists and physicians; as well as final year physical therapy and medical students and interns in Saudi Arabia. One-way analysis of variance was used to determine MSK test scores differences amongst orthopedists, primary care physicians, and physical therapists; and amongst medical and physical therapy students and interns.Results: A total of 680 participants were included (response rate is 86.7%.) The overall MSK test score was 48.2%; and the passing rate was 14%. There was a significant score difference amongst orthopedists (88.8%), primary care physicians (53.6%), and physical therapists (46.7%); F(2,431) = 38.1, p < .001). There was significant score difference amongst physical therapy students (45.3%), physical therapy interns (42.6%), medical students (52.3%) and medical interns (67.4%); F(3,242) = 10.7, p < .001).Conclusion: Except for orthopedists, the MSK medicine knowledge appears inadequate amongst healthcare providers, medical and physical therapy students and interns in Saudi Arabia. To improve knowledge in MSK medicine, increasing contents of MSK medicine in undergraduate education and postgraduate training is necessary.

Are my measures comparable across groups? A unified item- and scale-score-level approach to quantifying scalar non-invariance bias

When scalar invariance does not hold, which is often the case in application scenarios, the amount of non-invariance bias may either be consequential for observed mean comparisons or not. So far, only a few attempts have been made to quantify the extent of bias due to measurement non-invariance. Building on Millsap and Olivera-Aguilar (2012), we derived a new effect size measure, called Measurement Invariance Violation Index (MIVI), from first principles. MIVI merely assumes partial scalar invariance for a set of items forming a scale and quantifies the intercept difference of one non-invariant item (at the item-score level) or several non-invariant items (at the scale-score level) as the share (i.e., proportion) of the total observed scale score difference between groups. One can inspect the cancelation effects of item bias at the scale-score level when using directional instead of absolute terms. We provide computational code and exemplify MIVI in simulated contexts.

Improving Wellness of Operating Room Personnel: A Light-Based Intervention on Perceived Nursing-Related Stress

Background: Nursing is an emotionally demanding and physically draining occupation. Well-being of health care workers is essential to achieve success in care and have good cooperation relationships with other health professionals.Objective: The purpose of this study was to evaluate the effectiveness of a light-based intervention on perceived nursing-related stress in health care personnel working in an operating room environment.Methods: A total of 84 nurses participated in this randomized, cross-over controlled study. Intervention consisted of 4 weeks of bright blue-enriched light exposure using a LED head-mounted portable device (n = 42) or no light exposure (n = 42) separated by a 2-week washout period in a crossover fashion. Participants completes questionnaires for the Nursing Stress Scale (NSS).Results: Intervention and control groups were comparable in terms of demographics, with a median age of 34 (IQR: 27–49) and 69 (82%) female. The mean baseline NSS score was similar in both groups before intervention. The NSS score of the intervention group was significantly lower after intervention than the baseline score: the NSS score difference before and after intervention was 15.1 (SD 7.6) (p &lt; 0.001) and 19.7 (SD 7.5) (p &lt; 0.001) during the two successive periods of intervention, respectively. The cross-group comparison after intervention showed a significantly higher NSS score difference after intervention in the intervention group than the control group: 15.1 (SD 7.6) vs. 1.4 (SD 8.4) (p &lt; 0.001) and 19.7 (SD 7.5) vs. 1.7 (SD 8.9) (p &lt; 0.001) during the two successive periods of intervention, respectively.Conclusion: Alternative person-directed initiatives should be considered to improve the well-being of the health workforce in operating rooms, especially during the coronavirus pandemic.

A-197 Trail Making Test Normative Data from the National Alzheimer’s Coordinating Center: A Comparison of Regression and Non-Regression Methods

Objective Various methods are used to derive normative data for neuropsychological assessment measures. The National Alzheimer’s Coordinating Center (NACC) regression norms (2011) are frequently used within Alzheimer’s Disease Research Centers, yet little research exists comparing these norms to similar regression/non-regression-based norms. Normative data for the widely-used Trail Making Test (TMTA&B) was compared between two regression-based normative data methods (Mitrushina and NACC) and traditional normative methods (i.e., Mayo’s Older Americans Normative Studies [MOANS]). Method TMTA&B data were obtained from 14,873 cognitively normal NACC participants (ages: 50–89; education: M = 15.81, SD = 2.90). T-scores for TMTA&B scores based on Mitrushina, NACC, and MOANS norms were computed. T-scores for regression norms were bounded from 20 to 80. Cohen’s d effect sizes were used to compare differences in scores. Results MOANS and Mitrushina norms produced similar normative scores in the overall sample (TMTA T-score difference = 1.06, d = 0.112, TMTB T-score difference = 1.4, d = 0.144). NACC-derived scores were ~ 0.5 SD below MOANS (TMTA T-score difference = −5.3, d = 0.553, TMTB T-score difference = −4.1, d = 0.427) and Mitrushina scores (TMTA T-score difference = −6.3, d = 0.736, TMTB T-score difference = −5.6, d = 0.615). NACC data produced the lowest average TMTA&B T-scores across all 5-year age band groups. Conclusions Significantly lower TMT scores were obtained using NACC’s regression-based norms compared to both MOANS norms and Mitrushina regression norms. These results underscore that the choice of norms may under and/or overestimate cognitive functioning, and comparison norms must be chosen carefully when making decisions about patients’ cognitive status. Future research applying NACC’s regression-based norms to other commonly used neuropsychological measures is warranted.

A-167 A Comparison of Remotely Administered Verbal Paired Associates Subtests

Objective Due to the COVID-19 pandemic, many services attempted to quickly transition to a remote format. A need to validate remote delivery of neuropsychological measures arose. TestMyBrain (TMB) from the Many Brains Project has been utilizing teleneuropsychology in research since 2017. Method Volunteer research participants (N = 147, Mage = 29, Medu = 15 years, 64.7% white, 54.2% female, 83.2% right-handed, 52.1% utilized Mac Operating System) were administered TMB Verbal Paired Associates(TMBVPA) and WMS-IV Verbal Paired Associates I(VPAI) as part of a larger battery of test via zoom. The WMS-IV assessments adhered to standardization as much as possible such as limiting potential distractions. Results A correlation revealed a positive association between TMBVPA and VPAI r(150) = 0.312, p = &lt; 0.001. A linear regression revealed that performance on the TMBVPA positively predicted performance on the VPAI F(3, 144) = 9.344, p &lt; 0.001 accounting for 16.6% of the variability over and above known demographic variables. The rate of agreeance showed that 23.7% of TMBVPA scores were within a one score difference of the VPAI and 37.4% were within two scores. Conclusions The results suggest that the two remote administration formats may not be as congruent as originally thought. With 62.6% of scores outside of a two-point range and the low rate of agreement this suggests little real-world application of the TMBVPA. Although telepsychology has come a long way, remote neuropsychological measures may still not be a reality any time soon. Future research should compare both remote administration versions to a standardized in person administration as well as consider other factors that can influence administration formats.

Evaluating the effect of interventions for strengthening non-physician anesthetists’ education in Ethiopia: a pre- and post-evaluation study

Background Access to safe surgery has been recognized as an indispensable component of universal health coverage. A competent anesthesia workforce is a prerequisite for safe surgical care. In Ethiopia, non-physician anesthetists are the main anesthesia service providers. The Government of Ethiopia implemented a program intervention to improve the quality of non-physician anesthetists’ education, which included faculty development, curricula strengthening, student support, educational resources, improved infrastructure and upgraded regulations. This study aimed to assess changes following the implementation of this program. Methods A pre-and post-evaluation design was employed to evaluate improvement in the quality of non-physician anesthetists’ education. A 10-station objective structured clinical examination (OSCE) was administered to graduating class anesthetists of 2016 (n = 104) to assess changes in competence from a baseline study performed in 2013 (n = 122). Moreover, a self-administered questionnaire was used to collect data on students’ perceptions of the learning environment. Results The overall competence score of 2016 graduates was significantly higher than the 2013 class (65.7% vs. 61.5%, mean score difference = 4.2, 95% CI = 1.24–7.22, p < 0.05). Although we found increases in competence scores for 6 out of 10 stations, the improvement was statistically significant for three tasks only (pre-operative assessment, postoperative complication, and anesthesia machine check). Moreover, the competence score in neonatal resuscitation declined significantly from baseline (from 74.4 to 68.9%, mean score difference = − 5.5, 95% CI = -10.5 to − 0.5, p < 0.05). Initial gender-based performance differences disappeared (66.3% vs. 65.3%, mean score difference = − 1.0, 95% CI = − 6.11-3.9, p > 0.05 in favor of females), and female students scored better in some stations. Student perceptions of the learning environment improved significantly for almost all items, with the largest percentage point increase in the availability of instructors from 38.5 to 70.2% (OR = 3.76, 95% CI = 2.15–6.55, p < 0.05). Conclusion The results suggest that the quality of non-physician anesthetists’ education has improved. Stagnation in competence scores of some stations and student perceptions of the simulated learning environment require specific attention.