Emerging Socioeconomic Disparities in COVID-19 Vaccine Second-Dose Completion Rates in the United States

Although COVID-19 vaccination plans acknowledge a need for equity, disparities in two-dose vaccine initiation have been observed in the United States. We aim to assess if disparity patterns are emerging in COVID-19 vaccination completion. We gathered (n = 843,985) responses between February and November 2021 from a web survey. Individuals self-reported demographics and COVID-19 vaccination status. Dose initiation and completion rates were calculated incorporating survey weights. A multi-variate logistic regression assessed the association between income and completing vaccination, accounting for other demographics. Overall, 57.4% initiated COVID-19 vaccination, with 84.5% completing vaccination. Initiation varied by income, and we observed disparities in completion by occupation, race, age, and insurance. Accounting for demographics, higher incomes are more likely to complete vaccination than lower incomes. We observe disparities in completion across annual income. Differences in COVID-19 vaccination completion may lead to two tiers of protection in the population, with certain sub-groups being better protected from future infection.

Validation of a Novel Smartphone-Based Electronic Data Capture System Following Surgical Fixation of Distal Radial Fractures

Background: Large prospective institutional data provide the opportunity to conduct level II and III studies using robust methodologies and adequately powered sample-sizes, while circumventing limitations of retrospective databases. We aimed to validate a prospective data collection tool, the Orthopaedic Minimal Data Set Episode of Care (OME), implemented at a tertiary North American health care system for distal radial fracture (DRF) open reduction and internal fixation (ORIF). Methods: The first 100 DRF ORIFs performed after OME inception (February 2015) were selected for this validation study. A blinded review of the operative notes and charts was performed, and extracted data of 75 perioperative DRF ORIF procedure variables were compared with OME collected data for agreement. Outcomes included completion rates and agreement measures in OME versus electronic medical record (EMR)-based control datasets. Data counts were evaluated using raw percentages and McNemar tests. Cohen (κ) and concordance correlation coefficient analyzed categorical and numerical variable agreement, respectively. Results: Overall, OME demonstrated superior completion and agreement parameters versus EMR-based retrospective review. Nine data points (12.0%) demonstrated significantly higher completion rates within the OME dataset ( P < .05, each), and 88% (66/75) of captured variables demonstrated similar completion rates. Up to 80.0% (60/75) of variables either demonstrated an agreement proportion of ≥0.90 or were solely reported in the OME. Of 33 variables eligible for agreement analyses, 36.4% (12/33) demonstrated almost perfect agreement (κ > 0.80), and 63.6% (21/33) exhibited almost perfect or substantial agreement (κ > 0.60). Conclusions: The OME is a valid and accurate prospective data collection tool for DRF ORIF that is reliably able to match or supersede traditional retrospective chart review. Future investigations could use this tool for large-scale analyses investigating peri/intraoperative DRF ORIF variables.

Gamification Increases Completion Rates in Massive Open Online Courses

Massive Open Online Courses (MOOCs) aim at unlimited participation and open access via the web. There are concerns about the actual value of such courses. This is predominantly due to higher dropout rates. According to studies, only 7-13% go on to complete these courses. The high dropout rate in MOOCs is a challenge for education providers. This paper aims to explore reasons for high dropout rates within MOOCs and how they can be minimized. With this in mind, two research questions have been set for this study: 1) Why do MOOC participants not complete their courses? 2) How can the course completion rate be increased? Implementation of the strategies investigated in this paper can increase completion rates in MOOCs. In conclusion, after analyzing the collected data, the final results have shown that gamification increased the completion rate of MOOCs.

Personalized Reminders for Immunization Using Short Messaging Systems to Improve Human Papillomavirus Vaccination Series Completion: Parallel-Group Randomized Trial

Background Completion rates among adolescents who initiate the human papillomavirus (HPV) vaccine 3-dose series are low. SMS text message vaccine reminders are effective, but less is known about the best types for HPV series completion or the ability to assess and target vaccine decision-making stage. Objective The aim of this study is to compare the effectiveness of HPV vaccine series completion in minority adolescents who received precision and educational versus conventional SMS text message reminders. Methods Enrolled parents of adolescents aged 9-17 years who received the first HPV vaccine dose at 1 of the 4 academic-affiliated community health clinics in New York City were randomized 1:1 to 1 of the 2 parallel, unblinded arms: precision SMS text messages (which included stage-targeted educational information, next dose due date, and site-specific walk-in hours) or conventional SMS text messages without educational information. Randomization was stratified according to gender, age, and language. The primary outcome was series completion within 12 months. In post hoc analysis, enrollees were compared with concurrent nonenrollees and historical controls. Results Overall, 956 parents were enrolled in the study. The precision (475 families) and conventional (481 families) SMS text message arms had similarly high series completion rates (344/475, 72.4% vs 364/481, 75.7%). A total of 42 days after the first dose, two-thirds of families, not initially in the preparation stage, moved to preparation or vaccinated stage. Those in either SMS text message arm had significantly higher completion rates than nonenrollees (708/1503, 47.1% vs 679/1503, 45.17%; P<.001). Even after removing those needing only 2 HPV doses, adolescents receiving any SMS text messages had higher completion rates than historical controls (337/2823, 11.93% vs 981/2823, 34.75%; P<.001). A population-wide effect was seen from 2014 to 2016, above historical trends. Conclusions SMS text message reminders led to timely HPV vaccine series completion in a low-income, urban, minority study population and also led to population-wide effects. Educational information did not provide an added benefit to this population. Trial Registration ClinicalTrials.gov NCT02236273; https://clinicaltrials.gov/ct2/show/NCT02236273

The measurement properties and acceptability of a new parent-infant bonding tool (Me and My Baby) designed for use in a universal healthcare setting in the UK

NICE guidelines acknowledge the importance of the parent-infant relationship for child development but highlight the need for further research to establish reliable tools for assessment, particularly for parents of children under one year. This study explores the acceptability and psychometric properties of a co-developed tool, Me and My Baby (MaMB). Study design A cross-sectional design was applied. The MaMB was administered universally (in two sites) 27 with mothers during routine 6 to 8 week Health Visitor contacts. The sample comprised 467 mothers (434 MaMB completers and 33 non-completers). Dimensionality of instrument responses were evaluated via exploratory and confirmatory ordinal factor analyses. Item response modelling was conducted via a Rasch calibration to evaluate how the tool conformed to principles of fundamental measurement. Tool acceptability was evaluated via completion rates and comparing completers and non-completers demographic differences on age, parity, ethnicity, and English as an additional language. Free-text comments were summarised. Data sharing agreements and data management were compliant with the General Data Protection Regulation, and University of York data management policies. Results High completion rates suggested the MaMB was acceptable. Psychometric analyses showed the response data to be an excellent fit to a unidimensional confirmatory factor analytic model. All items loaded statistically significantly and substantially (>0.4) on a single underlying factor (latent variable). The item response modelling showed that most MaMB items fitted the Rasch model. Item reliability was high (0.94) yet the test yielded little information on each respondent, Me and My Baby (MaMB) as highlighted by the person separation index of 0.1 (=>2.0 is required to reliably discriminate between two groups). Conclusions and next steps MaMB reliably measures a single construct, likely to be infant bonding. However, further validation work is needed, preferably with enriched population samples to include higher- need/risk families. The MaMB tool may benefit from reduced response categories (from four to three) and some modest item wording amendments. Following further validation and reliability appraisal the MaMB may ultimately be used with fathers/other primary caregivers and be potentially useful in research, universal health settings as part of a referral pathway, and clinical practice, to identify dyads in need of additional support/interventions.

Data Entry Form Designing Tools and Software Usability in DHIS2

The advent of configurable software has shifted the implementation of software solutions from total reliance on software developers to towards increased participation of end-users. End-users are now able to create software solutions without the need for writing code but through configuration and customisation. Despite the increasing use of configurable software challenges on designing the software platform architecture, process of testing and usability exists in configurable software. The research aimed at evaluating how available interface elements influence usability in DHIS2. Empirical data was collected by studying the design of custom data collection forms for routine health data collection with two groups of users. 80% and 90% were recorded as completion rates of the designed task and overall efficiency of 86.23% and 89.94% was achieved between the two groups. Lack of relevant editing features, increased distance between related objects, lack of conformity to Keep It Simple, Stupid (KISS) and minimalistic design principle were found to be the major challenges affecting the usability.

Let’s talk about doctoral education. A reflection regarding the changes on it

Doctoral education is the link between research and higher education, being a hybrid area. In this context, the doctoral research project must correspond to the demands of both areas. The PhD. supervisor must be a team leader and, at some time, a doctorate guide, and a teacher. The PhD students must learn how to be a part of the research team, and simultaneously develop their research skills and knowledge. But PhD continues to be an individual and solitary journey, being the justification for it, the originality of knowledge created during the PhD. In the last years, in Portugal, PhD students and PhD supervisors were auscultated. The supervisors’ rules were captured, doctorate experiences were collected, and supervision processes were analysed and deepened knowledge about doctoral education. But still, this vision is incomplete not only because few supervisors took part in the research (first because the sample population were limited to one Portuguese University (NOVA Lisbon University) and secondly, because most of the PhD supervisors didn´t respond to the surveys. The data presented in this paper is part of a larger study that started at UNL before the pandemic. It examines the supervisor’s opinion regarding the PhD curriculum, constraints faced in day-to-day supervisor life, changes that may improve doctoral education (completion rates, decrease in attrition, curriculum, team supervision). But he also captures the doctorate perceptions regarding the doctoral research monitorization activities and instruments, constraints, and positive aspects during the PhD journey and, changes to be made in the PhD curriculum.

An 18-year Experience with an Innovative Geriatrics Training Model: Implications for the Workforce

Despite the growing population of older adults, the geriatrics workforce has not similarly expanded. The number of geriatrics fellows has declined by 14.3% from 2012-2017. Implementation of innovative training programs may improve this reality. In 2002, the Medical College of Wisconsin (MCW) created the first four-year combined medicine residency and geriatrics fellowship (Med-Ger). Similar programs are currently being developed. The aim of this study is to describe the outcomes of the MCW Med-Ger program. Primary endpoints: American Board of Internal Medicine (ABIM) pass rates, ABIM Geriatric Medicine Certification pass rates, fellowship completion rates, and geriatric-focused practice. Results: There was a Med-Ger program fill rate of 73.7% (n=38). There was equivalent ABIM pass rate of 100% between Med-Ger graduates (n=18) and traditional graduates (n=25). Med-Ger trainees were more likely to complete their geriatrics fellowship (94.4% vs. 88%) and practice in geriatric-focused careers (82.4% vs. 68.2%). These outcomes suggest the benefit of a combined program for training future geriatricians. The MCW Med-Ger fill rate exceeds the national geriatrics fellowship fill rate of under 50%. Additionally, graduates may be more likely to practice geriatric medicine. This may help address population needs for an increased geriatrics workforce. In 2020, the ACGME approved an Advancing Innovation in Residency Education (AIRE) Medicine-Geriatrics Integrated Residency and Fellowship national pilot program. Further investigation of why trainees choose Med-Ger training and are more likely to continue with careers in geriatrics is needed in order to replicate the success of the MCW Med-Ger program.