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PURPOSE: To determine whether the 12-item state empathy scale could be modified reliably to measure empathy in healthcare professions students and to detect changes in their empathy owing to a single improvisation (improv) session. METHODS: Three cohorts of students from two healthcare professions programs (total = 165 students) participated in an improv session. During the session, one of the researchers (BS) tasked the students with several improv activities. Participants' self-reported state empathy scores were assessed at three time points (pre-improv, post-improv, and end of semester) using revised, in-class paper versions of the State Empathy Scale. RESULTS: The exploratory factor analysis revealed a single factor solution for the revised scale, justifying the creation of an overall state empathy score from the questionnaire. Cronbach's alpha reliability values averaged 0.87. Students' mean empathy scores were higher directly after the improv session than directly prior to the session (p < 0.0001; effect size = r = 0.67, 0.55, and 0.79 for cohorts 1, 2, and 3, respectively). CONCLUSIONS: These findings show that a single one- or two-hour improv session can foster substantial increases in healthcare professional students' state empathy for one another. Greater healthcare professional empathy and compassion foster better healthcare team cooperation and patient outcomes, so healthcare professionals and their students should engage in such empathy-enhancing activities at regular intervals throughout their training and careers.

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Background: This article provides an update of the Reflective Practice Questionnaire (RPQ). The original RPQ consisted of 40-items with 10-sub-scales. In this article, the RPQ is streamlined into a 10-item single reflective practice construct, and a 30-item extended version that includes additional sub-scales of confidence, uncertainty/stress, and work satisfaction. Methods: A total of 501 university students filled out an online questionnaire that contained the original Reflective Practice Questionnaire, and two general measures of reflection: The Self-Reflection and Insight Scale, and the Rumination-Reflection Questionnaire. Results: Based on factor analysis, the RPQ was streamlined into a brief 10-item version, and an extended 30-item version. Small positive correlations were found between the RPQ reflective practice measure and the two measures of general reflection, providing discriminant validity evidence for the RPQ. The RPQ was found to be sensitive to differences among industries, whereas the general measures of reflection were not. Average reflective practice scores were higher for health and education industries compared to retail and food/accommodation industries.

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In studies of investigative interviewing, it is not well understood how participant experience of mock-crime activities might affect participants' desire to perform (well) in subsequent interviews. In this study, we utilized two immersive virtual reality mock-crimes to examine if participants' intrinsic motivation (i.e., competence, autonomy, relatedness) while committing the virtual mock-crime affects their desire to perform well in interviews. We also examined if the self-reported feeling of presence during the virtual reality mock-crime is associated with participants' intrinsic motivation. We found significant positive associations between presence and all intrinsic motivation variables in both truth and lie conditions. We also found that competence and relatedness significantly predicted the self-reported effort to perform well in interviews. We discuss these results in the context of prior literature and provide recommendations for researchers on the design of mock-crime experiences.

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Purpose: Previously we assessed healthcare professional students' feelings about team-based learning, implicit bias, and service to the community using an in-house paper survey. In this study, we determined whether this survey is a reliable and valid measure of prospective medical students' attitudes toward required service-learning in an Immunology course. To our knowledge, no published questionnaire has been shown to be dependable and useful for measuring such attitudes using only eight survey items. Methods: Fifty-eight prospective medical students in Colorado (CO) and 15 in Utah (UT) completed the same Immunology course using remote technology. In addition to the usual course content, students were required to write critical reflections on required team service-learning. On the last day of class, they completed the survey of attitudes toward service-learning (SASL). Results: Data analyses found Cronbach's alpha values of 0.84 and 0.85 for the surveys of UT and CO students, respectively. Factor analysis of CO student data revealed only one Eigenvalue greater than one (3.95) justifying retention of a single factor termed "attitudes toward required service-learning." In addition, CO students' attitudes toward community service were highly positive, while UT students' attitudes were nearer neutral (p < 0.0001). Conclusion: Our factor analysis and good Cronbach's alpha values support the conclusion that the SASL was a reliable measure of prospective medical students' attitudes toward required team service-learning for an Immunology course. Moreover, we used the SASL to distinguish these attitudes in CO versus UT students, and, thus, the SASL appears to be a valid measure of this difference. Calculation of similarly good Cronbach's alpha values - for a predecessor of the SASL among pharmacy, masters, and medical students at another institution - indicates that the SASL may be useful more widely. However, the reliability and validity of the SASL needs to be demonstrated more rigorously for other healthcare students at different universities.

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Primary and secondary education systems experienced substantial disruption during the COVID-19 pandemic. However, little is known about how public health policy has affected Australian teachers during the pandemic. This study examines teacher perspectives on a sudden change of policy, whereby schools were abruptly opened to students at the beginning of the pandemic. At the same time, strict social distancing rules applied to the remainder of the population. Qualitative data from 372 Western Australian schoolteachers were analysed using thematic analysis. Results highlight substantial impacts on teachers' workloads and adverse effects on wellbeing. Perceptions that they were acting as guinea pigs and subjected to different social distancing rules than other citizens were particular stressors. Findings highlight substantial consequences of public health policies on the roles and wellbeing of teachers.

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OBJECTIVE: To investigate the Australian general public's perception of appropriate medical scenarios that warrants a call to an emergency ambulance. METHODS: An online survey asked participants to identify the likely medical treatment pathway they would take for 17 hypothetical medical scenarios. The number and type of non-emergency scenarios (n = 8) participants incorrectly suggested were appropriate to place a call for an emergency ambulance were calculated. Participants included Australian residents (aged >18 years) who had never worked as an Australian registered medical doctor, nurse or paramedic. RESULTS: From a sample of 5264 participants, 40% suggested calling an emergency ambulance for a woman in routine labour was appropriate. Other medical scenarios which were most suggested by participants to warrant an emergency ambulance call was 'Lego in ear canal' (11%), 'Older person bruising' (8%) and 'Flu' (7%). Women, people aged 56+ years, those without a university qualification, with lower household income and with lower emotional wellbeing were more likely to suggest calling an emergency ambulance was appropriate for non-emergency scenarios. CONCLUSIONS: Although emergency healthcare system (EHS) capacity not increasing at the same rate as demand is the biggest contributor to EHS burden, non-urgent medical situations for which other low-acuity healthcare pathways may be appropriate does play a small role in adding to the overburdening of the EHS. This present study outlines a series of complaints and demographic characteristics that would benefit from targeted educational interventions that may aid in alleviating ambulance service attendances to low-acuity callouts.

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OBJECTIVE: To investigate the Australian general public's ability to identify common medical emergencies as requiring an emergency response. METHODS: An online survey asked participants to identify likely medical treatment pathways they would take for 17 hypothetical medical scenarios (eight emergency and nine non-emergency). The number and type of emergency scenarios participants correctly suggested warranted an emergency medical response was examined. Participants included Australian residents (aged>18 years; n = 5264) who had never worked as an Australian registered medical doctor, nurse or paramedic. RESULTS: Most emergencies were predominately correctly classified as requiring emergency responses (e.g. Severe chest pain, 95% correct). However, non-emergency medical responses were often chosen for some emergency scenarios, such as a child suffering from a scalp haematoma (67%), potential meningococcal disease (57%), a box jellyfish sting (40%), a paracetamol overdose (37%), and mild chest pain (26%). Participants identifying as Aboriginal or Torres Strait Islander suggested a non-emergency response to emergency scenarios 29% more often compared with non-indigenous participants. CONCLUSIONS: Educational interventions targeting specific medical symptoms may work to alleviate delayed emergency medical intervention. This research highlights a particular need for improving symptom identification and healthcare system confidence amongst Aboriginal and Torres Strait Islander populations.

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Body gaze behavior is assumed to be a key feature of sexual objectification. However, there are few self-report gaze measures available and none capturing behavior which seeks to invite body gaze from others. Across two studies, we used existing self-report instruments and measurement of eye movements to validate a new self-report scale to measure pervasive body gaze behavior and body gaze provocation behavior in heterosexual women and men. In Study 1, participants (N = 1021) completed a survey with newly created items related to pervasive body gaze and body gaze provocation behavior. Participants also completed preexisting measures of body attitudes, sexual assault attitudes, pornography use, and relationship status. Exploratory and confirmatory factor analyses across independent samples suggested a 12-item scale for men and women to separately measure pervasive body gaze (5 items) and body gaze provocation (7 items) toward the opposite sex. The two scales yielded excellent internal consistency estimates (.86-.89) and promising convergent validity via positive correlations with body and sexual attitudes. In Study 2, a subsample (N = 167) of participants from Study 1 completed an eye-tracking task to capture their gaze behavior toward matched images of partially and fully dressed female and male subjects. Men exhibited body-biased gaze behavior toward all the female imagery, whereas women exhibited head-biased gaze behavior toward fully clothed male imagery. Importantly, self-reported body gaze correlated positively with some aspects of objectively measured body gaze behavior. Both scales showed good test-retest reliability and were positively correlated with sexual assault attitudes.

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BACKGROUND: Recent advances in molecular source tracking make answering questions from residents regarding their exposure to microbial contaminants from industrial hog operations (IHOs) possible. Associations between residential distance to IHOs and exposure can be addressed by measuring livestock-associated (Staphylococcus aureus) and pig-specific bacteria in the air, on household surfaces, and in participants' nasal and saliva swabs. OBJECTIVES: Here we assess the mechanics, feasibility, capacity-building, and lessons learned during a pilot study employing this novel technology in community-based participatory research of bacterial exposure and human health. METHODS: Together, our team of academics and community members designed a field- and laboratory-based pilot study. Air samples, surface and human swabs, and questionnaires from households at varying distances from IHOs were collected. Data were assessed for completeness and quality by two independent reviewers. These metrics were defined as: missingness (completeness), incorrect data type (validity), out of range (validity), and outliers (accuracy). LESSONS LEARNED: While critical field equipment was obtained, and knowledge exchange occurred, leading to an increased capacity for future work, after review, 38 of 49 households were deemed eligible for inclusion in the study. Of eligible participants, 98% of required electronic survey questions were complete and 100% were valid; an improvement over prior work which employed paper surveys. While all human microbial and air samples were collected from eligible households (n = 231), (5%) of environmental swabs were reported missing. CONCLUSIONS: Using community-appropriate sampling protocols, a pilot study of residential exposure to bacteria from IHOs was completed. While high-quality data was collected from those eligible, we learned the necessity of early and continual data review.

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Advanced nutrient removal in water resource recovery facilities (WRRFs) can reduce coastal eutrophication, but can increase economic costs and indirect environmental impacts associated with energy and materials usage for WRRF construction and operation. A strategy of interest to reduce coastal eutrophication is the cultivation of seaweeds in proximity to WRRF discharge plumes to bioextract nutrients from coastal waters. We report economic and environmental trade-offs of this proposed strategy for a 1,170 m3·d-1 (0.31 mgd) WRRF in Boothbay Harbor, Maine, targeting a Water Environment Research Federation (WERF) level 2 effluent nitrogen goal of 3 mg-N·L-1. The scenarios investigated include WRRF upgrade and year-round nutrient bioextractive aquaculture (Saccharina latissima and Gracilaria tikvahiae cultivation) with end uses of bioenergy feedstock, fertilizer, or food. Based on biomass production characteristics and tissue nitrogen contents in Boothbay Harbor, an aquaculture site of 5.4 hectares would bioextract equivalent nitrogen mass as WRRF upgrade to meet level 2 nitrogen effluent goals. Using a techno-economic analysis, the cost of a WRRF upgrade was estimated to be $0.31 m-3 wastewater treated. The cost of bioextractive seaweed aquaculture depended on beneficial use of seaweed. If dried and sold as sea vegetables (for human consumption), a net revenue of $0.72 m-3 wastewater treated could be generated. If dried and sold as commercial fertilizer, the net cost of nutrient removal would be $0.26 m-3 wastewater treated, less than the WRRF upgrade. However, if anaerobically digested to produce biogas, the net cost of treatment was estimated to be $0.499 m-3 wastewater treated. WRRF upgrade and bioextractive aquaculture significantly reduced marine eutrophication. Bioextractive aquaculture with use as biofuel feedstock had the best performance on human carcinogenic toxicity, global warming, and fossil resource scarcity, marine ecotoxicity, and freshwater ecotoxicity. Use of seaweed product as sea vegetables was favorable considering human non-carcinogenic toxicity, marine eutrophication, freshwater eutrophication, and terrestrial ecotoxicity. The study results imply that nutrient bioextraction by seaweed aquaculture may be attractive as an alternative to advanced nutrient removal technologies in small coastal WRRFs, providing potential economic and environmental benefits for nutrient management.

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This study explored microbial adaptation to high ammonia concentrations (<1000 mg/L to 4000 mg/L) during anaerobic digestion (AD) under psychrophilic and mesophilic conditions, the latter of which yielded precipitates facilitating investigation of microbial response. The experimental setup was performed at bench-scale using microbial consortia from four different operating anaerobic digesters treating different organic wastes (WW-wastewater sludge, MN-manure, FW- food waste and CO-co-digestion (FW & MN)). Adaptation experiments were conducted with semi-continuous flow mode to resemble large-scale operation. Metagenome and 16S RNA analysis were performed for the first time in a psychrophilic reactor during an ammonia acclimation process. These analyses were also performed in mesophilic reactor exposed to precipitates and high ammonia levels. Diversity reduced when adaptation occurred successfully from 1.1 to 4 g/L of total ammonia nitrogen (TAN) under psychrophilic conditions, while the microbial community became more diverse under mesophilic conditions with ammonia inhibition. We report for the first time Methanocorposculum as a robust hydrogenotrophic methanogen at high ammoniacal concentrations under psychrophilic conditions. Additionally, Methanosarcina was present in low and high ammoniacal concentrations in mesophilic conditions, but there was a shift in species dominance. Methanosarcina barkeri stands out as a more resilient methanogen compared to Methanosarcina mazei, which initially dominated at <1.1 g/L TAN. We also explored the effects of sudden precipitates on methanogenic communities and methane production when they occurred under mesophilic conditions in two reactors. Methane production declined by more than 50% when precipitates occurred and was accompanied by pH reduction and VFA accumulation. Diversity data corroborated that methanogens were severely reduced. These two reactors were not able to recover with 50 days of added operation, demonstrating potential for long-term negative impacts of precipitate formation on AD performance stemming from negative impact to methanogenic communities.

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BACKGROUND: A novel coronavirus first reported in Wuhan City in China in 2019 (COVID-19) developed into a global pandemic throughout 2020. Many countries around the world implemented strict social distancing policies to curb the spread of the virus. In this study we aimed to examine potential change in mental/physical health and social relationships during a highly restrictive COVID-19 lockdown period in Australia during April 2020. METHODS: Our survey (n = 1, 599) included questions about concerns, social behaviour, perceived change in relationship quality, social media use, frequency of exercise, physical health, and mental health during COVID-19 lockdown (April, 2020). RESULTS: When estimating their mental health for the previous year 13% of participants reported more negative than positive emotion, whereas this increased to 41% when participants reflected on their time during COVID-19 lockdown. A substantial proportion (39-54%) of participants reported deterioration in mental health, physical health, financial situation, and work productivity. However, most of these participants reported 'somewhat' rather than 'a lot' of deterioration, and many others reported 'no change' (40-50%) or even 'improvement' (6-17%). Even less impact was apparent for social relationships (68% reported 'no change') as participants compensated for decreased face-to-face interaction via increased technology-mediated interaction. CONCLUSIONS: The psychological toll of COVID-19 on Australians may not have been as large as other parts of the world with greater infection rates. Our findings highlight how technology-mediated communication can allow people to adequately maintain social relationships during an extreme lockdown event.

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The COVID-19 outbreak has led to the implementation of strict restrictions in Australia, which have severely impacted sporting activities. Tennis is played by 6.2% of the population within the Oceania region, and is a valuable sport for maintaining social, mental, and physical health. Current literature indicates the COVID-19 pandemic has negatively affected the mental health of Australian residents. The aim of this study was to investigate changes in training and match play due to the outbreak, and its effects on emotional well-being of Australian senior tennis players. Additionally, explore any differences between middle aged (41-60 years) and senior (61 years and over) Australian tennis players. An online survey was used to assess training and match play habits, as well as ascertain the emotional well-being of tennis players. The survey was active from 24th April 2020 until 6th June 2020. Participants were adult (41+ years) tennis players from Australia. Wilcoxon signed rank tests were performed to check for differences in training hours and tennis matches played. Mann-Whitney U tests were used to assess the difference in Brief Emotional Experience Scale (BEES) scores, employment status as well as the training hours and tennis matches played between the two age groups. A Kendall's Tau B correlation test was performed to assess the associations of training, match play and demographic characteristics with BEES scores. Kruskal-Wallis tests assessed differences in BEES scores between participants of differing match play formats, tennis experience and cessation of tennis training time periods. There were 245 respondents who met our inclusion criteria. Tennis training hours along with the tennis matches played significantly decreased during COVID-19 compared to pre-COVID-19, 85.09 and 88.48%, respectively. No significant (p > 0.05) differences were observed between age groups for any of the training modality hours, nor was there any significant difference in number of tennis matches played. The participants average BEES score was 0.99 ± 1.27, indicating that respondents had a positive emotional well-being during the COVID-19 pandemic. The emotional well-being of the senior group was significantly (P = 0.002) higher than the middle aged group. Together, our results show that training and tennis match play decreased during the COVID-19 pandemic, however the emotional well-being of senior tennis players in Australia appeared to not be negatively affected.

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Highlights: No differences in coping or well-being in Australian community athletes based on the level of support received during COVID-19 restrictions.Community level athletes had better coping when a training program was provided.No difference between individual or team community athletes for well-being or coping scores. Australian community level athletes faced unprecedented changes to their training and competition options as the global COVID-19 pandemic took a stronghold. This disruption was predicted to have a negative impact on emotional well-being as communities braced through periods of social isolation and physical distancing requirements. This study provides an Australian perspective on the emotional well-being of community level athletes and the extent to which they coped during the COVID-19 pandemic. Emotional well-being and coping were measured using the Brief Emotional Experience Scale and the 28-item Brief Cope Scale. Both instruments were administered along with other questions pertaining to participant demographics and training status via an online survey between April and June 2020. The survey was disseminated to community athletes through word-of-mouth and social media platforms. No significant differences in emotional well-being were observed between athlete groups as a result of COVID-19 and its associated restrictions. Coping scores also appeared to be preserved in Australian community athletes, which contrasts the impact expected as a result of the COVID-19 pandemic. While tentative, the observed preservation in coping may have buffered potential declines in emotional well-being, which has been documented in professional and semi-professional athletes and the general population. These unexpected findings and tentative suppositions warrant further investigation and highlight the importance of conducting a country- or region-specific approach to examining the impact of COVID-19 on community athletes, as responses to COVID-19 are undoubtedly not consistent throughout the world.

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There is a growing body of international research examining psychological distress in law students. Generally, the studies have tended to be either very narrow, focussing on a single law school, or very broad, targeting all law students regardless of their institutional affiliation. This study adds to the existing literature by examining the levels of psychological distress of law students at two quite different law schools in Australia. An online survey was used to assess self-reported emotional well-being, university appraisal, university belongingness, perceptions of competitiveness and supportiveness, perceived sources of pressure, and motivations for studying law in 225 law students. Consistent with prior research, the data reflect lower levels of well-being in law student participants compared to the general public. However, the factors that appear to affect the students' well-being differed slightly between the two participant cohorts. For the law school that caters more to mature age and online students, the students' perception of their overall law school experience, belongingness, and support are important factors. Whereas for the law school that caters more to high achieving younger students, the competitiveness and perceived lack of support within the law school environment appear to have a greater influence on the students' self-reported well-being. In addition, across both participant cohorts, self-imposed pressure was notably high. Overall, the results of the study reported in this article provide valuable insights into the external and internal factors underpinning the well-established heightened levels of psychological distress in Australian law students.

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Interest in measurement of children's executive functions has shown a major increase over the past two decades. The present study evaluates two new apps (EYT and eFun) for measuring executive functions in children. The results of this study show that children (aged 5-8) enjoy executive function assessment in the form of games on an iPad. However, only one executive function, EYT working memory, showed significant positive correlations with several types of grades (e.g., English and maths) in primary school students. New, self-assessed, child-friendly executive function measurement tools have the potential to provide future possibilities for teachers to integrate information on cognitive ability into student learning plans.

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PURPOSE/OBJECTIVES: While the Commission on Dental Accreditation (CODA) requires programs to conduct faculty development, implementation of faculty development activities vary widely. Faculty development programs can enhance teaching, research, and leadership skills needed to transition from clinical practice to teaching. In 2012, the Health Resources and Services Administration (HRSA) funded 6 institutions to plan, develop, and operate programs for training oral healthcare providers who plan to teach in general, pediatric, public health dentistry, or dental hygiene. This performance study examines the results of the dental faculty development programs. METHODS: After the 5-year grant program (2012-2017), we used descriptive analysis to examine annual performance data including trainee demographics, faculty development activities, post-completion intentions, and course development activities. RESULTS: Nearly 300 trainees participated across 6 funded grantees; the majority were female, aged 30-49 years, and non-Hispanic White. For those who completed, 80% intended to teach. Common faculty development activities included community-based training, curriculum enhancements, Web-based training, and interprofessional education methods. Faculty development modalities included faculty seminars, Master's degrees, and mentoring. Pipeline activities, online resources, and continuing education supported dental students and providers moving into academics. CONCLUSIONS: Faculty development better prepares individuals to compete in academic environments and develop faculty. Community-based programs may utilize faculty development to recruit community preceptors and achieve calibration. HRSA investment in faculty development programs builds resources and infrastructure to promote continuing engagement in clinical education, research, and administrative skills. Future research is needed to establish the impact of faculty development initiatives on practice change and patient outcomes.

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PURPOSE: To examine the potential impact of Health Resources and Services Administration (HRSA) funding (predoctoral [PD] and postdoctoral [PDD] programs) on dentists' practice location in the United States. METHOD: The authors linked 2011-2015 data from HRSA's Electronic Handbooks to 2015 data from the American Dental Association Masterfile, dental health professional shortage areas, and rural-urban commuting area codes. They examined the associations between PD and PDD funding and dentists' practice location between 2004 and 2015 using a difference-in-differences analysis and multiple logistic regressions, adjusting for covariates. RESULTS: From 2004 to 2015, 21.2% (1,588/7,506) of dentists graduated from institutions receiving PD funding and 26.8% (2,014/7,506) graduated from institutions receiving PDD funding. Among dentists graduating from institutions receiving PDD funding, after adjusting for covariates, those graduating between 2011 and 2015 were more likely to practice in a rural area than those graduating between 2004 and 2010 (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.04-3.76). The difference-in-differences approach showed that PD and PDD funding significantly increased the odds that a dentist would practice in a rural area (respectively, OR = 2.70; 95% CI = 1.31-5.79/OR = 2.84; 95% CI = 1.40-5.77). CONCLUSIONS: HRSA oral health training program funding had a positive effect on dentists choosing to practice in a rural area. By increasing the number of dentists practicing in rural communities, HRSA is improving access to, and the delivery of, oral health care services to underserved and vulnerable rural populations.

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BACKGROUND: The Health Resources and Services Administration's Grants to States to Support Oral Health Workforce Activities, otherwise known as the State Oral Health Workforce Program (SOHWP), help states develop and implement innovations that address the workforce needs of dental Health Professional Shortage Areas in a manner appropriate to the states' individual needs. AIM: This cross-sectional study explores the broad impact of the SOHWP by comparing measures of dental workforce density and access to oral health care in states with multiple years of funding versus states with few or no years of funding. METHODS: We used data for 2006-2016 SOHWP awardees together with data from the 2016-2017 Area Health Resources Files and the 2016 Behavioral Risk Factor Surveillance System to compare numbers of dentists per 100,000 population and age-adjusted prevalence of annual dental visits among adults for long-term SOHWP-funded states versus states with few or no years of funding. RESULTS: Multi-year SOHWP funding is associated with higher workforce density and greater access to oral health care, especially in the Midwest and West. CONCLUSION: Allowing states funding utilization flexibility may result in improved outcomes. This finding can help inform planning and policy about whether and how to scale future training and workforce programs to achieve greater impact.

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