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BACKGROUND: In recent years, educational development centers (EDCs) have evolved among universities from a marginal to a strategic aspect. The present study aimed to achieve an applicable task description at two levels of basic and quality improvement for EDCs and educational development offices (EDOs). MATERIALS AND METHODS: This research used the triangulation method. Initially, the current condition of EDCs across the country was evaluated with an electronic questionnaire in 2019. In the second phase, the modified Delphi method was used in two rounds with purposive sampling and a researcher-made questionnaire. The research participants were from all of the country. In the RAND technique, an electronic questionnaire was sent to 14 experts in medical education. After the analysis, the results were discussed, and the questions were answered again. We determined frequency and used content analysis. RESULTS: The task descriptions containing basic and quality improvement have been developed in three main sections: Organizational communication of EDCs and EDOs for policymaking; organizational structures, organizational charts, and the budget of EDCs and EDOs; and developmental roles of EDCs and EDOs (curriculum policies, curriculum development, blended learning, community-oriented), faculty development, evaluation (student assessment, faculty evaluation, program evaluation, accreditation), research (educational research, educational scholarship, innovative educational designs, events), and students (student committee, talented students). CONCLUSION: The task description guidelines have been prepared with 68 articles in basic and quality improvement and three main sections, including organizational communication of the EDCs and EDOs, organizational structures, the budget of the EDCs and EDOs, and their development roles.

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The aim of this study was to identify differences in the prevalence and odds of cognitive impairment, hearing impairment, vision impairment, limitations in activities of daily living (ADLs), and ambulation limitations among three groups of older American adults: high school dropouts, General Educational Development (GED) recipients, and high school graduates. This study used secondary analysis of the nationally representative 2017 American Community Survey. The sample included 20,489 GED recipients, 154,892 high school graduates, and 49,912 high school dropouts. Our findings indicate that there is a gradient in health outcomes among older Americans, with the highest prevalence and odds of cognitive impairment, hearing impairment, vision impairment, ADL limitations, and ambulation limitations among high school dropouts, followed by GED recipients, and the lowest among high school graduates. Although GED recipients have better health outcomes than high school dropouts, there is still a significant disparity in health status between GED recipients and high school graduates.

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PURPOSE: The COVID-19 pandemic has led to changes in global health care. Medical societies had to update guidelines and enhance new services such as video consultations. Cancer treatment had to be modified. The aim of this study is to ensure optimal care for cancer patients with the help of high-quality training even in times of crisis. We therefore conducted a nationwide survey of physicians in training in oncological disciplines during the pandemic to assess the impact on their education. METHODS: The survey was sent to tumour centres, hospitals, specialist societies, and working and junior research groups and distributed via newsletters and homepages. Interim results and a call for participation were published as a poster (DEGRO) [26] and in the German Cancer Society (DKG) journal FORUM [42]. The survey contained 53 questions on conditions of education and training and on clinical and scientific work. Statistics were carried out with LimeSurvey and SPSS (IBM Corp., Armonk, NY, USA). RESULTS: Between February and November 2022, 450 participants answered the survey, with radio-oncologists being the largest group (28%). Most colleagues (63%) had access to digital training methods. Virtual sessions were rated as a good alternative, especially as multidisciplinary meetings (54%) as well as in-house and external training programs (48%, 47%). The time spent by training supervisors on education was rated as less than before the pandemic by 57%. Half of all participants perceived communication (54%), motivation (44%) and atmosphere (50%) in the team as bad. The participants felt strongly burdened by extra work (55%) and by a changed team atmosphere (49%). One third felt a change in the quality of training during the pandemic and rated it as negative (35%). According to 37% of the participants, this had little influence on their own quality of work. Additional subgroup analyses revealed significant differences in gender, specialty and education level. CONCLUSION: In order to improve oncology training in times of crisis, access to digital training options and meetings should be ensured. Participants wish for regular team meetings in person to enable good team spirit, compensation for overtime work and sufficient time for training supervisors for discussion and feedback.

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Although educational development of youths can profoundly affect their other domains of health and well-being across later life trajectories, little research has investigated the prolonged effects of family and individual contexts of youths in middle-school years, a most critical developmental and formative stage, on their educational achievement in middle-aged adulthood. The current study employed data of a nationwide representative sample of middle-school youth students in the Longitudinal Study of American Youth (LSAY) to examine how grade-7 parental support for college education, family SES, and educational expectations of youths contribute to their educational achievement in adulthood of mid-thirties through their development of grade-8 academic commitment and grade-9 educational performance in terms of English, mathematics, science, and social studies grade scores. Results based on structural equation modeling of longitudinal relationship found that grade-7 parental support for college education, family SES, and educational expectations of youths had significant and direct effects on youths' higher educational achievement in adulthood, and youths' grade-8 academic commitment and grade-9 educational performance significantly mediated the effects of grade-7 family SES, parental support for college education, and educational expectations of youths on their educational achievement in adulthood respectively and/or concurrently. Furthermore, interaction analysis supported the promotive but not buffering effects of grade-7 educational expectations of youths by family SES on their grade-9 educational performance and educational achievement in adulthood. Implications related to the important findings of the current study pertaining to educational development of youths are discussed.

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The purpose of this study was to clarify coaches' competencies (COM) regarding dual-career (DC) support for student athletes in Japan. The questionnaire survey was conducted at 31 universities with an online survey URL that was distributed to 300 collegiate athletic coaches. In total, there were 152 respondents (female, 19; male, 133; mean age, 43.15 ± 12.07 years; coaching experience, 12.83 ± 9.72 years). The online survey adopted a Japanese-translated version of the Dual-Career Competency Questionnaire (DCCQ), which has been translated into nine languages and is widely used in European counties. The scale consists of six factors and 33 items, each rated on a five-point scale of importance (IM) and possession (PO). The Japanese version of the DCCQ was validated through a confirmatory factor analysis, and the internal consistency of the items was confirmed by calculating the Cronbach's alpha coefficient. In addition, we examined differences between the IM and PO for DC support by t-tests and by calculating effect sizes. The validity and reliability of the Japanese version of the DCCQ were confirmed based on the goodness-of-fit index and Cronbach's alpha coefficients, respectively. Our examination of the differences between IM and PO in DC support revealed that coaches perceived the importance of DC support but did not possess the necessary COM to offer DC support. That finding was similar to those of previous European studies. In particular, the Japanese coaches who participated in our online survey recognized the importance of COM in terms of "collaboration with various stakeholders and departments" for DC support but did not feel as though they held sufficient COM in that regard. In other words, the improvement of DC support requires the development of a coaching program that fosters COM to work with various stakeholders. This key insight provides a direction and specific focus for programs to improve coaches' DC support for student athletes.

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BACKGROUND: Since vaccination is the decisive factor for controlling the COVID-19 pandemic, it is important to understand the process of vaccination success which is not well understood on a global level. The study is the first to judge the now completed "first wave" of the vaccination efforts. The analysis is very relevant for the understanding why and where the vaccination process observed got stuck by the end of 2021. METHODS: Using data from 118 countries globally and weighted least squared and survival analysis, we identify a variety of factors playing crucial roles, including the availability of vaccines, pandemic pressures, economic strength measured by Gross Domestic Product (GDP), educational development, and political regimes. RESULTS: Examining the speed of vaccinations across countries until the Fall of 2021 when the global process got stuck, we find that initially authoritarian countries are slow in the vaccination process, while education is most relevant for scaling up the campaign, and the economic strength of the economies drives them to higher vaccination rates. In comparison to North and Middle America, European and Asian countries vaccinated initially fast for 5% and 10% vaccination rate thresholds, but became rather slow reaching the 30% vaccination level and above. The findings are robust to various applied estimation methods and model specifications. CONCLUSIONS: Democratic countries are much faster than authoritarian countries in their vaccination campaigns when controlling for other factors. This finding suggests that the quality of government and the political environment play a key role in popular support for government policies and programs. However, despite the early success of their vaccination campaigns, the democratic country group has been confronted with strong concerns of vaccine reluctance among their vast populations, indicating the two most potent variables explaining the speed of the COVID-19 vaccination campaign are education and economic conditions.

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BACKGROUND: Clinical teaching-learning is a context-bound phenomenon. One of the problems related to field of medical education research is the lack of sufficient attention to context-appropriate methodologies. The purpose of this qualitative inquiry is to explain and represent teaching-learning in the clinical education of general medicine in Iran using the three types of maps situational, social worlds/arenas, positional, in combination with discourse analysis. METHODS: In this study, the authors used the situational analysis approach as a postmodern version of grounded theory. The data collection was undertaken in three stages. In the first stage, a mini literature review was conducted to highlight a possible gap in applying situational analysis in medical education research and the development of this methodology. In the second stage, the latest and most up-to-date documents of the Ministry of Health and Medical Education (MOHME) of Iran, the general medicine curriculum, and related documents were analyzed. Finally, the remote semi-structured interviews (web-based and telephone) were undertaken in the third stage. Participants in this stage included expert clinical teachers, medical education specialists, and students. In this study, the notes and transcripts were analyzed for the emergence and categorization of sub-themes and themes, represented in three maps. RESULTS: Thirty-one participants were involved in the web-based interviews, while seven participants took part in the telephone interview. Based on this research, the teaching-learning situation in clinical education on general medicine in Iran was represented in three maps; situational, social worlds/arenas, and positional. In addition, the results showed, clinical education of general medicine in Iran in six positions (curriculum; culture, behavior and attitude; management and leadership; environment, space and time; financial; and technology) has serious problems and challenges. Finally, based on the horizontal axis of the positional map, recommendations were provided to develop and support effective clinical teaching. CONCLUSIONS: The clinical learning environment is a complex and multi-layered social environment in which should be considered these numerous social layers, arenas, social worlds, and discourses while developing curricula and teaching.

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The COVID-19 outbreak, along with post-pandemic impact has prompted Internet Plus education to re-examine numerous facets of technology-oriented academic research, particularly Educational Big Data (EBD). However, the unexpected transition from face-to-face offline education to online lessons has urged teachers to introduce educational technology into teaching practice, which has had an overwhelming impact on teachers' professional and personal lives. The aim of this present work is to fathom which research foci construct EBD in a comprehensive manner and how positive psychological indicators function in the technostress suffered by less agentic teachers. To this end, CiteSpace 5.7 and VOSviewer were applied to examine a longitudinal study of the literature from Web of Science Core Collection with the objective of uncovering the explicit patterns and knowledge structures in scientific network knowledge maps. Thousand seven hundred and eight articles concerned with educational data that met the criteria were extracted and analyzed. Research spanning 15 years was conducted to reveal that the knowledge base has accumulated dramatically after many governments' initiatives since 2012 with an accelerating annual growth and decreasing geographic imbalance. The review also identified some influential authors and journals whose effects will continue to have future implications. The authors identified several topical foci such as data mining, student performance, learning environment and psychology, learning analytics, and application. More specifically, the authors identified the scientific shift from data mining application to data privacy and educational psychology, from general scan to specific investigation. Among the conclusions, the results highlighted the important integration of educational psychology and technology during critical periods of educational development.

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Adolescents in the U.S. do not meet current physical activity guidelines. Ecological models of physical activity posit that factors across multiple levels may support physical activity by promoting walkability, such as the neighborhood built environment and neighborhood socioeconomic status (nSES). We examined associations between neighborhood built environment factors and adolescent moderate-to-vigorous physical activity (MVPA), and whether nSES moderated associations. Data were drawn from a national sample of adolescents (12-17 years, N = 1295) surveyed in 2014. MVPA (minutes/week) were estimated from self-report validated by accelerometer data. Adolescents' home addresses were geocoded and linked to Census data from which a nSES Index and home neighborhood factors were derived using factor analysis (high density, older homes, short auto commutes). Multiple linear regression models examined associations between neighborhood factors and MVPA, and tested interactions between quintiles of nSES and each neighborhood factor, adjusting for socio-demographics. Living in higher density neighborhoods (B(SE): 9.22 (2.78), p = 0.001) and neighborhoods with more older homes (4.42 (1.85), p = 0.02) were positively associated with adolescent MVPA. Living in neighborhoods with shorter commute times was negatively associated with MVPA (-5.11 (2.34), p = 0.03). Positive associations were found between MVPA and the high density and older homes neighborhood factors, though associations were not consistent across quintiles. In conclusion, living in neighborhoods with walkable attributes was associated with greater adolescent MVPA, though the effects were not distributed equally across nSES. Adolescents living in lower SES neighborhoods may benefit more from physical activity interventions and environmental supports that provide opportunities to be active beyond neighborhood walkability.

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Buildings in Iraqi cities such as Baghdad and Mosul suffer from several problems such as the application of new materials in modern buildings that changed not just the identity of architectural heritage but also the quality of thermal comfort in façade design. This, unfortunately, adds to the damage regarding environmental sustainability and cultural values away from adaptable solutions to improve energy efficiency in building performance. One of the measures that must be taken to correctly plan in harmony with the Iraqi cities is to ensure the environmental control as part of the overall performance of building façade to maintain an active, healthy indoor environment while preserving the propriety of facade design elements, screen pattern, order and details. Therefore, there are many sustainable trends that vary in their usefulness such as biomimetics examples inspired from natural models in which form and function dictate one another. This is in order to maintain the integrated design relation between transparency, function, and elegance in the overall performance of façade elements. The research question is, how important is the choice of material in developing a sustainable element that revives environmental control while preserving the identity and values of façade design? The main goal of the research study is to identify the role of advanced technologies and the choice of smart glazing materials to revive the quality of thermal comfort in a way that not just sustains the identity of facade elements socially and culturally, but also to be responsive to the changes of climate conditions. Therefore, this research utilizes more than one technological tool such as Revit as a BIM tool with the application of smart dynamic materials such as Photovoltaics and Electrochromic in order to restore part of the design expression and enhance the building performance through its elements in contemporary façade design and its details. In this work, it can be seen that applying a set of technological tools allows to clearly illustrate the impact of smart dynamic materials to improve the quality of design and comfort while protecting the identity of contemporary façade elements when compared to static or traditional materials, aesthetically, and functionally.

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The purpose of this study is to examine and identify effective variables related to single-subject reading interventions for the struggling readers. This study conducted meta-analysis of 84 single-subject research articles of which 54 were published in Korean and 30 were published in English. Utilizing the Improvement Rate Difference (IRD), a total of 586 effect sizes were produced with the mean effect size of 0.77. Intervention variables were categorized into two types - participant-related and intervention-related variables. Collected studies were analyzed for each effect size calculation. Variables having large effects within grade levels, disability types, implementer and session duration are discerned along with further discussion and educational implications.

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An organization acquires legitimacy when it operates in an appropriate and desirable manner, satisfying the stakeholders' needs and expectations. Stakeholders claim to business schools sustainable and responsible management, knowledge transfer and research. In the last years, business schools adopted Corporate Social Responsibility as guideline of an integrated and holistic approach for their legitimation process. The aim of this research is to understand how business schools are reacting to the criticism that affects them and how they are reshaping their strategies in order to fulfill stakeholders' expectations, and to confirm which UN Sustainable Development Goals are the most cited in the sustainability reports of the best business schools in the world. We perform a content analysis of the latest sustainability reports published by the top 50 business schools, analyzing the 17 UN Sustainable Development Goals. We highlight that business schools focus social responsibility strategies mainly to define the professional standards to train future leaders qualified to manage organizations with a social, economic and environmental positive impact for all the stakeholders and capable to shape a better world.

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Nationalism's rise represents a potential harbinger of doom for the internationalization of higher education (IoHE). Space exists for research to amplify our understanding of the interplay between internationalization and nationalism from a public policy theory perspective. The study identified and classified policies and policy ideas pertinent to IoHE, and furthermore, explored how political rivalries in Taiwan have influenced IoHE's development under globalization. Analysis of documentary data from an online national database reveals how IoHE policy changes reflect the machinations of political actors to advance domestic political agendas and provoke controversy. The advocacy coalition framework informs our explanation of how the aforementioned changes reflect Taiwan's inward-looking political climate, unique geopolitical circumstances, and longstanding controversy over national identity. The paper discusses the implications of context for IoHE development across three consecutive government regimes to provide insights for further comparisons with other localities and contexts.

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Largely absent from educational/instructional technology journals, this study focused on how K-12 art teachers in a southern state used technology to support teaching and learning, uses they found to be the best, and what kinds of technology training they received as part of their initial teacher preparation. Findings indicated that presentation and resource access technologies had transformed the way art teachers in the study work with students and materials. They also had little use of technology to support students with special needs and had limited technology experiences in their own training. Elementary art teachers were found to have more examples of student higher-order thinking skills promoting technology use, while secondary art teachers had more student media creation and a desire to implement digital portfolios. Additional findings and interpretations are offered.

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INTRODUCTION: Debriefing is increasingly used to enhance learning and reflection in clinical practice. Nevertheless, barriers to implementing debriefings in the operating room (OR) include lack of time, the availability of trained facilitators, and difficulty gathering the full team after surgery. Spending five minutes on a debriefing during skin closure or between procedures may enhance learning and reflection on practice, generating to improve patient safety. The aim of this study was to explore characteristics, feasibility and content of short debriefings in the OR. METHODS: This was a mixed-method study of short debriefings, analyzing audio-recordings, field notes and relevance ratings from multi-professional teams, that conducted short debriefings in the OR at two University Hospitals in Denmark. RESULTS: A total of 135 debriefings were conducted, with a median duration of five minutes (range 1:19 min-12:05 min). A total of 477 team members participated in the debriefings. The teams' median rating of relevance was 6 (range 1-10). The rating was higher following challenging events and in debriefings where the surgeon actively participated in the conversation. The teams discussed non-technical skills in all the debriefings and verbalized reflections on practice in 75 percent of the debriefings. CONCLUSION: It was feasible to conduct short debriefings in a production-focused, complex work environment. In all the debriefings, the teams discussed various non-technical skills (NTS) and reflected on practice. The majority of team members rated the debriefings as relevant for their task management.

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Our research explored the structure of childhood visual play preferences, and examined different types of visual play in relation to individual differences in visualization and aptitudes in academic specializations requiring visualization skills. Principal component analysis dissociated visual-object play (e.g., exploring drawing media or decorative crafts) from visual-spatial play (e.g., assembling and disassembling mechanisms or playing with construction toys) preferences. Moreover, visual play preferences were dissociated from verbal play preferences (e.g., vocabulary games or making up stories). The structure of visual play preferences was consistent with object and spatial dimensions of individual differences in visualization. Visual-object and visual-spatial dimensions of play preferences were differentially related to measures of object visualization (processing pictorial appearances in terms of shape, texture, and color) versus spatial visualization (processing spatial relationships and spatial manipulations), as well as to aptitudes in artistic versus scientific domains. Furthermore, our research sheds new light on sex differences in play behavior: Previous studies commonly associated gender-specific play with visual versus verbal-social processing; our research demonstrated sex differences in play preferences across the two dimensions of visual play, where females preferred visual-object and males preferred visual-spatial play. Moreover, we found the object vs. spatial structure of visual play preferences was largely the same in both sexes, suggesting that differences in visual play preferences cannot be reduced to sex differences. Also, our questionnaire assessing visual-object, visual-spatial and verbal play preferences, developed for research purposes, demonstrated good reliability. Its two scales, assessing visual-object and visual-spatial play preferences, discriminatively correlated with assessments of individual differences in object and spatial visualization, respectively. This research creates a basis for further creation of comprehensive measures of visual play preferences, and should stimulate future studies examining visual play preferences and how they may create developmental opportunities for skills and preferences lasting into adulthood.

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Students that enroll in a vocational orientation program develop an early interest in the profession. Their involvement generates a higher sense of personal wellbeing, as well as positive academic and professional outcomes. A program was developed for high school students to experience first-hand what it means to work on health sciences. Two years after, the effects of the vocational program were assessed to analyze students' motivation and satisfaction with their professional orientation.

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BACKGROUND: Malnutrition has been identified as a factor in growth and learning. The current study aimed to determine the nutritional status and basic learning skills of children from Chocó, Colombia. METHODS: We conducted a cross-sectional study of 631 children aged 5-11 years from two schools, collecting anthropometric measurements, nutritional quality surveys and sociodemographic data. Neuropsychological batteries were applied. RESULTS: A total of 523 children were evaluated, with an average age of 8.49 ± 2.1 years. The results revealed that 2.9% of children were underweight, 0.4% were severely underweight, and 4.8% were diagnosed as having stunted growth. In addition, 71.8% of children were unable to draw a human figure. Beery-Buktenica Visual-Motor Integration test (VMI) performance was below the scores expected for these age groups in 73.9% of children. Battery of Differential and General Abilities (BADYG) performance revealed limited verbal skills. In a subsample of 117 children, anemia was detected in 12.8% of cases, and iron deficiency was present in 44.4% of cases. Global malnutrition was associated with impairments in BADYG performance (OR: 1.98; 95% CI: 1.07-3.86). CONCLUSIONS: The current results revealed that learning performance was below the expected level for children in these age groups across all of the applied tests. Although malnutrition could partially explain the poor performance of children in tests of learning abilities, additional factors are likely to be involved.

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PURPOSE: The purpose of this study was to explore the perceptions and attitudes toward interprofessional simulation-based education among Lebanese senior nursing students. METHODS: The study used an exploratory descriptive qualitative approach and collected data through focus groups. All focus group discussions were audiotaped, transcribed verbatim, and narratives were compared with the recordings to establish accuracy, credibility and reliability of data. Qualitative narratives were translated to English and analyzed through an inductive thematic content analysis. This study was reported according to the Standards for Reporting Qualitative Research (SRQR). RESULTS: Four major themes were identified: understanding roles and responsibilities, enhancing collaboration, improve personal and interpersonal skills, and patient outcomes. CONCLUSION: The senior nursing students showed a positive perception and attitude toward interprofessional simulation-based education. They found that interprofessional simulation-based education increased their knowledge and understanding of the importance of the roles of other professions, as well as their own role in providing patient care. Furthermore, they perceived that interprofessional simulation-based education improved their personal and interpersonal skills. These positive findings may contribute to their future success in an interprofessional team, which could lead to improved patient outcomes. Therefore, future research is needed to see how the reported benefits of interprofessional simulation-based education training are reflected in clinical practice and related to patient outcomes.

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OBJECTIVE: As compensation transitions from a fee-for-service to pay-for-performance healthcare model, providers must prioritize patient-centered experiences. Here, the authors' primary aim was to identify predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery. METHODS: The Michigan Spine Surgery Improvement Collaborative (MSSIC) was queried for all lumbar operations at the 1- and 2-year follow-ups. Predictors of patients' postoperative contentment were identified per the North American Spine Surgery (NASS) Patient Satisfaction Index, wherein satisfied patients were assigned a score of 1 ("the treatment met my expectations") or 2 ("I did not improve as much as I had hoped, but I would undergo the same treatment for the same outcome") and unsatisfied patients were assigned a score of 3 ("I did not improve as much as I had hoped, and I would not undergo the same treatment for the same outcome") or 4 ("I am the same or worse than before treatment"). Multivariable Poisson generalized estimating equation models were used to report adjusted risk ratios (RRadj). RESULTS: Among 5390 patients with a 1-year follow-up, 22% reported dissatisfaction postoperatively. Dissatisfaction was predicted by higher body mass index (RRadj =1.07, p < 0.001), African American race compared to white (RRadj = 1.51, p < 0.001), education level less than high school graduation compared to a high school diploma or equivalent (RRadj = 1.25, p = 0.008), smoking (RRadj = 1.34, p < 0.001), daily preoperative opioid use > 6 months (RRadj = 1.22, p < 0.001), depression (RRadj = 1.31, p < 0.001), symptom duration > 1 year (RRadj = 1.32, p < 0.001), previous spine surgery (RRadj = 1.32, p < 0.001), and higher baseline numeric rating scale (NRS)-back pain score (RRadj = 1.04, p = 0.002). Conversely, an education level higher than high school graduation, independent ambulation (RRadj = 0.90, p = 0.039), higher baseline NRS-leg pain score (RRadj = 0.97, p = 0.013), and fusion surgery (RRadj = 0.88, p = 0.014) decreased dissatisfaction.Among 2776 patients with a 2-year follow-up, 22% reported dissatisfaction postoperatively. Dissatisfaction was predicted by a non-white race, current smoking (RRadj = 1.26, p = 0.004), depression (RRadj = 1.34, p < 0.001), symptom duration > 1 year (RRadj = 1.47, p < 0.001), previous spine surgery (RRadj = 1.28, p < 0.001), and higher baseline NRS-back pain score (RRadj = 1.06, p = 0.003). Conversely, at least some college education (RRadj = 0.87, p = 0.035) decreased the risk of dissatisfaction. CONCLUSIONS: Both comorbid conditions and socioeconomic circumstances must be considered in counseling patients on postoperative expectations. After race, symptom duration was the strongest predictor of dissatisfaction; thus, patient-centered measures must be prioritized. These findings should serve as a tool for surgeons to identify at-risk populations that may need more attention regarding effective communication and additional preoperative counseling to address potential barriers unique to their situation.