A single-entry model and wait time for hip and knee replacement in eastern health region of Newfoundland and Labrador 2011–2019

Background A single-entry model in healthcare consolidates waiting lists through a central intake and allows patients to see the next available health care provider based on the prioritization. This study aimed to examine whether and to what extent the prioritization reduced wait times for hip and knee replacement surgeries. Method The survival regression method was used to estimate the effects of priority levels on wait times for consultation and surgery for hip and knee replacements. The sample data included patients who were referred to the Orthopedic Central Intake clinic at the Eastern Health region of Newfoundland and Labrador and had surgery of hip and knee replacements between 2011 and 2019. Result After adjusting for covariates, the hazard of having consultation booked was greater in patients with priority 1 and 2 than those in priority 3 when and at 90 days after the referral was made for both hip and knee replacements. Regarding wait time for surgery after the decision for surgery was made, while the hazard of having surgery was lower in priority 2 than in priority 3 when and indifferent at 182 days after the decision was made, it was not significantly different between priority 1 and priority 3 among hip replacement patients. Priority levels were not significantly related to the hazard of having surgery for a knee replacement after the decision for surgery was made. Overall, the hazard of having surgery after the referral was made by a primary care physician was greater for patients in high priority than those in low priority. Preferring a specific surgeon indicated at referral was found to delay consultation and it was not significantly related to the total wait time for surgery. Incomplete referral forms prolonged wait time for consultation and patients under age 65 had a longer total wait time than those aged 65 or above. Conclusion Patients with high priority could have a consultation booked earlier than those with low priority and prioritization in a single entrance model shortens the total wait time for surgery. However, the association between priority levels and wait for surgery after the decision for surgery was made has not well-established.

Going beyond the Text: Interactional Competence in Reading Comprehension Class

Drawing on the principles underlying conversation analysis (CA), this paper is a single case analysis of interaction in an English as a foreign language (EFL) reading comprehension classroom in Saudi Arabia. It looks at learning from a sociocultural perspective and uses constructs from this theoretical perspective. It focuses on Classroom Interactional Competence (CIC) (Walsh, 2013), showing classroom interaction features that are considered CIC. The paper reflects how an understanding of the concept can lead to more dialogic, engaged learning environments. The paper also connects CIC to teachers’ ability to manipulate simple classroom interactional resources to make the teaching process more effective. The paper demonstrates how teachers can induce CIC by utilizing interactional techniques, such as relaxing the mechanism and speed through which turns are taken or given, use of active listenership devices, extending wait time, and use of open-ended questions to expand topics under development. The paper argues that those techniques will help teachers, as evidenced from the cited examples, further enhance classroom participation so that it is convergent with their pedagogical goals. Finally, the paper has pedagogical implementations as it sheds light on techniques that help promote classroom interaction as an indication of learning among students with limited linguistic resources.

Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology

Background Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable evidence that can contribute to our broader understanding of HITs. Objective In this research, we aim to develop and demonstrate a variation of vignette testing that supports developers and designers in evaluating early-stage HIT designs while generating usable evidence for the broader research community. Methods We proposed a method called health concept surveying for untangling the causal relationships that people develop around conceptual HITs. In health concept surveying, investigators gather reactions to design concepts through a scenario-based survey instrument. As the investigator manipulates characteristics related to their HIT, the survey instrument also measures proximal cognitive factors according to a health behavior change model to project how HIT design decisions may affect the adoption and acceptability of an HIT. Responses to the survey instrument were analyzed using path analysis to untangle the causal effects of these factors on the outcome variables. Results We demonstrated health concept surveying in 3 case studies of sensor-based health-screening apps. Our first study (N=54) showed that a wait time incentive could influence more people to go see a dermatologist after a positive test for skin cancer. Our second study (N=54), evaluating a similar application design, showed that although visual explanations of algorithmic decisions could increase participant trust in negative test results, the trust would not have been enough to affect people’s decision-making. Our third study (N=263) showed that people might prioritize test specificity or sensitivity depending on the nature of the medical condition. Conclusions Beyond the findings from our 3 case studies, our research uses the framing of the Health Belief Model to elicit and understand the intrinsic and extrinsic factors that may affect the adoption and acceptability of an HIT without having to build a working prototype. We have made our survey instrument publicly available so that others can leverage it for their own investigations.

Walsh’s Classroom Modes and Interactional Features of Teacher Talk in Science Class at DCS Semarang

This research aims to find out how the realization of classroom modes and interactional features of teacher talk and identify the interactional features that either support or hindrance student's learning in science class elementary level. The descriptive qualitative method is applied in this study. Twelve lessons from 7 teachers were transcribed and analyzed using the Self Evaluation of Teacher Talk (SETT) framework adapted from Walsh (2006) supported by data interview. The findings show that all four classroom modes can be seen in all of the lessons, but classroom context modes were found in a limited portion. The teachers performed all interactional features where the most frequent occurrences are teacher echo, display question, seeking clarification, content feedback, and extended teacher turn. The lesser proportion of the interactional features are scaffolding, extended wait time, referential questions, direct repair, confirmation check, extended learner turn, teacher interruptions, form-focused feedback, and turn completion. From all the interactional features that have been employed, seeking clarification, content feedback, scaffolding, and extended wait time are strategies that potentially support students learning. On the other hand, teacher echo and display questions were found to hindrance students’ learning potentially.

The Impact of COVID-19 on the Surgical Wait Times for Plastic and Reconstructive Surgery in Ontario

Purpose: The aim of this study was to assess the impact of COVID-19 on surgical wait times for Plastic and Reconstructive Surgery (PRS) in Ontario, Canada. Methods: Ontario's wait time data has fourteen reporting categories for PRS. For each category, the mean wait time for consultation and for surgery were reported. Each category was given a priority ranging from 1 to 4. Two periods, three-month and six-month, were selected and compared to the same calendar months of the previous year. Wait times, surgical volume and percent change to the provincial wait time target were reported and compared to the baseline data. Results: This study reviewed 9563 consults and 15,000 operative cases. There was a 50% reduction in the volume of surgical consults during the study period compared to the baseline period (P = 0.004). The reduction ranged from 46% to 75% based on the reporting category. The volume of surgical cases decreased by 43% during the study period compared to the baseline period (P = 0.005). A statistically significant increase in the mean wait times for surgery was observed, involving priorities 2 to 4 (overall mean = 32 days, P ≤ 0.01). There was a 15% decrease in the percentage of surgeries meeting the provincial target times (P < 0.0001). Conclusion: COVID-19 has caused a significant reduction in the volume of cases performed in the majority of PRS categories with an overall increase in the wait times for consultation and for surgery. Recovery following COVID-19 will require strategies to address the growing volume of cases and wait times for surgery across all PRS categories.

On Designing a Socially Optimal Expedited Service and Its Impact on Individual Welfare

Problem definition: We consider the problem faced by a welfare-maximizing service provider who must make a decision on how to split a fixed quantity of resources between two variants of the service: a standard variant and an expedited variant. The service is mandatory, but customers can choose between the two variants. Choosing the expedited variant requires enrollment that incurs a fixed cost per period. Customers are strategic and have the same cost of waiting but are heterogeneous in the rate at which they use the service. Academic/practical relevance: The option of expedited security at U.S. airports (TSA PreCheck) is an instance where this problem arises. As has been the case with the PreCheck program, providers that offer expedited service may face criticism from customers, with the main concern being that the diversion of resources to expedited services increases wait time for regular customers. This has important policy implications for the provider, especially a government organization such as the TSA. Existing literature has focused on service differentiation as a means to maximize profit or overall social welfare, but its effect on individual customers has received little attention. Methodology: We find customer’s equilibrium decisions for any allocation choice made by the provider. Using the equilibrium result, we solve for the allocation choice that maximizes social welfare. Results: Even when customers behave strategically, an expedited service offered in parallel to a standard service cannot only increase overall welfare, but also do so for each customer individually. We also find that in a scenario where some customers lose out because of the expedited service, improving the efficiency of the expedited service is more effective than decreasing the enrollment cost to help those who are worse off. Managerial implications: The gains from offering expedited service do not have to come at the expense of regular customers. When they do, we provide recommendations for which decision levers are most effective at making the system fair.

Going beyond the Text: Interactional Competence in Reading Comprehension Class

Drawing on the principles underlying conversation analysis (CA), this paper is a single case analysis of interaction in an English as a foreign language (EFL) reading comprehension classroom in Saudi Arabia. It looks at learning from a sociocultural perspective and uses constructs from this theoretical perspective. It focuses on Classroom Interactional Competence (CIC) (Walsh, 2013), showing classroom interaction features that are considered CIC. The paper reflects how an understanding of the concept can lead to more dialogic, engaged learning environments. The paper also connects CIC to teachers’ ability to manipulate simple classroom interactional resources to make the teaching process more effective. The paper demonstrates how teachers can induce CIC by utilizing interactional techniques, such as relaxing the mechanism and speed through which turns are taken or given, use of active listenership devices, extending wait time, and use of open-ended questions to expand topics under development. The paper argues that those techniques will help teachers, as evidenced from the cited examples, further enhance classroom participation so that it is convergent with their pedagogical goals. Finally, the paper has pedagogical implementations as it sheds light on techniques that help promote classroom interaction as an indication of learning among students with limited linguistic resources.

InterTwin: Deep Learning Approaches for Computing Measures of Effectiveness for Traffic Intersections

Microscopic simulation-based approaches are extensively used for determining good signal timing plans on traffic intersections. Measures of Effectiveness (MOEs) such as wait time, throughput, fuel consumption, emission, and delays can be derived for variable signal timing parameters, traffic flow patterns, etc. However, these techniques are computationally intensive, especially when the number of signal timing scenarios to be simulated are large. In this paper, we propose InterTwin, a Deep Neural Network architecture based on Spatial Graph Convolution and Encoder-Decoder Recurrent networks that can predict the MOEs efficiently and accurately for a wide variety of signal timing and traffic patterns. Our methods can generate probability distributions of MOEs and are not limited to mean and standard deviation. Additionally, GPU implementations using InterTwin can derive MOEs, at least four to five orders of magnitude faster than microscopic simulations on a conventional 32 core CPU machine.