Objectives: To investigate if live births conceived in months when surface water agrichemicals are highest are at greater risk for birth defects.

Background Globalization has increased the demand for international experiences in medical education. International experiences improve medical knowledge, clinical skills, self-development, influence career objectives, and provide insights on ethical and societal issues. However, global health rotations can end up being no more than tourism if not structured to foster personal transformation and global citizenship. Objective We conducted a qualitative assessment of trainee-reported critical incidents to more deeply understand the impact of our global health experience on trainees. Method A cross-sectional survey was administered to trainees who had participated in a two-month elective in Kenya from January 1989 to May 2013. We report the results of a qualitative assessment of the critical incident reflections participants (n=137) entered in response to the prompt: “Write about one of their most memorable experiences and explain why you chose to describe this particular one.” Approach Qualitative analyses were conducted using thematic analysis and crystallization immersion analytic methods based on the principles of grounded theory, employing a constructivists’ research paradigm. Results Four major themes emerged. These themes included: Opening Oneself to a Broader World View; Impact of Suffering and Death; and Life Changing Experiences; and Commitment to Care for the Medically Underserved. Conclusions Circumstances that learners encounter in the resource-scarce environment in Kenya are eye-opening and life-changing. When exposed to these frame-shifting circumstances, students elaborate upon or transform existing points of view. These emotionally disruptive experiences in an international health setting allowed students to enter a transformational learning process with a global mind. Students can see the world as an interdependent society and develop the capacity to advance both their enlightened self-interest and the interest of people elsewhere in the world as they mature as global citizens. Medical schools are encouraged to foster these experiences by finding ways to integrate them into curriculum.

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Authorship Correction: (On Becoming a Global Citizen: Transformative Learning through Global Health Experiences). Ms. Ann Cottingham came forward after the paper was published requesting authorship for her contribution to the qualitative analyses and after review it was determined that her contributions were sufficient to qualify for authorship. Ms. Cottingham contributed to the qualitative analyses and reviewed and contributed to drafts of the manuscript. All authors have agreed in writing to the requested change.

Background and Purpose: Mobile health (mHealth) apps hold potential to transform healthcare, but their adoption in clinical settings takes time and how providers and families use them is unknown. Three clinics at Riley Hospital for Children are preparing to implement BabyNoggin, an app that collects developmental screening tools typically collected via paper forms. The purpose of this study was two-fold: 1) to understand pre-implementation processes and provider perspectives of integrating BabyNoggin into clinic workflow; and 2) to examine parental attitudes towards the use of apps for child development.  Project Methods: Pre-implementation clinical observations of workflow were performed in participating clinics. Semi-structured interviews informed by the Consolidated Framework for Implementation Research (CFIR) were conducted with each clinical team to understand perceived implementation facilitators and barriers. Lastly, parents with children aged 0-5 were recruited from study clinics and social media to participate in a 26-item survey to gauge their attitudes towards using apps in place of paper screening forms and for tracking their child’s development.  Results: Implementation workflows were co-created with each clinical team that should not increase visit length. Five CFIR interviews highlighted facilitators and barriers towards implementation of BabyNoggin to be considered during implementation. Out of 199 parents who completed the survey, 72.9% (n=145) reported a higher likelihood of downloading a child health app that was recommended by their pediatrician.     Conclusion and Future Steps: This study constituted the pre-implementation phase of a larger project involving the implementation of BabyNoggin. Future research will use these findings as a guide during implementation.

Background: Clinical care guidelines for universal developmental screening are meant to identify at-risk children as early as possible so that early intervention can be initiated. However, despite years of initiatives, developmental screening rates remain less than ideal. Recent innovations in mHealth apps that integrate developmental screening may offer an alternate way to optimize screening rates if it can encourage co-use and seamless integration into clinical workflow.Objective: Prior to the planned deployment of a clinic-based mHealth developmental screening app, the research team sought to identify and characterize opportunities and challenges to implementation, focusing on clinic workflow and multi-stakeholder engagement with providers and parents.Methods: Three clinic settings were recruited to participate from one children's hospital in Indianapolis, Indiana. Preimplementation clinical observations of workflow and team dynamics were performed. Potential adoption barriers and facilitators were explored through interviews with health care teams guided by the Consolidated Framework for Implementation Research (CFIR). Parents with children aged 0-5 were recruited from study clinics and social media to complete a 26-item survey to gauge their attitudes towards using apps in place of paper screening forms and for tracking their child's development.Results: Proposed implementation workflows were co-created with each clinical team so to not increase overall visit length, which was the main concern for health care providers. Providers had enthusiasm for use of mHealth tools; however, concerns were expressed about potential technology failures, data security and HIPAA and the workflow impacts. Two hundred fifty parents responded to the social media survey. The top reason for downloading child health apps were for a convenient way to track development (62.6%). Two-thirds of respondents expressed interest in an app that included developmental screening forms. Most parents prefer to complete screening tools on the day of the clinic visit (47.7%) or electronically prior to the visit (44.8%). Seventy-four percent of parents expressed a higher likelihood of using an app if recommended by the pediatrician. Conclusions:Parents and providers are interested and open to mHealth apps for child developmental screening. Provider buy-in and involvement in implementation planning is critical, both to integrating apps into clinic workflows and to encouraging parents to use the app.

BACKGROUND Clinical care guidelines for universal developmental screening are meant to identify at-risk children as early as possible so that early intervention can be initiated. However, despite years of initiatives, developmental screening rates remain less than ideal. Recent innovations in mHealth apps that integrate developmental screening may offer an alternate way to optimize screening rates if it can encourage co-use and seamless integration into clinical workflow. OBJECTIVE Prior to the planned deployment of a clinic-based mHealth developmental screening app, the research team sought to identify and characterize opportunities and challenges to implementation, focusing on clinic workflow and multi-stakeholder engagement with providers and parents. METHODS Three clinic settings were recruited to participate from one children’s hospital in Indianapolis, Indiana. Preimplementation clinical observations of workflow and team dynamics were performed. Potential adoption barriers and facilitators were explored through interviews with health care teams guided by the Consolidated Framework for Implementation Research (CFIR). Parents with children aged 0-5 were recruited from study clinics and social media to complete a 26-item survey to gauge their attitudes towards using apps in place of paper screening forms and for tracking their child’s development. RESULTS Proposed implementation workflows were co-created with each clinical team so to not increase overall visit length, which was the main concern for health care providers. Providers had enthusiasm for use of mHealth tools; however, concerns were expressed about potential technology failures, data security and HIPAA and the workflow impacts. Two hundred fifty parents responded to the social media survey. The top reason for downloading child health apps were for a convenient way to track development (62.6%). Two-thirds of respondents expressed interest in an app that included developmental screening forms. Most parents prefer to complete screening tools on the day of the clinic visit (47.7%) or electronically prior to the visit (44.8%). Seventy-four percent of parents expressed a higher likelihood of using an app if recommended by the pediatrician. CONCLUSIONS Parents and providers are interested and open to mHealth apps for child developmental screening. Provider buy-in and involvement in implementation planning is critical, both to integrating apps into clinic workflows and to encouraging parents to use the app.