Clinical Simulations in Academic Courses: Four Case Studies Across the Medical SLP Graduate Curriculum

Simulation practices are growing in both popularity and necessity within speech pathology programs. Simulation use can serve to not only minimize client risk but to increase student confidence and competence prior to patient contact, particularly with low incidence or medically fragile patients. This paper describes and reflects on four individual simulation experiences within one graduate speech language pathology program and their outcomes. The use of both simulated patients and mannequin training resulted in an increase in students\u27 perception of knowledge and confidence in their clinical skills with medical patients

Elinor Glyn's British Talkies: Voice, Nationality and the Author On-Screen

Existing accounts of Elinor Glyn's career have emphasized her substantial impact on early Hollywood. In contrast, relatively little attention has been paid to her less successful efforts to break into the UK film industry in the early sound period. This article addresses this underexplored period, focusing on Glyn's use of sound in her two 1930 British films, Knowing Men and The Price of Things. The article argues that Glyn's British production practices reveal a unique strategy for reformulating her authorial stardom through the medium of the ‘talkie’. It explores how Glyn sought to exploit the specifically national qualities of the recorded English voice amidst a turbulent period in UK film production. The article contextualizes this strategy in relation to Glyn's business and personal archives, which evidence her attempts to refine her own speaking voice, alongside those of the screen stars whose careers she sought to develop for recorded sound. It suggests that the sound film was marked out as an important, exploitable new tool for Glyn within a broader context of debates about voice, recorded sound and nationality in UK culture at this time. This enabled her to portray a distinctively national brand identity through her new film work and surrounding publicity, in contrast to her appearances in American silent films. The article will show that recorded sound further allowed Glyn performatively to foreground her role as author-director through speaking cameos. This is analysed in relation to wider evidence of her practice, where she reflected on the performative qualities of the spoken voice in her writing and interviews, and made use of radio, newsreel and live performance to perfect and refine her own skills in recitation and oration

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline