Comparing In Vivo versus Simulation Training for Transnasal Endoscopy Skills

Fiberoptic endoscopic evaluations of swallowing (FEES) is as important of a swallowing evaluation as the videoflouroscopic swallow study, but far fewer speech-language pathologists are competent in its use (Ambika, Datta, Manjula, Warawantkar, & Thomas, 2019; Brady & Donzelli, 2013; Pisegna & Langmore, 2016). One hurdle in FEES training is the necessity of practicing transnasal endoscopy on volunteers. The primary aim of this study was to compare the learning effectiveness of practicing transnasal endoscopy via simulation with practice in vivo for a student’s first passes of the endoscope. The end goal of this study was to determine the most cost-effective and feasible means of teaching transnasal endoscopy to graduate clinicians. Twenty-one graduate students practiced transnasal endoscopy in one of three conditions: in vivo, high-fidelity lifelike simulation, low-fidelity non-lifelike simulation. The learning outcomes assessed were speed of endoscopy, student confidence, and simulated patients’ comfort and perception of student skill. There were no significant differences between conditions found for any of these measures. Students in all conditions became more confident after practicing endoscopy, and that confidence was predictive of procedure time. The results of this study indicate that practice with simulation may be an important first step in teaching endoscopy

The Utility of Peer-to-Peer Practice for Teaching Speech-Language Pathology Students Transnasal Endoscopy

Introduction: Transnasal flexible endoscopy (TNFE) is necessary for multiple assessments in speech-language pathology (SLP), but it is generally considered an advanced practice technique to be learned during clinical practice. As such, there is no standardized way that it is taught in training programs, leading to a substantial knowledge gap for new graduates. Though peer-to-peer practice has been discussed as an important step in training, it is not clear whether it confers additional benefits above and beyond simulation. This study sought to answer that question in the areas of student confidence, endoscopy speed, and motivation to pursue further TNFE experiences. Methods: Thirty-six SLP graduate students completed TNFE training and one of two practice conditions: simulation only or simulation with additional peer-to-peer practice. Outcome measures included confidence and comfort surveys, intrinsic motivation to complete an additional TNFE experience, and speed of TNFE. Results: No significant differences were found between the two groups for any measure, and consistently low effect sizes indicated there was little difference between groups. Conclusions: These results indicate that teaching TNFE through simulation may provide similar outcomes to peer-to-peer practice during the initial training that an SLP graduate program can provide. This adds to the literature indicating that TNFE simulation is a worthwhile addition to SLP programs

Clinical Education Outcomes and Research Directions in Speech-Language Pathology: A Scoping Review

Purpose: To describe what researchers are investigating and how they are measuring the constructs of their investigations within the speech-language pathology (SLP) clinical education literature. Method: A scoping review methodology (Arksey & O’Malley, 2005) was employed to develop a picture of clinical education articles which reported a measured outcome. Articles that met criteria were categorized by the purpose of the investigation and the outcome measures reported. Result: 124 articles met inclusion criteria. Analysis of study purposes revealed a wide breadth of foci that were grouped into four broad clusters: Outcome Measures, Student Perspectives, Educational Contexts, and Teaching Methods. Most of the studies in the corpus relied only on student self-report measures. In addition, any specific outcome measure was typically used only once and not found in subsequent studies. Trends indicate a variety of constructs are being studied at an exploratory level with limited in-depth investigation. Conclusion: Given the inconsistency of outcome measures and reliance on self-report measures, more research is needed to validate recommendations of best practices in clinical education. Areas of need include developing and implementing validated outcomes, more frequent investigation of clinical education using measures other than student self-reports, and testing theories found in other fields

Reimagining Clinical Education Practices for Autism through the Multi-client Multilevel Mentorship Model

Speech-language pathology students require comprehensive graduate education to address the needs of their future autistic clients. Despite this need, survey research suggests that students receive limited didactic and clinical graduate training that sufficiently prepares them to work with autistic clients. Contemporary research into clinical education for autism includes several features, such as more support and group-based services, that do not align with traditional clinical education in the field (Anderson, 1988; Dudding et al., 2017). The purpose of this study is to describe feasibility (by acceptability and implementation) of a new clinical education protocol, the Multi-client Multilevel Mentorship (M3) model. The M3 model is a collaborative clinical education model that emphasizes in-the-room clinical supervision of group-based service delivery for a team of students. Two cohorts of student clinicians (N = 9) participated in two ten-week rotations where they provided (a) and a literacy intervention (b) an intervention targeting executive function for two groups of clients with mixed diagnoses including autism spectrum disorder. Two clinical educators supervised the sessions with additional support by peer mentors. Survey feedback from participants showed that they rated the clinical education experience highly, suggesting adequate acceptability of the M3 model. Participants demonstrated strong fidelity to one protocol and fair fidelity to the other, which was a positive indicator of implementation. Overall, student participants appear to benefit from the M3 model during an adapted group intervention protocol designed for autistic clients. Further testing of the M3 model’s effectiveness is warranted given the positive feasibility indicators

Anion vacancies as a source of persistent photoconductivity in II-VI and chalcopyrite semiconductors

Using first-principles electronic structure calculations we identify the anion vacancies in II-VI and chalcopyrite Cu-III-VI2 semiconductors as a class of intrinsic defects that can exhibit metastable behavior. Specifically, we predict persistent electron photoconductivity (n-type PPC) caused by the oxygen vacancy VO in n-ZnO, and persistent hole photoconductivity (p-type PPC) caused by the Se vacancy VSe in p-CuInSe2 and p-CuGaSe2. We find that VSe in the chalcopyrite materials is amphoteric having two "negative-U" like transitions, i.e. a double-donor transition e(2+/0) close to the valence band and a double-acceptor transition e(0/2-) closer to the conduction band. We introduce a classification scheme that distinguishes two types of defects (e.g., donors): type-alpha, which have a defect-localized-state (DLS) in the gap, and type-beta, which have a resonant DLS within the host bands (e.g., conduction band). In the latter case, the introduced carriers (e.g., electrons) relax to the band edge where they can occupy a perturbed-host-state (PHS). Type alpha is non-conducting, whereas type beta is conducting. We identify the neutral anion vacancy as type-alpha and the doubly positively charged vacancy as type-beta. We suggest that illumination changes the charge state of the anion vacancy and leads to a crossover between alpha- and beta-type behavior, resulting in metastability and PPC. In CuInSe2, the metastable behavior of VSe is carried over to the (VSe-VCu) complex, which we identify as the physical origin of PPC observed experimentally. We explain previous puzzling experimental results in ZnO and CuInSe2 in the light of this model.Comment: submitted to Phys. Rev.

The politics of evidence: methodologies for understanding the global land rush

Since the most recent ‘land rush’ precipitated by the convergent ‘crises’ of fuel, feed and food in 2007-08, the debate on the consequences of land investments has been massively heightened, with widespread media coverage, policy commentary and civil society engagement. The ‘land rush’ of recent years has been accompanied by a ‘literature rush’, with a fast-growing body of reports, articles, tables and books with varied purposes, metrics and methods. ‘Land grabbing’ is now a hot political topic around the world, discussed amongst the highest circles. This is why getting the facts right is really important, and having effective methodologies is crucial. Several global initiatives have set out to aggregate information on land deals, and to describe their scale, character and distribution. All have contributed to building a better picture of the phenomenon, but all have struggled with methodology. This JPS Forum identifies a profound uncertainty about what it is that is being counted, questions methods used to collate and aggregate ‘land grabs’, and calls for a second phase of land grab research which abandons the aim of deriving total numbers of hectares in favour of more specific, grounded and transparent methods.ESR

A Simple Artificial Life Model Explains Irrational Behavior in Human Decision-Making

Although praised for their rationality, humans often make poor decisions, even in simple situations. In the repeated binary choice experiment, an individual has to choose repeatedly between the same two alternatives, where a reward is assigned to one of them with fixed probability. The optimal strategy is to perseverate with choosing the alternative with the best expected return. Whereas many species perseverate, humans tend to match the frequencies of their choices to the frequencies of the alternatives, a sub-optimal strategy known as probability matching. Our goal was to find the primary cognitive constraints under which a set of simple evolutionary rules can lead to such contrasting behaviors. We simulated the evolution of artificial populations, wherein the fitness of each animat (artificial animal) depended on its ability to predict the next element of a sequence made up of a repeating binary string of varying size. When the string was short relative to the animats’ neural capacity, they could learn it and correctly predict the next element of the sequence. When it was long, they could not learn it, turning to the next best option: to perseverate. Animats from the last generation then performed the task of predicting the next element of a non-periodical binary sequence. We found that, whereas animats with smaller neural capacity kept perseverating with the best alternative as before, animats with larger neural capacity, which had previously been able to learn the pattern of repeating strings, adopted probability matching, being outperformed by the perseverating animats. Our results demonstrate how the ability to make predictions in an environment endowed with regular patterns may lead to probability matching under less structured conditions. They point to probability matching as a likely by-product of adaptive cognitive strategies that were crucial in human evolution, but may lead to sub-optimal performances in other environments

Global Biobank analyses provide lessons for developing polygenic risk scores across diverse cohorts

Polygenic risk scores (PRSs) have been widely explored in precision medicine. However, few studies have thoroughly investigated their best practices in global populations across different diseases. We here utilized data from Global Biobank Meta-analysis Initiative (GBMI) to explore methodological considerations and PRS performance in 9 different biobanks for 14 disease endpoints. Specifically, we constructed PRSs using pruning and thresholding (P + T) and PRS-continuous shrinkage (CS). For both methods, using a European-based linkage disequilibrium (LD) reference panel resulted in comparable or higher prediction accuracy compared with several other non-European-based panels. PRS-CS overall outperformed the classic P + T method, especially for endpoints with higher SNP-based heritability. Notably, prediction accuracy is heterogeneous across endpoints, biobanks, and ancestries, especially for asthma, which has known variation in disease prevalence across populations. Overall, we provide lessons for PRS construction, evaluation, and interpretation using GBMI resources and highlight the importance of best practices for PRS in the biobank-scale genomics era.</p