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Congenital Impairments, Physical Disabilities, Speech Communication, Speech Skills, Young Children, Language Skills, Cognitive Development, Speech Language Pathology, Evaluation Methods, Speech Impairments, Articulation Impairments, Foreign Countries, Child Development, Comprehension, Pronunciation, Surgery, Human Body, Psychomotor Skills, Environmental Influences, Early Intervention, Holistic Approach, Preschool Language Scale, MacArthur Communicative Development Inventory, Bayley Scales of Infant Development, and Australia

Purpose: Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method: Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results: Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion: Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.

Video Technology, Instructional Films, Instructional Effectiveness, Surgery, Medical Students, Caring, Emotional Response, Patients, Student Motivation, Positive Attitudes, and Educational Benefits

Medical students' motivations for choosing a medical career are likely based on and remain tethered to the affectively-laden caring component of doctor-patient interactions. However, this component is rarely presented in educational surgical videos. It is unknown whether affectively engaging students by including patient-related emotionally salient information potentiates or draws focus away from learning a surgical procedure and whether such information affects motivation and attitudes toward the video. Therefore, we investigate whether presenting a patient's emotional state before video surgery enhances or weakens the educational value of that video. In a within-subjects crossover design, second-year medical students (n = 130) viewed video clips of surgeries. These videos, from online medical education platforms, were preceded by the patient's information from the original video or by information about the patient's preoperative emotional preparation. After each video, participants completed a multiple-choice test about the video's content to measure learning, answered a question about their motivation to re-watch the video, and completed an attitude scale regarding the video. Incorporating patient's information into surgical videos significantly enhanced students' acquisition of the technical aspects of surgery procedures (p < 0.0001), motivation to re-watch the video (p < 0.001), and favorable attitudes toward the video (p = 0.02). These findings show that incorporating information about patients' emotional states may enhance students' positive attitudes and motivations toward educational videos and may improve their learning of surgical techniques. They also suggest that the role of this factor should be considered when developing guidelines for medical educational video release.

Dentistry, Research Reports, Form Classes (Languages), Surgery, Pediatrics, Language Usage, Authors, Discourse Analysis, Academic Language, English for Special Purposes, Teaching Methods, Writing (Composition), and Computational Linguistics

Research on intradisciplinary variations in self-mention marker use in research articles (RAs) in dentistry subdisciplines is lacking. The present study investigates self-mention markers used in each of the seven dentistry subdisciplines (oral sciences, periodontics, endodontics, pediatrics, prosthodontics, oral and maxillofacial surgery, and orthodontics), sections of RAs that employ more self-mention devices in each of the seven dentistry subdisciplines, and common rhetorical realizations of first-person pronouns in the seven dentistry subdisciplines. The analytical framework was primarily based on Hyland's (2003) four rhetorical functions of self-mentions in RAs. The findings showed the lack of qualitative and quantitative intradisciplinary variations across six of the seven dentistry subdisciplines. The first-person plural pronouns "we" and "our" were the most frequently employed self-mention devices in the Discussion section of RAs. Authors in the periodontics subdiscipline preferred to retain an objective stance through the use of passive constructions, abiding by the conventional norms of academic writing that restrict them. The findings also revealed that "explaining a procedure" and "stating findings/claims" were the most frequent realizations associated with the use of self-mention devices, with the exception of periodontics RAs that employed passive constructions instead. The findings contribute to the fields of discourse and genre studies as well as ESP/EAP courses. They may have implications for dentistry RA writing and teaching. An awareness of more frequently used self-mentions in dentistry RAs and their rhetorical functions can help English dentistry scholars successfully produce RAs in line with the academic writing norms of each subdiscipline.

Patients, Teamwork, Peer Relationship, Correlation, Obstetrics, Simulation, Birth, Surgery, Medical Education, Likert Scales, Clinical Experience, Teaching Methods, Affective Behavior, Predictor Variables, Group Dynamics, Scores, Knowledge Level, Medical Students, Student Attitudes, and Network Analysis

Research from outside the medical field suggests that social ties between team-members influence knowledge sharing, improve coordination, and facilitate task completion. However, the relative importance of social ties among team-members for patient satisfaction remains unknown. In this study, we explored the association between social ties within emergency teams performing simulated caesarean sections (CS) and patient-actor satisfaction. Two hundred seventy-two participants were allocated to 33 teams performing two emergency CSs in a simulated setting. We collected data on social ties between team-members, measured as affective, personal and professional ties. Ties were rated on 5-point Likert scales. In addition, participants' clinical experience, demographic data and their knowledge about team members' roles were surveyed. Perceived patient satisfaction was measured on a 5-point Likert scale. Data was analysed with a linear regression model using elastic net regularization. In total, 109 predictor variables were analysed including 84 related to social ties and 25 related to clinical experience, demographics and knowledge test scores. Of the 84 variables reflecting social ties, 34 (41%) had significant association with patient satisfaction, p < 0.01. By contrast, a significant association with patient satisfaction was found for only one (4%) of the 25 variables reflecting clinical experience, demographics and knowledge of team roles. Affective ties and personal ties were found to be far more important predictors in the statistical model than professional ties and predictors relating to clinical experience. Social ties between emergency team members may be important predictors of patient satisfaction. The results from this study help to enhance our conceptual understanding of social ties and their implications for team-dynamics. Our study challenges existing views of team-performance by placing emphasis on achieving collective competence through affective and personal social ties, rather than focusing on traditional measures of expertise.

Case Studies, Control Groups, Correlation, Drug Use, Autism, Pervasive Developmental Disorders, Comparative Analysis, Clinical Diagnosis, Matched Groups, Birth, Surgery, Body Composition, Perinatal Influences, Gender Differences, Mothers, and Participant Characteristics

A case-control study was performed to determine whether an association exists between exposure to synthetic oxytocin and a subsequent autism spectrum disorder diagnosis; 171 children under age 18 meeting "Diagnostic and Statistical Manual of Mental Disorders" (5th ed.) autism spectrum disorder criteria were compared to 171 children without autism spectrum disorder diagnosis matched by gender, birth year, gestational age, and maternal age at birth. A conditional logistic regression model was used to examine the association of clinical variables and autism spectrum disorder. Significantly elevated odds ratios for autism spectrum disorder were associated with first-time Cesarean section (odds ratio=2.56), but not a repeat Cesarean section. Odds ratios were also significantly elevated for subjects whose mother's body mass index was 35 or higher at birth (odds ratio=2.34) and subjects in which the reason for delivery was categorized as "fetal indication" (odds ratio=2.00). When controlling for these and other variables, the odds of developing autism spectrum disorder were significantly elevated in males with long duration of exposure (odds ratio=3.48) and high cumulative dose of synthetic oxytocin (odds ratio=2.79). No significant associations of synthetic oxytocin dosing and autism spectrum disorder were noted in female subjects. The association of elevated autism spectrum disorder odds found with high duration and high cumulative dose synthetic oxytocin in male subjects suggests the need for further investigation to fully elucidate any cause and effect relationship.

Computer Simulation, Teaching Methods, Nursing Education, Undergraduate Students, Instructional Effectiveness, Surgery, Medical Services, Comparative Analysis, Student Attitudes, Correlation, Learning Processes, Self Efficacy, and Outcomes of Education

The perceived effectiveness of an IVRLE may distinguish depending on the previous knowledge learners. The purpose of this research is to investigate the features of an immersive virtual reality learning environment (IVRLE) and to evaluate its perceived simulation effectiveness under the learning, attitude, and confidence sub-concepts. This study designed an IVRLE using gesture interaction for teaching preoperative surgical procedures and concepts to undergraduate nursing students. IVRLE implemented on different level nursing students to compare their perceived effectiveness regarding this learning environment.This research includes two main phases to explore perceived simulation effectiveness. In the first phase, each of 14 volunteer 3rd-year nursing students completed the learning scenario of IVRLE four times in a month. They applied the revised survey to assess the efficiency of this IVRLE after each session. In the second phase, 57 1st-year nursing students experienced same IVRLE for once. The data gathered from the first phase was analyzed using Freidman and Wilcoxon's non-parametric statistical tests. The data collected from 1st-year students was analyzed using a one-sample t-test, and the Pearson coefficient was calculated to discover the relationship between subscales. The findings of the first phase indicated a statistical significance among 1-4th and 3-4th implementations in favor of confidence subscale. The second phase analysis found a significant relationship between learning-confidence, learning-attitude, and attitude-confidence.Before using IVR systems as a learning tool, learners should be familiar with IVR technologies. The results of this research emphasize to design IVRLEs considering the desired learning outcomes, abilities, and expectations of the learners. This study showed that targeted and well-designed IVRLE helps to improve the confidence of learners in practical skills.

Outcomes of Treatment, Risk, Publications, Bias, Sample Size, Simulation, Meta Analysis, Correlation, Vignettes, Error Patterns, Surgery, and Drug Therapy

This study aimed to determine for continuous outcomes dependent on baseline risk, whether funnel plot asymmetry may be due to statistical artefact rather than publication bias and evaluate a novel test to resolve this. Firstly, we conducted assessment for publication bias in nine meta-analyses of postoperative analgesics (344 trials with 25 348 participants). Secondly, we attempted to resolve the observed asymmetry by considering meta-regression residuals as outcome (rather than mean difference) and (inverse) sample size as the exploratory variable (rather than SE). Since the approach resolved the asymmetry, we evaluated it, and related approaches, using a simulation study considering four scenarios comprised of every combination of baseline interactions and absolute selective publication bias being present or not (10 000 simulated meta-analyses per scenario with no residual between-study heterogeneity). The test based on meta-regression residuals and inverse sample size performed as well as conventional tests (Egger's test) when no baseline risk was present and reduced type I errors when baseline risk was present. It also had modest power to detect publication bias in the presence of baseline risk. We demonstrated that correlation between effect estimates and SEs produces funnel plot asymmetry in the presence of no publication bias for continuous outcomes dependent on baseline risk. Our novel approach of assessing funnel plot asymmetry using a modified funnel plot and test based on residuals and inverse sample size may have improved performance when carrying out publication bias assessments for unstandardized mean differences where treatment effects are dependent on baseline risk.

Nurses, Surgery, Self Efficacy, Electronic Learning, Educational Technology, Hospitals, Foreign Countries, Technological Literacy, Teaching Methods, Training, and Philippines

The conventional methods of education and training for operating room experience have been rendered impractical due to both the shortage and fast turnover of nurses in hospitals. Experts in the field of education are promoting e-learning modalities as a potential solution. However, issues were raised regarding the readiness of nurses to engage in e-learning due to lack of standardized competencies for practice, inconsistency in the integration of informatics courses in education, and lack of experts in the field. Literature reveals that self-efficacy is a major component of e-learning readiness. A descriptive-survey design was utilized to assess the elearning self-efficacy of operating room nurses in a selected hospital in the Philippines. The Modified E-learning Readiness Assessment Tool (MERAT) captured the elements of the construct along with its sub-domains: computer, internet/online, and software utilization self-efficacy. The frequency distribution and item means were computed. Item analysis revealed that the respondents have positive e-learning self-efficacy based on item means obtained ranging from 3.29 to 4.58 on a 1.0 to 5.0 scale. A secondary analysis was conducted by clustering the e-learning self-efficacy indicators based on the nature of the competency and data trends. It revealed that the participants perceived themselves to be "Very Good" in terms of complex computer skills, online etiquette, troubleshooting computer-related issues, and usage of an e-learning platform, and "Excellent" in terms of basic computer and online skills. The results of this study implied that e-learning initiatives might be used to augment education and training of operating room nurses despite issues on manpower and competency base. It is further recommended that research explore other domains of e-learning readiness and determine the impact of this modality in the field of health care.

Assistive Technology, Hearing Impairments, Deafness, Speech Communication, Children, Risk, Literacy Education, Auditory Perception, Phonology, Phonological Awareness, Phonemes, and Surgery

Radical advancements in hearing technology in the last 30 years have offered some deaf and hard-of-hearing (DHH) children the adequate auditory access necessary to acquire spoken language with high-quality early intervention. However, meaningful achievement gaps in reading and spoken language persist despite the engineering marvel of modern hearing aids and cochlear implants. Moreover, there is enormous unexplained variability in spoken language and literacy outcomes. Aspects of signal processing in both hearing aids and cochlear implants are discussed as they relate to spoken language outcomes in preschool and school-age children. In suggesting areas for future research, a case is made for not only expanding the search for mechanisms of influence on outcomes outside of traditional device- and child-related factors, but also for framing the search within Biopsychosocial systems theories. This theoretical approach incorporates systems of risk factors across many levels, as well as the bidirectional and complex ways in which factors influence each other. The combination of sophisticated hearing technology and a fuller understanding of the complex environmental and biological factors that shape development will help maximize spoken language outcomes in DHH children and contribute to laying the groundwork for successful literacy and academic development.

Foreign Countries, Medical Students, Medical Education, Surgery, Student Interests, Career Choice, Course Selection (Students), Value Judgment, and Saudi Arabia

The aim of the study was to evaluate the benefits from 4th year surgical course for medical students upon reaching 6th year surgical course. A questionnaire survey was conducted and questions regarding student satisfaction with the 4th year course and the benefits gained from this course in the 6th year were evaluated. Students were questioned regarding their interest in surgery as a career. A total of 67 students were enrolled in the study and the information collected from them was analyzed. The results showed that only 35 students reported in agreement of offering 1 surgery course; whereas, only 32 students reported in agreement of 2 surgery courses. The results also showed that only 26 students were interested in surgery as a career. The study emphasized on spreading awareness among students regarding surgery, and suggested that courses must be introduced in the curriculum to help students in their future decision making.

Spatial Ability, STEM Education, Course Selection (Students), Gender Differences, Barriers, Training, Genetics, Environmental Influences, Enrollment, Skill Development, Geology, Chemistry, Biology, Physics, Engineering, Mathematics, Surgery, and Individual Differences

Accumulated evidence indicates that low spatial ability makes a contribution, separate from levels of general or verbal intelligence, to the unlikelihood of students enrolling in, or succeeding in, STEM subjects. Further, there is a tendency for female students not to perform as well as males on some spatial tests, suggesting that this might be part of the reason for their under-representation in some STEM areas. However, the level of spatial ability has been shown to be related to both genetic and environmental factors, thereby suggesting that it can be improved with appropriate training. Here I look at some of this background and prior research, including training studies, in STEM subjects. Interestingly, as subject specific expertise develops, drawing on specific knowledge tends to replace need for spatial thinking, so it is the negotiation of any initial spatial barrier into a subject which is crucial. To effect this, I outline a relatively new spatial categorisation which could be valuable for STEM teachers as a framework to help them guide their students through the early spatial demands of their own teaching subject(s).

Human Body, Children, Anatomy, Surgery, and Congenital Impairments

Purpose: The purpose of this study is to examine the differences in velopharyngeal dimensions as well as levator veli palatini (levator) muscle morphology, positioning, and symmetry of children with repaired cleft palate with velopharyngeal insufficiency (VPI), children with repaired cleft palate with complete velopharyngeal closure, and children with noncleft anatomy. Method: Fifteen children ranging in age from 4 to 8 years were recruited for this study. Ten of the participants had a history of repaired cleft palate, half with documented VPI and the other half with velopharyngeal closure. Five participants with noncleft anatomy were matched for age from a normative database. The magnetic resonance imaging protocol, processing methods, and analysis are consistent with that used in previous literature. Results: Regarding velopharyngeal dimensions, median values were statistically significantly different between groups for sagittal angle (p = 0.031) and effective velopharyngeal ratio (p = 0.013). With respect to the levator muscle, median values were statistically significant for average extravelar length (p = 0.018), thickness at midline (p = 0.021), and thickness between the left and right muscle bundles at the point of insertion into the velum (p = 0.037). Remaining measures were not statistically significant. Conclusions: The levator muscle is significantly different among these three groups with respect to thickness at midline, extravelar length, and symmetry at the point of insertion into the velum. Sagittal angle and effective velopharyngeal ratio are also significantly different. Participants with repaired cleft palate and VPI displayed the greatest degree of asymmetry. Future research should control for surgical procedure type to determine the impact of surgery on the levator muscle and surrounding velopharyngeal anatomy.