Deficits In Training Research Articles

Nursing students training on domestic violence: How are we doing?

Introduction: Domestic violence is a public health problem. Evidence suggests deficits in nurses' knowledge and training in this area. Objectives: To identify the curricular units of the study plan for the Nursing degree course at a Health School in the north of Portugal that addresses the topic of domestic violence and identify improvement opportunities. Methodology: This is the first phase of an action-research study, with a qualitative exploratory and descriptive methodology and a non-probabilistic convenience sample. The following data collection instruments were used: documental analysis of the nursing degree study plan and a focus group with two fourth-year students and three professors. Results: No content related to the theme was identified in any of the curricular units. The focus group content analysis identified three categories: curricular program, importance of training, and opportunities for improvement. Conclusion: These results corroborate the available evidence, justifying and highlighting the relevance of the next phases of this study.

Mind the gap: exploring stakeholder perspectives on police-led pathways to crisis mental health care for young people in Ireland

ABSTRACT Over the past few decades, the level of police involvement at a community level in matters of mental health has increased significantly. Police are often the only agency immediately available day or night to respond to such emergencies and are often left to deal with mental illness and associated social crises with very limited support. Whilst recent years have witnessed an upsurge in governmental policy intended to safeguard vulnerable groups, such as young people and people with mental illness, there is a dearth of research regarding the proficiency and operability of these directives in practice. Even less is known about how these policies are practically applied to young people in crisis. The study examines the police-led care pathways of Irish youth experiencing a crisis mental health event from the commencement of police involvement through to the initiation of psychiatric care. Qualitative interviews were conducted with police and a group of stakeholders comprised of medical professionals and a social worker. Results indicate a complex care pathway beset with ambiguous policy and legislation, deficits in specialist training, and chronic under-resourcing of services. In the face of these shortcomings, police innovate informal practices that sometimes help and at other times pose a risk to young people in crisis. Furthermore, uncertainties surrounding formal procedure was a source of significant psychological burden for police and potential disciplinary action. These findings are discussed in the context of existing theory and research, and recommendations for policy and practice are offered.

Dyadic Training of Communication Partners for Autistic Students: A Feasibility Study

Access to communication is a primary challenge affecting the education of Autistic students who use augmentative and alternative communication devices. This is compounded by potential communication partners (e.g., teachers and classroom paraeducators) who have insufficient training and skills to meaningfully engage these students in communication. To address these deficits in skills and training, this feasibility study used a multiple probe across participants design to test the effects of using behavioral skills training on dyads of teachers and paraeducators in increasing teacher-delivered opportunities to respond and student communication responses. The results show that after training, teachers’ opportunities to respond and use student-specific strategies increased. Following the teachers’ implementation of the strategies, students’ prompted and unprompted communication increased. These results provide evidence that supports the use of behavioral skills training to support communication partner skill development and student communication needs. These methods showed positive social validity with participants and demonstrate a professional development method that is more feasible for use by school staff than individual training. The results of this study provide initial evidence of the effectiveness of these methods with dyads of participants as well as with licensed teachers, extending the extant research, which often focuses on the individual training of paraeducators.

Teaching Staff Mathematics University: Catalyst of the Emotional-Techno-Ontological Logic

The relevance of the study lies in the necessity to investigate the psycho-emotional state of teachers during the transition to remote teaching in universities and its impact on academic performance and emotional state of students. The aim of the research was to develop a theoretical approach to describe the emotional and techno-ontological logic of mathematics teachers during distance learning during the COVID-19 pandemic and the impact of their emotional state on the learning process. The study involved teachers and students from universities in Ecuador, both private and public. The study observed the behavior of teachers and students, analyzed the use of technology in mathematical activities, and analyzed personal opinions about the learning process of the participants of the study. A digital observation guide and open-ended interviews were used to collect data. The qualitative analysis program Atlas.ti was used to analyze the data. The program created three categories: andragogical retrotopia of mathematics, emotional scar in teacher preparation, and perceptions of the educational process. As the results of the research showed, there was a deficit of digital professional training of teachers in the university teaching of mathematics. And it was also found that the teacher played the role of a catalyst for the emotional-techno-ontological state of the educational process. As a result of the research work carried out, a theoretical approach is proposed, through which it is possible to avoid the manifestation of techno-ontological logical emotions in mathematics teachers in Ecuadorian universities.

Opening Pandora’s box - key facilitators of practice change in detecting and responding to childhood adversity - a practitioner perspective

BackgroundChildhood adversities worsen physical and mental health across the lifespan. Health and social care practitioners play a key role in identifying and responding to childhood adversity, however, may be reluctant to do so due to a perceived lack of services to refer to, time pressures and a deficit of training and confidence. We aimed to (1) quantify changes in practitioner comfort and confidence to identify and respond to childhood adversity following a multimodal intervention within an integrated child and family health and social care hub and (2) to understand barriers and facilitators of practice change.MethodsHub practitioners were surveyed about their competence and comfort to directly ask about and confidence to respond to adversity at baseline and then at six and twelve months post training. Interviews were undertaken to explore practitioner barriers and enablers of practice change. Interviews were recorded, transcribed verbatim, and analysed using reflexive thematic analysis. The theoretical domains framework was used to identify the key drivers of practice change.ResultsFifteen of 18 practitioners completed all three surveys and 70% reported increased competence and comfort to directly ask, and confidence to respond across a range of adversities over the 12-month intervention. Twenty-one practitioners completed interviews. Six themes were identified as either facilitators or barriers to practice change. Facilitator themes included (1) connection matters, (2) knowledge provides assurance, (3) confidence in ability and (4) choosing change. Barrier themes were (1) never enough time and (2) opening Pandora’s box. Following analysis, key drivers of practice change were ‘social influence’, ‘belief in capability’, ‘knowledge’ and ‘behaviour regulation’ while barriers to practice change were ‘environmental context and resources’ and ‘emotion’.ConclusionsPractitioners reported improved confidence in identifying and responding to adversity through a multimodal intervention delivered in an integrated Child and Family Hub. Changing practice requires more than just education and training. Opportunities for social connection and coaching to improve self-confidence and perceived competence are needed to overcome the fear of opening Pandora’s box.

Oral cancer diagnosis communication: Impact of an educational intervention using the SPIKES protocol.

This study evaluated the influence of a single educational intervention on the perception and knowledge of strategies for communicating oral cancer diagnoses. A educational intervention, 72 dentists and 41 dental undergraduates participated in the 'Maio Vermelho Project', a continuing education activity. Participants completed a 14-question online questionnaire concerning their experiences and perceptions of delivering difficult news. The educational intervention featured an interview illustrating the SPIKES protocol, broadcast on YouTube. Participants had a mean age of 40 years. A minority (21.2%) had encountered or experienced communicating an oral cancer diagnosis. Exposure to lectures on this topic during their education was uncommon (22.1%) but more prevalent among students. After the intervention, confidence in communicating a cancer diagnosis (29.2%) and addressing the patient's family (30.1%) in line with the SPIKES protocol increased. A training deficit persists in delivering cancer diagnoses, highlighting the need for educational interventions to empower students and professionals in this critical procedure. Integration of this topic into the dental undergraduate curriculum is imperative. Effectively communicating a cancer diagnosis poses challenges to healthcare professionals, impacting treatment outcomes. Implementing educational interventions ensures that professionals are well prepared to navigate this complex task, ultimately improving patient care.

Hematology/oncology clinical investigator training: Is current model of education adequate?

9005 Background: Clinical investigator training (CIT) is commonly performed in an apprenticeship manner rather than following a prospective education model. This may lead to disparities in educational prospects. There is greater accesiblity for training opportunites prevailing in larger academic institutions – an advantage not always within reach for majority of oncology patients and professionals. Lack of predefined standard competencies during fellowship training may lead to significant heterogeneity, weaken the current pipeline, and decrease the number of principal investigators (PIs) for clinical trials. We performed a national needs assessment to understand oncology trainee and faculty perceptions of CIT. Methods: Program directors and leaders at 102 U.S. hematology/oncology (hem/onc) fellowship programs were contacted via email to invite their respective trainees and faculty to answer a 32-question cross-sectional survey. The study was IRB excempt. The survey was developed with the University of Chicago Survey Lab. Four thematic areas were interrogated: current level of experience in CI, knowledge of PI roles and responsibilities (R/R), areas of perceived weakness/lack of confidence related to CI, and interest in a course that teaches CI. Response frequencies and descriptive statistics were analyzed, with the goal of informing future targeted educational initiatives. Results: 207 respondents from 47/102 (46%) institutions completed the survey between 5/2023 – 11/2023. Respondents included 92 (40%) trainees and 137 (60%) attendings, 47% were men, 47% women and 57% had more than 9 years of experience as an attending post-speciality training. Among attendings, only 4.4% reported never participating in CIT, compared to 55.4% of trainees. Informal or “on the job” teaching was the most common method of learning PI R/R with response rate of 58% in attendings and 62% in trainees. Trainees reported lack of confidence and need for education in all aspects of CIT, and 85% indicated high level of interest in enrolling in a CIT course. Most attendings reported lack of confidence in areas of budget development (57%), quality of life (70%) and translational correlatives (51%). Others reported feeling weaknesses in designing primary and secondary end points (32%), letter of intent writing (33%) and creating protocols (31%). 53% of the attendings were interested in enrolling in a CIT course. Conclusions: To our knowledge, this is the first reported survey formally assessing current perceptions of preparedness in CIT within hem/onc in the U.S. Our findings strongly indicate that CIT educational gaps exist, even for attendings with prior CIT experience, and that training deficits are marked for trainees. A structured, practical, and widely-accessible CIT program is urgently needed to prepare the future hem/onc workforce. Acknowledgement: MERITS program and Section of Hem/Onc at University of Chicago.

Training in cataract surgery in Spain: analysis of the results of a survey of the European Board of Ophthalmology in a Spanish cohort

IntroductionA survey conducted by the European Board of Ophthalmology (EBO) revealed significant differences in the surgical training of the ophthalmology residents in Europe, including a disparity between the sexes and a variation in the experience on cataract surgery (CC) between them. This study is about the Spanish sub-cohort of the survey, and its objective is to present and analyse the peculiarities of ophthalmology training in Spain within the European context, as well as discussing ways to harmonise and improve that training throughout the EU. MethodsWe analyse data of the Spanish participants in the EBO exams, defining subgroups by the Autonomous Communities existing in Spain. Results93 of 135 requested participants (68.9%) responded. A 60.2% passed the EBO exam between 2021 and 2022, being mostly women (65.59%) aged 31 years old on average. The 91.4% were right-handed, coming from 13 of the 17 Spanish autonomous communities, although mostly from the Community of Valencia, Madrid and Catalonia. Respectively, 16.1%, 3.2% and 8.7% of the respondents said they have completed 10 or more training sessions on animal eyes, synthetic eyes and through the virtual reality simulator. This training was correlated with greater self-confidence in the management of a posterior capsular tear during surgery (p .025). All respondents manifested to have already performed stages of the CC. The average number of operations reported was 181.6 with regional disparities. A significant difference is observed between the sexes against women (−28.3%, p 0.03). DiscussionOphthalmologists in Spain, much more than other European countries, have greater opportunities for surgical training, with surgical procedures during the residency, that nearly triples those made by the others. Spanish women refer, like their European colleagues, to be in disadvantage in learning opportunities about cataract surgery. The Simulation Based Medical Education (SBME) allows to respond to the training deficit and complements the training on the patient. Although we demonstrate a significant correlation between the number of procedures carried out and self-confidence to operate simple cases, the SBME would be a complementary tool in self-confidence in front of a complication like capsular rupture. ConclusionSpain massively adopts the model named by us "surgery for all”, despite the underrepresentation of women in this area, emphasising a need for cultural change that the SBME could facilitate.

Factors influencing implementation of simulation in nursing and midwifery training in Malawi.

The study explored factors influencing implementation of simulation-based education (SBE) in nursing and midwifery education in Malawi. This study aimed to identify factors influencing nursing and midwifery educators in selected training institutions and clinical sites. The study covered one district and four central hospitals, five professional training institutions, Ministry of Health and Nurses and Midwives Council of Malawi officials. Using mixed-methods approach, quantitative data were gathered from 293 participants, including 149 final-year nursing and midwifery students, and 144 clinical instructors. Qualitative data were obtained from 24 faculty members, 11 clinical instructors and two key informants. Researchers conducted 37 in-depth interviews, 10 focus group discussions and eight desk reviews. Descriptive statistics were used to analyse the quantitative data, while content analysis was used for qualitative findings. Five themes emerged from qualitative data: absence of simulation in regulatory body syllabi, insufficient formal training, demand for knowledgeable clinical instructors, inadequate human and material resources, and resistance to change. Survey results indicated that 83% of the participants had theoretical SBE knowledge but lacked practical skills, with only 13% considering SBE as a current teaching method. Educators emphasised lack of infrastructure, skills laboratories, teaching hospitals, equipment, and a deficit in formal training as critical barriers to SBE implementation. The study concluded that skilled educators, appropriate infrastructure and resources could facilitate SBE implementation in Malawi. Recommendations included regulatory body support, formal training for educators, utilisation of low-fidelity simulators, and establishment of SBE centres and corners in health facilities.

The uses of 3-dimensional printing technology in orthodontic offices in North America

The purpose of this study was to examine the use of orthodontic 3-dimensional (3D) printing technology in North America and to understand why orthodontists are, or are not, incorporating 3D printing technology in their practices. A survey questionnaire was delivered on a secure online platform, RedCap (Case Western Reserve University Clinical and Translational Science Award; no. UL1TR002548). The survey consisted of 14-34 items with branching logic. The association between participant demographics and in-house 3D printing was assessed using a chi-square test of independence. A total of 518 responses were recorded. The highest number of responses came from respondents in the 36-45-year age group. Most of the respondents were practice owners; 46.9% had 3D printers in their office. Chi-square tests of independence were performed on the data to see which associations existed. The strongest statistical associations with using an in-house 3D printer are seen with patient load, practice type, years since residency, and orthodontist's position. Approximately 75% of orthodontists use 3D printing technology in some capacity in North America. Major factors that influenced orthodontists to incorporate 3D printing technology into their office were self-interest and research. Major factors that have prevented orthodontists from not incorporating 3D printing technology into their office were space for equipment/ventilation and digital workflow training deficit. Orthodontists use their 3D printers mostly to make plastic retainers from printed models. The strongest associations with using in-house 3D printers are seen in patient load, practice type, years since residency, and orthodontist position. Increasing patient load and being in private practice increases the likelihood of having a 3D printer.

School-Based Screening and Brief Intervention for Adolescent Substance Use With Telehealth-Delivered Case Consultation and Education.

Screening, brief intervention, and referral to treatment (SBIRT) is a public health framework for addressing adolescent substance use. Implementation of SBIRT in schools carries the potential to improve substance use treatment access and service acceptance for students, but faces barriers related to knowledge deficits, low comfort, and lack of training in screening and brief interventions among school-based mental health (SBMH) providers. This report describes the development and acceptability evaluation of a school-based SBIRT program designed to overcome common implementation barriers of SBIRT related to provider confidence, knowledge, and training deficits by supplementing the traditional model with telehealth-delivered addiction consultation and education (ACE). Program components include core SBIRT trainings, telehealth-delivered ACE sessions, and outreach support for SBMH providers. Each ACE session included a didactic expert presentation on a clinical topic and a provider-presented patient case with discussion. Sessions were delivered using a Project ECHO-based hub-and-spoke format with monthly 1-hour virtual meetings. Interviews and surveys with SBMH providers on substance use screening and intervention practices and perceived barriers were used to inform program design choices and tailor the curriculum. Acceptability data were collected at 9 months. SBMH provider participants reported increased confidence, knowledge, and evidence-based screening and early intervention practices, and high acceptability, satisfaction, and benefit from the program. Ongoing barriers to referral to treatment were reported. This pilot study suggests that supplementing traditional SBIRT with telehealth-delivered ACE sessions can address common implementation barriers and serve as a scalable model to improve SBIRT adoption in schools.

The impact of specialised translator training and professional experience on legal translation quality assurance: an empirical study of revision performance

ABSTRACT The relevance of translation and law degrees as pathways to professional legal translation is the subject of persistent debate, but there is limited research on the relationship between legal translators’ backgrounds and competence levels in practice. This study compares the revision performance of several groups of institutional translators (44 in total) according to their academic backgrounds (legal translation specialisation, translation degrees with no legal specialisation, law degrees or other degrees) and legal translation experience (more or less than three years). The scores of justified, missing and over-corrections, among other indicators, corroborate the crucial impact of legal translation specialisation and subject-matter knowledge in ensuring legal translation quality, while experience can serve to partially fill certain training deficits. Qualified translators with a legal specialisation stood out as the most efficient revisers, followed by law graduates, translation graduates without a legal specialisation and other translators. A subsequent holistic assessment of the revised target text yielded results globally in line with the revision scores, as well as mixed perceptions of the target text as potential machine output. The findings support the added value of legal translator training, and are of relevance for translator recruitment and workflow management. They also challenge the rationale behind ISO 20771:2020 qualification requirements.

Knowledge and Confidence of Obstetrics and Gynecology Residents in the Evaluation and Management of Heavy Menstrual Bleeding Due to Inherited Bleeding Disorders.

Heavy menstrual bleeding (HMB) is common, and 20-30% of patients presenting with HMB are diagnosed with an inherited bleeding disorder (IBD). Despite the frequent association of HMB with bleeding disorders, specific learning objectives on this topic are lacking for Obstetrics and Gynecology (OBGYN) residents. We sought to determine the exposure of OBGYN residents to didactics, clinical training, and confidence in evaluation and management of patients with HMB due to IBDs. Prospective survey of OBGYN residents through email solicitation. Residents were invited to complete an anonymous 26-item survey, querying residents' confidence in evaluation and management of HMB in patients with and without IBDs. In total, 239 OBGYN residency programs were invited to participate and 20 programs responded. Among 388 residents, 84 completed the survey (21.6%). The majority reported didactics on HMB evaluation (n = 71, 85.5%) and treatment (n = 77, 92.8%); however, for HMB due to IBDs, only 35 residents (42.4%) reported didactics on evaluation and 28 (33.7%) reported didactics on treatment. Confidence in evaluation and management of HMB was high but decreased significantly with an IBD. Residents who received didactics on IBDs reported more confidence in their evaluation than residents who did not receive didactics (mean Likert scale score of 3.67 vs. 3.23, p = 0.002). Increasing postgraduate year level was associated with more confidence in treatment (p < 0.001) and did not differ based on type of training program (p = 0.825). OBGYN residents have decreased confidence in evaluation and management of HMB due to IBDs. Resident confidence increases with didactics and training. Residents would benefit from curricula designed to address this deficit in training.

Building Cybersecurity Capacities in Zambia’s Business Sector: Guideline for SMEs

This research explores cybersecurity awareness and implementation within Zambia’s small and medium-sized enterprises (SMEs), a sector increasingly targeted by cyberattacks that lead to substantial financial losses. The study’s primary aim was to enhance cyber awareness and develop actionable guidelines for SMEs in Zambia. Utilising an interpretivist philosophy and inductive approach, the methodology encompassed semi-structured interviews, cross-sectional analysis, and a comprehensive review of CISA, ENISA guidelines, and Zambia’s Data Protection Act. Findings indicate a notable deficit in cybersecurity training and awareness among SMEs. Key concerns include inadequate data security measures, a lack of formal cybersecurity policies, and a reliance on basic tools like antivirus software. In response, the study formulated targeted guidelines, emphasising the integration of cyber awareness into SME governance and risk management. These guidelines have garnered significant interest from Zambian government entities, highlighting their potential influence on national cybersecurity policy. The study contributes theoretically by contextualising international cybersecurity standards within Zambia’s unique SME landscape. Methodologically, it pioneers a Cyber Awareness Framework tailored to Zambian SMEs, underscoring the critical role of human factors in cybersecurity. Practically, the research has sparked engagement among SMEs and government bodies, demonstrating its applicability and potential for shaping policy. However, limitations include reliance on outdated demographic data and a focus on digitally enabled SMEs, potentially overlooking broader IT governance aspects and less digitized businesses. Future research should aim for comprehensive, up-to-date analysis across all SME sectors, contributing to a more inclusive and resilient cybersecurity landscape in Zambia.

Perspectives on Admissions and Care for Residents With Opioid Use Disorder in Skilled Nursing Facilities

Skilled nursing facilities (SNFs) are being referred more individuals with opioid use disorder (OUD), even when their medical needs are not directly associated with OUD. To characterize factors that influence SNF admission for individuals with OUD and identify strategies for providing medications for OUD (MOUD) in SNFs. In this semistructured qualitative study, interviews were conducted with SNF administrators from 27 SNFs in Rhode Island from November 5, 2021, to April 27, 2022. Data analysis occurred from August 22, 2022, to May 31, 2023. Themes and subthemes on administrator perspectives on admissions and care for people with OUD in SNFs. Audio interviews were transcribed, coded, and analyzed using codebook thematic analysis and guided by community-engaged and participatory research principles. The study included 29 participants representing 27 SNFs in Rhode Island. Participant roles were administrators (17 participants [59%]), directors of nursing (6 participants [21%]), directors of admissions (5 participants [17%]), and unit managers (1 participant [3%]). Participants described active substance use, Medicaid insurance, housing instability, and younger age as potential barriers to SNF admission for individuals with OUD. The lack of formal guidelines for OUD management, staff shortages, facility liability, state regulations, and skills and training deficits among staff were cited among challenges of effectively meeting the needs of residents with OUD. Many participants reported inadequate institutional capacity as a source of negative outcomes for people with OUD yet expressed their concerns by characterizing individuals with OUD as potentially violent, nonadherent, or likely to bring undesirable elements into facilities. Participants also shared strategies they used to better serve residents with OUD, including providing transportation to support group meetings in the community, delivery in advance of resident arrival of predosed methadone, and telemedicine through the state's hotline to prescribe buprenorphine. In this qualitative study of administrator perspectives about admissions and care for individuals with OUD in SNFs, gaps in institutional capacity overlapped with stigmatizing beliefs about OUD; such beliefs perpetuate discrimination of individuals with OUD. Adequate SNF funding and staffing combined with OUD-specific interventions (eg, antistigma training, community partnerships for MOUD and recovery support) could incentivize SNFs to serve individuals with OUD and facilitate OUD care consistent with practice guidelines.

Pilot implementation of a telemedicine care bundle: Antimicrobial stewardship, patient satisfaction, clinician satisfaction, and usability in patients with sinusitis.

Telemedicine-specific clinical pathways (CPWs), coupled with electronic health record (EHR) order panels, provide an opportunity to ensure evidence and guideline concordant care for conditions at risk for inconsistent diagnoses and management strategies. Standardized provider and patient-facing illness scripts may fill gaps in clinicians' communication skills secondary to a training deficit in virtual care delivery. We aimed to implement and assess the impact of a novel care bundle for sinusitis on antimicrobial use, patient satisfaction, clinician satisfaction, and usability in patients with sinusitis. A sinusitis care bundle (SCB) for virtual urgent care patients included a sinusitis CPW with communication scripts, sinusitis order panels (SOP), and a patient education smart-phrase (SPESP) within visit instructions. Antimicrobial use was assessed during a 15-month period prior to the start of SCB element implementations and 14-months following, using statistical process control charts. Patient satisfaction was measured using Likert-style surveys. Clinician satisfaction was assessed using a novel survey addressing the SCB-targeted domains (decision support, communication, efficiency, usability, and overall satisfaction). There were 69,785 and 64,019 evaluable patients in the pre-care and post-care bundle periods, respectively. Despite a significant increase in patients receiving a sinusitis diagnosis in the post-care bundle period (3.2% pre- vs. 6.2% post-, p < 0.001), antimicrobial prescribing decreased by 3.9% (p < 0.001), with statistical process control evidence of special cause change. There was a 5.1% decrease (p < 0.001) in negative patient survey responses after implementation. Clinician survey revealed substantial agreement in the domains relating to improving communication with patients and/or families, with the highest satisfaction for the SPESP over the SOP. Implementation of a telemedicine care bundle for patients diagnosed with sinusitis can balance multiple elements of quality care. The combination of a clinical care pathway, standardized language, and order panels within the EHR has the potential to improve patient satisfaction and decrease antimicrobial prescribing.

Paraprofessionals in a Special Education Setting: A Qualitative Exploration of Their Perceptions

Paraprofessionals support teachers and students in the classroom. Their roles and responsibilities vary; however, their goal is always to improve student achievement. The purpose of the study was to fill a gap in the literature related to special education paraprofessionals’ perceptions, attitudes, and beliefs on the support and trainings they receive prior to and during their job as a paraprofessional for students in a special education setting. Generic qualitative methodology was used to capture the thoughts, experience, and perceptions of 42 paraprofessionals across the United States. Data collection included an eight-question online questionnaire. Results of the study revealed five patterns including (a) paraprofessionals are coming in with some training, (b) their ongoing training is not always consistent, (c) the biggest areas of struggle are addressing challenging behavior, (d) their education does not always prepare them for the responsibilities in the classroom, and (e) further support is needed for them to fulfil their responsibilities. After further analysis and synthesis, the five patterns were then condensed into two overarching themes which included paraprofessional training deficits and need for behavior support training. These findings are significant to school leaders and educators in order to properly support paraprofessionals in their roles of ensuring student learning and success.

Pain: The Silent Public Health Epidemic.

More than 50 million Americans suffer from chronic pain, costing our society an estimated 565 to 635 billion dollars annually. Its complexity and training deficits in healthcare providers result in many patients receiving ineffective care. Large health inequities also exist in access to effective pain care for vulnerable populations. The traumatic history of indigenous people and people of color in regards to the experience of pain care perpetuates a lack of trust in the healthcare system, causing many to hesitate to seek medical treatment for painful events and conditions. Other vulnerable populations include those with sickle cell disease or fibromyalgia, whose experience of pain has not been well-understood. There are both barriers to care and stigma for patients with pain, including those taking prescribed doses of long-term opioids, those with known substance use disorder, and those with mental health diagnoses. The suffering of patients with pain can be "invisible" to the clinician, and to one's community at large. Pain can affect all people; but those most vulnerable to not getting effective care may continue to suffer in silence because their voices are not heard. Since 1973, pain societies around the globe have worked tirelessly to bring clinicians together to advance pain and opioid education, research, and patient care. These improvements consist of pain education, integrative treatment, and the understanding that a therapeutic alliance is critical to effective pain management. Pain education for both pre and post-licensure health professionals has increased substantially over the last decade. In addition, integrative and interdisciplinary approaches for clinical pain management are now considered best practices in pain care for patients with moderate to severe pain in addition to the development of a strong therapeutic alliance.

The state of agricultural mechanics in the preparation of school-based agricultural education teachers

Agricultural mechanics is a primary subject area in school-based agricultural education (SBAE). Despite a high prevalence in SBAE, preservice and in-service SBAE teachers have frequently expressed concerns regarding teaching agricultural mechanics. Early 21st century research documented the characteristics of preservice SBAE teacher training in agricultural mechanics, although more recent studies have suggested that the agricultural mechanics training requirements have changed. This study sought to compare the agricultural mechanics preparation of preservice SBAE teachers between 2000 and 2021. A survey instrument was distributed to a representative of every institution with an undergraduate SBAE teacher preparation program in the contiguous United States, resulting in an 86.7% response rate. The results were compared to previous studies from 2000 and 2005. A reduction in the average number of required agricultural mechanics credit hours was found. Faculty perceptions of importance and preservice teacher preparation had increased slightly; however, deficits were found in all competency groups. Further research is warranted to determine the perceptions of preservice and in-service SBAE teachers regarding agricultural mechanics. Recommendations include that teacher educators evaluate current preparation methods for preservice SBAE teachers and provide professional development in the areas where the greatest training deficits were observed.

Confronting the dialectic between quality and access in early psychosis care in the United States: Finding the synthesis by leveraging psychological expertise.

Coordinated specialty care (CSC) is the dominant model for early psychosis care in the United States, representing a proactive recovery-oriented approach to serious mental illness in its early stages. CSC involves broad multidisciplinary support for participants, including from psychologists in some CSC teams, encompassing educational and vocational support, medication management, psychotherapy, case management, peer support, and family interventions. CSC programs have proliferated in the last 20 years, leading to a quality-access dialectic, where increasing access to treatment simultaneously prompts concerns about care quality, particularly in the context of staffing shortages and funding limits. Evidence-based psychosocial treatment, including psychotherapy, is an integral part of CSC, yet workforce training deficits, workforce turnover, and CSC financing pose threats to intervention fidelity and thus CSC participants' ability to access high-quality care. We propose an enhanced role for psychologists as a way of resolving the quality-access dialectic in the area of psychosocial treatment, specifically evidence-based therapy. We describe the potential of psychologists' skills in clinical supervision, formulation, evidence-based interventions and measurement-based care, drawing on practice examples. After considering possible limitations, we outline implementation models, for example, drawing on Early Psychosis Intervention Network and Project Extension for Community Healthcare Outcomes. We conclude with four recommendations: Psychologists should be placed in CSC team or network-leadership roles; psychological expertise should be made available to CSC teams for training, consultation, and technical assistance; psychological expertise should be used to address CSC implementation challenges; and research is needed to demonstrate psychologists' value to stakeholders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).