Ratings Of Competence Research Articles

Competencies Associated With Australian and New Zealand Podiatrists’ Perceptions of Their Preparedness for Graduate Clinical Practice

Podiatry training institutions are responsible for preparing future podiatrists to be competent and safe practitioners. This follow-up study investigated podiatrists’ self-reported preparedness to practice through their ratings of various competencies. An online retrospective survey comprising closed and open-ended questions was distributed to registered and practising podiatrists in Australia and New Zealand. Of the 74 podiatrists who completed the survey, 75.7% felt “prepared” for clinical practice at graduation, with preparedness univariately associated with being female (p = .042), overall perception of clinical competence (p = .004), preparedness for clinical placement as a student (p < .001), theoretical knowledge (p < .001), manual skills (p = .002), and clinical competence standards (p < .001). Multivariable analysis identified preparedness for student clinical placement (OR = 8.95, 95%CI 1.92 – 41.76) and overall theoretical knowledge (OR = 19.29, 95%CI 3.76 – 99.13) being significantly associated with perceived preparedness for practice. Age, qualification, and graduation year were not associated with perceived preparedness. Positive clinical placement experiences enhanced their perceived preparedness, while limited clinical exposure hindered preparedness, potentially resulting in a probable theory-practice gap, and lowered professional self-efficacy. While generally feeling prepared to practice as podiatrists at graduation, they identified the need for additional hands-on learning with early patient exposure in diverse settings during their training, which should improve self-efficacy.

HR managers stereotyping frontline managers

AbstractThis study explored how human resource (HR) leaders' biased perceptions of frontline manager (FLM) effectiveness influence HR ratings of FLM competencies, resulting in insufficient training and job preparation for these critical employees. The literature review examined FLM research, ratings of supervisory competencies and the underlying theoretical frameworks of implicit leadership theory and leadership categorization theory, and their relationship to informal learning. The research used mixed methods, with a qualitative critical incident study to identify competencies, followed by a quantitative survey to compare ratings, followed by qualitative in‐person interviews to confirm survey findings. Results revealed a significant difference between HR and other raters of FLMs, including the FLMs themselves, with regard to FLM effectiveness, and these differences are informed by HR stereotypes of FLMs. Recommendations and implications suggest HR's role in providing unbiased assessment could lead to essential FLM training and development.

The Association of ACGME Milestones With Performance on American Board of Surgery Assessments: A National Investigation of Surgical Trainees.

To determine the relationship between, and predictive utility of, milestone ratings and subsequent American Board of Surgery (ABS) vascular surgery in-training examination (VSITE), vascular qualifying examination (VQE), and vascular certifying examination (VCE) performance in a national cohort of vascular surgery trainees. Specialty board certification is an important indicator of physician competence. However, predicting future board certification examination performance during training continues to be challenging. This is a national longitudinal cohort study examining relational and predictive associations between Accreditation Council for Graduate Medical Education (ACGME) Milestone ratings and performance on VSITE, VQE, and VCE for all vascular surgery trainees from 2015 to 2021. Predictive associations between milestone ratings and VSITE were conducted using cross-classified random-effects regression. Cross-classified random-effects logistic regression was used to identify predictive associations between milestone ratings and VQE and VCE. Milestone ratings were obtained for all residents and fellows(n=1,118) from 164 programs during the study period (from July 2015 to June 2021), including 145,959 total trainee assessments. Medical knowledge (MK) and patient care (PC) milestone ratings were strongly predictive of VSITE performance across all postgraduate years (PGYs) of training, with MK ratings demonstrating a slightly stronger predictive association overall (MK coefficient 17.26 to 35.76, β = 0.15 to 0.23). All core competency ratings were predictive of VSITE performance in PGYs 4 and 5. PGY 5 MK was highly predictive of VQE performance [OR 4.73, (95% CI, 3.87-5.78), P <0.001]. PC subcompetencies were also highly predictive of VQE performance in the final year of training [OR 4.14, (95% CI, 3.17-5.41), P <0.001]. All other competencies were also significantly predictive of first-attempt VQE pass with ORs of 1.53 and higher. PGY 4 ICS ratings [OR 4.0, (95% CI, 3.06-5.21), P <0.001] emerged as the strongest predictor of VCE first-attempt pass. Again, all subcompetency ratings remained significant predictors of first-attempt pass on CE with ORs of 1.48 and higher. ACGME Milestone ratings are highly predictive of future VSITE performance, and first-attempt pass achievement on VQE and VCE in a national cohort of surgical trainees.

Escape the Monotony: Gamification Enhances Nursing Education

IntroductionCreating meaningful and engaging learning opportunities can be challenged by budgets, time, and learning management systems with limited methods of interaction. An innovative method was necessary to meet competency evaluation and continuing education needs for emergency department staff. DesignGamification and simulation techniques were combined to offer an interactive learning opportunity through an escape room format to improve engagement and knowledge retention. This educational offering was designed to enhance staff learning of trauma care and processes at emergency departments that are not designated trauma centers. OutcomesEmergency department team members completed the trauma escape room challenge, and postsurvey results demonstrated favorable ratings of new knowledge acquisition, skill competency, teamwork, and confidence when providing care for a trauma patient. DiscussionNurse educators can “escape” the monotony of passive learning by using active learning strategies including the fun of gamification to improve clinical skills and confidence.

Evaluation of learning transfer after a perinatal/neonatal palliative care virtual training course.

The success of a training can be determined by the degree of learning transfer. To address a gap in educational offerings during the pandemic, an interdisciplinary team developed and offered a 3-day virtual course, called Next Level Perinatal Palliative Care Training. This study aimed to evaluate the transfer of learning and practice from a virtual training course on perinatal/neonatal palliative care (PNPC) by a range of clinicians. A descriptive prospective survey design was used to collect data at two time points, immediately following the training course and 6 months later. Frequency and descriptive statistics were used to measure the implementation of PNPC quality indicators, self-reported competence, and clinical facilitators and barriers. A t-test was used to compare participants' anticipated learning transfer to actual learning transfer. Two open-ended items assessed benefits and drawbacks of virtual training. At course completion, participants anticipated opportunities to implement PNPC strategies with means of 84-87, and at the 6-month mark, the reported implementation had means ranging from 71 to 77. At 6 months post training, participants reported feeling competent/highly competent in each variable with frequency scores of 89%-98%. The opportunity to learn key concepts of PNPC and refresh skill sets ranked as the top facilitators, while the top barriers were the lack of opportunity to use PNPC principles and the lack of funding. Learning transfer after a virtual training course of PNPC proved to be successful, with a high rate of self-reported actual implementation and competence at 6 months after the training.

P-634 Is duo stim a better approach than non-consecutive cycles in patients undergoing PGTA?

Abstract Study question Are there differences in the results of cycles and in the time to achieve an euploid embryo in cycles with DuoStim compared to non-consecutive cycles? Summary answer A DuoStim strategy does not compromise ovarian response, oocyte competence or euploidy rate, and reduces time to pregnancy. What is known already In patients with advanced maternal age undergoing PGT-A, the risk of not reaching embryo transfer is relatively high. Increasing the number of oocytes available should increase the chances of finding a healthy euploid embryo and reach embryo transfer. Recently, DuoStim has been proposed as an alternative to accumulate oocytes prior to the final cycle in which oocytes will be fertilized, cultured, and biopsied Duostim strategy allows to reduce the time between ovarian stimulations, which may reduce the stress that waiting for assisted reproduction treatments entails for patients Study design, size, duration Retrospective study carried out at our institution during 2015-2020 with 451 patients &amp;gt; 38 years undergoing PGT-A and whose previous cycles were distributed as follows: n = 101 performed DuoStim (first OS with oocyte vitrification, second was reinitiating OS five days after OPU) and a control group of 350 patients who underwent two standard non-consecutive cycles, the first to accumulate oocytes and from the second cycle, and then performed PGT-A with all oocytes, fresh and vitrified. Participants/materials, setting, methods All patients undergoing PGT-A performed 1 or 2 ovarian stimulations (OS) cycles to accumulate oocytes. OS cycles were re-initiated after a 5-day interval. Trophectoderm biopsies were studied by NGS. The variables were expressed as mean ± SD and comparison among groups by using ANOVA. Main results and the role of chance Mean age was comparable in both groups, DuoStim vs control 39.3±3.1 vs 39.2±3.0; p:0.76 AMH was lower in DuoStim group compared with control group (1.07±0.56 vs 2.64±4.1 ng/mL; p:0.006, and AFC were 4.3±2 vs 7.1±3; p:0.013 respectively. Gonadotropin doses were higher in DuoStim group compared control group 4576.8±1847 vs 4045±1857 IU; p:0.01, and total stimulation days were significantly higher in DuoStim compared with control group (22.7±4.85 vs 18.5±10,74; p &amp;lt; 0.001. The mean of total eggs retrieved in both OS were similar between DuoStim and control group (12.9 vs 13.1; p = 0.78) The ratio of euploid embryos found was similar 35.99 % vs 38.6% When we compared pregnancy rates per embryo transfer, were similar between both groups 66.6% (36/54) vs 65.3% (132/211); p value=0.98. We confirmed differences in the time to achieve the first euploid embryo in favour of DuoStim group 30.2±6 vs 36±9 with a p value: 0.001. Limitations, reasons for caution The retrospective nature is the major limitation of this study. The study population reflects the indication of PGT-A in a particular setting, mainly advanced maternal age and in DuoStim group a poor prognosis profile Wider implications of the findings Accumulating oocytes through vitrification prior to PGT-A with DuoStim offers similar clinical outcomes in both groups, it may reduce time to reach an euploid embryo, which is relevant for advanced maternal age group of patients. Trial registration number Not applicable

Influence of physical fitness and weight status on autonomic cardiac modulation in children.

This study provides reference values for cardiovascular modulation at rest, during maximal exercise test and recovery after exercise in Caucasian children according to weight status and cardiorespiratory fitness (CRF)level. Additionally, the current study analyzed several correlations between autonomic cardiovascular modulation, cardiorespiratory performance and cardiometabolic risk. The principal goal of this study was to analyze cardiac function at rest, during maximum exercise, and during the recovery phase in children grouped according to weight status and CRFlevel. One hundred and fifty-two healthy children (78 girls) 10-16 years of age were divided into three groups: soccer and basketball players (SBG), endurance group (EG), and sedentary people with overweight and obesity (OOG). A cardiac RR interval monitor recorded the cardiac data and specific software analyzed the cardiac autonomic response through heart rate (HR) and HR variability. The study analyzed resting HR (RHR), HRpeak, and HR recovery (HRR). OOG showed significant poorer performance in the Léger test lower V̇O2 max and higher values of blood pressure at rest and post-exercise than sport groups. The EG presented the best results in CRF and cardiometabolic risk (CMR) in relation to SBG and OOG. The OOG showed higher percentage of HR values, compatible with an unhealthy cardiovascular autonomic modulation than the sport groups, with significant differences in bradycardia, HR reserve, and HRR 5 min. Aerobic performance, vagal activity, blood pressure, chronotropic competence, and HRR have significant associations with CMR parameters. The current study presents reference values of autonomic cardiac function in Caucasian children according to weight status and cardiorespiratory fitness level. Aerobic performance, vagal activity, blood pressure, chronotropic competence, and heart rate during the recovery period after exercise have significant associations with cardiometabolic risk parameters. Children with overweight and obesity show signs of autonomic dysfunction reflected as low cardiac vagal activity and poor chronotropic competence.

Enhanced milieu teaching with phonological emphasis: A pilot, telepractice study for parent training in early intervention

Purpose This pilot study evaluated enhanced milieu teaching with phonological emphasis (EMT + PE) parent training intervention delivered through telepractice and its impact on parent implementation, child speech outcomes, and child language outcomes. Method A multiple baseline design across behaviours was used to assess response to parent training and child outcomes. The intervention was delivered to four parents and their young children with repaired cleft palate. Speech production, receptive language, and expressive language were assessed prior to intervention. EMT + PE strategies including matched turns, modelling and expansions, and prompting/speech recasting were taught to parents using the teach-model-coach-review model. Social validity questionnaires were administered pre- and post-intervention to assess parents’ rating of competence and confidence for managing their child’s early development. Reliability and procedural fidelity were conducted. Result All parents increased their use of modelling and expansions, and prompting and speech recasting in response to training, as evidenced by large effect sizes. Children also responded positively to these strategies by increasing percentage of consonants correct (PCC) and target vocabulary, although PCC gains were less than observed in a prior hybrid telepractice and face-to-face intervention. Social validity measures indicated parents increased their confidence to provide intervention for their children. Conclusion This pilot study indicated that effective parent training in EMT + PE strategies can be delivered through telepractice.

Physician ratings of physician assistant competencies and their experiences and satisfaction working with physician assistants: Results from the supervising physician survey in Ontario, Canada.

Physician Assistants (PAs) are a relatively new addition to the Ontario healthcare system. To understand the impact of the PA role, this study investigated supervising physician satisfaction and perception of PA roles, interprofessional team integration, pandemic supports, and barriers and enablers to PA employment. A web-based survey was conducted of 118 physician supervisors of Ontario PA education program alumni. PAs were employed in a variety of community and hospital settings. In addition to patient care, PAs were involved teaching (65.6%), quality improvement (52.7%), and mentorship (40.0%). Overall, 92.9% of physicians indicated they were satisfied with their PAs. Important barriers to hiring PAs included maintaining PA salaries, billing limitations, and PA shortages. PAs have established themselves as valuable and competent members of healthcare teams. By continuing to explore the enablers and barriers to PA employment from the physician perspective, health leaders can continue to optimize and support role integration.

Behavioral Indicator-Based Initial Flight Training Competency Assessment Model

Ensuring training safety is paramount to flight schools. In response to the inadequacy of traditional flight training assessment for comprehensive quantitative evaluation of cadet competency, an initial flight training competency assessment standard based on behavioral indicators was developed and optimized using the VENN model. Firstly, the Assessor Score Measurement Form (ASMF) was constructed according to the requirements of the Training Evaluation Worksheet specification, such as typical subjects, observations, and completion criteria. Secondly, based on the basic principles of the experience of the flight expert and the Competency-Based Training and Assessment (CBTA), a matrix of correlations between the observations and each competency-based behavioral indicator was created to construct a competency assessment matrix. In addition, a two-dimensional model for representing competency items characterized by behavioral indicators was established and an optimization model for competency assessment criteria was constructed. Finally, through combining actual flight training data, the proposed method was validated in the flight screening check phase. The results show that the optimized flight training competency assessment scheme can be well quantified and matched to real instructor ratings with an accuracy of 84%. The assessment worksheet, the assessment matrix, and the VENN competency rating model can be adapted to the different teaching requirements of each flight phase, achieving a perfect match between the behavioral indicators and the competency items, which is highly versatile. The proposed model can more accurately reflect the core competencies of flight trainees, enable quantitative assessment of behavioral indicators and competency items, and provide support for subsequent training of trainees.

How to communicate with patients in written asynchronous online conversations: an intervention study with undergraduate medical students in a cross-over design.

The patient-physician encounter is the core element in the treatment of patients and the diagnosis of disease. In these times of digitalization, patient-physician communication is increasingly taking place online: patients embrace new possibilities offered digitally, and physicians are encouraged to adapt accordingly. Since a huge part of online communication is written, this study aims to investigate how medical students communicate with patients online by focusing on their written competencies and whether an intervention might improve their competencies. This study was performed in an explanatory cross-sectional manner with a cross-over design. Second-year medical students participated. An intervention was developed on how to formulate an appropriate written response to a patient's request and integrated a longitudinal communication class. The intervention consists of education on general set-up (e.g., greetings), syntax, spelling, content and kind of communication (e.g., appreciative attitude). After meeting a patient in a simulated role play medical students received the patient's request via a digital platform. The control group had the same simulated role play and the same task but they received the intervention on communication afterwards. Intervention and control group were statistically compared based on a checklist. Twenty-nine medical students took part in the study. The results showed that the medical students had basic competencies in dealing with written communication independent if they received the intervention (CG: M = 3.86 ± 1.23 vs. IG: M = 4.07 ± 1.03; p = 0.625). Similar results were also for the emotional competency ratings (MCG = 3.36 ± 1.08; MIG = 3.67 ± 0.98; p = 0.425).The intervention was able to lead to a more appreciative response toward patient. Intervention on basic competencies such as simple language and clear presentation might not be needed as an integral part in medical education. However, medical students should learn how to present empathic and authentic behavior in written online communication.

Social networks are shaped by culturally contingent assessments of social competence

Cultural outsiders, like immigrants or international students, often struggle to make friends. We propose that one barrier to social connection is not knowing what it means to be socially competent in the host culture. First-year students at a U.S. business school (N = 1328) completed a social network survey and rated their own social competence and that of several peers. International students were rated by peers as less socially competent than U.S. students, especially if they were from nations more culturally dissimilar to the U.S. International students’ self-reported competence ratings were uncorrelated with peers’ judgments. Social network analysis revealed international students were less central to their peer networks than U.S. students, although this gap was reduced if peers evaluated them as socially competent. Peer-reported competence mediated the effects of international student status on social network centrality. Since learning local norms takes time, we suggest inclusivity will require host communities to define social competence more broadly.

Effect of an Individually Tailored and Home-Based Intervention in the Chronic Phase of Traumatic Brain Injury

Traumatic brain injury (TBI) can cause long-lasting and heterogeneous difficulties that require an individually tailored approach to rehabilitation. However, high-quality studies of treatment options in the chronic phase of TBI are lacking. To evaluate the effect of a home-based, individualized, and goal-oriented rehabilitation intervention in the chronic phase of TBI. This study was an intention-to-treat parallel-group assessor-blinded randomized clinical trial with 1:1 randomization to an intervention or control group. Participants included adults in southeastern Norway who had sustained a TBI more than 2 years earlier, lived at home, and had ongoing TBI-related difficulties. A population-based sample of 555 individuals were invited, and 120 were included. Participants were assessed at baseline, 4 months, and 12 months after inclusion. Specialized rehabilitation therapists provided the intervention in patients' homes or via video conference and telephone. Data collection was conducted between June 5, 2018, and December 14, 2021. The intervention group received an 8-session individually tailored and goal-oriented rehabilitation program over 4 months. The control group received usual care in their municipality. Preestablished primary outcomes were disease-specific health-related quality of life (HRQOL; measured by the Quality of Life After Brain Injury [QOLIBRI] overall scale) and social participation (measured by the Participation Assessment With Recombined Tools-Objective [PART-O] social subscale). Preestablished secondary outcomes included generic HRQOL (measured by the EuroQol 5-dimension 5-level [EQ-5D-5L] questionnaire), difficulty with TBI-related problem management (target outcomes; mean severity calculated across 3 main self-identified problem areas that were individually measured using a 4-point Likert scale), TBI symptoms (measured by the Rivermead Post Concussion Symptoms Questionnaire [RPQ]), psychological distress (depression and anxiety; measured by the Patient Health Questionnaire 9-item scale and the Generalized Anxiety Disorder 7-item scale [GAD-7], respectively), and functional competency (measured by the Patient Competency Rating Scale). Among 120 participants in the chronic phase of TBI, the median (IQR) age was 47.5 (31.0-55.8) years, and the median (IQR) time since injury was 4 (3-6) years; 85 (70.8%) were male. A total of 60 participants were randomized to the intervention group, and 60 were randomized to the control group. Between baseline and 12 months, no significant between-group effects were found for the primary outcomes of disease-specific HRQOL (QOLIBRI overall scale score: 2.82; 97.5% CI, -3.23 to 8.88; P = .30) or social participation (PART-O social subscale score: 0.12; 97.5% CI, -0.14 to 0.38; P = .29). At 12 months, the intervention group (n = 57) had significantly higher generic HRQOL (EQ-5D-5L score: 0.05; 95% CI, 0.002-0.10; P = .04) and fewer symptoms of TBI (RPQ total score: -3.54; 95% CI, -6.94 to -0.14; P = .04) and anxiety (GAD-7 score: -1.39; 95% CI, -2.60 to -0.19; P = .02) compared with the control group (n = 55). At 4 months only, the intervention group (n = 59) had significantly less difficulty managing TBI-related problems (target outcomes mean severity score: -0.46, 95% CI, -0.76 to -0.15; P = .003) compared with the control group (n = 59). No adverse events were reported. In this study, no significant results were observed for the primary outcomes of disease-specific HRQOL or social participation. However, the intervention group reported improvements in secondary outcomes (generic HRQOL and symptoms of TBI and anxiety) that were maintained at 12-month follow-up. These findings suggest that rehabilitation interventions could help patients even in the chronic phase of TBI. ClinicalTrials.gov Identifier: NCT03545594.

Sommerlad–Furlow modified palatoplasty: A retrospective study

The purpose of this study was to introduce the surgical process of Sommerlad–Furlow modified (S–F) palatoplasty and compare its surgical and functional outcomes with conventional Sommerlad (S) palatoplasty.Patients with non-syndromic cleft palate who had undergone either S–F palatoplasty or S palatoplasty were retrospectively reviewed. Data on the outcomes of velopharyngeal function and postsurgical palatal fistula incidence were collected for all patients. Data for preselected factors, including gender, age at palatoplasty, and cleft type, were also collected. Chi-square tests were conducted.1254 patients were included. The postsurgical velopharyngeal competence (VPC) rate after S–F palatoplasty was significantly higher than after S palatoplasty (total, 70.5% vs 57.9%, p < 0.0001; age ≤ 1, 87.0% vs 69.2%, p < 0.0001; 1 < age ≤ 2, 78.3% vs 69.3%, p = 0.0479). With regard to different types of cleft palate, the postsurgical VPC rates after S–F palatoplasty were all significantly higher than for S palatoplasty in all patients younger than 2 years of age (complete cleft palate, 78.7% vs 62.4%, p = 0.0016; hard and soft palate cleft, 84.4% vs 74.8%, p = 0.0172; submucosal cleft and soft palate cleft, 96.6% vs 68.4%, p = 0.0114). The postoperative fistula rate after S–F palatoplasty was 4.3%.This modified palatoplasty technique provided adequate cleft palate closure, with satisfactory speech outcomes and low fistula rates, while older age at palatoplasty may affect the postsurgical outcomes. Within the limitations of the study it seems that the Sommerlad–Furlow modified technique is an option for cleft palate repair.

Designing a short-term training course curriculum using the quality function deployment (QFD)

PurposeThis research has been taken up by the human resource center of organization X, for designing a curriculum for a training course named “Basic Computer Application”, by optimizing topics and finalizing teaching strategies, based on needs and expectations collected from past and prospective training participants from different ranks of employees of X. The study aims to discuss this issue.Design/methodology/approachThe research strategy adopted is based on a survey conducted using a specially designed questionnaire. The questionnaire was circulated to 256 personnel selected randomly having computer backgrounds as well as non-computer backgrounds, who had either attended past batches of the same training course or attended different training courses. The data thus collected was processed using VOC Table and the affinity diagram and subsequently fed into the house of quality (HOQ) for obtaining desired output.FindingsThe study has identified and optimized topics for the course, based on employee needs/wants, using the two-stage QFD approach. After delivering the course with an optimized curriculum and teaching strategy, it is observed that the overall participant satisfaction performance of the course has increased from 3 to 4.6, which is higher than the goal set at 4. This indicates an overall enhancement in the satisfaction of participants with the delivery of the new improved course curriculum.Research limitations/implicationsAs indicated by the survey findings, the competence level of personnel with computer backgrounds is higher than that of personnel without computer backgrounds, which would result in different design considerations while constructing QFDs for these two entirely different groups of participants. This study has been limited to the course curriculum design for personnel with non-computer backgrounds only. The curriculum design for personnel with computer backgrounds will be addressed separately, in a future study.Originality/valueThis is an original study conducted on randomly selected employees across the country from among personnel working for different establishments of organization X. The approach taken in this study for optimizing a course curriculum is unique in the way that it uses a two-stage QFD, which is traditionally used for the design of a product, its components, and the subsequent manufacturing process. This study has employed a planning matrix that incorporated participant-given ratings for each individual need and also participant-decided benchmarking ratings of other similar courses. Estimation of final target has been done by factoring in participants' competence ratings for each individual topic, for a more truthful representation of participant opinion on the final output. This study has also adopted a unique approach of considering only top 80% (in terms of frequency of occurrence) of total responses while calculating weighted averages, instead of calculating the mean value of all data points. In this way, only the significant contributors have been considered while analyzing data.

Prognostic Factors for Speech Outcome among Patients with Submucous Cleft Palate Managed by Furlow Palatoplasty or Posterior Pharyngeal Flap.

Submucous cleft palate (SMCP) is a particular subtype of cleft deformity for which the optimal surgical timing and technique are still under debate. This study aimed to identify potential prognostic factors for the speech outcome of patients with SMCP and provide evidence for further management strategy optimization. The authors reviewed patients with nonsyndromic SMCP who received either Furlow palatoplasty (FP) or posterior pharyngeal flap (PPF) between 2008 and 2021 in a tertiary hospital-based cleft center. Both univariate and multivariate logistic regression models were used to screen preoperative variables, including cleft type (overt or occult), age at surgery, mobility of velum and pharyngeal wall, velopharyngeal closure ratio, and pattern. The receiver operating characteristic curve was used to determine the cutoff value of the significant predictors for subgroup comparison. A total of 131 patients were enrolled, with 92 receiving FP and 39 receiving PPF. Age at operation and cleft type were identified as having significant effects on FP outcome. Patients operated on before 9.5 years of age had a significantly higher velopharyngeal competence (VPC) rate than those operated on after that age. The speech outcome among patients with occult SMCP was significantly worse than that of patients with overt SMCP after FP treatment. No preoperative variable was found to be correlated with PPF outcome. PPF yielded a higher VPC rate than did FP among patients operated on after 9.5 years of age. The prognosis of patients with SMCP treated with FP is sensitive to age at surgery and cleft type. PPF may be considered for older patients in settings with limited access to multiple surgical procedures, especially when occult SMCP is diagnosed. Therapeutic, III.

Curricular representation of neurogastroenterology: A survey among medical students in Germany.

Neurogastroenterological disorders (NGDs) are highly prevalent and substantially impact patients' quality of life. Effective treatment of NGDs depends on the competence and training of medical caregivers. Students' perceived competence in neurogastroenterology and its place in medical school curricula are assessed in this study. A multi-center digital survey among medical students was conducted at five universities. Self-ratings of competence regarding basic mechanisms, diagnosis, and treatment of six chronic medical conditions were assessed. These included irritable bowel syndrome (IBS), gastroesophageal reflux disease, and achalasia. Ulcerative colitis, hypertension, and migraine were included as references. Of 231 participants, 38% remembered that neurogastroenterology was covered in their curriculum. Highest competence ratings were stated for hypertension and the lowest for IBS. These findings were identical for all institutions irrespective of their curricular model and demographic parameters. Students who remembered neurogastroenterology as a part of their curriculum reported higher competence ratings. According to 72% of students, NGDs should be highlighted more prominently in the curriculum. Despite its epidemiological relevance, neurogastroenterology is only weakly represented in medical curricula. Students report low levels of subjective competence in handling NGDs. In general, assessing the learners' perspective on an empirical basis may enrichen the process of national standardization of medical school curricula.

Feasibility of Family-Centered Workshops for Children Aged 18-36 Months with Language Developmental Delay

BackgroundFamily-centered workshops' effects on children with language developmental delay remain unknown. This study assessed the feasibility of workshops for children with language developmental delay. MethodsA total of 122 children aged 18-36 months with language developmental delays and their parents participated in six sessions of 2-h family-centered multidisciplinary workshops for 6 weeks. The Mandarin-Chinese Communicative Development Inventory, Peabody Developmental Motor Scale, Emotional Competency Rating Scales, Pediatric Outcomes Data Collection Instrument, Child Health Questionnaire, Pediatric Quality of Life Inventory, Caregiver Strain Index, Impact on Family Scale, PedsQL Family Impact Module, and World Health Organization Quality of Life (QOL) were administered to the children and their parents before and after the workshop. ResultsWe found improvement of emotion (P = 0.037), upper extremity and physical function (P = 0.038), and transfer and basic mobility (P = 0.019) in children and parental QOL related to children's conditions (P = 0.049), with no effect on communication ability and QOL in children and family strain and function. We also noted more significant improvement in children with pure developmental language delay than in children with nonpure developmental language delay concerning the success rates (from delayed to normal development) for expressive vocabulary (P < 0.001) and word combination (P = 0.002). Satisfaction levels toward the workshop were high. ConclusionsFamily-centered workshops improved children's emotions, functional performance, and parental QOL. Although the samples were too small to test different conditions of the developmental delay, the workshops for children with language developmental delays are acceptable and feasible.

Influence de la comparaison symbolique versus non symbolique sur le risque de difficultés d’apprentissage en mathématiques en éducation de la petite enfance

The main goal of this study was to clarify if students at risk of Mathematics Learning Disabilities had deficits in symbolic, non-symbolic processing, or both. Other purpose was to know if the Open Algorithm Based on Numbers (OBN) teaching method offers advantages over Closed Algorithms Based on Ciphers (CBC) method. A total of 307 Early Childhood Education students participated in this study. Based on student’ scores obtained in Test of Early Mathematics Ability (TEMA-3), that assesses formal and informal thinking, three analysis groups were designed: low-performance group, average-performance group, and high-performance group. There were significant differences in symbolic comparison and, consequently, the post hoc analysis showed significant differences between all groups in symbolic comparison except between the High and Average groups calculation. However, there were no differences in non-symbolic comparison between any of the groups. The teaching method and the mathematical competence showed a significant effect only on the symbolic comparison, resulting in a small size of effect for both the method and the Early Math Competence rate. These data support the dual representation hypothesis, in which the non-symbolic magnitudes would activate the Numerical Approximation System (ANS) and the symbolic quantities an exact representation of the numbers. This being a significant source of mathematical learning that could contribute to the improvement of the ANS.

Exposure to nonnative-accented speech reduces listening effort and improves social judgments of the speaker

Prior research has revealed a native-accent advantage, whereby nonnative-accented speech is more difficult to process than native-accented speech. Nonnative-accented speakers also experience more negative social judgments. In the current study, we asked three questions. First, does exposure to nonnative-accented speech increase speech intelligibility or decrease listening effort, thereby narrowing the native-accent advantage? Second, does lower intelligibility or higher listening effort contribute to listeners’ negative social judgments of speakers? Third and finally, does increased intelligibility or decreased listening effort with exposure to speech bring about more positive social judgments of speakers? To address these questions, normal-hearing adults listened to a block of English sentences with a native accent and a block with nonnative accent. We found that once participants were accustomed to the task, intelligibility was greater for nonnative-accented speech and increased similarly with exposure for both accents. However, listening effort decreased only for nonnative-accented speech, soon reaching the level of native-accented speech. In addition, lower intelligibility and higher listening effort was associated with lower ratings of speaker warmth, speaker competence, and willingness to interact with the speaker. Finally, competence ratings increased over time to a similar extent for both accents, with this relationship fully mediated by intelligibility and listening effort. These results offer insight into how listeners process and judge unfamiliar speakers.