Perceptions of employability related to severity of hypernasality: a pilot study.

The primary aim of this investigation was to evaluate listener auditory-perceptual assessment of employability for individuals with hypernasal speech. Using an online survey platform, listeners with managerial experience evaluated speech samples from individuals with varying hypernasal resonance disorder severity to determine auditory-perceptual judgements regarding intelligence and employability. Speech samples of individuals with hypernasal speech were rated lower on scales of intelligence and employability, and more likely to be selected for jobs with infrequent rates of communication and lower levels of responsibility. Additionally, males with hypernasal speech were perceived as less intelligent, less employable, and more likely to be selected for a job with infrequent communication in comparison to females with hypernasal speech. Results of this preliminary investigation suggest that individuals with hypernasal speech may face employment barriers. The conclusions collected from this initial investigation open the doors for further research addressing linguistic considerations and aspects of employability. This is an important consideration for individuals with either acquired or congenitally related hypernasal resonance disorder.

Controlled-Release Hydrogel Microspheres to Deliver Multipotent Stem Cells for Treatment of Knee Osteoarthritis.

Osteoarthritis (OA) is the most common form of joint disease affecting articular cartilage and peri-articular tissues. Traditional treatments are insufficient, as they are aimed at mitigating symptoms. Multipotent Stromal Cell (MSC) therapy has been proposed as a treatment capable of both preventing cartilage destruction and treating symptoms. While many studies have investigated MSCs for treating OA, therapeutic success is often inconsistent due to low MSC viability and retention in the joint. To address this, biomaterial-assisted delivery is of interest, particularly hydrogel microspheres, which can be easily injected into the joint. Microspheres composed of hyaluronic acid (HA) were created as MSC delivery vehicles. Microrheology measurements indicated that the microspheres had structural integrity alongside sufficient permeability. Additionally, encapsulated MSC viability was found to be above 70% over one week in culture. Gene expression analysis of MSC-identifying markers showed no change in CD29 levels, increased expression of CD44, and decreased expression of CD90 after one week of encapsulation. Analysis of chondrogenic markers showed increased expressions of aggrecan (ACAN) and SRY-box transcription factor 9 (SOX9), and decreased expression of osteogenic markers, runt-related transcription factor 2 (RUNX2), and alkaline phosphatase (ALPL). In vivo analysis revealed that HA microspheres remained in the joint for up to 6 weeks. Rats that had undergone destabilization of the medial meniscus and had overt OA were treated with empty HA microspheres, MSC-laden microspheres, MSCs alone, or a control vehicle. Pain measurements taken before and after the treatment illustrated temporarily decreased pain in groups treated with encapsulated cells. Finally, the histopathological scoring of each group illustrated significantly less OA damage in those treated with encapsulated cells compared to controls. Overall, these studies demonstrate the potential of using HA-based hydrogel microspheres to enhance the therapeutic efficacy of MSCs in treating OA.

Hospital-based violence prevention programmes in South Wales Emergency Departments: A process evaluation protocol.

BACKGROUND: Addressing violence related harm is a global public health priority. While violence is primarily managed in the criminal justice system, healthcare supports and manages those injured by violence. Emergency Departments (EDs), the primary destination for those seriously injured, have emerged as a candidate location for violence prevention initiatives. There is limited evaluation of ED-based violence prevention, and a lack of guidance for the implementation and delivery of them. Nurse-led Violence Prevention Teams (VPTs) have been developed and implemented in two EDs in Wales, UK. This protocol describes methods used in the process evaluation of these VPTs. AIM: To understand how VPTs function, how they were implemented, and mechanisms of impact, as well as the exploration of wider contextual factors influencing their function. METHODS: Adopting a critical realist approach and informed by the Medical Research Council (MRC) guidance for process evaluations, the process evaluation will employ qualitative methods to collect and analyse data: a scoping review of evidence of effectiveness that considers the causal mechanisms underpinning violence; a documentary analysis to determine operational considerations concerning the development, implementation and delivery of the VPTs; a descriptive analysis of routine ED data to characterise the prevalence of violence-related attendances in each ED; interviews with professional stakeholders (N = 60) from the violence prevention ecologies in which the VPTs are embedded. DISCUSSION: This protocol outlines a process evaluation of a novel, nurse led violence prevention intervention. Findings will be used to inform policy makers' decision making on whether and how VPTs should be used in practice in other EDs across the UK, and the extent that a single operational model should be adjusted to address the local characteristic of violence. To the authors knowledge, this is the first process evaluation of a UK-based, nurse led Emergency Department Violence Prevention Team. TRIAL REGISTRATION: Protocol registration ISRCTN: 15286575. Registered 13th March, 2023.

Speech-language pathologists' counselor self-efficacy.

INTRODUCTION: The purpose of this study was to measure and determine the factors that influence counseling self-efficacy in speech-language pathologists. METHODS: Data was collected through an anonymous 95-question web-based survey. Five hundred and twenty-seven completed responses were received. RESULTS: The results indicated that participants in the study were confident in their counseling abilities and skills; however, lesser confidence in skills related to personal adjustment counseling were observed. Further, emotional intelligence, internal locus of control, counseling training, and years of experience were positively related to counseling self-efficacy. CONCLUSIONS: Speech-language pathologists may increase their counseling self-efficacy through increased training opportunities and experiences, development of greater emotional intelligence, and by having an internal locus of control.

Impact of COVID-19 Infection and Persistent Lingering Symptoms on Patient Reported Indicators of Nutritional Risk and Malnutrition.

Persistent malnutrition after COVID-19 infection may worsen outcomes, including delayed recovery and increased risk of rehospitalization. This study aimed to determine dietary intakes and nutrient distribution patterns after acute COVID-19 illness. Findings were also compared to national standards for intake of energy, protein, fruit, and vegetables, as well as protein intake distribution recommendations. Participants (≥18 years old, n = 92) were enrolled after baseline visit at the Post-COVID Recovery Clinic. The broad screening battery included nutritional assessment and 24-h dietary recall. Participants were, on average, 53 years old, 63% female, 69% non-Hispanic White, and 59% obese/morbidly obese. Participants at risk for malnutrition (48%) experienced significantly greater symptoms, such as gastric intestinal issues, loss of smell, loss of taste, or shortness of breath; in addition, they consumed significantly fewer calories. Most participants did not meet recommendations for fruit or vegetables. Less than 39% met the 1.2 g/kg/day proposed optimal protein intake for recovery from illness. Protein distribution throughout the day was skewed; only 3% met the recommendation at all meals, while over 30% never met the threshold at any meal. Our findings highlight the need for nutritional education and support for patients to account for lingering symptoms and optimize recovery after COVID-19 infection.

Hyaluronic Acid Hydrogel Microspheres for Slow Release Stem Cell Delivery.

Cell therapies are hampered by a lack of available delivery systems, resulting in inconsistent outcomes in animal studies and human clinical trials. Hydrogel encapsulants offer a broad range of tunable characteristics in the design of cell delivery vehicles. The focus of the hydrogel field has been on durable encapsulants that provide long-term paracrine function of the cells. However, some cell therapies require cell-to-cell contact in order to elicit their effect. Controlled release microencapsulants would be beneficial in these situations, but appropriate polymers have not been adaptable to microsphere manufacturing because they harden too slowly. We developed and tested a novel microencapsulant formulation (acrylated hyaluronic acid: AHA) with degradation characteristics as a controlled release cell delivery vehicle. The properties of AHA microspheres were evaluated and compared to those of poly(ethylene glycol) diacrylate (PEGDA), a durable hydrogel. AHA microspheres possessed a higher swelling ratio, lower diffusion barrier, faster degradation rate, a lower storage modulus, and a larger average diameter than microspheres composed of PEGDA. Additionally, in vitro cell viability and release and short-term in vivo biocompatibility in immune competent Sprague-Dawley rats was assessed for each microsphere type. Compared to PEGDA, microspheres composed of AHA resulted in significantly less foreign body response in vivo as measured by a lack of cellularity or fibrotic ring in the surrounding tissue and no cellular infiltration into the microsphere. This study illustrates the potential of AHA microspheres as a degradable cell delivery system with superior encapsulated cell viability and biocompatibility with the surrounding tissue.

Volume and Verve: Understanding Correction/Behavioral Warnings in Teacher-Child Classroom Interactions Involving an African American Kindergarten Student.

Purpose Using a framework of culturally and linguistically responsive classroom management, this study employed both quantitative and qualitative analyses of ethnographic data to illustrate patterns of corrections/behavioral warnings in teacher-child interactions for an African American child in the classroom. Method Three child participants and their teacher were recruited for the study: MJ, an African American kindergartner, the focal child, and two same-sex Filipino classmates who spoke a nonmainstream dialect of English, Ben and Leo, for frame of reference. None of the three boys were diagnosed with language-learning difficulties. Data analyses included (a) categorical analyses of observational field notes taken across a 7-week period of classroom observation and (b) situated discourse analysis taken from video-recorded small group literacy lessons also in the classroom. Results Two key findings emerged. First, MJ, the focal participant, received a relatively high frequency of correction/behavioral warnings, both relative to the other forms of teacher-initiated interaction and also relative to his two classmates. Second, the majority of MJ's corrections/behavioral warnings were directed toward his volume and verve-features that have been associated with the communication style of many African American students. Conclusions We need to include teachers and administrators in our discussions about the communication style of African American students and broaden these discussions to explicitly consider the influence of nonverbal features, such as volume and verve, on patterns of teacher-student communication interactions. In particular, such communication features may be contributing to high-stakes outcomes for African American children, such as referrals, diagnoses, educational placements, and disciplinary actions.

Assessing the electronic Bedside Paediatric Early Warning System: A simulation study on decision-making and usability.

BACKGROUND: The Bedside Paediatric Early Warning System (BedsidePEWS) is a clinical decision support tool designed to augment clinician expertise, objectively identify children at risk for clinical deterioration, and standardize and prioritize care to improve outcomes in community settings. Although the paper-based BedsidePEWS documentation record has been shown to improve clinicians' perception of their ability to detect deterioration and follow care recommendations, research is needed to asses this impact empirically. Furthermore, as hospitals progressively move toward electronic clinical systems, knowledge regarding the impact of BedsidePEWS' novel electronic interface on clinicians' performance and user experience is required. OBJECTIVES: The primary objectives of this study were (1) to compare adherence to evidence-based care recommendations using a) electronic health record software, b) paper BedsidePEWS, and c) a novel electronic BedsidePEWS interface, and (2) to describe end-users' experiences of usability and opportunities for improvement of both paper and electronic BedsidePEWS. METHODS: Paediatric nurses participated in a repeated measures simulation study. Participants assessed simulated patients, documented patient data, and responded to a series of questions regarding follow-up care for each patient. Three patient types (i.e., stable, mild deterioration, severe deterioration) were assessed in each of three intervention conditions (i.e., electronic health record, paper BedsidePEWS, electronic BedsidePEWS). Following simulation scenarios, participants provided comments regarding the usability of the paper and electronic tools. RESULTS: Participants made 12.7% and 18.0% more appropriate care decisions with paper and electronic BedsidePEWS, respectively, than with the electronic health record intervention (p < 0.001). Accurate BedsidePEWS severity of illness score calculation was related to better adherence to evidence-based care recommendations (65%), compared to inaccurate calculation (55%), and electronic BedsidePEWS was associated with 15.7% fewer calculation errors than paper (p < 0.005). Electronic BedsidePEWS demonstrated usability benefits over its paper predecessor, including automatic score calculation and data plotting, and the potential to eliminate double charting, and participants expressed a preference for electronic BedsidePEWS in all aspects of the debrief questionnaire (p < 0.001). CONCLUSIONS: BedsidePEWS in both paper and electronic formats significantly improved participants' ability to detect deterioration and follow care recommendations compared to electronic health record software. Furthermore, results suggest that electronic BedsidePEWS would afford improved patient care in excess of the paper-based original and further contribute to the standardization, prioritization, and improvement of care in community settings.

The influence of workplace discrimination and vigilance on job satisfaction with people who stutter.

Purpose The purpose of the present study is to examine the association between workplace discrimination, vigilance, and job satisfaction in people who stutter and compare this with people who do not stutter. Method Seventy-two people who stutter (PWS) and 92 people who do not stutter (PWNS) participated in an online survey. Participants completed a survey assessing 6 different areas: (a) background information, (b) job satisfaction, (c) everyday discrimination, and (d) heightened vigilance. Mediation analyses were conducted to evaluate the relationship between the independent variables and dependent variable. Results There was a relationship between being a PWS and job satisfaction, discrimination, and vigilance. PWS were found to experience higher discrimination as well as be more vigilant. Discrimination and vigilance were found to mediate the relationship between stuttering and job satisfaction. Conclusion Results of this study indicate that the participants who stutter differ from PWNS in their job satisfaction, discrimination, and vigilance. Clinicians can prepare PWS with self-advocacy strategies, legal knowledge of what their rights are as an employee who identifies as a person who stutters with a disability, a legal understanding of workplace discrimination, and counseling on the impact of vigilance on workplace experiences.

3D-printing enabled micro-assembly of a microfluidic electroporation system for 3D tissue engineering.

Electro-transfection is an essential workhorse tool for regulating cellular responses and engineering cellular materials in tissue engineering. However, most of the existing approaches are only focused on cell suspensions in vitro, which fails to mimic an in vivo tissue microenvironment regarding the 3D electric field distribution and mass transport in a biological matrix. However, building a 3D electro-transfection system that is compatible with 3D cell culture for mimicking the in vivo tissue microenvironment is challenging, due to the substantial difficulties in control of the 3D electric field distribution as well as the cellular growth. To address such challenges, we introduce a novel 3D micro-assembly strategy assisted by 3D printing, which enables the molding of 3D microstructures as LEGO® parts from 3D-printed molds. The molded PDMS LEGO® bricks are then assembled into a 3D-cell culture chamber interconnected with vertical and horizontal perfusion microchannels as a 3D channel network. Such a 3D perfusion microchannel network is unattainable by direct 3D printing or other microfabrication approaches, which can facilitate the highly-efficient exchange of nutrition and waste for 3D cell growth. Four flat electrodes are mounted into the 3D culture chamber via a 3D-printed holder and controlled by a programmable power sequencer for multi-directional electric frequency scanning (3D µ-electro-transfection). This multi-directional scanning not only can create transient pores all over the cell membrane, but also can generate local oscillation for enhancing mass transport and improving cell transfection efficiency. As a proof-of-concept, we electro-delivered the pAcGFP1-C1 vector to 3D cultured HeLa cells within peptide hydrogel scaffolding. The expressed GFP level from transfected HeLa cells reflects the transfection efficiency. We found two key parameters including electric field strength and plasmid concentration playing more important roles than the pulse duration and duty cycles. The results showed an effective transfection efficiency of ∼15% with ∼85% cell viability, which is 3-fold higher compared to that of the conventional benchtop 3D cell electro-transfection. This 3D µ-electrotransfection system was further used for genetically editing 3D-cultured Hek-293 cells via direct delivery of CRISPR/Cas9 plasmid which showed successful transfection with GFP expressed in the cytoplasm as the reporter. The 3D-printing enabled micro-assembly allows facile creation of a novel 3D culture system for electro-transfection, which can be employed for versatile gene delivery and cellular engineering, as well as building in vivo like tissue models for fundamentally studying cellular regulation mechanisms at the molecular level.

Towards the synthetic design of camelina oil enriched in tailored acetyl-triacylglycerols with medium-chain fatty acids.

The ability to manipulate expression of key biosynthetic enzymes has allowed the development of genetically modified plants that synthesise unusual lipids that are useful for biofuel and industrial applications. By taking advantage of the unique activities of enzymes from different species, tailored lipids with a targeted structure can be conceived. In this study we demonstrate the successful implementation of such an approach by metabolically engineering the oilseed crop Camelina sativa to produce 3-acetyl-1,2-diacyl-sn-glycerols (acetyl-TAGs) with medium-chain fatty acids (MCFAs). Different transgenic camelina lines that had been genetically modified to produce MCFAs through the expression of MCFA-specific thioesterases and acyltransferases were retransformed with the Euonymus alatus gene for diacylglycerol acetyltransferase (EaDAcT) that synthesises acetyl-TAGs. Concomitant RNAi suppression of acyl-CoA:diacylglycerol acyltransferase increased the levels of acetyl-TAG, with up to 77 mole percent in the best lines. However, the total oil content was reduced. Analysis of the composition of the acetyl-TAG molecular species using electrospray ionisation mass spectrometry demonstrated the successful synthesis of acetyl-TAG containing MCFAs. Field growth of high-yielding plants generated enough oil for quantification of viscosity. As part of an ongoing design-test-learn cycle, these results, which include not only the synthesis of 'designer' lipids but also their functional analysis, will lead to the future production of such molecules tailored for specific applications.

Clinical Implications for Working With Nonmainstream Dialect Speakers: A Focus on Two Filipino Kindergartners.

Purpose: The purpose of this clinical focus piece is to increase familiarity with Philippine English (PE) and highlight clinical implications for working with nonmainstream dialect speakers. Method: The clinical focus draws on descriptive case study data from 2 Filipino kindergarten boys who live in the United States. Multiple ethnographic data sources were subjected to contrastive analyses regarding nonmainstream features in the children's speech that might be consistent with PE. Results: The 2 boys demonstrated grammatical and phonological features consistent with their home dialect, PE, and individualized variation relative to one another. We utilize these findings to illustrate 2 key implications for providing culturally competent clinical services when working with nonmainstream dialect speakers: (a) validate and support all Mainstream American English Learners in the classroom and (b) recognize that variance within a dialect is not always indicative of disorder. Explicit recommendations for clinical practice are provided. Conclusion: Understanding and validating the diversity of nonmainstream dialect speakers within the U.S. schools are critical to providing culturally competent speech-language services.

Physical activity: perceptions of people with severe traumatic brain injury living in the community.

PRIMARY OBJECTIVE: Increasing physical activity (PA) among people with severe traumatic brain injury (TBI) represents an important long-term rehabilitation goal. To design effective interventions to promote PA, the factors associated with PA engagement post-TBI need to be understood. RESEARCH DESIGN: A qualitative study design was employed to investigate the factors influencing PA engagement in people with severe TBI living in the community. METHODS AND PROCEDURES: Face-to-face interviews were conducted with eight people with severe TBI three to five years post-injury. A constant comparative method of data collection and analysis was adopted. MAIN OUTCOMES AND RESULTS: Interviews were analysed using thematic analysis. Three themes were identified: continuance of self and PA (perception of self, stage of life, and PA normality), beliefs about PA (knowledge of PA and associated benefits), and purpose of PA engagement (reasons for being physically active). Lifelong PA habits and current life priorities impacted on PA engagement post-TBI and influenced whether TBI-associated impairments were considered as a barrier to PA. CONCLUSION: Among this group of people, PA engagement post-TBI was influenced by perceptions of lifelong PA habits and current life priorities. Interventions to increase PA need to address these perceptions and adapt PA to account for life priorities within the context of TBI-associated impairments.

Predictors of physical activity levels of individuals following traumatic brain injury remain unclear: A systematic review.

OBJECTIVE: To identify factors which influence physical activity levels (PALs) of people with traumatic brain injury (TBI). DATA SOURCES: Eight electronic databases. STUDY SELECTION: A systematic search was performed to identify articles that reported the measurement (quantity) of PALs of individuals with TBI. DATA EXTRACTION/SYNTHESIS: Two authors reviewed andextracted the data independently. Article quality was evaluated using the Law critical review tool. RESULTS: Six studies were identified that met the inclusion criteria. All studies found that PALs of participants with TBI were below those recommended for health benefits. Although a number of environmental and personal barriers restricted PA participation, motivation and exercise self-efficacy were the most frequently identified facilitators of PA in the TBI population. Despite apparent links, the relationship between mobility capacity and PALs was unclear from the results of this systematic review. CONCLUSION: The results of this systematic review demonstrated that little is known about PALs of individuals with TBI. PALs of participants with TBI were less than required for health maintenance. Self-efficacy to exercise and motivation were the most frequently identified facilitators of PA in the TBI population.

"So we would all help pitch in:" The family literacy practices of low-income African American mothers of preschoolers.

UNLABELLED: The development of emergent literacy skills are important for the development of later literacy competencies and affect school readiness. Quantitative researchers document race- and social class-based disparities in emergent literacy competence between low-income African American and middle-income White children. Some researchers suggest that deficits in parenting practices account for limited literacy skills among low-income African American children. A small body of qualitative research on low-income African American families finds that despite economic challenges, some African American families were actively engaged in promoting child literacy development. Using qualitative interviews that emphasize family strengths, we add to this small body of research to highlight positive family practices obscured in many quantitative analyses that concentrate on family shortcomings. Specifically, we examine in-home literacy practices and child literacy development with a sample of low-income African American mothers (families) of preschoolers. Key findings include identification of various literacy activities promoting child literacy development and inclusion of multiple family members assisting in literacy activities. These findings add to substantive discussions of emergent literacy and resilience. Insights from the qualitative interviews also provide culturally-sensitive recommendations to childhood educators and speech-language pathologists (SLP) who work with low-income African American families and children. LEARNING OUTCOMES: Reader should recognize that (1) there is not a 'right' phenotype and therefore not a right form of environmental input and (2) that context matters (at both the level of the cell and the individual organism).

Which factors influence the activity levels of individuals with traumatic brain injury when they are first discharged home from hospital?

PRIMARY OBJECTIVES: To determine the predictors of physical activity levels (PALs) of people with traumatic brain injury (TBI) during the transition from hospital to home. RESEARCH DESIGN: A prospective cohort study. PARTICIPANTS: Twenty-three individuals with TBI, consecutively admitted to TBI inpatient rehabilitation, who had independent community mobility potential on inpatient discharge. METHODS AND PROCEDURES: PALs (steps per day) were monitored at three time points: (T1) final week of inpatient rehabilitation, (T2) first week at home and (T3) 6 weeks following discharge. Measures across the physical, emotional and cognitive domains were performed at T1 and compared with PALs at T3. RESULTS: PALs decreased significantly on hospital discharge (T2), compared to T1, and remained below recommended guidelines for maintenance of health and wellbeing at 6 weeks post discharge (T3). Motivation to exercise was the primary predictor of PALs at T3 (p < 0.01), with fatigue (p < 0.05) and anxiety (p < 0.05) also being significantly associated. Measures of physical ability were not correlated with PALs at T3. CONCLUSIONS: PALs decreased significantly on discharge from hospital and remained below inpatient levels despite physical capacity for higher PALs. Motivation, fatigue and anxiety were important influencers of PALs during the transition home period.

Survivors Perceptions of Recovery following Air Medical Transport Accidents.

Abstract Objective: Air medical transport (AMT) teams play an essential role in the care of the critically ill and injured. Their work, however, is not without risk. Since the inception of the industry numerous AMT accidents have been reported. The objective of this research is to gain a better understanding of the post-accident sequelae for professionals who have survived AMT accidents. The hope is that this understanding will empower the industry to better support survivors and plan for the contingencies of post-accident recovery. Methods: Qualitative methods were used to explore the experience of flight crew members who have survived an AMT accident. "Accident" was defined using criteria established by the National Transportation Safety Board. Traditional focus group methodology explored the survivors' experiences following the accident. Results: Seven survivors participated in the focus group. Content analysis revealed themes in four major domains that described the experience of survivors: Physical, Psychological, Relational and Financial. Across the themes survivors reported that industry and company response varied greatly, ranging from generous support, understanding and action to make safety improvements, to little response or action and lack of attention to survivor needs. Conclusion: Planning for AMT post-accident response was identified to be lacking in scope and quality. More focused efforts are needed to assist and support the survivors as they regain both their personal and professional lives following the accident. This planning should include all stakeholders in safe transport; the individual crewmember, air medical transport companies, and the industry at large.