Utilisation of simulation-based learning to decrease student anxiety and increase readiness for clinical placements for speech-language pathology students.

PURPOSE: To investigate the use of two versions of a simulation-based learning experience (SBLE) to decrease speech-language pathology (SLP) students' anxiety and increase their confidence and sense of preparedness for clinical placements. METHOD: Two cohorts of third-year SLP students (n = 33) participated in a mixed-methods study with each cohort completing one version of the SBLE. Participants completed pre- and post-program quantitative ratings of anxiety, confidence, and preparedness for clinical placements and participated in focus groups. Three clinical educators also provided qualitative data in debriefs and interviews. RESULT: Significant decreases in student ratings of anxiety, and increases in confidence and sense of preparedness, were found for participants from both versions of the SBLE. No significant differences were found between changes in each measure between the two groups. Qualitative data from the student focus groups and clinical educator interviews described affective changes in the students, which concurred with the quantitative results. CONCLUSION: Results suggest this SBLE can be used to improve SLP students' self-perceptions of readiness for clinical placements. Comparable outcomes can be achieved for students using the shorter, less resource intensive version of the SBLE program, with reduced costs, to overcome barriers to its implementation.

High throughput identification of human monoclonal antibodies and heavy-chain-only antibodies to treat snakebite.

Snakebite envenoming is a priority Neglected Tropical Disease that causes an estimated 81,000-135,000 fatalities each year. The development of a new generation of safer, affordable, and accessible antivenom therapies is urgently needed. With this goal in mind, rigorous characterisation of the specific toxins in snake venom is key to generating novel therapies for snakebite. Monoclonal antibodies directed against venom toxins are emerging as potentially strong candidates in the development of new snakebite diagnostics and treatment. Venoms comprise many different toxins of which several are responsible for their pathological effects. Due to the large variability of venoms within and between species, formulations of combinations of human antibodies are proposed as the next generation antivenoms. Here a high-throughput screening method employing antibody-based ligand fishing of venom toxins in 384 filter-well plate format has been developed to determine the antibody target/s The approach uses Protein G beads for antibody capture followed by exposure to a full venom or purified toxins to bind their respective ligand toxin(s). This is followed by a washing/centrifugation step to remove non-binding toxins and an in-well tryptic digest. Finally, peptides from each well are analysed by nanoLC-MS/MS and subsequent Mascot database searching to identify the bound toxin/s for each antibody under investigation. The approach was successfully validated to rapidly screen antibodies sourced from hybridomas, derived from venom-immunised mice expressing either regular human antibodies or heavy-chain-only human antibodies (HCAbs).

US Nationwide Multi-City Media Coverage of COVID-19 Responses: Community Structure Theory, Belief System, and a "Violated Way of Life".

Community structure analysis compared city characteristics and newspaper coverage of state/local government responses to COVID-19 in 25 major U.S. cities, sampling all 250+ word articles from 4/4/20 to 7/6/20. The resulting 588 articles were coded for "prominence" and "direction" (favorable/unfavorable/balanced-neutral coverage), then combined into each newspaper's composite "Media Vector" (range=0.3552 to -0.5197, or 0.8749). Twenty-one of 25 newspapers (84%) displayed unfavorable coverage of local COVID-19 responses. Pearson correlations and regression analysis confirmed a muscular "violated way of life" pattern, when a community perceives itself as threatened by a "biological threat or a threat to a cherished way of life." Political and belief system polarization (in particular percent Evangelical and percent voting Republican) were strongly associated with unfavorable coverage of local pandemic responses, compared to more favorable responses linked to percent voting Democratic or percent Catholic. Vulnerability (percent uninsured) was also linked to negative coverage. Conversely, two different measures of access to healthcare (percent municipal spending on health and welfare, and physicians/100,000) were significantly linked to favorable coverage of the same local government efforts. Community structure theory's grass roots "bottom up" expectations linking community demographics to variations in reporting on critical issues were robustly confirmed.

Covalent bicyclization of protein complexes yields durable quaternary structures.

Proteins are essential biomolecules and central to biotechnological applications. In many cases, assembly into higher-order structures is a prerequisite for protein function. Under conditions relevant for applications, protein integrity is often challenged, resulting in disassembly, aggregation, and loss of function. The stabilization of quaternary structure has proven challenging, particularly for trimeric and higher-order complexes, given the complexity of involved inter- and intramolecular interaction networks. Here, we describe the chemical bicyclization of homotrimeric protein complexes, thereby increasing protein resistance toward thermal and chemical stress. This approach involves the structure-based selection of cross-linking sites, their variation to cysteine, and a subsequent reaction with a triselectrophilic agent to form a protein assembly with bicyclic topology. Besides overall increased stability, we observe resistance toward aggregation and greatly prolonged shelf life. This bicyclization strategy gives rise to unprecedented protein chain topologies and can enable new biotechnological and biomedical applications.

Anoxia begets anoxia: A positive feedback to the deoxygenation of temperate lakes.

Declining oxygen concentrations in the deep waters of lakes worldwide pose a pressing environmental and societal challenge. Existing theory suggests that low deep-water dissolved oxygen (DO) concentrations could trigger a positive feedback through which anoxia (i.e., very low DO) during a given summer begets increasingly severe occurrences of anoxia in following summers. Specifically, anoxic conditions can promote nutrient release from sediments, thereby stimulating phytoplankton growth, and subsequent phytoplankton decomposition can fuel heterotrophic respiration, resulting in increased spatial extent and duration of anoxia. However, while the individual relationships in this feedback are well established, to our knowledge, there has not been a systematic analysis within or across lakes that simultaneously demonstrates all of the mechanisms necessary to produce a positive feedback that reinforces anoxia. Here, we compiled data from 656 widespread temperate lakes and reservoirs to analyze the proposed anoxia begets anoxia feedback. Lakes in the dataset span a broad range of surface area (1-126,909 ha), maximum depth (6-370 m), and morphometry, with a median time-series duration of 30 years at each lake. Using linear mixed models, we found support for each of the positive feedback relationships between anoxia, phosphorus concentrations, chlorophyll a concentrations, and oxygen demand across the 656-lake dataset. Likewise, we found further support for these relationships by analyzing time-series data from individual lakes. Our results indicate that the strength of these feedback relationships may vary with lake-specific characteristics: For example, we found that surface phosphorus concentrations were more positively associated with chlorophyll a in high-phosphorus lakes, and oxygen demand had a stronger influence on the extent of anoxia in deep lakes. Taken together, these results support the existence of a positive feedback that could magnify the effects of climate change and other anthropogenic pressures driving the development of anoxia in lakes around the world.

Professional Identity Formation in Allied Health: A Systematic Review with Narrative Synthesis.

Phenomenon: Professional identity formation is a key component of health professional education. Changing expectations of healthcare requires more than competencies, but also an ingrained responsibility to patients, with our values and behaviors aligned with community expectations of patient-centered health professionals. Research into professional identity formation has focused on nursing and medical training, and, although allied health professionals make up one third of the workforce, research is uneven across these disciplines. Health professions educators from these under-researched disciplines have less guidance for how to support students' professional identity, meaning students may graduate with less mature professional identities. This systematic literature review synthesizes the research on professional identity formation across nine similar allied health disciplines. The purpose is to guide health professions educators in the formation of professional identity in allied health students. Approach: We carried out a systematic literature review, registered on Prospero, following the PRIMSA framework, to find, appraise, and synthesize research on professional identity for nine allied health professions. We synthesized extracted data using a narrative synthesis with convergent qualitative meta-integration of qualitative and quantitative data. Results: Our database searches combined with ancestry and forward searching resulted in 70 studies that met inclusion criteria. Studies came from 17 countries, from seven of the included disciplines (art therapy, dietetics, occupational therapy, physiotherapy, podiatry, psychology, and speech pathology) and from undergraduate, postgraduate, and new graduate perspectives. We found professional identity was influenced by the places of learning (curriculum and clinical experiences or placements), interactions with people (relationships with academics, peers, supervisors, patients,and role models), and educational practices engaged (dialogue, reflection, processing challenges), each acting on the individual person (student or new graduate) who also brought unique characteristics and experiences. Insights: This model of influences can inform health professions education to enable students to develop and graduate with a stronger professional identity formation.

Association Between Socioeconomic Factors, Race, and Use of a Specialty Memory Clinic.

BACKGROUND AND OBJECTIVES: The capacity of specialty memory clinics in the United States is very limited. If lower socioeconomic status or minoritized racial group is associated with reduced use of memory clinics, this could exacerbate health care disparities, especially if more effective treatments of Alzheimer disease become available. We aimed to understand how use of a memory clinic is associated with neighborhood-level measures of socioeconomic factors and the intersectionality of race. METHODS: We conducted an observational cross-sectional study using electronic health record data to compare the neighborhood advantage of patients seen at the Washington University Memory Diagnostic Center with the catchment area using a geographical information system. Furthermore, we compared the severity of dementia at the initial visit between patients who self-identified as Black or White. We used a multinomial logistic regression model to assess the Clinical Dementia Rating at the initial visit and t tests to compare neighborhood characteristics, including Area Deprivation Index, with those of the catchment area. RESULTS: A total of 4,824 patients seen at the memory clinic between 2008 and 2018 were included in this study (mean age 72.7 [SD 11.0] years, 2,712 [56%] female, 543 [11%] Black). Most of the memory clinic patients lived in more advantaged neighborhoods within the overall catchment area. The percentage of patients self-identifying as Black (11%) was lower than the average percentage of Black individuals by census tract in the catchment area (16%) (p < 0.001). Black patients lived in less advantaged neighborhoods, and Black patients were more likely than White patients to have moderate or severe dementia at their initial visit (odds ratio 1.59, 95% CI 1.11-2.25). DISCUSSION: This study demonstrates that patients living in less affluent neighborhoods were less likely to be seen in one large memory clinic. Black patients were under-represented in the clinic, and Black patients had more severe dementia at their initial visit. These findings suggest that patients with a lower socioeconomic status and who identify as Black are less likely to be seen in memory clinics, which are likely to be a major point of access for any new Alzheimer disease treatments that may become available.

Electronic health record data quality assessment and tools: a systematic review.

OBJECTIVE: We extended a 2013 literature review on electronic health record (EHR) data quality assessment approaches and tools to determine recent improvements or changes in EHR data quality assessment methodologies. MATERIALS AND METHODS: We completed a systematic review of PubMed articles from 2013 to April 2023 that discussed the quality assessment of EHR data. We screened and reviewed papers for the dimensions and methods defined in the original 2013 manuscript. We categorized papers as data quality outcomes of interest, tools, or opinion pieces. We abstracted and defined additional themes and methods though an iterative review process. RESULTS: We included 103 papers in the review, of which 73 were data quality outcomes of interest papers, 22 were tools, and 8 were opinion pieces. The most common dimension of data quality assessed was completeness, followed by correctness, concordance, plausibility, and currency. We abstracted conformance and bias as 2 additional dimensions of data quality and structural agreement as an additional methodology. DISCUSSION: There has been an increase in EHR data quality assessment publications since the original 2013 review. Consistent dimensions of EHR data quality continue to be assessed across applications. Despite consistent patterns of assessment, there still does not exist a standard approach for assessing EHR data quality. CONCLUSION: Guidelines are needed for EHR data quality assessment to improve the efficiency, transparency, comparability, and interoperability of data quality assessment. These guidelines must be both scalable and flexible. Automation could be helpful in generalizing this process.

Longer duration of seasonal stratification contributes to widespread increases in lake hypoxia and anoxia.

The concentration of dissolved oxygen (DO) is an important attribute of aquatic ecosystems, influencing habitat, drinking water quality, biodiversity, nutrient biogeochemistry, and greenhouse gas emissions. While average summer DO concentrations are declining in lakes across the temperate zone, much remains unknown about seasonal factors contributing to deepwater DO losses. It is unclear whether declines are related to increasing rates of seasonal DO depletion or changes in seasonal stratification that limit re-oxygenation of deep waters. Furthermore, despite the presence of important biological and ecological DO thresholds, there has been no large-scale assessment of changes in the amount of habitat crossing these thresholds, limiting the ability to understand the consequences of observed DO losses. We used a dataset from >400 widely distributed lakes to identify the drivers of DO losses and quantify the frequency and volume of lake water crossing biologically and ecologically important threshold concentrations ranging from 5 to 0.5 mg/L. Our results show that while there were no consistent changes over time in seasonal DO depletion rates, over three-quarters of lakes exhibited an increase in the duration of stratification, providing more time for seasonal deepwater DO depletion to occur. As a result, most lakes have experienced summertime increases in the amount of water below all examined thresholds in deepwater DO concentration, with increases in the proportion of the water column below thresholds ranging between 0.9% and 1.7% per decade. In the 30-day period preceding the end of stratification, increases were greater at >2.2% per decade and >70% of analyzed lakes experienced increases in the amount of oxygen-depleted water. These results indicate ongoing climate-induced increases in the duration of stratification have already contributed to reduction of habitat for many species, likely increased internal nutrient loading, and otherwise altered lake chemistry. Future warming is likely to exacerbate these trends.

Anoxia decreases the magnitude of the carbon, nitrogen, and phosphorus sink in freshwaters.

Oxygen availability is decreasing in many lakes and reservoirs worldwide, raising the urgency for understanding how anoxia (low oxygen) affects coupled biogeochemical cycling, which has major implications for water quality, food webs, and ecosystem functioning. Although the increasing magnitude and prevalence of anoxia has been documented in freshwaters globally, the challenges of disentangling oxygen and temperature responses have hindered assessment of the effects of anoxia on carbon, nitrogen, and phosphorus concentrations, stoichiometry (chemical ratios), and retention in freshwaters. The consequences of anoxia are likely severe and may be irreversible, necessitating ecosystem-scale experimental investigation of decreasing freshwater oxygen availability. To address this gap, we devised and conducted REDOX (the Reservoir Ecosystem Dynamic Oxygenation eXperiment), an unprecedented, 7-year experiment in which we manipulated and modeled bottom-water (hypolimnetic) oxygen availability at the whole-ecosystem scale in a eutrophic reservoir. Seven years of data reveal that anoxia significantly increased hypolimnetic carbon, nitrogen, and phosphorus concentrations and altered elemental stoichiometry by factors of 2-5× relative to oxic periods. Importantly, prolonged summer anoxia increased nitrogen export from the reservoir by six-fold and changed the reservoir from a net sink to a net source of phosphorus and organic carbon downstream. While low oxygen in freshwaters is thought of as a response to land use and climate change, results from REDOX demonstrate that low oxygen can also be a driver of major changes to freshwater biogeochemical cycling, which may serve as an intensifying feedback that increases anoxia in downstream waterbodies. Consequently, as climate and land use change continue to increase the prevalence of anoxia in lakes and reservoirs globally, it is likely that anoxia will have major effects on freshwater carbon, nitrogen, and phosphorus budgets as well as water quality and ecosystem functioning.

Increased adoption of best practices in ecological forecasting enables comparisons of forecastability.

Near-term iterative forecasting is a powerful tool for ecological decision support and has the potential to transform our understanding of ecological predictability. However, to this point, there has been no cross-ecosystem analysis of near-term ecological forecasts, making it difficult to synthesize diverse research efforts and prioritize future developments for this emerging field. In this study, we analyzed 178 near-term (≤10-yr forecast horizon) ecological forecasting papers to understand the development and current state of near-term ecological forecasting literature and to compare forecast accuracy across scales and variables. Our results indicated that near-term ecological forecasting is widespread and growing: forecasts have been produced for sites on all seven continents and the rate of forecast publication is increasing over time. As forecast production has accelerated, some best practices have been proposed and application of these best practices is increasing. In particular, data publication, forecast archiving, and workflow automation have all increased significantly over time. However, adoption of proposed best practices remains low overall: for example, despite the fact that uncertainty is often cited as an essential component of an ecological forecast, only 45% of papers included uncertainty in their forecast outputs. As the use of these proposed best practices increases, near-term ecological forecasting has the potential to make significant contributions to our understanding of forecastability across scales and variables. In this study, we found that forecastability (defined here as realized forecast accuracy) decreased in predictable patterns over 1-7 d forecast horizons. Variables that were closely related (i.e., chlorophyll and phytoplankton) displayed very similar trends in forecastability, while more distantly related variables (i.e., pollen and evapotranspiration) exhibited significantly different patterns. Increasing use of proposed best practices in ecological forecasting will allow us to examine the forecastability of additional variables and timescales in the future, providing a robust analysis of the fundamental predictability of ecological variables.

Fluoro-Bridged Clusters in Rare-Earth Metal-Organic Frameworks.

The modulator 2-fluorobenzoic acid (2-fba) is widely used to prepare RE clusters in metal-organic frameworks (MOFs). In contrast to known RE MOF structures containing hydroxide bridging groups, we report for the first time the possible presence of fluoro bridging groups in RE MOFs. In this report we discuss the synthesis of a holmium-UiO-66 analogue as well as a novel holmium MOF, where evidence of fluorinated clusters is observed. The mechanism of fluorine extraction from 2-fba is discussed as well as the implications that these results have for previously reported RE MOF structures.

The promises and challenges of women's colleges: Leadership and equity.

Women's colleges have a unique and successful history in fostering women's leadership relying on transformational and feminist leadership frameworks. Yet, their work in creating more inclusive and intersectional campus communities often falls short. This article offers some solutions on how women's colleges can best move forward to advance leadership and equity on campus.

Ten simple rules for training yourself in an emerging field.

The opportunity to participate in and contribute to emerging fields is increasingly prevalent in science. However, simply thinking about stepping outside of your academic silo can leave many students reeling from the uncertainty. Here, we describe 10 simple rules to successfully train yourself in an emerging field, based on our experience as students in the emerging field of ecological forecasting. Our advice begins with setting and revisiting specific goals to achieve your academic and career objectives and includes several useful rules for engaging with and contributing to an emerging field.

Identifying gaps in the photographic record of the vascular plant flora of the Americas.

Field photographs of plant species are crucial for research and conservation, but the lack of a centralized database makes them difficult to locate. We surveyed 25 online databases of field photographs and found that they harboured only about 53% of the approximately 125,000 vascular plant species of the Americas. These results reflect the urgent need for a centralized database that can both integrate and complete the photographic record of the world's flora.

Characterization of a Holmium 4,4'-Biphenyldicarboxylate Metal-Organic Framework and Its Potential as a Holmium Carrier System.

There is growing interest in Holmium carriers for radiotherapeutic applications. In this work, a holmium-based metal-organic framework (MOF) using the 4,4'-biphenyldicarboxylic acid (H2BPDC) linker was synthesized and characterized to explore its potential as a radiotherapeutic carrier. The 3D MOF [Ho(BPDC)2]·(CH3)2NH2 was characterized by single crystal X-ray diffraction, FTIR, TGA and PXRD. A challenge to overcome in lanthanide-based MOFs is the deformation or collapse of the framework that can occur after evacuation of the pores. This structure displays high thermal stability and no collapse was observed when the molecules confined in the pores were removed. The coordination around the holmium center (CN = 8) is the key to this stability since only the organic linker and no solvent molecules coordinate to the metallic center. The porosity of the material was confirmed by high-pressure carbon dioxide (CO2) adsorption-desorption analysis. The stability of the MOF, its holmium content (28 wt%) and its porosity are features that make this material a potential holmium carrier for radiotherapeutic applications.

Transition from a 1D Coordination Polymer to a Mixed-Linker Layered MOF.

A novel copper(II) metal-organic framework (MOF) has been synthesized by modifying the reaction conditions of a 1D coordination polymer. The 1D polymer is built by the coordination between copper and 2,2'-(1 H-imidazole-4,5-diyl)di-1,4,5,6-tetrahydropyrimidine (H-L1). The geometry of H-L1 precludes its ability to form extended 3D framework structures. By adding 1,4-benzenedicarboxylic acid (H2BDC), a well-studied linker in MOF synthesis, we achieved the transition from a 1D polymer chain into porous 2D layered structures. Hydrogen bonding between L1 and BDC directs the parallel stacking of these layers, resulting in a 3D structure with one-dimensional channels accessible by two different pore windows. The preferred growth orientation of the crystal produces prolonged channels and a disparity in pore size distribution. This in turn results in slow diffusion processes in the material. Furthermore, an isoreticular MOF was prepared by substituting the BDC linker by 2,6-naphthalenedicarboxylic acid (H2NDC).

Working with children with autism: an interprofessional simulation-based tutorial for speech pathology and occupational therapy students.

There is an increasing need to include interprofessional experiences in undergraduate health education. Simulation is one methodology revered as being able to facilitate interprofessional learning opportunities in a safe, structured environment. This project aimed to develop, trial and evaluate an interprofessional simulation role-play tutorial utilising DVD resources. In total, 70 speech pathology students and 76 occupational therapy students participated in a role-play involving DVD footage and documentation to facilitate assessment planning and analysis of assessment data for a child with autism. Questionnaires asked participants to rate their perceived experiences across 13 items using a 5-point Likert scale, as well as three open-ended questions. The results revealed positive reactions to the role-play and suggested that students felt that the learning objectives had been met. Many students expressed interest in engaging in further interprofessional learning experiences. Taken in conjunction with other similar studies, interprofessional simulation-based workshops using DVD footage may provide a manageable alternative to traditional interprofessional learning modalities, in particular when incorporating clients with complex and developmental disabilities.