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Spaced education is a learning strategy to improve knowledge acquisition and retention. To date, no robust evidence exists to support the utility of spaced education in the Family Medicine residency. We aimed to test whether alerts to encourage spaced education can improve clinical knowledge as measured by scores on the Canadian Family Medicine certification examination. Method: We conducted a cluster randomized controlled trial to empirically and pragmatically test spaced education using two versions of the Family Medicine Study Guide mobile app. 12 residency training programs in Canada agreed to participate. At six intervention sites, we consented 335 of the 654 (51%) eligible residents. Residents in the intervention group were sent alerts through the app to encourage the answering of questions linked to clinical cases. At six control sites, 299 of 586 (51%) residents consented. Residents in the control group received the same app but with no alerts. Incidence rates of case completion between trial arms were compared using repeated measures analysis. We linked residents in both trial arms to their knowledge scores on the certification examination of the College of Family Physicians of Canada. Results: Over 67 weeks, there was no statistically significant difference in the completion of clinical cases by participants. The difference in mean exam scores and the associated confidence interval did not exceed the pre-defined limit of 4 percentage points. Conclusion: Further research is recommended before deploying spaced educational interventions in the Family Medicine residency to improve knowledge.

A crosslinguistic study is underway concerning children's protracted phonological development (i.e. speech sound disorders). The current article reports pilot Spanish data for this study from two 4-year-old boys with protracted phonological development. The purposes of the pilot study were to: (1) develop and evaluate a word list for elicitation that could be used across Spanish dialects and that sufficiently sampled Spanish word lengths, stress patterns, word shapes and phonemes; and (2) to derive hypotheses for the larger study, based on patterns found in these children's speech, and a review of the literature. The two speakers showed some developmental patterns reported for other languages (e.g. constraints on production of liquids and word-initial consonants in unstressed syllables) but also patterns that may reflect Spanish phonological inventories, allophony and frequencies. These data helped consolidate the Spanish word list for elicitation and led to questions for the ongoing study concerning word structure, multisyllabic words, liquids, fricatives and vowel sequences. (Contains 4 tables and 7 notes.)

We evaluated a novel, computerized feelings assessment instrument (MAAC) in 54 children with anxiety disorders and 35 nonanxious children ages 5 to 11. They rated their feelings relative to 16 feeling animations. Ratings of feelings, order of feeling selection, and correlations with standardized anxiety measures were examined. Positive emotions were rated more highly and visited earlier by nonanxious children. Children with anxiety disorders explored fewer emotions. MAAC ratings on several positive emotions showed inverse correlations with state anxiety. Although needing further evaluation, MAAC may facilitate feelings assessment in young children and may distinguish children with anxiety disorders from nonanxious children. (Contains 2 tables.)

Objective: Cognitive behavior therapy (CBT) for children has been shown efficacious, but community access to it is often limited by the lack of trained therapists. This study evaluated a child, CBT-focused, 20-session weekly group supervision seminar with a didactic component which was provided to community mental health practitioners by experienced CBT therapists from an academic center. Methods: Twenty-two practitioners from four community mental health agencies completed the training in four groups (one for each agency); one group was trained by videoconference. The authors assessed outcomes immediately after the training and at 6-month follow-up using a mixed-method design including quantitative and qualitative methods to ensure a comprehensive evaluation. Results: Participants' knowledge on a multiple-choice test of child CBT increased with training, as did their self-reported confidence using CBT and desire to do further child CBT. Therapist age and use of an intake diagnostic screen related to positive outcomes, and participants advocated for more structured training. Conclusion: Child CBT can be successfully taught to community practitioners using this training model, but refinement based on participant feedback and further studies that include direct observation of CBT skills are needed.

Ultrasound has shown promise as a visual feedback tool in speech therapy. Rural clients, however, often have minimal access to new technologies. The purpose of the current study was to evaluate consultative treatment using ultrasound in rural communities. Two speech-language pathologists (SLPs) trained in ultrasound use provided consultation with ultrasound in rural British Columbia to 13 school-aged children with residual speech impairments. Local SLPs provided treatment without ultrasound before and after the consultation. Speech samples were transcribed phonetically by independent trained listeners. Eleven children showed greater gains in production of the principal target /[image omitted]/ after the ultrasound consultation. Four of the seven participants who received more consultation time with ultrasound showed greatest improvement. Individual client factors also affected outcomes. The current study was a quasi-experimental clinic-based study. Larger, controlled experimental studies are needed to provide ultimate evaluation of the consultative use of ultrasound in speech therapy. (Contains 2 figures and 4 tables.)

Purpose: Ultrasound can provide images of the tongue during speech production. The present study set out to examine the potential utility of ultrasound in remediation of North American English /r/. Method: The participants were 2 Canadian English-speaking adolescents who had not yet acquired /r/. The study included an initial period without ultrasound and 13 treatment sessions, each 1 hr long, using ultrasound. Speech samples were recorded at screening and immediately before and after treatment. Samples were analyzed acoustically and with listener judgments. Ultrasound images were obtained before, during, and after the treatment period. Results: Three speech-language pathologists unfamiliar with the participants rated significantly more posttreatment tokens as accurate [r]s in single words and some phrases. Acoustic analyses showed an expected lowering of the third formant after treatment. A qualitative observation of posttreatment ultrasound images for accurate [r] tokens showed tongue shapes to be more similar to those of typical adults than had been observed before treatment. Participants needed continued practice of their newly acquired skills in sentences and conversation. Conclusion: Two-dimensional dynamic ultrasound appears to have potential utility for remediation of /r/ in speakers with residual /r/ impairment. Further research is needed with larger numbers of participants to establish the relative efficacy of ultrasound in treatment. (Contains 4 tables, 4 figures and 2 footnotes.)

The present paper comprises an overview of techniques using ultrasound in speech (re)habilitation. Ultrasound treatment techniques have been developed for English lingual stops, vowels, sibilants, and liquids. These techniques come from a series of small "n" studies with adolescents and adults with severe hearing impairment, residual speech impairment or accented speech at the Interdisciplinary Speech Research Laboratory at the University of British Columbia. Ultrasound allows excellent visualization of tongue shape features, which is especially useful for feedback during speech (re)habilitation. Further research is needed to evaluate the efficacy of ultrasound in speech (re)habilitation. (Contains 6 figures.)

Studied the re-entry process of corporate and governmental employees (N=200) returning to Canada after working overseas. Research found re-entry into the original culture was a more difficult transition than moving to the foreign culture. Home-country managers tended to exhibit xenophobia in assessing the potential and actual effectiveness of returnees. (Author)

The article presents a study that investigates and determines the genetic mutation frequency of the gene encoding of the transient outward current (Ito) of patients who died of sudden cardiac arrest in Canada. Researchers carried out different types of tests, including mutation analysis, mutagenesis and cloning, of 51 patients who had J-wave syndrome. Moreover, they found that the potassium voltage-gated channel (KCND2) gene is the prime cause of the J-wave syndrome and death of patients.