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Background: Over 8 million children with disabilities live in Africa and are candidates for augmentative and alternative communication (AAC), yet formal training for team members, such as speech-language therapists and special education teachers, is extremely limited. Only one university on the continent provides postgraduate degrees in AAC, and other institutions provide only short modules at an undergraduate level. The need for an introductory training course on AAC that is accessible by university students continent-wide was identified. An online programme, namely an intelligent tutoring system (ITS), was identified as a possible option to facilitate interactive learning without the need for synchronous teaching. The use of an ITS is shown to be effective in developing knowledge and clinical reasoning in the health and rehabilitation fields. However, it has not yet been applied to student teaching in the field of AAC. Aim: To determine both the feasibility of an ITS to implement an AAC curriculum for students in four African countries, and the usability and effectiveness of such a system as a mechanism for learning about AAC. Method & Procedures: The study included two components: the development of a valid AAC curriculum; and using the ITS to test the effectiveness of implementation in a pre- and post-test design with 98 speech-language therapy and special education students from five universities. Outcomes & Results: Statistically significant differences were obtained between pre- and post-test assessments. Students perceived the learning experience as practical, with rich content. Conclusions & Implications: The findings suggest that the ITS-based AAC curriculum was positively perceived by the students and potentially offers an effective means of providing supplementary AAC training to students, although modifications to the system are still required.

Background: Mentorship is critical to success in postgraduate science, technology, engineering, math, and medicine (STEMM) settings. As such, the purpose of this study is to comprehensively explore the state of mentorship interventions in postgraduate STEMM settings to identify novel practices and future research directions. The selection criteria for reviewed articles included: (1) published between 2002 and 2022, (2) peer-reviewed, (3) in English, (4) postgraduate mentees, (5) a program where mentorship is a significant, explicit focus, and (6) a description of mentee outcomes related to the mentorship intervention. Overall, 2583 articles were screened, and 109 articles were reviewed. Results: Most postgraduate STEMM mentorship intervention studies lack strong evidence to evaluate the effectiveness of the intervention, with only 5.5% of articles designed as randomized controlled trials. Most mentorship interventions (45.6%) were created for faculty, and few (4%) were for postdoctoral researchers. Also, only 18.8% of interventions focused on underrepresented groups in STEMM. Most interventions (53.7%) prescribed a dyadic structure, and there was more mentorship training for mentors than mentees. Conclusion: Overall, these findings identify gaps in mentorship interventions and provide step-by-step guidance for future interventions, including a consideration for underrepresented groups and postdoctoral scholars, robust mentorship training, and more randomized controlled trials.

OBJECTIVE: Opioid overdose is a public health epidemic adversely impacting individuals and communities. To combat this, California passed a law mandating that prescribers offer a naloxone prescription in certain circumstances. Our objective was to evaluate associations with Californias naloxone prescription mandate and emergency department (ED) overdose visits/hospitalizations, opioid and naloxone prescribing, and 30-day mortality. METHODS: This retrospective cohort study included data from January 1, 2018, to December 31, 2019, and included all Kaiser Permanente Southern California (KPSC) members aged >10 years across 15 KPSC EDs. Exposure was defined as presentation to the ED within the study period. The primary outcome was ED visits for opioid overdose pre- and post-implementation of Californias naloxone prescription mandate. RESULTS: A total of 1.1 million ED visits (534K pre/576K post) were included in the study population. ED opioid overdose visits were 344 (6.4/10,000) pre-policy and 351 (6.1/10,000) post-policy implementation, while non-opioid overdose visits were 309 (5.8/10,000) pre-implementation and 411 (7.1/10,000) post-implementation. The unadjusted rate of visits with opioid prescriptions decreased significantly (14.9% pre to 13.5% post) after implementation. ED naloxone prescriptions increased substantially (104 pre vs. 6031 post). Primary adjusted interrupted time series analysis found no statistical difference between monthly opioid overdose visits pre versus post (odds ratio 1.02, 95% confidence interval [CI] 0.98‒1.07). Difference-in-differences analysis revealed no significant changes in hospitalization (coefficient [CE] = ‒0.05, 95% CI = ‒0.11 to 0.02) or 30-day mortality (CE = ‒0.01, 95% CI = ‒0.03 to 0.01). CONCLUSION: This study revealed that the implementation of Californias naloxone prescription mandate was associated with significantly increased naloxone prescribing and decreased opioid prescribing, but no significant change in ED opioid overdose visits, hospitalizations, or 30-day mortality. This indicates that increasing naloxone prescribing alone may not be sufficient to lower opioid overdose rates.

Introduction: Medical and nonmedical ketamine use is increasing in the United States. This will likely lead to an increase in emergency department (ED) visits in individuals experiencing associated side effects. Physicians will need to be able to effectively recognize and manage ketamine-related complications.Case Report: A 31-year-old male with a three-year history of inhalational, intramuscular, and intravenous nonmedical ketamine use presented to the ED twice within a week with symptoms of severe atraumatic back pain, abdominal pain, and dyspepsia. A comprehensive workup, including advanced imaging, was unrevealing for identifiable causes, and the patient was discharged with instructions for primary care follow-up for further evaluation. The patient used information shared on Reddit, an online forum and social network, to identify that the cause of his pain was related to chronic ketamine use. Subsequently, upon discontinuation of ketamine, the pain improved in 24 hours. The patient self-navigated to addiction treatment.Conclusion: Emergency physicians should consider sequelae of chronic ketamine use as a possible cause for gastrointestinal and urologic symptoms in the ED. In addition to thorough examination and assessment for other acute medical problems, patients should be offered education, symptomatic treatment, and linkage to harm reduction and substance use disorder treatment services.

Introduction: The application of structural competency and structural vulnerability to emergency medicine (EM) research has not been previously described despite EM researchers routinely engaging structurally vulnerable populations. The purpose of this study was to conduct a scoping review and consensus-building process to develop a structurally competent research approach and operational framework relevant to EM research.Methods: We conducted a scoping review focused on structural competency and structural vulnerability. Results of the review informed the development of a structural competency research framework that was presented throughout a multi-step consensus process culminating in the 2021 Society for Academic Emergency Medicine Consensus Conference. Feedback to the framework was incorporated throughout the conference.Results: The scoping review produced 291 articles with 123 articles relevant to EM research. All 123 articles underwent full-text review and data extraction following a standardized data extraction form. Most of the articles acknowledged or described structures that lead to inequities with a variety of methodological approaches used to operationalize structural competency and/or structural vulnerability. The framework developed aligned with components of the research process, drawing upon methodologies from studies included in the scoping review. Conclusion: The framework developed provides a starting point for EM researchers seeking to understand, acknowledge, and incorporate structural competency into EM research. By incorporating components of the framework, researchers may enhance their ability to address social, historical, political, and economic forces that lead to health inequities, reframing drivers of inequities away from individual factors and focusing on structural factors.

This article presents a framework that considers how relationships, representation, and respect can be prioritized, presented, and nurtured in early learning environments to support and foster equity and inclusion. This simultaneously supports an enhanced sense of belonging and creates an environment where students feel valued and respected. As an encompassing approach, the components of the framework should be considered in both curricular and pedagogical decisions and practices, where teachers reflect upon: (1) what they are teaching; (2) how students interpret and receive what is being taught; and (3) how the learning experience interacts with and enhances students' experiences and understanding.

Multicultural and culturally sustaining approaches to education help educators act on two essential concepts: that each student is unique and that uniqueness is central to the academic and social development of every student. Language is a key aspect of this uniqueness, and because language is integral to culture and identity, understanding language variation and diversity is critical to education equity. All educators need knowledge and tools to honor and value students' (and their families' and communities') language differences and variations, to understand and address any language-related challenges students may face, and to support students' academic, social, and emotional development. Efforts to help all students achieve their highest potential are incomplete without an understanding that linguistic discrimination, inseparable from racial discrimination, has historically limited African Americans' access to opportunities afforded other citizens. This article focuses on linguistic variations specific to African American English and ways educators can actively and creatively support Black students.

Academic institutions are now expected to engage in developing and assessing learning outcomes; however, responsibility outcomes, such as respect for human dignity (RFHD), can be particularly challenging. As part of our Biopsychology course and Sensation and Perception course over the past decade, we applied the scientist-educator model of learning and drew from the literature on prejudice reduction to develop our RFHD interventions, which involved face-to-face interactions with others who had sensory deficits or brain/spinal cord injuries. We iteratively created two pre-post measures to assess development of different aspects of RFHD: a Behavioral Tendencies Questionnaire and a 4-Factor RFHD Model Questionnaire. Recently, we modified the intervention and the assessments for adoption in our Class, Race, and Ethnicity in Society course. This paper reports findings from these three courses and a control course in engineering (n = 153). Findings support our two sets of hypotheses, regarding 1) the efficacy of the assessments to capture different likelihoods for interacting with others targeted by the interventions and changes over time in these factors, and 2) positive effects of the face-to-face intervention activities. This study demonstrates RFHD can be developed and assessed in a college course and provides new assessments for RFHD that are easily modified for a variety of types of others (e.g., individuals who are homeless versus blind or of a particular race).

BackgroundMany long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed, at least in part, to moral distress and a negative nurse practice environment.ObjectiveThe purpose of the study was divided into two parts: first, to investigate the relationships among nurse practice environment, moral distress, and intent to stay; second, to explore the potential mediating effect of the nurse practice environment on the intent to stay among those with high levels of moral distress.DesignThis study was a descriptive, cross-sectional survey using targeted sampling.ParticipantsA total of 215 participants completed the surveys. Participants were nationally representative of long-term care nurses by age, years of experience, employment status, and type of health setting.MethodsThis study was an online national survey of long-term care nurses' perceptions of their intent to stay, moral distress level (Moral Distress Questionnaire), and nurse practice environment (Direct Care Staff Survey). Structural equation modeling analysis explored intent to stay, moral distress, and the nurse practice environment among long-term care nurses.ResultsThe mean moral distress score was low, while the mean nurse practice environment and intent to stay scores were high. Moral distress had a significant, moderately negative association with the nurse practice environment (β = -0.41), while the nurse practice environment had a significant, moderately positive association with intent to stay (β = 0.46). The moral distress had a significant, moderately negative association with intent to stay (β = -0.20). The computed structural equation modeling suggested a partially mediated model (indirect effect = -0.19, p = 0.001).ConclusionSince the nurse practice environment partially mediates the relationship between moral distress and intent to stay, interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.Clinical relevanceOur study demonstrated that the nurse practice environment mediates moral distress and intent to stay. Interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

INTRODUCTION: Lung cancer screening is widely underutilized. Organizational factors, such as readiness for change and belief in the value of change (change valence), may contribute to underutilization. The aim of this study was to evaluate the association between healthcare organizations preparedness and lung cancer screening utilization. METHODS: Investigators cross-sectionally surveyed clinicians, staff, and leaders at10 Veterans Affairs from November 2018 to February 2021 to assess organizational readiness to implement change. In 2022, investigators used simple and multivariable linear regression to evaluate the associations between facility-level organizational readiness to implement change and change valence with lung cancer screening utilization. Organizational readiness to implement change and change valence were calculated from individual surveys. The primary outcome was the proportion of eligible Veterans screened using low-dose computed tomography. Secondary analyses assessed scores by healthcare role. RESULTS: The overall response rate was 27.4% (n=1,049), with 956 complete surveys analyzed: median age of 49 years, 70.3% female, 67.6% White, 34.6% clinicians, 61.1% staff, and 4.3% leaders. For each 1-point increase in median organizational readiness to implement change and change valence, there was an associated 8.4-percentage point (95% CI=0.2, 16.6) and a 6.3-percentage point increase in utilization (95% CI= -3.9, 16.5), respectively. Higher clinician and staff median scores were associated with increased utilization, whereas leader scores were associated with decreased utilization after adjusting for other roles. CONCLUSIONS: Healthcare organizations with higher readiness and change valence utilized more lung cancer screening. These results are hypothesis generating. Future interventions to increase organizations preparedness, especially among clinicians and staff, may increase lung cancer screening utilization.

Despite a sound policy framework, the right of learners with disabilities in South Africa to inclusive and equitable quality education is not being met. A key reason hindering the realisation of this right is that there are very few teacher education programs focused on supporting learners with disabilities. Acknowledging the urgency of teacher education, in this paper we draw on qualitative data from 109 teacher participants and 39 course facilitators of a series of disability inclusion-focused teacher education short courses in the Western Cape province of South Africa. Based on their experience of the courses, we consider how teachers can be empowered to meet the diverse needs of their learners within an inclusive framework. Findings highlight that professional and personal growth facilitated a more empathic understanding of learners and the opportunity to collaborate with others, enabling teachers to find creative ways of solving problems faced in their workplaces. To support teachers in meeting the needs of their learners, teacher training should facilitate active reflection on the role they play in shaping the lives of their learners, and prepare teachers to respond to challenges strategically, taking advantage of the resources available to them within and beyond their school environment.