Immediate and long-term improvement in lexical stress perception: the role of teacher and peer feedback

This study investigated to what extent teacher and peer feedback promote L2 lexical stress perception skills and how gains are maintained over time. Eighty-two participants from 11 sections of first-year German courses at three universities were assigned to a teacher feedback group, a peer feedback provider group, a peer feedback receiver group, or a control group. After completing a pronunciation training on word stress in German–English cognates, the teacher group received feedback on their pronunciation from a teacher, the provider group gave feedback to peers, and the receiver group received feedback from peers. The control group did not complete the pronunciation training or receive feedback. Results comparing learners’ pretest, immediate posttest, and delayed posttest perception accuracy revealed that the teacher group and the provider group made significant gains in terms of their ability to perceive word stress in cognates, whereas the receiver group and the control group showed no improvement.

A Case for the Non-Neurologist Telestroke Provider

Introduction: Telestroke networks have effectively increased the number of ischemic stroke patients who have access to acute stroke therapy. However, the availability of a dedicated group of stroke subspecialists is not always feasible. We hypothesize that rates of tPA recommendation, sensitivity of final diagnosis, and post-tPA hemorrhagic complications do not differ significantly between neurologists and an emergency-medicine physician during telestroke consultations.Methods: Retrospective review of all telestroke consults performed at a comprehensive stroke center over 1 year. Statistical analysis: Chi squared test.Results: Three hundred and three consults were performed among 6 spoke sites. 16% (48/303) were completed by the emergency medicine physician; 25% (76/303) were performed by non-stroke-trained neurologists, and 59% (179/303) were completed by a board-certified Vascular Neurologist. Overall rate of tPA recommendation was 40% (104/255), 38% (18/48), 41% (73/179), and 41% (31/76) among the all neurology-trained, emergency medicine-trained, stroke neurology-trained and other neurology- trained provider groups, respectively (p = 0.427). Sensitivity of final stroke diagnosis was 77% (14/18) and 72% (75/104) in the emergency-medicine trained and neurology-trained provider groups (p = 0.777) No symptomatic hemorrhagic complications following the administration of tPA via telestroke consultation occurred in any group over this time period. One asymptomatic intracerebral hemorrhage was observed (0.96% or 1/104) in the neurology-trained provider group.Discussion/Conclusion: Our results did not illustrate any statistically significant difference between care provided by an emergency medicine-trained physician and neurologists during telestroke consultation. While our study is limited by its relatively low numbers, it suggests that identifying a non-neurologist provider who has requisite clinical experience with acute stroke patients can safely and appropriately provide telestroke consultation. The lack of formerly trained neurologists, therefore, may not need to serve as an impediment to building an effective telestroke network. Future efforts should be focused on illuminating all strategies that facilitate sustainable telestroke implementation.

Providing vs. receiving peer feedback: Learners’ beliefs and experiences

This study used questionnaires eliciting quantitative and qualitative data to investigate (1) foreign language learners’ beliefs about peer feedback on pronunciation before and after a peer feedback intervention and (2) peer feedback providers’, peer feedback receivers’, and teacher feedback receivers’ experiences of the intervention. Participants included 127 first-year learners of German. They were assigned to a peer feedback provider group, a peer feedback receiver group, a teacher feedback receiver group, or a control group. After a general pronunciation training for the first three groups and a metacognitive instruction session for the first two groups, the peer feedback providers were instructed to give feedback on their peers’ pronunciation whereas the peer feedback receivers were asked to incorporate their peers’ feedback and the teacher feedback receivers were asked to incorporate feedback from their teachers. Quantitative and qualitative data from a pre- and post-intervention beliefs questionnaire revealed that while all groups held mostly positive beliefs about peer feedback before the intervention, only the peer feedback providers’ beliefs changed over time, specifically, their beliefs about peer feedback were significantly more positive after the intervention. Data from an exit questionnaire further indicated that the teacher feedback receivers found their feedback more useful than the peer feedback receivers. Moreover, while the peer feedback providers found correcting peers beneficial for their own language development, many of them felt uncomfortable giving feedback, whereas the peer feedback receivers did not feel uncomfortable receiving it. These findings suggest that peer feedback providers may need additional instruction to help them feel more comfortable correcting other learners.

Is giving better than receiving?

This study investigated the effects of teacher and peer corrective feedback on pronunciation development, with a special focus on whether providing or receiving peer feedback on pronunciation is more beneficial for L2 production skills. Participants included 96 L2 learners of German. They were assigned to one of three experimental groups or a control group. After general pronunciation training on a segmental and a suprasegmental feature, the teacher group received feedback from a teacher, the provider group gave feedback to peers, and the receiver group listened to feedback from peers. The control group received neither pronunciation training nor feedback. Results from native speaker comprehensibility ratings of learners’ productions indicated that while all groups outperformed the control group, both the teacher and the provider group improved more than the receiver group. In addition, the provider group had a slight edge over the teacher group. Theoretical and pedagogical implications of these findings are discussed.

Urban water security priorities. An Australian industry perspective

Urban water security is a critical element of sustainable development, and sustainable water management requires a participatory and collaborative approach across all stakeholders. However, literature suggests that there can be diverse and potentially conflicting views within community and expert groups. This research aimed to understand the extent of views within a group of industry professionals on objectives, themes and definitions of urban water security. Using 22 semi-structured interviews with participants from Queensland Australia, we found that, for the group, the priorities for urban water security are water quality and human health, quantity of supply to meet efficient demand, and reliability and resilience of supply systems. We also found diverse views on the importance of sustainability, water-related hazards, environment and ecosystem health, affordability and risk, to water security in the urban context. We conclude that there is agreement within the water service provider group on priority needs, and suggest there is potential for community and service providers to agree on urban water security needs. The research findings support operationalisation of security concepts, highlight potential barriers to achieving urban water security, and provide insights for further engagement with urban water stakeholders.

628. The Role of the Advanced Practice Provider in Infectious Disease: Opportunities for Growth

Background Advanced Practice Providers (APPs), including nurse practitioners and physician assistants, provide high quality medical care in multiple specialties by extending the physician workforce. However, within the Infectious Disease (ID) specialty, their demographics, areas of practice, and experience are not well described. To better understand this key group, we examined APP years of experience in ID, primary practice settings, and perceived practice barriers from the APP perspective. Methods We created a survey using REDCap which was distributed between 12/1/2019-1/31/2020 to APPs practicing in ID by social media, direct emails to key stakeholders, and online Infectious Disease Society of America (IDSA) community forums. Results Ninety-three APPs responded to the posted survey from across the US (figure 1). Most respondents (45 [49%]) had between 2-9 years of overall experience as an APP, while 14 (15%) between 10-15 years, and 24 (26%) had >16 years of experience. Experience specifically as an ID APP varied, with the majority (56%) having 2-9 years of experience and 25% reporting >16 years of experience as an APP. Although over half of the respondents worked in an outpatient adult ID clinic, they also practiced in diverse settings and within multiple ID sub-specialties (figure 2). The other most common areas of practice included inpatient adult ID, HIV care, and outpatient parental antimicrobial therapy programs. Limited formalized ID education and misconceptions about APP scope of practice were perceived barriers to practicing in ID (figure 3). Lack of recognition as a peer amongst physician colleagues was also identified as a practice barrier. Advanced Practice Provider Survey Response by Region Advanced Practice Provider ID Practice Areas Perceived Advanced Practice Provider Barriers Conclusion Our survey results demonstrate that the APP ID workforce is an experienced provider group, both in terms of total years as an APP and years exclusively in ID, working in a large variety of ID settings in a number of geographic locations. Creation of specific and directed ID educational opportunities, along with collaborating physician support and inclusion, are identified as significant areas of improvement. The establishment of APP-specific training programs and educational courses will create more opportunities for APPs and further expand the ID workforce. Disclosures Steven A. Pergam, MD, MPH, Chimerix, Inc (Scientific Research Study Investigator)Global Life Technologies, Inc. (Research Grant or Support)Merck & Co. (Scientific Research Study Investigator)Sanofi-Aventis (Other Financial or Material Support, Participate in clinical trial sponsored by NIAID (U01-AI132004); vaccines for this trial are provided by Sanofi-Aventis)

A Randomized Trial of Voice-Generated Inpatient Progress Notes: Effects on Professional Fee Billing

Background Prior evaluations of automated speech recognition (ASR) to create hospital progress notes have not analyzed its effect on professional revenue billing codes. As ASR becomes a more common method of entering clinical notes, clinicians, hospital administrators, and payers should understand whether this technology alters charges associated with inpatient physician services. Objectives This study aimed to measure the difference in professional fee charges between using voice and keyboard to create inpatient progress notes. Methods In a randomized trial of a novel voice with ASR system, called voice-generated enhanced electronic note system (VGEENS), to generate physician notes, we compared 1,613 notes created using intervention (VGEENS) or control (keyboard with template) created by 31 physicians. We measured three outcomes, as follows: (1) professional fee billing levels assigned by blinded coders, (2) number of elements within each note domain, and (3) frequency of organ system evaluations documented in review of systems (ROS) and physical exam. Results Participants using VGEENS generated a greater portion of high-level (99233) notes than control users (31.8 vs. 24.3%, p < 0.01). After adjustment for clustering by author, the finding persisted; intervention notes were 1.43 times more likely (95% confidence interval [CI]: 1.14–1.79) to receive a high-level code. Notes created using voice contained an average of 1.34 more history of present illness components (95% CI: 0.14–2.54) and 1.62 more review of systems components (95% CI: 0.48–2.76). The number of physical exam components was unchanged. Conclusion Using this voice with ASR system as tested slightly increases documentation of patient symptom details without reliance on copy and paste and may raise physician charges. Increased provider reimbursement may encourage hospital and provider group to offer use of voice and ASR to create hospital progress notes as an alternative to usual methods.