Sensorimotor adaptation to a non-uniform formant perturbation generalizes to untrained vowels.

When speakers learn to change the way they produce a speech sound, how much does that learning generalize to other speech sounds? Past studies of speech sensorimotor learning have typically tested the generalization of a single transformation learned in a single context. Here, we investigate the ability of the speech motor system to generalize learning when multiple opposing sensorimotor transformations are learned in separate regions of the vowel space. We find that speakers adapt to a non-uniform "centralization" perturbation, learning to produce vowels with greater acoustic contrast, and that this adaptation generalizes to untrained vowels, which pattern like neighboring trained vowels and show increased contrast of a similar magnitude.

Augmenting perceived stickiness of physical objects through tactile feedback after finger lift-off.

Haptic Augmented Reality (HAR) is a method that actively modulates the perceived haptics of physical objects by presenting additional haptic feedback using a haptic display. However, most of the proposed HAR research focuses on modifying the hardness, softness, roughness, smoothness, friction, and surface shape of physical objects. In this paper, we propose an approach to augment the perceived stickiness of a physical object by presenting additional tactile feedback at a particular time after the finger lifts off from the physical object using a thin and soft tactile display suitable for HAR. To demonstrate this concept, we constructed a thin and soft tactile display using a Dielectric Elastomer Actuator suitable for HAR. We then conducted two experiments to validate the effectiveness of the proposed approach. In Experiment 1, we showed that the developed tactile display can augment the perceived stickiness of physical objects by presenting additional tactile feedback at appropriate times. In Experiment 2, we investigated the stickiness experience obtained by our proposed approach and showed that the realism of the stickiness experience and the harmony between the physical object and the additional tactile feedback are affected by the frequency and presentation timing of the tactile feedback. Our proposed approach is expected to contribute to the development of new applications not only in HAR, but also in Virtual Reality, Mixed Reality, and other domains using haptic displays.

Walking the Talk: "Reflexivity" to Advance Integration of Patient Reported Outcomes for Cancer Care Screening.

In this commentary, we propose the use of video-reflexive ethnography (VRE) as a means to support integration of patient-reported outcomes (PROs) in cancer care screening. As for any policy or intervention, the optimization of PROs depends on moving beyond their mere formal introduction, and depends on the integration of PROs in the everyday practice contexts of health care professionals (HPEs). The use of VRE allows for video-playback sessions among oncology professionals to support team-based learning and practice-change grounded in "reflexivity." Through a review of previous methods used to support organizational change in healthcare settings (e.g., policies, quality improvement initiatives, simulation sessions), we present some unsung advantages of VRE that can be applied to a complex integrated setting, such as cancer care. As opposed to other methods to create change, VRE does not dictate new measures, but rather supports "bottom-up" provider-initiated changes to health care practices and contexts, grounded in collaborative day-to-day practice. We argue that VRE optimizes PROs in cancer care by facilitating their effective and sustainable integration, to promote improved patient care.

Consequences of Local Conspecific Density Effects for Plant Diversity and Community Dynamics.

Conspecific density dependence (CDD) in plant populations is widespread, most likely caused by local-scale biotic interactions, and has potentially important implications for biodiversity, community composition, and ecosystem processes. However, progress in this important area of ecology has been hindered by differing viewpoints on CDD across subfields in ecology, lack of synthesis across CDD-related frameworks, and misunderstandings about how empirical measurements of local CDD fit within the context of broader ecological theories on community assembly and diversity maintenance. Here, we propose a conceptual synthesis of local-scale CDD and its causes, including species-specific antagonistic and mutualistic interactions. First, we compare and clarify different uses of CDD and related concepts across subfields within ecology. We suggest the use of local stabilizing/destabilizing CDD to refer to the scenario where local conspecific density effects are more negative/positive than heterospecific effects. Second, we discuss different mechanisms for local stabilizing and destabilizing CDD, how those mechanisms are interrelated, and how they cut across several fields of study within ecology. Third, we place local stabilizing/destabilizing CDD within the context of broader ecological theories and discuss implications and challenges related to scaling up the effects of local CDD on populations, communities, and metacommunities. The ultimate goal of this synthesis is to provide a conceptual roadmap for researchers studying local CDD and its implications for population and community dynamics.

Plant-Soil Moisture Positive Feedback Maintaining Alternative Stable States in the Alpine Marsh Ecosystem.

A self-reinforcing positive feedback is regarded as a critical process for maintaining alternative stable states (ASS); however, identification of ASS and quantification of positive feedbacks remain elusive in natural ecosystems. Here, we used large-scale field surveys to search for ASS and a positive feedback mechanism under a wide range of habitats on the Tibetan Plateau. Using multiple methods, we proved that three stable states exist that accompany alpine marsh degradation. Positive feedbacks between changing soil moisture and plant community composition forced the ecosystem into another stable state, and the alteration of water use efficiency (WUE) of the component species contributed to this shift. This study provides the first empirical evidence that positive feedback loops maintain ASS in the alpine marsh ecosystem on the Tibetan Plateau. Our research revealed the powerful driving role of plants in transitions between states, which may support the conservation and restoration of global alpine marsh ecosystems.

Coexistence of Competing Plants Under Plant-Soil Feedback.

Plant-soil feedback (PSF), the reciprocal interaction between plants and their soil environment, is a fundamental ecological process that can influence coexistence and functional structure in plant communities. Current theory establishes that PSF may enhance diversity or lead to exclusion depending on whether soil conditioning disproportionately benefits heterospecific or conspecific individuals. However, a more complete picture of the impact of PSF requires understanding how PSF interacts with competition. To that end, here we propose an integrated mathematical model combining trait-based competition and soil-explicit PSF. Contrary to the current paradigm, we find that soil conditioning that disproportionately favours conspecific individuals can promote coexistence. Additionally, we show that priority effects are common when soil-conditioning species differ in their edaphic preferences. These effects can allow species with large differences in competitive ability to coexist under certain soil conditions. Our results provide testable predictions tying community-level functional patterns in plant communities to PSF and competition.

Engineering Plant Metabolism for Synthesizing Amino Acid Derivatives of Animal Origin Using a Synthetic Modular Approach.

The biosynthesis of amino acid derivatives of animal origin in plants represents a promising frontier in synthetic biology, offering a sustainable and eco-friendly approach to enhancing the nutritional value of plant-based diets. This study leverages the versatile capabilities of Nicotiana benthamiana as a transient expression system to test a synthetic modular framework for the production of creatine, carnosine, and taurine-compounds typically absent in plants but essential for human health. By designing and stacking specialized synthetic modules, we successfully redirected the plant metabolic flux toward the synthesis of these amino acid derivatives of animal origin. Our results revealed the expression of a standalone creatine module resulted in the production of 2.3 µg/g fresh weight of creatine in N. benthamiana leaves. Integrating two modules significantly carnosine yield increased by 3.8-fold and minimized the impact on plant amino acid metabolism compared to individual module application. Unexpectedly, introducing the taurine module caused a feedback-like inhibition of plant cysteine biosynthesis, revealing complex metabolic adjustments that can occur when introducing foreign pathways. Our findings underline the potential for employing plants as biofactories for the sustainable production of essential nutrients of animal origin.

Halide Perovskite Thin Film Lasing Mode Control.

Metal halide perovskite semiconductors have emerged as highly efficient amplifying materials; to ensure practical applicability, it is important to have precise control over the spectral and polarization characteristics of lasing emission. In this study, we present effective strategies for manipulating single- and multimode lasing from surface-emitting and optically pumped perovskite distributed feedback lasers. We show that cladding structures can be made to modify the optical properties of guided transverse electric and magnetic modes within the gain medium. This leads to spectral tuning of multipeak lasing emission and the generation of linear polarization modes. Our results are supported with a comprehensive multilayer slab waveguide model and confirmed with two different perovskite materials: methylammonium lead iodide and cesium lead bromide.

International medical students' experiences of psychological safety in feedback episodes: a focused ethnographic study.

BACKGROUND: Feedback and psychological safety are well-established concepts within medical education, vital for student learning and progress. However, the concepts remain unexplored in the context of international students. This area deserves attention given the unique challenges faced by the overseas medical students due to cultural differences. The present study examines international students' experiences of psychological safety in feedback interactions in a Scottish undergraduate medical programme. METHODS: A focused ethnographic approach was adopted to explore international students' experiences and perceptions of psychological safety in their feedback experiences. Data were collected in the form of field observations and semi-structured interviews, involving both student and faculty participants. Approximately 13hrs of fieldwork and a total of 11 interviews were conducted. These were analysed using a combination of inductive and deductive thematic analysis. RESULTS: Data analysis identified four key themes: feedback delivery, educator attributes, cultural factors and longitudinal educational relationships. Both staff and student participants highlighted how environmental factors such as room design and group size functioned as enablers or barriers to psychological safety in feedback episodes. Additionally, students appreciated tutors who expressed vulnerability and demonstrated awareness of their cultural backgrounds. Students described significant differences between the feedback approaches in the host (UK) institute and that in their home country. Longitudinal associations fostered trust and familiarity with peers and tutors, enhancing students' receptivity to learning and feedback. CONCLUSION: This present study highlights cultural differences in feedback practices across countries and their impact on psychological safety among international students. It stresses the importance of integrating overseas students by considering group dynamics, environment and diverse student needs. Staff awareness of cultural variability, openness to tutor vulnerability and fostering long-term educational relationships can greatly enhance psychological safety in learning and teaching activities. These insights are relevant amidst the growing globalisation of medical education and the mobility of students across borders, advocating for tailored integration to optimise their learning experience and achievement.

Inclusive leadership and employee workplace well-being: the role of vigor and supervisor developmental feedback.

PURPOSE: Employees within organizations actively pursue and maintain their workplace well-being. Although there are current studies that have examined the linking inclusive leadership to employee workplace well-being, the underlying intrinsic link between the two remains unclear. On the basis of self-determination theory, this research examined the relationship between inclusive leadership, vigor, supervisor developmental feedback, and workplace well-being. PATIENTS AND METHODS: Data were collected from 61 teams that totaled 342 full-time employees through a 3-stage questionnaire. Multilevel Structural Equation Modeling and Monte Carlo simulations were conducted on data for hypothesis testing. RESULTS: Inclusive leadership positively correlated with employee workplace well-being. Employee vigor mediates the link between inclusive leadership and employee workplace well-being. Supervisor developmental feedback moderated the relationship between inclusive leadership and employee vigor. CONCLUSIONS: Inclusive leadership can improve employees' workplace well-being by stimulating their vigor. Therefore, managers need to be able to effectively meet employees' basic needs to stimulate their vigor. Based on meeting employees' basic needs, managers can also provide targeted developmental feedback to meet employees' growth needs, which can more effectively promote employees' vigor and workplace well-being.

Dual Coaching of Medical Clerkship Students' History Taking Skills by Volunteer Inpatients at the Bedside and Faculty Physicians on Zoom During the COVID-19 Pandemic.

Purpose: Coaching is a well-described means of providing real-time, actionable feedback to learners. We aimed to determine whether dual coaching from faculty physicians and real inpatients led to an improvement in history-taking skills of clerkship medical students. Patients and Methods: Expert faculty physicians (on Zoom) directly observed 13 clerkship medical students as they obtained a history from 26 real, hospitalized inpatients (in person), after which students received immediate feedback from both the physician and the patient. De-identified audio-video recordings of all interviews were scored by independent judges using a previously validated clinical rating tool to assess for improvement in history-taking skills between the two interviews. Finally, all participants completed a survey with Likert scale questions and free-text prompts. Results: Students' history-taking skills - specifically in the domains of communication, medical knowledge and professional conduct - on the validated rating tool, as evaluated by the independent judges, did not significantly improve between their first and second patient interviews. However, students rated the dual coaching as overwhelmingly positive (average score of 1.43, with 1 being Excellent and 5 being Poor), with many appreciating the specificity and timeliness of the feedback. Patients also rated the experience very highly (average score of 1.23, with 1 being Excellent and 5 being Poor), noting that they gained new insights into medical training. Conclusion: Students value receiving immediate and specific feedback and real patients enjoy participating in the feedback process. Dual physician-patient coaching is a unique way to incorporate more direct observation into undergraduate medical education curricula.

Situating homeostasis in organisms: maintaining organization through time.

Since it was inspired by Bernard and developed and named by Cannon, the concept of homeostasis has been invoked by many as the central theoretical framework for physiology. It has also been the target of numerous criticisms that have elicited the introduction of a plethora of alternative concepts. We argue that many of the criticisms actually target the more restrictive account of homeostasis advanced by the cyberneticists. What was crucial to Bernard and Cannon was a focus on the maintenance of the organism as the goal of physiological regulation. We analyse how Bernard's and Cannon's broad conception of what was required to maintain the organism was narrowed to negative feedback, characterized in terms of setpoints, by the cyberneticists and demonstrate how many of the alternative concepts challenge the role of setpoints - treating them as variable in light of circumstances or in anticipation of future circumstances, or as dispensable altogether. To support our analysis, we draw on the experimental and theoretical work on thermoregulation, a phenomenon that has been considered as a paradigmatic example of homeostasis and has been a common focus of those advancing alternative concepts. To integrate the insights advanced by the original proponents of homeostasis and the theorists proposing replacement notions we advance a framework in which regulation is viewed from the perspective of maintaining the organism.

Regulation of idiopathic pulmonary fibrosis: a cross-talk between TGF-ß signaling and MicroRNAs.

Pulmonary fibrosis (PF) is a highly complex and challenging disease affecting the respiratory system. Patients with PF usually have an abbreviated survival period and a consequential high mortality rate after the diagnosis is confirmed, posing serious threats to human health. In clinical practice, PF is typically treated by antifibrotic agents, such as Pirfenidone and Nintedanib. However, these agents have been reported to correlate with substantial adverse effects, escalating costs, and insufficient efficacy. Moreover, it remains unclarified about the multifactorial pathology of PF. Therefore, there is an urgent demand for elucidating these underlying mechanisms and identifying safe, efficient, and targeted therapeutic strategies for PF treatment. The crucial role of the transforming growth factor-ß (TGF-ß) signaling pathway in PF development has been explored in many studies. MicroRNAs (miRNAs), which function as post-transcriptional regulators of gene expression, can significantly affect the development of PF by modulating TGF-ß signaling. In turn, TGF-ß signaling can regulate the expression and biogenesis of miRNAs, thereby substantially affecting the progression of PF. Hence, the therapeutic strategies that focus on the drug-targeted regulation of miRNAs, either by augmenting down-regulated miRNAs or inhibiting overexpressed miRNAs, may hinder the pathways related to TGF-ß signaling. These strategies may contribute to the prevention and suppression of PF progression and may provide novel insights into the treatment of this disease.

The affective response to positive performance feedback is associated with motor learning.

Motor skill learning and performance are improved when successful actions are paired with extrinsic rewards, such as money. Positive feedback indicating successful task performance is thought to induce intrinsic reward associated with goal attainment, evidenced by increases in positive affect that correlate with neural reward signaling. However, it is not clear whether the subjective, internal reward processes elicited by positive feedback promote motor learning and performance.Here, we tested the hypothesis that intrinsic reward elicited by positive feedback promotes motor learning and performance. Participants practiced a visuomotor interception task using a joystick, and received feedback during practice indicating success or failure depending on their accuracy. During practice, the accuracy demands were adapted to control and vary the frequency of positive feedback across randomly ordered blocks of practice at either 50%, 70%, or 90%. Performance was measured for each condition as the average accuracy during practice. Learning was estimated by measuring the accuracy pre and post practice in the absence of feedback. We queried participants periodically on their enjoyment of the task to index affective responses to performance feedback.The intrinsic reward elicited by positive feedback, operationalized by the increase in enjoyment immediately following positive versus negative feedback, was positively correlated with learning from pre to post practice. However, increasing the overall amount of positive feedback by lower accuracy demands did not improve performance. These results suggest that experiencing intrinsic reward due to positive feedback benefits motor learning only when it is contingent on good performance.

Immediate effects of different feedback methods on running jump height and motion improvement in male college basketball players.

The study aimed to assess the validity and accuracy of estimating running jump (RJ) height using the high-speed camera of a smartphone and to evaluate the effectiveness of oral and visual feedback via a smartphone in enhancing RJ movements and height in skilled athletes. Twenty male college basketball players were randomly assigned to either the Oral Feedback (OF) or Oral and Visual Feedback (OVF) group. Initially, participants performed RJs on force plates while being recorded with an iPhone (240 fps). Jump heights were estimated using the video, force plate data, and position data from pelvic markers (JHiPhone, JHFP, and JHRM, respectively). Subsequently, each group received tailored feedback based on the RJ video. After feedback, participants performed RJs again, and jump heights were re-estimated. The JHiPhone measurements were systematically higher but showed acceptable random errors compared to JHRM, with excellent reproducibility and strong positive correlations with JHFP and JHRM. Only the OVF group showed significant improvements in jump height post-feedback. Our results indicate that JHiPhone is a valuable and accurate tool for sports settings. Additionally, the results demonstrated that visual feedback using a smartphone is effective and should complement oral feedback to enhance RJ jump height in real sports settings.

Give It to Me Straight Doc: A Medical Student Perspective on Effective Goal-Oriented Clinical Education.

The clinical years of medical school are a time when students navigate a new learning environment. Due to inexperience, discordance may exist between veteran attendings and students who do not have their bearings in this new setting. We propose a solution to strengthen the clinician-student relationship by promoting a culture of goal-oriented clinical education via a two-pronged approach. First, standardized learning objectives should be established for each clinical rotation. Second, and arguably more importantly, students should create individualized goals to complement these objectives and further their personal educational interests. Once a culture of goal-oriented clinical education is implemented, we believe students will navigate their clinical years with increased confidence and competence. In this piece, we discuss our personal attitudes toward why clinicians and students should set goals, how they can set them, and what these goals should include. Once goals are established, feedback must be provided to students to continue the learning process. This comes in the form of comments from supervising preceptors who focus on areas of interest identified by the student, as well as from the results of standardized assessments. We passionately believe that together, the synergism of goal setting, feedback, and assessment creates a perfect mixture conducive to the formation of a positive learning environment.

Fostering TBL Success at Alfaisal University: A Complex Adaptive Systems Approach.

This study explores the implementation of Team-Based Learning (TBL) at Alfaisal University's College of Medicine through the lens of Complex Adaptive Systems (CAS) theory. The research question investigates how the application of CAS principles can enhance the implementation and effectiveness of TBL in medical education. The study employed a convergent parallel mixed methods longitudinal design, integrating quantitative performance metrics and qualitative themes. Quantitative analysis revealed modest improvements in individual and team-based learning scores, with a promising trend of students moving from the lower to the higher quartiles over time. Qualitative insights aligned with CAS principles, highlighting the adaptive implementation, emergent outcomes, self-organization, positive feedback loops, and depth of learning facilitated by TBL. The findings demonstrate the value of a CAS-informed approach in navigating the complexities of educational change and fostering a more resilient and adaptive educational model. The study contributes to the understanding of how CAS theory can guide the successful implementation of innovative pedagogies like TBL in medical education.

Coachability: A Longitudinal Curriculum to Promote Medical Students' Growth Mindset, Feedback Utilization, and Resilience.

Introduction: The concept of medical student coachability, adapted from athletics and business management, offers a framework for characterizing students' roles as clinical learners. We defined coachability as effectively seeking, receiving, and using feedback-even negative feedback-to change behavior and reach learning goals. To facilitate success in our clinical clerkships, we sought to empower preclerkship students' capacity to be coached. Methods: Our curriculum comprised two large-group presentations and three small-group seminars totaling approximately 5 hours, distributed over 2 years: a year 1 orientation, a year 2 refresher, and a longitudinal year 2 seminar series. Medical students designed and first implemented the curriculum under faculty supervision in academic year (AY) 2015-2016 and have continuously managed and run it since. The AY 2022-2023 curriculum management team evaluated the curriculum cross-sectionally via student survey and focus groups. Results: Approximately 575 students have completed the curriculum since 2015. Immediately following curriculum delivery, AY 2022-2023 year 2 students (response rate: 70%-97%) rated it a valuable educational experience and described plans to implement the lessons learned in their clerkship. Focus group participants (eight clerkship students who participated in the coachability curriculum in AY 2021-2022) reported using coachability strategies to positive effect for their clinical learning and well-being. Discussion: Our curriculum's flexible, modular format facilitates adoption by others. Future development could expand coachability offerings across the continuum of medical school. However, the curriculum should remain led by students passionate about medical education and willing to try new things to continuously adapt content and instructional strategies.

Pharmacists' mental health support behaviours with simulated patients: a mixed-methods pilot study.

BACKGROUND: Simulated mental health role-plays provide a safe and relevant learning experience for pharmacy students, improving confidence in and attitudes towards providing mental health support. Little research explores the use of mental health role-plays, enacted by trained actors, with pharmacists. OBJECTIVES: This study aimed to pilot the adaptation of simulated patient (SP) role-plays, from the university classroom with students, to a workshop with pharmacists, and explore pharmacists' experiences. METHODS: Pharmacists attended a two-hour workshop. Trained actors enacted simulated scenarios (previously developed for pharmacy education) with pharmacist volunteers, while being observed by peers, a workshop facilitator and mental health consumer educator (MHCE). Pharmacists engaged in self-assessment immediately post-roleplay, followed by performance feedback and debrief discussions with MHCEs, workshop facilitators and peers. Pharmacists completed pre- and post-workshop surveys exploring intended mental health support behaviours, then invited to participate in an interview exploring their workshop experiences and opinions about using mental health role-plays in clinical practice (via mystery shopping). Non-parametric tests were conducted to analyse role-play and survey scores, and thematic analyses undertaken on interview transcripts. RESULTS: Thirty-five pharmacists attended the workshop. Fourteen role-plays were analysed. Pharmacist self-assessment scores were significantly lower than MHCE scores (p=0.028). Overall, the role-plays significantly increased pharmacists' intentions in supporting a person experiencing mental health crises such as suicide and psychosis, as well as encouraging other supports (p<0.05). Four themes emerged from interviews (n=4): realistic context for skills application and practice, benefits of observing, self-assessment and feedback, and integrating into clinical practice (via mystery shopping). CONCLUSION: SP role-plays of mental health symptoms and crises, enacted by trained actors, may effectively assess and enhance pharmacists' intended mental health support behaviours. It is recommended that the SP method is adapted into clinical practice, via repeated mystery shopping visits with immediate performance feedback, to shape pharmacists' mental health support behaviours.