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Paul (2018a, 2018b) discussed the concept of critical thinking in a series of "American Annals of the Deaf" editorials examining how critical thinking might serve as a "springboard" to deep knowledge or wisdom and wondering if critical thinking should be viewed as a noble endeavor or hopeless cause. Paul explored three questions in which he considered (a) types of critical thinkers, (b) teaching and evaluating critical thinking, and (c) empathy's role in critical thinking. Responding to Paul, the author focuses on the same questions by summarizing Paul's view, then following with his own. He also explores the question "What is critical thinking?" Mostly, the author's views resemble Paul's, but he elaborates on places where he thinks gaps or possible misunderstandings exist. The author concludes that critical thinking is indeed a noble endeavor because it is not just what you think that matters, but how you think.

Experts frequently assess competency in criminal settings where the rate of feigning cognitive deficit is demonstrably elevated. We describe the construction and validation of the Denney Competency Related Test (D-CRT) to assess feigned incompetency of defendants in the criminal adjudicative setting. It was expected the D-CRT would prove effective at identifying feigned incompetence based on its two alternative, forced-choice and performance curve characteristics. Development and validation of the D-CRT occurred in described phases. Items were developed to measure competency based upon expert review. Item analysis and adjustments were completed with 304 young teenage volunteers to obtain a proper spread of item difficulty in preparation for eventual performance curve analysis (PCA). Test-retest reliability was assessed with 44 adult community volunteers. Validation included an analog simulation design with 101 jail detainees using MacArthur Competency Assessment Test-Criminal Adjudication and Word Memory Test as criterion measures. Effects of racial/ethnic demographic differences were examined in a separate study of 208 undergraduate volunteers. D-CRT specificity was identified with 46 elderly clinic referrals diagnosed with mild cognitive impairment and dementia. Item development, adjustment, and repeat analysis resulted in item probabilities evenly spread from.28 to 1.0. Test-retest correlation was good (.83). Internal consistency of items was excellent (KR-20 >.91). D-CRT demonstrated convergent validity in regard to measuring competency related information and as well as malingering. The test successfully differentiated between jail inmates asked to perforfm their best and inmates asked to simulate incompetency (AUC =.945). There were no statistically significant differences found in performance across racial/ethnic backgrounds. D-CRT specificity remained excellent among elderly clinic referrals with significant cognitive compromise at the recommended total score cutoff. D-CRT is an effective measure of feigned criminal incompetency in the context of potential cognitive deficiency, and PCA is assistive in the determination. Additional validation using knowns groups designs with various mental health-related conditions are needed. [ABSTRACT FROM AUTHOR]

The urea cycle enzyme argininosuccinate lyase (ASL) enables the clearance of neurotoxic ammonia and the biosynthesis of arginine. Patients with ASL deficiency present with argininosuccinic aciduria, an inherited metabolic disease with hyperammonemia and a systemic phenotype coinciding with neurocognitive impairment and chronic liver disease. Here, we describe the dysregulation of glutathione biosynthesis and upstream cysteine utilization in ASL-deficient patients and mice using targeted metabolomics and in vivo positron emission tomography (PET) imaging using (S)-4-(3-18F-fluoropropyl)-l-glutamate ([18F]FSPG). Up-regulation of cysteine metabolism contrasted with glutathione depletion and down-regulated antioxidant pathways. To assess hepatic glutathione dysregulation and liver disease, we present [18F]FSPG PET as a noninvasive diagnostic tool to monitor therapeutic response in argininosuccinic aciduria. Human hASL mRNA encapsulated in lipid nanoparticles improved glutathione metabolism and chronic liver disease. In addition, hASL mRNA therapy corrected and rescued the neonatal and adult Asl-deficient mouse phenotypes, respectively, enhancing ureagenesis. These findings provide mechanistic insights in liver glutathione metabolism and support clinical translation of mRNA therapy for argininosuccinic aciduria. Editor's summary: Genetic argininosuccinate lyase (ASL) deficiency results in excess blood ammonia and downstream neurological and metabolic impairments. Gurung et al. report that ASL deficiency in patients also causes dysregulation of glutathione synthesis. Lipid nanoparticle–encapsulated human ASL mRNA corrected glutathione and urea metabolism and ameliorated liver disease symptoms in a mouse model of the disease. PET imaging of the mice further suggested that [18F]FSPG, as a readout of glutathione synthesis, may have utility in monitoring the extent of disease and treatment response. —Catherine Charneski [ABSTRACT FROM AUTHOR]

Glycogen storage disease (GSD) type 1a is an inherited autosomal recessive metabolic disease caused by a deficiency in glucose-6-phosphatase activity. The objectives of this research were to systematically review the published literature on the epidemiology of GSD 1a and to assess the performance of reported epidemiology measures in a simulation model. In this systematic literature review 2,539 record titles and abstracts were screened. Of these, only 11 studies contained relevant data on GSD 1a disease epidemiology. Reported disease frequency ranged from 0.085/100,000 to 10.3/100,000 newborns when considering all the GSD literature. When this was narrowed to GSD 1 and GSD 1a, the range was tightened to 0.25–3.02/100,000 and 0.085–4.9/100,000 newborns, respectively. Most of the identified studies counted the number of diagnoses in a defined period and related to the number of births in the same (Dx method) or different time period (DoB method). The simulation model results indicate that in most of the situations, the Dx method provides a closer estimate to the true disease incidence than the DoB method. Despite the scarcity of epidemiology data, the results of this systematic review strongly support that GSD 1a and its parent disease groups (GSD and GSD 1) are rare diseases. [ABSTRACT FROM AUTHOR]

Elite boarding schools endeavor to instill in their students elite-class solidarity, strong beliefs in both meritocracy and the essential rightness of the status quo, and practical political know-how. Each of these objectives is wholly compatible with the self-interest of their students and their families. In the vast majority of working-class schools, class-consciousness is discouraged, individual effort is valorized, and collective effort is denigrated; faith in meritocracy and the rightness of the status quo go unchallenged, and practical political know-how is replaced by a naive, Disneyland concept of American democracy. None of this is compatible with the self-interest of working-class students, and, therefore, they remain unmotivated and experience little school success. Weekend schools for children run by the American Socialist Party from 1900 to 1920 were based on assumptions compatible with working-class self-interest and offer a model for motivating and educating working-class students today. (Contains 6 notes.)

Purpose: I respond to Kamhi's (2011) conclusion in his article "Balancing Certainty and Uncertainty in Clinical Practice" that rational or critical thinking is an essential complement to evidence-based practice (EBP). Method: I expand on Kamhi's conclusion and briefly describe what clinicians might need to know to think critically within an EBP profession. Specifically, I suggest how critical thinking is relevant to EBP, broadly summarize the relevant skills, indicate the importance of thinking dispositions, and outline the various ways our thinking can go wrong. Conclusion: I finish the commentary by suggesting that critical thinking skills should be considered a required outcome of our professional training programs.

Purpose: The purpose of this tutorial is to describe 10 criteria that may help clinicians distinguish between scientific and pseudoscientific treatment claims. The criteria are illustrated, first for considering whether to use a newly developed treatment and second for attempting to understand arguments about controversial treatments. Method: Pseudoscience refers to claims that appear to be based on the scientific method but are not. Ten criteria for distinguishing between scientific and pseudoscientific treatment claims are described. These criteria are illustrated by using them to assess a current treatment for stuttering, the SpeechEasy device. The authors read the available literature about the device and developed a consensus set of decisions about the 10 criteria. To minimize any bias, a second set of independent judges evaluated a sample of the same literature. The criteria are also illustrated by using them to assess controversies surrounding 2 treatment approaches: Fast ForWord and facilitated communication. Conclusions: Clinicians are increasingly being held responsible for the evidence base that supports their practice. The power of these 10 criteria lies in their ability to help clinicians focus their attention on the credibility of that base and to guide their decisions for recommending or using a treatment.

In light of emerging findings concerning untreated recovery and neural plasticity, this paper re-examines the viability of an NIH conference recommendation [Cooper, J. A. (1990). Research directions in stuttering: Consensus and conflict. In Cooper, J. A. (Ed.), "Research needs in stuttering: Roadblocks and future directions" (pp. 98-100). Rockville, MD: American Speech-Language-Hearing Association.] that adults who have recovered from stuttering might inform our understanding of the nature and treatment of persistent stuttering. It is suggested that those who have recovered could constitute a behavioral, cognitive, and neurophysiologic benchmark for evaluating stuttering treatment for adolescents and adults, while helping to identify the limits of recovery from a persistent disorder. This possibility seems especially promising because of findings from recent studies investigating untreated recovery during childhood and adulthood, the emerging evidence concerning neural plasticity and reorganization, and reports of neural system changes during stuttering treatment. Potential obstacles to applying findings from unassisted recovery to treatment do exist, but the benefits of attempts to fully understand stuttering certainly outweigh the difficulties. Educational objectives: After completing this activity, the learner will be able to: (1) describe two complexities involved in determining whether recovery from stuttering was assisted or unassisted; (2) discuss the implications for stuttering research of two neural plasticity research findings from areas other than stuttering; and (3) evaluate the possible implications for stuttering treatment of a coordinated research program that addresses behavioral, cognitive, and neurological characteristics of assisted and unassisted recovery from stuttering.

The purpose of this study was to investigate the nature of recovery from stuttering based on the experiences of adults who recovered without treatment. Using a semi-structured, open-ended interview format, 15 speakers verified as persons who recovered without treatment were asked to describe their status as everyday speakers. Seven speakers reported that they no longer stuttered and eight reported that they still stuttered on occasion. Interview material was coded and analyzed by the investigators and checked by independent judges. Results suggested that complete recovery was possible for speakers who reported that they no longer stuttered; whereas, those who still stuttered occasionally appeared to no longer be handicapped by stuttering, but required some vigilance to maintain their relatively fluent speech. Educational objectives: After completing this activity, the learner will be able to: (1) describe the relevance of self-report data for evaluating the nature of recovery from stuttering without treatment; (2) describe the differences in self-perception concerning the nature of recovery for those who no longer have any tendency to stutter compared to those who still have an occasional tendency to stutter; and (3) suggest the possible implications for understanding the nature of recovery from persistent stuttering based on investigations of late recovery without treatment. (Contains 2 tables and 2 figures.)

The difficulties of generalization and maintenance in stuttering treatment is discussed. Three strategies for promoting generalization and maintenance in school settings are suggested based on current research evidence: probing and training for generalization; incorporating real-life elements into therapy; and training clients to self-regulate their behavior. (Contains references.) (Author/CR)

This study examined a validation procedure combining self-reports with independent verification to identify cases of recovery from stuttering without formal treatment. A Speech Behavior Checklist was administered to 42 individuals familiar with recovered subjects' past speech. Analysis of subjects' descriptions of their past stuttering was corroborated by the independent informants on the checklist. (DB)

Twelve adult stutterers were instructed to self-rate the speech naturalness (how natural their speech sounds) and feel naturalness (the amount of attention they are paying to the way they are speaking) of their speech under a variety of conditions across repeated rating occasions. Results showed that subjects were relatively consistent and valid self-raters. (Author/JDD)

Stroke significantly impairs health-related quality of life (HRQL). Stroke survivors with aphasia (SWA) experience lower HRQL than stroke survivors without aphasia (SSA) as a result of poorer communication and social functioning. The extent to which aphasia influences HRQL in African-Americans and the components of social functioning that are most important to HRQL warrants further exploration. There were two main objectives of this paper. The first was to survey HRQL domains of communication, physical, mental/emotional, role, and social functioning in African American SWA and SSA. The second was to examine if social support and social network predicted HRQL in SWA. A total of 39 African American adults (62.4 ± 11.10) participated in this descriptive cross-sectional case control study. Patient-reported outcome measures were used to assess HRQL, perceived social support, and social network in SWA, SSA, and normal-aging healthy controls (NAH). Data analysis included an ANOVA and moderator regression to determine if social support or social network predicted HRQL in SWA. SWA reported a significantly lower overall HRQL (p = <.000) than NAH adults. Communication HRQL was the hallmark difference found between SWA and SSA (p = <.000). Social support and social network were relatively similar among all three groups. However, social support and social network did not predict HRQL in SWA. Findings from this study suggest that social HRQL continues to be significantly lower in SWA; however, social support and social network factors do not drive differences among African-Americans. Moreover, communication HRQL remains the hallmark difference between SWA and SSA. [ABSTRACT FROM AUTHOR]

There is an increasing interest in developing direct calculation methods and procedures for determining extreme wave loads on ship girders (e.g. ISSC, 2000 [1]). Ships experiencing bottom and bow flare slamming have heightened the need for computational tools suitable to accurately predict motion and structural responses. The associated nonlinear impact problem is complicated by the complex free surface and body boundary conditions. This paper examines a 'blended' linear-nonlinear method by which extreme loads due to bottom impact and flare slamming can be determined. Using a high-speed container ship as an example, comparisons of motions, shear and bending moments, and pressures are made in head and oblique bow-quartering waves. The time-domain computer program used in the comparison is based upon partially nonlinear models. The program, NSHIPMO, is an blended strip theory method using 'impact' stations over the forward part of the ship and partially nonlinear stations over the rest. Body exact hydrostatics and Froude-Krylov excitation are used over the entire hull. The impact theory of Troesch and Kang [2] is employed to estimate the sectional nonlinear impact forces acting upon the specified nonlinear sections, while the linear theory of Salvesen et al. (STF) [3] is used to blend the remainder of the hydrodynamic forces, that is the radiation and diffraction components. Results from the simulation are presented with discussions of accuracy and time of computation. Several issues associated with the blended nonlinear time-domain simulation are presented, including modeling issues related to directional yaw-sway control and a vertical plane dynamic instability in long waves that has not previously been recognized. [DOI: 10.1115/1.1578499]

The connections between poetic syllables have finally broken down, We pushed on them so long our arms were hurting. --From Erin Mouth's 'Ordinary Cranium' included in the Winter 1991 edition [...]

There is no empirical basis for determining goals for stuttering treatment. One approach that might resolve this issue is to systematically investigate persons who claim to have recovered from stuttering without the assistance of treatment. However, critical methodological and conceptual issues must be overcome first in order to assure these persons had a valid stuttering problem and that their recovery was independent of treatment. This study examined a validation procedure for solving these issues based on the combination of two methods: independent verification and self-reports. Forty-two subjects participated: 14 adults who recovered from stuttering without assistance, 14 adults with persistent stuttering, and 14 adults who were normally fluent speakers. For the independent verification, a Speech Behavior Checklist was administered to 42 individuals familiar with the recovered subjects' past speech and the other subjects' current speech. Results indicated that persons who knew the recovered subjects when they used to stutter recalled speech behaviors consistent with subjects who still stuttered, but not the same as speech behaviors consistent with subjects who never stuttered. These findings were supported by an objective analysis of the recovered subjects' descriptions of their past stuttering. Furthermore, a content analysis of subjects' self-reports indicated that recovery was independent of treatment. KEY WORDS: spontaneous recovery, self-report, self-directed, cross-validation, treatment outcome

The efficacy of stuttering treatment has been a contentious issue in recent years. Two issues of primary concern include the treated stutterer's abnormal speech quality and the problem of continually self-monitoring fluency skills. One approach to addressing these issues is to obtain stutterers' self-ratings of speech quality and levels of speech monitoring. However, the reliability and validity of such self-ratings need to be assessed before they are suitable for use in stuttering treatment. The present study investigated one method of estimating the reliability and validity of stutterers' self-ratings of how natural their speech sounds (speech naturalness), and how natural they feel about the amount of attention they are paying to the way they are speaking (feel naturalness). Twelve adult stutterers were instructed to self-rate the speech and feel naturalness of their speech under a variety of rhythmic stimulation conditions across repeated rating occasions. With some qualifications, the results showed that stutterers were relatively consistent and valid self-raters of speech quality and levels of speech monitoring.

The study reported in this paper was designed to replicate and extend the results of an earlier study (Ingham, Cordes, & Gow, 1993) that investigated time-interval judgments of stuttering. Results confirmed earlier findings that interjudge agreement is higher for these interval-recording tasks than has been previously reported for event-based analyses of stuttering judgments or for time-interval analyses of event judgments. Results also confirmed an earlier finding that judges with intrajudge agreement levels of 90% or better show higher interjudge agreement than judges with lower intrajudge agreement scores. This study failed to find differences between audiovisual and audio-only judgment conditions; between relatively experienced and relatively inexperienced student judges; and, most importantly, between the judgments made, and the agreement levels achieved, by judges from two different clinical research settings. The implications of these findings for attempts to develop a reliable measurement method for stuttering are discussed.