Tag Archives: ASHA 2011

The Dudes Do ASHA 2011: Day 4. On Bondage, Booze, and Bayesian Statistics

It’s a cheap trick I know, but the “bondage” referred to in the title refers to the binding of a laptop with a smartphone, otherwise known as tethering. Casual visitors who have landed here via a Google search hoping for some images of people tied up and engaging in fetishistic practices should leave now because there are none. Tethering is a little trick you can use if you find yourself without an easily accessible WiFi connection – such as at the San Diego Convention Center. Interestingly, the brochure in my hotel room touts the city as being one of the most “wired” places on the world but it conveniently leaves out the phrase “at a price.” There is a WiFi connection to be had inside the Convention Center but it is a fee-for-use option that, as always, seems steep for 10 minutes, which is about the time I needed to upload the latest blog posts.

Tethering an android phone

Computer bondage

However, with a cable and a piece of free software, it’s possible to tether a computer to a smartphone and use the phone’s Internet connectivity as a router. Specifically, I’m using a Dell Latitude, a Droid 3, a USB cable to connect the two, and a piece of software called PdaNet – one version running on the phone and its partner-in-crime running on the laptop. [1]

I say “in crime” because the phone company don’t really want you to do this. What they want is for you to pay an extra $20 per month on top of the $30 per month you are currently using in order to download through your phone. This strikes me as odd because whether I download data to my phone or my laptop via the phone, it’s the same data use. And seeing as I also have an unlimited data plan, what’s the difference? So, the outcome of this is that tethering is frowned upon and can, if the phone company finds out, can lead to a stiff warning followed by being kicked off the system.

In truth, I never tether if I can possibly avoid it, simply because it’s actually much, much easier (and more stable) to use WiFi or an ethernet connection. I reserve tethering to emergency situations. Such as the SDCC.

The tethering took place immediately following my last ASHA session for 2011; a short course entitled Evidence-based Statistics for Measuring Strength of Evidence, a title that sounds benign enough but turned out to be a wolf in sheep’s clothing. The presenters, David Maxwell and Eiki Satake, are both Professors at Emerson College and clearly know their stuff.

Evidence based practice pyramid

EBP Pyramid

I became an SLP partly because the part of the brain that deals with numbers is clearly non-functioning in my case. I know enough math to keep me away from the casinos [2] and overpaying at the bar, but when equations and formulae come onto the scene, I suffer from math blindness. Which is why this particular course had me cranking up my brain volume to eleven in order to follow some of the arguments.

And that’s where the Bayesian [3] statistics came in and I learned the difference between a Bayesian  and a Frequentist approach to statistical analysis. Let me try to summarize what the presenters were suggesting and how it relates to EBP. Essentially, they say that;

(a) Current research practice in Speech and Language Pathology uses a Frequentist model that relies on creating a null hypothesis and testing it against a P-value.

(b) This model inherent works on a “pass” or “fail” basis but tells you little about the strength or power of a treatment.

(c) Such p-values are not the best way to deal with clinical outcomes.

(d) A Bayesian model uses a modified P-value – the “precise P” as opposed to the “imprecise P” – which is more meaningful for clinical data.

(e) Using a Bayesian precise P-values tells us more about the strength of experimental observations and is, therefore better for evidence-based practice.

(f) There is a difference between statistical significance and clinical significance, and the latter is better evaluated using a Bayesian method.

This summary is probably hugely unfair because condensing a 3-hour short course into five sentences is hardly “best practice,” and there was a 150+ slides handout to accompany it, and that’s tough to condense! Nevertheless, if there’s a single take-away idea, it’s that we should be considering Bayesian methods for EBP. [4]

Fortunately, there is a book available that explains Bayesian statistics as applied to EBP; The Handbook of Statistical Methods: Single Subject Design (2008) [5]. I have the sneaky feeling that this is unlikely to be light, bedtime reading but I’ll see if I can track a copy down in the library before splashing out on a copy for the bookshelf.

Handbook of statistics

Satake et al. 2008

Which brings us to the booze and perhaps the second most useful piece of information to come out of the short course; beer and statistics do mix!

At some point in their training, SLP’s will have come across the “Student’s t-test,” which is not, as it suggests, a “t-test” for a “Student” to use but one originated by someone called “Student.” It turns out that “Student” was, in fact, the pseudonym of William Gosset, a statistician who worked on a project with folks at the Guinness corporation to test the quality of the beer. The t-test provided a way for beer testers to take a few small samples, measure them, and then use the test to get a quality score. Now there’s a job! Unfortunately for Gosset, as a Guinness employee, he couldn’t publish what was proprietary information. Nor did he want to face any ribbing from his colleagues because he was working for a private company – a beer maker at that. However, he was eventually allowed to write papers but under the nickname of “Student,” hence the ultimate name of “Student’s t-test.”

Guinness

Guinness

At this point, I recommend you’ve had enough statistics for the day and head for a local bar to do your own research into how effective the t-test is at quality control. The sample size is up to you.

Notes
[1] Setting up your phone and laptop for tethering is not rocket science and Google is your friend for using the PdaNet 3.0 software. As I said, it’s not illegal but if the Cell Network Mafia come a-knocking, I take no responsibility if you’re found at the bottom of a river with concrete overshoes. If you’re using a Mac and an iPhone, I can’t help you, but undoubtedly “there’s an app for that” and it’s so intuitive you can give it to a 6-month-old to set it up for you.

[2] Gambling (or as the industry prefers to call it in a miserable effort to make it sound more friendly, gaming) is an example, par excellence, of applied probability. All you really need to know in order to avoid living your life under bridges and drinking rubbing alcohol hidden inside a brown bag are two things; (a) the gambling industry only exists because the odds are always in their favor, and (b) your odds of becoming extremely wealthy by gambling are so small as to be, in most cases, negligible to zero. Casinos always tell you about the big winners but don’t provide you with a list of losers. By all means go out with $100 in your pocket for a night of fun, at the end of which you expect to have lost it all, but when you start thinking, “OK, maybe just another hundred and then I’ll call it quits,” start practicing how to make the sentence “Honey, I lost the house” acceptable.

[3] It’s pronounced /’bəɪziˌjʌn /. I add this because I was saying it wrong for years!

[4] I found a short summary of Satake’s critique of Frequentist statistics in an article he wrote in 2010. Entitled Moving Forward to Evidence-Based Statistics: What Really Prevents Us?, he explains why the traditional P-value is misleading and why. http://www.pluralpublishing.com/web_flyer/web_flyer_community_august/web_flyer_community_august.htm 

[5] Satake, E., Jagaroo, V., and Maxwell, D.L. (2008). Handbook of Statistical Methods: Single Subject Design. San Diego, CA: Plural Publishing.

The Dudes Do ASHA 2011: Day 3. Of Anti-Social Networks and Tweet Ups

Being “of a certain age,” I remember the times before cell phones and before the Internet. The world wasn’t actually in black and white during those times but it was different. The development of connectivity via cellular networks and the global Internet web has created a culture where people are available all the time, unless they physically choose to go off the grid. Whether this has affected human cultural evolution for good or ill is still under debate, a discussion that will doubtless continue for many years to come.

In her book, Alone Together: Why We Expect More from Technology and Less from Each Other, MIT psychologist Sherry Turkle [1] says that “our networked life allows us to hide from each other, even as we are tethered to each other.” What we call “Social Networks” can function as anti-social networks, providing virtual relationships that are measured by the number of Facebook friends or Twitter followers one has.

Alone Together: Turkle

The strength of connectivity is seen in a study by Jan Van den Bulck from the University of Leuvan in Belgium, where is was found that among 13-year-olds, 13.4% reported being woken up one to three times a month; 5.8% were woken once a week; 5.3% were woken several times a week; and 2.2% were disturbed every night. Being permanently connected can be a serious problem for some kids. [2]

In another study by Glenn Wilson from the University of London, he studied the technology company Hewlett Packard and found that employees who spent lots of time texting at work suffered from reduced concentration and productivity. [3]

But is the fabric of social relationships breaking down or are they just changing to accommodate new technologies?

Well, the good news is that given the opportunity to meet face-to-face, the individuals of the Twitter group #SLPeeps are happy to stop tweeting for at least an hour for the great ASHA 2011 tweet up! Between 4:30 and 5:30 PST on November 19th, some 20 virtual friends got together to introduce themselves in the flesh. Not everyone could get there because it is, after all, a conference, and some folks already had commitments elsewhere. But even those who couldn’t be there were tweeting about the event.

These types of interaction are part of the ASHA experience. Sure, we all come to hear lectures and enrich our knowledge, but the human networking is far more important. You can download the notes and slides from any of the presentations but you can’t download the company of friends. So whether it’s a tweet up, a night in a restaurant, a few drink by the bar, or a boat trip across the bay to Coronado Island, it’s these old-fashioned social networks that matter.

Notes
[1] Turkle, S. (2011). Alone Together: Why We Expect More from Technology and Less from Each Other. Basic Books: New York.

[2] Van den Bulck, J. (2003). Text messaging as a cause of sleep interruption in adolescents; evidence from a cross-sectional study. Journal of Sleep Research, 12, 263-284.

[3] Cited in Crystal, D. (2008). Txtng: the gr8 db8. Oxford University Press: Oxford.

The Dudes Do ASHA 2011: Day 1. On Traveling, Truth, and EBP

journey, (n). / /. A day’s travel; the distance traveled in a day or a specified number of days.

According to the English writer Oliver Goldsmith, “Life is a journey that must be traveled no matter how bad the roads and accommodations.” Well, in all honesty, when the journey is to the ASHA 2011 conference in San Diego and the accommodations are at the Hilton San Diego Bayfront, it’s hard to imagine anyone feeling any sympathy for our having to travel for hours and across thousands of miles to get here. When you’re sitting back in a swanky, high-priced bar drinking White Russians and nibbling on a $26 selection of gourmet meatballs, you keep glancing at the hotel entrance to see if the “Occupy San Diego” people are about to storm the building with flaming torches, dragging off “the rich” to a hastily constructed gibbet.

The Odysea Bar

Still, it’s not as if this is the regular lifestyle for the Speech Dudes. No sir! For every luxury hotel we stay in there are tales we can tell of others that involve insect infestations, bullet-proof check-in desks, ear-splitting air-conditioners, no air-conditioners (in a Coloradan summer), and one just on the edge of a European red-light district that rented by the hour. So rest assured the Dudes are immensely appreciative of their current locations, split as they are between the Hilton and the Marriott, also with a view of the bay.

Despite having traveled individually from the East Coast, Mid-West, and Canada, we are, after all, Speechies, and within minutes of ordering food and drinks at 10:30 pm PST, the conversation  shifted from how which is the worst airport in the US (Philadelphia  is currently in the running, says one of us) to Speech Pathology, specifically the issue of outcomes. Incredible as it may seem that a group of guys at a bar would want to get into Evidence-based Practice rather than the sad state of the NBA and the prospect of not being able to spend some quality time over Christmas secretly hoping LeBron James will twist an ankle and bruise his ego, we ploughed into the current fad for dropping iPads [2] on every kid with a pair of hands as the “miracle cure” from St. Stephen of Jobs and the Angels at Apple.

The messianic zeal of evangelical Jobbites [3] is such that the answer to life, the Universe, and everything, is quite simply “there’s an App for that.” And if there isn’t, then someone will make one and all will be well. It’s no use talking about “levels of evidence” or “controlled experiments” or even “proof” because there is, of course, lots of “proof” on YouTube, and, of course, sales of iPads outstrip the gross domestic product of several South American countries so they must be useful.

Already, Jobbites reading this are spluttering and trembling, their wobbling fingers poised to launch into a tirade of near-religious rhetoric in defense of the New World Order, where Apple will save the world by the benevolent use of the “One store to bring them all and in the darkness bind them.” But take a deep breath and hold back for just a few minutes.

Whether using technology for teaching articulation skills, sentence construction, fluency, AAC, literacy, and so on, the glamour [2] of the machine can cloud our judgment. Our pads, tablets, smart phones, and laptops are such magical totems that we really want them to be special. The trick is for us to make sure we are open-minded enough to see the benefits of new technology (or just new approaches in general) but not so open-minded that our brains fall out.

Sackett, Strauss, Richardson, Rosenberg, and Haynes (2000) [3] talked about using a foreground question to determine the quality of external evidence that can help us make informed decisions about using a new approach. The use the acronym PICO as a memory aid that helps us formulate a testable question;

  • A Patient or Problem
  • An Intervention (a treatment or evaluation)
  • A Comparison or Contrast
  • An Outcome (measurable, of course)

Thus, a good question to ask would be “If I use this app for a month (I) with my 4-year-old client with a hearing loss (P) will the improvement in selecting new images on the screen (O) be better than if I’d used simple picture books (C).”

OK, so you can fine tune this in a few ways but we’re writing a blog post not an EBP textbook. The point is that we do have the clinical tools to evaluate the use of flashy new technology if we ask the right questions. Just using an app for a month and noticing “change” tells you nothing; the client may have “changed” if you’d let them watch SpongeBob SquarePants with you because the interaction was the cause, not the app.

Healthy skepticism is not a rejection of change but a necessary perspective to evaluate the extent of change. What is dangerous about new approaches, technological or social, is when claims are made to efficacy that are based purely on anecdote and a wish to see things happen.

And who would have thought White Russians and meatballs could lead to this.

Time for bed…

Time for bed

Notes

[1] Curiously it is iPads and not tablets in general. A recent report asked schools if they were considering buying new tablet technology for the classrooms and 100% said iPads against 0% for any other device. Now, doesn’t that strike anyone else as odd if the education system is supposed to be evaluating things on merit? Or is this a triumph for Apple’s marketing department? Just a thought.

 [2] The word glamour not only means “fascination” or “allure” but also “a magical spell cast over a person to hold them in thrall.” Literary types might want to take a read, or re-read, of Tennyson’s Idylls of the King and the verses entitled The Beguiling of Merlin. This demonstrates poetically how the glamorous Vivienne enchants and defeats the Arthurian mythological wizard.

[3] A Jobbite is an individual who considers Steve Jobs and all his works as beyond criticism. Followers of Ayn Rand have a similar perspective, which ultimately can result in the emergence of cults. Although Jobs was unquestionably influential in the world of technology, it’s easy to forget that Apple succeeded because of the creativity and hard-work of its workers. Jobs himself didn’t actually sit down and build iAnythings – he facilitated it, and there was his skill.

[4] Sackett, D.L., Strauss, S.E., Richardson, W.S., Rosenberg, W. and Haynes, R.B. (2000) Evidence-based medicine: How to practice and each EBM. Edinburgh, Scotland: Churchill Livingstone.