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Background: In the digital environment, users' academic reading behaviour has changed, working with many articles simultaneously to search, filter, scan, link, annotate and analyse content fragments. The semantic enhancement environment has been widely set with semantic technologies to offer additional and handy support for users and thus facilitate the reading process. Despite many efforts devoted to developing a semantic enhancement environment, less attention has been paid to its actual effects. Objectives: This study aims to explore the effects of a semantic enhancement environment. Methods: Elaborating on cognitive load theory and focusing on academic reading, this study compared users' cognitive load and reading effect under the semantic enhancement environment and plain text environment and verified the three hypotheses. Results and conclusions: Through experiments and statistical analysis, this study found that, under a semantic enhancement environment, users had their cognitive load reduced and their reading effect improved. Consequently, a semantic enhancement environment promotes academic reading. Takeaways: This study adds to previous literature on semantic publishing by empirically corroborating the conducive effects of semantic enhancement environment in academic reading. Additionally, it justifies semantic publishing and provides a reference for the future design of semantically enhanced reading environments. Lay Description: What is already known about this topic?: The effects of a semantic enhancement environment are open to discuss.Academic reading is fundamental to researches and hence needs promotion.Limited studies investigated the effects of a semantic enhancement environment on academic reading.Publishers require effective reading environment designs. What this paper adds?: This study constructed a semantic enhancement reading environment to conduct a reading experiment.The experiment tested cognitive load, by using WP scale, and reading effects, by answer time and answer score.Semantic enhancement environment reduces users' cognitive load, promotes users' reading effects, and bolsters users' understanding of academic reading materials, especially in microstructure content.The design of semantic enhancement reading environments needs to fully consider the features of reading materials and give users a controllable way of interaction. The implications of study findings for practitioners: Compared to plain text environment, semantic enhancement environment is preferred in academic reading.Publishers are encouraged to add semantic enhancements to their publications.This study discussed how to design an effective learning and reading environment from the perspectives of reading resources, media forms of resources, and interaction modes. [ABSTRACT FROM AUTHOR]

Background: In example‐based learning, examples are often combined with generative activities, such as comparative self‐explanations of example cases. Comparisons induce heavy demands on working memory, especially in complex domains. Hence, only stronger learners may benefit from comparative self‐explanations. While static text‐based examples can be compared easily, this is challenging for transient video‐based modelling examples used in complex domains because simultaneous processing of two videos is not feasible. Objectives: To allow for such comparisons, we combined video‐based modelling examples with static representations (i.e., summarizing tables) of the observed optimal and a suboptimal solution of the problem‐solving process. A comparative self‐explanation prompt asked learners to compare the different solution approaches. Our study investigated the impact of video‐based modelling examples versus independent problem‐solving on cognitive load and problem‐solving skill development. Moreover, we investigated the effects of comparative versus sequential self‐explanation prompts, depending on learners' prior knowledge. Methods: In an experiment, 118 automotive apprentices learned a car malfunction diagnosis strategy. Apprentices were divided into three groups: (1) modelling examples with comparative self‐explanation prompts, (2) modelling examples with sequential prompts, and (3) no examples or prompts. Diagnostic knowledge and skills were assessed before and after the intervention. Cognitive load was measured retrospectively. Results and conclusions: Despite no observed effects on cognitive load, modelling examples enhanced diagnostic knowledge and diagnostic skills with scaffolds, though not independent diagnostic skills without scaffolds. The need for more practice opportunities to foster independent diagnostic skills is assumed. Additionally, comparative prompts seem promising for learners with higher prior knowledge. Takeaways: Video‐based modelling examples were more beneficial for learning than practising to apply the diagnostic strategy. Static representations allow for comparisons of video examples and comparative prompts are promising for learners with higher prior knowledge (cf. expertise‐reversal effect). Further research, especially on the effects on cognitive load, is necessary. Lay Description: What is already known about the topic?: Text and video examples that model how to solve a problem are widely used in education.Text examples often include self‐explanation prompts that ask learners to compare several examples.For video examples, such comparison prompts have seldom been investigated, because comparisons are difficult to implement for transient videos. What does this paper add?: This paper shows that video examples combined with static summaries of processes that have been shown in the video example are effective and allow for comparisons of video examples.Such comparisons seem to be more promising for learners with higher prior knowledge. Implications for practice: Practitioners could combine video examples with static summaries of the processes shown in the video examples to allow for comparisons. [ABSTRACT FROM AUTHOR]

Background: Mindfulness practices enhance executive function skills and academic achievement, spurring interest in integrating mindfulness interventions into education. Embedding mindfulness practice into a digital math game may provide a low‐cost, scalable way to induce mindfulness and boost game‐based learning, yet this approach remains unexplored. Objectives: We investigated the learning benefits of integrating mindfulness exercises in a digital math learning game and examined how students' trait mindfulness might moderate the outcomes. Methods: Two classroom studies were conducted with 404 5th and 6th grade students from six public schools in the U.S. (nStudy 1 = 227, nStudy 2 = 177). The two randomized controlled experiments assigned students to one of the three conditions: passive control (playing the digital learning game Decimal Point), story‐enriched active control, or mindfulness‐enriched condition. Trait mindfulness, learning gains, and in‐game problem‐solving (including problem‐solving duration, error count and correctness after reminder) were assessed. Study 2 included a manipulation check to better understand the effects of the mindfulness intervention. Results: Findings showed no significant differences in learning gains, problem‐solving duration or error count among the conditions. Students' trait mindfulness did not moderate these outcomes. Mindfulness reminders in the mindfulness‐enriched game led to more correct answers after errors than jokes in the story‐enriched game. Study 2 revealed that we failed to induce higher state mindfulness through the mindfulness inductions. Conclusions: Mindfulness prompts could be especially beneficial for students experiencing frustration during gameplay, warranting more exploration for digital game‐based instruction. We highlight barriers and future directions for fostering mindfulness through computer‐based instruction in classrooms. Lay Description: What is currently known about this topic?: Researchers focus on digital games as productive learning environments for math, with potential for higher learning gains compared with traditional methods. However, results are mixed, and not all games lead to improved math outcomes.Executive function (EF) skills are crucial for math learning, and mindfulness‐based interventions show promise in enhancing EF skills in school‐aged students.Embedding mindfulness practice into a digital math game may provide a low‐cost, scalable way to induce mindfulness and, in turn, boost EF skills and game‐based learning, yet this approach remains unexplored What does this paper add?: This paper presents the results of two randomized control trials investigating the feasibility and benefits of incorporating mindfulness exercises into a digital math game designed for middle school students. Benefits are compared to those of a story‐enriched and regular version of the same digital math learning game.The paper also explores variations in the effects of the mindfulness‐enriched game based on students' initial trait mindfulness levels.We observe that listening to mindfulness inductions at the beginning of game sessions do not induce mindfulness, and therefore does not benefit math learning.We find that mindfulness prompts received after recurrent errors can be beneficial for students' problem solving. Implications of study findings for practitioners: Our study provides important information on how digital learning game designers should attempt to induce mindfulness in a digital game to promote learning.Digital learning game designers should consider incorporating mindfulness exercises into their games strategically. Presenting mindfulness inductions in audio format at the beginning of game sessions may not induce mindfulness or benefit math learning. Instead, designers should focus on integrating mindfulness prompts at moments when students encounter frustration within the learning game.Beyond embedding audio mindfulness exercises in the game, learning designers should also consider alternative technological and game features to induce mindfulness within a learning game. [ABSTRACT FROM AUTHOR]

Background: This study examines the effect of a Theory of Mind (ToM) intervention on ToM abilities and social–emotional functioning in adolescents with developmental language disorder (DLD) or who are deaf/hard of hearing (D/HH). It emphasizes the importance of self‐reflection and measurement for personal growth. The research design incorporates both subjective and objective measures to evaluate the intervention's efficacy. Aims: To investigate the impact of the ToM intervention on ToM abilities and social–emotional functioning in adolescents with DLD or who are D/HH. It hypothesizes that participants in the intervention groups will show improved ToM and social–emotional functioning compared with those in the control groups. Methods & Procedures: Adolescents with DLD or who are D/HH were recruited through collaboration with educational institutions. The study utilized a pre‐/post‐test design, assigning participants to either the intervention or the control group. The ToM intervention involved targeted activities to enhance ToM abilities. ToM abilities and social–emotional functioning were assessed using standardized tests and self‐report questionnaires. Statistical analyses compared outcomes between the intervention and no intervention groups. Outcomes & Results: The findings reveal subjective improvements in social–emotional functioning among the D/HH intervention group. However, no significant effects on objective ToM measures were observed. These results highlight the need for further investigation and refinement of interventions in these areas. Future research should focus on improving intervention strategies and exploring additional objective measures to gain a comprehensive understanding of the intervention's impact on ToM and social–emotional functioning in this population. Conclusions & Implications: The ToM intervention shows subjective benefits in improving social–emotional functioning among D/HH adolescents. However, it does not yield significant effects on objective ToM measures. These findings emphasize the ongoing need to refine interventions targeting ToM abilities and social–emotional functioning in this population. Future studies should explore alternative strategies and incorporate additional objective measures to enhance understanding and outcomes. WHAT THIS PAPER ADDS: What is already known on this subject: Before this study, it was known that ToM interventions have the potential to enhance ToM abilities. However, the specific effects of such interventions on subjective and objective measures for ToM and social–emotional functioning in adolescents with DLD or who are D/HH remained unclear, necessitating further research. What this paper adds to the existing knowledge: This study adds to the existing knowledge by demonstrating subjective improvements in social–emotional functioning among adolescents who are D/HH and underwent a ToM intervention. However, no significant effects on objective ToM measures were observed. These findings highlight the need for refining interventions and exploring additional measures to better understand the intervention's impact. What are the potential or actual clinical implications of this work?: The subjective improvements in social–emotional functioning observed in this study have important clinical implications. They suggest that ToM interventions can positively impact the social well‐being of adolescents who are D/HH. However, the lack of significant effects on objective ToM measures emphasizes the need for further research and intervention refinement to address specific areas of improvement in this population. [ABSTRACT FROM AUTHOR]

Background: Pictures drawn by people with aphasia (PWA) are often more challenging to understand than those drawn by healthy people. There are two types of objects: those that tend to be drawn symbolically (symbolically drawn objects—SOs) and those that are likely to be drawn realistically (realistically drawn objects—ROs). Aims: To compare the identification rate and number of misunderstanding types between SOs and ROs drawn by PWA and healthy controls (HCs). To reveal trends in the misunderstandings of drawings by PWA, and to identify the language or cognitive abilities related to the identification rate of pictures drawn by PWA. Methods & Procedures: We designed a drawing task involving SOs and ROs. A total of 18 PWA and 30 HCs completed the task, and respondents identified the drawings. The identification rate and number of misunderstandings were analysed with two‐way analysis of variance (ANOVA) including group (PWA and HCs) and object type (SOs and ROs). The misunderstandings were divided into four categories varying in semantic and morphological similarity; these ratios were examined with a chi‐square test. The relationships of language and cognitive abilities with the identification rate were investigated with multiple regression analyses. Outcomes & Results: There was a significant effect of the interaction between group and object type on the identification rate (F(1.1387) = 3.90, Mean Squared Error (MSE) = 4139.67, p = 0.04): the identification rates for ROs were lower in the PWA than in the HCs. For the number of misunderstanding types, an interaction was observed between group and object type (F(1.56) = 8.26, MSE = 26.93, p < 0.01): the number of misunderstanding types for ROs in the PWA was greater than that in the HCs. The misunderstanding patterns differed between ROs and SOs (χ2(3) = 694.30, p < 0.001, V = 0.37). ROs were semantically related, whereas SOs were morphologically related. The identification rates of ROs and SOs were correlated only with Kanji writing scores (ROs: β = 3.66, p = 0.01; SOs: β = 6.57, p < 0.01). Conclusions & Implications: In drawings by the PWA, SOs had a higher identification rate, while ROs had a lower identification rate and a greater variety of misunderstandings. SOs may increase drawing motivation. Interventions to improve the identifiability of SOs and ROs should reflect each character. Identification rates were correlated only with Kanji writing scores. The PWA, whose native language was Japanese and had preserved Kanji writing abilities, and their communication abilities may be increased through drawing. WHAT THIS PAPER ADDS: What is already known on the subject: PWA often have impaired drawing abilities and draw pictures that third parties misinterpret. Some objects tend to be drawn symbolically, and some are drawn realistically. However, it is not clear whether there is a difference between these types of drawings depicted by PWA in identifiability and the tendency to be misunderstood by ordinary people. In addition, the relationships between language or cognitive abilities and the identification rate of drawn pictures are not clear. What this paper adds to the existing knowledge: The identification rate differed between SOs and ROs. In drawings by PWA, SOs had a higher identification rate, while ROs had a lower identification rate and the greatest variety of misunderstandings. Approximately half of the misunderstandings were related to the target object. SOs tended to be confused with morphologically related objects, while ROs tended to be confused with semantically related objects. Identification rates were correlated only with Kanji writing scores. What are the potential or actual clinical implications of this work?: To motivate PWA's drawing, it is suitable to begin with SOs. Examining drawing ability from the perspective of SOs and ROs increases the chance of identifying drawing ability. PWA whose native language is Japanese and have preserved Kanji writing abilities may be able to increase their communication abilities through drawing. [ABSTRACT FROM AUTHOR]

Background: Training parents to implement language and communication intervention strategies is an effective approach to promote language development for children with language delay. Aims: This study introduces an online parent training program conducted in Hubei province, China, which was designed to help parents of language‐delayed children with a diagnosis of autism spectrum disorder (ASD), developmental language disorder (DLD) or global developmental delay (GDD) apply language intervention strategies into daily interactions and promote their children's language development at home. Methods & Procedures: The Bethel Hearing and Speaking Training Center Family Training for Early Communication & Language Development (Bethel Family Training Program, BFT) (Bethel HSTC, 2020) was designed to improve the language and communication skills for children with language delay in a naturalistic way. The caregivers (including parents, grandparents and other main caregivers) participated in an 8‐h online program, including lectures on milestones in child language development, common misunderstandings of child language development, and three basic family language intervention strategies ('Looking together, playing together, and talking together') incorporating active learning through video analysis and discussion. Tongji Hospital in Hubei then continued with 3 months of online home intervention monitoring to all the caregivers via weekly online Q&As led by BFT certified speech therapists' team. The Gesell Developmental Schedules (GDS) was carried out before the online parent training program and after the 3‐month online home intervention monitoring. Outcomes & Results: 146 families whose children aged 12–68 months with language delay participated in the online training program. The results of the GDS assessments conducted before and after the program showed that not only did the developmental quotient (DQ) of language improve, but so did the DQ of social behaviour and adaptive behaviour (p < 0.001). There is no between‐group difference in the application of three strategies between the ASD group and the DLD or GDD group (p > 0.05). Furthermore, both caregivers' ability to apply 'looking together, playing together, talking together' strategies and the effective interaction time played important roles in improving the child's language abilities. Conclusion & Implications: The online parent training focusing on improving daily interaction with children through speech–language stimulation strategies promoted the development of language skills. It is an economic and practical approach for children with language delay who have limited access to local language intervention programs. WHAT THIS PAPER ADDS: What is already known on the subject: Parent‐implemented language intervention is an effective approach at improving children's language development. Telepractice is an appropriate model of service delivery for audiologists and speech–language therapists and may be the primary mode of service delivery or may supplement in‐person services. What this paper adds to the existing knowledge: This paper explores the effectiveness of an online parent training program and provides new evidence that online training on language support strategies (looking together, playing together, talking together) followed by home intervention monitoring works for Mandarin‐speaking children and it is equally effective for children with ASD and non‐ASD diagnosis. What are the potential or actual clinical implications of this work?: Developmental behavioural paediatricians and speech–language therapists in countries and areas that lack sufficient training resource for every child will have the option to deliver parent training and home intervention monitoring online, which will save time and cost considerably while offering convenience. [ABSTRACT FROM AUTHOR]

Purpose Although tablet computers offer advantages in data collection over traditional paper-and-pencil methods, little research has examined whether the 2 formats yield similar responses, especially with underserved populations. We compared the 2 survey formats and tested whether participants' responses to common health questionnaires or perceptions of usability differed by survey format. We also tested whether we could replicate established paper-and-pencil findings via tablet computer. Methods We recruited a sample of low-income community members living in the rural southern United States. Participants were 170 residents (black = 49%; white = 36%; other races and missing data = 15%) drawn from 2 counties meeting Florida's state statutory definition of rural with 100 persons or fewer per square mile. We randomly assigned participants to complete scales (Center for Epidemiologic Studies Depression Inventory and Regulatory Focus Questionnaire) along with survey format usability ratings via paper-and-pencil or tablet computer. All participants rated a series of previously validated posters using a tablet computer. Finally, participants completed comparisons of the survey formats and reported survey format preferences. Findings Participants preferred using the tablet computer and showed no significant differences between formats in mean responses, scale reliabilities, or in participants' usability ratings. Conclusions Overall, participants reported similar scales responses and usability ratings between formats. However, participants reported both preferring and enjoying responding via tablet computer more. Collectively, these findings are among the first data to show that tablet computers represent a suitable substitute among an underrepresented rural sample for paper-and-pencil methodology in survey research. [ABSTRACT FROM AUTHOR]

Background: Driven by the ongoing need to provide high‐quality learning and teaching, universities recently have shown an increased interest in using learning analytics (LA) for improving learning design (LD). However, the evidence of such improvements is scarce, and the maturity of such research is unclear. Objectives: This study is aimed to evaluate the maturity of research discussing LA‐driven LD improvements in higher education. Methods: The systematic review analyses 49 empirical papers, assesses their quality and suggests further research directions. The review elaborates on methodological (research questions, strategy and methods, LA‐LD integration theoretical backgrounds) and substantial (LA‐driven LD improvements, types of data used, LA software development) features of the papers. Results and Conclusions: The findings demonstrated the lack of theoretical alignment between LA and LD, with research tending towards user experience studies. The most frequently used research strategy was a case study; experiments were very rare. Researchers predominantly used parsing for collecting data and AI methods for analysing it; mostly used data types related to registering learners' engagement with learning activities as well as resources and tools provided in digital learning environments. Takeaways: The research area discussing LA‐driven LD improvements still has a way to go before attaining the level of full maturity. Only a third of the papers reported actual LA‐driven LD improvements; moreover, only three papers measured their effectiveness. The presented LA software was mostly at the beta or implementation stages and did not assess the impact of using this software. Lay Description: What is already known about this topic: Universities show an increased interest in using LA for improving LD.The evidence of such improvements being efficient is scarce.Learning analytics is weakly grounded in learning and teaching. What this paper adds: LA‐LD research presented in the reviewed papers cannot yet be considered fully mature.Almost half of the research was carried out using a case study approach, intrinsically challenging in terms of replication and validity. As few as three out of the reviewed studies applied an experimental approach, capable of stating the cause–effect relationship between LA and LD.All the studied papers mentioned improvements in LD, but only around a third of them reported actual improvements, another one‐third suggested potential improvements, and the rest did not come down to describing any.The LA software presented in the papers was mostly at the testing or implementation stages, and the impact of implemented software on LD has yet to be evaluated. Implications for practice and/or policy: Future LA‐LD research to become more mature may well elaborate on theoretical footing, contribute to the cause–effect relationship between LA and LD utilising experimental research design, ensure sufficient sample size.Practitioners' efforts should be directed to operationalising LD for efficient measurements, addressing pedagogical challenges when applying LA, and assessing LA‐driven improvements introduced into LD. [ABSTRACT FROM AUTHOR]

Background: Early and effective treatment for children with developmental language disorder (DLD) is important. Although a growing body of research shows the effects of interventions at the group level, clinicians observe large individual differences in language growth, and differences in outcomes across language domains. A systematic understanding of how child characteristics contribute to changes in language skills is still lacking. Aims: To assess changes in the language domains: expressive morphosyntax; receptive and expressive vocabulary; and comprehension, in children in special needs education for DLD. To explore if differences in language gains between children are related to child characteristics: language profile; severity of the disorder; being raised mono‐ or multilingually; and cognitive ability. Methods & Procedures: We extracted data from school records of 154 children (4–6 years old) in special needs education offering a language and communication‐stimulating educational environment, including speech and language therapy. Changes in language were measured by comparing the scores on standardized language tests at the beginning and the end of a school year. Next, we related language change to language profile (receptive–expressive versus expressive‐only disorders), severity (initial scores), growing up mono‐ and multilingually, and children's reported non‐verbal IQ scores. Outcomes & Results: Overall, the children showed significant improvements in expressive morphosyntax, expressive vocabulary and language comprehension. Baseline scores and gains were lowest for expressive morphosyntax. Differences in language gains between children with receptive–expressive disorders and expressive‐only disorders were not significant. There was more improvement in children with lower initial scores. There were no differences between mono‐ and multilingual children, except for expressive vocabulary. There was no evidence of a relation between non‐verbal IQ scores and language growth. Conclusions & Implications: Children with DLD in special needs education showed gains in language performance during one school year. There was, however, little change in morphosyntactic scores, which supports previous studies concluding that poor morphosyntax is a persistent characteristic of DLD. Our results indicate that it is important to include all children with DLD in intervention: children with receptive–expressive and expressive disorders; mono‐ and multilingual children, and children with high, average and low non‐verbal IQ scores. We did not find negative relations between these child factors and changes in language skills. WHAT THIS PAPER ADDS: What is already known on the subject: Intervention studies indicate that intervention can be effective, but not for all children with DLD, and not in all language domains. Longitudinal studies on language development show stable growth patterns in children with DLD at the group level. A systematic understanding of how child characteristics contribute to changes in language skills is still lacking. What this paper adds to existing knowledge: In this study, we report on the language gains of a cohort of 154 children with DLD (4–6 years old), in a special education setting for children with language disorders. Our sample includes children with receptive–expressive disorders and expressive‐only disorders, and monolingual as well as multilingual children. Our results show that children's language skills improved. The co‐normed tests we used revealed that the children had much lower growth in morphosyntax than in the other language domains. Language gains between children with receptive–expressive and expressive‐only language disorders did not differ, children with lower initial test scores showed more improvement than children with higher initial scores, multilingual children showed more gains in expressive vocabulary than monolingual children, and there was no effect of non‐verbal IQ on change in language scores. What are the potential or actual clinical implications of this work?: The results suggest that catching up on language is possible for children with DLD. It is important to include all children with DLD in intervention: mono‐ and multilingual children; children with receptive–expressive and expressive disorders; and children with high, average and low non‐verbal IQ scores. We did not find negative relations between these child factors and changes in language skills. The limited growth in morphosyntax compared with other linguistic areas warrants the attention of both practitioners and researchers, with a particular focus on the implementation of research findings in clinical practice. [ABSTRACT FROM AUTHOR]

Recent research has stated that early oral language acquisition difficulties are related to reading and writing difficulties. Children with developmental language disorder (DLD) experience difficulties with several dimensions of language. In this study we focus on the specific difficulties of children with DLD in spelling. We examine the impact of lexicality and length in written production of Spanish‐speaking children with DLD. A total of 18 children with language difficulties (Mage = 8;4) were compared with age‐matched children (Mage = 8;2). Participants completed a spelling‐to‐dictation task of words and pseudo‐words, where length was manipulated. A digital tablet was used to collect data and obtain measures of accuracy, latencies and total writing durations. Results showed that children with DLD produced more errors, longer latencies and longer writing durations than age‐matched children. Regarding accuracy, analysis of the errors shows that children in the control group produce few errors, most being substitutions, while children with DLD made more errors and of more varied categories. Moreover, they were more affected by length on writing accuracy than the control group. WHAT THIS PAPER ADDS: What is already known on this subject: Children with language difficulties are more likely to present reading difficulties. There are fewer studies analysing the impact of oral language difficulties in writing skills. What this paper adds to existing knowledge: The study suggests that children with oral language difficulties also have impairments in spelling, impacting on accuracy, duration and reaction time, possibly related to poor phonological working memory. What are the potential or actual clinical implications of this work?: This study highlights the need to emphasize early oral intervention and language‐related processing skills to help prevent written language difficulties. [ABSTRACT FROM AUTHOR]

Background: Aphasia is often accompanied by impairment of non‐language cognitive functions. Assessment of cognitive capacity in people with aphasia (PWA) with standard neuropsychological methods may be problematic due to their language difficulties. Numerous experimental studies indicate that P300 may be considered as an index of cognitive capacity in both healthy and clinical samples. Accordingly, the measurement of event‐related potentials enables the investigation of behaviourally non‐observable mental processes underlying the cognitive functions that are assessed with neuropsychological tests. Aims: To investigate in PWA the relationship between P300 parameters and cognitive function efficiency measured with neuropsychological methods. Methods & Procedures: A total of 25 PWA after left‐hemispheric stroke participated in the study. Electrophysiological (EEG) signals were recorded during the performance of a visual Go‐No Go task. P300 was identified on nine electrodes, which were then pooled in three lines: left (F3, C3, P3), central (Fz, Cz, Pz) and right (F4, C4, P4). The neuropsychological assessment of cognitive functions included mental speed, short‐term memory, divided attention, executive functions, auditory language comprehension and expression. Outcomes & Results: P300 latency correlated with indices of several cognitive functions: temporal resolution, psychomotor speed, spatial short‐term memory, planning, word and sentence comprehension, as well as verbal fluency. Shorter P300 latencies were accompanied by greater efficiency of the abovementioned functions. In contrast, significant correlations between P300 amplitudes and cognitive measures were fragmentary. Conclusions & Implications: In PWA, P300 latency might be related to cognitive functioning, especially to measures that rely heavily on the speed of information processing. However, P300 seems to be unrelated to more complex cognitive functions. P300 latency may be used as a neurophysiological correlate of cognitive efficiency in PWA and might have potential applications in monitoring the effects of therapeutic interventions in this patient group. What this paper adds: What is already known on the subject: P300 parameters have been reported to be associated with cognitive performance in both healthy individuals and clinical groups (e.g., patients with Alzheimer's disease). Previous studies show that the presence of P300 at the early post‐stroke stage may be a predictor of better recovery of comprehension in PWA. What this paper adds to existing knowledge: Our results show for the first time that P300 may be used as a neurophysiological correlate of cognitive efficiency in PWA. In our study, P300 latency was associated with several languages and non‐language cognitive functions, especially with those whose effectiveness depends mainly on processing speed. In PWA, shorter latency corresponded to more efficient cognitive functioning. What are the potential or actual clinical implications of this work?: P300 measurement may be potentially useful in assessing the efficiency of certain cognitive functions in PWA. It may be also used to monitor the recovery process of PWA and to verify the effects of therapeutic interventions. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate a new prenatal education program evaluation tool, the UpStart Parent Survey – Prenatal, in terms of: (a) reliability and validity; (b) sensitivity to change over time; (c) whether results differed for mothers versus fathers; and (d) whether results differed when using an electronic tablet‐computer versus a paper survey. Design and Sample: Psychometric study. Participants were 277 expectant mothers (n = 161) and fathers (n = 106) enrolled in Childbirth Essentials, a 6‐week prenatal education program. Measures: The UpStart Parent Survey – Prenatal is a retrospective pretest/posttest survey with three scales: Parenting Knowledge, Parenting Experience, and Program Satisfaction, and three open‐ended questions. Results: The UpStart Parent Survey – Prenatal is sensitive to change and demonstrated significant positive differences in parenting knowledge and parenting experience. There was no difference in results whether the survey was completed by mothers or fathers. Results were similar whether paper or electronic formats were used. The survey was easy to complete. Conclusion: The UpStart Parent Survey – Prenatal holds promise as a reliable and valid evaluation tool to capture outcomes of brief prenatal education programs that target the general population of expectant parents. [ABSTRACT FROM AUTHOR]

Background: The majority of children with cerebral palsy (CP) experience challenges in functional communication from a young age. A pivotal aspect of functional communication is language comprehension. A variety of classification systems and questionnaires are available to classify and describe functional communication skills in children with CP. A better understanding of the convergent validity of (subsections of) these tools, as well as their relationship with spoken language comprehension, will be valuable in both clinical practice and research. Aims: To investigate the convergent validity of (subsections of) functional communication tools and the relationship with spoken language comprehension in children with CP. Methods & Procedures: Cross‐sectional data on 138 children were subdivided into three developmental stages based on (Dutch) educational phases: ages 18 months–3;11y (n = 59), 4;0–5;11 years (n = 37) and 6;0–8;11 years (n = 42). The following functional communication tools were used to classify and describe functional communication: Communication Function Classification System (CFCS), subscales of the Caregivers Priorities and Child Health Index of Life with Disabilities—Dutch Version (CPCHILD‐DV) and the Focus on Communication Under Six‐34 (FOCUS‐34) questionnaire. Spoken language comprehension was assessed with the Computer‐Based instrument for Low motor Language Testing (C‐BiLLT). Correlations between the functional communication tools, and with the C‐BiLLT, were calculated using Pearson's and Spearman's correlation coefficients. It was hypothesized a priori that correlations of at least 0.60 suggest good convergent validity. Outcomes & Results: At all developmental stages, a significant ordered decreasing tendency of communication outcomes was found across CFCS levels; lower CFCS levels were associated with lower scores on the CPCHILD‐DV and FOCUS‐34, and with a lower level of spoken language comprehension (C‐BiLLT). Correlation coefficients of the functional communication tools exceeded 0.60 at all developmental stages. Correlations between C‐BiLLT raw scores and the functional communication tools varied between 0.351 and 0.591 at developmental stage 18 months–3;11 years, between 0.781 and 0.897 at developmental stage 4;0–5;11 years, and between 0.635 and 0.659 at developmental stage 6;0–8;11 years. Conclusions & Implications: The functional communication tools assessed in this study showed convergent validity at all developmental stages. The CFCS, currently most widely used in paediatric rehabilitation, is adequate in the classification of functional communication. However, for more detailed clinical goal setting and evaluation of change in functional communication, the additional use of FOCUS‐34 or CPCHILD‐DV is recommended. What this paper adds: What is already known on the subject: A range of functional communication tools are available that help describe and classify functional communication in children with CP. These include the CFCS, subsections of CPCHILD‐DV and FOCUS‐34. The CFCS classifies functional communication in daily life with familiar and unfamiliar partners. Specific subsections of the CPCHILD‐DV and FOCUS‐34 include items that pertain to communicative participation. The innovative C‐BiLLT provides a standardized method to assess spoken language comprehension in children with CP and significant motor impairments. What this paper adds to existing knowledge: In the present study, convergent validity was confirmed between CFCS and specific subsections of the CPCHILD‐DV and FOCUS‐34. Correlations between these functional communication tools and the C‐BiLLT were moderate to strong. What are the potential or actual clinical implications of this work?: For clinical and research purposes (for instance, accurate prescription of augmentative and alternative communication—AAC), healthcare and educational professionals together with parents need to know how functional communication tools converge and how functional communication levels relate to the comprehension of spoken language. The CFCS provides a valid classification of functional communication abilities in children with CP. However, to measure change in functional communication and to evaluate treatment outcomes, use of additional functional communication tools such as the CPCHILD‐DV and FOCUS‐34 is recommended. When discrepancies are found between communicative abilities and spoken language comprehension, it is strongly recommended that valid tools are used in a more detailed examination of the child's spoken language comprehension skills and functional communication. [ABSTRACT FROM AUTHOR]

Background: Data literacy (DL) is vital for teachers, as it enables them to build on data and improve teaching and learning. Therefore, developing DL among pre‐service teachers is critical. Objectives: The purpose of this study is threefold: to evaluate whether a feedback visualisation of peer assessment‐based teaching approach (FVPA‐based teaching approach) can (1) promote pre‐service teachers' DL; (2) enhance their learning motivation; and (3) improve their cognitive load. Methods: The research was conducted based on a pre‐test‐post‐test control group quasi‐experimental design. With 20 participants in the experimental group and 21 in the control group, a total of 41 pre‐service teachers were included in the study. The pre‐service teachers in the experimental group adopted the FVPA‐based teaching approach, and those in the control group adopted the traditional peer assessment‐based learning approach. Results and Conclusions: The experimental group participants outperformed the control group participants in DL, learning motivation, and cognitive load. FVPA was conducive to helping pre‐service teachers critically interpret data, understand their teaching and learning issues, and improve self‐reflection. The findings indicate a reciprocal relationship between learning motivation and DL; improving the learning motivation of pre‐service teachers could promote their DL. Implications: This study contributes to current knowledge by providing empirical evidence on the benefits of an FVPA‐based teaching approach in improving pre‐service teachers' DL, motivation, and cognitive load. The study findings, limitations, and prospects for future research are discussed. Lay Description: What is already known about this topic?: Teacher data literacy has emerged as a crucial competency for the forthcoming generation of educators, gaining attention from education institutions globally.Peer assessment, a well‐established practice in pre‐service teacher education, has proven effective in enhancing the learning experience for disadvantaged students by fostering motivation and improving academic performance.Despite the acknowledged benefits of feedback visualisation in facilitating self‐reflection, motivation, and academic performance, creating meaningful visualisations remains a challenge for educators and learners. What this paper adds?: This study introduces feedback visualisation in peer assessment to enhance comprehension of feedback information among pre‐service teachers.Feedback visualisation augments the benefits derived from peer assessment, refining data literacy, improving learning motivation, and alleviating cognitive load among pre‐service educators.The analysis of data directly relevant to pre‐service teachers and the provision of timely feedback can motivate critical analysis and utilisation of data, facilitating the identification of pedagogical and learning challenges.The study explores intricate interactions among learning motivation, data literacy, and cognitive load within the context of peer assessment visual feedback. The implications of study findings for practitioners: We encourage teacher educators to implement peer assessment instruction grounded in visual feedback for a comprehensive understanding of learning outcomes, identification of pedagogical challenges, determination of causes, and evidence‐informed instructional decision‐making.Teacher educator should diversify strategies to augment the motivation of pre‐service teachers, cultivating their proactive engagement in data analysis, interpretation, and application to enhance overall data literacy.We recommend that teacher educators provide rich visual feedback or present complex data in a visually accessible format for pre‐service teachers who need additional assistance to mitigate cognitive load and facilitate successful learning outcomes. [ABSTRACT FROM AUTHOR]

Background: Developmental Language Disorder (DLD) impacts various aspects of children's language abilities, including the processing of inflectional morphology. Prior research suggests that children with DLD exhibit deficits in processing speed and sensitivity to grammatical inflections, yet the relationship between these deficits remains unclear. Aims: This study aimed to investigate the relationship between processing speed and sensitivity to inflectional morphology in children with DLD, focusing on their real‐time processing abilities in response to regular past tense, third person singular, and regular plural inflections at different rates of sentence articulation. Method: Eighteen children with DLD and 18 age‐matched controls underwent word monitoring tasks that assessed sensitivity to grammaticality of inflections in sentences presented at normal and slow rates of articulation. Results: At a normal rate of articulation, children with DLD demonstrated slower response times and reduced sensitivity to grammaticality across all inflections compared to controls. When the articulation rate was slowed, children with DLD showed improved sensitivity, particularly to regular plural and third person singular inflections, although deficits in processing the regular past tense persisted. Conclusions: The findings suggest a significant relationship between processing speed and inflectional morphology sensitivity in children with DLD. Slower articulation rates improved grammatical sensitivity for certain inflections, highlighting the potential of tailored interventions that consider processing speed limitations. Persistent difficulties with the regular past tense inflection indicate the need for targeted support for children with DLD in this area. WHAT THIS PAPER ADDS: What is already known on this subject: Children with Developmental Language Disorder (DLD) have a wide range of language difficulties, but deficits in inflectional morphology are regarded as a 'hallmark' of the disorder. Children with DLD are also very likely to show deficits in speed of processing, although it is not known if a 'slowness to process' can causally explain the language difficulties these children experience. What this study adds to existing knowledge: When grammatical sensitivity was measured using an online real‐time task, children with DLD showed widespread inflectional deficits when sentences were spoken at a normal conversational rate. When sentence articulation rate was slowed down, children with DLD were faster, more accurate and more sensitive to the grammaticality of constructions. However, deficits in the regular past tense remained persistent, even in this slow‐rate condition. What are the clinical implications of this work?: This study has implications for clinical and educational practices that work with children with DLD to improve their language skills. The findings of this study show that when children with DLD are given more time to process incoming information, their grammatical skills significantly improve. This study also shows that deficits in the regular past tense are persistent, and children are likely need extensive and intensive support with this particular grammatical feature. [ABSTRACT FROM AUTHOR]

Previous research has found that music brings back more vivid and emotional autobiographical memories than various other retrieval cues. However, such studies have often been low in ecological validity and constrained by relatively limited cue selection and predominantly young adult samples. Here, we compared music to food as cues for autobiographical memories in everyday life in young and older adults. In two separate four‐day periods, 39 younger (ages 18–34) and 39 older (ages 60–77) adults recorded their music‐ and food‐evoked autobiographical memories in paper diaries. Across both age groups, music triggered more frequent autobiographical memories, a greater proportion of involuntary memories, and memories rated as more personally important in comparison to food cues. Age differences impacted music‐ and food‐evoked memories similarly, with older adults consistently recalling older and less specific memories, which they rated as more positive, vivid, and rehearsed. However, young and older adults did not differ in the number or involuntary nature of their recorded memories. This work represents an important step in understanding the phenomenology of naturally occurring music‐evoked autobiographical memories across adulthood and provides new insights into how and why music may be a more effective trigger for personally valued memories than certain other everyday cues. [ABSTRACT FROM AUTHOR]

Background: Pragmatics has generally been defined as the ability to use language in social situations, it is commonly regarded as the third major component of language ability. To date, there is no tool for assessing early pragmatic development of Chinese‐speaking children. Aims: To describe the translation of the Language Use Inventory (LUI) from English to Mandarin Chinese and to report findings on the Chinese version's reliability, validity and developmental sensitivity. Methods & Procedures: The original English version of the LUI was translated into Mandarin Chinese. Parents of 177 typically developing (TD) toddlers and preschool children completed the inventory to examine its internal reliability and construct validity and how scores differed across ages and sexes. A total of 31 parents out of the 177 completed the LUI‐Mandarin, again within 4 weeks, to assess test–retest reliability. To examine discriminative validity, 43 parents of age‐ and sex‐matched TD children and children with autism spectrum disorder (ASD) recruited from Nanjing Brain Hospital affiliated with Nanjing Medical University completed the LUI‐Mandarin. Outcomes & Results: Cronbach's alpha values for the LUI‐Mandarin's three parts and for 11 of 12 LUI‐Mandarin subscales were 0.707–0.992, with most values in the 0.825–0.992 range. Test–retest reliability ranged from 0.66 to 0.95, indicating good to excellent reliability. Factor analysis of the LUI‐Mandarin revealed two different factors, and the total variance explained was 74.38%. The LUI‐Mandarin total scores and subscale scores increased with age for both boys and girls, providing evidence of the inventory's developmental sensitivity. Girls, however, had higher total scores than boys at earlier ages (18–23 months). The results of the discriminant validity study revealed that performance was significantly lower in the ASD group than in the TD group with respect to LUI total scores and subscale scores (except for subscale A). Conclusions & Implications: The LUI‐Mandarin is the first and only questionnaire available in China that evaluates the pragmatic language skills of children aged between 18 and 47 months. The results of the study show that the LUI‐Mandarin is a valid and reliable tool for Chinese toddlers and preschool children. What this paper adds: What is already known on this subject: The LUI is a parent‐report questionnaire that can provide comprehensive information about very young children's communicative competence. It is widely used both for assessment and to guide intervention. Additionally, it has been translated into French, Italian, Polish, Arabic, Portuguese and Norwegian and it shows good reliability and validity. What this paper adds to existing knowledge: In the present study we describe the translation of the LUI from English to Mandarin Chinese and report findings on the Chinese version's reliability, validity and developmental sensitivity. What are the potential or actual clinical implications of this work?: The LUI‐Mandarin is the first and only questionnaire available in China that can evaluate pragmatic language skills of children aged between 18 and 47 months. The results show that the LUI‐Mandarin is a valid and reliable tool for use with Chinese toddlers and preschool children. [ABSTRACT FROM AUTHOR]

Dysphagia (impaired swallowing) is known to contribute to decreased quality of life, and increased length of hospital stay and mortality post‐stroke. Despite the advancements in stroke treatment with the introduction of thrombolysis and endovascular clot retrieval (ECR), patients continue to present with high rates of dysphagia. Speech and language therapists and stroke teams should consider the presence of haemorrhagic transformation, success of reperfusion and presence of communication deficits as risk factors for dysphagia post‐ECR and/or thrombolysis. Purpose: To establish incidence rates and patterns of dysphagia following the administration of reperfusion therapies in acute ischaemic stroke management. Method: A retrospective review of 193 patients admitted with acute ischaemic stroke to a quaternary stroke unit in Australia over a three year period was completed. Clinical information extracted included demographics, type (thrombolysis and/or endovascular clot retrieval) and success of reperfusion therapy, and the progression of dysphagia and related factors. Results: Over half of all patients treated with reperfusion therapies presented with dysphagia on initial assessment by speech‐language pathology (SLP). The type of reperfusion therapy administered was not significantly correlated with the presence of dysphagia. Dysphagia on initial assessment was significantly correlated with the presence of aphasia on initial assessment, the presence of haemorrhagic transformation, and the success of reperfusion. Increased rates of enteral feeding were also found in this study compared to figures reported in literature. Conclusion: This study identified ongoing high rates of dysphagia amongst this patient population regardless of treatment type, demonstrating the need for ongoing SLP management post stroke. Further research is required in this area to develop an evidence‐base for SLPs and the wider medical team and to inform clinical practice guidelines. What this paper adds: What is already known on the subject: Stroke is one of the leading causes of disability and death internationally. Dysphagia (impaired swallowing), a common sequalae of stroke, is known to contribute to decreased quality of life, increased length of hospital stay and mortality. With advancements in technology, treatments for acute ischaemic stroke (endovascular clot retrieval and thrombolysis) are increasing in popularity. However, limited research exists exploring the impact of these therapies on dysphagia. What this paper adds: Despite the advancements in stroke treatment, patients continue to present with high rates of dysphagia. Dysphagia following thrombolysis and/or ECR was found to be significantly correlated to the presence of aphasia, haemorrhagic transformation, and the success of reperfusion (regardless of treatment type). Additionally, increased rates of enteral feeding were found amongst this patient population compared to figures reported in the literature for patients following traditional stroke management. Clinical implications of this study: Speech‐language pathologists and the wider medical team should consider dysphagia as an ongoing consequence of stroke following reperfusion therapies, with consideration for success of reperfusion and adverse outcomes i.e., haemorrhagic transformation. Further research is required to provide an evidence‐base and specific guidelines for the management of dysphagia post reperfusion therapies, including use of enteral feeding. [ABSTRACT FROM AUTHOR]

Introduction: This study investigates the effectiveness of the segmentation principle from the cognitive theory of multimedia learning as well as the effectiveness of the generative learning strategy of summarization in immersive virtual reality (IVR) within a sample of preadolescents. Although previous research has supported the effectiveness of these instructional methods in multimedia learning, it remains unclear whether segmentation, summarization or the combination of both are superior to a stand‐alone IVR lesson in facilitating learning. Methods: To address this gap, 190 sixth to seventh grade students learned about the human body in an IVR lesson. Students were randomly assigned to one of four experimental conditions: (a) an IVR lesson divided into four segments (segmentation condition); (b) an IVR lesson, where students summarized after the entire lesson (summarizing condition); (c) an IVR lesson presented in four segments, where students summarized after each segment (combined condition); and (d) an IVR lesson without any manipulation (control condition). Results: Results indicated that, compared to the control condition, adding segmentation or summarization to an IVR lesson leads to better transfer, but not to acquiring more factual knowledge. Combining the two methods did not improve learning. Conclusion: The findings support the evidence that choosing appropriate instructional methods for IVR lessons can foster transfer. Lay Description: What is currently known about the subject matter: The use of immersive virtual reality (IVR) in classroom settings is increasing rapidlyThere are mixed results related to the efficiency of using IVR for learning facts and conceptsFew studies have investigated if efficient instructional design guidelines generalize to IVRFew studies have investigated the efficiency of IVR within a children sample What their paper adds: A class‐room investigation of the value of using different instructional design methods for designing IVR lessons within a children sampleResults indicated that, compared to the control condition, adding segmentation or summarization to an IVR lesson leads to better transferAdding segmentation or summarization did not lead to more factual knowledge Implications of study findings for practitioners: Choosing appropriate instructional methods for IVR lessons can foster transferStudents profit most from IVR lessons when they are given opportunities for refection during or following the immersive experience [ABSTRACT FROM AUTHOR]

Background: Speech intelligibility is a global indicator of the severity of a speech problem. It is a measure that has been used frequently in research and clinical assessment of speech. Previous studies have shown that factors, such as measurement method and listener experience, can influence speech intelligibility scores. However, these factors of speech intelligibility assessment have not yet been investigated in people with Down syndrome (DS). Aims: To compare the speech intelligibility scores in speakers with DS measured using two methods: orthographic transcription and visual analogue scale (VAS), by two groups of listeners, experienced listeners and naïve listeners. Also, to examine the relationship across the four sets of speech intelligibility scores by means of correlational analysis. Methods & Procedures: A total of 30 adolescents and adults with DS read or repeated 12 sentences from a standardized test of intelligibility for adults with dysarthria. Each sentence was saved as a separate sound file and the 360 sentences were divided to form eight sets of stimuli. A total of 32 adults (16 experienced and 16 naïve) served as listeners of speech intelligibility. Each listener heard a single set of sentences and independently estimated the level of intelligibility for each sentence using a VAS in one task and wrote down the words perceived (i.e., orthographic transcription) in another task. The order of the two tasks was counterbalanced across listeners and the tasks were completed at least 1 week apart. Outcomes & Results: Repeated‐measures analysis of variance (ANOVA), confirmed by mixed‐methods analysis, showed that the scores obtained using orthographic transcription were significantly higher than those obtained using VAS; and the experienced listeners' scores were significantly higher than the naïve listeners' scores. Spearman rank correlation analysis showed that the four sets of scores across all conditions were strongly positively correlated with each other. Conclusions & Implications: Listeners, both experienced and naïve, may udge speech in DS differently when using orthographic transcription versus VAS as the method of measurement. In addition, experienced listeners can judge speech intelligibility differently compared with listeners who are less exposed to unclear speech, which may not represent 'real‐world' functional communicative ability. Speech and language therapists should be aware of the effect of these factors when measuring intelligibility scores and direct comparison of scores obtained using different procedures and by different groups of listeners is not recommended. What this paper addsWhat is already known on the subjectPrevious research on other clinical groups (e.g., Parkinson's disease) has shown that speech intelligibility scores can vary across different measurement methods and when judged by listeners with different experience. However, these factors have not yet been investigated in people with DS.What this paper adds to existing knowledgeSimilar to the findings reported for other clinical groups, using an impressionistic measurement method, such as VAS, can result in different speech intelligibility scores compared with scores obtained from orthographic transcription in speakers with DS. Furthermore, experienced listeners can perceive intelligibility as better compared with naïve (untrained) listeners for this group.What are the potential or actual clinical implications of this work?When measuring speech intelligibility, speech and language therapists should be aware that scores obtained using orthographic transcription can be higher than those obtained using VAS. They should also be aware that their increased exposure to hearing atypical speech may cause them to judge the speech difficulty as less severe and lead to an inaccurate representation of speech performance. Speech and language therapists should consider these factors when interpreting assessment results and especially when using intelligibility measures for treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: The articulatory accuracy of patients with dysarthria is one of the most affected speech dimensions with a high impact on speech intelligibility. Behavioural treatments of articulation can either involve direct or indirect approaches. The latter have been thoroughly investigated and are generally appreciated for their almost immediate effects on articulation and intelligibility. The number of studies on (short‐term) direct articulation therapy is limited. Aims: To investigate the effects of short‐term, boost articulation therapy (BArT) on speech intelligibility in patients with chronic or progressive dysarthria and the effect of severity of dysarthria on the outcome. Methods & Procedures: The study consists of a two‐group pre‐/post‐test design to assess speech intelligibility at phoneme and sentence level and during spontaneous speech, automatic speech and reading a phonetically balanced text. A total of 17 subjects with mild to severe dysarthria participated in the study and were randomly assigned to either a patient‐tailored, intensive articulatory drill programme or an intensive minimal pair training. Both training programmes were based on the principles of motor learning. Each training programme consisted of five sessions of 45 min completed within one week. Outcomes & Results: Following treatment, a statistically significant increase of mean group intelligibility was shown at phoneme and sentence level, and in automatic sequences. This was supported by an acoustic analysis that revealed a reduction in formant centralization ratio. Within specific groups of severity, large and moderate positive effect sizes with Cohen's d were demonstrated. Conclusions & Implications: BArT successfully improves speech intelligibility in patients with chronic or progressive dysarthria at different levels of the impairment. What this paper addsWhat is already known on the subjectBehavioural treatment of articulation in patients with dysarthria mainly involves indirect strategies, which have shown positive effects on speech intelligibility. However, there is limited evidence on the short‐term effects of direct articulation therapy at the segmental level of speech. This study investigates the effectiveness of BArT on speech intelligibility in patients with chronic or progressive dysarthria at all severity levels.What this paper adds to existing knowledgeThe intensive and direct articulatory therapy programmes developed and applied in this study intend to reduce the impairment instead of compensating it. This approach results in a significant improvement of speech intelligibility at different dysarthria severity levels in a short period of time while contributing to exploit and develop all available residual motor skills in persons with dysarthria.What are the potential or actual clinical implications of this work?The improvements in intelligibility demonstrate the effectiveness of a BArT at the segmental level of speech. This makes it to be considered a suitable approach in the treatment of patients with chronic or progressive dysarthria. [ABSTRACT FROM AUTHOR]

Background: Information is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts treatment prognosis. Aims: To investigate the predictors of treatment dropout and treatment outcome for children who were treated for early stuttering with the Lidcombe Program (N = 277). Methods & Procedures: A total of 32 variables were used as predictors in regression analyses of short‐ and medium‐term Lidcombe Program outcome, and of treatment dropout. Outcomes & Results: Regression analyses associated children who have better language skills and easy temperament with better treatment outcome, although only a small portion of the variance of treatment outcome was accounted for by these variables. There was an association between treatment dropout and parental scores on a personality screening tool relating to their impulsivity. Conclusions & Implications: Variables identified as predictors of Lidcombe Program treatment outcome were statistically significant, but not clinically significant. They did not account for a clinically substantive portion of treatment outcomes. Findings about parental impulsivity and their relationship with intervention drop‐out require replication with prospective methods and comprehensive assessment of parent psychological status. This is particularly important because parents are involved in conducting all early interventions. What this paper addsWhat is already known on the subjectInformation is available about what predicts Lidcombe Program treatment time, but nothing is known about what predicts Lidcombe Program treatment outcome.What this paper adds to existing knowledgeThere are predictors of Lidcombe Program treatment outcome that are statistically significant, but none are clinically significant.What are the potential or actual clinical implications of this work?Clinicians can tell parents that nothing has been found that can assist with making prognostic indications about treatment outcome for their children. [ABSTRACT FROM AUTHOR]

Background: A total of 68% of pre‐school children with cleft palate have speech problems requiring speech therapy. There is a lack of access to regular targeted therapy. Parent training leads to positive outcomes in early communication skills in cleft palate and non‐cleft speech disorders. Connected health has been used to address inadequate access to therapy, providing intervention to those who would not otherwise receive therapy. Aims: To evaluate the speech, activity and participation outcomes of Parent Led, Therapist Supervised, Articulation Therapy (PLAT) compared with routine speech therapy intervention in parent–child dyads. Methods & Procedures: A total of 44 children, aged 2.9–7.5 years, were included in a two‐centre, two‐phase randomized controlled trial. Informed consent and assent were obtained. Participants and speech and language therapists (SLTs) were unblinded to the groups. Parents, in the parent‐trained group (n = 23), attended 2 days' training, received a detailed speech therapy programme, and undertook intervention over 12 weeks supported by the cleft specialist SLT using FaceTime and one face‐to‐face session. In the control arm (n = 21), parent–child dyads received six therapy sessions over 12 weeks with a research SLT, comparable with usual care. Speech recordings were undertaken pre‐ and post‐intervention. Percent consonant correct (PCC) was analysed by external SLTs blinded to the time and group. Activity and participation were measured using the Intelligibility in Context Scale (ICS) and Focus on Outcomes for Children Under Six (FOCUS) questionnaire. Outcomes & Results: There was no evidence of an interaction between Time and Group or an overall statistical difference between groups for PCC scores. There was a statistically significant difference over time for both groups (words: p < 0.002; confidence interval (CI) = 9.38–16.27; d = 0.57; sentences: p < 0.002; CI = 16.04–25.97; d = 0.23). Effect sizes were medium for words and small for sentences. For intelligibility and participation, there was no evidence of an interaction between Time and Group or an overall statistical difference between groups. A statistically significant difference over time was found for intelligibility (F = 29.97, d.f. = 1, 42, p < 0.001, 95 % CI = 1.45–3.15 d = 0.46) and for participation (F = 14.19, d.f. = 1, 41, p < 0.001 95% CI = 7.63–25.03; d = 0.36) with FOCUS results indicating clinically meaningful (parent‐led group) and significant (control group) change in participation. Conclusions & Implications: PLAT can be as effective as routine care in changing speech, activity and participation outcomes for children with cleft palate, when supported by a specialist cleft SLT using connected health. What this paper addsWhat is already known on this subjectOver 50% of children with cleft palate require speech therapy. However, there is a lack of timely, accessible speech therapy services in the UK and Ireland. Previous studies have shown that parents can deliver therapy effectively, and that connected health can support the delivery of speech therapy. This study aims to provide evidence that parent‐led therapy with the supervision of a specialist cleft therapist using FaceTime is effective.What this paper adds to existing knowledgeThis randomized controlled trial indicates that parents can be trained to deliver therapy for children with cleft palate speech disorders, under the supervision of an SLT. This approach results in improved speech, activity and participation outcomes similar to routine care.What are the potential or actual clinical implications of this work?This study indicates that both parent‐led articulation therapy and routine care showed meaningful gains in speech, activity and participation, and that parent‐led articulation therapy when supported by a cleft SLT using connected health could be an additional service delivery model for children with cleft palate speech disorders. [ABSTRACT FROM AUTHOR]

Background: Picture‐naming tests (PNTs) evaluate linguistic impairment in dementia due to semantic memory impairment, impaired lexical retrieval or perceptual deficits. They also assess the decline in naming impairment at various stages of dementia and mild cognitive impairment (MCI) that occurs due to progressive cognitive impairment. With the increasing numbers of people with dementia globally, it is necessary to have validated naming tests and norms that are culturally and linguistically appropriate. Aims: In this cross‐sectional study we harmonized a set of 30 images applicable to the Indian context across five languages and investigated the picture‐naming performance in patients with MCI and dementia. Methods & Procedures: A multidisciplinary expert group formed by the Indian Council of Medical Research (ICMR) collaborated towards developing and adapting a picture naming test (PNT) known as the ICMR‐PNT in five Indian languages: Hindi, Bengali, Telugu, Kannada and Malayalam. Based on cross‐cultural adaptation guidelines and item‐wise factor analysis and correlations established separately across five languages, the final version of the ICMR‐PNT test was developed. A total of 368 controls, 123 dementia and 128 MCI patients were recruited for the study. Psychometric properties of the adapted version of the ICMR‐PNT were examined, and sensitivity and specificity were examined. Outcomes & Results: The ICMR‐PNT scores in all languages combined were higher in controls compared with patients with dementia and MCI (F2, 615 = 139.85; p < 0.001). Furthermore, PNT scores for MCI was higher in comparison with patients with dementia in all languages combined (p < 0.001). The area under the curve across the five languages ranged from 0.81 to 1.00 for detecting dementia. There was a negative correlation between Clinical Dementia Rating (CDR) and ICMR‐PNT scores and a positive correlation between Addenbrooke's Cognitive Examination—III (ACE‐III) and ICMR‐PNT scores in control and patient groups. Conclusions & Implications: The ICMR‐PNT was developed by following cross‐cultural adaptation guidelines and establishing correlations using item‐wise factor analysis across five languages. This adapted PNT was found to be a reliable tool when assessing naming abilities effectively in mild to moderate dementia in a linguistically diverse context. What this paper adds: What is already known on this subject: Picture‐naming evaluates language impairment linked to naming difficulties due to semantic memory, lexical retrieval or perceptual disturbances. As a result, picture naming tests (PNTs) play an important role in the diagnosis of dementia. In a heterogeneous population such as India, there is a need for a common PNT that can be used across the wide range of languages. What this study adds to existing knowledge: PNTs such as the Boston Naming Test (BNT) were developed for the educated, mostly English‐speaking, Western populations and are not appropriate for use in an Indian context. To overcome this challenge, a PNT was harmonized in five Indian languages (Hindi, Bengali, Telugu, Kannada and Malayalam) and we report the patterns of naming difficulty in patients with MCI and dementia. The ICMR‐PNT demonstrated good diagnostic accuracy when distinguishing patients with mild to moderate dementia from cognitively normal individuals. What are the potential or actual clinical implications of this work?: With the growing number of persons suffering from Alzheimer's disease and other forms of dementia around the world, its critical to have culturally and linguistically relevant naming tests and diagnosis. This validated ICMR‐PNT can be used widely as a clinical tool to diagnose dementia and harmonize research efforts across diverse populations. [ABSTRACT FROM AUTHOR]

Background: It is estimated that up to one in three lesbian, bisexual or queer (LBQ) women in Australia have children. In the past decade, it has become common for LBQ women to pursue pregnancy using clinic‐acquired donor sperm. Aims: The aims of this paper are to explore pathways to parenthood among Australian LBQ women in the context of increased access to fertility clinics and identify the type of clinical fertility services being used. Materials and method: This paper reports on female LBQ parents and expectant/prospective parents who participated in a 2016/2017 online survey of Australian lesbian, gay, bisexual, transgender and queer (LGBTQ) adults exploring reproductive choices, pathways to parenthood, conception method and use of clinical fertility services. Results: More than half the children reported on by current parents (52%) had been conceived using clinical fertility services. When asked what factors influenced a parent respondent's decision to use fertility services: 80% indicated access to donor sperm, 41% indicated fertility problems. Of respondents who had accessed donor sperm, over half (57%) had used in vitro fertilisation (IVF) services. Conclusions: These findings indicate that use of fertility clinics to access donor sperm is common for LBQ women, including those with no known fertility problems, and that most women who access donor sperm conceive using IVF rather than intrauterine insemination. More needs to be known about the context and reasons for this, including factors that influence LBQ women's decision making on their pathway to parenthood. [ABSTRACT FROM AUTHOR]

Background: Articulatory excursion and vocal intensity are reduced in many children with dysarthria due to cerebral palsy (CP), contributing to the children's intelligibility deficits and negatively affecting their social participation. However, the effects of speech‐treatment strategies for improving intelligibility in this population are understudied, especially for children who speak languages other than English. In a cueing study on English‐speaking children with dysarthria, acoustic variables and intelligibility improved when the children were provided with cues aimed to increase articulatory excursion and vocal intensity. While French is among the top 20 most spoken languages in the world, dysarthria and its management in French‐speaking children are virtually unexplored areas of research. Information gleaned from such research is critical for providing an evidence base on which to provide treatment. Aims: To examine acoustic and perceptual changes in the speech of French‐speaking children with dysarthria, who are provided with speech cues targeting greater articulatory excursion (French translation of 'speak with your big mouth') and vocal intensity (French translation of 'speak with your strong voice'). This study investigated whether, in response to the cues, the children would make acoustic changes and listeners would perceive the children's speech as more intelligible. Methods & Procedures: Eleven children with dysarthria due to CP (six girls, five boys; ages 4;11–17;0 years; eight with spastic CP, three with dyskinetic CP) repeated pre‐recorded speech stimuli across three speaking conditions (habitual, 'big mouth' and 'strong voice'). Stimuli were sentences and contrastive words in phrases. Acoustic analyses were conducted. A total of 66 Belgian‐French listeners transcribed the children's utterances orthographically and rated their ease of understanding on a visual analogue scale at sentence and word levels. Outcomes & Results: Acoustic analyses revealed significantly longer duration in response to the big mouth cue at sentence level and in response to both the big mouth and strong voice cues at word level. Significantly higher vocal sound‐pressure levels were found following both cues at sentence and word levels. Both cues elicited significantly higher first‐formant vowel frequencies and listeners' greater ease‐of‐understanding ratings at word level. Increases in the percentage of words transcribed correctly and in sentence ease‐of‐understanding ratings, however, did not reach statistical significance. Considerable variability between children was observed. Conclusions & Implications: Speech cues targeting greater articulatory excursion and vocal intensity yield significant acoustic changes in French‐speaking children with dysarthria. However, the changes may only aid listeners' ease of understanding at word level. The significant findings and great inter‐speaker variability are generally consistent with studies on English‐speaking children with dysarthria, although changes appear more constrained in these French‐speaking children. What this paper addsWhat is already known on the subjectAccording to the only study comparing effects of speech‐cueing strategies on English‐speaking children with dysarthria, intelligibility increases when the children are provided with cues aimed to increase articulatory excursion and vocal intensity. Little is known about speech characteristics in French‐speaking children with dysarthria and no published research has explored effects of cueing strategies in this population.What this paper adds to existing knowledgeThis paper is the first study to examine the effects of speech cues on the acoustics and intelligibility of French‐speaking children with CP. It provides evidence that the children can make use of cues to modify their speech, although the changes may only aid listeners' ease of understanding at word level.What are the potential or actual clinical implications of this work?For clinicians, the findings suggest that speech cues emphasizing increasing articulatory excursion and vocal intensity show promise for improving the ease of understanding of words produced by francophone children with dysarthria, although improvements may be modest. The variability in the responses also suggests that this population may benefit from a combination of such cues to produce words that are easier to understand. [ABSTRACT FROM AUTHOR]

Given the widespread use of touch screen devices, the effect of the users' fingers on information processing and learning is of growing interest. The present study drew on cognitive load theory and embodied cognition perspectives to investigate the effects of pointing and tracing gestures on the surface of a multimedia learning instruction. Learning performance, cognitive load and visual attention were examined in a one‐factorial experimental design with the between‐subject factor pointing and tracing gestures. The pointing and tracing group were instructed to use their fingers during the learning phase to make connections between corresponding text and picture information, whereas the control group was instructed not to use their hands for learning. The results showed a beneficial effect of pointing and tracing gestures on learning performance, a significant shift in visual attention and deeper processing of information by the pointing and tracing group, but no effect on subjective ratings of cognitive load. Implications for future research and practice are discussed. Lay Description: What is currently known about the subject matter? Pointing and tracing gestures enhance learning with multimediaThe effect is true for paper based and digital learning instructionsLess is known about the cause of this effect with regard to complex learningDifferent theoretical explanations are currently discussed What our paper adds to this A detailed analysis of the effect using eye‐tracking and touch screen dataEvidence that the effect of pointing and tracing is mediated by eye‐movementsRelevant information concerning the discussion about theoretical explanations The implications of study findings for practitioners Pointing and tracing gestures can guide the learners' visual focus of attentionPointing and tracing gestures can increase the learners' visual attentionPointing and tracing gestures foster information processing when learning with multimediaLearners can or even should use pointing and tracing gestures to support learning [ABSTRACT FROM AUTHOR]

Background: Video‐based training has been widely adopted by private organizations and public authorities to educate occupants on various types of building emergencies. However, the effectiveness of video‐based training for preparing occupants for building emergencies has not been rigorously studied nor has the impact of emergency type been investigated on training effectiveness. Objectives: This study examines whether video‐based training is an effective method to prepare occupants for building emergencies and how the effectiveness differs in the context of different building emergencies. Methods: We simulated fire and active shooter emergencies in a virtual office building and conducted evacuation experiments to examine participants' emergency responses using both objective and subjective metrics. A total of 108 participants were recruited and responded to the fire or active shooter incident with or without video‐based training. Results and Conclusions: The results revealed that participants with video‐based training more often chose to follow other recommendations when responding to building emergencies instead of simply following others. Results from ANOVA showed that training increased participants' self‐efficacy significantly, especially for those in the active shooter group. Moreover, participants in the active shooter simulation had a higher level of response efficacy than those in the fire emergency simulation. Our results also demonstrated the influence of emergency type on participants' final decisions and considerations of the recommendations. Implications: Our results suggested that video‐based training is effective in improving participants' emergency preparedness and changing their behaviour patterns to a certain extent such as reducing following behaviour and encouraging safe evacuations. Additionally, statistically significant interactions between video‐based training and emergency types suggested that training effectiveness should be considered in accordance with the emergency type. Lay Description: What is already known about this topic: People can behave differently in different types of building emergencies. Understanding human behaviours in building emergencies is essential for developing emergency preparedness strategies.Emergency training is important for building occupants and video is a widely used media for emergency training. However, its training effectiveness needs to be evaluated. What this paper adds: We used virtual environments to investigate evacuation behaviour.The effectiveness of video‐based training and human responses in building emergencies were studied on both subjective responses and objective measurements.Video‐based training significantly reduced the occurrence of following behaviours.The different natures of the fire emergency and active shooter incidents shape the effectiveness of video‐based training. Implications of study findings for practitioners: Video‐based training can improve building occupants' emergency preparedness to a certain extent.Emergency training media should be designed considering the influence of emergency type. [ABSTRACT FROM AUTHOR]

Background: Treatment of paediatric trauma requires specialized infrastructure, medical equipment, medical staff and ancillary support personnel that have been specifically trained for such tasks. Aims and Objectives: To examine the perceptions and attitudes of physicians and nurses in general and paediatric emergency departments (PEDs) on training, confidence, and management of paediatric trauma in order to facilitate the establishment of an optimal model for admitting and treating paediatric trauma patients. Design: Drawing on published literature and a previously conducted qualitative study that explored the provision of medical care to paediatric trauma patients, we conducted an attitude survey. Methods: A 26‐item paper‐based questionnaire was distributed by nurse managers to all staff working within general EDs and PEDs of 22 medical centres across Israel. Results: Of 843 physicians and nurses who completed the survey, 61.1% considered PEDs the most appropriate facility for treating both minor and severe paediatric trauma, 88.5% believed that minor paediatric trauma should be treated in designated paediatric trauma centres, and 53.6% deemed that paediatric emergency medicine specialists are the most suitable primary decision makers in paediatric trauma. PED teams expressed greater professional confidence for treating paediatric trauma and multiple casualty incident patients. Greater professional confidence was positively correlated with paediatric trauma training, greater exposure to paediatric trauma cases, and working in larger medical centres. Conclusions: The results of the current study suggest that PEDs are perceived to be more appropriate for dealing with paediatric trauma. Also, treatment of severe trauma may be more appropriate in centres that admit large numbers of paediatric trauma cases. Relevance to clinical practice: Emergency medicine teams should undergo training for dealing with paediatric trauma. Such training would develop their skills, increase their confidence, and enhance their emotional abilities to cope with paediatric trauma. [ABSTRACT FROM AUTHOR]

Prior studies have focused on general technology use and technology use in domain‐general applications and quantity of technology use. Recent evidence suggests that investigations should consider how technology is used in more contextually specific ways, including how technology is used for various cognitive tasks in specific classrooms. The purpose of this study was to examine the ways in which classroom content area and student goal orientation have a coordinated influence for how students used technology to support learning. The sample included high school students in a Midwestern state who were surveyed on their motivation and how they used technology to support learning. The study employed hierarchical linear modelling to examine how goal orientation and classroom content area predicted various levels of Bloom's Digital Taxonomy. Students who adopted mastery‐oriented goals were more likely to use technology for various cognitive tasks, especially those at higher levels of complexity. Lastly, the association between mastery goal orientation and some aspects of technology use was conditioned on content area, although effect sizes were small. This study showed that, overall, technology is used differentially across four core content areas. Students in mathematics classrooms used technology less, however much of technology use was evident at lower cognitive levels. Second, students' goal orientation, and in particular their mastery goals influence how technology is used across content areas, and this is marginally conditioned on content area. Technology use should match the instructional context to maximize technology use and students' goal orientation. Lay Description: What is already known about this topic: Computer technology tools support cognitive engagementTechnology tool availability differs by content areaStudent motivation is often positively related to increased technology use What this paper adds: Student technology use for various cognitive tasks differed by content areaStudents with mastery goals were more likely to use technology differentlyMotivational patterns' effect on technology use did not differ by content areaStudents in math used technology qualitatively less than other content areas Implications for practice and/or policy: Greater emphasis should be placed on choosing technology to match content areasTechnology should be appropriately chosen to maximize cognitive learning tasksTo support technology use, teachers should help student mastery learning goals [ABSTRACT FROM AUTHOR]

Child homicides are rare occurrences, but when they occur, they often cause significant outrage. This paper examines the role of varying degrees of intimacy between victims and perpetrators in determining characteristics in child homicide cases. Focusing on 533 cases of child homicide between 1985 and 2012 in Ontario, Canada, characteristics of intrafamilial and extrafamilial cases, biological and step/foster parents, and maternal and paternal perpetrators are compared. Results show that characteristics of the child homicide vary depending on the degree of intimacy between victims and perpetrators, including: perpetrator and victim age, weapon use, suicide following the offence, sexual violence and use of excessive force. These findings provide support for developmental victimology and a routine activities theoretical perspective. Suggestions for future research and policy implications are also discussed. 'Examines the role of varying degrees of intimacy between victims and perpetrators in determining characteristics in child homicide cases' Key Practitioner Messages: Younger children are at a greater risk of homicide from family members, while older children are at a greater risk of homicide from individuals outside the family.Developmental victimology and routine activities theory can contribute to a better understanding of the dynamics between victims and perpetrators in child homicide.Collaboration should take place between researchers, child death review committees, mental health services, social services and policymakers to improve child homicide prevention and intervention initiatives. [ABSTRACT FROM AUTHOR]

The present study investigates affective‐motivational, attention, and learning effects of unexplored emotional design manipulation: Contextual animation (animation of contextual elements) in multimedia learning game (MLGs) for children. Participants (N = 134; Mage = 9.25; Grades 3 and 4) learned either from an experimental version of the MLG with a high amount of contextual animation or from an identical MLG with no contextual animation (control). Children strongly preferred (χ2 = 87.04, p <.001) and found the experimental version more attractive (p <.001, d = −1.11). No significant differences in overall enjoyment and learning outcomes were found. Attention differences, measured by dwell times and fixation durations, were small and reached only borderline significance (p =.035; d = −0.39). The implication is that contextual animation in MLG for children increases such instructional materials' attractiveness without compromising cognitive processes needed for learning; however, it does not lead to their higher instructional efficiency. Lay Description: What is already known about this topic: Contextual animation is frequently used in multimedia learning games (MLGs) for children.Contextual animation is understood to be non‐expository picture motion, which can be added to already existing representational pictures that provide context for target instruction.It is not known whether or not contextual animation, which embellishes already existing representational contextual pictures, harms learning for children in the case of MLGs. What this paper adds: Children (Grades 3 and 4) strongly prefer the game with added contextual animation compared to the game without it.No between‐group differences in overall learning enjoyment and learning outcomes were found.Small attention‐allocation effects of borderline significance were detected. Implications for practice Adding contextual animation (i.e., added non‐expository picture motion) to multimedia learning games for children will increase the attractiveness of the materials and will not hamper learning. Investment into the production of costly contextual animation may be worthwhile in the case of instructional games intended for uncontrolled settings (e.g., at home or during leisure time). In formal contexts (e.g., school), it is less clear whether investment into contextual animation is needed, since children are extraneously motivated to learn and animation does not appear to enhance learning outcomes. [ABSTRACT FROM AUTHOR]

We used a randomized controlled trial to investigate if a mobile game, GraphoLearn (GL), could effectively support the learning of first graders (N = 70), who have severe difficulties in reading and spelling. We studied the effects of two versions of the game: GL Reading, which focused on training letter‐sound correspondence and word reading; and GL Spelling, which included additional training in phonological skills and spelling. During the spring of first grade, the children trained with tablet computers which they could carry with them during the six‐week intervention. The average exposure time to training was 5 hr 44 min. The results revealed no differences in the development of reading or spelling skills between GL players and the control group. However, pre‐training self‐efficacy moderated the effect among GL Reading players: children with high self‐efficacy developed more than the control group in word reading fluency, whereas children with low self‐efficacy developed less than the control group in spelling. Lay Description: What is already known: Serious games can support children's reading achievement, but less is known about their effects in mobile learning.GraphoLearn (GL) is a serious game designed to support reading acquisition, but previous studies suggest its effect on word‐level reading is limited.Explicit training of phonological skills and spelling could facilitate transfer to word reading.Self‐efficacy predicts persistence and effort in achievement situations but its role in mobile game‐based learning is not well known. What this paper adds: A randomized controlled trial was used to study if mobile game‐based learning supports children with reading difficulties.A new GL version, training phonological and spelling skills, had no effect on the development of reading and spelling skills.Children with high self‐efficacy benefited from training with the standard GL. Implications for practitioners: When using mobile games as support tools, close attention should be paid to learner characteristics and game design.Children with high self‐efficacy may be better able to regulate their behaviour during independent training with mobile games, leading to better learning outcomes. [ABSTRACT FROM AUTHOR]

Retrieval practice promotes retention more than restudying (i.e., the testing effect) and is applied to many educational settings. However, little research has investigated means to enhance this effect in educational settings. Theoretical accounts assume retrieval practice to be the most effective whenever retrieval is difficult but successful. Therefore, we developed a novel retrieval practice procedure, which adapts to learners' abilities and can be applied irrespective of learning content. This adaptive procedure aims to make retrieval gradually easier whenever students provide an incorrect answer. In a field experiment, students read book chapters as part of a weekly university course. In three consecutive weeks, they then practiced reading assignments by (a) adaptive testing, (b) non‐adaptive testing and (c) restudy. In Week 4, a surprise criterial test took place. Restudy outperformed both testing conditions, whereas adaptive testing performed equally well as non‐adaptive testing. However, exploratory analyses revealed that with increasing retention intervals, the superiority of restudy disappeared. Furthermore, whenever participants fully read the assignments and retention intervals increased, adaptive testing outperformed non‐adaptive testing. In sum, adaptive retrieval practice did not prove to be generally superior, but retention interval and students' preparation for class might be conditions rendering adaptive retrieval useful in educational settings. Lay Description: What is already known about this topic: Testing is a commonly used technique to assess progress in computer‐assisted learning environmentsStudents often benefit from the testing effect, that is practicing retrieval of information (testing) from memory benefits long‐term retention compared to restudyingCurrently, empirical evidence how to enhance the benefits of this technique in educational contexts is scarce What this paper adds: We propose a new approach to increase the benefit of the testing effect: For each question in retrieval practice the individual ability to retrieve this information from memory is consideredTo do so, cue informativeness of retrieval cues adapts to the individual ability level and thus makes the tests cognitively effortful but solvableThis adaptive approach is put to test in a higher education context and by using multiple‐choice questionsIn sum, adaptive retrieval practice did not prove to be generally superior to non‐adaptive retrieval practice or restudy However, retention interval and students' preparation for class might be conditions rendering adaptive retrieval useful in educational settings Implications for practice and/or policy: Findings can be implemented in educational contexts when multiple‐choice questions are used to enhance learningLearning can be optimized in computer‐assisted learning environments that allow adaptive testingWe advise adaptive retrieval only when students are well prepared for practice and when time between practice and final assessment exceeds two weeks [ABSTRACT FROM AUTHOR]

Previous studies on the interactive response system (IRS) have generally adopted the lecture method to facilitate teaching and learning, while few have made efforts to investigate the learning effects of instructional methods and IRS activities on learning and teaching. The purpose of the present study was therefore to explore whether the use of the IRS with two different teaching methods would affect students' learning performance. A quasi-experimental design was employed, with the teacher conducting the course using the learner as leader strategy in the experimental group (E.G.) and the teacher leader strategy in the control group (C.G.). The experiment was conducted over a period of 15 weeks (a semester), and questionnaires were administered at the beginning, in the middle and after the experiment to elicit the learners' views on the IRS application. The results support previous research which found that using the IRS improved learners' engagement and interaction. They also provide further evidence that the use of the IRS with both teaching strategies not only had a short-term learning effect but could also be a tool for sustaining students' learning motivation and self-directed learning for long-term learning purposes. Besides, the use of the learner as leader strategy contributed to enhancing discussion in groups, especially for the leading groups. The use of the IRS with the learner as leader strategy benefited those who acted as leaders in taking the initiative to learn the course content, and also engaged the students who acted as learners in concentrating on the course because it was their classmates who were leading. Lay Description What is already known about this topic The interactive response system (IRS) facilitates course interaction, and increases course attendance and learning performance, Most studies have integrated the IRS with lectures to facilitate teaching and learning, What this paper adds The paper explored the effectiveness of using the IRS with two teaching methods on students' learning for a semester., The use of the learner as leader strategy with IRS benefited the learners who acted as leaders in taking the initiative to learn the course content, and engaged the students who acted as learners in concentrating on the course., Implications for practice and/or policy Students are benefited in taking the initiative to learn the contents through hosting the IRS activity., Teachers could adopt both lectures and learner as leader strategy with IRS to sustain students' learning motivation and self-directed learning for long-term learning purposes. [ABSTRACT FROM AUTHOR]

In this paper we compare the fidelity of a Peer‐Led Asthma Self‐Management Program for Adolescents (PLASMA) and its attention control. A randomized controlled trial involving two groups—the PLASMA group and the attention control group—was conducted between 2015 and 2018. Adolescents 12–17 years old (N = 259) in three cities in the United States received asthma self‐management education implemented at a day camp, followed by bi‐monthly, follow‐up contact for 12 months. Thirty‐five peer leaders and six adult educators implemented education sessions for the PLASMA and the attention control groups, respectively. The intervention was the peer‐led delivery of the content instead of the educational content itself. This study compares the extent to which the education sessions and follow‐up contacts were implemented in accordance with the study protocol by the peer and adult educators. Most topics on asthma knowledge and skills (85–95%) were delivered as intended at an adequate pace in both groups. Peer leaders missed more content in the psychosocial domain than adult educators—14% versus 0%, respectively (t = −3.7; p =.010). PLASMA participants reported high content and time fidelity for all education sessions (94% to 97.6%). Greater success in bimonthly follow‐up contacts was reported in the attention control groups, with 4.6 (± 1.5) contacts on average compared to 2.6 (±2.02) in the PLASMA groups (t = 9.02; p <.001). Most components of the asthma self‐management program were implemented with high fidelity in both groups. The relatively low fidelity in delivering psychosocial content and performing follow‐up contacts in the PLASMA groups underscores the need for intensive training to enhance peer leaders' competency with managing these aspects of PLASMA to maximize fidelity. Peer leaders can implement asthma self‐management educational components of the intervention with high fidelity similar to adult educators. [ABSTRACT FROM AUTHOR]

The study aims to identify the effect of a flipped classroom approach designed according to the cognitive theory of multimedia learning on the academic achievements of eighth‐grade students (aged 14 years) in Saudi Arabia in computer science. To this end, a quasi‐experimental design was used, with a sample of 67 students; 33 students were assigned to the experimental group, whereas 34 comprised the control group. The experimental group was subjected to the flipped classroom approach, whereas the control group was given direct instruction. To measure student achievements, an instrument that measures cognitive skills based on Revised Bloom's taxonomy levels was designed. Findings revealed a positive effect on the experimental group's achievement levels with respect to Bloom's higher order thinking skills, that is, applying, analysing, and evaluating. No difference was found between the two groups in terms of academic achievements at the remembering and understanding levels of Bloom's taxonomy. Moreover, learners with low prior knowledge showed a higher improvement in academic achievements compared with those with high prior knowledge. This corresponds to the assumption of the cognitive theory of multimedia learning that learners with low prior knowledge would benefit from its principles more than learners with high prior knowledge. Lay Description: What is already known about this topic: Increasingly, K‐12 teachers around the world are using the flipped classroom approach (FCA) with their students.Previous studies have shown mixed results on the effects of flipped learning on academic achievements.Scholarly research is limited regarding the use of cognitive theory of multimedia learning (CTML) as a theoretical framework for designing instructional videos in flipped learning.Several flipped learning studies have not provided data of their outcomes or assessment as per level of cognition. What this paper adds: This study presents an improved approach for flipped learning by integrating CTML with flipped learning.A comparison was conducted for the effects of FCA designed according to CTML on the academic achievements of students with high and low prior knowledge.A proposed model has been introduced for the application of flipped learning in K‐12 education. Implications for practice and/or policy: Designing instructional videos in flipped learning should be based on a theoretical framework.Flipped learning research needs to employ Bloom's taxonomy to understand the outcomes or assessments according to cognition levels.Adopting FCA designed according to CTML may be more important for teachers whose students clearly suffer from poor academic achievements. [ABSTRACT FROM AUTHOR]

Objective This study aims to ascertain if differences exist in the perception of the professional practice environment and personal well-being of nurses across different geographical areas in Queensland. Design This paper was performed on a prospective, self-report cross-sectional on-line survey. Setting The study was conducted among the nurses employed in public and private health care settings: acute hospitals, community health and aged care in Queensland, Australia. Participants Participants of this study were 1608 registered and enrolled nurses and assistants in nursing, current members of the Queensland Nurses Union in 2013 and who provided a workplace postcode. One thousand eight of these participants worked in major cities, while 382 in rural locations and 238 in remote areas. Interventions None. Main outcome measures Scores of well-being as determined by the following scales: the Depression, Anxiety and Stress Scale, the Professional Quality of Life Scale version 5, the Connor-Davidson Resilience Scale and of the Professional Practice Environment using the Practice Environment Scale - Nursing Work Index Revised. Results Nurses employed in major cities perceived 'nursing foundations for quality care' more favourably than those from other settings. Remote area nurses had lower levels of secondary traumatic stress than nurses in major cities and rural areas. There was no difference between nurses across their geographical locations for stress, anxiety, depression, compassion satisfaction, burnout, resilience and the four other measures of the Practice Environment Scale. Conclusions The study findings provide new data suggesting that, with the exception of secondary traumatic stress, the personal well-being of nurses does not differ across geographical settings. Similarly, with the exception of the subscale of 'nursing foundations for quality care' there was no difference in perceptions of the professional practice environment. As secondary traumatic stress is associated with burnout, this finding needs to be investigated further. [ABSTRACT FROM AUTHOR]

Poor diet quality (diet diversity and animal‐source food [ASF] consumption) during childhood negatively affects growth, development, behaviour and physiologic function in later life. Relatively less is known about the impact of poor diet on the growth of school‐age children compared to children <5 years of age, especially in low/middle‐income countries. A better understanding of delivery strategies for effective interventions to improve diet and hence growth in school‐age children is needed. A 36‐month longitudinal controlled impact evaluation in rural Nepal assessed the nutrition and growth of children <5 years of age in families assigned via community clusters to full package intervention (community development, training in nutrition [during pregnancy and for children <5 years] and livestock husbandry), partial package (training only) or control (no inputs). Concurrent data were collected prospectively (baseline plus additional four rounds) on school‐age children (5–8 years at baseline) in these households; the present study analysed findings in the cohort of school‐age children seen at all five study visits (n = 341). Diet quality improved more in the full package school‐age children compared to those in partial package or control households. full package children consumed more ASF (β +0.40 [CI 0.07,0.73], p < 0.05), more diverse diets (β +0.93 [CI 0.55,1.31], p < 0.001) and had better head circumference z‐scores (β +0.21 [CI 0.07,0.35], p < 0.01) than control children. In conclusion, a multi‐sectoral community development intervention was associated with improvements in diet and growth of school‐age children in rural Nepal even though the intervention focused on the diet of children <5 years of age. The diet and growth of school‐age children can be favourably influenced by community‐level interventions, even indirectly. Key messages: Relatively less is known about the factors that influence diet quality and growth in school‐age children compared to younger children, especially in low‐ and middle‐income countries.Better diet quality and growth were found among school‐age children whose families participated in an impact study multi‐sectoral intervention compared to children in control families or those whose families only received nutrition training.Diet and growth of school‐age children can be favourably influenced by community‐level interventions. [ABSTRACT FROM AUTHOR]

This study developed a web‐based multimedia assessment system (WMA system) and applied it to science laboratory instruction. The goal was to improve students' knowledge acquisition under science laboratory instruction. The developed system enabled learners to perform self‐assessments by responding to multimedia technology test items online. The system recorded each learner's complete answer history and provided the students with personalized learning resources. This study adopted a quasi‐experimental research design. The learning content was an "experiment on separating mixtures." Students participating in the research were divided into a typical science laboratory instruction group (TI group; n = 25) and a group that received instruction through the WMA system (WMA group; n = 26). Before instruction, all the students completed the conceptual knowledge and experimental knowledge pretests. During instruction, the TI group watched the teacher's demonstration experiment, and the students then performed the experiment in a real laboratory. In the WMA group, after learning through the WMA system, the students also performed the experiment in a real laboratory. After instruction, all the students completed the conceptual knowledge and experimental knowledge posttests. The findings indicated that the students in the WMA group showed significantly higher improvements in their scientific conceptual knowledge and experimental knowledge. Lay Description: What is already known about this topic: Although science laboratory instruction is important to science education, the role of science laboratory instruction in science education has been increasingly questioned.Many teachers still follow outmoded science laboratory instruction methods in their teaching, which makes students treat scientific experiments as "following recipes to cook."Multimedia technology is effective in assisting science laboratory instruction because proper scientific experiment course and computer‐simulated activities allow students to solve scientific problems dynamically.What this paper adds: This research proposed an effective approach to perform science laboratory instruction based on digital self‐assessment and combines it with the teaching activities in a real laboratory.The web‐based multimedia assessment system (WMA system) are developed to administer multimedia technology test items and assist students in performing self‐assessment in science laboratory instruction.Integrating WMA system into science laboratory instruction is effective in improving students' conceptual knowledge and experimental knowledge.Implications for practice: Conducting scientific experiments online using a self‐assessment approach allows students to examine their own understanding of scientific experimental procedure and receive personalized learning feedback.The online self‐assessment approach could be applied in "flipped learning" of science laboratory instruction to allow learners to do assessment‐centred personalized online learning about scientific concepts and knowledge related to scientific experiment before performing a real scientific experiment. [ABSTRACT FROM AUTHOR]

Background Previous studies on the autobiographical memory ( AM) of depressed patients had inconsistent findings. Various severities of depression in patients in these studies may lead to conflicting results. However, the differences in the procedure of the autobiographical memory tests ( AMTs) may also influence the AM results. Objective In this study, we analyse the results published so far to research the AM characteristics of patients with depressive disorders and identify moderators that affect the assessment results while using AMT in this field. Method A systematic search was conducted using following databases: MEDLINE, Pub Med, Science Direct, Cnki, and Google Scholar, yielding 22 studies of patients with depressive disorders and autobiographical memory published between 1986 and 2010. Results The results of meta-analysis showed that, compared with the control group, the patients with depressive disorders reported less specific AMs ( g = −1.051) and more overgeneralized AMs ( g = 1.115). The patients with depressive disorders also recalled more slowly ( g = 0.400). The effect sizes of overgeneral memory could be predicted by the self-reported depression score of the depressed patients ( B = −.329, p < .01). The mean effect sizes of AMT indices were affected by the AMT characteristics (i.e., number of cue word, max response time, prompting, presentation of cue word, taping, and so on). Conclusions Our results suggest that overgeneralization and response lag are the AM deficits in patients with depressive disorders. The parameters of AMT are important factors, which are related to the inconsistency in the assessment of AM in patients with depressive disorders. Some recommendations on AMT and programme research design are given for future research. Practitioner Points This paper provides new insight into the current understanding of the AM deficits in patients with depressive disorders., This paper gives new recommendations on AMT and program research design for future clinical implications. [ABSTRACT FROM AUTHOR]

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Aim: To test the psychometric properties of the Finnish version of the Dempster Practice Behaviour Scale and explore nurses' professional autonomy along with which characteristics are related to it. Design: An instrument validation and a descriptive cross‐sectional study. Methods: The web‐based survey was conducted in September 2021 at two university hospitals in Finland. Exploratory factor analysis (EFA) was used to explore the factor structure of the modified instrument, while Cronbach's α coefficients were calculated to determine the reliability of the scale. Descriptive univariate and multivariate analyses were conducted to examine Registered Nurses' professional autonomy. The study followed STROBE guidelines. Results: During the validation process, the 30 items of the Dempster Practice Behaviour Scale were reduced to 25 items. The S‐CVI/Ave for the translated scale was 0.94. When one additional item was omitted from the EFA, the results supported five factors, which explained 45.9% of the total variance. The mean overall autonomy score was 3.63 out of 5, with readiness and empowerment the subscales with the highest and lowest, respectively, mean values. The linear regression models showed that age, nursing experience, unit type, education, shift, and perceptions of the importance of professional autonomy were related to the subscales describing professional autonomy. Conclusion: The psychometric testing provided evidence that the translated instrument was reliable. Nurses assessed that they are skilled professionals who are accountable for their actions. However, they experienced rather low levels of professional autonomy in empowerment and valuation. Health care organizations should consider this through authentic leadership and, thus, possibly strengthen professional autonomy. [ABSTRACT FROM AUTHOR]

Aim: This study focuses on the fathers of children with chronic illnesses in an effort to clarify how the stressor and the father's sense of coherence (SOC) influence their mental health and how the father's SOC is associated with the social support. Design: Cross‐sectional study. Methods: We conducted a self‐reported questionnaire survey of 137 respondents (51 fathers of children with chronic illnesses, 86 fathers of healthy children) were statistically using ANOVA. Results: The fathers' stressor was significantly related to their SOC. Furthermore, the SOC of the fathers majorly influenced their mental health, while having a buffering effect on the stressor with respect to depression. And their SOC was significantly positively associated with the social support. Our findings underscore that father's SOC has a buffering effect on self‐mental health and is important for maintaining mental health and enhancing SOC to reduce the stressors of these fathers with respect to depression. [ABSTRACT FROM AUTHOR]

Although sucrose is widely administered to hospitalized infants for single painful procedures, total sucrose volume during the entire neonatal intensive care unit (NICU) stay and associated adverse events are unknown. In a longitudinal observation study, we aimed to quantify and contextualize sucrose administration during the NICU stay. Specifically, we investigated the frequency, nature, and severity of painful procedures; proportion of procedures where neonates received sucrose; total volume of sucrose administered for painful procedures; and incidence and type of adverse events. Neonates <32 weeks gestational age at birth and <10 days of life were recruited from four Canadian tertiary NICUs. Daily chart reviews of documented painful procedures, sucrose administration, and any associated adverse events were undertaken. One hundred sixty‐eight neonates underwent a total of 9093 skin‐breaking procedures (mean 54.1 [±65.2] procedures/neonate or 1.1 [±0.9] procedures/day/neonate) during an average NICU stay of 45.9 (±31.4) days. Pain severity was recorded for 5399/9093 (59.4%) of the painful procedures; the majority (5051 [93.5%]) were heel lances of moderate pain intensity. Sucrose was administered for 7839/9093 (86.2%) of painful procedures. The total average sucrose volume was 5.5 (±5.4) mL/neonate or 0.11 (±0.08) mL/neonate/day. Infants experienced an average of 7.9 (±12.7) minor adverse events associated with pain and/or sucrose administration that resolved without intervention. The total number of painful procedures, sucrose volume, and incidence of adverse events throughout the NICU stay were described addressing an important knowledge gap in neonatal pain. These data provide a baseline for examining the association between total sucrose volume during NICU stay and research on longer‐term behavioral and neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Background and Objective The aim of this study is to analyze the relationship between the subgingival colonization by Candida albicans and other yeasts with the severity of chronic periodontitis ( CP). Material and Methods After sample size calculation, 40 patients with CP and 20 healthy subjects ( HS) were included in the study. Cases of slight-moderate ( MCP, n = 23) and severe CP ( SCP, n = 17) were defined according to the Centers for Disease Control/American Association of Periodontology classification. Subgingival samples were acquired using sterile paper-points from the sulcus or the deepest periodontal pocket of each healthy and subject with CP, respectively, and were cultured aerobically on three selective media. Yeast colonies that grew on the surface of plates were later identified by biochemical reactions. Statistical tests were used to analyze the association between subgingival yeast colonization (number of yeast-positive individuals and colony forming units ( CFU) per subject) and periodontal disease status, considering statistical significance when P < 0.05. Results Although several yeast species were found ( C. parapisilosis, Rhodotorula sp., C. dubliniensis and C. tropicalis), only C. albicans was present in all the patients with yeast-positive CP. Twelve patients (30%) with CP presented yeasts in the subgingival biofilm while only three patients (15%) in the HS group were positive for these microorganisms. No statistical difference was found between the CP and HS groups ( P = 0.084). However, when the CP group was divided on the basis of severity, statistical differences were observed between the SCP and MCP groups (47% vs. 17%, P = 0.043), and between the SCP and HS groups (47% vs. 15%, P = 0.033). No statistical difference was observed between the MCP and HS groups (17% vs. 15%, P = 0.832). High densities of yeasts were found only in patients with MCP and SCP (mean and range 61.25 (0-100) CFU/plate and mean and range 51 (0-101) CFU/plate, respectively). Conclusion In this group of patients, subgingival colonization of some yeasts, especially C. albicans, was associated with the severity of CP. [ABSTRACT FROM AUTHOR]

Background and Objective Gingival crevicular fluid has been suggested as a possible source of biomarkers for periodontal disease progression. This paper describes a technique for the analysis of gingival crevicular fluid from individual sites using mass spectrometry. It explores the novel use of mass spectrometry to examine the relationship between the relative amounts of proteins and peptides in gingival crevicular fluid and their relationship with clinical indices and periodontal attachment loss in periodontal maintenance patients. The aim of this paper was to assess whether the mass spectrometric analysis of gingival crevicular fluid may allow for the site-specific prediction of periodontal disease progression. Material and Methods Forty-one periodontal maintenance subjects were followed over 12 mo, with clinical measurements taken at baseline and every 3 mo thereafter. Gingival crevicular fluid was collected from subjects at each visit and was analysed using matrix-assisted laser desorption/ionization time-of-flight ( MALDI- TOF) mass spectrometry. Samples were classified based upon pocket depth, modified gingival index ( MGI), plaque index and attachment loss, and were analysed within these groups. A genetic algorithm was used to create a model based on pattern analysis to predict sites undergoing attachment loss. Results Three hundred and eighty-five gingival crevicular fluid samples were analysed. Twenty-five sites under observation in 14 patients exhibited attachment loss of > 2 mm over the 12-mo period. The clinical indices pocket depth, MGI, plaque levels and bleeding on probing served as poor discriminators of gingival crevicular fluid mass spectra. Models generated from the gingival crevicular fluid mass spectra could predict attachment loss at a site with a high specificity (97% recognition capability and 67% cross-validation). Conclusions Gingival crevicular fluid mass spectra could be used to predict sites with attachment loss. The use of algorithm-generated models based on gingival crevicular fluid mass spectra may provide utility in the diagnosis of periodontal disease. [ABSTRACT FROM AUTHOR]

In this study, we used eye-tracking methodology for deeper understanding of the refutation text effect on online text comprehension. A refutation text acknowledges the reader's alternative conceptions about a phenomenon, refutes them and presents the correct conceptions. We tested two hypotheses about its facilitation effect: the coherence hypothesis (refutation text is more coherent than standard text, thus facilitating comprehension) and the elaboration hypothesis (refutation text involves deeper processing, thus facilitating comprehension). Forty university students read one refutation text and one non-refutation text about two science topics. Offline data confirmed that refutation text readers recall more scientific facts than non-refutation text readers. Online eye-tracking measures revealed both an increase and a decrease in reading time in response to the refutation statements. Topic-medial text sentences with the correct science facts were fixated for a shorter time when first encountered in the refutation text. Refutation statements, however, increased integrative processing at the end of each text paragraph, as indexed by longer look-back fixation times on topic-final sentences with the science concepts, as well as longer look-back fixation times directed to the refutation statements. These findings support the elaboration hypothesis and are discussed in the light of current accounts of the refutation effect for theory development and educational practice. Lay Description What is already known about this topic: Science texts are often challenging to read, especially when the reader has misconceptions about the topicand must undergo conceptual-change learning in order to successfully comprehend the text., A specific type of text, the refutation text, mayact as a powerful resource in facilitating conceptual change, but findings from process-oriented investigations have been inconclusive with respect to its efficacy in this regard., What this paper adds: Refutation statements lead to faster processing of scientific facts that contradict commonly held misconceptions during the first-pass reading., Refutation statements also encourage readers' later integrative processing during rereading,to monitor and ensure resolution of the conflict between their own conceptions and the conceptual information contained within the text., Implications for practice and/or policy: Immediate introduction of new science concepts in an expository text may not benefit readers' comprehension when they have existing misconceptions within the relevant knowledge domain., The use of sentences explicitly refuting readers' misconceptions has the potential to induce and sustain the conscious and deliberate processing that is required for them to become aware of the conceptual conflict, increasing their likelihood of resolving it., Update made on 05 November 2016, after first online publication: Since the publication of this article, a Practitioner Notes section has been implemented for this journal. This article has been updated with the Practitioner Notes section. [ABSTRACT FROM AUTHOR]

Objective A challenge in studying human salivary glands is to maintain the cells ex vivo in their three-dimensional (3D) morphology with an intact native extracellular matrix ( ECM) environment. This paper established a human salivary 3D organotypic slice culture model that could maintain its physiological functions as well as allowing a direct visualization of the cells. Methods Human salivary biopsies from six patients were embedded in agarose and submerged in cold buffer for thin (50 μm) sectioning using a vibratome. 'Salivary slices' were mechanically supported by a porous membrane insert that allowed an air-liquid interface and cultured in serum-free culture media. Cell viability, proliferation, apoptosis, physiological functions, and gene expression were assessed during 14 days of culture. Results Human salivary slices maintained cell survival (70-40%) and proliferation (6-17%) for 14 days ex vivo. The protein secretory (amylase) function decreased, but fluid (intracellular calcium mobilization) function was maintained. Acinar, ductal, and myoepithelial cell populations survived and maintained their 3D organization within the slice culture model. Conclusion The human salivary slice culture model kept cells alive ex vivo for 14 days as well as maintaining their 3D morphology and physiological functions. [ABSTRACT FROM AUTHOR]

Aim: Moral courage among healthcare workers has been extensively studied. However, few studies have been conducted on oncology specialist nurses, who frequently encounter complex moral situations. This study aimed to describe the current situation regarding moral courage and explored its influence on oncology specialist nurses in China. Design: This was an exploratory, descriptive study. Methods: A convenience sample of 390 nurses was conducted from 15 hospitals in Sichuan Province, China, between March and May 2023. Participants were assessed using the Moral Distress Scale‐Revised, Nurses' Moral Courage Scale and the Moral Sensitivity Questionnaire. Results: The results demonstrated that moral courage was negatively associated with moral distress, and positively associated with moral sensitivity. Having a master's degree or above, an intermediate title or senior title, medical ethics training, moral distress or moral sensitivity contributed to explaining 54.1% of the variance in moral courage. Conclusions: Moral courage was associated with several factors. Developing clinical intervention strategies and effective teaching methods will be critical for improving moral courage. No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]