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Background: Continued professional development (CPD) is required for updated skills and knowledge. This study evaluates the efficacy of a CPD programme for mainstream school teachers. Aims: In an 11‐week intervention programme, speech–language therapists (SLTs) presented the participating teachers with whole‐class teaching techniques aimed at creating a language and communication‐supporting classroom environment. The effects of the intervention on the language development of the students in the teachers' classes were assessed. Methods & Procedures: A total of 211 first‐ and second‐year students (Mage = 7;6, range = 6;5–8;9) underwent standardized language assessments of receptive and expressive language abilities before and after their teachers' participation in the CPD. The students were divided into intervention and delayed intervention groups to enable randomized intervention allocation. Linear mixed modelling was used to estimate the individual and interaction effects of group, time and demographic factors. Outcomes & Results: Significant effects of time, group and school, respectively, but no interaction between time and group indicates that while all students advanced between assessments, the progress was not attributable to the teachers' participation in the CPD. Conclusions & Implications: Results are discussed in light of those of recent studies of universal services to support optimal language development. WHAT THIS PAPER ADDS: What is already known on this subject: Although inconclusive, previous research indicates that intervention delivered to teachers by SLTs has the potential to improve the language abilities of the students in the teachers' classrooms. What this paper adds to existing knowledge: This study explored the language development of first‐ and second‐year mainstream school students whose teachers took part in a CPD programme aimed at establishing language and communication‐supporting teaching techniques. Results indicate that the development of the students' language abilities could not be attributed to the teachers' participation in the CPD. What are the potential or actual implications of the work?: SLTs are often asked to guide teachers and teaching staff rather than themselves conduct individual assessments and interventions. The results of this trial can be used to inform the discussion on how to prioritize between tasks. [ABSTRACT FROM AUTHOR]

Introduction: Media comparison studies examining the effectiveness of immersive virtual reality in education have yielded inconclusive findings, leaving the question of its impact on learning compared to conventional media unanswered. To address this issue, our study employs a novel approach that combines media comparison with an investigation on the influence of broader educational context. Methods: In the experiment, 262 students from two distinct types of lower secondary schools—comprehensive school and multi‐year gymnasium (a selective academic school)—participated. The students received a lesson on topography and contour line interpretation, using either an immersive virtual environment or a PowerPoint slideshow. A transfer test was carried out before, immediately after, and 1 month after the lesson to measure knowledge application. Results: The impact of the media (immersive virtual reality vs. PowerPoint slideshow) on learning outcomes was found to be minimal, with no clear advantage of one over the other in any experimental condition. In contrast, a significant influence on learning gains was observed due to school type. Multi‐year gymnasium students consistently outperformed comprehensive school students in the pre‐test and demonstrated greater learning gains, regardless of the learning media. Conclusion: The present study employs an innovative approach by integrating a comparative analysis of different media types with an investigation into the impact of learner characteristics. By including students from distinct types of schools, the study provides insights into the differential effects of immersive virtual reality in varied educational contexts. Lay Description: What is already known about this topic: Media comparison studies typically assess the effectiveness of immersive virtual reality as a learning medium in comparison to other instructional methods in education.The findings of these studies differ markedly.Numerous factors impact learning outcomes in an immersive virtual environment. What this paper adds: Recommendation that research in the field should explore not only if but also when and how IVR learning is effective.Evidence that learning achievements may not be affected by the medium used.Evidence that the type of school can significantly influence learning gains.Evidence that cognitive dispositions, such as spatial abilities, can be another factor that influence learning outcomes. Implications for practice: A technology‐centred approach alone does not allow for a proper evaluation of the learning gain potential of IVR, learner characteristics and broader educational context should also be taken into account.IVR as a learning medium may not be appropriate for all students and every educational setting.To ensure reliable evaluation of learning gains, it is necessary to align the content and format of the intervention in both learning mediums as closely as possible.Measuring learning gains not only immediately after the intervention but also with a significant time delay can contribute to a more comprehensive understanding. [ABSTRACT FROM AUTHOR]

Background Study: As flipped learning is a flexible pedagogical methodology to tailor students' needs and maximize the learning effects, this study integrated peer learning with MosoTeach‐supported flipped mode in an undergraduate blended EFL course. MosoTeach is a popular online learning platform in China with a variety of learning resources. Objectives: The study aimed to test the impact of MosoTeach flipped learning (MTFL) mode on undergraduate EFL students' perceived motivation, participation, feedback, and test performance. Methods: A quasi‐experimental design was carried out in Z university during the spring semester of 2020, with the experimental group (n = 34) adopting the MTFL model and a control group (n = 33) the non‐flipped mode. Results and Conclusions: The independent t‐test results showed that the experimental MTFL group outperformed the control group in post‐test scores, and a positive correlation was found in the relationship between the experimental MTFL group's post‐test scores and MosoTeach learning experience points (LEPs). Moreover, the course perception questionnaire survey indicated a higher level of students' perceived motivation, participation, and feedback in the experimental MTFL group, which corresponded to the results of the content analysis of students' responses to open‐ended questions and reflective reports. But students in both groups experienced challenges such as isolation, procrastination and technological anxiety. Lay Description: What is currently known about this topicFlipped language learning is mostly reported to be effective in improving EFL learning.Peer learning is mostly reported to be effective in improving EFL learning.MosoTeach was investigated in English learning contexts before, but without experimental design. What this paper addsMosoTeach proved as a valid online learning platform in flipped language learning, and the learning experience points (LEPs) on MosoTeach could predict students' exam performance.Students in the experimental group (MosoTeach‐supported flipped) had better exam performance and a higher level of motivation, participation and feedback.Students in both groups experienced isolation, procrastination and technological anxiety. Implications for practice:Peer discussion boards in MosoTeach provide learning support effectively for students in pre‐class learning.Group projects and peer assessment in MosoTeach integrate pre‐class peer discussion into in‐class interaction successfully.MosoTeach provides equal opportunity for every student in the large‐size Chinese English classes, thus contributing to the equity of in‐class peer interactions. [ABSTRACT FROM AUTHOR]

Background: Although conventional writing procedures are still the dominant instructional procedures in English as a foreign language (EFL) contexts, instructors are still struggling with time limitations to improve EFL students writing skills properly. Additionally, EFL students are not engaged in the writing process since they lack the required information about the writing tasks. Objectives: The present study, therefore, applied a sequential explanatory mixed‐methods approach to explore the impact of a flipped writing classroom on EFL students' writing skills (i.e. writing content, writing organization, and language use) and writing motivation on the one hand and possibly recommend a better instructional procedure for students' writing skills and writing motivation in EFL context on the other hand. Methods: To this aim, two intact classes were selected as the participants of the study. The two classes were randomly assigned to a flipped classroom with 27 EFL students and a non‐flipped classroom with 24 EFL students. The non‐flipped classroom was instructed through conventional writing instruction over 16 sessions whereas the flipped classroom was taught with the same content in a flipped writing mode in 10 sessions. Two timed writing tasks, a writing motivation scale, and an individual semi‐structured interview were used to gather the required data. Results and Conclusions: The findings indicated that the flipped writing classroom outperformed the non‐flipped writing classroom in improving the EFL students' writing performance, writing organization, language use, and writing motivation; however, no significant differences were found between the two groups' writing content. Moreover, the data analysis from the individual semi‐structured interview indicated that the flipped students had positive attitudes and perceptions towards the flipped writing classroom which further supported the quantitative findings. Implications: Practical implications for collaborative writing instruction using video clips and other electronic materials are suggested. Lay Description: What is already known about this topic: In a flipped classroom model, English language students can view video clips prior to class time in order to use the class time for doing academic exercises and projects in a collaborative manner.As in student‐centred learning environments, a flipped classroom engages English language students in more active learning processes, encourages them to enquire about the video lectures, and tests and evaluates their skills in applying knowledge.Individual differences, such as motivational variables and affective factors disjointedly or conjointly affect writing processes, especially in English language contexts. What this paper adds: Flipping an English language collaborative writing course improves English language students' writing performance, writing organization, language use, and writing motivation.Flipped classroom is more effective than non‐flipped classroom in improving English language students' writing performance, writing organisation, language use, and writing motivation.Flipped English language students hold positive attitudes and perceptions towards flipped collaborative writing classroom. Pedagogical implications: English language instructors are recommended to design a flipped classroom to provide English language students with video clips before class time, so students can have more collaborative and evaluative writing activities during the class time.English language students can have and receive more peer/instructor writing mediations on the writing tasks and make better use of class time (based on the video clips) and develop their writing performance accordingly.By designing a flipped classroom, English language students can enhance their writing motivation, and also, they properly cover the required materials in a shorter time. [ABSTRACT FROM AUTHOR]

Background: Successful communication is vital to quality of life. One group commonly facing speech and communication difficulties is individuals with intellectual disability (ID). A novel route to encourage clear speech is offered by mainstream smart speakers (e.g., Amazon Alexa and Google Home). Smart speakers offer four factors important for learning: reward immediacy, spaced practice, autonomy/intrinsic motivation and reduced social barriers. Yet the potential of smart speakers to improve speech intelligibility has not been explored before. Aims: To determine whether providing individuals with intellectual disabilities with smart speaker devices improved ratings of speech intelligibility for (1) phrases related to device use and (2) unrelated words via a semi‐randomized controlled trial. Methods & Procedures: In a semi‐randomized controlled trial, an intervention group of adults with ID (N = 21) received smart speakers, while a control group (N = 22) did not. Before and after about 12 weeks, participants were recorded saying smart speaker‐related phrases and unrelated words. Naïve participants then rated the intelligibility of the speech recordings. Outcomes & Results: The group that received smart speakers made significantly larger intelligibility gains than the control group. Although the effect size was modest, this difference was found for both smart speaker‐related phrases and unrelated words. Conclusions & Implications: While the mechanism of action remains to be determined, the presence of smart speakers in the home had a demonstrable impact on ratings of speech intelligibility, and could provide cost‐effective inclusive support for speech and communication improvement, improving the quality of life of vulnerable populations. What this paper addsWhat is already known on the subjectSpeech intelligibility is a key obstacle for social relationships and quality of life across several vulnerable populations (children with speech difficulties, older adults with dementia, individuals with ID). Anecdotal reports suggest mainstream smart speakers (e.g., Amazon Alexa, Google Home), could improve speech intelligibility.What this paper adds to existing knowledgeWe used a semi‐randomized controlled trial to show that using a smart speaker for about 12 weeks could improve ratings of speech intelligibility in adults with ID for both smart speaker‐related phrases and unrelated words.What are the potential or actual clinical implications of this work?These initial findings suggest that smart speaker technology could be a novel, and inclusive, route to improving speech intelligibility in vulnerable populations. [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: Eye movement modelling examples (EMME) are demonstrations in which learners' not only see a model's (e.g., a teacher's) task performance on a computer screen (as in regular video examples) but also the model's eye movements (represented as moving coloured dots overlaid on the screen). Thereby EMME help guide learners' attention towards the relevant information and can model cognitive strategies which are otherwise unobservable for learners. Objectives: This study investigated whether EMME can help to learn deductive reasoning strategies and how the presence/absence of a teacher's verbal explanation affects learning from EMME. Methods: Secondary education students (N = 137) were randomly assigned to study video examples under one of four conditions in a 2 (EMME: yes/no) x 2 (verbal explanations: yes/no) between‐subjects design. Results and Conclusions: Results revealed only a beneficial effect of the presence of verbal explanations on performance on the practice problems, but no pretest‐to‐posttest learning gains. Implications: Seeing the teacher's eye movements does not appear to enhance learning of deductive reasoning. The presence/absence of the teacher's verbal explanation does not seem to affect learning deductive reasoning. Lay Description: What is currently known about the subject matter?: Eye movement modelling examples (EMME) are demonstrations in which learners not only see a teacher's task execution on a computer screen (as in video examples) but also the teacher's eye movements.The eye movements in EMME were visualized as moving coloured dots overlaid on the screen recording.EMME help direct attention to relevant information and enhance learning; it is not yet known if this also applies to reasoning problems.It is unknown if and how presence/absence of a teacher's verbal explanation affects learning from EMME. What our paper adds to this?: Secondary education students watched EMME or regular video examples with/without a teacher's verbal explanation.The examples demonstrated how to solve deductive reasoning problems (adapted version of the Mastermind game).Performance and learning gains were examined and revealed no differences between conditions. The implications of study findings for practitioners: Seeing the teacher's eye movements does not appear to enhance learning of deductive reasoning.The presence/absence of the teacher's verbal explanation does not seem to affect learning deductive reasoning. [ABSTRACT FROM AUTHOR]

Supportive counseling and facilitated referrals to support organizations have shown positive effects on mental health and coping with domestic and family violence. However, the reasons why and how such effects are significant remain unknown. The current paper used data from a randomized controlled trial of a psychosocial intervention implemented in Nepal among 140 abused pregnant women. The hypothesized mediating effects of self‐efficacy and social support on mental health and quality of life of abused pregnant women were tested using serial mediation analyses. Significance of parameter estimates and bias‐corrected 95% confidence intervals (CIs) for the indirect effects were generated using bootstrapping. The postintervention changes in self‐efficacy and social support were found to have significant mediating effects on the relationship between the intervention and changes in both mental health and quality of life of participants post intervention. The positive effects on outcomes were seen at follow‐up as well, though to a lesser extent. Further interventions should focus on enhancing abused women's self‐efficacy and social support to ensure their positive mental health and better lives. [ABSTRACT FROM AUTHOR]

With the advent of mobile technologies, well‐designed fraction apps can be used to help children gain fraction knowledge, a challenging topic for both teachers and students. The present pilot study adopted a quasi‐experimental design to investigate whether children can learn fraction concepts equally well if half of the lesson time (20 min) is replaced with game‐based learning. Keeping the total lesson time (40 min) identical, the control group (N = 33) received traditional instruction, and the experimental group (N = 32) was presented with a blended learning approach spending half of the class time (20 min) playing tablet‐based fraction games, where each of the learners had their own tablet. The results suggested that in the posttest, the experimental group achieved similar learning gains to the control group and appear to have achieved better performance in the transfer test than the control group. This paper also discusses the efficiency of game‐based learning, the mechanism of how fraction games might enhance learning, and the potential of integrating game‐based learning in educational settings. Lay Description: What is already known about this topicAs a significant mathematical concept in daily life, fractions are crucial for later success in math learning.As a promising new technology, educational games show a great potential for improving learning.Well‐designed fraction apps can be used to help children gain fraction knowledge.What this paper addsGame‐based fraction learning can be combined with formal learning in school education.Game‐based fraction learning might provide a more efficient approach to increasing students' conceptual knowledge of fractions.The result showed that the experimental group achieved a similar cognitive level as the control group although they spent half of the time playing a game, suggesting that children can gain knowledge from the experiences of playing games.What are the implications for practice and/or policyThe result suggests that the proper use of educational games in teaching fractions can make learning more efficient.Further research needs to be done to determine whether the fraction understanding gained through playing these games will have an impact on students' future learning of more complicated fraction concepts. [ABSTRACT FROM AUTHOR]

For the training of academic skills, digital educational games with integrated adaptivity are promising. Adaptive games are considered superior to non‐adaptive games, because they constantly assess children's performance, and accordingly adapt the difficulty of the tasks corresponding to the children's individual level. However, empirical evidence with regard to the effectivity of adaptive compared to non‐adaptive games is limited. A study was conducted with 191 children from the third year of Kinder garten who were enrolled in one of three conditions, that is, playing an adaptive version of the reading game (RG), a non‐adaptive version of the RG or training with pen‐and‐paper exercises. In all three conditions, children trained emergent reading (phonological awareness and letter knowledge) once a week for 30 min over a period of 5 weeks. Children's performance on cognitive (phonological awareness, letter knowledge, reading fluency) and non‐cognitive (motivation, self‐concept) factors was assessed. Results revealed a significant improvement in phonological awareness and letter knowledge in all conditions. However, no differences between the conditions were observed with respect to children's improvement on phonological awareness and letter knowledge or on their post‐test scores for reading fluency. With regard to motivation and self‐concept, again, no differences in these non‐cognitive factors were observed across conditions. [ABSTRACT FROM AUTHOR]

Background: Learning which letters correspond to which speech sounds is fundamental for learning to read. Based on previous experimental studies, we developed a serious game aiming to boost letter‐speech sound (L‐SS) correspondences in a motivational game environment. Objectives: The goal of this study was to determine the efficacy of this game in training L‐SS correspondences in pre‐readers. Additionally, an extended version of the game was developed given the importance of handwriting in audio‐visual integration. We established whether including a motoric component in the game boosted the letter‐speech sound training on top of the effect of the game without the motoric component. Methods: One‐hundred forty‐five kindergartners were randomly allocated to play either the standard audio‐visual version of the game, the motoric version or a control math game. All children were pre‐ and post‐tested on L‐SS knowledge and reading accuracy. Results and conclusions: We found that playing the game enhanced pre‐readers' L‐SS knowledge, but not reading accuracy, after a short, intensive intervention period of 3 weeks. However, children who played the motoric version of the game did not differ significantly from either the standard or the control condition. Implications: This game was efficient in training L‐SS correspondences in pre‐readers. These results suggest that this game might be useful as a preventive evidence‐based intervention for at‐risk children in kindergarten who might benefit from a head start before learning how to read. Future studies are needed to examine whether a longer intervention period results in L‐SS knowledge being translated into reading skills. Lay Description: What is already known about this topic: Automatised and fluent reading requires much exposure and practice, but intensive teacher support for all at‐risk readers is economically and practically unfeasibleHandwriting movement likely to enhance coupling of auditory and visual informationOne way to provide high exposure is with game‐based interventionsLack of studies examining the efficacy of these interventions What this paper adds: Serious game enhances letter‐speech sound knowledge in pre‐readers after 3 weeks of intensive interventionThis effect did not transfer to reading performanceNo additional effect of the handwriting movement, possibly due to the short intervention periodIn‐game measures slightly mediated intervention progress Implications for practice and/or policy: Growing evidence of game‐based interventions as promising tools to support reading developmentGame can possibly serve as evidence‐based intervention for at‐risk children in kindergarten who might benefit from a head start before learning how to read [ABSTRACT FROM AUTHOR]

Background: Socially shared regulation is a vital factor that affects students' collaborative programming performance. However, students' weak group metacognitive skills or inability to adopt shared regulation mechanisms lead to unsatisfactory collaborative programming learning. Objectives: This study proposes an approach to support socially shared regulation in collaborative programming learning in order to enhance students' programming achievements and group metacognition. Methods: A quasi‐experimental study was conducted in a junior high school over a 10‐week period to investigate the impact of the proposed approach on programming achievements, group metacognition, and cognitive load. Forty eighth‐grade students participated in the study, with the experimental group learning via the proposed approach, while the control group used the conventional collaborative programming learning approach. Results and Conclusions: The analysis included data from 38 participants. The experimental results showed that the programming achievements and group metacognition of the experimental group were significantly better than those of the control group. Additionally, the proposed approach did not increase the cognitive load of the students. Implications: This study has important implications for teachers, learners, and researchers in collaborative programming and social regulation. Our proposed collaborative programming learning approach enhances learners' social regulation and performance, providing teachers with an effective tool for improving collaborative programming learning. This study also extends the field of socially shared regulation of learning (SSRL), demonstrating its potential to improve the effectiveness of collaborative programming learning and highlighting the need for future research to explore the mechanisms of SSRL in this context. Lay Description: What is already known about this topic?: Programming learning is difficult for most learners.Collaborative programming is an effective method of programming learning.Students' weak group metacognitive skills or inability to adopt shared regulation mechanisms lead to unsatisfactory collaborative programming learning. What this paper adds?: This study proposes a method to enhance collaborative programming learning by supporting socially shared regulation among students.The study utilized a quasi‐experimental to demonstrate the effectiveness of the approach in improving students' programming learning performance.The shared regulation approach was found to significantly improve students' programming achievements and group metacognition when compared to conventional collaborative programming approaches.Importantly, the shared regulation approach did not increase the cognitive load of the students, indicating its potential for practical implementation in programming education. The implications of study findings for practitioners: This study has shown that an approach that supports social shared regulation can improve student performance in collaborative programming learning, and that teachers can use this approach to help students learn programming better collaboratively.This study also contributes to the field of social shared regulated learning by demonstrating how it can support collaborative programming and improve its effectiveness. [ABSTRACT FROM AUTHOR]

Background: Perceptual, cognitive and previous clinical experience may influence a novice Videofluoroscopic Swallowing Study (VFSS) analyst's trajectory towards competency. Understanding these factors may allow trainees to be better prepared for VFSS training and may allow training to be developed to accommodate differences between trainees. Aims: This study explored a range of factors previously suggested in the literature as influencing the development of novice analysts' VFSS skills. We hypothesised that knowledge of swallow anatomy and physiology, visual perceptual skills, self‐efficacy and interest, and prior clinical exposure would all influence VFSS novice analysts' skill development. Methods & Procedures: Participants were undergraduate speech pathology students recruited from an Australian university, who had completed the required theoretical units in dysphagia. Data assessing the factors of interest were collected—the participants identified anatomical structures on a still radiographic image, completed a physiology questionnaire, completed subsections of the Developmental Test of Visual Processing—Adults, self‐reported the number of dysphagia cases they managed on placement, and self‐rated their confidence and interest. Data for 64 participants relating to the factors of interest were compared with their ability to accurately identify swallowing impairments following 15 h of VFSS analytical training, using correlation and regression analysis. Outcomes & Results: Success in VFSS analytical training was best predicted by clinical exposure to dysphagia cases and the ability to identify anatomical landmarks on still radiographic images. Conclusions & Implications: Novice analysts vary in the acquisition of beginner‐level VFSS analytical skill. Our findings suggest that speech pathologists who are new to VFSS may benefit from clinical exposure to dysphagia cases, sound foundational knowledge of anatomy relevant to swallowing and the ability to see the anatomical landmarks on still radiographic images. Further research is required to equip VFSS trainers and trainees for training, to understand differences between learners during skill development. WHAT THIS PAPER ADDS: What is already known on the subject: The existing literature suggests that no vice Video fluoroscopic Swallowing Study (VFSS) analysts training may be influenced by their personal characteristics and experience. What this study adds: This study found that student clinicians, clinical exposure to dysphagia cases and their ability to identify anatomical landmarks relevant to swallowing on still radiographic images prior to training best predicted their ability to identify swallowing impairments after training. What are the clinical implications of this work?: Given the expense of training health professionals, further research is required into the factors that successfully prepare clinicians for VFSS training, including clinical exposure, foundational knowledge of anatomy relevant to swallowing and the ability to identify the anatomical landmarks on still radiographic images. [ABSTRACT FROM AUTHOR]

Background: The language of the science curriculum is complex, even in the early grades. To communicate their scientific observations, children must produce complex syntax, particularly complement clauses (e.g., I think it will float; We noticed that it vibrates). Complex syntax is often challenging for children with developmental language disorder (DLD), and thus their learning and communication of science may be compromised. Aims: We asked whether recast therapy delivered in the context of a science curriculum led to gains in complement clause use and scientific content knowledge. To understand the efficacy of recast therapy, we compared changes in science and language knowledge in children who received treatment for complement clauses embedded in a first‐grade science curriculum to two active control conditions (vocabulary + science, phonological awareness + science). Methods & Procedures: This 2‐year single‐site three‐arm parallel randomized controlled trial was conducted in Delaware, USA. Children with DLD, not yet in first grade and with low accuracy on complement clauses, were eligible. Thirty‐three 4–7‐year‐old children participated in the summers of 2018 and 2019 (2020 was cancelled due to COVID‐19). We assigned participants to arms using 1:1:1 pseudo‐random allocation (avoiding placing siblings together). The intervention consisted of 39 small‐group sessions of recast therapy, robust vocabulary instruction or phonological awareness intervention during eight science units over 4 weeks, followed by two science units (1 week) taught without language intervention. Pre‐/post‐measures were collected 3 weeks before and after camp by unmasked assessors. Outcomes & Results: Primary outcome measures were accuracy on a 20‐item probe of complement clause production and performance on ten 10‐item unit tests (eight science + language, two science only). Complete data were available for 31 children (10 grammar, 21 active control); two others were lost to follow‐up. Both groups made similar gains on science unit tests for science + language content (pre versus post, d = 2.9, p < 0.0001; group, p = 0.24). The grammar group performed significantly better at post‐test than the active control group (d = 2.5, p = 0.049) on complement clause probes and marginally better on science‐only unit tests (d = 2.5, p = 0.051). Conclusions & Implications: Children with DLD can benefit from language intervention embedded in curricular content and learn both language and science targets taught simultaneously. Tentative findings suggest that treatment for grammar targets may improve academic outcomes. What this paper adds: What is already known on the subject: We know that recast therapy focused on morphology is effective but very time consuming. Treatment for complex syntax in young children has preliminary efficacy data available. Prior research provides mixed evidence as to children's ability to learn language targets in conjunction with other information. What this study adds: This study provides additional data supporting the efficacy of intensive complex syntax recast therapy for children ages 4–7 with Developmental Language Disorder. It also provides data that children can learn language targets and science curricular content simultaneously. What are the clinical implications of this work?: As SLPs, we have to talk about something to deliver language therapy; we should consider talking about curricular content. Recast therapy focused on syntactic frames is effective with young children. [ABSTRACT FROM AUTHOR]

Background: Performance goal orientations are influential motivational factors for predicting learning performance. However, a lack of attention has been paid to investigating the effects of performance goal orientations on learning performance and in‐game performance in the context of digital game‐based learning. Objectives: This study implemented a game‐based English vocabulary learning system and investigated how performance goal orientations affected learners' learning performance and in‐game performance. Methods: A total of 59 non‐English major university students participated in this study, divided into performance‐approach learners (PAPL) and performance‐avoidance learners (PAVL) based on their performance goal orientations. The English vocabulary listening test and log data were collected for conducting quantitative analyses. Results and conclusions: The results showed that the PAPL outperformed the PAVL in learning performance, whereas the two groups demonstrated similar gain scores and overall in‐game performance. Moreover, the results showed that the PAVL's learning performance was strongly associated with all aspects of in‐game performance in the learning activities. Conversely, the PAPL's learning performance was only associated with two aspects of in‐game performance in the competition activities. Implications: The findings of this study suggest that performance goal orientations play significant roles in both learning performance and in‐game performance, which could benefit the PAVL's in‐game performance, which is a substantial factor in promoting their learning performance via DGBL. Lay Description: What is already known about this topic: Digital game‐based learning (DGBL) has been widely adopted in various subject areas.DGBL is an effective learning approach for language learning.Performance goal orientations are influential motivational factors in predicting learning performance.Relevant empirical research on performance goal orientations in DGBL is scarce and inconclusive. What this paper adds: A game‐based English vocabulary learning system was developed based on the considerations of different characteristics of performance goal orientations.This study provides understandings of the impact of performance goal orientations on both learning performance and in‐game performance in DGBL.Performance‐approach learners outperformed performance‐avoidance learners, whereas the two groups demonstrated similar gain scores and overall in‐game performance.Performance‐avoidance learners' in‐game performance is a substantial factor in promoting their learning performance via DGBL. Implications for practice and/or policy: Educators should consider adopting game‐based assessment to reduce the gap between learners with different performance goal orientations.DGBL can be a potential approach to supporting different performance goal orientations, but it is particularly beneficial to learners with performance‐avoidance goals.Learners with different performance goal orientations need different types of learning activities to achieve better performance.A personalized DGBL system should be developed to accommodate the needs and preferences of learners with performance‐approach and performance‐avoidance goals. [ABSTRACT FROM AUTHOR]

Background: Process data, data generated by a user's interaction with a web‐based application, is an emerging tool in educational research. The current study explores using process data as a measure of implementation fidelity to a randomized control trial (RCT) of the Read It Again Mobile (RIA‐M) curricular supplement. Objectives: To determine the extent to which teachers implemented RIA‐M and to assess the utility of using process data in the assessment of fidelity. Methods: The RCT involved 30 pre‐kindergarten classrooms with a sample of n = 216 students. RIA‐M provides a curricular supplement which teachers may incorporate into classroom instruction and is delivered via a tablet computer. Pre and post literacy assessments are used to determine treatment effect. Process data, produced from teacher interactions with the tablet, and classroom observations are used to assess fidelity. Results and Conclusions: Our findings indicate no difference between treatment and control students in the RCT. Yet, we find that process data provides unique fidelity information concerning treatment exposure, adherence, and quality of program delivery. Specifically, process data indicated that teachers did not demonstrate the same level of fidelity that was captured in classroom observations. This finding provides some evidence for the absence of an intervention effect. Major Takeaways: The current study improves our understanding of how web‐based interventions may be assessed for implementation fidelity using process data. Further, process data offers a potentially reliable and scalable measure of fidelity for other web‐based educational interventions. Lay Description: What we know about the topic: Mobile technology‐based interventions are on the rise in many educational settings.Fidelity to educational interventions can be difficult to reliably assess.Teachers may be resistant to implementing technology in classrooms. What this paper adds: Examines a pilot study of a mobile technology‐based curricular intervention for teachers designed to improve early reading and literacy.Examines a new method for assessing fidelity of mobile technology‐based interventions.Compares the new method to traditional methods of assessing fidelity to educational interventions. Implications for practice and/or policy: The presence of technology in the classroom does not assure that the technology will be used effectively.Mobile technology‐based interventions may require additional monitoring and coaching to assure use as intended.Process data, generated in the use of technology‐based interventions, may provide a unique way to measure fidelity to the intervention. [ABSTRACT FROM AUTHOR]

Organizational‐level occupational health interventions have great potential to improve employees' health and well‐being. However, they often compare unfavourably to individual‐level interventions. This calls for improving methods for designing, implementing and evaluating organizational interventions. This paper presents and discusses the regression discontinuity design because, like the randomized control trial, it is a strong summative experimental design, but it typically fits organizational‐level interventions better. The paper explores advantages and disadvantages of a regression discontinuity design with an embedded randomized control trial. It provides an example from an intervention study focusing on reducing sickness absence in 196 preschools. The paper demonstrates that such a design fits the organizational context, because it allows management to focus on organizations or workgroups with the most salient problems. In addition, organizations may accept an embedded randomized design because the organizations or groups with most salient needs receive obligatory treatment as part of the regression discontinuity design. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) can promote design performance, and may generate a high cognitive load and affect creative design thinking as well. In order to examine the effect of VR application on cognitive load and engineering design creativity, this study recruited 81 eighth‐grade students as participants and employed a non‐equivalent‐groups quasi‐experimental design to examine how VR application influences creativity components and creative performance. A creativity component scale (creative motivation, creative thinking, and professional cognition), a measurement of creative performance, and a cognitive load scale were used to collect data. The study also investigated the ability of VR application to predict creativity components and creative performance, using cognitive load as the mediator. The conclusions are as follows: (1) VR application had marked effects on professional cognition and creative motivation but no effect on creative thinking skills. (2) VR application had marked effects on the novelty and usefulness aspects of creative performance, particularly with respect to usefulness. (3) VR application had marked effects on extraneous and germane cognitive load, but no influence on intrinsic cognitive load, and (4) Both VR application and cognitive load were able to predict creativity components and creative performance. Their abilities to predict creative performance approached an acceptable level. Nevertheless, VR application had no effect on general creative thinking skills; therefore, other teaching strategies are needed to strengthen creative thinking. Lay Description: What is already known about this topicVirtual reality (VR) can transmit complex knowledge.Virtual reality (VR) can promote design performance.What this paper addsInfluence of VR application on creativity components and creative performance.Ability of VR application and cognitive load to predict creativity components.Ability of VR application and cognitive load to predict creative performance.Implications for practice and/or policyUsing VR teaching to improve learning effects and creativity in high‐risk, expensive, and inaccessible learning fields.Using VR teaching to practice repeatedly, and facilitate basic understanding of the application. [ABSTRACT FROM AUTHOR]

This study proposes a computer‐assisted system with a design based on Polya's problem‐solving model. The system is designed to help average and low‐achieving second graders in mathematics with word‐based addition and subtraction questions. The emphasis of using the specific model was on dividing the problem‐solving procedure into stages and the concentration on the stages that are problematic for students. Specifically, we compared mathematical word problem‐solving performance and computational skills of students who utilized the computer‐assisted system with students who employed general strategy instruction. Participants consisted of 52 second‐grade students randomly assigned to treatment conditions. Students were pretested and posttested with mathematical problem‐solving and computation tests, and repeated measures of their progress with respect to word problem solving were registered. The results showed there was a significant difference between the experimental and control groups in terms of the word problem‐solving progress measure, favouring the experimental group. This confirms that providing students with a computer‐assisted system offered the opportunity to explore all stages of the problem‐solving procedure as one possible way to enhance their problem‐solving skills. Lay Description: What is currently known about the subject matter Problem‐based learning is recognized as an instruction method that positively influence learning outcomes along with higher order thinking skills.The use of computers to implement findings from qualitative research related to problem‐solving teaching strategies can develop reasoning skills in mathematics and problem solving of elementary students with learning difficulties in mathematics.Polya's model helps students to solve mathematical word‐based problems. What the paper adds to this subject This paper suggests that efforts to improve word problem solving should focus on episodes students neglect when solving problems.This study proposes a computer‐assisted system with a design based on Polya's problem‐solving model.This empirical study investigates whether providing students with computer‐based assistance at each stage of the problem‐solving process helps students to overcome their difficulties.This study explores whether students fail to solve the problem because they do not understand the specific relations among the three problem quantities, or in choosing a correct solution strategy, or in carrying out the solution strategy correctly. The implications of study findings for practitioners Combining Polya's model with computer assistance at each solving procedure stage enhances student's capabilities to solve mathematical word‐based problems.Students encountered problems when reviewing their solutions; this signifying that students did not recognize the variants of the problem. [ABSTRACT FROM AUTHOR]

Many studies have demonstrated the crucial role of vocabulary in predicting reading performance in general. More recent work has indicated that one particular facet of vocabulary (its depth) is more closely related to language comprehension, especially inferential comprehension. On this basis, we developed a training application to specifically improve vocabulary depth. The objective of this study was to test the effectiveness of a mobile application designed to improve vocabulary depth. The effectiveness of this training was examined on 3rd and 4th grade children's vocabulary (breadth and depth), decoding and comprehension performances. A randomized waiting‐list control paradigm was used in which an experimental group first received the intervention during the first 4 weeks (between pretest and post‐test1), thereafter, a waiting control group received the training for the next 4 weeks (between postest1 and posttest2). Results showed that the developed application led to significant improvements in terms of vocabulary depth performance, as well as a significant transfer effect to reading comprehension. However, we did not observe such a beneficial effect on either vocabulary breadth or written word identification. These results are discussed in terms of the links between vocabulary depth and comprehension, and the opportunities the app presents for remedying language comprehension deficits in children. Lay Description: What is already known about this topic:Vocabulary is a powerful predictor of both word identification and text comprehensionVocabulary depth rather than breadth is more closely related to language comprehensionDepth of vocabulary is particularly predictive of inferencing skills What this paper adds:We develop a new training application specifically targeting vocabulary depthThe training led to significant gain in children's knowledge for the taught wordsWe also observe a transfer effect with significant improvements in reading comprehension Implications for practice and/or policy:Vocabulary depth trainings represent a good way for remedying language comprehension deficits [ABSTRACT FROM AUTHOR]

Experiences in immersive 3D virtual reality (VR) are more presence‐inducing, and so it may be tempting to claim that content will be learned better in VR. This randomized control trial study on natural selection challenges that assumption. This study answers the question of whether learning STEM in an immersive 3D VR environment is always superior to learning via a 2D monitor (PC). This is a 2 × 2 × 3 design. The first factor is platform immersivity (low = 2D PC, or high = 3D VR), the second factor is level of embodiment (lower = watching playback video, or higher = using mouse/controller to agentically manipulate content), and the third factor is test time (pretest, posttest, and follow‐up). There was a significant main effect for embodiment, the high embodied and agentic groups learned the most. There was not a main effect for platform, because the participants in the low embodied VR group performed significantly worse than the three other groups. Although, the one high embodied, VR group learned and retained the most knowledge. A path‐analysis revealed that the effect of platform was significantly mediated by presence, agency, and engagement. The smaller learning gain in the low embodied VR condition suggests that participants come to the immersive VR experience with expectations about agency and control of the virtual content, and when those expectations were not met, the disconnect was deleterious for learning. More agentic and interactive control of manipulable virtual content is encouraged. Design is critical, and platform is not destiny. Lay Description: What is already known about this topic?: VR has special affordances like presence and embodied content manipulation that can increase learning, if used correctly.Compared to 2D desktop, being in 3D VR generally induces more presence and more engagement.When students physically reenact, using gesture or embodied learning, greater learning gains are often seen. What this paper adds?: The high embodied, active VR group learned the most and reported the most engagement.Overall, being active and embodied resulted in more learning (regardless of the platform of desktop or VR).Embedded and embodied kinesthetic in‐process assessments during gameplay are valid measures of comprehension.The pathways leading to post‐play and 1 week follow‐up knowledge are complex. Implications for practice and/or policy?: Designers should strive to create embodied and agentic tasks in educational VR games.Watching a playback video on a 2D PC (desktop) platform can be appropriate for learning, but passive viewing videos in immersive VR can attenuate learning.Designers should include more embedded, in‐process data gathering during educational gameplay.Some guidelines are given for in‐process assessments, these assessments can lead to more dynamic, adaptive learning. [ABSTRACT FROM AUTHOR]

While the use of experiments is important for developing students' scientific knowledge and skills, challenges may arise when teachers and students are conducting experiments in class, such as non‐reusable experimental resources, safety issues and difficulties simulating some specific effects. Augmented reality (AR) technology affords an alternative approach to conducting experiments by bringing students a virtual–real mixed learning environment. In this study, taking junior high school physics knowledge on the magnetic field as an example, we designed and developed an AR‐based mobile simulated experiment tool. This study investigates the effect of the AR‐based experiment on students' knowledge improvement and cognitive load compared with 3D and traditional experiments. A sample of 122 ninth‐grade students was randomly chosen and assigned to three groups (AR, 3D and Traditional). The results demonstrate that students in the AR group performed better than those in the 3D and Traditional groups in terms of their knowledge improvement. The AR group students also experienced the lowest cognitive load among the three groups. Moreover, students had positive perceptions about AR and 3D tools. The implications of this study are discussed. Lay Description: What is already known about this topic: Experiment is an important method for students' magnetic field learning.Traditional magnetic experiment consists of various procedures that may cause some inconvenience during learning.Augmented reality (AR) provides a virtual–real fusion environment to assist teaching and learning.While some studies indicate positive impact of AR on learner's cognitive load, some do not. What this paper adds: An AR‐based mobile simulated experiment tool was proposed based on the junior high school physics knowledge, the magnetic field.A Comparison was made among AR, 3D and traditional experiment for magnetic field learning.Higher knowledge improvement and lower cognitive load were observed in the AR group.3D and Traditional groups showed similar knowledge improvement and cognitive load. Implications for practice and/or policy: The AR design with hand‐held devices has unlimited scalability of educational applications.Serving the real object as marker and using the professional algorithm to simulate some specific phenomenon were recommended in future AR studies.The findings indicated that AR experimental tool had a statistically significant effect on students' knowledge improvement and cognitive load.The similar result between 3D and Traditional groups implies that not everything virtualized is good; we must consider the actual teaching and learning situations. [ABSTRACT FROM AUTHOR]

As immersive virtual reality (IVR) systems proliferate in classrooms, it is important to understand how they affect learning outcomes and the underlying affective and cognitive processes that may cause these outcomes. Proponents argue that IVR could improve learning by increasing positive affective and cognitive processing, thereby supporting improved performance on tests of learning outcome, whereas opponents of IVR contend that it could hurt learning by increasing distraction, thereby disrupting cognitive learning processes and leading to poorer learning outcomes. In a media comparison study, students viewed a biology lesson either as an interactive animated journey in IVR or as a slideshow on a desktop monitor. Those who viewed the IVR lesson performed significantly worse on transfer tests, reported higher emotional arousal, reported more extraneous cognitive load and showed less engagement based on EEG measures than those who viewed the slideshow lesson, with or without practice questions added to the lessons. Mediational analyses showed that the lower retention scores for the IVR lesson were related to an increase in self‐reported extraneous cognitive load and emotional arousal. These results support the notion that immersive environments create high affective and cognitive distraction, which leads to poorer learning outcomes than desktop environments. Lay Description: What is already known about the topic: IVR is gaining popularity in classrooms, and it is important to understand its effects on learning.Some theories suggest IVR could help learning because it may increase motivation.Other theories suggest IVR could hurt learning because it causes distraction. What this paper adds: The biology lesson displayed in IVR led to less learning than a PowerPoint lesson.Viewing the IVR lesson caused higher emotional arousal than viewing the PowerPoint lesson.The IVR lesson led to more distraction based on self‐report and EEG measures than the PowerPoint lesson.These results suggest that IVR creates high emotional and cognitive distraction, which leads to less learning. Implications for practice: Using IVR to replace traditional classroom lessons may not yet be useful.However, because students report enjoying IVR, it may be useful to use in addition to conventional lessons.Future research should determine how specific factors of the technology and the learners affect 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]

Sound‐augmented toys producing factual knowledge were thought to encourage incidental, playful learning in children with visual impairments (VIs). A group of 15 children with VIs and 22 sighted controls played with a sound‐augmented savannah landscape and listened to an informative story in a counterbalanced order. Children's knowledge about savannah animals was assessed at baseline and after each condition in order to quantitatively compare knowledge gains between conditions. Results indicated that children with VIs gained more knowledge than sighted controls from playing with the sound‐augmented toy. Furthermore, offering both the augmented toy and the informative story led to higher knowledge gains than a single medium, especially in children with VIs. Sound‐augmented toys could therefore be a useful addition to the current curriculum in special education for children with VIs. Lay Description: What is already known about this topic: Game‐based learning is becoming more popular as educational context.Children with visual impairments are often unable to benefit from a predominantly visual learning context.Augmented environments encourage exploratory learning by enhancing physical materials with technology.Sound‐augmented toys might encourage playful learning in children with visual impairments. What this paper adds: This empirical study compared an innovative sound‐augmented toy with traditional verbal instruction.Both children with visual impairments and a sighted comparison group participated.The targeted learning outcome was factual knowledge about animals.Children gained comparable knowledge from the augmented environment as from verbal instruction.The augmented toy was a more effective learning context for children with visual impairments than in sighted children. Implications for practice and/or policy: Sound‐augmented environments encourage object interaction and playful learning in children with visual impairments.Sound‐augmented toys can be a useful addition to the current curriculum of children with visual impairments in special education. [ABSTRACT FROM AUTHOR]

To investigate the effects of 8‐week hiking bench training on cardiorespiratory and muscular responses of highly trained sailors during hiking emulation. Twenty‐four sailors were assigned into two groups: the hiking bench training group (HTG, n = 12) and the control group (CG, n = 12). Both groups maintained their regular training with the HTG performed two additional hiking bench training sessions per week for 8 weeks, while the CG performed an equivalent duration of on‐water sailing training. Physiological responses were assessed by performing four successive 3‐min hiking bouts on a sailing emulation ergometer before and after the 8‐week training period. Comparing the pretest, both groups exhibited a significant decrease (p < 0.05) in the percentage of maximal oxygen uptake (%VO2max) and maximal heart rate (%HRmax); the HTG experienced a greater decrease in %VO2max in bouts 2 and 3. The root mean square (RMS) of rectus femoris (RF), vastus lateralis (VL), rectus abdominis (RA), and external oblique decreased significantly (p < 0.05), whereas the mean power frequency (MPF) of RF, VL, and RA exhibited an increasing trend. The RMS of RF and RA in HTG were lower than those in CG in the initial three bouts; VL and EA in HTG were lower than those in CG in bouts 1 and 2 (p < 0.05). The MPF of RA in HTG was significantly increased in bouts 2, 3, and 4 (p < 0.05). Eight‐week hiking bench training could improve hiking economy and the activation of lower limb and trunk muscles delaying the onset of fatigue in sailors. Highlights: Hiking is the most physically demanding task in dinghy sailing, eliciting highly specific cardiorespiratory, and muscular responses. Highly trained sailors attempt to improve the physiological response and performance of hiking through hiking bench training.Hiking bench training involves a series of movement exercises performed by sailors on sailing emulation ergometer that are tailored specific profiles with the objective of optimizing sailing performance.Hiking bench training can effectively enhance the economy of hiking among highly trained sailors, improve the activation of lower limb and trunk muscles, and delay the onset of fatigue in hiking. Hiking bench training can be used as an effective means of enhancing hiking performance for highly trained sailors. [ABSTRACT FROM AUTHOR]

A promising method to support game‐based learning is to facilitate learners' externalization of cognitive and metacognitive processes. Externalizing Problem Representation (EPR) refers to a cognitive behaviour in which a learner constructs her own representations overtly. The purpose of this study is to investigate whether learning supports promoting EPR enhance qualitative understanding and quantitative proficiency in ratios and proportional relationships in a learning game (i.e., E‐Rebuild) context. Specifically, this study investigated the effects of representation format in problem representation on qualitative understanding and quantitative proficiency in a learning game context. The results of this study indicate that (a) symbolic learning supports better facilitate comprehension of math concepts and their relations than iconic learning supports in video game contexts, (b) symbolic learning supports better facilitate players' reflection for implicit understanding and promote their math problem‐solving skills, (c) participants in the symbolic learning support group increased significantly in qualitative understanding but not in quantitative proficiency after gameplay, and (d) participants in the iconic learning support group experienced significant growth in quantitative proficiency but not in qualitative understanding after gameplay. Lay Description: What is already known about this topic: Video games potentially facilitate implicit qualitative understanding more than quantitative knowledge test performance.Educational game designers lack a good understanding of the design and development of effective learning supports in educational games. What this paper adds: Symbolic learning supports for problem representation better facilitate comprehension of math concepts and their relations than iconic learning supports in video game contexts.Participants experienced significant growth in quantitative proficiency after they processed the iconic in‐game learning supports in game‐based math tasks.Participants' qualitative understanding in the symbolic learning support group increased significantly after playing E‐Rebuild‐based math game task. Implications for practice and/or policy: This study informs scholars and designers of game‐based learning about designing learning support and its properties in video game contexts: Learning support design to promote math problem representation across problem translation and problem integration.This study provides design principles for learning supports in math learning game; symbolic learning supports facilitate qualitative understanding whereas iconic learning supports facilitate quantitative proficiency in math learning game. [ABSTRACT FROM AUTHOR]

Behaviour change communication (BCC) can improve infant and young child nutrition (IYCN) knowledge, practices, and health outcomes. However, few studies have examined whether the improved knowledge persists after BCC activities end. This paper assesses the effect of nutrition sensitive social protection interventions on IYCN knowledge in rural Bangladesh, both during and after intervention activities. We use data from two, 2-year, cluster randomised control trials that included nutrition BCC in some treatment arms. These data were collected at intervention baseline, midline, and endline, and 6-10 months after the intervention ended. We analyse data on IYCN knowledge from the same 2,341 women over these 4 survey rounds. We construct a number correct score on 18 IYCN knowledge questions and assess whether the impact of the BCC changes over time for the different treatment groups. Effects are estimated using ordinary least squares accounting for the clustered design of the study. There are 3 main findings: First, the BCC improves IYCN knowledge substantially in the 1st year of the intervention; participants correctly answer 3.0-3.2 more questions (36% more) compared to the non-BCC groups. Second, the increase in knowledge between the 1st and 2nd year was smaller, an additional 0.7-0.9 correct answers. Third, knowledge persists; there are no significant decreases in IYCN knowledge 6-10 months after nutrition BCC activities ended. [ABSTRACT FROM AUTHOR]

Cardiovascular (CV) disease accounts for one third of deaths in females, with hypertension (HTN) and type 2 diabetes mellitus (T2DM) risk factors for its development. Global longitudinal strain (GLS) is a strong prognostic indicator for future CV dysfunction and can be impaired in women with HTN and T2DM. This study aimed to determine if exercise impacts GLS in women with HTN or T2DM. A randomized crossover trial was conducted with 15 women (aged 64.1 ± 4.7) diagnosed with HTN (n = 12) or T2DM (n = 3). Participants completed an 8‐week exercise and 8‐week non‐exercising control period, separated by a 21.6 ± 14.2‐week washout period. Resting echocardiography and exercise testing were performed pre and post each arm to measure GLS and aerobic fitness (VO2peak). GLS (%) improved significantly following exercise (−16.8 ± 1.5 to −18.4 ± 1.8; p ≤ 0.001, d = 0.98), but not control (−17.2 ± 2.0 to −16.9 ± 1.4; p = 0.585, d = −0.14). Similarly, VO2peak (mL/kg/min) increased following exercise (18.0 ± 2.1 to 19.2 ± 2.6; p ≤ 0.001, d = 0.53), but not control (17.5 ± 2.7–17.2 ± 2.7; p = 0.269, d = −0.12). There were significant between‐group differences for GLS (p ≤ 0.001, d = 1.02) and VO2peak (p = 0.011, d = 0.63). Aerobic exercise positively impacts GLS and VO2peak in women with HTN and T2DM. GLS may inform exercise professionals regarding the early effectiveness of an aerobic exercise intervention and infer a reduction in CV disease risk. Highlights: The impact of aerobic exercise on global longitudinal strain (GLS), and other measures of cardiovascular (CV) function, was explored in women with hypertension and type 2 diabetes.Eight weeks of aerobic exercise significantly improved GLS (very large effect; d = 1.02) and aerobic capacity (moderate effect; d = 0.63) compared to control.Improvements observed in GLS and aerobic capacity were clinically meaningful. Significant reductions in systolic and diastolic blood pressure were also observed following exercise, but not control.GLS can measure the effectiveness of aerobic exercise on myocardial function in women at risk of developing CV disease. [ABSTRACT FROM AUTHOR]

Prenatal iron supplementation improves children's health and cognitive performance, but few studies explore behavioural development. This study assessed the effects of adjusting prenatal iron supplementation to maternal iron stores during early pregnancy on children's behavioural problems. Randomized controlled trial conducted in Tarragona (Spain) involving 230 nonanaemic pregnant women and their children after a 4‐year follow‐up. Based on haemoglobin (Hb) levels before gestational week (GW) 12, women receive different iron doses: those with Hb = 110–130 g/L were randomized to receive 80 or 40 mg/day and those with Hb > 130 g/L were randomized to receive 20 or 40 mg/day. Maternal iron stores at GW12 were classified using serum ferritin (SF) as low (SF < 15 µg/L), normal (SF = 15–65 µg/L), and normal‐high (SF > 65 µg/L). Children's behaviour was assessed by parents using the Child Behaviour Checklist for ages 1.5–5 years and the Behaviour Rating Inventory of Executive Function‐Preschool Version, and by teachers using the Teacher's Report Form for ages 1.5–5 years. Multivariable regression models were performed. Taking 80 mg/day of iron improved child behaviour when women had low iron stores but worsened it when mothers had normal–high iron stores, except for depressive and attention/hyperactivity problems. Taking 20 mg/day of iron improved behaviour only in those children whose mothers had SF > 65 µg/L in early pregnancy. Additionally, executive functioning improved at high doses of prenatal iron when maternal baseline SF < 15 µg/L. Adjusting prenatal iron supplementation to both maternal baseline Hb levels and iron stores reduces behavioural problems in 4‐year‐old children. Key messages: Prenatal iron supplementation succeeds in improving maternal haematological outcomes and cognitive performance of children, but few studies have focused on behavioural development.Prenatal iron supplementation adjusted to maternal iron stores reduces behavioural problems in 4‐year‐old children.Maternal iron stores early in pregnancy should be measured in addition to haemoglobin concentration.These findings contribute greatly to the advancement of public health by giving physicians the tools to prescribe the most appropriate dose of iron supplementation to contribute to better child development. [ABSTRACT FROM AUTHOR]

Background The effectiveness of two treatment approaches (phonological therapy and articulation therapy) for treatment of 14 children, aged 4;0-6;7 years, with phonologically based speech-sound disorder (SSD) has been previously analysed with severity outcome measures (percentage of consonants correct score, percentage occurrence of phonological processes and phonetic inventory). Considering that the ultimate goal of intervention for children with phonologically based SSD is to improve intelligibility, it is curious that intervention studies focusing on children's phonology do not routinely use intelligibility as an outcome measure. It is therefore important that the impact of interventions on speech intelligibility is explored. Aims This paper investigates the effectiveness of the two treatment approaches (phonological therapy and articulation therapy) using intelligibility measures, both in single words and in continuous speech, as the primary outcome. Methods & Procedures Fourteen children with phonologically based SSD participated in the intervention. The children were randomly assigned to phonological therapy or articulation therapy (seven children in each group). Two assessment methods were used for measuring intelligibility: a word identification task (for single words) and a rating scale (for continuous speech). Twenty-one unfamiliar adults listened and judged the children's intelligibility. Reliability analyses showed overall high agreement between listeners across both methods. Outcomes & Results Significant improvements were noted in intelligibility in both single words (paired t(6) = 4.409, p = 0.005) and continuous speech (asymptotic Z = 2.371, p = 0.018) for the group receiving phonology therapy pre- to post-treatment, but no differences in intelligibility were found for those receiving the articulation therapy pre- to post-treatment, either for single words (paired t(6) = 1.763, p = 0.128) or continuous speech (asymptotic Z = 1.442, p = 0.149). Conclusions & Implications Intelligibility measures were sensitive enough to show changes in the phonological therapy group but not in the articulation therapy group. These findings emphasize the importance of using intelligibility as an outcome measure to complement the results obtained with other severity measures when exploring the effectiveness of speech interventions. This study presents new evidence for the effectiveness of phonological therapy in improving intelligibility with children with SSD. [ABSTRACT FROM AUTHOR]

Background Previous studies have reported that obese people with trisomy 21 suffer from lowgrade systemic inflammation. A recent study has found that aerobic training reduced inflammation in obese women with Down syndrome. To the best of our knowledge, the study reported in this paper is the first to determine for how long these effects were maintained after completion of the programme. Methods Twenty premenopausal obese women (18-30 years old) with Down syndrome volunteered for this study. Eleven were randomly assigned to the intervention group and performed a 10-week aerobic training programme, 3 sessions per week, consisting of warming-up followed by treadmill exercise (30-40 min) at a work intensity of 55-65% of peak heart rate and a cooling-down period. The control group included 9, age, sex and BMI matched women with Down syndrome that did not perform any training programme. Fat mass percentage and distribution were measured. Plasma level of IL-6 and high-sensitive C-reactive protein (hs-CRP) were monitored. Time-course changes for these outcomes were assessed at pre- and post-intervention. Further, they were re-evaluated at 1, 3 and 6 months after completion of the programme. Results Three months after completion of the programme, plasma levels of IL-6 and hs-CRP were significantly increased. Up to 6 months later, both fat mass percentage and waist circumference (WC) were significantly increased. Furthermore, physical fitness was also impaired in the intervention group. No changes were observed in the control group. Conclusion A 3-month detraining period significantly impaired chronic inflammation in obese women with DS. [ABSTRACT FROM AUTHOR]

Objective: Certain treatments have demonstrated acute efficacy for binge‐eating disorder (BED) but many patients who receive "evidence‐based" interventions do not derive sufficient benefit. Given the dearth of controlled research examining treatments for patients who fail to respond to initial interventions, this study tested the efficacy of cognitive‐behavioral therapy (CBT) for patients with BED who do not respond to initial acute treatments. Methods: Prospective randomized double‐blind placebo‐controlled single‐site trial, conducted August 2017–December 2021, tested 16‐weeks of therapist‐led CBT for non‐responders to initial treatment (naltrexone/bupropion and/or behavioral therapy) for BED with obesity. Thirty‐one patients (mean age 46.3 years, 77.4% women, 80.6% White, mean BMI 38.99 kg/m2) who were non‐responders to initial acute treatments were randomized to CBT (N = 18) or no‐CBT (N = 13), in addition to continuing double‐blinded pharmacotherapy. Independent assessments were performed at baseline, throughout treatment, and posttreatment; 83.9% completed posttreatment assessments. Results: Intention‐to‐treat remission rates were significantly higher for CBT (61.1%; N = 11/18) than no‐CBT (7.7%; N = 1/13). Mixed models of binge‐eating frequency (assessed using complementary methods) converged revealing a significant interaction between CBT and time and a significant main effect of CBT. Binge‐eating frequency decreased significantly with CBT but did not change significantly with no‐CBT. Since only four patients received behavioral treatment during the acute treatments, we performed "sensitivity‐type" analyses restricted to the 27 patients who received pharmacotherapy during the acute treatment and found the same pattern of findings for CBT versus no‐CBT. Conclusions: Adult patients with BED who fail to respond to initial pharmacological treatments should be offered CBT. Public Significance: Even with leading evidence‐based treatments for binge‐eating disorder, many patients do not derive sufficient benefit. Almost no controlled research has examined treatments for patients who fail to respond to initial interventions. This study found that that cognitive‐behavioral therapy was effective for patients with binge‐eating disorder who did not respond to initial interventions, with 61% achieving abstinence. [ABSTRACT FROM AUTHOR]

Background: Magic‐based programs have been utilised to enhance well‐being across various health aspects. However, there is a lack of studies on whether performing magic tricks can provide mental health benefits for older adults living in the community. Therefore, this study aims to investigate the effects of a magic‐based intervention program on self‐esteem, depressive symptoms, and quality of life (QOL), and to examine the relationship between these factors in older adults. Methods: Thirty‐eight participants, aged 60–90 years, were randomly assigned to either a magic intervention group or a control group. The magic intervention program, tailored for older adults, was conducted for 90 min, twice weekly, over 6 weeks. The Rosenberg Self‐Esteem Scale (RSE), the 15‐item Geriatric Depression Scale (GDS‐15), and the World Health Organization Quality of Life‐BREF scores were measured and analyzed in both groups before and after the intervention. Results: The magic‐based intervention significantly increased self‐esteem and reduced depressive symptoms in older adults, with large effect sizes. However, no significant impact on QOL was observed. Additionally, no significant correlation was found between the improvement in self‐esteem and the reduction in depressive levels. Despite this, a moderate but significant negative correlation was detected between the post‐intervention scores of RSE and GDS‐15 in the magic intervention group. Conclusions: The study demonstrated that the magic intervention program was beneficial in promoting mental health in community‐dwelling older adults. Implementing magic programs in communities appears to be an effective approach to enhance self‐esteem and alleviate depressive symptoms in the older population. [ABSTRACT FROM AUTHOR]

Objective: The StRONG study demonstrated that higher calorie refeeding (HCR) restored medical stability faster in patients hospitalized with anorexia nervosa (AN) and atypical AN (AAN), with no increased safety events compared with standard‐of‐care lower calorie refeeding (LCR). However, some clinicians have expressed concern about potential unintended consequences of HCR (e.g., greater mealtime distress). The purpose of this study was to examine patient treatment preference and compare mealtime distress, food refusal, and affective states between treatments. Method: Participants (N = 111) in this multisite randomized clinical trial were ages 12–24 years, with AN or AAN, admitted to hospital with medical instability who received assigned study treatment (HCR or LCR). Treatment preference was assessed prior to randomization in the full sample. In a subset of participants (n = 45), linear mixed effect models were used to analyze momentary ratings of mealtime distress (pre, during, and post‐meals) and daily affective state during the hospitalization. Results: About half (55%) of participants reported a preference for LCR. Treatment assignment was not associated with food refusal, mealtime distress, or affective states in the subsample. Food refusal increased significantly over the course of refeeding (p =.018). Individuals with greater depression experienced more negative affect (p =.033), with worsening negative affect over time for individuals with higher eating disorder psychopathology (p =.023). Discussion: Despite understandable concerns about potential unintended consequences of HCR, we found no evidence that treatment acceptability for HCR differed from LCR for adolescents and young adults with AN and AAN. Public Significance: The efficacy and safety of higher calorie refeeding in hospitalized patients with anorexia nervosa has been demonstrated. However, it is not known whether higher calorie refeeding (HCR) increases meal‐time distress. This study demonstrated that HCR was not associated with increased mealtime distress, food refusal, or affective states, as compared with lower calorie refeeding. These data support HCR treatment acceptability for adolescents/young adults with anorexia nervosa and atypical anorexia nervosa. [ABSTRACT FROM AUTHOR]

Dietary countermeasures to mitigate detrimental spaceflight‐induced effects on bone health would alleviate the requirements and the consequences imposed by other types of countermeasures for this risk. We hypothesised that antioxidant supplementation during 60 days of 6° head‐down tilt bed rest (HDBR), an analogue of spaceflight, would have a protective effect on bone mineral density (BMD), content (BMC) and bone structure parameters. An exploratory, randomised, controlled, single‐blind intervention trial was conducted in a parallel design with 20 healthy male volunteers (age 34 ± 8 y, weight 74 ± 6 kg). The study included 14 days of baseline data collection (BDC) before bed rest, followed by 60 days of HDBR and a 14‐day recovery period. Ten subjects in the antioxidant group received a supplement (741 mg/d polyphenols, 2.1 g/d omega‐3 fatty acids, 168 mg/d vitamin E and 80 μg/d selenium) daily. Ten subjects in the control group received no supplement. The diet was consistent with dietary reference intakes, individually tailored based on the subject's bodyweight and strictly controlled. We measured whole‐body, lumbar spine and femur BMD and BMC, as well as BMD of the cortical and trabecular compartments of the distal radius and tibia, and cortical and trabecular thickness during BDC, HDBR and recovery. Data were analysed using linear mixed models. The supplementation of an antioxidant cocktail did not mitigate the deteriorating effects of HDBR on BMD, BMC and bone structure parameters. Our findings do not support a recommendation for antioxidant supplementation for astronauts. [ABSTRACT FROM AUTHOR]

Purpose: We tested the feasibility of survivorship care plan (SCP) delivery with/without a lay health educator (LHE) telephone‐delivered information session among rural cancer survivors, and their effects on health‐related self‐efficacy and knowledge of cancer history. Methods: Randomized trial of cancer survivors from 3 rural oncology clinics featuring either SCP alone (control) or SCP plus LHE‐delivered information session (intervention). Participants completed a questionnaire on health‐related self‐efficacy and knowledge of cancer‐specific medical history. Responses were compared to medical records for accuracy. SCPs were then mailed to participants. Approximately 5 months later, participants completed a follow‐up questionnaire. A subset of participants took part in subsequent qualitative interviews about their study experience. Findings: Of 301 survivors approached, 72 (23.9%) were randomized (mean age 66.4 years; 3.1 years from diagnosis; 62.5% female), and 65 (90.3%) completed the study. Global mental and physical health or self‐efficacy scores did not change significantly from baseline to follow‐up for either group. In exploratory analyses, self‐efficacy increased in participants with inadequate/marginal health literacy in the intervention arm (+0.7, 95% CI = 0.1‐1.2; P =.01). Accuracy of knowledge did not improve but was high at baseline (mean 76.0±14.5%). 60.1% and 48.4% of control and intervention participants, respectively, found SCPs definitely/somewhat useful. Qualitative data (n = 20) suggested that SCPs were helpful to patients when primary and oncology care were less integrated. Conclusions: An LHE‐delivered informational session was feasible but had limited benefit to rural cancer survivors versus delivery of SCP alone but may be of benefit to patients with low health literacy or with less integrated care. [ABSTRACT FROM AUTHOR]

Background: Differences in metabolic responses between diets rich in monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) could affect energy balance and weight maintenance. The present study was a secondary analysis to investigate 8‐week diet interventions rich in either PUFA (cottonseed oil [CSO]) or MUFA (olive oil [OO]) on metabolic responses in adults with dyslipidaemia. Methods: Forty‐one adults with dyslipidaemia completed this randomised trial consisting of an 8‐week partial‐outpatient feeding trial. Provided foods accounted for about 60% of their daily energy needs, with about 30% of energy needs provided by CSO (n = 20) or OO (n = 21). At pre‐ and postdiet intervention visits, participants consumed a high saturated fatty acid (SFA) meal (35% daily energy needs, 47.9% from SFA), and fasting and 3.5‐h postprandial indirect calorimetry were used to measure energy expenditure (EE) and substrate oxidation. Results: No changes were observed in fasting measures. The OO group had greater increases in postprandial EE (p = 0.002); however, there were no differences in substrate oxidation between groups. A lack of metabolic flexibility was found in both groups, which was partially explained by changes in insulin sensitivity (homeostasis model assessment of insulin resistance). Conclusions: The results of the present study show that OO, but not CSO, diet enrichment improves EE after an occasional high SFA meal, which may improve weight maintenance over time. This study is registered at clinicaltrials.gov (NCT04397055). Key points: An olive‐oil‐enriched diet may improve postmeal energy expenditure more than a cottonseed‐oil‐enriched diet.Exploratory analysis suggests that changes in insulin resistance (homeostasis model assessment of insulin resistance) may contribute to one's ability to adapt to a high‐fat diet. [ABSTRACT FROM AUTHOR]

There is ample evidence that multimedia learning is challenging, and learners often underutilize appropriate cognitive processes. Previous research has applied prompts to promote the use of helpful cognitive processing. However, prompts still require learners to regulate their learning, which may interfere with learning, especially in situations where cognitive demands are already high. As an alternative, implementation intentions (i.e. if‐then plans) are expected to help regulate behaviour automatically due to their specific wording, thereby offloading demands. Accordingly, this study aimed at investigating whether implementation intentions compared with prompts improve learning performance, especially under high cognitive load. Students (N = 120) learned either in a control condition without instructional support, with prompts, or with implementation intentions. Within each condition, half of the participants studied the multimedia instruction under conditions of either high or low cognitive load, which was experimentally manipulated by instructing them to perform one of two secondary tasks. In line with our hypotheses, the results showed that under low cognitive load, both prompts and implementation intentions led to better learning than the control condition. By contrast, under high cognitive load, only implementation intentions promoted learning. Thus, implementation intentions are an efficient means to promote learning even under challenging circumstances. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare the efficacy of e‐flipped and online case‐based workshops on the nurses' knowledge, attitude and behaviour regarding thalassemia during the COVID‐19 pandemic. Design: A pre‐test–posttest interventional study was conducted with two intervention groups and a control group. Methods: One hundred and fifty nurses were recruited from comprehensive urban health centres in June–December 2020. The nurses were randomly allocated to one of the three groups: case‐based e‐flipped workshop (n = 50), case‐based online workshop (n = 50) and control (n = 50). A researcher‐made questionnaire was completed by eligible subjects at baseline, after the end of the training sessions and 4 weeks after interventions to assess their knowledge, attitude and behaviour. Data were analysed in IBM SPSS v16.0. ANOVA and Tukey's post hoc tests were used to compare the three groups. Results: The mean knowledge, attitude and behaviour scores in the intervention groups increased significantly more than that in the control group (p <.001). One week and 4 weeks following the intervention, the mean score of knowledge, attitude and behaviour in the e‐flipped group was greater than that in the online group (p <.001). According to the results, e‐flipped and online case‐based workshops can improve nurses' knowledge, attitude and behaviour regarding thalassemia. [ABSTRACT FROM AUTHOR]

Background: The risk of periodontal diseases development increased in patients with malocclusion undergoing orthodontic treatment. Thus, the aim of this study was to examine the efficacy of the use of adjunctive rinses with nano‐Argentum to standard oral hygiene regimen in subjects wearing fixed orthodontic appliances. Materials and Methods: Eighty patients were observed for 1 year. They were divided in two groups: in test group patients were instructed to rinse with non‐ionic colloidal silver solution according to protocol for 6 months as an adjunct to standard; in control group the patients followed the standard oral hygiene regimen. Index of efficiency of oral hygiene (PHPm), community periodontal index (CPI) and papillary‐marginal‐alveolar index (PMA) were evaluated before treatment and after 1 and 6 months. For statistics analysis, Mann–Whitney, Kruskal–Wallis tests and Pearson criterion were used. Results: Baseline hygiene levels in two groups had no differences. Oral hygiene indices were significantly lower in the test group in comparison with control after 1 month (PHPm = 0.38 ± 0.18 and 1.19 ± 0.45, respectively, p < 0.01; PMA = 11.78 ± 8.5 and 47.25 ± 20.9, respectively, p < 0.05; CPI = 0.65 ± 0.53 and 1.53 ± 0.77, respectively, p < 0.01) and 6 months (PHPm = 0.5 ± 0.2 and 1.2 ± 0.4, respectively, p < 0.01; PMA = 11.62 ± 19.6 and 66.33 ± 27.9, respectively, p < 0.01; CPI = 0.63 ± 0.73 and 1.68 ± 0.78, respectively, p < 0.01). Conclusions: The use of the test solution as an adjunct to standard oral hygiene provided a significant beneficial effect in terms of oral hygiene in patients undergoing orthodontic treatment. [ABSTRACT FROM AUTHOR]

Policy PointsMass vaccination is essential for bringing the COVID‐19 pandemic to a close, yet substantial disparities remain between whites and racial and ethnic minorities within the United States.Online messaging campaigns featuring expert endorsements are a low‐cost way to increase vaccine awareness among minoritized populations, yet the efficacy of same‐race/ethnicity expert messaging in increasing uptake remains unknown.Our preregistered analysis of an online vaccine endorsement campaign, which randomly varied the racial/ethnic identity of the expert, revealed no evidence that information from same race/ethnicity experts affected vaccine interest or the intention to vaccinate.Our results do not rule out the possibility that other low‐cost endorsement campaigns may be more effective in increasing vaccine uptake, but do suggest that public health campaigns might profitably focus on issues of access and convenience when targeting minoritized populations in the United States. Context: The COVID‐19 pandemic in the United States has been unequally experienced across racial and ethnic groups. Mass vaccination is the most effective way to bring the pandemic to an end and to manage its public health consequences. But the racialization of public health delivery in the United States has produced a sizable racial/ethnic gap in vaccination rates. Closing this gap in vaccine uptake is therefore essential to ending the pandemic. Methods: We conducted a preregistered, well‐powered (N = 2,117) between‐subjects survey experiment, fielded March 24 to April 5, 2021, in which participants from YouGov's online panel—including oversamples of Black (n = 471), Hispanic/Latino/a (n = 430), and Asian American (n = 319) participants—were randomly assigned to see COVID‐19 vaccine information endorsed by same‐ or different‐race/ethnicity experts or to a control condition. We then measured respondents' vaccination intentions, intention to encourage others to get vaccinated, and interest in learning more information and sharing information with others. Findings: Same‐race/ethnicity expert endorsements had no measurable effect on nonwhite or white respondents' willingness to get the COVID‐19 vaccine, to encourage others to get the vaccine, or to learn more or share information with others. Conclusions: Our study provides empirical evidence suggesting online endorsements from same‐race/ethnicity experts do not increase vaccine interest, advocacy, or uptake, though same‐race/ethnicity endorsements may be effective in other venues or mediums. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed the effects of massage therapy using 5% lavender oil on the severity of restless legs syndrome (RLS) and the quality of life (QoL) of patients on hemodialysis (HD). Design and methods: This is a randomized placebo‐controlled study with a pretest–posttest design. This study was conducted from January 30, 2019, to May 6, 2019, at HD centers in Turkey, and it includes 58 participants—31 study patients and 27 controls. Data were collected using patient identification form, RLS severity rating scale, Kidney Disease Quality of Life Scale (KDQOLTM‐36) and patient follow‐up charts. As per the massage therapy protocol, the patients in the study and control groups received massage therapy with lavender oil and baby oil, respectively. Findings: RLS severity significantly decreased in all follow‐up weeks in the study group and in the first, second, and third follow‐up weeks in the control group. There were significant differences between the groups in terms of KDQOLTM‐36 subscales and total scores at the initial and final follow‐ups. Conclusion: In HD patients, massage with lavender oil lessened the severity of RLS and improved the QoL. Accordingly, this therapy can be recommended to HD patients. Clinical relevance: Massage therapy during HD sessions is easy, inexpensive, and patient‐friendly with no side effects. It is known to reduce symptoms and enable the patients to easily perform daily activities of living. Massage therapy with lavender oil is effective and can be easily applied to patients with RLS by nurses. Trial registration: This study was registered under the Clinical Trials protocol registration system (NCT04630470) upon completion. [ABSTRACT FROM AUTHOR]

Aims: To examine the effects of e‐learning on intimate partner violence (IPV) knowledge, preparatory/reinforcing behaviors for supporting IPV victims, and IPV screening of midwives and nurses. Methods: Participants were randomly assigned to the intervention group (IG: e‐learning) and control group (CG: no e‐learning). The primary outcome was the mean change in knowledge score. The secondary outcomes were the mean number of types of practiced preparatory/reinforcing behaviors and the proportions of participants who practice screening. Unpaired t tests were performed in intention‐to‐treat analysis. Results: Of the 88 participants, 45 were randomly assigned to the IG and 43 to the CG. For the post‐1‐test, the IG had a mean change in the knowledge score of 8.5 points with a significant difference from the 1.4 points in the CG (mean difference [MD] 7.1, 95% CI [4.1, 10.1]). The mean change between the pre‐test and the post‐2‐test was significantly larger in the IG (7.9 points) than in the CG (1.3 points) (MD 6.6, 95% CI [3.3, 9.9]). The mean number of types of practiced behaviors at the post‐1‐test and post‐2‐test was significantly higher in the IG than in the CG (MD 1.4, 95% CI [0.1, 2.8]). There was no significant difference in the proportions of participants who practice screening between the two groups postintervention. Conclusions: The e‐learning effectively improved knowledge and promoted preparatory/reinforcing behaviors. [ABSTRACT FROM AUTHOR]

Objectives: Patient safety is regarded as a critical quality monitoring indicator for medical institutions. The effects of a multimedia‐based patient education intervention on knowledge, attitudes, and behaviors regarding fall prevention were observed. Methods: The study had a quasi‐experimental research design and enrolled 140 participants. Seventy participants in the experimental group received multimedia‐based patient education and a health education leaflet, while those in the control group received only the health education leaflet. A structured questionnaire was used for data collection at baseline, and a posttest was applied after the intervention. Results: The participants were predominantly treated in the gastroenterology department (45.7%), followed by the pulmonology department (33.6%). A total of 86.4% of patients had not experienced a fall within 3 months. After the intervention, the average scores for all variables in the experimental group were higher than those in the control group. The results indicate that attitudes, knowledge, and behaviors regarding fall prevention among patients in the pulmonology department were higher than those among patients in the gastroenterology department; the differences were statistically significant. Conclusion: The individualized health education content was of substantial significance for patients with different disease backgrounds and facilitated changes in their knowledge, attitudes, and behaviors regarding falls. Relevance to clinical practice: Multimedia‐based patient education influenced inpatients' knowledge, attitudes, and behaviors for preventing falls. [ABSTRACT FROM AUTHOR]

Adequate maternal healthcare practices are crucial to both maternal and infant nutrition outcomes. The Sylhet region of Bangladesh is vulnerable and performs poorly, as maternal and child health indicators are falling behind compared to other areas. Suchana, a large‐scale intervention programme aims to improve the health and nutritional status of mothers and children in this region. The objective of the present analysis is to assess the changes in indicators related to maternal healthcare practices among Suchana beneficiaries. We obtained data from the Suchana baseline and endline evaluation survey. Descriptive statistics were employed to summarize data. The following maternal healthcare practices were considered: if a Suchana beneficiary mother received antenatal care (ANC) from skilled service providers, took day time resting during pregnancy, consumed additional diet during pregnancy, took at least 100 iron‐folic acid (IFA) tablets during pregnancy and took a vitamin A capsule after delivery. Logistic regression analysis was performed to assess the impact of the Suchana intervention on maternal healthcare practices. The prevalence of the outcome variables at endline in the intervention area were as follows: 40% of mothers received at least four ANC from skilled service providers, 50% practiced daytime resting during pregnancy, 51% consumed additional diet during pregnancy, 41% took at least 100 iron‐folic acid tablets during pregnancy, 39% received postnatal care and 30% took a vitamin A capsule after delivery. The Suchana intervention significantly, positively improved indicators related to maternal healthcare practices; these findings support future larger‐scale programmes to improve maternal healthcare practices among vulnerable people in rural Bangladesh. [ABSTRACT FROM AUTHOR]

Micronutrient supplementation is widely used to prevent stunting in children under 5 years in low‐ and middle‐income countries (LMIC), but the impact of treatment has been disappointing, possibly due to non‐compliance. Our aim was to deliver long‐term micronutrient supplementation via a novel, culturally acceptable liquid food to improve linear growth in a high stunting prevalence region. In a randomised control trial, 971 children aged 6–72 months received either 'Chispuditos®' (n = 681), a hot drink (atole) fortified with micronutrients (atole + MN) (9 mg/zinc, 12.5 mg/iron), or lactose‐free milk (n = 290) for 18 months. Primary outcomes were changes in length/height‐for‐age (HAZ) score and the prevalence of stunting at 18‐month follow‐up. Adherence was monitored monthly, and 73% children in atole + MN group consumed at least half their daily zinc and iron requirement. At 18 months, there was no difference between the treatments in growth [mean change in HAZ −0.02 (95% CI −0.12, 0.08)] or stunting [atole + MN 41%, milk 41%; RR 0.99 (95% CI 0.84, 1.19)]. There were no differences in haemoglobin (HB), ferritin or zinc. No children had iron deficiency anaemia (IDA) at outcome, but zinc deficiency remained equally prevalent in both groups: atole + MN 35%, milk 35% [RR 1.02 (95% CI 0.83, 1.24)]. There was no difference in morbidity between the groups, and micronutrient status was unrelated to HAZ. Long‐term micronutrient supplementation via a culturally acceptable food had no impact on stunting or morbidity, raising the question of whether large‐scale micronutrient supplementation is worthwhile. [ABSTRACT FROM AUTHOR]

Background: Older adults and their caregivers often believe it is either too late or too difficult to make health‐focused lifestyle changes. However, this is inaccurate, as older adults can make health promotion focused lifestyle changes thereby improving their health. This study developed and evaluated a self‐care education program using Pender's Health Promotion Model and its influence on health‐focused behaviour changes among older Iranians. Method: This was a quasi‐experimental study with a convenience sample of 136 community‐living older adults from Tabriz, Iran. The participants were randomly assigned to either an intervention (n = 69) or control (n = 67) group. Chi‐square test, independent t tests and Analysis of covariance (ANCOVA) statistical methods were used to compare pre‐ and post‐intervention data, control and intervention groups and changes over time. The intervention was an eight‐week educational program with pre‐ and post‐intervention data collected using the Health Promoting Lifestyle Profile II (HPLP II) questionnaire. Results: The mean difference and confidence limits of the older adults' health behaviours pre‐ and post‐intervention scores were 2.228 (−5.450 – 9.916) and ‐ 35.820 (−32.051 – 39.588). The covariance analysis adjusting for the baseline values showed significant differences post‐intervention (p<0.0001) in the areas of interpersonal communication, physical activity, nutrition, stress management and spiritual growth. Conclusion: The health promotion education intervention illustrated that older Iranians could improve their health outcomes in several areas. Thus, culturally tailored intervention programs can be successful in challenging the opinion that older adults cannot make behaviour changes supporting their health. [ABSTRACT FROM AUTHOR]

Objective: To test the effectiveness of a dentifrice containing the turmeric and licorice extract compared to a control for preventing plaque and gingivitis over a four‐month period. Material and methods: Ninety (non‐dental) participants with moderate gingival inflammation (≥ 40%) were selected. The triple blind study consisted of two phases, namely at first a 3‐week pre‐experimental phase of using an oxygenating and chlorhexidine (CHX) mouthrinse. Secondly, a 4‐month experimental period in which participants were randomly assigned to a test or control group. All were instructed to brush their teeth twice daily for 2 minutes with their assigned dentifrice. Gingival bleeding (BI), plaque (PI) and gingivitis (GI) were assessed. Results: Eighty participants completed the protocol. At the first assessment in the pre‐experimental phase, the mean scores of all indices showed no differences for the two groups. At the second session, the values of all three parameters had decreased significantly (p < 0.001). At the last session, the BI values were 0.52(0.25) for the test group and 0.56(0.25) for the control, the mean GI was 0.27(0.17) for the test group and 0.31(0.16) for the control, and for PI the scores were 1.89(0.46) for the test group and 1.98(0.43) for the control group. Statistical comparison of the scores for the two groups at each stage of the study showed no significant difference for any of the parameters. Conclusion: Within the limits of the current study design, dentifrice formulation and concentration of turmeric/licorice extracts, the results show that the adjuvant effect of the natural ingredients in the test dentifrice was not evident on clinical parameters of gingivitis and plaque. [ABSTRACT FROM AUTHOR]

Hopelessness is associated with decreased physical activity (PA) and increased adverse events and death in patients with ischemic heart disease (IHD). Rates of PA in patients with IHD continue to be low in both hospital‐based cardiac rehabilitation and home settings. While researchers have investigated strategies to increase PA among patients with IHD, interventions to promote PA specifically in IHD patients who report hopelessness are lacking. We describe the protocol for a NIH‐funded randomized controlled trial designed to establish the effectiveness of a 6‐week intervention (Heart Up!) to promote increased PA in IHD patients who report hopelessness. Participants (n = 225) are randomized to one of three groups: (1) motivational social support (MSS) from a nurse, (2) MSS from a nurse plus significant other support (SOS), or (3) attention control. Aims are to: (1) test the effectiveness of 6 weeks of MSS and MSS with SOS on increasing mean minutes per day of moderate to vigorous PA; (2) determine the effects of change in moderate to vigorous PA on hopelessness; and (3) determine if perceived social support and motivation (exercise self‐regulation) mediate the effects of the intervention on PA. A total of 69 participants have been enrolled to date. The protocol has been consistently and accurately used by research personnel. We address the protocol challenges presented by the COVID‐19 pandemic and steps taken to maintain fidelity to the intervention. Findings from this study could transform care for IHD patients who report hopelessness by promoting self‐management of important PA goals that can contribute to better health outcomes. [ABSTRACT FROM AUTHOR]