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Rationale, aims and objectives Despite extensive evidence on the value of patient decision support interventions ( DESIs), there is no consensus on optimal DESI formats. Assessing clinicians' perceptions about DESI formats can help facilitate their adoption. The aim of this study was to assess clinicians' perceptions of DESIs formats and potential use in practice. Methods Semi-structured qualitative interviews were conducted with doctors from diverse practice areas (internal medicine, OB/ GYN, surgery, medical oncology, emergency medicine) and elicited perceptions toward patient DESIs formats (digital vs. paper) and timing of administration. Questions also elicited beliefs underlying attitudes, perceived social norms and self-efficacy for using DESIs and the feasibility of doing so. Data analysis was conducted using a thematic analysis approach. Results Participants identified strengths of both more comprehensive digital and shorter paper-based tools and thought they could complement each other. Participants consistently expressed the advantages of using DESIs outside the consultation to supplement clinical discussions about cancer decisions given the amount of information to discuss during these emotion-laden conversations. Participants felt that patients with older age and lower socio-economic status were more likely to use a paper-based compared with a digital DESI. Participants also noted challenges related to reliable resources such as computers and Internet in the practice setting, which would be necessary for implementing the digital DESIs on site. Conclusions Clinicians' perceptions and opinions about value of DESIs can vary widely across doctor, patient and clinic characteristics. A one-size-fits-all approach to implementation might not be feasible, suggesting that flexible approaches to providing decision support for patients are needed to drive broader adoption. [ABSTRACT FROM AUTHOR]

Background: Methodological problems have impeded successful epidemiological research into disorders of gut‐brain interactions (DGBI), as previous studies were limited in terms of study population, diagnostic criteria, number of disorders assessed, data collection methods, and geographic area. Most prevalence estimates were based on pooling data from heterogeneous studies using inappropriate pooling methods, seriously limiting the relevance of the results. The Rome Foundatiion Global Epidemiology Study (RFGES) aimed to rectify these limitations using rigorous methodology to survey the prevalence of 22 DGBI in large population samples in 33 countries. Its aims were to conduct a comprehensive, multinational epidemiological study using rigorous research methodology, gain a better understanding of the burden of the DGBI, gain reliable regional estimates of DGBI prevalence, and advance our understanding of the pathophysiology of IBS. The study questionnaire consisted of the 89‐item Rome IV Adult Diagnostic Questionnaire enabling the diagnosis of 22 DGBI, and an 80‐item supplemental questionnaire that enabled analyses of the association of multiple factors with DGBI diagnoses. Purpose for review article: This review paper introduces a special issue on the Rome Foundation Global Epidemiology study (RFGES) with a narrative description of its conception, development, and implementation, its outcomes to date, and its potential contribution to neurogastroenterology. It includes 15 papers that reflect the range of RFGES studies from single country papers to intra‐regional studies, to inter‐regional studies, and one global study. [ABSTRACT FROM AUTHOR]

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Objective: To determine the level of agreement of disease flare severity (distinguishing severe, moderate, and mild flare and persistent disease activity) in a large paper-patient exercise involving 988 individual cases of systemic lupus erythematosus.Methods: A total of 988 individual lupus case histories were assessed by 3 individual physicians. Complete agreement about the degree of flare (or persistent disease activity) was obtained in 451 cases (46%), and these provided the reference standard for the second part of the study. This component used 3 flare activity instruments (the British Isles Lupus Assessment Group [BILAG] 2004, Safety of Estrogens in Lupus Erythematosus National Assessment [SELENA] flare index [SFI] and the revised SELENA flare index [rSFI]). The 451 patient case histories were distributed to 18 pairs of physicians, carefully randomized in a manner designed to ensure a fair case mix and equal distribution of flare according to severity.Results: The 3-physician assessment of flare matched the level of flare using the 3 indices, with 67% for BILAG 2004, 72% for SFI, and 70% for rSFI. The corresponding weighted kappa coefficients for each instrument were 0.82, 0.59, and 0.74, respectively. We undertook a detailed analysis of the discrepant cases and several factors emerged, including a tendency to score moderate flares as severe and persistent activity as flare, especially when the SFI and rSFI instruments were used. Overscoring was also driven by scoring treatment change as flare, even if there were no new or worsening clinical features.Conclusion: Given the complexity of assessing lupus flare, we were encouraged by the overall results reported. However, the problem of capturing lupus flare accurately is not completely solved. [ABSTRACT FROM AUTHOR]

Background: The collection of subgingival plaque samples with paper points is time-consuming and accident-sensitive. However, the collection of saliva is simple and contains pathogens of all intraoral surfaces. The aim of this study is to investigate whether a sampling strategy with mouthrinse (mouthrinse sample [MSP]; test) leads to results comparable with standard sampling method (multiple site test from the deepest pocket of each quadrant [MT4]; control).Methods: In 50 patients with periodontitis, subgingival plaque was sampled from the deepest pocket of each quadrant by using paper points and by gaining saliva with saline mouthrinse. Analysis was performed using a commercially available polymerase chain reaction test for 11 periodontal pathogens.Results: Detection frequency of Aggregatibacter actinomycetemcomitans (MT4/MSP: 42%/36%), Porphyromonas gingivalis (78%/66%), Tannerella forsythia (98%/84%), Treponema denticola (94%/74%), Parvimonas micra (86%/62%), Campylobacter rectus (90%/76%), Eubacterium nodatum (64%/30%), Prevotella intermedia (58%/54%), and Eikenella corrodens (90%/82%) was higher with MT4 than MSP. For Fusobacterium nucleatum (100%/100%), there was no difference between test and control. Only detection frequency of Capnocytophaga species (68%/74%) was higher with MSP than MT4. Differences were significant for P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum.Conclusions: There is no significant difference between MT4 and MSP for detection frequency of key pathogen A. actinomycetemcomitans. Key pathogens P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum show statistically higher detection frequencies with MT4. [ABSTRACT FROM AUTHOR]

Objectives: DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) is designed to address fundamental, and, as yet unanswered questions about inequalities, outcomes and costs following diagnosis with dementia. These answers are needed to improve the quality of care and equity of access to care, and therefore the quality of life, of people with dementia and their carers.Method: DETERMIND is a programme of research consisting of seven complementary workstreams (WS) exploring various components that may result in unequal dementia care: WS1: Recruitment and follow-up of the DETERMIND cohort-900 people with dementia and their carers from three geographically and socially diverse sites within six months following diagnosis, and follow them up for three years. WS2: Investigation of the extent of inequalities in access to dementia care. WS3: Relationship between use and costs of services and outcomes. WS4: Experiences of self-funders of care. WS5: Decision-making processes for people with dementia and carers. WS6: Effect of diagnostic stage and services on outcomes. WS7: Theory of Change informed strategy and actions for applying the research findings.Outcomes: During the life of the programme, analysing baseline results and then follow-up of the DETERMIND cohort over 3 years, we will establish evidence on current services and practice. DETERMIND will deliver novel, detailed data on inequalities in dementia care and what drives positive and negative outcomes and costs for people with dementia and carers, and identify factors that help or hinder living well with dementia. [ABSTRACT FROM AUTHOR]

The main aim of this paper is to explore and discuss the interesting juxtaposition of patient involvement within a standardised Enhanced Recovery After Surgery care programme (ERAS). We address our aim by examining the work and strategies of nursing staff caring for patients during postoperative recovery from surgery, exploring how these two potentially competing priorities might effectively co‐exist within a hospital ward. This was a qualitative exploratory study, with data generated through 42 semi‐structured interviews with patients and nurses who had taken part in an ERAS programme in one of three hospital wards in the United Kingdom, adopting a reflexive thematic approach to data analysis. We shine a light on the work undertaken by patients and nurses during the navigation of postoperative recovery, identifying strategies of collaboration and negotiation during this journey. Furthermore, we also identify and consider patients engaged in peer‐peer support during postoperative recovery. This paper adds to the existing literature and current ways of thinking in relation to the quest for standardised, clinically effective care balanced with the aspirations for individualised, patient‐centred care. This paper also helps inform thinking about the use of care pathways in relation to service delivery, considering how best to initiate and deploy best practice aimed at safe and effective postoperative recovery. [ABSTRACT FROM AUTHOR]

Objectives: A prospective parallel cohort trial was conducted to compare outcomes of patients treated with maxillary protraction vs LeFort 1 maxillary advancement surgery.Setting and Sample Population: The primary site for the clinical trial is Children's Hospital Los Angeles; the satellite test site is Seattle Children's Hospital. All patients have isolated cleft lip and palate and a skeletal Class III malocclusion.Material and Methods: A total of 50 patients, ages 11-14, will be recruited for the maxillary protraction cohort. The maxillary surgery cohort consists of 50 patients, ages 16-21, who will undergo LeFort 1 maxillary advancement surgery. Patients with additional medical or cognitive handicaps were excluded from the study.Results: Current recruitment of patients is on track to complete the study within the proposed recruitment period.Conclusion: This observational trial is collecting information that will examine dental, skeletal, financial and quality-of-life issues from both research cohorts. [ABSTRACT FROM AUTHOR]

Purpose: Sociometric studies and adult reports have established that children with Language Disorder (LD) are at risk of peer relationship difficulties. However, we have limited knowledge of how children with LD understand friendship, whom they deem as a good or bad friend, and what role their friendship concepts play in their relationships with peers. This exploratory study aimed to conduct a qualitative investigation into the friendship concepts that children with LD hold and to explore their strategies for making friends. Methods: We conducted multiple, art‐informed interviews on the topic of friendship with 14 children with LD at the age of 6–8 years. Participating children were based in the United Kingdom and Republic of Ireland. They attended enhanced provision, specific speech and language classes and mainstream classrooms. We used framework analysis to map children's responses to Selman's (1979) developmental model of interpersonal understanding, which espouses a theory of children's social development within the context of peer relationships. Results: The understanding of friendship formation in children with LD varied from physical presence to mutual support and sharing. Children's ideas about a good/bad friend represented the lowest developmental stage. Participants from the mainstream classroom demonstrated the highest stages of interpersonal understanding. Children with LD did not mention their language abilities as a barrier to making friends. Conclusion: There are limited studies exploring friendship directly from children with LD, and this study provides insights into this gap, by utilising art‐informed interviews. Children's immature understanding of a good/bad friend points towards a potential susceptibility to false friends, which we suggest needs further empirical validation. We also found that children with LD did not pay attention to their language difficulties when making friends, which raises questions about the ways diagnoses are shared with children. WHAT THIS PAPER ADDS: What is already known on the subject: Children with Language Disorder (LD) are at risk of peer relationship difficulties. Studies to date are based on sociometrics and adult reports. Only a few studies employ participatory approaches to research with children, directly engaging children with LD when exploring their friendships What this paper adds: This paper directly asks children with LD about their understanding of friendship and strategies for making friends.Physical proximity and play are important to children.s understanding of friendship especially in recognising good and bad friends. This indicates potential reasons for children with LD being susceptible to false friendsAdditionally, children with LD do not perceive language and communication as a barrier to making friends. What are the potential or actual clinical implications of this work?: Concepts around friendship and good/bad friends should be routinely assessed and targeted (if appropriate) in interventions. The study highlights the need to continue discussing practices around sharing diagnoses with children with LD. [ABSTRACT FROM AUTHOR]

Introduction: Virtual reality (VR) technology is a potential method to use in cognitive intervention, but the use of VR in cognitive stimulation intervention for older adults has not been investigated. Therefore, the aim of this study was to investigate the mood change of older adults after participating in the VR cognitive stimulation activity.Methods: This is a multicenter randomized controlled, cross-over trial. The intervention was a VR cognitive stimulation activity, and the control was a paper-and-pencil activity. The participants were older adults with age over 60 and recruited in the elderly community centers. The Positive and Negative Affect Score (PANAS) was used to measure mood change. Mean difference (MD) with 95% confidence interval (95% CI) was calculated. The Simulator sickness questionnaire was used to measure adverse events.Results: A total of 236 participants from 19 community centers were recruited. After the VR activity, the participants had a significant increase in total PANAS positive affect score (MD = 2.09, 95% CI = 0.69 to 3.49), and a significant reduction in total negative affect score (MD = -1.99, 95% CI = -2.55 to -1.43). The reduction in negative affect score was significantly larger in VR activity than paper-and-pencil activity (MD = -0.48, 95% CI = -0.98 to 0.00). Besides, only three participants reported severe advance events after VR activity.Conclusions: The use of VR technology is well accepted by older adults. Therefore, the use of VR technology through smartphone and a mobile app can be a potential method for future cognitive training interventions. [ABSTRACT FROM AUTHOR]

Introduction: Although Jordan has made significant progress toward expanding the utilization of facility‐based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors. Methods: Utilizing a pre–post design, quality gaps in intrapartum care were assessed among 959 women pre‐ and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions. Results: The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was −0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, −0.24 (±0.39) and −0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (β = 0.61), mode of birth (β = −0.60), admission timing (β = −0.41), continuity of midwifery care (β = −0.43), physician's gender (β = −0.62), active labour duration (β = 0.37), and pain management (β = −0.33) to be the key determinants of the overall quality gap in intrapartum care. Conclusion: Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan. Patient or Public Contribution: This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan. [ABSTRACT FROM AUTHOR]

This paper reports on data that is part of a wider evaluation of a small‐scale project that offers support to parents, children and families affected by alcohol and substance use. Using semi‐structured interviews and a focus group, the data in this paper explore mother's sense making of their substance use and their experiences of various professional interventions which have helped or hindered their personal journeys of recovery. Mothers' narratives suggested a self‐critical inner dialogue conceptualized as shame. Fear of stigma and a sense of shame derived from historical abuse and had a profound effect on how mothers perceived themselves and how they negotiated a web of professionals involved in their lives. Community projects with a focus on understanding mothers and their needs, and not the risk they posed to their children, were considered most supportive. Interventions working within a non‐judgemental and empathetic framework that fostered the importance of relationships and connection had a greater impact on mothers' long‐term recovery goals. [ABSTRACT FROM AUTHOR]

Background: Acute and late toxicities in patients treated with (chemo)radiotherapy for head and neck cancer (HNC) is common and can negatively impact quality of life and performance. Performance status instruments measure the functional ability to perform daily life activities and are important tools in the oncologic population. Aims: Since Dutch performance status scales for the HNC population are lacking, we conducted this study to translate the Performance Status Scale for Head and Neck Cancer Patients (PSS‐HN) into Dutch (D‐PSS‐HN) and to validate this version. Methods & Procedures: The D‐PSS‐HN was translated into Dutch according to the internationally described cross‐cultural adaptation process. It was administered to HNC patients and together with the Functional Oral Intake Scale completed by a speech and language pathologist at five different time points during the first 5 weeks of (chemo)radiotherapy. Patients were asked each time to complete the Functional Assessment of Cancer Therapy and the Swallowing Quality of Life Questionnaire. Pearson correlation coefficients were used to calculate convergent and discriminant validity and the evolution of D‐PSS‐HN scores was assessed by means of linear mixed models. Outcomes & Results: A total of 35 patients were recruited and > 98% of the clinician‐rated scales were completed. Convergent and discriminant validity were demonstrated, with all correlations rs between 0.467 and 0.819, and between 0.132 and 0.256, respectively. The subscales of the D‐PSS‐HN are sensitive to detect changes through time. Conclusion & Implications: The D‐PSS‐HN is a valid and reliable instrument to assess performance status in patients with HNC treated with (chemo)radiotherapy. It is a useful tool to measure HNC patients' current diet level and functional abilities to perform daily life activities. WHAT THIS PAPER ADDS: What is already known on the subject: Acute and late toxicities in patients treated with (chemo)radiotherapy for HNC are common and can negatively impact quality of life and performance. Performance status instruments measure the functional ability to perform daily life activities and are important tools in the oncologic population. However, Dutch performance status scales for the HNC population are lacking. Therefore, we translated the Performance Status Scale for Head and Neck Cancer Patients (PSS‐HN) into Dutch (D‐PSS‐HN) and validated this version. What this paper adds to existing knowledge: We translated the PSS‐HN and demonstrated its convergent and discriminant validity. The subscales of the D‐PSS‐HN are sensitive to detect changes through time. What are the potential or actual clinical implications of this work?: The D‐PSS‐HN is a useful tool to measure HNC patients' functional abilities to perform daily life activities. The tool can easily be used in clinical settings: since data collection duration is very short, this facilitates clinical (and research‐related) implementation of the scale. Patients' individual needs could be identified by using the D‐PSS‐HN, resulting in more appropriate approaches and (early) referrals if needed. Interdisciplinary communication could be facilitated. [ABSTRACT FROM AUTHOR]

Introduction: Telepractice service delivery of allied health interventions to people with disability can potentially reduce access barriers and improve service equity. However, questions remain regarding telepractice functionality for people with disability. This study addressed questions related to how allied health clinicians and managers perceive telepractice as functioning in the provision of therapy services to people with disability. Methods: Thirteen interviews of allied health clinicians and managers from across Australia were conducted between 21 November and 22 February via MS teams. Qualitative methodology and critical realist theoretical paradigm underpin the study. Data analysis was completed using a reflective thematic analysis method and five themes were generated and described utilising an analytic metaphor. Results: The study themes were described in relation to a shopping for shoes analytic metaphor and the five themes included (1) a shoe for every foot, (2) planned purchases, (3) shoe on the other foot, (4) you need both shoes and (5) help choosing their shoes. In summary, the function of telepractice fits differently for each individual, similar to pairs of shoes. Conclusions: Telepractice has its own strengths and weaknesses and isn't a direct substitute for in‐person sessions, much like left and right shoes are similar but not the same. The results support participant perceptions that telepractice functions best as an adjunct to in‐person sessions through a flexible hybrid delivery model in the provision of therapy services to people with a disability. A strategy for improving perceived usefulness may involve positioning telepractice as unique with strengths and weaknesses, not replacing in‐person care. Patient or Public Contribution: The paper forms part of a larger codesign process which included customer and carer participants throughout the design and planning of the project, inclusion of a peer researcher, and the selection of the analytic metaphor including in the findings of this article production. [ABSTRACT FROM AUTHOR]

Background: This paper reports on a participatory project on the history of learning disability. The paper makes contributions to discourses on using participatory research methods with people labelled with learning disabilities, on the nature of research impact in participatory research, and on the lived experience of learning disability today. Methods: We used a two‐step methodology. The first step involved searching for and selecting archive material relating to the history of learning disability. The second step involved a series of participatory workshops. We worked collectively to systematically analyse the case history of Antonia Grandoni. Then we responded to it in a variety of creative ways. In doing so, we made connections between Antonia's life and our own. Findings: Many of Antonia's experiences seem very similar to what people labelled with learning disabilities often encounter today. These include discrimination, segregation and dehumanisation. Despite this, we very much enjoyed doing the research. As well as finding out about the history, some of us learned new skills, some of us grew in confidence, and we also made new friends. Conclusions: Participatory methods are an effective way of making digital archive material more accessible to people labelled with learning disabilities. In this project, using participatory methods revealed a lot of parallels between how we think somebody experienced learning disability in the mid‐19th century, and how it is experienced today. They also resulted in significant impact on the people doing the research. Accessible summary: This is a paper about how we researched learning disability history together.We used material in a digital archive as well as creative methods to do our research.Working this way helped us learn about ourselves, and each other's experiences of learning disability, whilst we learned about the history.This is important because people with learning disabilities have not often been able to do historical research.Research like this matters because doing it teaches us useful skills and can be empowering. [ABSTRACT FROM AUTHOR]

This paper focuses on data science in digital cultural heritage in Brazil, where there is a lack of systematized information and curated databases for the integrated organization of documentary knowledge. Thus, the aim was to systematically map the different forms of information organization and representation applied to objects from collections belonging to institutions affiliated with the federal government's Special Department of Culture. This diagnosis is then used to discuss the requirements of devising strategies that favor a better data science information infrastructure to reuse information on Brazil's cultural heritage. Content analysis was used to identify analytical categories and obtain a broader understanding of the documentary sources of these institutions in order to extract, analyze, and interpret the data involved. A total of 215 hyperlinks that can be considered cultural collections of the institutions studied were identified, representing 2,537,921 cultural heritage items. The results show that the online publication of Brazil's digital cultural heritage is limited in terms of technology, copyright licensing, and established information organization practices. This paper provides a conceptual and analytical view to discuss the requirements for formulating strategies aimed at building a data science information infrastructure of Brazilian digital cultural collections that serves as future projects. [ABSTRACT FROM AUTHOR]

Background: In order to conduct research that is meaningful to speech and language therapy services and their patients, it is often desirable to conduct the research within routine clinical services. This can require considerable time and commitment from speech and language therapists (SLTs). It is therefore important to understand the impact that such participation in research can have. Aims: To explore the impact of research participation in the Big CACTUS study of self‐managed computerized aphasia therapy conducted in 21 UK NHS speech and language therapy departments. Methods & Procedures: An online survey was sent to SLTs who took the lead role for the study at their NHS Trust to evaluate the impact of study participation in three domains: capacity‐building, research development and health services. The questionnaire, based on the VICTOR framework for evaluating research impact, included Likert scale statements and closed and open‐ended questions. The results from open‐ended questions were coded and analysed using framework analysis in NVivo 12 and the data from closed questions were analysed descriptively. Outcomes & Results: A total of 12 SLTs returned the survey. Nine codes were identified from open‐ended questions and 20 predefined from the literature. Analysis of the responses demonstrated the perceived impact including improvements in practices and access to therapy, investments in infrastructure, increased SLT profile, and impact on research culture among SLTs. The usefulness of the intervention during the COVID‐19 pandemic was also highlighted. Conclusions & Implications: The results suggest participation in Big CACTUS has resulted in improvements in patient care and SLT research capacity and culture in speech and language therapy departments. What This Paper Adds: What is already known on the subject: Practice‐based research is encouraged to assist with the clinical relevance of the research findings. Participation in research can be seen as an activity that is additional to the core business of patient care and it can be difficult to secure time to participate or conduct research in clinical settings. Impact evaluation initiatives of individual trials facilitate early identification of benefits beyond the trial. What this paper adds to existing knowledge: This study describes specific examples of the impact on services, staff and patients from SLT participation and leadership in the Big CACTUS speech and language therapy trial in clinical settings. What are the potential or actual clinical implications of this study?: Clinical services participating in research may benefit from improved clinical care for patients both during and after the study, an improved professional reputation, and increased research capacity and culture within the clinical settings. [ABSTRACT FROM AUTHOR]

Aims: Reflexivity is central to the construction of knowledge in qualitative research. This purpose of this paper was to outline one approach when using reflexivity as a strategy to ensure quality of the research process. Design: In this exploratory research, reflexivity was established and maintained by using repeated questionnaires, completed online. Using the approach presented by Bradbury‐Jones (2007) and Peshkin's I's, the aim of the research was to identify the researcher's values, beliefs, perspectives and perceptions prevalent in the research. Methods: Qualitative data were collected in online reflexive questionnaires, completed monthly by the researcher from January 2017 to December 2018. Data analysis used interpretive and reflective reading and inductive processes. Results: Seventeen questionnaires were analysed. Data indicated use of questionnaires enabled and detailed development of specific strategies to ensure trustworthiness. Importantly, reflexivity, supported by questionnaires, brought about transformation through self‐awareness and enlightenment. [ABSTRACT FROM AUTHOR]

Background: Communication and cognitive impairments are known barriers to shared decision‐making. Most people diagnosed with motor neurone disease (MND) will develop a motor speech impairment over the disease course. Some will develop cognitive, linguistic or behavioural disturbance. Despite this, the impact of communication and cognitive impairment on personal healthcare decision‐making in MND is not well known. Aims: This exploratory, longitudinal study aimed to capture the perspectives of people living with MND (plwMND) and family members on managing their healthcare with, or in anticipation of, a communication impairment. Methods & Procedures: Semi‐structured interviews and functional assessments were conducted with plwMND and family members over one to three time points between December 2017 and January 2020. Participants were recruited from a specialist MND clinic using a maximum variation sampling approach. Interview transcripts were analysed using trajectory data analysis: a matrix‐based approach for thematic analysis of longitudinal data. The study was underpinned by interpretive descriptive methodology. Outcomes & Results: A total of 19 plwMND with a range of MND phenotypes and 15 family members were recruited. Disease progression and participant withdrawal resulted in attrition, however 12 plwMND and seven family members participated at all three time points. Consistent cognitive screening was not feasible, which limited the opportunity to explore the impact of cognitive change. An overarching theme 'Communicating takes effort' was identified and illustrates the efforts required to compensate for, or circumnavigate, impairments to maintain involvement in healthcare. Assistance from family and accommodation from healthcare professionals (HCPs) was needed for ongoing engagement. Where plwMND were dependent on alternative communication devices, this assistance was essential and primarily carried out by family members. Despite these efforts, the quality, quantity and accuracy of communication were sometimes compromised. Participants equated good communication with receiving good healthcare, and some expressed anxiety in the anticipation of being unable to express their needs to healthcare workers. Conclusion & Implications: Communication impairment has a direct impact on healthcare involvement. This study demonstrates the effort required by plwMND and their carers to maintain or maximize ongoing involvement. This effort may not always be visible to HCPs. This information may prompt clinicians to consider the best ways to conduct clinical consultations to accommodate patients' abilities. Compromised communication experiences can be moderated by accommodations and support from HCPs and appropriate adjustments in the health system. Asking patients about their communication preferences and needs, allowing extra time and conducting multidisciplinary sessions are examples of such support. What this paper adds: What is already known on this subject?: Communication and cognitive impairments are known contributors to negative health outcomes and barriers to shared decision‐making generally. The existing literature in decision‐making in MND does not address the specific impact of these impairments on personal healthcare involvement for plwMND and their carers. What this paper adds to existing knowledge?: This paper reports the findings of a research project that interviewed 19 plwMND and 15 carers on one to three occasions over a 26‐month period to obtain their perspectives of the impact of communication on healthcare involvement. Whilst a priori the intention was to look at both communicative and cognitive decline, only the former was achieved. The effort and often 'invisible' activity undertaken to manage or maintain involvement in healthcare is identified. Communication impairment requires support and accommodation, otherwise healthcare involvement can be compromised. Results show participants may associate effective communication with good healthcare. What are the potential or actual clinical implications of the work?: Clinicians may wish to use these insights from plwMND and their carers to guide adjustments to their professional practice to maximize healthcare involvement for their patients. Tailored education for different healthcare groups is needed to improve understanding of MND‐related communication impairments and supportive strategies so that involvement in healthcare is not compromised. [ABSTRACT FROM AUTHOR]

The context of this paper is family situations where young people are experiencing significant behavioural and emotional problems. Based on a qualitative study, it offers an empirical and theoretical contribution to the understanding of family‐related factors that promote or hinder behaviour change. Data were collected through face‐to‐face, semi‐structured group interviews with nine families (28 participants), all of them mandatory recipients of child welfare services in Croatia. Thematic analysis comprised primary coding designed to elicit information about individual family members' capacity for change and secondary coding of family‐level phenomena. The results indicated 10 phenomena that were judged to represent factors that helped or hindered change. The discussion section suggests three broad categories of capacity to change at family level (Goals and Priorities; Problem solving dynamics; and Development of role relationship). This analysis is offered as the basis for an examination of the concept of family capacity for change. [ABSTRACT FROM AUTHOR]

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

Background: People with post‐stroke dysphagia often require informal care from family to facilitate safe swallowing, modify food/drink or administer tube‐feeds. Previous survey studies have found dysphagia may increase family caregiver burden. However, the experiences of family members in this population have not been fully explored. Aims: To explore family members' experiences of living with a spouse with post‐stroke dysphagia. Methods & Procedures: This exploratory qualitative study used one‐to‐one semi‐structured interviews to explore family members' experiences. They were asked open questions about previous eating routines, dysphagia onset, their role and future hopes. Interviews were audio‐recorded, transcribed and analysed thematically with an inductive approach to determine key features of family members' experiences. Outcomes & Results: Five spouses aged 70–93 years participated. Their relatives' strokes happened 3 months to 3 years before the interview. Five themes were identified: 'I do all of it'; making sense of dysphagia; emotional responses; reflecting on relationships; and redefining lifestyle. Conclusions & Implications: It is important to consider family members' perspectives as they often provide vital care to loved‐ones with dysphagia. In relation to eating and drinking, maintaining elements of previous routines seems important to families. Healthcare professionals should consider these when making recommendations for rehabilitation. Family members have differing perspectives of the comparative impact of dysphagia; patient and family priorities should be explored for healthcare professionals to provide better‐targeted support. What this paper adds: What is already known on the subject: Informal caregivers, often spouses, play a vital role in supporting the health and well‐being of older people with health conditions. The presence of post‐stroke dysphagia may present increased challenges for the informal caregiver. There are limited studies qualitatively exploring the experiences of informal caregivers in this population. What this paper adds to existing knowledge: Current health and social care provision for this population leaves informal caregivers feeling they have been left to manage dysphagia alone. Informal caregivers demonstrate a breadth of knowledge about their spouse's dysphagia, problem‐solving effective solutions. Informal caregivers have a range of interpretations of the nature and cause of dysphagia; leading to miscommunication with health professionals and complex emotional responses. What are the potential or actual clinical implications of this work?: Healthcare professionals might consider ways in which to support dysphagic patients' families later in their care pathway, through scheduling reviews or running dysphagia patient and family groups. Health and social care professionals and policymakers should learn from informal caregivers' expertise to promote better health and quality‐of‐life outcomes for the patient and caregiver. Equal, open conversations between health and social care professionals and patients/families on their understanding of dysphagia may help informal caregivers to better voice their concerns and support mutual understanding. This has implications for adherence to recommendations, psychological well‐being and patient safety. [ABSTRACT FROM AUTHOR]

To undertake a literature search and critical appraisal of best available evidence to answer the clinical question: Does the addition of clonidine (I) to standard treatment with an opioid (C) improve outcomes (O) in infants with Neonatal Abstinence Syndrome? A search of both comprehensive (MedLine and Embase) and pre-filtered databases (Dynamed, UpToDate and TRIP), utilising Boolean Operators to combine search terms appropriately. Three relevant studies were identified. One paper describing the outcomes of a randomised controlled trial by Agthe et al. (2009) most accurately answered the clinical question posed. This paper was critically appraised, and evidence applied to the clinical scenario. The use of clonidine as an adjunct to opioid in the management of infants with NAS reduces the total number of treatment days and dose of opioid required to control symptoms. However, there is a higher risk of rebound in symptoms post-cessation of opioid and clinicians need to account for this in their discharge planning. More large scale, multi-centre high-quality research is needed to clarify the role of clonidine in the treatment of NAS: as monotherapy versus adjunct, the optimal dose and longer-term impact on neurodevelopment. [ABSTRACT FROM AUTHOR]

The effective collection and management of personal data of rapidly migrating populations is important for ensuring adequate healthcare and monitoring of a displaced peoples' health status. With developments in ICT data sharing capabilities, electronic personal health records (ePHRs) are increasingly replacing less transportable paper records. ePHRs offer further advantages of improving accuracy and completeness of information and seem tailored for rapidly displaced and mobile populations. Various emerging initiatives in Europe are seeking to develop migrant-centric ePHR responses. This paper highlights their importance and benefits, but also identifies a number of significant ethical, legal and social issues (ELSI) and challenges to their design and implementation, regarding (1) the kind of information that should be stored, (2) who should have access to information, and (3) potential misuse of information. These challenges need to be urgently addressed to make possible the beneficial use of ePHRs for vulnerable migrants in Europe. [ABSTRACT FROM AUTHOR]

A classification scheme for periodontal and peri-implant diseases and conditions is necessary for clinicians to properly diagnose and treat patients as well as for scientists to investigate etiology, pathogenesis, natural history, and treatment of the diseases and conditions. This paper summarizes the proceedings of the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. The workshop was co-sponsored by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) and included expert participants from all over the world. Planning for the conference, which was held in Chicago on November 9 to 11, 2017, began in early 2015. An organizing committee from the AAP and EFP commissioned 19 review papers and four consensus reports covering relevant areas in periodontology and implant dentistry. The authors were charged with updating the 1999 classification of periodontal diseases and conditions and developing a similar scheme for peri-implant diseases and conditions. Reviewers and workgroups were also asked to establish pertinent case definitions and to provide diagnostic criteria to aid clinicians in the use of the new classification. All findings and recommendations of the workshop were agreed to by consensus. This introductory paper presents an overview for the new classification of periodontal and peri-implant diseases and conditions, along with a condensed scheme for each of four workgroup sections, but readers are directed to the pertinent consensus reports and review papers for a thorough discussion of the rationale, criteria, and interpretation of the proposed classification. Changes to the 1999 classification are highlighted and discussed. Although the intent of the workshop was to base classification on the strongest available scientific evidence, lower level evidence and expert opinion were inevitably used whenever sufficient research data were unavailable. The scope of this workshop was to align and update the classification scheme to the current understanding of periodontal and peri-implant diseases and conditions. This introductory overview presents the schematic tables for the new classification of periodontal and peri-implant diseases and conditions and briefly highlights changes made to the 1999 classification. It cannot present the wealth of information included in the reviews, case definition papers, and consensus reports that has guided the development of the new classification, and reference to the consensus and case definition papers is necessary to provide a thorough understanding of its use for either case management or scientific investigation. Therefore, it is strongly recommended that the reader use this overview as an introduction to these subjects. Accessing this publication online will allow the reader to use the links in this overview and the tables to view the source papers (Table 1). [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the prevalence and patterns of comorbidity in community‐dwelling older people with type 2 diabetes mellitus (T2DM) attending general practice settings in Australia. Methods: This study involved a cross‐sectional analysis using the Bettering the Evaluation and Care of Health (BEACH) sub‐study data. In a series of sub‐studies, a representative sample of general practitioners was asked to record all diagnosed chronic conditions for patients at 40 consecutive encounters using structured paper‐based recording forms. The dataset was analysed with descriptive analyses, and exploratory factor analyses were applied to examine comorbidity patterns. Results: Of the 14,042 patients aged 65 years or older, 2688 had a diagnosis of T2DM (19%). Of the 2688 patients with T2DM, hypertension was present in 67% (95% CI: 64.6–70.0), followed by arthritis 52% (95% CI: 48.8–54.8), hyperlipidaemia 45% (95% CI: 41.8–47.9), ischemic heart disease, 23% (95% CI: 20.7–24.9), depression 16% (95% CI: 48.8–54.8), atrial fibrillation 10% (95% CI: 8.9–11.6), congestive heart failure 7% (95% CI: 6.0–8.1), stroke/cerebrovascular accident 7% (95% CI: 5.4–8.2) and peripheral vascular disease 5% (95% CI: 4.4–6.2). We identified two comorbidity patterns among older people with T2DM. The first were psychological and musculoskeletal conditions and the second were cardiovascular conditions and chronic renal failure. Conclusions: The prevalence of cardiovascular and non‐cardiovascular comorbidities in community‐dwelling older people with T2DM was high. Adequate primary care strategies should be in place to support the long‐term care for this population. [ABSTRACT FROM AUTHOR]

Background: Haptic feedback has been shown to be an effective facilitator of the learning of scientific concepts in a series of studies. However, little is known about the underlying salient learning mechanisms, which are activated when learning from haptic feedback. Objectives: We investigate the learning mechanism in a higher chemistry education setting, in which the students learned about the abstract concept of potential energy in a quantum chemical context. Methods: In this work, we present a mixed‐methods problem‐solving prior to instruction (PS‐I) study with chemistry bachelor students. In an interactive quantum chemistry learning environment, the students explored the energetic profiles of nucleophilic substitution reactions and the corresponding activation barriers experienced as repulsion and attraction. We measured cognitive and affective mechanisms which have been shown to be activated in PS‐I designs, such as knowledge gap awareness, state curiosity, and positive affect as well as the learning outcome quantitatively and the learning trajectories qualitatively. Results and Conclusions: Planned contrasts revealed a small hindering effect of the haptic feedback on the learning outcome. Thematic analysis of the qualitative data lets us attribute this effect to the lack of scaffolding of the haptic feedback and the spontaneous atomic movements in the simulation, which may be interpreted as a visual representation of force in itself. This work highlights the importance of accurate mappings of the haptic feedback unto the target domain and further delivers insight into the prior conceptions of chemistry undergraduate students. Lay Description: What is already known about this topic: Haptic feedback can facilitate learning by grounding abstract concepts in sensory experiences.While previous studies have reported positive affective results, the cognitive results are ambiguous.Moreover, it was frequently reported that the learning of potential energy in a (quantum) chemical context is particularly difficult due to (i) the lack of grounding opportunities and (ii) the diverse previous conceptions. What this paper adds: A learning environment to interact with molecular systems in real‐time is proposed.The concept of activation energy is grounded in sensory experience of pushing and being pulled.The mixed‐methods design allows to explore cognitive and affective variables as well as the specific prior conceptions activated by the environment. Implications for practice and/or policy: We found a small negative effect of the haptic feedback on the learning outcome, potentially due to insufficient introduction of it to the students.The spontaneous movement of the atoms was identified as a more suitable external representation of the force.Future studies should investigate, if explicit introduction of the embodied metaphor can reverse this effect. [ABSTRACT FROM AUTHOR]

Background: Artificial Intelligence (AI) literacy is a crucial part of digital literacy that all individuals should possess in today's technologically advanced world. Despite the potential benefits that AI education offers, little research has been done on how to teach AI literacy to children. Objectives: This study aimed to fill that gap by investigating how children were engaged in AI literacy activities that are supported by intelligent agents. These activities were implemented in a Hong Kong kindergarten with a class of six 5‐year‐olds (Mage = 62.83 months, SD = 2.91) over a 6‐week period. Methods: The study gathered data from multiple sources, including classroom observations, teacher interviews, and documents/artefacts. Results and Conclusions: The results showed that children could learn about AI through interaction with intelligent agents in embodied learning contexts. The findings of this study have implications for the broader field of digital technology education, particularly in the context of early childhood education. Lay Description: What is already known about this topic: Artificial Intelligence (AI) literacy is essential in today's world.Little research exists on engaging young children in learning AI literacy. What this paper adds: Technology‐enhanced embodied learning approach affords multimodality in enabling young children's learning with AI‐related agents.Project‐based learning and real‐life examples can enhance children's learning. Implications for practice and/or policy: Early exposure to AI can help children navigate the increasingly digital world.Practical approaches, such as embodied and multimodal learning, seem to be effective.Teachers can enhance children's digital learning by using pedagogical strategies like project‐based learning and real‐life examples. [ABSTRACT FROM AUTHOR]

Introduction: Current strategies to address shortages of rural doctors focus on developing a pipeline for rural generalist practice. Limited research has explored how doctors' professional journey engenders the skills required to practice rurally. Objective: This paper analyses how rural general practitioners' clinical pathway informs their scope of practice and future retention. Design: Qualitative thematic analysis using semi‐structured telephone interviews. Twenty‐one general practitioners appointed in their local health district of Murrumbidgee and Southern New South Wales, Australia, within the past 10 years. Participants comprised 10 Australian medical graduates (AMG) and 11 international medical graduates (IMG). Findings: AMGs and IMGs contrasted how their pathway into rural practice, and capacity to work rurally, informed their scope of practice. Australian medical graduates' familiarity with rural areas was consolidated through congruous experiences, including at rural clinical schools. Paradoxically, the fluency of their training limited the amount of unsupervised experience and confidence AMGs gained. Together with a focus on work‐life balance, this limited many to providing mainstream general practice, precluding extending their scope of practice. International medical graduates described disseminated experiences, often unsupervised in high‐volume contexts. However, a lack of professional opportunities prevented them from extending their scope of practice. Discussion: IMG and AMG motivation and pathway for working rurally differ. Respective cohorts have concerns regarding requisite skills and knowledge for rural practice, which incorporates opportunity and recognition. Entry points for training should be variable to allow consideration of life stage, prior skill development and extension of scope of practice. Conclusion: Doctors' scope of practice is informed by their pathways into rural practice. Australian medical graduates may not gain adequate competence during expedited training programs to confidently undertake extended clinical activities. International medical graduates, however lacked the opportunities and support, to utilise their expertise in rural practice. Complementarily utilising the expertise and commitment of both AMGs and IMGs may synergistically address workforce shortages. [ABSTRACT FROM AUTHOR]

Background: Mobile‐assisted language learning (MALL) has long been advocated to promote students' language study outcomes. However, little is known about how using instant messaging applications (an example of MALL) affect student motivation, language anxiety, and actual achievement. Objectives: To help close this gap, we have conducted a quasi‐experimental study, in which we have used self‐determination theory to test a mediational process model, in an effort to understand the psychological mechanisms that underlie the effect of instant messaging applications on student outcomes. Methods: Two groups of Saudi undergraduate students (N = 447) were recruited to participate in the study. Participants under the experimental condition were invited to engage in language‐related tasks with their teacher outside of class through the WhatsApp application, whereas participants under the control condition received standard teaching. We applied partial least square structural equation modelling (PLS‐SEM) to test our model. Results and Conclusions: The results of the PLS‐SEM showed that the total effects of using instant messaging applications on autonomous motivation and L2 achievement were significant but that language anxiety was influenced only indirectly and negatively through language achievement. Also, the PLS‐SEM showed that our results have strong predcitive power indicating support for external validity. Implications: Our results show that instant messaging applications can be used to facilitate interest and achievement and to decrease anxiety. Furthermore, we are contributing to L2 methodological literature by using applications of PLS‐SEM in experimental designs that can help researchers and practitioners of motivational processes. Lay Description: What is already known about this topic: Using WhatsApp and more broadly instant messaging applications are conceived to be motivating in language teaching contextStudies indicate students are inclined toward using these applications in language learningResearch shows that using WhatsApp is easy to apply for language teaching purposes What this paper adds: The study examined the effect of using WhatsApp on language learners' motivation, achievement, and language anxietyA pre‐ and post‐test approach with experimental and control condition has been used to evaluate the effect more accuratelyThe study employs Self‐determination Theory as a theoretical framework for testing a motivational process modelResults show that using WhatsApp predicted the outcomes directly and indirectly Implications for practice and/or policy: WhatsApp can significantly encourage university students to better learning of the language skills especially in times where face‐to‐face communication is limitedWhatsApp is conditioned by the guidance of instructors, their ongoing formative and summative assessmentWhatsApp appears to allow students enjoy their learning process due to the opportunities for collaborative work and constant exchange of content [ABSTRACT FROM AUTHOR]

Objective: To determine the effects on weight loss of three abbreviated behavioral weight loss interventions with and without coaching and mobile technology.Methods: A randomized controlled efficacy study of three 6-month weight loss treatments was conducted in 96 adults with obesity: 1) self-guided (SELF), 2) standard (STND), or 3) technology-supported (TECH). STND and TECH received eight in-person group treatment sessions. SELF and STND used paper diaries to self-monitor diet, activity, and weight; TECH used a smartphone application with social networking features and wireless accelerometer.Results: Weight loss was greater for TECH and STND than SELF at 6 months (-5.7 kg [95% confidence interval: -7.2 to -4.1] vs. -2.7 kg [95% confidence interval: -5.1 to -0.3], P < 0.05) but not 12 months. TECH and STND did not differ except that more STND (59%) than TECH (34%) achieved ≥ 5% weight loss at 6 months (P < 0.05). Self-monitoring adherence was greater in TECH than STND (P < 0.001), greater in both interventions than SELF (P < 0.001), and covaried with weight loss (r(84) = 0.36-0.51, P < 0.001).Conclusions: Abbreviated behavioral counseling can produce clinically meaningful weight loss regardless of whether self-monitoring is performed on paper or smartphone, but long-term superiority over standard of care self-guided treatment is challenging to maintain. [ABSTRACT FROM AUTHOR]

Child protection continues to be a pressing social problem. Robust and relevant research is essential in order to ensure that the scale and nature of child maltreatment are understood and that preventative and protective measures are effective. This paper reports selected results from a mapping review of research conducted in the UK and published between January 2010 and December 2014. The purpose of the review was twofold: to develop a typology of child protection research; and to use this typology to describe the features and patterns of empirical research undertaken recently in the UK in order to inform a future research agenda. The paper reports the maltreatment types, substantive topics and research designs used within empirical research published in academic journals. It identifies a number of challenges for the field including the need for conceptual clarity regarding types of abuse, greater methodological diversity and a shift of focus from response to prevention of child maltreatment. The importance of a national strategic agenda is also emphasised. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Messages A substantial proportion of empirical research focuses on child maltreatment generally and less is known about some specific types of maltreatment such as exposure to domestic abuse and child trafficking., More robust evidence is particularly needed concerning the effectiveness of interventions and choice of preventative approaches., Research-minded practitioners have an important contribution to make to the development of a practice-relevant research agenda. [ABSTRACT FROM AUTHOR]

Objective This paper presents the first Naturalistic Decision Making model of prehospital resuscitation decision‐making, which has clear implications for education, practice and support. Methods: A mixed‐methods exploratory sequential research design consisting of interviews with ambulance personnel (study 1), focus groups with ambulance educators, managers and peer supporters (study 2), and an online survey of graduating paramedic students (study 3). This paper reports the model developed from integrated findings, across all three studies. All research was undertaken in New Zealand and underpinned by a critical realist worldview. Results: The Prehospital Resuscitation Decision Making model identifies key processes, challenges and facilitators before, during and after ambulance personnel attend a cardiac arrest event. It is the only descriptive model of resuscitation decision making which acknowledges the decision‐maker, non‐prognostic factors and the importance of adequate preparation and support. Conclusions: This research project is the first to comprehensively explore and model ambulance personnel perspectives on decisions to start, continue or stop resuscitation. The decision‐making process is complex and difficult to simply formularise. Education and supports must assist ambulance personnel in navigating this complexity. Where resuscitation is withheld or terminated, ambulance personnel need to feel confident that they can effectively provide after‐death care. [ABSTRACT FROM AUTHOR]

Some media have suggested that many youths who have previously completed a gender transition are "detransitioning". Their experience is often framed around the idea of regrets but rare are the articles that provide a nuanced examination of their journey. This article presents the perspectives of youths who have detransitioned or discontinued a transition regarding their experiences and feelings on their journey from transition to detransition. Semi‐structured interviews were conducted with 20 youths between the age of 16 and 25 years who were recruited on social media and who transitioned and detransitioned or discontinued their transition. Data were analysed according to thematic analysis. Regrets and feelings of satisfaction can both coexist. The processes of transition and discontinuation or detransition appear to be non‐linear and participants do not necessarily return to a cisgender identity. Ambiguous loss theory is applied to frame youth experiences and feelings and to suggest way forward for intervention. Highlights: This paper examines the experiences and feelings of youth on their journey from transition to detransition.Their journey is experienced as non‐linear, and often comprised mixed feelings and experiences about transition and detransition steps.Ambiguous loss theory allows a nuanced understanding of feelings and experiences of their journey from transition to detransition. [ABSTRACT FROM AUTHOR]

In this paper, I discuss the question of partiality and impartiality in the application of triage. Triage is a process in medical research which recommends that patients should be sorted for treatment according to the degree or severity of their injury. In employing the triage protocol, however, the question of partiality arises because socially vulnerable groups will be neglected since there is the likelihood that the social determinants of a patient's health may diminish her chance of survival. As a process that is based on the severity of a patient's injury, triage will be unfair, and hence negatively partial, to socially vulnerable people. Thus, I aim in this paper to show that the triage protocol fails as an impartial evaluative process because its only aim is to maximize survivability. I contend that: (i) triage would lead to the neglect of the social condition of patients or victims, and (ii) it will only serve the utilitarian purpose of maximization of outcomes which may not be justified in some cases. [ABSTRACT FROM AUTHOR]

Accessible Summary: Developing ways of asking adults with intellectual disability about difficult topics such as death is important to our understanding.This study explores how adults with intellectual disabilities can be supported to report difficult experiences using the example of understanding death and bereavement. The paper describes the way in which we worked with adults with intellectual disabilities to understand how they preferred to talk about death and bereavement.This process showed us that it is possible to support adults with intellectual disabilities to talk about these difficult experiences. There are important lessons for researchers who want to talk with adults with intellectual disabilities about difficult topics and experiences. Background: This paper considers the challenges regarding the development and use of self‐report tools for sensitive, personal topics, in this case experiences of death and bereavement for individuals with intellectual disabilities (ID). These challenges are represented through the experience of the development of a self‐report measure of complicated grief for use with individuals with intellectual disabilities. Materials and method: Focusing on the topic of bereavement, and using a case study format, this paper describes the development of a self‐report measure for complicated grief. Results: Following three phases of questionnaire development, the Complicated Grief Questionnaire for People with Intellectual Disabilities (CGQ‐ID) was adapted for use as a self‐report measure with individuals with intellectual disabilities. The development process, informed by recommendations in the research literature, provides evidence that self‐report is possible with individuals with intellectual disabilities even when the topic is as sensitive as bereavement and when abstract concepts such as emotions are involved. Conclusions: The adaptation process described here might provide a useful template for the development of other scales on sensitive topics. [ABSTRACT FROM AUTHOR]

Virtual reality is widely recognized as offering the potential for fully immersive environments. This paper introduces a framework that guides the creation and analysis of immersive environments that are pedagogically structured to support situated and experiential education. The "situated experiential education environment" framework described in this paper is used to examine the impact that a virtual environment can have on the user experience of participants in a virtual space. The analysis of a virtual environment implemented to support learner exploration of issues of tourism development and the related impacts, suggest that this type of experience is capable of providing participants with a holistic experience of real‐world environments that are otherwise too expensive, impractical, or unethical for large groups of people to visit in person. The pedagogical value of such experiences is enabled through immersion in a reality‐based environment, engagement with complex and ambiguous situations and information, and interaction with the space, other students, and teachers. The results demonstrate that complex immersive learning environments are readily achievable but that high levels of interactivity remain a challenge. Lay Description: What is already known about this topic: Virtual reality (VR) technology is developing rapidly with interest from practitioners and researchers increasing concurrently.Although VR headsets are extensively researched in a gaming context, there is insufficient research examining the user‐experience of VR headsets in the context of education.What this paper adds: Users reported a multitude of positive features of the VR headsets in the context of experiential learning that is situated in a meaningful context, such as a Pacific island when learning about sustainable development.In particular, a strong sense of immersion was reported by users of the VR headsets.Additionally, the complexity of the material studied, an important feature of situated experiential learning, was also reported to high.Implications for practice and/or policy: VR headsets provide significant opportunities to foster situated experiential learning in a virtual environmentParticularly the immersive experience and the complexity of the material studied were reported to be effective with the VR headsets. However, the interaction with other learners and teachers could not be examined in depth, although interaction is also an important feature of situated experiential learning [ABSTRACT FROM AUTHOR]

In addition, the individual patient data for each of the 4 "significant" correlations were presented graphically in Figures 2A-D of the paper.2 When a stepwise linear regression analysis was undertaken, only baseline BMI was identified as an independent risk factor for predicting the degree of weight loss. Thus, it is possible that some lean patients had measured BMIs on a particular day that classified them as normal; even if no true change subsequently occurred, a second BMI assessment is likely to fall into the lean category. When I read papers that contain correlation calculations, I disregard the I P i -values entirely and focus on only the absolute size of the I r i -value; when it is <0.7 ( I r i SP 2 sp = 50%), I am inclined to interpret the alleged correlation as not being very important, even if it is true. Association vs causation, body mass index, correlation coefficient, diabetes, metformin, obesity, p-values in correlation, regression to mean, r-value, weight loss. [Extracted from the article]

The COVID‐19 pandemic has caused disruptive changes across different life experiences essential to children's growth and development, including early childcare services and schools, thus threatening precious opportunities for children in early childhood to learn. The pandemic has also undermined the collaborative and alliance relationship between childcare services and families which has been widely considered an important aspect of modern services. This paper presents and discusses results from a mixed‐method exploratory study with early childcare services for children between 0 and 6 years in Italy in 2021, involving both teachers and parents, to understand experiences, educational practices put in place in childcare services, feelings, resources and risks perceived by families and teachers. [ABSTRACT FROM AUTHOR]

Background: The transition from teacher‐centred towards student‐centred approaches in English language teaching, accompanied by developments in educational technology, has attracted researchers' attention to reverse teaching or flipped class. The related literature asserts that this mode of instruction might influence instructors' and students' participation in the class. Objectives: To shed more light on the role of flipped class in affecting language learning strategies and skills, this study applied a sequential explanatory mixed‐methods approach to explore the impact of flipped class on English as a foreign language (EFL) learners' writing metacognitive strategies and writing skills. Methods: Forty‐six intermediate EFL learners with an age range of 21–27, studying at a private language institute, were randomly divided into two groups of 23 learners. The two groups were randomly assigned to a flipped class, which received writing metacognitive strategies and writing skills through video clips before the class time, and a non‐flipped class, which received writing metacognitive strategies and writing skills in a conventional way during the class time. Results and Conclusions: The results revealed that both flipped and non‐flipped classes improved the EFL learners' writing metacognitive strategies, writing performance, writing content, and writing organisation. Furthermore, one‐way ANCOVA analyses indicated that the flipped class outperformed the non‐flipped class in writing metacognitive strategies, writing performance, writing content, and writing organisation. Thematic analyses, which were used to help analyse individual semi‐structured interviews, uncovered a number of categories and themes, signifying the flipped learners' positive perceptions towards the flipped class, such as enhancing motivation, self‐confidence, and writing collaboration. Implications: Pedagogical implications were discussed for flipping writing metacognitive strategies and writing skills. Lay Description: What is already known about this topic?: Metacognitive strategies, including planning, monitoring, and evaluation strategies, help English language learners become more successful writers.Writing skills, including writing content, writing organisation, and language use, help learners deal with collaborative writing activities effectively.Flipped class has been shown to be an effective mode of instruction to improve English language learners' language learning strategies and skills. What this paper adds?: Flipped class improves English language learners' writing metacognitive strategies, writing performance, writing content, and writing organisation.Flipped class is more effective than non‐flipped class in improving English language learners' writing metacognitive strategies and writing skills.English language learners' motivation, self‐confidence, and writing collaboration are increased as a result of the flipped writing course. Pedagogical implications: Writing metacognitive strategies and writing skills need to be flipped in English language contexts in order to free up time for more effective in‐class collaborative writing activities. [ABSTRACT FROM AUTHOR]

Introduction: During the COVID‐19 lockdown in 2020, teachers had to shift their teaching and assessment to online. Formative assessment (FA) can help teachers to engage, guide and monitor students' (online) learning. However, more knowledge is needed of how teachers could use the full FA process online. Methods: In this study data from 50 secondary school teachers, who taught different grade levels and subjects and joined a FA learning network that started before and continued during the lockdown, were collected. The study investigates how they used online FA practices differently than face‐to‐face FA, what challenges and opportunities they experienced in online FA and what lessons they learned and intended to keep. This mixed methods study used data from a questionnaire, interviews and webinars that were segmented, coded and analysed. Results: Results showed that many teachers implemented new FA strategies and adopted, more often than in their face‐to‐face practice, all the five phases of the FA process in an aligned matter in online FA. Teachers indicated opportunities in stimulating student engagement and guiding and monitoring student learning more at an individual level in the online FA process, but also experienced challenges, mainly in lack of interaction online. Discussion: The sudden and necessary shift to online FA, due to the COVID‐19 lockdown, challenged teachers to more fundamentally reconsider their assessment practices and assumptions. Teachers intended to make use of these learned lessons to improve their future (blended) FA practice. Lay Description: Known about the subject matter: Online formative assessment (FA) can help teachers to engage, guide and monitor online learning.Most earlier research of online FA looked at parts of the FA process or tools.Teachers' former knowledge and skills in FA influences the online implementation.Online FA offers opportunities to promote learning, but is also challenging. What their paper adds to this: Experienced teachers were able to implement complete FA processes online.Teachers experienced that online FA could stimulate student engagement.Teachers made more time for individual help and feedback during online FA.Teachers intended to maintain these lessons learned in their future (blended) FA practice. The implications of study findings for practitioners: Combining online FA activities with face‐to‐face activities creates opportunities for future blended FA.The five phases of the FA cycle help teachers to implement FA online or in blended forms. [ABSTRACT FROM AUTHOR]

This paper provides guidance for researchers with some mathematical background on the conduct of time-to-event analysis in observational studies based on intensity (hazard) models. Discussions of basic concepts like time axis, event definition and censoring are given. Hazard models are introduced, with special emphasis on the Cox proportional hazards regression model. We provide check lists that may be useful both when fitting the model and assessing its goodness of fit and when interpreting the results. Special attention is paid to how to avoid problems with immortal time bias by introducing time-dependent covariates. We discuss prediction based on hazard models and difficulties when attempting to draw proper causal conclusions from such models. Finally, we present a series of examples where the methods and check lists are exemplified. Computational details and implementation using the freely available R software are documented in Supplementary Material. The paper was prepared as part of the STRATOS initiative. [ABSTRACT FROM AUTHOR]

A recent paper in Drug and Alcohol Review analysed the information on cancer disseminated by 27 alcohol industry funded organisations. The independent UK alcohol education charity Drinkaware was among the organisations whose information was studied, and based on the analysis claims were made of misrepresentation of evidence about the alcohol-related risk of cancer and alcohol industry influence. This commentary challenges the validity of these findings in respect to the evidence relating to the Drinkaware information, as the analysis is found to be misrepresenting the information by both disregarding the wider information content provided and the order and prominence with which alcohol-related cancer risk is presented. Furthermore, it is argued that the public has a right to be provided with relevant evidence-based information about cancer risk. It is critical that Drinkaware's important public health function is not compromised by unjustified allegations of inaccuracy and by unwarranted attacks on its independence and integrity. [ABSTRACT FROM AUTHOR]

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The 2003 Health Economics paper by Dolan, Olsen, Menzel and Richardson on 'An inquiry into the different perspectives that can be used when eliciting preferences in health' presents a conceptual framework of six perspectives along two dimensions: preferences (personal, social, and socially inclusive personal) and context (ex ante and ex post). The objective of our paper is to re-think this framework. We ask four questions concerning: the patient, or the user of the treatment; the payer of the treatment; the assessor of the value of treatment; and the timing of the illness and the nature of its risk. These questions refine the preference and context dimensions, and lead to the identification of perspectives not classified by the original framework. We propose an extended framework with five preferences (personal, non-use, proxy, social, and socially inclusive personal) and five contexts (one of which is ex post and four ex ante): since two of these cells are empty, this results in 23 possible perspectives. Online Supplementary Information presents 11 of these more formally to clearly distinguish between them and uses monetary and non-monetary (time trade-off) valuation tasks as examples. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose To examine the nature of the interruptions during medication work. Design An exploratory descriptive design was used with 28 nurses during 15 medication rounds in the medical, surgical, and gynecology wards at a 1000‐bed tertiary teaching hospital in Saudi Arabia. Methods: Non‐participant prospective observational and follow‐up interview methods were used to collect data. A standard paper‐based tool and digital stopwatch to count the interruptions were used. Nurses' sources, the secondary tasks undertaken, and the impacts of the interruptions were considered. The data were analyzed via descriptive analysis. Results: A total of 87 medication‐related events occurred. In these, 182 interruptions accounted for 90.0% of the total. Interruptions were more frequent during medication administration and often occurred in the corridors and patients' rooms. Nurses, medical officers, and impediments were frequent sources of interruptions. The secondary tasks attended by the nurses were mostly related with impediment resolutions and patients' needs. System failures appeared to be associated with clinical and procedural errors. Conclusion: The results of this study provide information regarding the course of interruptions during medication work in a Saudi Arabian hospital. Nurses were the main source of interruptions related with the provision of patient care and resolution of impediments. Interruptions tended to be associated with clinical errors and procedural failures due to system failure. Promoting a culture of respect and workplace etiquette in global healthcare settings demands minimizing non‐life‐threatening interruptions during nursing works. Clinical relevance: Strategies used in hospital management systems that affect nursing, pharmacies, human resources, and ancillary service department collaborations should be monitored for effectiveness and to ensure patient safety. Various approaches toward medication management systems, such as the utilization of an Omnicell automatic dispensing machine and cabinets within each patient's room, as well as others, such as wearing a "no‐interruption zone" sign, could be tailored and matched to the context of the practice to reduce interruptions. [ABSTRACT FROM AUTHOR]

Background: Immersive VR is still rarely used as an intervention for meeting the affective end goals of student learning despite its positive impact on affection. Also, studies regarding the use of immersive VR as an intervention for affective achievement in broader educational contexts are still lacking. Objectives: This study aimed to examine the effect of immersive VR and perspective‐taking on presence and empathy. Methods: A total of 148 pre‐service teachers participated in experiments, using either a head‐mounted display or a flat screen device to view two VR videos with different perspective‐taking affordances. This study used a mixed design with one between‐subject variable of immersion level and one within‐subject variable of perspective‐taking to explore how immersive VR experiences influenced participants' perceived level of presence and empathy. Results and Conclusions: The results showed that the level of immersion affects perceived presence, but it was the type of perspective‐taking that affects empathetic reactions. We also found an interaction effect between immersion levels and perspective‐taking. The direct embodiment in VR combined with high immersion produced stronger empathy than with low immersion, while the perspective of an observer was better in evoking empathy when experienced with low immersion. Implications: This study gives a guidance on how to take advantage of this new technology in educational settings, and apply it to instructional activities to enhance students' empathy. In addition, it could serve as a reference when developing or introducing educational contents with respect to the types of contents that are more effective in educational settings. Lay Description: What is already known about this topic: The use of immersive virtual reality (VR) has gained increasing attention for its potential to increase students' engagement, interest, and motivation in education.The use of head‐mounted displays (HMDs) increases the level of perceived presence.Perspective‐taking promotes the development of empathy.The importance of empathy has been recently emphasized more in education. What this paper adds: The high immersive VR with an HMD increased the level of perceived presence among pre‐service teachers.The type of perspective‐taking provided in VR content affects the level of empathic reactions.The direct embodiment in VR combined with high immersion produced stronger empathy than with low immersionThe perspective of an observer was better in evoking empathy when experienced with the low immersive VR. Implications for practice and/or policy: Immersive VR when integrated into instructional practices would help students to develop empathy.It is important to select appropriate VR devices and content for designing interventions and maximizing educational benefits. [ABSTRACT FROM AUTHOR]

Introduction: British South Asians have a higher prevalence of overweight and obesity than the wider population. Bradford (UK), with its high Pakistani presence and levels of economic deprivation, has exceptionally high instances, especially in deprived areas where many Pakistanis reside. British Pakistani women in Bradford are more likely to be overweight and obese. There is uncertainty on how these women can be aided to manage their weight. Therefore, the objective of this study was to explore the obesity concerns of Pakistani women living in deprived inner‐city areas of Bradford. Methods: Three focus groups interviews were carried out with 23 Pakistani women living in deprived areas of Bradford. Data were analysed thematically. Results: This exploratory study identified a wide range of concerns that women had around managing their weight. Participants disclosed distrust in information given around medication, conflicting dietary information and reported low levels of trust in women‐only organized physical activities. Cultural barriers were identified, which included the gender role of the woman, the lack of culturally appropriate dietary advice, cultural misunderstandings of what constitutes a healthy diet and healthy weight, the lack of culturally suitable exercise facilities and conforming to family and community expectations. Other concerns were language barriers around a lack of understanding, the inability to read Urdu and reliance on others to translate information. Conclusion: These findings have implications for researchers, local authorities, policy makers and others with an interest in reducing the rates of obesity in this population. Recommendations include training health practitioners to be culturally aware of the diet and eating practices of this community, exploring different ways to support socially isolated women to be more physically active at home, addressing physical activity and diet misconceptions and designing obesity management information materials appropriate for a range of literacy levels. Patient or Public Contribution: Public contributors were involved in the development of the interview guide and design of the research. A pilot focus group with participants not included in the present paper was used to help test and refine the focus group questions. Interview transcripts were member checked by participants, and participants assisted with data analysis. [ABSTRACT FROM AUTHOR]

When widespread use of sex-selective abortion and sex selection through assisted reproduction lead to severe harms to third parties and perpetuate discrimination, should these practices be banned? In this paper I focus on India and show why a common argument for a ban on sex selection fails even in these circumstances. I set aside a common objection to the argument, namely that women have a right to procreative autonomy that trumps the state's interest in protecting other parties from harm, and argue against the ban on consequentialist grounds. I perform a pairwise comparative analysis of sex selection and its plausible alternatives and argue that that the ban fails to improve the state of affairs relative to a scenario without a ban. The ban makes the situation worse, especially for mothers and their daughters. India should therefore repeal its ban on sex selection. [ABSTRACT FROM AUTHOR]

Psychiatric genomics research with African populations comes with a range of practical challenges around translation of psychiatric genomics research concepts, procedures, and nosology. These challenges raise deep ethical issues particularly around legitimacy of informed consent, a core foundation of research ethics. Through a consideration of the constitutive function of language, the paper problematises like-for-like, designative translations which often involve the 'indigenization' of English terms or use of metaphors which misrepresent the risks and benefits of research. This paper argues that effective translation of psychiatric genomics research terminology in African contexts demands substantive engagement with African conceptual schemas and values. In developing attenuated forms of translational thinking, researchers may recognise the deeper motivational reasons behind participation in research, highlighting the possibility that such reasons may depart from the original meaning implied within informed consent forms. These translational issues might be ameliorated with a critical re-examination of how researchers develop and present protocols to institutional ethics review boards. [ABSTRACT FROM AUTHOR]